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Child Protection in Humanitarian Action Review: Dangers and Injuries

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Acknowledgements ThisreviewwascommissionedbytheAllianceforChildProtectioninHumanitarianAction,previouslyknownastheChildProtectionWorkingGroup(CPWG),andwrittenbyAlysonEynon,anindependentconsultantworkingundertheChildProtectionMinimumStandardsWorkingGroup.ItwasmadepossiblebythegeneroussupportoftheUSOfficeofForeignDisasterAssistance(OFDA).Thefollowingorganisationsarethankedfortheroletheyplayedinitsdevelopment:PLANINTERNATIONAL,TERREDESHOMMES,SAVETHECHILDREN,UNHCR,UNICEF,WARCHILD,WORLDVISIONINTERNATIONAL

Specialthanksgotothefollowingpeoplewhocontributedtheirtime,thoughts,resourcesandexperiences:AnitaQueirazza,AnnalisaBrusati,BhagabatiSedain,CamillaJones,CarolinNehme,ChiaraCeriotti,DwightZabala,EdouardNdong,EmilyBlakeTurner,FatumaArinaitwe,GbemisolaAkinboyo,Gilles-PhilippePage,GiovannaVio,GustavoLaurie,HelenKearney,HeleneRuud,JoannaWedge,JosephKabagambe,KatharineWilliamson,LindsayShearer,LotteClaessens,MakibaYamano,MarionPrats,MarlaPetal,MinjaPeuschel,MonikaSandvik-Nylund,NaimaChohan,NicolasMartin-Achard,PaulMurphy,PuspaPant,RobMcconnell,SabineMichaud,SabineRakotomalala,SerenaZanella,ShyamolChoudhury,SolomonMamo,SusanAndrews,TimMoyle,TomMecrow,WayneBleier,ZarrenaVasquez,VirginiaHowells.Editor:HelenKearney.

Acronyms and abbreviations AXO AbandonedexplosiveordnanceCAAFAGChildrenassociatedwitharmedforceorarmedgroupsCFS ChildfriendlyspaceCPiE ChildprotectioninemergenciesCPMS ChildprotectionminimumstandardsCPRA ChildprotectionrapidassessmentCPWG ChildprotectionworkinggroupCWD ChildrenwithdisabilitiesC4D CommunicationforDevelopmentDRR DisasterriskreductionERW ExplosiveremnantsofwarGBV GenderbasedviolenceIED ImprovisedexplosivedeviceLMIC Lowandmiddle-incomecountriesMRE MineriskeducationMRM MonitoringandreportingmechanismNFI Non-fooditemNGO Non-governmentorganisationUN UnitedNationsUNHCR UnitedNationsHighCommissionforRefugeesUNICEF UnitedNationsChildren’sFundUXO UnexplodedordnanceWHO WorldHealthOrganisation

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Contents Acknowledgements................................................................................................................................................1Acronymsandabbreviations..................................................................................................................................1Contents.................................................................................................................................................................2SectionOne:Introduction......................................................................................................................................4

Definitionsofkeyterminologies:.......................................................................................................................4BackgroundandObjectives................................................................................................................................5Methodology......................................................................................................................................................6Limitations..........................................................................................................................................................7Conceptualframework.......................................................................................................................................8Structureofdocument.....................................................................................................................................11

SectionTwo:TheHumanitarianContext,DangersandInjuries...........................................................................11Dangersandinjuriesinnon-emergencycontexts............................................................................................11Dangersandinjuriesinemergencies................................................................................................................12Dangersandinjuriesindifferenttypesofemergencies...................................................................................13Typesofdangersandinjuriesinemergencies:.................................................................................................14

Falls...............................................................................................................................................................15Drowning......................................................................................................................................................16Roadtrafficinjuries......................................................................................................................................19FireandBurns...............................................................................................................................................20Animalbites,stingsandattacks...................................................................................................................22Indiscriminateweaponsinconflict...............................................................................................................24

Wheredangersandinjuriesoccur....................................................................................................................29Whoisatriskinemergencies?.........................................................................................................................30

UnaccompaniedandSeparatedChildren.....................................................................................................30ChildLabourers.............................................................................................................................................31Childrenassociatedwitharmedforcesandarmedgroups..........................................................................33Childrenincontactwithjusticesystems......................................................................................................34Childrenwhoaredisplaced,seekingasylumorrefugees.............................................................................35Childrenwithdisabilities.............................................................................................................................36

SectionThree:KeyissuesandLessonsLearned...................................................................................................38Theroleofchildprotectionandotherhumanitarianactors............................................................................38

Childprotection............................................................................................................................................38Mineactionandsafetymessaging...............................................................................................................39Education......................................................................................................................................................40Health...........................................................................................................................................................41Shelter..........................................................................................................................................................43Water,SanitationandHygiene.....................................................................................................................44

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Campcoordinationandmanagement..........................................................................................................45Coordination.....................................................................................................................................................45Workingwithchildrenandtheirparents.........................................................................................................46Assessmentandsituationalanalysis................................................................................................................46Donoharm.......................................................................................................................................................48Effectivepreventionandresponsestrategies..................................................................................................51

DisasterRiskReduction................................................................................................................................52Awarenessraisingandadvocacy..................................................................................................................55MineRiskEducation.....................................................................................................................................56Injurysurveillance.........................................................................................................................................60Safetymessagingandriskeducation............................................................................................................60Communityriskmapping..............................................................................................................................61Community-basedchildprotection..............................................................................................................61Supportforsurvivorsofexplosiveweapons................................................................................................63FirstAid.........................................................................................................................................................64Casemanagementandreferralservices......................................................................................................65ChildFriendlySpacesandChildren’sClubs..................................................................................................69Psychosocialdistressandsupportinterventions..........................................................................................71

SectionFour:Availabletechnicalexpertise..........................................................................................................72SectionFive:Challenges.......................................................................................................................................74SectionSix:RecommendationsandConclusions.................................................................................................76

Forallhumanitarianworkers...........................................................................................................................76Forchildprotectionpractitioners.....................................................................................................................78Fordonors........................................................................................................................................................79

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Section One: Introduction Definit ions of key terminologies1:

ChildProtectionIsthepreventionofandresponsetoabuse,neglect,exploitationofandviolenceagainstchildren.Childprotectioninemergenciesincludesspecificactivitiesbychildprotectionactors,whetherbynational,community-based,and/orhumanitarianstaff,supportinglocalcapacities.Italsoincludesactivitiesinotherhumanitariansectorsthatimprovechildren’ssafety,evenwherethisisnottheirspecificpurpose.Dangerisoftendefinedasanimmediatethreattoachild’ssafety,indicatingcircumstanceswherehazardsarepresentthathavethepotentialtocauseharmorinjury.Itisalsoageneralwordforliabilitytoallkindsofinjury,bothclosebyandcertain,orremoteanddoubtful.DisasterRiskReductionistheconceptandpracticeofreducingtheriskofdisasterthroughsystematiceffortstoanalyseandmanagecasualfactors.Itincludesreducingexposuretohazards,lesseningthevulnerabilityofpeopleandproperty,wisemanagementoflandandtheenvironment,andimprovingpreparednessforadverseevents.Emergenciesarebroadlydefinedasathreateningconditionthatrequiresurgentaction.Effectiveemergencyactioncanavoidtheescalationofsuchaneventintoadisaster.Disasteristheseriousdisruptiontothefunctioningofacommunityorasocietyinvolvingwidespreadhuman,material,economicorenvironmentallosses,andimpactsthatexceedtheabilityoftheaffectedcommunityorsocietytocopeusingitsownresources,andwhichthereforerequiresurgentaction.Thetermcoversnaturalandman-madedisastersandconflicts,andincludessuchtermsas“crisis”and“emergency”.Explosiveremnantsofwar(ERW),areexplosivemunitionsleftbehindafteraconflicthasended,theyincludeunexplodedartilleryshells,grenades,mortars,rockets,airdroppedbombs,clustermunitions,andunexplodedorabandonedIEDs.Undertheinternationallegaldefinition,ERWconsistofUXOandAXO,butnotmines.Unexplodedordnance(UXO)areunstableexplosivedevicesthatfailtodetonateasintended,andareleftbehindduringandafterconflicts,theyposedangerssimilartolandmines.Abandonedexplosiveordnance(AXO)areexplosiveweaponsthathavenotbeenusedduringarmedconflict,havebeenleftbehind,andarenolongerundercontrolofthepartythatleftitbehind;theymayormaynothavebeenpreparedforuse.ExplosiveWeaponsaffectanareaaroundthepointofdetonation,usuallythroughtheeffectsofblastandfragmentation.Asaworkingdefinition,theyareconsideredtoinclude“explosiveordnance”and“improvisedexplosivedevices”–bothofwhicharesubjecttolegalrulesintheConventiononConventionalWeapons(CCW).2Theyincludemortarorartilleryshells,clusterbombsandairdroppedbombs,andimprovisedexplosivedevices(IEDs).Clustermunitions/bombscontainseveraltohundredsofexplosivesub-munitions.Theyaredroppedfromtheairorfiredfromthegroundandaredesignedtobreakopenmid-air,releasingsub-munitionsandsaturatinganareathatcanbeaswideasseveralfootballfields.Hazardsarepotentiallydamagingphysicalevents,naturalphenomenonorhumanactivitythatmaycauselossoflife,injuryorotherhealthimpacts,propertydamage,lossoflivelihoodsandservices,socialandeconomicdisruptionorenvironmentaldamage.Somedefinitionssuggesthazardsaredangersthatcanbeforeseenbutnotavoided.Injuryisoftendefinedasdamageorharm(aparticularformorinstance)doneto,orsufferedbyaperson.Itisalsodefinedas“thephysicaldamagethatresultswhenahumanbodyissuddenlysubjectedtoenergyin

1ThesesdefinitionsandtermsareadaptedfromtheCPWG2012,MinimumStandardsforChildProtectioninHumanitarianAction,CPWG,Geneva.TheLandmineandClusterMunitionsMonitorWebsite–Theissues(AprogrammetoprovideresearchandmonitoringfortheInternationalCampaigntoBanLandminesandtheClusterMunitionCoalition),http://www.the-monitor.org/en-gb/the-issues.aspx.TheInternationalNetworkonExplosiveWeapons,“INEWCallCommentary,”(Workingdefinitions)2011,http://www.inew.org/about-inew/inew-call-commentary.TEACHVIPLessonsModulesFoundationsandMethods:http://teach-vip.edc.org/course/category.php?id=3&lang=en_utf82InternationalNetworkonExplosiveWeapons(INEW).2011.Preventinghumansufferingfromtheuseofexplosiveweaponsinpopulatedareas–theINEWcall.Canbefoundat:http://www.inew.org/about-inew/inew-call-commentary

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amountsthatexceedthethresholdofphysiologicaltolerance—orelsetheresultofalackofoneormorevitalelements,suchasoxygen”.Injuriesareabroadtermcoveringamultitudeofhealthproblems,eachofwhichisassociatedwithdifferentfactorsandforwhichdifferenttypesofinterventionsarepossible.Injuriesareclassifiedasintentionalorunintentional.UnintentionalInjuriesoccurwhentheharmwasnotdeliberate,eitherbyoneselforbyanotherperson.Frequentlyandtraditionallyreferredtoas‘accidents’,whichseeminevitableandlackapparentcause,thereisnowconsensusthattheycanandshouldbepreventedandpredictedwhenprecautionsaretaken.IntentionalInjuriesoccurfromself-directed,interpersonalorcollectiveviolenceandresultfromharminflictedbydeliberatemeans.Landminesinthisdocumentrefertoanti-personneloranti-vehicleexplosivedevices,whichareplacedonorunderthegroundandwhicharedesignedtobeexplodedbythepresence,proximityorcontactofapersonorvehicleandwillincapacitate,injureorkilloneormorepersons.Lifeskillsareskillsandabilitiesforpositivebehaviourthatenableanindividualtoadapttoanddealeffectivelywiththedemandsandchallengesofeverydaylife,helppeopletothink,feel,actandinteractasindividualsandasparticipatingmembersofsociety.Theycanbegeneral(e.g.analysingandusinginformation)ortopic-specificsuchasriskreduction,firstaid,swimmingskills,environmentalprotection,healthpromotion,peacebuildingetc.Theneedforlifeskillsoftenincreasesincrisis,requiringincreasedemphasisonbuildinglifeskillsthatarerelevanttotheemergencyandlocalcontext.Preventionreferstoactionstakentoavoidtheadverseimpactsofhazardsandrelateddisastersuponpeople,property,livelihoodsandtheenvironment.Injurypreventionistheactionsorinterventionsthatpreventaninjuryeventfromhappeningormakethemlesslikelytooccur.Inthisdocument,thetermalsoconsidersinjurycontrolandactionsaimedatreducinginjuriesandthephysicalandemotionalconsequencesofinjuriesaftertheyoccur,includingbyimprovingthesystemsandservicesthatrespondtoinjuries.Riskreferstolikelihoodthatahazardwillhappenitsmagnitudeanditsconsequences.Itrelatestotheprobabilityofexternalandinternalthreats(suchasnaturalhazards,HIVprevalence,armedattacksetc.)occurringincombinationwiththeexistenceofindividualvulnerabilities(suchasage,poverty,physicalormentaldisabilitiesormembershipofamarginalisedgroup).RiskAssessment/Mappingisthemethodologyusedtodeterminethenatureandextentofriskbytakingintoaccountpotentialhazardsandexistingconditionsofvulnerabilitythattogethercouldcauseharm.Itshouldalsotakeaccountofcommunitycapacitytoresistorrecoverfromtheimpactofthehazard.Safetyisthestateofbeingsafe,andreferstopeople’sphysicalandpersonalwell-beingandintegrityalongwiththeirfreedomfromphysical,environmental,social,spiritual,political,emotionalorpsychologicalharm.SafetyMessaginginthecontextofthisreview,denotesactivitiestoraiseawarenessandpromotebehaviouralchangetoeducateboysandgirls,theirparentsandcommunitiesonabroadvarietyofhazards(naturalorman-made)inanygivencommunitytoreducetheriskofinjuryordeath.CloselylinkedtothisisMineRiskEducation(MRE)whichfocusesoneducationalactivitieswhichreducetheriskofinjuryanddeathfromminesandERW.Vulnerabilityreferstothephysical,social,economicandenvironmentalfactorsorprocessesthatincreasethesusceptibilityofacommunityorindividualstodifficultiesandhazardsthatputthematriskasaresultofloss,damage,insecurity,sufferinganddeath.Well-beingistheconditionofholistichealthandtheprocessofachievingthiscondition,itreferstophysical,emotional,socialandcognitivehealth.

Background and Objectives TheintroductionoftheMinimumStandardsforChildProtection(CPMS)inHumanitarianActioncreatedtheopportunityforrenewedfocusonthephysicaldangersandinjuriesthatchildrenexperienceduringemergenciesasaspecificlifesavingchildprotectionneed.Standard#7onDangersandInjuriesstatesthatgirlsandboysareprotectedagainstharm,injuryanddisabilitycausedbyphysicaldangersintheirenvironments,andthephysicalandpsychologicalneedsofinjuredchildrenarerespondedtoinatimelyandefficientway.Withthenumberandseverityofdisastersandconflictincreasing,3climatechangeandpolitical

3JLeaning,andDGuha-Sapir(2013).NaturalDisasters,ArmedConflict,andPublicHealth.NewEnglandJournalofMedicine

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instabilitypresentinalargenumberofcountries,agrowingrecognitionofinjuriesasasignificantpublichealthconcern,andincreasedattentiononDisasterRiskReduction(DRR).Thisreview,commissionedbytheglobalAllianceforChildProtectioninHumanitarianAction(previouslyknownastheChildprotectionWorkingGroup)aimstostrengthentheknowledgebasearoundthisstandard,sharebestpracticeandhighlightlessonslearned.Eventually,itishopedthatthisreviewwillcontributetoimprovinghumanitarianactioninthisareaofwork,savelivesandpreventdisabilityinchildren.WhileitisbelievedchildprotectionactorsarepartiallyaddressingtheproblemintheirwiderresponsestoChildProtectioninEmergencies,therewasanidentifiedneedtosupporttheimplementationofthisminimumstandardwithfurtherknowledge.Itshouldalsobenotedthattheissueofphysicaldangersandinjuriesinemergenciesishighlycross-sectoral,requiringthecommitmentofanumberofsectorsandservices,primarilyhealth,campmanagement,education,waterandsanitation,andprotection.Withaclearfocusonprotectingthelivesandwellbeingofgirlsandboys,childprotectionactorshaveacentralroletoplayalongsideothers.

