Effects of War on Child Health*

The influence of any environmental factor on a growing organism must be measured in terms of the immediate effect produced and also of the ultimate effect on subsequent development. When the growing organism is a child the matter becomes infinitely complex, since the health of the child is intimately bound up with his physical, intellectual, emotional, and moral development. The last of these is least accessible to scientific evaluation but is of profound importance in determining the child's immediate and subsequent adjustment to society. Furthermore, war conditions themselves are so fluid and variable that by their very nature they are ill-adapted to planned survey or statistical assessment. It will be clear, therefore, that my subject is one where the broad generalization, the clinical impression, and all the uncheckable quotations so anathematized in modern scientific medicine still hold pride of place. In saying this I have not lost sight of the many excellent surveys of children under war conditions which have in fact been carried out. But it is true in general that many of the effects of total war involving the child population will necessarily be unassessable. One has only to consider the unorganized movement of populations and the disruption of civilian services and records for this to become plain. My own direct interest in the subject dates from the Spanish Civil War, when in 1937 I was brought abruptly into contact with the problems of large-scale evacuation of children from a city in a state of siege. During the succeeding ten years I have had the opportunity of seeing something of the effects of war on children in a dozen different countries, and of comparing the problems arising and the methods adopted for their solution. The particular points I wish to illustrate are these: the disruption of home and family life of the individual child: the instability of his environment, varying from constant movement before an advancing army to evacuation under aerial bombardment; the lowered and often conflicting moral standards with which the child is likely to be brought into contact; the commonest disease processes likely to affect the child; and the means taken to safeguard the welfare of particular childhood populations in countries at war. Broadly speaking, total war as it affects the child may be considered as an infectious disease: the first phase or period of incubation is that during which a peacetime economy is being rapidly turned over to wartime needs; the second phase is the period of eruption or invasion, which is likely to be fulminating, when a rapidly moving front will result in mass movements of civilian refugees; the third