James Denselow, Head of Conflict and Humanitarian Policy and Advocacy, joined a panel this week at the sixth World Innovation Summit for Health conference (WISH) to update how progress is being made on addressing issues around children being killed and injured in modern conflict.
The conference sees scientific researchers, tech leaders, medics and thought leaders from across the globe to discuss the health issues of our time and panels looked at topics ranging from health in the post-Covid world to how sport can improve people’s mental health. Our panel on paediatric blast injury brought together medics from Ukraine, Syria and Palestine who’ve had first-hand experience of saving the lives of children injured by the weapons of adults.
The war on children
I started the event by reminding the audience of one single incident that shows the challenges we face around children injured in war. One morning back in April 2018, a dozen children in eastern Afghanistan started to play outside their home after a night in which they struggled to sleep due to the sounds of war. One of the children found a sleek dull-green object and they shared it round the other children who gathered around it and started to play with it.
'It' was a rocket propelled grenade that detonated. Shrapnel tore through their flesh. Five of the children would lose portions of a leg, and two would lose most of both. Three children, and one adult who was with them, would lose their lives before reaching the hospital.
Our founder, Eglantyne Jebb, famously said that all wars are waged against children. Over 25 years ago the UN agreed to monitor and act upon the worst six Grave Violations against children in armed conflict. Since 2005, over 280,000 grave violations against children have been verified in the UN’s annual reports on the situation of children in armed conflict. Of these, more than 40.7 % related to the killing and maiming of children. Over the last 10 years, 26 children have been killed or maimed on average every day. That’s equivalent to a classroom of children killed and maimed every day for over a decade.
Modernisation of conflict
Urbanisation and trends in modern conflict have brought weapons designed to pierce the thick armour of tanks onto the doorstep of children’s homes, their playgrounds, and their schools. Only 30% percent of the world’s population lived in cities in 1950, a figure projected to rise to as high as 75% by 2050. There were an estimated 50 million people suffering the effects of urban conflict prior to the escalation of the conflict in Ukraine in February of this year. Data shows that when explosive weapons are used in populated areas, 90% of the victims are civilians.
The late Queen Elizabeth II of the UK once said that 'a child’s vulnerability and helplessness can bring out the best in us'. The Paediatric Blast Injury Partnership (PBIP) was formed in 2018. With leadership from Save the Children and Imperial College London it brought together medics, researchers and scientists, humanitarians, and practitioners in conflict settings to recognise the particular vulnerabilities children have to explosive weapons and how to better treat them.
I believe it is one example of the 'best in us'. At the WISH conference one of the BioNtechfounders, Dr Özlem Türeci, said that “effective partnerships inspire innovation”. The PBIP was originally a loose coalition of partners based around the vision of helping children in war zones through innovation, partnership and passion – but helped by WISH and the energy of so many individuals and organisations from across the world it has emerged quickly from small beginnings.
At the summit the PBIP formally launched the Ukrainian translation of the world’s first ever paediatric blast injury field manual. Designed to help medical professionals from across the continuum of care, from the point of injury to rehabilitation, it has now been translated into six languages and distributed in thirteen countries. The partnership is transitioning from a start up and almost proof of concept phase, into one that looks to scale up across three tracks of work: scientific research, humanitarian advocacy and medical operational use.
Looking to the future
Our vision is that within this scale-up the partnership will evolve into an actual ‘Centre for Paediatric Blast Injury Studies’ that can unite the three strands of work under a medium-term strategy to bring the greatest possible impact for children hurt or at risk of being hurt by explosive weapons.
Save the Children is looking to use the huge challenge of children caught up in the escalation of fighting in Ukraine to deepen our partnership with Imperial College London around cutting-edge research into the subject of paediatric blast injury, looking to integrate studies with Ukrainian medical and academic partners. It’s worth remembering that according to the International Blast Injury Research Network (IBRN) over $1 billion has been spent on blast injury research on adults since 2000, the vast majority by the US military. The equivalent spent on looking at the paediatric cohort is virtually nil and into this space we must go.
This is research is very much driven to improving practical outcomes for blast injured children. At a visit to the Imperial laboratories recently we saw, for instance, researchers who are looking to develop prosthetics that grow with the child, avoiding the need for expensive prosthetic replacements and painful medical interventions over the course of their lives.
What's next
In terms of humanitarian advocacy this November will see a signing ceremony in Dublin Castle of a new political declaration strengthening the protection of civilians from the humanitarian consequences arising from the use of explosive weapons in populated areas. Major military powers have indicated they intend to endorse this declaration that makes clear reference to the vulnerabilities of children to this issue. What happens after the declaration is endorsed by states is critically important with the opportunity for new national action plans to put the protection of children in conflict as a clear priority.
In terms of medical operational next steps in addition to further translations of the field manual into Russian and Spanish, colleagues are close to finish designing a training course for medics that can be adapted and used across a variety of settings depending on the status of the healthcare system and the intensity of the conflict. We hope that the digital evolution of the manual is to become an interactive resource that becomes the child's clinical record that can also actively guide the care of the child and crucially begin to collect data to help fill our knowledge and therefore capability gap. There is also a huge opportunity to create resources for ‘zero responders’ those who come across blast injured children who have no medical training at all but need guidance as to how to take immediate steps to save their lives.
For the evolution from a partnership to a centre to occur we will need more allies, funders, and specialists to realise the potential to properly address an issue that has been essentially unknown as a distinct endeavour until recent years. Save the Children looks forward to continuing to help address this challenge that threatens the lives of so many children across the world.