Methodology Thereviewinvolvedtheexaminationandsynthesisofpublishedandgreyliterature,anonlinesurvey,andtelephoneinterviewswithkeyfieldandheadquarters-basedpractitioners.

AcomprehensivedocumentsearchandreviewtookplaceincludingrelevantresearchandprogrammaticreportsfromNGOs,UNagencies,interagencygroups,andacademicinstitutions,particularlythoseknowntoAlliancemembers,injuryspecialists,andpreviousreviewscarriedoutunderotherCPMS;emergencyneedsassessments,particularlychildprotection,protectionandeducation;onlinepressreleasesandnewsreports.Aninternet-basedsearchwasundertaken,includingkeydocumentcentresofmajorNGOsandUNagencies,WHOHealthStatisticsandInformationSystem,registersofacademicjournalssuchastheNationalCenterforBiotechnologyInformation,SageJournalsonline,TheBritishMedicalJournal,ResearchGate,andTheLancet.Intotal179documentsformedthebasisofthisreview.

Documentanalysis:Documentsnotcontainingrelevantinformationtothereviewwerediscounted.Theremainderwereanalysedfortheextentandpatternsofdangersandinjuriesinemergencies;activitiestopreventandrespondtodangersandinjuriesinemergencies;lessonslearnedandgoodpractice;challenges;technicalexpertise;linkagestoDRRandsystemsstrengthening;othersectorsandotherareasofchildprotection.Includedinthedocumentreviewwastheanalysisof16InterAgencyChildProtectionRapidAssessments(CPRA)toseeifanycomparisoncouldbemadeaboutdangersandinjuriesacrossreportedfindings.Ofthese,fiveincludedallriskstophysicalsafetycombiningbothviolentandnon-violentthreats;4sixreportedviolentthreatsandnon-violentthreatsbutasseparateissues;5andfiveassessedonlyviolentthreatsbutincludedERW.6Thefindingsandanalysisofalldocumentswereconsolidatedandshapethenextstagesofthereview.

Survey:AnonlinesurveywasdraftedandpublishedwidelyamongAlliancemembersandcoordinationgroups.33peopleansweredthesurvey.Thequestionnairewasnotintendedtobewhollyrepresentativeofthesector;however,thedatasuppliedprovidessomeinsightsintohowpractitionersviewtheissuesforchildren.61%respondentswerechildprotectionactors,15%wereprotectionactors,andtheremaining24%wereeducation,health,campmanagement,Non-FoodItem(NFI)/Shelter,GenderbasedViolence(GBV)andFoodSecurity.74%workedforNGOs,10%workedfortheUNandtheremaining16%workedforlocalNGOsInter-governmentalorganisationsorcoordinationbodies.77%ofrespondentsworkfororganisationsactingtopreventandrespondtodangersandinjuriesinemergencies.

ReviewofWHOGlobalHealthEstimates:PublicallyavailabledatafromtheWHOonestimatecause-specificmortalityratesbyage,genderandcountryin2012hasbeenreviewed,analysedandutilisedinpartsofthisreviewtohighlightrelevantindicativefindingsondangersandinjuries.Althoughglobalestimatedataisavital

4MyanmarRakhineState(2012),PhilippinesCentralMindanao(2014),PhilippinesTyphoonBhopal(2013),KurdistanRegionofIraq(2014),OPTGaza(2014).5EthiopiaGambella(2014),Tunisia(2011),SouthCentralSomalia(2011),ThailandFlooding(2012),YemenHajjahGovernorate(2012),PhilippinesTyphoonHaiyan(2014).6Syria(2013),NorthMali(2012),PakistanKhyberPakhtunkhwa(2013),Lebanon(2013),Za’atariCampJordan(2012).

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sourceofinformationforhumanitarianactionanddisasterriskreduction,itdoeshavesomechallengesthatarehighlightedinFigureOnebelow.

Keyinformantinterviews:Followingthesurvey,keyinformantinterviewswereconductedwithamixofchildprotectionpractitioners,DRR,humanitarianandinjuryspecialistsfromglobal,regionalandfieldlevels.20interviewsandsixdetailedwrittensubmissionstookplace.SixinterviewsdiscussedemergenciesinAsia(Afghanistan,NepalandPhilippines),fiveinAfrica(Uganda,CentralAfricanRepublic,Ethiopia,Sudan),threediscussedemergenciesintheMiddleEast(SyriaandLebanon),andninewerewithglobalorregionallevelpractitionerswhoworkedforNGOs,UNICEFortheUNHCR.Keyinformantswerequestionedonactivitiesorprogramsthatexisttopreventandaddressdangersandinjuriesinchildren;relevantdocumentation;theroleofdifferentactorsincludingchildrentheirparentsandthecommunity;inter-sectorallinkagesandcollaborationwithotherpartners;effectiveapproachesandstrategies;advocacy;lessonslearnedincludingstrengthsandfacilitatingcomponents,gaps,challengesandunintendedrisks.

Reportfindings:Thefindingsoftheliteraturereview,survey,andinterviewsweredraftedintothisreport,whichwasreviewedbytheCPMSWorkingGroupandleadingexpertsbeforebeingfinalised.

Limitations WiththedominanceofemergenciesinAsia,theMiddleEastandAfrica,theAmericasandEuropewerenotequallyrepresented.English,FrenchandalimitednumberofdocumentsinArabicwerereviewed,butnodocumentsinSpanish.InterviewswereconductedinEnglish.

Widevariationsexistinthecoverageandqualityofdataontheonthecauseofdeathandinjuryofchildreninemergencies.Generally,higherqualityandquantityofdataisavailableincircumstanceswhereexplosiveremnantsofwarandlandminesarepresent,althoughthisisnotalwaysthecase.Verylittleisknownaboutothercausesofdeathandinjuriesfromphysicaldangersinemergencies.Datathatdoesnotlookattheissueisrarelydisaggregated,andthecausesofinjuriesfrequentlyunreported.GlobalandcountrylevelestimatesonthenumberofdeathscausedbyintentionalandunintentionalinjuriesareavailableformostWHOmembercountries,butdonotadequatelyshowtheimpactofemergencies.

Anoteaboutmortalitydata

UsingWHOglobalestimatesofmortalityratesandcategorisationsinrelationtodangersandinjuriesinhumanitarianemergenciespresentsanumberofchallenges:

Deathsfromnaturaldisasters(actsofnature)areoftencombinedinthecategory‘otherunintentionalinjuries’,witheventslikeasphyxiationandpoisoning.Whilstdeathratesfromparticularinjurytypesthathappentooccurinemergenciesarenotclassedundertheinjuryitself,forinstanceifyoudrowninafloodthisisnotclassifiedasdrowning,butasanactofnature.Thisresultsinlargenumbersofdeathsnotbeingrecordedaccurately,underreportingaroundtheissueofinjuryandpolicydevelopmentthatisnotfullyawareoftheextentoftherisks.

Estimatedeathratesrelevanttodisastersandconflictunderutiliseothersourcesofnationaldatapertinenttoemergenciessuchasmineactiondatabases,ortheEm-DatInternationalDisasterDatabase.

Accurateclassificationisdependentonfunctioningandwell-trainedsystemsofhealthsurveillance.Inmanydevelopingcountriesandthoseaffectedbydisasterandconflictthisisnotavailable,andinthecasesofinjuriestheyarenotalwaysboughttotheattentionofmedicalteams.

Inlowerandmiddleincomecountries,mortalityininfants’accountsforoverthreequartersofallmortality,mostoccurringinthefirstyearoflife,andmainlyduetocommunicabledisease(sepsis,neonataltetanus,etc.),ornon-communicablediseases(birthinjury,congenitalconditions,etc.).Becauseofthesehighratesinthefirstyear,theagegrouping0-4yearsmasksthetrueextentofinjuriesinearlychildhood,andsignificantlylowersthedeathrateofinjuriescomparedtoothercausesofdeath.Thisdecreasesawarenessabouttheriskofinjuriesinthefirst5yearsoflife,whichforsomeinjuryissuessuchasdrowningareasignificantconcernwhensomanychildrenunder5arekilledeachyear.Asaresult,injurydeathratesaremoreusefullypresentedseparatelyforinfancy(0-1years)andchildhood(1-17years),ratherthanbirthtoadulthood(0-17years).

Figure1Source:Linnanetal.(2012).ChildDrowning:EvidenceforanewlyrecognizedcauseofchildmortalityinlowandmiddleincomecountriesinAsia,andLinnan,M.(2015).WatersafetyandchilddrowninginVietnam,areportforSavetheChildrenVietnam.

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Therewasafocusoninformationfrominternationalorganisations,suchasUNICEF,WHO,LandmineMonitor,UNHCRandInternationalNGOssuchasWatchList,SavetheChildrenandHandicapInternational.Aselectionofsmallerinjuryprevention-specificnationalNGOs,andindividualresearchers,werealsorepresented.AlthoughtheRedCrossarerecognisedasamajoractorinthisissue,thelackofspecificinformationonchildrenlimitedthequantityofresourcesreviewed.TherewasarelianceonpublishedevaluationsofMineRiskEducationprojectscompletedbyUNICEF.

Analysisislackinginanumberofareasofdocumentationregardingchildprotectioninhumanitarianaction.Beyondbroadtermsthatareusedtodescribetypesofinjuries,‘environmentalrisks’arefrequentlygroupedtogetherwithoutsufficientdetailtobeofuse.

Insummary,verylittleisknownaboutthehealth,wellbeingandprotectionofchildrenwhohavebeeninjuredanddisabledinhumanitariancontexts,howtheirliveshavebeenimpactedbytheirinjuries,theemergencyorsubsequentresponse.

Conceptual framework Inordertoguidethisreview,itwasimportanttooutlineaconceptualframeworkinrelationtotheboththekeyresearchquestionsandtheminimumstandard,bothofwhichestablishdangersandinjuriesasanindependentstandard.ItwasalsoimportanttooutlinetheinterdependencewithotherstandardsandtheCPMS10principles,focusingontheguidingprinciplesoftheConventionontheRightsoftheChild,corehumanitarianprinciplesoftheSphereStandardsandcoreprinciplesoftheCPMS.7Thekeyresearchquestionswere:

• Whatarethedangersandinjuriesthatchildrenendureinhumanitariancontexts?• Whatarethecurrentapproachesandavailabletechnicalexpertisetopreventandrespondto

associatedissuesinemergencies?• Whatarethechallengesthatpreventastrongerresponsetoassociatedissuesinemergencies?• What key recommendations would help address the gaps in programming for child protection in

humanitarianaction?

Beforediscussingthespecificsofwhathasbeenincludedinthisconceptualframework,itisimportanttounderstand‘intention’inrelationtodangersandinjuries:

Intention:Childrenareinjuredbothintentionallyandunintentionallybefore,during,andafterhumanitarianemergencies.Theyalsofaceamultitudeofphysicaldangersintheirenvironment.Thesemayariseasadirectconsequenceoftheemergency,ormayhavebeenpresentbeforetheemergencyandworsenedbytheensuinghumanitariansituation.Whilethemajorityofdangersandinjuriesconsideredunderthisrevieware‘unintentional’,importantcrossoversandlinkagesarenotedwithsome‘intentional’injuries,particularlyinconflict-affectedareas.

Somedangersandinjuries,inmostinstancesareeasilycategorisedas‘unintentional’,suchasthosesustainedfromroadtrafficcollisions,burnsfromhousefiresorcooking,drowninginswollenorfloodedrivers,damagedinfrastructure,exposuretodangerouswaste,orincidentsinvolvingthestorageandunintendeddischargeofweapons.Inaddition,therearedangersandinjurieswhichoccurinconflictaffectedareaswhichalthoughstemfromviolentintentareclassifiedasunintentional,suchasvictim-activatedexplosionsor‘unintentionalexplosions’fromlandminesandexplosiveremnantsofwar(ERW).Whenunintentionalinjuriesareconsidered

7Survivalanddevelopment;Non-Discrimination;Childparticipation;Bestinterestsofthechild;Donoharm;Impartiality;Protectionfromphysicalandpsychologicalharm;Assistpeopletoclaimtheirrights,accessavailableremediesandrecoverfromtheeffectsofabuse;Strengthenchildprotectionsystems;Strengthenchildren’sresilienceinhumanitarianaction(CPMSProgrammingforCPiE,CPMSStandard4:ProgrammeCycleManagement,ProgrammingforChildProtectioninEmergencies:HowtoincorporatetheCPMSintoallaspectsoftheProgrammeCycle.CPWGSeptember2015)

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theyquiteoftenprovokequestionsabout‘whatcausedtheinjury’or‘whatinourphysicalenvironmentwasresponsibleforit?8

Therearealsodangersandinjuriesthatare‘intentional’bynatureandstemfromviolenceorself-harm,suchasthosewherechildrenarekilled,maimedortortured,orinjuredasaresultofintentionalattacksonpopulatedareas,schoolsorhospitals;orinjuriessustainedfromphysicalorsexualviolencebymembersofchildren’sfamiliesorcommunities.Whenintentionalinjuriesareconsideredtheyquiteoftenprovokequestionssuchas‘whocausedtheinjury’,or‘whowasresponsibleforit?’

Finally,therearedangersandinjuriesthatarenotsoclearlyclassifiedandpredominatelyoccurinconflictsettings.Theseoccurwhentherewasanintenttouseforce,butitdidnotnecessarilymeantherewasanintenttocausedamageorharm,particularlytociviliansorchildren.Suchinjuriescouldbesustainedfromchildrenbeingcaughtincrossfire;poorlytargetedexplosiveweapons,shellingorairstrikesthatlandoncivilianhomes,hospitalsorschools;theuseofchemicalweaponsetc.Injuriessustainedcouldstrictlybeclassifiedasintentionalordiscriminateastheyoriginatefromcollectiveviolence,butcouldalsobeperceivedasindiscriminateandthereforeunintentional.Itshouldalsobenotedthatevidencefromnon-emergencysettingsshowsthatmanyinjuriesaremisclassified.9

WhileitistheaimofthisreviewtofocusondangersandinjurieshighlightedthroughCPMS#7,itwasacknowledgedfromtheoutsetthatavailableanddocumentedbestpracticeislimited.Withthisinmind,thefollowingwasconsideredundertheconceptualframeworkduringthisreview:

Interconnectedness:TherearemanylinkagesbetweenthedangersandinjuriesconsideredunderCPMS#7andthosetypicallyfallingunderotherminimumstandards,suchasPhysicalViolenceandotherHarmfulPractices(CPMS#8),PsychosocialDistressandMentalDisorders(CPMS#10),ChildrenAssociatedwithArmedForcesorArmedGroups(CPMS#11),andChildLabour(CPMS#12).Thisreviewwillnotfocusonthedangersandinjuriestraditionallyconsideredunderthosechildprotectionneeds,butwillhighlightrelevantlinkagesandlearning.

Phases:Before(DRRandpreparedness),duringandafter(response,recovery,reconstruction)humanitarianemergencies.

Typesofemergencies:Suddenonsetfromnaturalhazards,slowonsetfromnaturalhazards,conflictandcomplexemergencies,protractedcrisis,andpandemicandepidemicemergencies.

Placeswherephysicaldangersarepresentandinjuriesoccur:thehome(insideandoutside),thecommunity(schools,services,placesofwork,camps,onthewaytoplaces).

