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BMJ Paediatr Open
BMJ Paediatr Open
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bmjpo
BMJ Paediatrics Open
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BMJ Publishing Group BMA House, Tavistock Square, London, WC1H 9JR

39289037
10.1136/bmjpo-2024-002843
bmjpo-2024-002843
Viewpoint
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Child rights and the necessity for an Optional Protocol for the Protection of Children in Armed Conflicts
http://orcid.org/0000-0001-7661-1551
Goldhagen Jeffrey 12jeffrey.goldhagen@jax.ufl.edu

http://orcid.org/0000-0001-5830-9287
Adamkiewicz Tom 3tadamkiewicz@msm.edu

1 Pediatrics, University of Florida, Jacksonville, Florida, USA
2 International Society for Social Pediatrics and Child Health, Geneva, Switzerland
3 Family Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
Dr; jeffrey.goldhagen@jax.ufl.edu
JG and TA declare they have no competing interests to declare. No commercial entities provided support for the work reported in the submitted manuscript. No commercial entities can be viewed as having an interest in the general area of the submitted manuscript. There are no similar financial associations involving their spouses or their children under 18 years of age. Finally, there are no non-financial associations that may be relevant to the submitted manuscript.

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Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Child Health
Ethics
Health Policy
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pmc This year marks the 35th and 100th anniversaries of the UN Convention on the Rights of the Child (CRC, 1989) and Declaration of the Rights of the Child (1924), and the 75th anniversary of the Geneva Conventions (1949). Yet, shockingly, this year’s United Nations (UN) Report on Children and Armed Conflict decries the ‘… complete disregard for child rights, notably the inherent right to life’ in today’s escalating armed conflicts.1

According to the UN, in 2023 a total of 32 990 grave violations were verified against 22 557 children. The number of children killed (5301) and maimed (6348) increased overall by a staggering 35% as compared with 2022, and, in Israel and Palestinian territories by 155%, Sudan 480% and Myanmar 123%. Burkina Faso, the Democratic Republic of the Congo, Somalia, Syria, Ukraine and other regions have also been affected.1 Verification of Palestinian children killed is ongoing.

In most modern conflicts, 90% of casualties are civilians, including children. Through direct harm, destruction of infrastructure, blockades, sanctions, and repeated dislocations—armed conflicts cause physical, mental, developmental and behavioural trauma to children that often affect them long after cessation of hostilities.14 An estimated 3.2 million children under 5 years of age died in armed conflicts between 2000 and 2019.2

Why do international laws, conventions and statutes provide insufficient protection to children, and can this be improved? In 2002 the Rome Statute established the International Criminal Court to complement national courts in litigating individuals that commit grave crimes, such as Crimes of Genocide, defined as acts committed with the intent to destroy, in whole or in part, a national, ethnic, racial or religious group. War crimes are also included and are defined as severe breaches of the Geneva Conventions. The latter outlines how civilians, wounded and sick soldiers, prisoners of war, and medical personnel and facilities are protected under principles of humanity, impartiality and neutrality. The Conventions form a major part of International Humanitarian Law (IHL), otherwise known as the Law of War.

The UN CRC (1989) delineates inherent rights and protections to which all children are entitled. Regional agreements further specify child rights in African and Islamic countries. Although the CRC is part of International Human Rights Law, it defers to IHL regarding armed conflicts (Article 38). The Optional Protocol to the CRC on the Involvement of Children in Armed Conflict (2000) is limited in scope stipulating that members of armed forces under the age of 18 do not take part in hostilities.

It is important to understand that IHL is designed to provide a basic framework for the conduct of warfare, while limiting harm to civilians. IHL defines military principles of proportionality (limit attacks to what is needed), distinction (only attack military targets) and precaution (avoid harm to civilians). In modern warfare, many civilians, including children are killed or injured when bombs are dropped in urban areas where civilians are in proximity to military or dual use targets (eg, power plants, bridges, etc). These casualties are considered ‘incidental harm’, ‘collateral damage’, and are often legal according to IHL. In addition, although some sites are protected by IHL (religious sites, schools, hospitals, historical sites), these are also often targeted if allegedly used as military targets. This is further complicated when non-State actors use civilians or protected sites as shields.

Children are by definition unique civilians requiring special protections. There is an immediate need to better protect them against harm in present and future hostilities using existing international laws, conventions and statutes. Additionally, a new Optional Protocol to the CRC on the Protection of Children in Armed Conflict is needed to better protect children in armed conflicts. A ratified Protocol would ensure the protection of children from direct life-threatening harm, provide for their basic needs, unify and expand existing rights and protections, include monitoring mechanisms, and hold policymakers, State, non-State, military and humanitarian actors accountable.35 The following is a possible framework for the Optional Protocol.

