When children are present in a genocide

Injured children brought to receive medical care at al-Shifa Hospital after an Israeli airstrike on the al-Nasan building in Gaza City, October 27, 2023. (Photo: Saeed Jaras/APA Images)

“The children are always ours,

every single one of them, all over the globe;

and I’m beginning to suspect that

whoever is incapable of recognizing this

may be incapable of morality.”

James Baldwin

When children are present in a place that is bombed, they die more frequently than adults. Their smaller bodies are not capable of absorbing the impact as well. Their heads are bigger and heavier and hit surfaces with greater force relative to their size. Their abdominal organs are not as well protected by their rib cages and are more exposed to blunt trauma. Their hearts and lungs are smaller, closer to the surface, less muscular and spacious, and less protected. The smaller the child, the greater their risk.

When you bomb a place with children in it,

your primary intention is to kill all the children first.

Injured children brought to al-Aqsa Martyrs Hospital in Deir al-Balah for treatment following Israeli attacks in Gaza on March 19, 2024. (Photo: Ali Hamad/APA Images)

When children are present in a place that is starved of food and water, they die more rapidly than adults. Because of their increased metabolic needs and greater body surface area, a lack of clean water and nutrition affects them profoundly. Dehydration can set in in a matter of hours, malnutrition in a matter of days. Their eyes sink and their skins tent. They grow listless and their development stunts. Over time, their organs start to slow and falter, their kidneys become unable to filter urine, their hearts unable to keep pace. In infants, this happens even more rapidly, with simple electrolyte deficiencies from a lack of formula leading to seizures and, eventually, death. The smaller the child, the greater their risk. When you cut off water and food to a population with children, your primary intention is to starve all the children first.

Palestinian children try to get some food from one of the charitable hospices in Deir al-Balah in the central Gaza Strip. 

When children are present in a place where there is no housing, where they are exposed to cold temperatures, they die more rapidly than adults. Children are more intensely affected by hypothermia due to higher heat loss from their relatively larger heads and greater body surface area. They have less subcutaneous fat to protect them from the cold, and they radiate heat more quickly. For many cold children, they will go to sleep and never wake up. For others, the cold will affect them in other ways, slurring their speech and causing them to be confused, slowing their heart and breathing rates, making them faint. If the hypothermic state is prolonged, they will die. The smaller the child, the greater their risk. When you destroy most of a population’s housing and force people to live outside in constant cold temperatures, your primary intention is for the children to die first.

When children are present in a place where there is no education because their schools have been destroyed, their teachers killed, and the remaining school buildings have become shelters, their futures will be in peril. Even a year without school, much less the many years it takes to rebuild decimated school systems, can lead to stunted development, poverty, risk of addiction, unemployment, and lifelong mental health struggles. The smaller the child, the greater the risk, with the first five years of a child’s educational development being particularly crucial. When you destroy a population’s schools, your primary intention is to destroy the futures of all the remaining children.

When children are present in a place where they are consistently exposed to violence, it impacts their lives profoundly in many ways. These Adverse Childhood Experiences can cause toxic stress, affecting children’s brain development, immune systems, and stress-response systems. Children who experience toxic stress from violence enacted on their communities will have difficulty with relationships, will struggle with finances, jobs, and depression throughout their lives. Their health may be affected, causing a cascade of increased risk for diabetes, heart disease, and cancer. These struggles may be passed down intergenerationally and, if they survive the acute violence, may affect the lives of their children and their children’s children. These experiences have a dose-response relationship — the earlier and more frequently a child is exposed to violence, the greater the risk. When you consistently enact violence on a population of children, your primary intention is to deprive generations of future children of the capacity to live full, healthy, and free lives.

Injured children brought to al-Aqsa Martyrs Hospital in Deir al-Balah for treatment following Israeli attacks in Gaza on March 19, 2024. (Photo: Ali Hamad/APA Images)

When children are present when their parents have been killed, their whole lives change irrevocably. The loss of a parent during childhood can lead to a wide range of serious and enduring health consequences, ranging from schizophrenia, to major depression, to suicide. If that death is witnessed by the child, the consequences are far more dire. When the number of children who have lost one or both parents balloons to 25,000, an entire generation of children will be forever bereaved. When you kill off thousands of parents, your primary intention is to irreversibly alter the lives of the children who remain.

When children are present in Palestine in a time of genocide, they will always be the most vulnerable, the most affected, and the most in need of our protection. They will need pediatricians, such as myself, to act en masse to stand for them, to speak the truth about them, and to demand that their lives, communities, and futures be preserved. As their lives hang in the balance, they will need us to say unequivocally to the U.S. and Israel: ceasefire now.

Sabreen Akhter is a pediatric emergency physician with expertise in childhood trauma, international humanitarian aid, and childhood development. She has written for The Washington Post, Al Jazeera, The Chicago Tribune, and The Seattle Times.