Who:Children:Whatroledoesachildoryoungpersonplayinidentifyingdangersandpreventinginjury?Howarechildrensupported?Families/Caregivers:Howarefamiliesandcaregiverssupported(duringpreventionandresponse)?Whatroledofamily/caregiversplayinidentifyingdangersandpreventinginjury?Whatactivitiesinthehouseholdincreaseormitigaterisk?Community:Howdocommunityactionssupportaresponsetodangersandinjuriesinchildren?Howarecommunitiessupported?Whatare/whatshapessocietalbeliefs,norms,practicesarounddangersandinjuries?Howdoesthecommunityenvironmentcontributetodangersandinjuries?Whatimpactdotheactionsofthecommunityhaveinpreventing,respondingandrecoveringfromdangersandinjuries?Childprotectionactors:Whatroledochildprotectionactorsplayinpreventingandresponding/recoveringtodangersandinjuries?Howisitintegratedintotheirbroaderresponsesforchildren?Howdotheycontributetotheriskofdangersandinjuries?Othersectors/actors:Howdotheyrespondtothisissue?Istherecross-sectorallearning?Howdochildprotectionandother

8WHOclassifyandrecordunintentionalinjuriestoinclude:Roadtrafficcollisions;Falling;Burns;Drowning;Poisoning;Wild/domesticanimalsorsnakebites;smothering,asphyxiation,choking,hypothermiaandhyperthermia.AfulllistoftheinjuriesconsideredunderMinimumStandard#7andrelevantinhumanitariancontextscanbefoundbelow.9Lewit,E.MandSchuurmannBaker,L.(1995)TheFutureofChildren.LowBirthWeight.Volume5Number1Spring1995.CHILDINDICATORS:UnintentionalInjuries

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sectors/actorslinkonthisissue?Isdatashared,aresystematicreferralsmade,aretherejointawareness-raisingefforts?Thehazardsordangersconsideredforthepurposeofthisreviewinclude:

• Roadtrafficcollisions(motorisedornon-motorisedvehicles,pedestrian)• Falling(cliffs,trees,pits,trenches,heights)• Burns(fire,cookingoil,boilingwater,hotdrinks,electrocution)• Drowning(rivers,lakes,oceans,pitlatrines,wells,reservoir,floodsandlandslides)• Poisoning(medicines,chemicals,pesticides)• Wild/domesticanimals(snakebites,dogbites,insects)• Sharpobjects(knives,barbedwire)• Exposuretogarbagecontaininginfectiouswaste• Damagedorcollapsinginfrastructure(roofsandwallscollapsing,exposedelectricalandbarbedwire,

rubble)• Impact,injuriesandconsequencesofexplosiveweapons(intentionalandunintentional)• Explosiveremnantsofwar(clusterbombs,mortars,shells,grenades,ammunition,etc.)• Landmines• Injuriessustainedduringattacksoncivilians,schoolsandhospitals(recognisingthatthereiscross

thematiclearninginbothpreventionandresponse)• Beingcaughtincrossfire,orinjured/killedasaresultofunsecuredweapons• Chemicalandgasattacks

Inthecontextofphysicaldangersandinjuriesthefollowingtypesofpreventionandresponsestrategies arealsoconsidered,thisstructure is based on a tried and tested public health approach to violence and injury prevention.10

• Primarypreventionstrategiesthataimtopreventtheinjuryeventfromtakingplace,andrelatestothetimebeforeinjuriesactuallyoccur.E.g.,latrinesarebuiltsothatsmallchildrencannotfallin;sitesandservicesaresituatedawayfrombusyroads;hazardoustools,equipmentorchemicalsstoredoutofchildren'sreach;bucketorwatertanks/reservoirsarecovered.Safecookingandfirefuelsandmaterialsareprovided,particularlyforat-riskgroupssuchaschild-headedhouseholds,youngmothers,familiesaffectedbydisability,amongothers.Theengagementofthecommunity,eldersandolderchildrentoidentifyandmaphazardousareasandsharelearningbetweendifferentagegroups.Itmightalsoincludethingslikelegislationandenforcementmandatingtheuseofseatbeltsorbikehelmets,orsafebuildingpracticesinzonesat-riskfromnaturalhazards.Primarypreventionstrategiesthataimtopreventdeath/injury,andminimiseharmduringaneventfromunavoidable/presenthazards.E.g.,manyDRRactivitiessuchasfixingfurnituretowallsinearthquakezones;rescueswimminginstructioninfloodproneareasandfamiliaritywithPersonalFlotationDevice.DRRmessagesonearthquakesafetyintheeventofaquake;buildingpathsawayfromriversandlakes;teachingfirst-aidandsafeevacuationpracticestochildreninhigh-riskareas;safetymessagesandMineRiskEducation(MRE)inwarzones;wearingseatbeltsandmotorbikehelmetsetc.

• Secondaryandtertiarypreventionstrategiesthataimtopreventorminimizeinjuryafteraneventhasoccurred,reducingthelong-termconsequencesandimpactoftheinjuryordeath.E.g.Ensuringaccesstofreerapidmedicalcareforpeopleinjuredinanemergency;providingeffectiverehabilitationservicesforchildrenseverelyinjured;identifyingfamilieswhohavelostparentsorchildreninanemergencyandensuringtheyareadequatelysupported;supportgroupsforrecentlydisabledchildrenoradults;vocationaltrainingforrecentlydisabledadultsoradolescents,amongothers.

10AdaptedfromTEACHViolenceandInjuryPrevention(VIP)manual,WHO&EducationDevelopmentCentre,2010.

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Structure of document Thereportisdividedintoanintroductorychaptercoveringallfoundationalcontentincludingbackground,methodology,definitionsandconceptualframework.Thereportthenprovideskeyfindingsonhowdangersandinjuriespresentinemergenciesincludingdifferentcontexts,differenttypes,differentgroupsofchildrenandwheretheyaremostatrisk.Thethirdchapterlooksatexamplesofprogrammingapproachesandlessonslearnedtoaddressdangersandinjuriesinemergencies,includingtherolesofdifferentsectors,coordination,assessments,workingwithchildrenandparents,followedbykeypreventativestrategiessuchasDRR,awarenessraising,riskmapping,supportforsurvivorsandcasemanagementandchildfriendlyspaces.Thereportconcludeswithalookatavailabletechnicalresourcesandexpertise,challenges,recommendationsandconclusions.

Section Two: The Humanitarian Context, Dangers and Injuries Dangers and injuries in non-emergency contexts Globallymorethanfivemillionpeoplediedfrominjuriesin2012,1.4millionfromintentionalinjuries,and3.7millionfromunintentionalinjuries.11Thisis6.6%oftheworld’sdeaths,morethanthetotalnumberofpeoplewhodiedfromHIV/AIDS,tuberculosisandmalariacombined.12

Itisimportanttounderstandthepre-crisiscontext,asitisbelievedinthemaincausesofmortalityinchildrenduringemergenciesareusuallythesameconditionsthatcausemorbidityinnon-emergencysettings.13Itisalsoimportanttokeepinmindthatinnon-emergencycontexts:

• Thenatureofinjuriesvariesconsiderablyaccordingtoage,sex,regionandincome.• Childrenandadolescentsaremoreatrisk.Theyliveinaworldbuiltforadultsandevidenceshowsstrong

associationsbetweeninjuries,achild'sage,developmentalstageandtheactivitiestheyundertake.14• Unintentionalinjuriesaccountforalmost90%ofinjurycasesandaretheleadingcauseofdeathfor

childrenandyoungpeopleaged10-19yearsold.15• In2012morechildrenandyoungpeople(0-29years)diedfromunintentionalinjuriesthanthosewho

diedfrommalnutrition,parasiticdiseases(includingmalaria,denguefeverandtrypanosomiasis),andHIV/Aidscombined.16

• Reportedinjurydeathsaresteadilyincreasinginmanylow-andmiddle-incomecountries(LMIC).17Approximately90%ofinjury-relateddeathsoccurinLMIC.Peoplefrompoorereconomicbackgroundshavehigherratesofdeathfrominjuryandnon-fatalinjuriesthanwealthierpeople.Thisistrueregardlessofacountry’seconomicstatus.18Themillionsofdeathsthatresultfrominjuriesrepresentonlyasmallfractionofthoseinjured.Tensofmillionsofchildrenrequirehospitaltreatmentforinjurieseachyear.19By2020ithasbeenpredictedthatinjurieswillaccountfor20%ofallillhealthintheworld.20

11TakenfromWHO,2012,GlobalHealthEstimates(GHE)rawdata:Deathsbyage,sexandcause.Availablefrom‘GlobalSummaryEstimates’http://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html12IBID13WHO,2011,DisasterRiskManagementforHealthFactSheet:DisasterRiskManagementforHealth-ChildHealth14MPedenetal,2008,WHO&UNICEF,WorldReportonChildInjuryPrevention:AnOverviewPresentation.Availablefromhttp://www.who.int/violence_injury_prevention/child/injury/world_report/report/en/15MPeden,KOyegbite,JOzanne-Smith,AAHyder,CBranche,AKMFazlurRahman,FRivaraandKBartolomeos(2008)Worldreportonchildinjuryprevention,Geneva,WHOandUNICEF16TakenfromWHO,2012,GlobalHealthEstimates(GHE)rawdata:Deathsbyage,sexandcause.Availablefrom‘GlobalSummaryEstimates’http://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html17Whilstinjurydeathrateshavedeclinedinhighincomecountriesduetoproveneffectivepreventivestrategies.LMIChaveseenincreasesforexampleinroadtrafficcrashes,whereeconomicdevelopmenthasseenanincreaseinthenumberofvehiclesontheroad,withinsufficientlegislationandenforcementtoensuresafety,therehasbeenanassociatedriseinrelatedcrashes,injuriesanddeaths.18WHO,2014,InjuriesandViolence:TheFacts19MPedenetal,2008,WHO&UNICEF,WorldReportonChildInjuryPrevention:AnOverviewPresentation.Availablefromhttp://www.who.int/violence_injury_prevention/child/injury/world_report/report/en/20RAGosselin,DASpiegel,RCoughlin,LGZirkle,2009,WHO,Injuries:theneglectedburdenindevelopingcountries.BulletinoftheWHO2009;87:246-246.doi:10.2471/BLT.08.052290.Availablefrom:http://www.who.int/bulletin/volumes/87/4/08-052290/en/

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• Manyofthosewhosurviveinjuriesareleftwithtemporaryorpermanentdisabilities.Insomecountriesitisestimatedthatuptoonequarterofdisabilitiesresultfrominjuries.21StudieshaveshownthatinMexico17.7%andinSierraLeone14.3%ofdisabilitiesresultfromunintentionalinjuries.22

• Injuriesmorecommonlyhappentoboys.Boysunder15accountfor58%ofdeathsrelatingtounintentionalinjuriesinthisagegroup,andareclosetothreetimesmorelikelytodiefromaroadinjurythanfemalesofthesameage.Formalesbetweentheagesof15to29yearstheproportionofmaleswhodiefrominjuriesinthisagegroupincreasesto75%.23BoysarealsogreatercasualtiesofERWandlandminesthangirls,in2014,boysrepresented82%ofchildcasualties.24TheyaremorelikelytocomeintocontactwithminesorERW,becauseoftheirinvolvementinoutdooractivities.25Howeveritshouldbenotedagainthatinjuryratesvary.IntheEasternMediterraneanandSouthEastAsia,fire-relateddeathratesofyoungwomenaged15to29yearsarearound1.5timesandtwotimeshigherthanmen.26

• Roadtrafficinjuriesaretheleadingcauseofdeathworldwideforyoungpeopleaged15–29years,whiledeathsfromdrowningaretheeighth.Inchildrenfiveto14yearsold,roadtrafficinjuriesarethefourthbiggestkiller,drowningthefifthandburnstheninth.Onlyintheagegroup0-5years,doesinjurynotmakethetoptenleadingcauseofdeath.27Thisisbecauseofinfant’ssusceptibilitytoneonatalconditions,communicableandnon-communicablediseasesinthefirstyearoflife(seeFigureOneaboveforfurtherdetails).Aschildrengrowbetween1-4yearsold,theyareincreasinglyvulnerabletoinjuryin2008,unintentionalinjurieswerethreeofthetop15causesofdeathofchildrenbetweentheagesof1-4yearsold,drowning(8th),roadtrafficinjuries(9th)andfirerelatedburns(11th).

Dangers and injuries in emergencies Homes,schoolsandcommunitiescanbeinherentlydangerousplacesforchildrenwhentheyarefacedwithdisasterandconflict.Duringtheactualeventchildrenmayencounterhazardssuchascollapsingbuildings,risingfloodwaterorbeingcaughtincrossfire.Everydayhazardspresentbeforetheemergency,suchasdangerousroadsorrivers,maybemagnified.Oncetheinitial‘event’isover,childrenoftenfacedisplacementsometimesfarawayinunfamiliarsurroundingswheretheymaynotbeawareofthedangers.Or,ifstayingclosertohomeindevastatedcommunities,livingwherethehazardsmaybeobviousbutdifficulttoavoid.Inaddition,theinfluxofhumanitarianassistancecanpresentnewdangers:commonlyreportedarethelocationofIDPand/orrefugeesitesandroadincidentscausedbyvehiclesinvolvedinrespondingtoemergencies.28Illnessesandinjuriesmaygountreatedwhenthecopingcapacitiesoffamiliesareaffectedandhealthservicesaredamaged,leadingtothemultiplicationofvictimsandchildrenatriskofsecondaryinjuries,infectionandlastingorpermanentimpairmentsordisabilities.29Thosewhoarenaturallymorevulnerableinemergenciessuchasseparatedchildren,refugeesorchildrenwithexistingdisabilitiescanbeatevengreaterriskofinjuryandharmfromtheworldaroundthem.30

Inmanycountriesfrequentlyaffectedbyconflictornaturaldisasters,injuryratesarealreadyhigh.IntheDemocraticRepublicofCongo,unintentionalinjuriesarethesecondbiggestkillerofchildrenbetweentheagesof5and14,secondonlytodiarrhoealdisease.Similarly,inPakistanandthePhilippinesunintentionalinjuriesareestimatedtobethebiggestkillerofchildrenbetweentheagesof5and14years.31Incountrieswherechildrenarealreadyexposedtodangerandharmcausingsignificantlevelsofdebilitatingandfatalinjuries,

21WHO(2016),Injury-relateddisabilityandrehabilitation.Canbefoundat:http://www.who.int/violence_injury_prevention/disability/en/.Accessedon15thJanuary201622IBID23AdaptedfromWHOestimatesdeathratesbycause,ageandgender2012TakenfromWHO,2012,GlobalHealthEstimates(GHE)rawdata:Deathsbyage,sexandcause.Availablefrom‘GlobalSummaryEstimates’http://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html24LandmineandClusterMunitionMonitor.2015.TheImpactofMines/ERWonChildrenNovember2015.25UNICEF.2013.TheStateoftheWorld’sChildren2013:ChildrenwithDisabilities26WHO,2014,InjuriesandViolence:TheFacts27IBID28ThroughkeyinformantinterviewsandCPWGChildProtectionRapidAssessments.29UNICEF(2013).TheStateoftheWorld’sChildren2013:ChildrenwithDisabilities30MPeden,KOyegbite,JOzanne-Smith,AAHyder,CBranche,AKMFazlurRahman,FRivaraandKBartolomeos(2008).Worldreportonchildinjuryprevention.WHOandUNICEF31TakenfromWHO,2012,GlobalHealthEstimates(GHE)rawdata:Deathsbyage,sex,cause,andWHOmemberstates.Availablefrom‘WhoMemberStates2012’http://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html

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humanitarianchildprotectionactorsmustbecognisantof,andactiveinthepreventionandresponsetophysicalinjuriesinemergencyaffectedcommunitiesthroughtheirday-to-daywork.