Article 1. Targeting children

Children must not be killed, and never be targets of attack or used as shields. All parties must comply with international humanitarian and human rights laws. Places where children live and frequent must never be attacked or serve as cover for combatants and weapons. Children should be protected from explosive weapons, and not used as soldiers or subjected to sexual violence or abduction.

Article 2. Children and families on the move

Children must not be involuntarily separated from families. Evacuations should adhere to international legal norms and sufficient warning provided to prevent untoward incidents. Children and parents should be free to seek refuge internally or across borders with a right to return.

Article 3. Safe and neutral zones

Basic needs of children should be met, including provision of safe shelter, water, food, clothing and healthcare. Safe-zones in conflict areas should be established and monitored with the continued physical presence of independent observers who report to the UN Security Council.

Article 4. Healthcare

Health services should be protected and never attacked or used to shield combatants or for non-medical military purposes, as stipulated in international law. Healthcare personnel must not be threatened, extorted, kidnapped or put in unnecessary danger. Transport of medical supplies must be protected and uninterrupted. Healthcare facilities should be monitored by independent accountable mechanisms.

Article 5. Care of wounded children

Care of wounded children should follow evidence-based standards for prehospital emergency services, evacuation and trauma care. Adherence to such standards should include rigorous data collection through robust registries. Regional medical personnel and facilities should be voluntarily and collaboratively engaged without putting anyone at undue risk. Physical and psychological rehabilitation during and post-conflict must be provided.

Article 6. Schools

Schools in conflict-zones should meet acceptable educational standards, must never be attacked, used to hide combatants or to recruit children into combat. Teachers and other school staff must be protected.

Article 7. State and non-State actor responsibilities

Evidence-based protocols with ongoing monitoring for the prevention of harm to children should be implemented by policymakers, militaries and humanitarian organisations.

Data on attacks affecting children should be recorded and analysed to improve military protection and mitigation strategies.

Humanitarian organisations should collaborate in medical-epidemiological data collection—methodologies must comply with the acceptable ethical principles and standards for humanitarian conflicts.

Funding to fulfil the above must be adequate and shared by State, public and private sectors—including arms industries and investors, who should be financially accountable for post-conflict rehabilitation of children.

Social media must desist from practices that harm children.

State and non-State actors who commit crimes must be held accountable.

Article 8. State and non-State actors who commit crimes of violence against children in war must be held accountable

IHL defined war crimes should be expanded to specifically address harm against children. This includes wanton negligent or willfully intentional harm to children by: (1) direct attacks of civilian populations with children, that are either separate from military objects, or attacked without making reasonable efforts to separate children from military objects; or (2) shielding military objects among civilian populations with children.

The process for petitioning the Committee on the Rights of the Child to support the development of an Optional Protocol on the Protection of Children in Armed Conflict should be initiated. If not now, when?

Acknowledgements

The authors would like to acknowledge the participants at the International Society for Social Pediatrics and Child Health (ISSOP) Beirut conference whose contributions served as the substance of ISSOP’s 'Beirut Declaration' and Issue Brief, 'Prevention & Mitigating Harm for All Children in Armed Conflict'. We also acknowledge Ms RayKay Watley for her support with the development and submission of the manuscript. Most importantly, it is with the deepest respect that we honour the lives of the millions of children who have died and been injured—physically and emotionally, by our global failure to protect them.

Review Process File
17 09 2024

Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Patient consent for publication: Not applicable.

Ethics approval: Not applicable.

Provenance and peer review: Commissioned; externally peer reviewed.
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References

1 A/78/842-s/2024/384 3 general assembly security council promotion and protection of the rights of children and armed conflict 2024 Available https://documents.un.org/doc/undoc/gen/n24/095/07/pdf/n2409507.pdf Accessed 8-Nov-2024
2 Jawad M Hone T Vamos EP et al Implications of armed conflict for maternal and child health: A regression analysis of data from 181 countries for 2000-2019 PLoS Med 2021 18 e1003810 10.1371/journal.pmed.1003810 34582455
3 Shenoda S Kadir A Pitterman S et al The Effects of Armed Conflict on Children Pediatrics 2018 142 e20182585 10.1542/peds.2018-2585 30397166
4 Adamkiewicz T Goldhagen J Mitigating Armed Conflict Casualties in Children Pediatrics 2021 147 e2020027847 10.1542/peds.2020-027847 33208497
5 Beirut Declaration Prohibition of harm to children in armed conflict 2020 Available https://issop.org/2020/01/23/beirut-declaration-prohibition-of-harm-to-children-in-armed-conflict/