Dangers and injuries in different types of emergencies Confl ict and complex emergencies. In2014,approximately230millionchildrenlivedincountriesandareasaffectedbyarmedconflicts,withnearly17.4millioncaughtupintheviolentconflictsaffectingCentralAfricanRepublic,Iraq,SouthSudan,theOccupiedPalestinianTerritories,Syria,UkraineandtheLakeChadBasinRegion.32Itisestimatedthatabout63,000children(0-14years)havediedinwarandlegalinterventionsaroundtheworldbetween1990and2013.33Inconflict,childrencanbeaffecteddirectlybyphysicalinjuriessustainedduringaerialorgroundattacks,indiscriminateshellingandortheuseofImprovisedExplosiveDevices(IED),includingPerson-BorneIEDsorVehicle-BorneIEDs.Inadditiontootherrisksthatcharacteriselivinginconflict-affectedareas,suchasdangerousroadsbesetbymilitaryandhumanitarianvehicles,orplayingamongstthedebrisofdestroyedbuildingsthatcontaindeadlyERW.Conflictincreasesthelikelihoodthatgirlsandboyswillbecomedisabled,theirsizeandearlierstagesofdevelopment,meanstheyoftensustainmoreseriouslydisablinginjuriesthanadultsbecauseoffighting,landminesorotherERW.Thisalsomeansthattheywillrequirecontinuingphysiotherapy,prosthesesandpsychologicalsupport.34Childrennotonlysufferthephysicalconsequenceofwarbutalsopsychologicalconditionsresultingfromtheseinjuriesorthetraumaticeventwhichaccompaniedtheinjury,suchasflashbacksandnightmares,losingtheabilitytospeakorfeelingsofdepression.Theirabilitytounderstandwar,theirfamily’sabilitytocopewithresultingdisabilityandpotentialrejectionfromfamilyorcommunitywillalsoinfluencechildren’spsychologicalwell-being.35

Sudden onset emergencies from natural hazards. Disastersfromnaturalhazardsaffect10timesasmanypeopleasarmedconflicts--anestimated300millionin2010.36Asthenumberofsuddenonsetsemergenciesincreases,sodothenumberofdisablinginjuriessufferedbychildren.Deathratescanalsobehigherinchildrenthaninadultsinnaturaldisasters,WHOreportthat30-50%offatalitiesarisingfromnaturaleventsarechildren.37OnemortalitystudyinPort-au-PrincefollowingtheHaitiearthquake,estimatedthat65.9%ofthosekilledwerechildrenundertheageof12,whichasaproportionofthetotalpopulationofPort-au-Princeatthetimethiswasabout5.8%.38Thissamereportestimatedthatchildrenunder18weresixtimesmorelikelytohavebeenkilledduringtheearthquakethanadults,and11timesmorelikelythanadultstodieoftheirinjuries.39Inthe2005tsunamiinSriLankathedeathratesforchildrenunderfivewerereportedtobemorethanfourtimesthoseofadults40andinAchethehighestmortalityrateswereseenamongtheyoungestchildren(andtheelderly),converselytheyalsoexperiencedthelowestinjuryratesasfarfewersurvived.Heregenderalsoplayedakeyroleinsurvivalandinjury,asitwasfoundthatnearlytwo-thirdsofthosereporteddeadormissingwerefemale,withfemalesmorethan1.4timesmorelikelytodiethanmales.InthehighestimpactareasofAceh,theriskofinjurywasloweramongfemalesthanmales,yetinthelesser-affectedareas,theoppositewasobservedwherefemalesfacedincreasedinjuryrisk.41Inadditioninthe2015Nepaleseearthquake,itwasfoundthat28%ofthedeceasedwerechildren.42,43

32UNICEF(2014).Childrenandemergenciesin2014:Facts&Figures;andUNICEF(2015)Nigeria+Sub-RegionalCrisisUpdateNigeria,Cameroon,ChadandNigerNovember2015.33GlobalBurdenofDiseaseStudy2013:IHME34UNICEF(2013).TheStateoftheWorld’sChildren2013:ChildrenwithDisabilities35BWilliamson(2011).TheImpactofERWonChildren.ThejournalofERWandmineaction.Fall2011.Availablefromhttp://www.jmu.edu/cisr/journal/15.3/notes/williamson/williamson.pdf36UNICEFEvaluationOffice(December2013)EvaluationofUNICEFProgrammestoProtectChildreninEmergencies:SynthesisReport37WHO,2011,DisasterRiskManagementforHealthFactSheet:DisasterRiskManagementforHealth-ChildHealth38Kolbeetal.,2010,‘Mortality,crimeandaccesstobasicneedsbeforeandaftertheHaitiearthquake:arandomsurveyofPort-au-PrinceHouseholds’,Medicine,ConflictandSurvival,26:4,281-297.39IBID40S.DoocyC.Robinson,C.MoodieandG.Burnham.2008.Tsunami-relatedinjuryinAcehProvince,Indonesia.JohnsHopkinsBloombergSchoolofPublicHealthandCentersforDiseaseControlandPrevention,USA.GlobalPublicHealthVol.4,No.2,March200941IBID42UNICEFNepalHumanitarianSituationReport#19.Kathmandu.Availablefrom:http://www.unicef.org/appeals/files/UNICEF_Nepal_Humanitarian_SitRep_20Aug2015.pdf.Accessedon12thMarch2016

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Slow onset disaster from natural hazards and protracted crisis . Childreninprotracteddisasters,suchasdroughtsandprolongedfoodinsecuritycanbeatincreasedriskfrominjuryandenvironmentalhazards.Theymaybefrequentlyleftaloneorunsupervisedwhileparentsareawaysecuringfoodandlivelihoodsorareoverwhelmedwiththecrisis,orentrustedtothecareofothers–oftenchildrenthemselvesortheelderly--temporarilyorpermanently,leavingchildrenvulnerabletoinjury.Olderchildrencanbeforcedintochildlabour,whichmaybecomeincreasinglydangerousasthecrisispersistsandchildrenseekworkfurtherawayindangerousindustries/employmenttohelptheirfamilycopewiththecrisis.

Pandemic and Epidemic Crisis .Althoughtheverynatureofepidemicsiscentredondisease-specificpublichealthcrisis,recentexperiencefromtheEbolaoutbreakshowedanumberofoccasionswherethephysicalenvironmentforchildren-beyondtheprimarypublichealthenvironment-deterioratedtosuchanextentthatphysicalsafetywascompromisedandinjuriesensued.InoneexamplewhereprotestersattemptedtobreakamilitaryenforcedquarantineinMonrovia’sWestpoint,a17-year-oldboywasshotbyastraybullet.UponreturninghomehewasturnedawaybyhisfamilyforfearthathisinjurieswererelatedtoEbolaandhewouldputthematriskofcontractingthedisease.Likethousandsofotherchildrenleftorphaned,abandonedorlivingonthestreetsbecauseofEbola,hewasthenatriskofmanyotherphysicaldangersandprotectionconcerns.44

Types of dangers and injuries in emergencies: Thegraphbelowgivesanindicativeillustrationofthemajorcausesofinjuryforchildrenlivingincountriesthathaveformallyrecognisedchildprotectionsub-clustersoperatinginhumanitarianoperations(Seefootnoteformoreinformationondataused).Indeterminingwhichissuestoincludeinthisreview,thebelowfindingsonmagnitudewereusedalongsideimportantfindingsraisedinemergencyassessments.Thissectionwillexaminethefollowingsixcausesofinjury:falls,drowning,burns,roadinjuries,andanimalbites/stingsandcollectiveviolenceandexplosiveweapons.45

Figure3Source:WHO,2012,GlobalHealthEstimates.Deathsfrom“Otherunintentional”includecategoriessuchassmothering,asphyxiation,choking,animalandvenomousbites,hypothermiaandhyperthermiaaswellasnaturaldisasters.Althoughthis2012datais

43Nepal:Officialfiguresforcasualtiesanddamage,June2015,MinistryofHomeAffairsNepalandNepalPolice.AvailablefromHumanitarianDataExchangehttps://data.hdx.rwlabs.org/dataset/official-figures-for-casualties-and-damage44P.Sawer(2014).Pressrelease:ThousandsofchildrenorphanedbyEbolaoutbreak.TheTelegraph.14thOctober2014.Availablefrom:http://www.telegraph.co.uk/news/worldnews/ebola/11171614/Thousands-of-children-orphaned-by-Ebola-outbreak.html.Accessedon14.1.1645WHO,2011,DisasterRiskManagementforHealthFactSheet:DisasterRiskManagementforHealth-ChildHealth

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notspecificallyreflectiveofdeathratesduringhumanitariancrisis,itprovidessomeinformationtoaidanalysisoftheextentandcausesofinjuriesincountriesaffectedbyemergencies.46

Understanding different injuries. Itwasapparentfromearlyoninthereviewthattherewereimportantmisunderstandingsabouthowdangersandinjuriesaffectchildreninemergenciesandageneralsensethatrelevantevidencefromdevelopmentcontextsareunderutilisedbyhumanitarians.47Toexplorethisfurtherthesurveyaskedwhetherrespondentsknewthemaincausesoffatalandnon-fatalchildinjuriesfordifferent-agedchildrenintheirworkingcontexts.Aswecanseefromthegraphsbelow,lessthanathirdofrespondentswereconfidentintheirknowledgeoftheissues,whilemostwereunsure.

Thissectionisintendedtoprovidekeyfindingsandaselectionofexamplesinrelationtodifferenttypesofdangersandcausesofinjuriescommonlyfoundinemergencies.

Falls Nearly47,000childrenandteenagersdiefromfallseachyear.Foreveryfatalfallthereareapproximately690childrenwhomissschoolduetoinjuryfromthefall.Fallsaretheleadingcauseoflong-termdisabilityandnon-fatalinjury,butaccountforonlyasmallproportionoffatalchildinjuries.48

Inthisreview,fallswerehighlightedasanissueinanumberofhumanitariancontextsincircumstancesthatarewhollyorpartiallyavoidable.Forinstance,inCentralAfricanRepublic(CAR),injuriesfromfallswerenotedalongsidebeingcaughtinthecrossfire,aschildrenwerefleeingaschoolunderattack.49Andina2007householdsurveyintheworstflood-affectedareasofBangladesh,fallsmadeup22%ofthereportedunintentionalinjuriesaffectingchildren.Onechildreportedlyslippedonamuddysurfaceandfracturedhisrighthand,buthismothersaidtherewasnothingshecoulddobecausethefloodhadmadethewholeareaslipperyandherchildwasattractedtoplayinthemudandwaterawayfromsupervision.50Onekeyinformant

46ThisdataincludescountriesthatonJanuary18th2016werelistedontheCPWGwebsiteasbeingformallyclusterized,andincludes:Afghanistan,CAR,DRC,Fiji,Guinea,Indonesia,Iraq,Kenya,Mali,Nepal,Niger,Nigeria,Pakistan,PapuaNewGuinee,Philippines,SolomonIslands,Somalia,SouthSudan,Sudan,Syria,Turkey,Yemen.VanuatuwasnotincludedasthereisnoWHOdataforthiscountry.ThedataistakenfromthemostrecentWHOGlobalHealthEstimates(GHE)2012.Website:Estimatesfor2000-2012-CauseSpecificMortality–BYCountry-Diseaseandinjurycountrymortalityestimates2000-2012-WHOMemberStates2012.Availablefromhttp://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html.(AccessedonJanuary11th2016).Thedataispublicallyavailable,andforchildrenusestheageranges0-4years,5-14yearsand15-29years.Becausetheupperagegroup(15-29years)includeschildrenandadults,thishasbeendiscountedforthepurposesofthisgraph.Itshouldbenotedhowever,thatifthisgraphweretorepresentallchildrenundertheageof18,itwouldmorethanlikelyshowhigherdeathratesforroadinjuries,interpersonalviolence,self-harmandcollectiveviolence.47Suchasinjurysurveys,dataontheglobalburdenofdisease,andratesofinjury,deathanddisability,plus,informationfromassessmentswhichemphasizetheextentandtypesofdangersandinjuries48MPedenetal,2008,WHO&UNICEF,WorldReportonChildInjuryPrevention:AnOverviewPresentation.Availablefromhttp://www.who.int/violence_injury_prevention/child/injury/world_report/report/en/49Watchlist.CAR.2015.VulnerableStudentsUnsafeSchools.http://watchlist.org/wordpress/wp-content/uploads/2144-Watchlist-CAR_EN_LR.pdf50ABiswas,ARahman,SMashreky,FRahman,KDalal(2010).Unintentionalinjuriesandparentalviolenceagainstchildrenduringflood:astudyinruralBangladesh

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workinginEthiopiaspokeofrefugeechildrenfromSouthSudan,whogoouttocollectfruitsfromlocaltrees,wheresometimestheyfallfromthetreesandbreaktheirlegsandankles,andthenfaceangerandpunishmentfromthelocalcommunityforstealing.51

Themostcommontypeoffallcitedwassmallchildrenfallingintoopenpitsorpitlatrines.InanassessmentofrefugeecampsandhostcommunitiesinGambellaEthiopia,respondentsindicatedthatunsafeplacessuchasriversidesandopenpitswerethesecondhighestriskforchildreninthecamps,withdirectobservationsfromthecampsindicatingthepresenceofopenpitsandlatrines31%ofthetime.52InthePhilippines,assessmentsinareasaffectedbyTyphoonBophaandconflictinCentralMindanaohavebothhighlightedopenpitlatrines,ditchesanddeepholes,ashazardsfacingchildrenintheseemergencies.

OneinterventionthatwashighlightedinMyanmarcamefromtheunfortunatedeathsoftwochildrenfallingintopitlatrines,whichresultedinamulti-sectorcampwidefocusonsafety.Nofurtherinformationoneffortstopreventfallsinchildrenduringhumanitariancrisesarosethroughthisreview.

Drowning Drowningkills372,000peopleayear,7%ofallinjury-relateddeathsintheworld,53175,000ofthosekilledarechildren54--20childrenanhour.Whenachilddrowns,significantinvestmentsintheirhealthandsocialdevelopmentarelost;inLMIC,whichaccountforover90%ofdeathsthis,hasahugeimpact.55Thetablebelowhighlightsregionaldifferencesindrowningasleadingcauseofdeathamongstchildrenandadolescents.AscanbeseeninmanypartsofSouth,CentralandEastAsiaandthePacificdrowningistheleading,secondorthirdcauseofdeathamongallchildrenage5to14.

Figure4Source:WHO(2014)GlobalReportonDrowningPrevention:PreventingaLeadingKiller

51Keyinformant152GovernmentofEthiopia,BureauofWomenChildrenandYouthAffairsandTheBureauofLabourandSocialAffairs(2014)ChildProtectionRapidAssessment,GambellaMay2014Inter-AgencyAssessmentofChildProtectionConcernsinSelectedHostCommunitiesandRefugeeCamps53WHODrowningFactSheetN°347UpdatedNovember(2014).Availablefrom:http://www.who.int/mediacentre/factsheets/fs347/en/54MPeden,KOyegbite,JOzanne-Smith,AAHyder,CBranche,AKMFazlurRahman,FRivaraandKBartolomeos(2008)Worldreportonchildinjuryprevention,WHOandUNICEF55WHO(2014)GlobalReportOnDrowning:PreventingALeadingKiller

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Riskfactorsinclude:Age,whilstchildrenunderfivearemostatrisk,oftenduetotheirmobilitybutlimitedunderstandingofdanger,children’svulnerabilitychangeswithageastheiruseofwaterchanges.56Supervisionisalsoakeyfactorinthedrowningofyoungchildren;evidencefromAsiasuggestsdrowningrisksarehigherwhenchildrenareleftinthecareofgrandparentsorgenerallyintheabsenceoftheirparents.Whereaswithadolescents,particularlyboysittendstobethatthereislesssupervision,theyarefurtherawayfromhome,andtheyaremoreengagedinrisktakingbehaviouraroundwater;forallchildrenoverfouryearsoldinAsia,drowningmostlyoccurswhilsttheyarecarryingoutnon-recreationaldailyactivities.57Childrenwholivenearopenwatersources,suchasditches,ponds,irrigationchannels,orpoolsandwellsareespeciallyatrisk,asmostdrowningeventshappeninandaroundthehome.58

Datacollectionisparticularlychallenging;itiswidelybelievedthatthereisasignificantunderrepresentationofthefullimpactofdrowningonreportedestimates.Forinstance,officialdatacategorisationmethodsdonotrecorddrowningdeathsasdrowningwhentheyarecausedbyaflood,typhoon,cyclone,tsunamiorothernaturaldisaster(deathfromanactofnature),watertransportincidents(transportfatality),suicideorhomicide(intentionalinjury).Thisresultsinlargenumbersofdeathsnotbeingcountedasdrowning.InHICswherethishasbeenstudieditundercountsdrowningbyasmuchas50%,59andinAsiaitisthoughtthatthesebiasesanduncertaintiesmaskthefactthatdrowningisaleadingcauseofchilddeathinLMICsacrosstheregion.60

Drowning during f loods and other humanitarian crisis Between2000and2010,floodsaccountedfor44%ofthepeopleaffectedbydisastersworldwide.61Wherefloodsareexpectedtoincreaseinseverityandfrequencysocanthelevelsofdrowningassociatedwiththemunlesspreventativemeasuresareputinplace.Drowningaccountsfor75%ofdeathsinflooddisasters,whichmayincreaseinLMICswherepeopleliveinfloodproneareaswithweakearlywarningandfloodpreventionsystems,andfewpossibilitiesforevacuation.62

FindingsondrowningfromLMICsinSouthEastAsiaduringdisastersshowthatalthoughdrowninginaquaticdisasterssuchasatsunamiormonsoonfloodsfrequentlymaketheheadlines,theyarenotasignificantcauseofchilddrowningdeaths,comparedtothenumberswhodrownwhileundertakingroutinedailyactivities.63Yetthesedeathsarerarelyconsiderednewsworthy,nordotheycreatebroaderpoliticalorsocialimplicationsthatmightdriveimprovedreportingandaction.64

Itwasalsofoundthatalthoughdrowningratesarehighestduringtherainyseason,mostoccursinthedryseason,whichtypicallylastsmuchlonger;andthatevenduringtherainyseason,drowningmostlyoccurredinsunnyweather.Wheretherainsdonotcauseactualflooding,theyincreasetheamountofstandingwaterinditchesandponds,whichresultsinmanymorewaterhazardsinachild’senvironment.Wheretheyareabletoplayoutsideduringsunnyweather,theyhaveincreasedexposuretotheserisks.65

56WHO(2014)GlobalReportOnDrowning:PreventingALeadingKiller57Linnan,Michael,etal.(2012).‘ChildDrowning,Evidenceforanewlyrecognizedcauseofchildmortalityinlowandmiddle-incomecountriesinAsia’,InnocentiWorkingPaper2012-07,SpecialSeriesonChildInjuryNo.2.Florence:UNICEFInnocenti58MPeden,KOyegbite,JOzanne-Smith,AAHyder,CBranche,AKMFazlurRahman,FRivaraandKBartolomeos(2008)Worldreportonchildinjuryprevention,WHOandUNICEF59Linnan,M.(2015)WaterSafetyandChildDrowninginVietnamAreportforSavetheChildrenVietnam60Linnan,M,etal.(2012).UNICEF.‘ChildDrowning:EvidenceforanewlyrecognizedcauseofchildmortalityinlowandmiddleincomecountriesinAsia’,WorkingPaper2012-07,SpecialSeriesonChildInjuryNo.2.61UNICEFEvaluationOffice(2013)EvaluationofUNICEFProgrammestoProtectChildreninEmergencies:SynthesisReport62DrowningFactSheetN°347UpdatedNovember2014WHOhttp://www.who.int/mediacentre/factsheets/fs347/en/63Linnan,M,etal.(2012).UNICEF.‘ChildDrowning:EvidenceforanewlyrecognizedcauseofchildmortalityinlowandmiddleincomecountriesinAsia’,WorkingPaper2012-07,SpecialSeriesonChildInjuryNo.2.64IBID.In2011,devastatingmonsoonfloodsacrosssouth-eastAsiacaused1,500deathsacrosstheregionwithalargeproportionofthemchildren.However,surveysshowthatmanytimesthisnumberofchildrendrowneveryyear,ineachofthecountriesaffectedbytheflooding.65IBID

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Perhapsanotherreasondrowningisunderrepresentedinemergenciesisacommonperceptionthatdrowningcausesdeathsintheacutephaseofanemergency–whenanareaisbeinginundatedwithwater–andoncethefloodwaterrecedessodoesthedangerfromdrowning.ThiswashighlightedinthePhilippineswhereaquicklyreleasedchildprotectionprioritiesbriefnoted“Someareasremainwaterlogged,althoughtheriskofdrowningislikelytobereducingdaily.”66Yetifthiswasthecase,itperhapsfailedtorecognisetheimportantrisksthatwereleftbehindaftertheinundation.Childrenwhomightnothavebeenexposedtoopenwaterwerenowconfrontedwithlargepoolsandbodiesofopenwaterthatremainedforsometime.67Veryfewrespondentstothesurveyalsofeltthatlivingnexttowater(15%)andnotbeingabletoswim(7%)weresignificant(top5)riskfactorsforchildren.Givenwhatweknowabouttheextentofdrowningsthathappenineverydaylifeandemergencies(aschildrenarecopingwithahugechangeinthephysicalenvironment),drowningshouldbeconsideredaseriousrisktothehealthandwellbeingofchildrenduringtheacutephase,andthroughoutresponseandrecovery.

Inaddition,thereremainsafocusamongsthealthpractitionersandothers,thatthemajor

healththreatsinfloodsarecommunicableandvector-bornediseases.Thiscanbeseenacrossinjurytypesinemergencies,whereeffortstopreventdiseases--throughtheprovisionofcleanwater,sanitationandantibiotics--arehugelysuccessful,whileinfloods,drowningpreventionreceiveslittleattentionbothintheacutestagesandintheaftermath.68Althoughguidanceisincreasinglychangingtorecognisetherisksofunintentionalinjuries,guidancesuchasUNICEFsEmergencyFieldHandbookplacesemphasisoncommunicablediseasesandparasiticdiseasesbeingthecommonthreatforflood-affectedpopulations,despiteoutbreaksbeingrarelyobserved.69AnexampleofthisinpracticecomesfromBangladesh,whereinthe2007floods,itwasfoundthatdrowningwasresponsiblefor9outof10childdeaths(729of820childdeaths-89%),allamongveryyoungchildren,diarrhoeaaccountedforjust22ofthe820childdeaths(3%)andpneumoniajust19cases(2%),70yetUNICEF’sresponsedidnotincludeanymeasurestopreventdrowning.71

Inadditiontofloodsandaquaticdisasters,childrenareknowntodrownduringothersituationsofdisplacement.InSouthSudansinceasearlyas2007ithasbeenreportedthatincommunitieswhichhavebeendisplacedintocampsalongtheRiverNile,childrenwhoareforcedtouseopenwaterwhichtheywouldn’t

66GlobalCPWG(2013).TyphoonHaiyanChildProtectionPrioritiesandConsiderationsasof15/11/1367FloodingwassubsequentlyidentifiedasakeyphysicalriskfacingchildrenintheChildProtectionandEducationClusterJointNeedsAssessment–Philippines2014whererisksoutsideofthehome(includingflooding)werereportedin93%ofRegionVIIIbarangaysandin80%overall.68Linnan,Michael,etal.(2012).‘ChildDrowning:EvidenceforanewlyrecognizedcauseofchildmortalityinlowandmiddleincomecountriesinAsia’,WorkingPaper2012-07,SpecialSeriesonChildInjuryNo.2.69HumanitarianHealthAction.Floods:TechnicalHazardSheet-NaturalDisasterProfile.Availablefromhttp://www.who.int/hac/techguidance/ems/floods/en/70Linnan,Michael,etal.(2012).‘ChildDrowning:EvidenceforanewlyrecognizedcauseofchildmortalityinlowandmiddleincomecountriesinAsia’,WorkingPaper2012-07,SpecialSeriesonChildInjuryNo.2.71UNICEFpressrelease:Floods2007http://www.unicef.org/bangladesh/activities_4991.htm.Accessedon29thDecember2015.

Figure5Source:CPWG(2011)ChildProtectionRisksduetoFloodinginThailandInter-AgencyChildProtectionRapidAssessmentReport;andTheAllianceforSafeChildrenFactsheet:DrowningApublichealthemergency(undated)availablefrom:http://www.tasc-gcipf.org/downloads.html

Thailand:Underrepresenteddrowning

Despitedrowningbeingamajorcauseofchilddeathinfloods,itisoftennotreportedbycommunitiesorrecordedasacauseofdeath.In2011,aCPRAwasconductedafterextensivefloodinginThailand.Itidentifieddrowningastheleadingcauseofdeath,accountingfor94.5%ofthedeathsamongchildren.Yetinresponsetothequestion'whatwerethenon-violentaccidentsthatledtothedeathorinjuryofchildreninthissite?’themajorityofsitesreportedunsafeobjects,dangerfromwildanimals(crocodilesandsnakes),andtrafficaccidentsasthemaincausesofharmtochildren,notdrowning.Theassessmentrelatedthistothehighlevelofnon-fatalinjuriestochildrenthatwererecorded(77%ofallnon-fatalinjurieswereduetoroadtrafficcollisions,falls,animalbites,andsharpobjects).Butitisalsoworthconsideringunder-reportingrelatedtocommunityperceptionsofdrowning,aswasfoundinonehouseholdsurveyfromThailand.Thisshowedthatnearlythreeoutoffourdrowningcasesareneverreportedtoahospital,representing2000deathsthatwerenotrecorded.

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havenecessarilybeenexposedtopreviouslyhavedrownedduringthemanypracticalitiesofdailylifeandhouseholdchoresthatarebasedaroundtheriver.SimilarcaseswerealsoreportedinEthiopianrefugeecampsfortheSouthSudanese.

Road traff ic injuries

Roadtrafficinjuriesclaimednearly3500livesadayin2012–anincreaseofmorethan600adayfrom2000.72Itistheleadingcauseofdeathamongst15–19-year-oldsandthesecondleadingcauseamong5–14-year-olds. Childrenwhoareinjuredorkilledinroadtrafficincidentsarenottheonlyoneswhosuffer;whenparentsarekilledtherecanbeanimpactonotherchildprotectionconcerns,aswasfoundinSouth-EastAsiawhere20–66%oforphanslostoneormoreparentsinaroadcrash.73

Roadincidentsandinjurieswerereportedfromabroadnumberofcontextsasanoteworthyhazardfacingchildreninemergencies.Generalfactorsincreasingchildren’srisktoroadinjurieswerehighlighted,includinglevelsofphysicalandcognitivedevelopment,prevalenceofrisk-takingbehaviourandpeerinfluence.74Emergenciesincreasedchildren’sriskdirectlythroughthelocationofcampsandservicesnexttobusyroads,75thedestructionofsafewalkingpathsbytheemergency,76thecontaminationofroadsidesbyERW,77theincreasednumberoftrucksandfleetvehiclesontheroadfortheresponse,andwhereandhowchildrenwalktoschool.78

InNepalfollowingthe2015earthquakePlanInternationalconductedrisk-mappingwithchildren.Althoughidentifiedrisksineachoftheaffectedareasvaried,inanumberoflocationschildrenwereconcernedabout

72WHOMediaCentre:Thetop10causesofdeathhttp://www.who.int/mediacentre/factsheets/fs310/en/index2.html73MPeden,KOyegbite,JOzanne-Smith,AAHyder,CBranche,AKMFazlurRahman,FRivaraandKBartolomeos(2008)Worldreportonchildinjuryprevention,WHOandUNICEF.Percentageoforphansdependedonthecountry.74MPeden,KOyegbite,JOzanne-Smith,AAHyder,CBranche,AKMFazlurRahman,FRivaraandKBartolomeos(2008)Worldreportonchildinjuryprevention,WHOandUNICEF75FollowingTyphoonBophathelocationofevacuationcampsandbunkhousesthatarenearroads,riversandmountainoussites,werealsofoundtoberiskytochildren,androadorcaraccidentswereprobableinareaswherethetemporaryhousingorschoolisnearroadwaysandchildrenmayspendtimeplayingincloseproximity.(ProtectionRisksforChildrenasaResultofTyphoonBopha(Pablo)Inter-AgencyChildProtectionRapidAssessmentReportChildProtectionSub-ClusterDavao,PhilippinesMarch2013)76InitiallyraisedthroughMulti-SectorInitialRapidAssessment,itwasreportedthatbrokenpavementsandroadscontinuedtoposeahighthreatforphysicalinjuriesinmid-December.(ChildProtectionandEducationClusterJointNeedsAssessmentTyphoonHaiyan)77ThesystematiclayingofminesonroadsinMaliwasreportedasaparticularriskfacingreturneechildren.(Revue-Documentaire-sur-la-protection-de-lenfance-dans-le-contexte-de-la-crise-malienne-12-03-2013_ProtCluster)78InthePhilippines(TyphoonHaiyan)response,ajointchildprotectionandeducationassessmentinMarch2014notedthatunsafesheltersandbusyroadswerethehighestriskareas,whichalsoimpactedchildren’saccesstoeducation:Caregiversexpressedconcernaboutchildrentravellingtoschoolbythemselves,andsaidthatoldersiblingsoftentaketheyoungerchildrentoschoolforsafetyreasons.

PromisingPracticeinUganda

InUgandapromisingpracticeonroadsafetywasidentifiedinchildprotectionactivitiesfordisplacedSouthSudanesefamilieslivinginNorthWesternpartsofthecountry.Asrefugeeshavefledseekingsafetyfromfighting,villagesandserviceshavesprungupalongroads,onwhichthevolumeoftrafficpassingbyiseverincreasing.SavetheChildrenhavesupportedbottom-upriskidentificationandpreventionthroughadolescentpeersupportgroups;itwasthroughthesegroupsthatroadinjurieswereidentifiedasakeyproblemaschildrenwerefrequentlybeinginjuredbycarsandmotorbiketaxisastheylayandplayedbythesideoftheroad.Theinstallationofspeedhumpsandsignsalongtheroadtoslowtrafficdidnothavethedesiredeffect,sothepeergroupcameupwiththeideafortheolderchildrentoguidetheyoungeronestoandfromschoolandthechildren’scentres(CFS)intheafternooninan‘organisedwalk’,withcaregiversandvolunteerswalkingchildrentotheschoolorcentresinthemorning.Althoughthisprogrammehasnotbeenevaluated,theprogrammehasbeenwellreceivedandisthoughttobesuccessfulduringterm-time.However,onelessonlearnedhasbeenthatthenumberofaccidentswasfoundtoincreaseduringholidayswhenthenumberofpeopletravellingincreasesandschoolsareclosed.

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roadcollisions,asthenumberofdistributionandreconstructiontrucksandNGO/UNfleetvehiclesontheroadshadincreased.79Thisalsoreportedlyexacerbatedwhatwasacommonpracticebeforetheearthquakewherechildren,mostlyboys,couldbefoundclingingtothebackofvehicles,placingthematagreatlyincreasedriskofbeinginjured.80Planconductedawarenessraisingwithchildrenandorientatedtheirownfleetandallrentalcarandtruckdriversonthechildprotectionpolicyanddrivingprotocols,whichincludedsafedrivingspeedsandwhattodotowhenachildclingstothecar.

RoadsafetyhasbeenrecognisedconsistentlyacrossthreeCPRAsinthePhilippinesasakeyconcernforchildren’sphysicalsafety,highlightingkeylinkstobothchildprotectionandeducationactorsamongstothers.

• FollowingfightinginCentralMindanaoin2014,60%ofassessedsitessaidthesituationsthatposethehighestriskofinjuriesordeathtochildrenaretheconditionsencounteredwhilstthechildrenareontheirwaytoandfromschool.Farawayfromcommunities,thisoftenrequiresalongwalk,withenvironmentalhazardsalongtheway,suchasbadroadsandrivercrossings.81

• AfterTyphoonBopha,itwasreportedtherewereeithernopathwaysand/ordangerouspathwaysforchildrentogettoandfromschoolduringthelongwalktoschoolandbackhome,wheretheywerevulnerabletoroadaccidents.HereitwasrecommendedthatLocalGovernmentUnits,barangaygovernment,schools,theeducationclusterandcampmanagementshouldworktogethertopreventphysicaldangerstochildren.Particularsuggestionswere:- Buildingnewschoolsawayfrommainroadsandhighways;- Placingsignsandspeedbumpsonroadsandpassagewaystoensurecarsreducetheirspeed;- Andcreatingmarkedpathsconnectingmajorresidentialareastoschools,especiallywhenpaths

arenearrivers,railroadsorotherpotentialsourcesofharmtochildren.82• InTyphoonHaiyanresponsewhenroadsafetyremainedaconcernsixmonthsafterthetyphoon

struck,somekeylessonslearnedandrecommendationsfromaninteragencyworkshoponthejointeducationandchildprotectionassessment,highlightedtheneedto:- prioritizethedevelopmentofcommunicationsonroadsafetyfromthebeginningoftheresponse

effortandinvolveC4D(CommunicationforDevelopment)strategies,theDepartmentofPublicWorksandHighways(DWPH),educationandchildprotectionactors;

- includeroadsafetymessagesintochild-friendlyspace(CFS)lessonplans,C4Dstrategies,andschoollessonplans;

- buildresilienceandemergencypreparednesswithinDPWHtoplanforemergencieswhichoftenplacechildrenatriskontheroadsastheytraveltoandfromhome,schoolandwork,supportBarangayDisasterRiskReductionManagementCommittees(BDRRMC)totakethelead;

- Coordinateeducationandchildprotectionactivities,especiallyconcerningphysicalsafetymessaging,roadsafetyandawareness,workingwithBDRRMC,schoolcommittees,barangayofficialsandotherclusters.83

Fire and Burns Burnsaretheonlychildinjuryoccurringmorecommonlyingirlsthanboysinmanypartsoftheworld,althoughinsomesettings,boysareatgreaterriskduetotheirrisk-takingbehaviour.84Burnsaretheninthleadingcauseofdeathamongstchildrenage5to14yearsoldintheworld.85Inhumanitariancontextsfireand

79Oxfamreportedafleetexpansionfromjust5vehiclesbeforetheearthquaketo50afterwards,mostlymadeupofrentalcare,thisrapidgrowthbringsitsownsetofchallengestoensureadequatetraining,drivingandvehiclestandards.(keyinformantinterview20)80Keyinformantinterview681UNICEF,2014.CPRAReport,Philippines(CentralMindanao),June201482ProtectionRisksforChildrenasaResultofTyphoonBopha(Pablo)Inter-AgencyChildProtectionRapidAssessmentReportChildProtectionSub-ClusterDavao,PhilippinesMarch201383ChildProtectionandEducationClusterJointNeedsAssessmentTyphoonHaiyan(Yolanda)-AffectedMunicipalitiesinthePhilippinesFinalReportMarch-May2014RegionVIandVIII,ThePhilippines84WHO&UNICEF,2012,WorldReportonInjuryPrevention85WHO,2014,InjuriesandViolence:TheFacts

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burnsweremorefrequentlymentionedthroughoutthereviewasariskinresponseswheredisplacementoccurs.Theverynatureofdisplacementmeansfamiliesareoftenlivinginmultifunctionalspaces,inacloseproximitytoothershelters,andusingtypesofheatingandcookingthatmaybeunfamiliarornotdesignedfortemporaryshelters.Globalresearchsuggeststhatachild’sageanddevelopmentplayasignificantroleinrisk.Infantshavethehighestdeathrates,whereonehotdrinkcanseverelyscoldaninfant;childrenaged10–14havethelowest;andthedeathrateclimbsagainfor15–19yearolds–possiblybecauseofgreaterexposure,employment,experimentationandrisktaking.86

Socioeconomicstatusandpovertyalsoplayarole;thereisnotablyhigherincidenceofburnsamongchildreninLMICsandbetweendifferentsocioeconomicclasseswithinhigh-incomecountries.Othersocioeconomicfactorswhichcanoftenbecomemorecommoninaprotractedcrisisinclude:lowratesofliteracywithinthefamily;livinginovercrowdeddwellingsorwithclutteredareasinthehome;failuretoproperlysupervisechildren;historyofburnsamongsiblings;andtheabsenceoflawsandregulationsrelatingtobuildingcodes,smokedetectorsandflammableclothing.87Inadequateaccesstoagoodsupplyofwaterintodouseflamesorstopflamesspreadingisanotherstrongriskfactor.Unsafeequipmentsuchasheat/lightsources,cookingequipment,fireworksandflammablesubstancessuchaskeroseneallcarryinherentrisksparticularlywhenaccessibletochildren.Cookingandlivingareasarethemostdangerousplacesforchildren,withrespecttoburnsandthetwopeaktimesofthedaywhenburnincidentsaremostreportedarethelatemorning,whendomestictasksarebeingdone,andaroundthetimeofeveningmeals.88

InUgandancampsforthedisplacedSouthSudanese,onechildprotectionteamwasfacedwiththeproblemofchildrenbeingleftaloneinthehome,orentrustedtootherchildrenineffectbecomingunaccompaniedorchild-headedhouseholdsforaperiodoftimewhilsttheirparentsreturntoSouthSudanonaregularbasis.Inthiscontext,childrenwerecookingunsupervisedandmanyburninjuriesfromopenfireswerebeingreportedandtreated.Inaresource-constrained,ruralenvironment,theresponsehasbeentoseekfirstaidfromvillagehealthworkers.Whentheburnisnotsevere,childrenaretakentothecommunityhealthcentre,andwhenseveretheyaretakentohospital.Inthecaseofachildwhohasbeenleftalone,andamemberoftheChildProtectionCommittee(CPC)ismadeawareoftheincident,theyareabletostepinandsupportthechild,identifyingsomeone(usuallyneighbours,extendedfamilyorCPCmembers)totemporarilycareforthem.Inchild-headedhouseholds,otherdependentchildrenarecaredforbytheimmediateneighbours,underclosesupervisionoftheRefugeeWelfareCommittee(RWC),whoalsomonitoroverallchildprotectionconcerns,providesupporttounaccompaniedminors,andarethe‘whistleblowers’ofchildprotectionconcernswithin

86MPeden,KOyegbite,JOzanne-Smith,AAHyder,CBranche,AKMFazlurRahman,FRivaraandKBartolomeos(2008)Worldreportonchildinjuryprevention,WHOandUNICEF87IBID88MPeden,KOyegbite,JOzanne-Smith,AAHyder,CBranche,AKMFazlurRahman,FRivaraandKBartolomeos(2008)Worldreportonchildinjuryprevention,WHOandUNICEF

ThevalueofreconstructivesurgeryforayoungSyrianburnsvictimNine-year-oldJudysufferedasevereburnandwassubsequentlyunabletomoveherrightarm,whenanexplosionrockedthefamilyhouseinSyria,knockingapotofboilingwateroffthestoveandalloverherarm.AfterfleeingSyriaforthesafetyofEgyptandtoseektreatment,thefamilyapproachedUNHCR,whichhasalimitedbudgettohelppeopleinneedofmedicalcare.ButasJudy’sburndidn’tmeetthecriteriaforassistanceandfundswereneededformorepressingcases,shewasleftwiththeprospectoflife-longdisability.Fortunately,thechallengesJudyfacedwerehighlightedduringapictureexhibitionaboutrefugeesinEgypt,andaninfluentialvisitorwasmovedbyherstoryandhelpedarrangetheplasticsurgeryJudydesperatelyneededtobeabletoregainmobilityinherarm.FollowingsurgeryJudyisrecoveringwell,andslowlyregaininguseofherarm.Thiscasehighlightsthatformanycrisis-affectedchildren,itisoftenextremelydifficulttogettheappropriatelevelofcaretohelpthemreachtheirpotentialandleadfulfillinglives.Whilesufferingfromaburninjuryisatraumaticexperiencethathasaprofoundeffectonthedevelopmentofachild,reconstructivesurgeryhassignificantbenefitsduringtherecoveryprocess.

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thecamps.Oncebackathomefollowingmedicaltreatment,ChildProtectionOfficersareabletotalkwiththechildandidentifytheirneeds;theythenseeksupportandreferralstootherCPWGpartners,aswellprovidematerialsupport(i.e.foodorclothes)andconsistentfollow-up,postinjurycare,andcounsellingtobothparentandchild.Topreventtheseinjuriesfromhappening,theCPCandRWChaveidentifiedoldermorematuregirlsfromthepeer-to-peergrouptoteachyounggirlsthecookingskillstheyneedtotakecareofthemselves.Onenoteworthychallengehasbeenthetraditionalcommunitybeliefthatgirlsmustlearntocookfromayoungage.89

Onekeyinformantrecountedanunfortunatecasewhereagencieshadtorapidlyconsidersafetyinreceptioncentreswhenasmallchildfellintoahotpanofpeasduringthepreparationandservingofhotmealsfornewarrivals.Hereitwasnotpossibletosavethechild’slife,buttheincidenthighlightedthesignificantriskspresenttochildren,andmeasureswereimmediatelyputinplacetopreventithappeningagain.Organisationsinchargeofhotmealsoptedtoremovechildrenfromthehazard,wheretheyqueuefortheirmealsawayfromthecookingareaandhotpansinaseparateline.90

Animal bites, st ings and attacks Itisthoughtuptofivemillionpeoplearebittenbysnakeseachyear;ofthese,poisonoussnakescauseconsiderablemorbidityandmortality.Thereareanestimated2.4millionpoisonoussnakebiteseachyearcausingbetween94,000and125,000deaths,andanadditional400,000amputationsandotherseverehealthconsequences,suchasinfection,tetanus,scarring,contracturesandpsychologicalcomplications.Pooraccesstohealthcareandscarcityofanti-venomincreasestheseverityoftheinjuriesandtheiroutcomes.91Youngchildrenareatgreaterriskofbitesastheydonotunderstandthedangerposed,havehighercontactrates,andhavealowbodymassthatmakesthemmorevulnerabletosnakevenomthanadults.92

Animalandsnakebiteswarrantinclusionasaseparatecategoryinemergencies,astherewereafewadditionalfactorsthatcametolightduringthisreview.Firstly,childrenwhoarebitteninemergenciesareoftenpreventedfromseekingmedicalhelpbecauseoftheverynatureoftheemergency;forinstance,childrenwhohavebeenbittenbysnakeswhiletrappedonhighgroundduringfloodingareunabletoseekmedicalcareandanti-venombecauseoftheinundationofwateraroundthem.Secondlyitwasfoundacrossanumberofcountriestherewaseitheraveryrealthreatfromanimals,oraperceivedfearofanimalsamongstchildrenwhohavebeenaffectedbyemergencies.Forinstance,inDadaab,Kenya‘bush’or‘forest’areaswereidentifiedbychildrenasbeingunsafebecauseofwildanimals,93althoughnoreportsofactualattackscouldbeidentified.Similarly,in2011inThailandwhenparticipantsofapost-floodingCPRAwereaskedtoidentifynon-violentphysicalriskstochildrenduringtheflood,themajorityofsitesreportedadangerfromcrocodilesandpoisonoussnakes;andinruralareas,snakeswerethehighestreportedrisk.94

Wild animal attacks in an emergency - fear or actual threat? InThailandtherewerenumerouslocalandinternationalmediareportsandphotosthatoverahundredcrocodileshadescapedfromfarmsduringtheflood;onelargeNGOreported“Wearehearingdisturbingreportsofdangerousanimalssuchassnakesandcrocodilesappearinginthefloodwaters.Yeteverydayweseechildrenplaying,bathingorwalkinginthewater”.95HowevertheCPRAfindingsalsopointedoutthatthehighreportsofdangerfromanimalscouldhavebeeninfluencedbythegreatmediaattentiononescapedcrocodilesandpoisonoussnakes,whichmighthavemadekeyinformantsmoreawareoftheserisks.96Anddespitethereportedfear,asubsequentsearchofmediaandresponseinformationforthisreviewbroughtnoactualcasestolight.

89Keyinformantinterview1590Keyinformantwrittensubmission2491WHOFactsheet373:SnakeBitesavailablefromWHOMediaCentre:http://www.who.int/mediacentre/factsheets/fs373/en/92MPeden,KOyegbite,JOzanne-Smith,AAHyder,CBranche,AKMFazlurRahman,FRivaraandKBartolomeos(2008)Worldreportonchildinjuryprevention,WHOandUNICEF93SavetheChildren(2009).ChildProtectionAssessmentReportDadaab,Kenya,September200994CPWG(2011)ChildProtectionRisksduetoFloodinginThailandInter-AgencyChildProtectionRapidAssessmentReport95BJackson,PressRelease29thOctober2011:Floodcrocfear:KidsindangeraskillersinvadeswampedBangkok.Availablefrom:http://www.thesun.co.uk/sol/homepage/news/3901410/Kids-in-danger-as-killers-invade-swamped-Bangkok.html96CPWG(2011)ChildProtectionRisksduetoFloodinginThailandInter-AgencyChildProtectionRapidAssessmentReport

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Insomeplaceshowever,thethreatofanimalattacksisveryreal,particularlyduringflooding.InthefloodswhichaffectedlargepartsoftheUnitedStatesinMay2015,snakebiteswereaveryrealconcernandonechildren’shospitalreportedthatitwastreating12timesthenormalnumberofsnakebites.97InBangladeshsnakebiteswerefoundtoberesponsiblefor9%ofdeathsinchildrenfollowingfloodingin2007,secondonlytodrowningandfollowedbypneumoniaanddiarrhoea.Risingwatersforcepeopleandanimalstoshareareasofdryground,bringingthemintocloseproximity.Moreover,floodreliefeffortsdonotoftenincludetheprovisionofsnakeanti-venom.98Inrelationtothislastpoint,the2005BangladeshNationalHealthandInjurySurveyforchildrenhighlightedthepotentialforusingtheschoolsasapreventionmeasureagainstsnakebitesfollowingfloods.Whereschoolsfunctionasfloodandcyclonesheltersduringtimesofemergency,locatedonhighergroundtheycouldbecomesafehavensandstockedwithanti-venom,emergencymedicalkits,andemergencyreliefsupplies.Reportingtheycouldbeaneffectivemeansofdecreasingthelargenumbersofsnakebitesassociatedwithfloods,aswellasservingotherbenefitssuchasdecreaseddrowning,improvedpublichealthoutcomes,schoolbaseddisasterpreparedness,andlifeskillsforlivinginplacesfrequentlyaffectedbyflooding.99

97KieranCorcoranPressRelease:http://www.dailymail.co.uk/news/article-3104298/Death-toll-Texas-floods-rises-31-snake-bites-soar-baseball-stadium-flooded-rain-continues.html.Accessedon12thNovember201598Linnan,Michael,etal.(2012).‘ChildDrowning:EvidenceforanewlyrecognizedcauseofchildmortalityinlowandmiddleincomecountriesinAsia’,WorkingPaper2012-07,SpecialSeriesonChildInjuryNo.2.99ARahman,AKMFazlurRahman,SShafinaz,MLinnan,(2005)BangladeshHealthandInjurySurveyReportonChildren

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Indiscriminate weapons in confl ict A2013synthesisevaluationwhichincludedananalysisof11conflict-affectedcountries,foundthatthetopconcernforgirlsandboysaged12-17,wasthe‘immediateeffectsofarmedconflict’,whichincludedshelling,bombing,landmines/ERW,andarmedcombat.100Aneverincreasingriskfacingmillionsofchildrenaroundtheworld,thissectionincludesfurtheranalysisonthephysicalimpactofwaronchildrenandlooksatexplosiveweaponsofwar,landminesandERW,beingcaughtincrossfire,chemicalandgasattacksandkillingandmaiming.

Explosive weapons in populated areas Theincreasinguseanddestructivepowerofexplosiveweaponsinmodernwarfarehasadevastatingphysicalandhumanitarianimpactonchildrenacrosstheworld,particularlythoselivinginurbanandheavilypopulatedareas.101Childrensuffermultiple,complexandseverewoundsandfrequentlyalifetimeofpermanentdisabilityfromtheblast,fragmentation,andcollapsingstructures.Theylosetheirfamiliesandhomes,theireducationandsufferpsychosocialdistress.

Althoughtheuseandimpactofexplosiveweaponsarenotsystematicallyrecorded,andsomeexpertsarguethatitisdifficulttocalculateexactlyhowmanychildrenarekilledorinjured,102organisationsareincreasingly

100UNICEFEvaluationOffice(2013)EvaluationofUNICEFProgrammestoProtectChildreninEmergencies:SynthesisReportDecember2013101J.Borrie.,M.Brehm.,2011.Enhancingcivilianprotectionfromuseofexplosiveweaponsinpopulatedareas:buildingapolicyandresearchagenda.InternationalReviewoftheRedCross:Volume93Number883September2011102K.Smith,SavetheChildren.2011.DevastatingImpact:Explosiveweaponsandchildren

CounteringRumoursofAnimalAttacksinNepal

ThroughaninnovativeprojectundertheCommunicatingwithCommunitiesCluster(CCC),#quakehelpdesk.orgwassetupimmediatelyfollowingtheearthquaketoprovideMobileCitizenHelpdesks,ahotline,SMSreporting,andaidaccountability.Aspartofthisprojectafunctionwasinitiatedtocapturerumoursandperceptionstotryandeliminateinformationgapsbetweenmedia,humanitarianagenciesandcommunities.Byprovidingfacts,‘OpenMic’aimedtocreateabetterunderstandingoftheneeds,anddebunkrumoursbeforetheycoulddomoreharm.Initsveryfirstissueof‘OpenMicNepal’theissueofanimalattacksandsnakebiteswasraisedbycommunitiesasafearthattheywouldbeattacked.“Rumoursarecirculatingthatpeoplearegettingattackedbywildanimals.”“Peopleareafraidofwildanimalsandsnakes”,“Peoplelivingintentsareafraidofwildanimals”(…)“Peoplelivinginopenspacesareafraidofwildanimalsandsnakes,”weresomeofthereportsreceivedbyvolunteers.Thesefearswereechoedthroughchildren’ssessionsconductedbyPlanInternational-particularlyindistrictslivingclosetonationalparksandatnight-andinaninter-agencychildren’sconsultation,whichnoteditparticularlyamongstyoungerchildren.ToaddressthesefearsOpenMicNepalBulletingavethefollowinginformation:

• DistrictPolicehavesaidthattheyhavereceivednoreportsofpeoplebeingattackedbywildanimals.• Theyhowever,warnedthatpeoplelivingclosetojunglesareatriskofbeingattacked.• Tokeeppeoplesafefromwildanimals,policepersonnelhavebeenpatrollingtheareassurroundingthe

temporarycamps.• Anyattackbywildanimalsshouldbereportedtothelocalpolice.• Peopleareadvisedtoremainvigilantandkeepatorchnearthematnight.Livingspacesshouldbekept

unclutteredandclean.Asnakepreysonfrogsandmice.Itisimportanttoensurethattheyarenotaroundlivingareas.Ifpossible,tentsandsheltersshouldbesetupawayfromthickbushes.Youngchildrenshouldnotbeleftontheirown.

• Thephonenumberofthelocalpolicewasgiven.Thistypeifinterventionnotonlyservesapurposeintermsofinjuryreduction,itsupportspeople’s

Figure8OPENMICNEPALListen.Verify.ReportJuly06,2015Issue#1.Availablefrom:http://www.quakehelpdesk.org/openmic/issue1/English.pdf;andKeyInformantInterview6;andPlan,SavetheChildren,UNICEF,WorldVision,GovernmentofNepalCentralChildWelfareBoard,GovernmentofNepalMinistryofFederalAffairsandLocalDevelopment(2015).AfterTheEarthquake:Nepal’sChildrenSpeakOutNepalChildren’sEarthquakeRecoveryConsultation.2015

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attemptingtodosomoreaccurately.TheExplosiveViolenceMonitoringProject,103between1October2010and31December2012,recorded898attacksinvolvingexplosiveweaponsthatkilledorinjured2,685children;thiswasroughly1in5ofthetotalciviliancausalitiesrecorded,andin2012alone,thiswas123childrenkilledorinjuredeverymonth.104Thesamemonitoringin2014identifiedchildcasualtiesfromexplosiveweaponsacross28countries;40%ofchildrenkilledorinjuredwereinGazaand25%wereinSyria.105Clustermunitionsalsocontinuetodisproportionatelyaffectciviliansyearafteryear;between2010and2014,92%ofallcausalitiesreportedwerecivilians.Theimpactonchildrenisequallystark;inthesamefouryears,childrenaccountedforhalfofallclustermunitioncausalities.106

Childrenareparticularlyindangerfromairstrikes.In2014,44%ofallreportedchilddeathsandinjuriesfromexplosiveweaponswerereportedasbeingcausedbyair-launchedexplosiveweapons,oneexampleofthiswasthedeathof18children,andfourcriticallyinjuredwhenasingle2000lbbombfellonanapartmentblockinGazawhichhadbeenhometothreefamiliesinthecityofKhanYounis.107

Althoughthegenderandageofchildrenkilledinattacksarerarelyrecorded,someevidencepointstowardswomenandgirls’increasedriskfromexplosiveweaponsparticularlyinpopulatedareasastheirrolesrevolvemainlyaroundthehome.108OtherreportshighlightthatboysaremoreatriskaswasfoundinSyriawhereboyswerekilledatanoverallratioof2:1,reducingforyoungerchildrenandrisingto4:1forolderboys;109andPakistanwhereboyswerethoughttobeatgreaterriskofshellingastheyweremorelikelytobeplayingoutsidewhenmilitaryactionstarted.110

Landmines and ERW Itisoftencivilianswhofallvictimwhenexplosiveweaponsfailtodetonateasintendedorhavebeenabandonedbythosewhoputthemthere.Similarly,landmineslayinwaitjustunderorabovethesurfacereadytocausedestructionatanymomenttowhoeverstraysintotheirpath.SignificantefforthasbeenmadetoeradicatinglandminesandERWinthelast20years,andthelast10yearshaveseenimportantsuccessin103ActiononArmedViolence(AOAV),ExplosiveViolenceMonitoringProject.AOAVisaNGOwhichaimstoremovethethreatofweapons,monitortheimpactofexplosiveweaponsaroundtheworldandinvestigatewhatcausesarmedviolence–fromgunstosuicidebombings.ItsdataisbasedonEnglishLanguagemediareportsfromacrosstheworld.104SarahLeo.ActiononArmedViolence(AOAV).17thMay2013.Infographic:ChildrenandExplosiveViolence.105J.Hunter.,RPerkins.ActionagainstArmedViolence(AOAV).2014.ExplosiveStates:Monitoringexplosiveviolencein2014106InternationalCampaigntoBanLandmines–ClusterMunitionCoalition(ICBL-CMC)(2015).ClusterMunitionsMonitor2015:SpecialFive-YearReport107J.Hunter.,RPerkins.ActionagainstArmedViolence(AOAV).2014.ExplosiveStates:Monitoringexplosiveviolencein2014108IJ.Borrie.,M.Brehm.,2011.Enhancingcivilianprotectionfromuseofexplosiveweaponsinpopulatedareas:buildingapolicyandresearchagenda.InternationalReviewoftheRedCross:Volume93Number883September2011109H.Dardagan.,H.Salama.OxfordResearchGroup.2013.StolenFuturesThehiddentollofchildcasualtiesinSyria110UNICEFEvaluationOffice(2013)EvaluationofUNICEFProgrammestoProtectChildreninEmergencies:SynthesisReportDecember2013

Figure9Source:H.Dardagan.,H.Salama.OxfordResearchGroup.2013.StolenFutures:ThehiddentollofchildcasualtiesinSyria;DundarSahin,Director,AKUTInstituteofTrainingandResearch,Turkey,takenfromhttps://www.whitehelmets.org/;andHumanRightsWatch,20thDecember2015,Russia/Syria:ExtensiveRecentUseofClusterMunitionsIndiscriminateAttacksDespiteSyria’sWrittenGuarantees

TheimpactofexplosiveweaponsinSyria

NowherehastheimpactofexplosiveweaponsbeensoacutelyfeltasinSyria;onecommentatorclaims“TobeabletounderstandaccuratelythedamageandthethreatandthedevastationofthedisasterinSyria,theyarehavinga7.6earthquake50timesaday".Whetherthisispreciselyaccurateornot,thecasualtyfiguresareunmistakable.OnereportfoundthatfromMarch2011totheendofAugust2013atotalof113,735peoplewerekilledintheconflict.Ofthese11,420childrenhadbeenkilled,andoutofthe10,586caseswhereaspecificcauseofdeathwasrecordedforchildren,71%(7,557)werekilledbyexplosiveweapons.HumanRightsWatchhaverecordeddetailedinformationof9attacksusingclustermunitionsbetween30Septemberand20December2015,whereatlast35peoplewerekilledincluding17children;20oftheseattackshitcampsforthedisplaced.

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reducingthenumberofpeoplekilledormaimed.Between2005and2014,casualtyratesalmosthalvedfrom7,009to3,678ayear.111Yetchildcausalitiesremaindisproportionatelyhigh:in201439%ofallciviliancasualtiesforwhomtheiragewasknownwerechildren.Across33states,1038childrenwerekilled(319)orinjured(716);andonaveragebetween2005and2014,42%ofcivilianlandmineandERWcasualtieshavebeenchildren.112

ChildrenaremorevulnerabletolandminesandERW,bothintermsofprobableexposureandphysicalimpact;theirsizemeanstheirvitalorgansareclosertodetonation;theyhavelowerthresholdsforsubstantialbloodloss,ahigherchanceofrequiringamputation,andaremorelikelytodieorsufferseriousinjuriessuchassevereburns,shrapnelwounds,damagedlimbs,blindnessordeafness.Morethanonethirdofchildrenrequireamputationfollowingalandmine/ERWincident.113WhenMineRiskEducation(MRE)strategiesarenotadequatelychildfriendlyoragesensitive,orwhentheyhavenotbeensufficientlyfieldtested,childrenmaynotunderstandthemessagesthatwarnthemofthedangers,theymaybetooyoungtoreadorilliterate,whichcanrenderwarningsignsuseless.114TherearenumerousexamplesofchildrenpickinguplandminesandERW,tamperingwiththemandusingthemastoys,insomecases,alackofsufficientrecreationactivitieswasfoundtoencouragechildrentogotocontaminatedareas;115andinotherseconomicpressurecauseschildrentocollectandresellthemasscrapmetal.

Similarly,tootherphysicaldangersandinjuries,childrenofdifferentagesandgendersareaffecteddifferently.In2014,81%oflandmineandERWchildvictims(wherethesexwasknown)wereboys.ConsideredtobeatgreaterriskfromlandminesandERWbecauseoftheirmoresignificantroleoutsidethehouseinactivitiessuchasherdinganimals,collectingfoodorfuel,boysarealsomorelikelytobeinvolvedinhazardouschildlabour,whichisknowntobeaggravatedbythepresenceoflandminesandERWinconflictdebriswhichchildrenscavengethroughtocollectscrapmaterialanddamagedgoods.116LandminesandERWhavealsobeenfoundtoaffectolderchildrenmorethanyoungerchildren;inAfghanistan,onereportidentifiedthatchildrenbetweentheagesofeightand17weremostlikelytobeinvolvedinanincident,117andanotherthatbetweentheagesof10-14isthepeakageforcasualtiesfromERWfollowedby15-18.118Inbothreports,boyswerethepredominantvictims.

2014sawanincreaseinchildcasualtiesreportedacrossmanyconflict-affectedcountries(Afghanistan,DemocraticRepublicoftheCongo(DRC),Somalia,andMali).Insomeofthestateswiththegreatestnumbersofcasualties,thepercentageofchildcasualtieswasmuchhigherthantheannualglobalaverageof39%.Childrenconstituted77%ofallciviliancasualtiesinDRC,68%inTurkey,and55%inSouthSudan.119AccordingtotheLandmineMonitor2015,Afghanistanismosthighlyaffected,with561childcasualtiesreportedin2014;thisisoverhalf(54%)ofallchildcasualtiesrecordedglobally,andjustunder46%ofallcasualtiesinAfghanistan.120IneasternUkrainebetweenMarch2014andMarch2015,atleast109childrenhavebeeninjuredand42killedbylandminesandERW.121

LandminesandERWcontinuetokillandmaimpeoplelongafterfightinghasceased.Asrecentlyas2012,twoSyrianchildrenwhohadcrossedintoTurkeyseekingrefugewerekilledbylandmineslaidbytheTurkish

111InternationalCampaigntoBanLandmines–ClusterMunitionCoalition(ICBL-CMC)(2015)LandmineMonitor2015.Casualtiesincludethosefromantipersonnelmines,antivehiclemines,victim-activatedIEDs,abandonedexplosiveordnance(AXO),unexplodedordnance(UXO),andclustermunitionremnants,112TheImpactofMines/ERWonChildren,2015,InternationalCampaigntoBanLandmines–ClusterMunitionCoalition(ICBL-CMC).113UNICEF.2013.TheStateoftheWorld’sChildren2013:ChildrenwithDisabilities114CPWG.2015.Amatteroflifeanddeath115AswasfoundinSriLanka.EvaluationofUNICEFSriLankaMineRiskEducationActivitiesInternationalEmergencyandRefugeeHealthBranchCentersforDiseaseControlandPreventionAtlanta,U.S.A.October-December2010116ILOIPEC&ILOITC2010,TheWFCLinconflictandpostconflictsettings:resultsfromaresearchproject,ILO,Geneva. 117Watchlist,2010.SettingtheRightPriorities:ProtectingChildrenAffectedbyArmedConflictinAfghanistan.118UNICEFCPIEevaluation2013.119TheLandmineMonitor2014.andTheImpactofMines/ERWonChildren,2015,InternationalCampaigntoBanLandmines–ClusterMunitionCoalition(ICBL-CMC).120TheLandmineMonitor2014.andTheImpactofMines/ERWonChildren,2015,InternationalCampaigntoBanLandmines–ClusterMunitionCoalition(ICBL-CMC).121UNICEFPressrelease31stMarch2015.ChildrenkilledandinjuredbylandminesandunexplodedordnanceineasternUkraine.Availablefrom:http://www.unicef.org/media/media_81398.html.Accessed10thSeptember2015

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militaryinthe1950s.122AndfurtherdangerssuchasfloodinghavebeenshowntoaggravatetheimpactofERW,astheymovethemfromwheretheyoncelay,disturbongoingvictimassistance,andremovingsignsandmarkingsthatshowcontaminatedareas.Thispresentsnewriskstochildreninareasthatwerethoughtpreviouslytobesafeasthefollowingthreecasestudieshighlight:

• In2010,catastrophicfloodsinPakistandislodgedminesandotherdangerousitemsfromthehillsofSouthWaziristanwashingthemdownhilltonearbydistricts,contaminatingvastareasoflandthatwerepreviouslysafe,asthefloodwatersrecededUXOcausedciviliancasualties,includingwomenandchildren.123Inonecaseafarmerwhodidn’tknowwhathewasbringinghome,carriedalandminebacktothefamilyhome,wherehis4-year-oldsonplayedwithitandlosthislowerleginanexplosion.IntotalsevenchildrenandwomenwerekilledbyERWinPakistanafterthefloods,butmanyliveswerethoughttohavebeensavedbyidentificationandtimelyreportingthatfollowedMREconductedbycommunityvolunteers,inanareawhereextensivedeminingwasprohibitivelyexpensive.124

• InBosniaandHerzegovina,UNDPrespondedtotheimpactoffloodsinareascontaminatedbylandminesandERW,andUXOpeoplehadkeptprivatelyintheirhomes,whichthenbecamearisktoothersasitwascarriedawaybyfloodwater,bydesigningapost-floodguidetorespondingtoERW,whichwaspublishedonline.125

• Finally,inCambodiawhereover64,000peoplehavebeeninjuredorkilledbylandmines,28%ofthesebeingchildren,floodinginOctober2013sweptthroughcontaminatedareas,dislodginganduncovering174minesandERWthatwereidentifiedbycommunities.126149ofthesewerefoundedinriceandfarmingfieldsthathadbeencultivatedyearonyear,23werefoundinvillagesand2wereinpreviouslyclearedareas.127Theflooddestroyedroadsandinfrastructure,complicatingaccesstoaffectedareas,theevacuationoffamiliesandtheremovaloflandmines/ERWbyroad.Insomeprovinces,whichhadnotbeenpreviouslyaffectedbyflooding,alternativetransportsuchasboats,wasnotavailable.Wherefloodingwasrepeatedtwotothreetimesthatyear,damagetoricefields,cultivationandpropertiesresultedinincreasingnumberofpeoplegoingintoforeststocuttreesorcollectwildfoodincontaminatedareas,increasingtheirexposuretominesandERW.128FurtherdetailsontheMREputinplacefollowingthefloodsinCambodiacanbyfoundonpage57ofthisdocument.129

Giventhatnumerouscasualtiesgounrecordedinmanycountries,thetotalnumberofchildcasualtiesannuallyislikelytobemuchhigher,andinsomeoftheworld’smostmine-affectedcountries,thepercentageofcasualtiesrepresentedbychildrenishigherstill.130InSyria,whereincidentsarethoughttobesignificantlyunderreportedduetosecurityandescalatingconflict,issuesoflandminesandERWalsoreceivelessattentionincomparisontoexplosiveweaponsinactivecombat.However,vasttracksoflandmineshavebeenlaidalongtheborders,posingconsiderablerisktothosefleeingfighting,andthosewhowanttoreturnlongintothefuture.

Being caught in crossfire Casesofchildrenbeingcaughtincrossfirewereidentifiedinanumberofcountries,andinmanyplacesarerelatedtothereadyavailabilityofsmallarms.InLibya,childrenreportedindiscriminatefiringofweaponsona

122HRWPressreleaseDecember4th2014.Availablefrom:https://www.hrw.org/news/2014/12/02/syria/turkey-landmines-kill-civilians-fleeing-kobani.AccessedOctober8th2015.123AddressingTheImpactofLandminesandExplosiveRemnantsofWarinPakistanNovember2012GenevaCall&SPADO124UNICEFPressRelease.2010.UNICEFrespondstounexplodedordnancethreatinaftermathofPakistanfloodcrisishttp://www.unicef.org/infobycountry/pakistan_56777.html.Accessedonthe10thJuly2015.125UNDPPressrelease.May22nd2014.FloodingUnearthsLandmineDanger.Availablefrom:http://www.ba.undp.org/content/bosnia_and_herzegovina/en/home/presscenter/articles/2014/05/22/undp-flooding-unearths-landmine-danger.html;andJ.PorobicandL.Palmbach.UNDP.February4th2015.Dolandminesfloat?Apost-floodguidefromBosniaandHerzegovina.Availableat:http://europeandcis.undp.org/blog/2015/02/04/do-landmines-float-a-post-flood-guide-from-bosnia-and-herzegovina/.Bothaccessedon10thJuly2015.126UNICEFCambodiaMREReport2013(Internalprojectdocument)127IBID128IBID129MoredetailsarefoundinSectionThreeKeyissuesandlessonslearned–Mineactionandsafetymessaging.130UNICEF.2013.TheStateoftheWorld’sChildren2013:ChildrenwithDisabilities

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regularbasisinBenghaziafterthecivilwarin2011.131IntheCentralAfricanRepublic,caseswerereportedlyconnectedtochildren’severydayactivitiessuchasgoingtoschool,playingfootballandgoingtochurch.132InSyriawhere2,806childrenarereportedtohavebeenkilledbysmallarmsfirebetweenMarch2011andAugust2013,researchersbelievethatalthoughchildrenmaybeunintentionallykilledbystrayorricochetingbullets,lackofintentioncannotbearguedforatleast1,153ofthecaseswhichhavebeendocumentedbycivilsocietygroups,wherechildrenwerekilledbysniperfireorsummaryexecution.133Boys,especiallyolderboys,aredisproportionatelyaffected;theyfacegreaterriskspartlybecausetheyspendmoretimeoutdoorsduringtimesofconflict,butarealsopotentiallyengagedincombatorcombatsupportroles.134Finally,inAfghanistan,2014sawdeadlyconsequencesforchildrenwhenAfghanNationalSecurityForces(ANSF)andNATO’sInternationalSecurityAssistanceForce(NATO-ISAF)escalatedtheirgroundoffensiveswiththeTalibanincivilian-populatedareas.Wherethenumberofchildcasualtiesassociatedwithgroundcombatandcrossfiremorethandoubled;groundengagementstookthelivesof112childrenandinjured408,anincreaseof111%over2013.TheUNinAfghanistanhaveattributed74%ofallciviliancasualties135toanti-governmentelements,8%toANSFand1%NATO-ISAF,while12%couldnotbeattributedtoaspecificparty.136

Chemical weapons Althoughnotwidelyused,thesehighlyindiscriminateweaponscontinuetoposearisktochildren,particularlyintheMiddleEastwherepartiesinEgypt,Iraq,Iran,Israel,LibyaandSyriaareallthoughttoholdstockpiles.137Syriaistheonlycountrywheretheyarecurrentlyused,andalthoughchildrenaremuchmorelikelytodiefromairbombardmentsorshellingthanchemicalweapons,138areportoftheUNMissionontheallegeduseofchemicalweaponsintheGhoutaareaofDamascusinAugust2013concluded“chemicalweaponshavebeenusedintheongoingconflictbetweenthepartiesintheSyrianArabRepublic,alsoagainstcivilians,includingchildren,onarelativelylargescale”.139Onereport–conductingadetailedanalysisoflocalcausalitydatabases-found128children(63boysand65girls),werekilledinthatchemicalattack.140Inresponsetothis,NGOsandcivilsocietyorganisationshaveincluded‘whattodoinagasattack’insafetyand‘InCaseofEmergency’(ICE)messagingthathasbeenusedinschools,childfriendlyspaces,communitygroupsandothers.141

Kil l ing and maiming under the MRM TherearemanylinksthatshouldbereinforcedbetweenkillingandmaimingundertheMRManddangersandinjuriesinemergenciesunderCPMS#7.AlthoughtheintentionalityoftheinjurymaybeadifferentiatingfactorundertheMRM,theresponse–medicalandsocial–availableforchildrenwhohavebeenmaimedbyviolence,seriouslyinjuredinanIDPcampfire,ordisabledbyalandmineshouldbethesame.Gainscouldalsobemadeindatacollection,informationsharingandadvocacy,particularlywithregardtoindiscriminateweaponsunderkillingandmaiming,andtheprovisionofresponseservices.

Wherechildprotectionactorsaimtostrengthencoordinationwithhealth,education,mineaction,andotherprotectionactorstoraiseawarenessorimprovereportingundertheMRM,itwouldalsopaydividendsto

131ChildProtectioninEmergenciesRapidNeedsAssessmentLibyaApril/May2011SavetheChildren132WatchlistonChildreninArmedConflict(2015)VulnerableStudents,UnsafeSchools:AttacksandMilitaryuseofschoolsintheCentralAfricanRepublic;andIRIN,PressRelease25thApril2013.ChildrenbearbruntofCARcrisis.Availablefromhttp://www.irinnews.org/report/97921/children-bear-brunt-of-car-crisis.Accessedon13thJanuary2016.133H.Dardagan.,H.Salama.OxfordResearchGroup.2013.StolenFuturesThehiddentollofchildcasualtiesinSyria134IBID135Thetotalnumberofchildcasualtiesincreased34%inthefirstsixmonthsof2014to1,071,including295killedand776injured,theseincludedthosekilledbycrossfire,groundengagementsandlandminesandUXOs.136UnitedNationsRegionalInformationforWesternEurope.PressRelease.10thJuly2014.CaughtintheCrossfire.Availablefromhttp://unric.org/en/latest-un-buzz/29315-caught-in-the-crossfireaccessedon13thJanuary2016.137NuclearThreatInitiativeCountryProfiles.Accessedon20.4.2016.Canbefoundathttp://www.nti.org/learn/countries/138DebaratiGuha-Sapir,JoseMRodriguez-Llanes,MadelynHHicks,Anne-FrançoiseDonneau,LouisLillywhite,FouadMFouad,CiviliandeathsfromweaponsusedintheSyrianconflict,BMJ2015139SecretaryGeneral.BanKi-Moon.16September2013.Statement:Secretary-General'sremarkstotheSecurityCouncilonthereportoftheUnitedNationsMissionstoInvestigateAllegationsoftheUseofChemicalWeaponsontheincidentthatoccurredon21August2013intheGhoutaareaofDamascus.Availablefrom:http://www.un.org/sg/statements/index.asp?nid=7083.Accessedon10thOctober140H.Dardagan.,H.Salama.OxfordResearchGroup.2013.StolenFuturesThehiddentollofchildcasualtiesinSyria141BothSavetheChildrenandSyrianCivilDefence/Maydayhaveincludedgasattacksingeneralsafetymessagingwhichcoversawidevarietyofphysicalsafetymessages.SeeSafetymessagingandriskeducationformoredetails

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initiateadialogueonanallhazardsapproachtoinjurypreventionandresponse,inparticularhazardswhichpresentthegravestphysicaldangersforaffectedpopulations,supportedbyevidencefrominjurysurveillance.

Where dangers and injuries occur Whileitisnotpossibletomakeanystatisticalcomparisonoftheplaceswherechildrenaremostatriskfromdangersandinjuriesintheirphysicalenvironments,bylookingatthefindingsfromtheinteragencyassessmentsexaminedaspartoftheliteraturereview,wecantellthatinandaroundthehomeandalongchildren’sjourneystoschoolormarketswereidentifiedasplaceswhererisksarehighestforchildreninemergencies.Wecanassumethat‘onthewayto’includeschildren’scontactwithsomeformoftravel,beitonfoot,bycarorothermeans.AsmanyoftheassessmentswereconductedpartlyorinIDPsettings,includingcamps,wecanalsopresumethesefindingsarerelevantincampsettings.

Inaddition,theassessmentsandkeyinformantinterviewsnotedduringdisplacementorjourneysawayfromfightingordisaster;areassurroundingmilitarycompounds;WASHfacilitiesandlatrines;innewarrivalortransitsites,orinlocationswhereIDPservicesarelocated.However,itshouldalsobereiteratedthateachcontextisuniqueandhasdifferentenvironmentalandsocialfactorsthatwillinterplaywiththehazardspresent,contributingtoachild’srealandperceivedsenseofsafety.Childrenareaffectedbydangersandinjuriesdependingonawiderangeoffactorsandonlythroughassessmentandanalysiswhichincludesdisaggregationbyageandgendercanonetellwhichplacesaremostdangerousfordifferentgroupsofchildreninaparticularcontext.

Iraq(2014)

TyphoonHaiyan(2015)

CentralMindanaoCrisis(2014)

TyphoonBopha(2013)

OPTGaza(2014)

EthiopiaGambella(2014)

SomaliaLowerJuba(2011)

Tunisia(2011)

Thailand(2011)

Yemen(2012)

MyanmarRakhineState(2012)

1st Athome

Outsideofhome

Onthewaytoschool

Onthewaytoschool

Athome

Collectingfirewoodorwater

Onthewaytomarket

Onthewaytomarket

Outsideofhome

Onthewaytomarket

Athome

Onthewaytowork

Inthecamp

2nd Other(streets,latrines)

Onthewaytoschool

Athome Athome Outsideofhome

Onthewaytoschool

Athome

Inthecamp

Onthewaytoschool

3rd Onthewaytomarket

Athome Inschool Inschool

Onthewaytomarket

Atthemarket

Roads Onthewaytowork

4th Onthewaytowork

Atwork Onthewaytowork

Inschool Onthewaytoschool

Atthemarket

5th Atwork Onthewaytowork

Inthecamp

Atwork Inschool

Inschool

Atthemarket

Atwork

InoraroundtheInoronthewaytoInoronthewaytoInoronthewayInthecampthehomeschoolmarkettoworkOther(Roads,latrines,streets,collectingwaterorwood)

Figure10Source:Takenfrompublishedinter-agencyassessments,whichhaveincludedphysicaldangersandinjuries.5includedanassessmentofallriskstophysicalsafety,combiningbothviolentandnon-violentthreatsintheirquestioning‘whatarethemainrisksthatleadtothedeathofinjurychildren?’(Myanmar,PhilippinesMindanao,TyphoonBhopal,Iraq,OPTGaza);and6reportedviolentthreatsandnon-violentthreatsasseparateissues(Ethiopia,Tunisia,Somalia,Thailand,Yemen,TyphoonHaiyan).

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Who is at r isk in emergencies? Whensurveyrespondentswereaskedtoranktheperceivedriskfactorscontributingmostsignificantlytochildrenreceivingunintentional,fatalornon-fatalinjuriesinhumanitariancontexts,thefollowingweremostfrequentlychosen(inorderofimportance):

(1) Livinginaconflict/post-conflictzone;andapoorunderstandingandknowledgeoflocaldangers(2) Displacement(3) Beingunaccompaniedorseparatedfromfamily;andreducedadultsupervision(4) Childlabour(5) Livingonthestreets(6) Existingcultureofdangerouspracticesinrelationtochildsafety;andlowlevelsofeducation(7) Theageofthechild(8) Havingaphysical,sensoryorintellectualimpairment;orparents/carerswithdrugoralcohol

addiction.Manyofthosechosenreflectseriouschildprotectionconcernsandhighlighttheneedforabroadrangeofchildprotectioninterventionstoconsiderhowboysandgirlsareinjuredintheirday-to-dayactivities.Althoughonesurveyrespondentcautioned“weneedtoavoidlabellingsomeoneatriskbecausethey‘areseparatedorliveonthestreet,orhaveaphysicaldisability’...thelabeldoesn'tmakethematgreaterrisk,it’sthevulnerableandresilientfactorsthatexistthatmakethempronetoinjury”,somegeneralisationscanbemadefromthesefindings.

Unaccompanied and Separated Children Capableadult/parentalsupervisionishighlightedthroughoutmuchoftheliteratureonchildhoodinjuriesasakeyriskfactor;thiswasalsohighlightedthroughthesurveyalongsidebeingunaccompaniedorseparatedfromfamily.Inmanyemergencies,thechild’sriskofinjurymaybeequallyattributedtothelackofparentalsupervision,astothefactofthechildbeingunaccompanied,particularlyforyoungerchildrenwhofacegreaterriskstoinjurywhentheyarenotsupervised.Thiswashighlightedintheearliersectiononburns,wherechildrenwereleftaloneforlongperiodsoftimeandwereconsequentlyatriskofhouseholdburns.

Onefurtherassumptioncanbethatunaccompaniedchildren(ofallages)whoareinsomeformofalternativecarefacethepossibilitythatdespitecarebeinginplace,itmayinadequatelyprotectthemfrominjuriesandmayplacethematfurtherrisk,particularlyiftheyexpectedtoworkorcarryoutdangeroushouseholdchores.Furthermore,onceinjured,youngunaccompaniedorseparatedchildrenareunlikelytoknowwheretogoforhelpandassistanceandgainaccesstoavailablehumanitarianservices,andtheirinjuriesarethereforelikelytocausegreaterlong-termissues.142

Itisworthnotingthatpoorlyexecutedevacuation–itselfaresponsetoimmediatedangerandphysicalinjury–canactuallycausechildrentobecomeseparatedfromtheirfamilies.Thismaybeeitherforimmediatephysicalsafetyaswasseeninthe2000Mozambiquefloodswhenhelicoptersliterallypickedpeopleofftreesasfloodwatersswelledaroundthem,orinthe2010Haitiearthquakewhereseverelyinjuredchildrenwereevacuatedbymilitarymedicalteamswithinandoutsideofthecountry.Inbothcases,informationwasnottakenatthetimeofevacuation,presentingfurtherproblemsforchildprotectionactorsasfamilyreunificationeffortsgotunderway.Thisisawell-recognisedissuebetweenhealthandchild/protectionactors,andtheforthcomingInterAgencyFieldGuidanceonUnaccompaniedandSeparatedChildrenhighlightsthefollowinglearning:143

1 Protectandassistinplace:Thepriorityistoprovideprotectionandhelpthatwillenablefamiliestomeettheneedsoftheirchildreninplace.Thisinvolvesidentifyingthoseneedsclearlyandaddressingthemeffectively,sothatpeopleareabletochoosetoremainwheretheyareandtokeeptheirfamiliestogether.

142ThompsonH(2015).AMatterofLifeandDeath:Childprotectionprogramming’sessentialroleinensuringthewell-beingandsurvivalduringandafteremergencies.2015143UnaccompaniedandSeparatedChildrenFieldHandbook(Draft:Copyeditedversion)Inter-agencyWorkingGrouponUnaccompaniedandSeparatedChildren

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2 Preservefamilyunity:Ifevacuationisunavoidable,themosteffectivewaytoreduceanyharmtochildrenistoevacuatethemwithparentsorprimarycaregivers.

3 Evacuateonlyunderproperconditions:Thisincludesensuringthatthewishesofparentsandchildrenareconsidered,thatevacuationisundertakeninsafety,thatthebestinterestsofthechildareassessedwhenmakingarrangementsforthereceptionandcareofchildrenandthathelpisgiventoensurethatfurtherorpermanentseparationdoesnotoccur.

Child Labourers Childlabouranditsworstformsarebytheirverynatureharmfultochildren,deprivingboysandgirlsofopportunitiesforaneducationandcompromisingphysicalandmentaldevelopment.Inmanycountriesaffectedbyemergencies,childlabourisalreadyapervasiveproblemfacingmillionsofchildren;theaddedpressureandconditionsofanemergencycanexacerbatethephysicalandenvironmentalriskstheyface.ThiswasreportedinNigerduringtheSahelfoodcrisis,wherethenumberofadolescentsinchildlabourincreasedfrom31%to60%,withmanyduringthecrisisbeingpushedtoworkoutsidetheircommunitiesinmoredangerousformsofwork.144IntheCentralAfricanRepublic,a2011surveyinIDPcampsinthenorthofthecountryrevealedthatmanygirlsandboyswereengagedintheworstformsofchildlabourwithinthehostcommunitiestosupporttheirfamilies.Displacedchildrenalsofacedmoresubstantialrisksthantheirnon-displacedpeersbecausetheyfoundthemselvesinanunfamiliarenvironment,engaginginworktheymightnotbeproficientat,becausetheyhadcomefromfamilieswithdifferentlivelihoodsbackgrounds,suchasherding,andwereprobablynotfamiliarwithlocallawsandsocialnorms.145Withincreasingpovertyduetothecrisistheyhadlittlechoicebuttoengageindangerousformsofwork,suchasmining,fishing,constructionorhunting.146

Inmanycountriesaffectedbyconflict,thefollowingtrendsinchildlabourandchildren’sphysicalwellbeinghavebeenobserved:

• InPalestine,athirdofrespondentsinthe2014GazaCPRAhighlightedthatchildrenwereinvolvedinnewtypesoflabourthatdidnotexistbeforethecrisis,suchascollectingERW,rocksandironfromdestroyedhouses;thiswaspartiallythoughttoberelatedtoapossiblelackofawarenessastotheseriousnessoftheseactivities.147

• Inthemostconflictandmine-affectedareasofPakistan,itwasfoundthatchildrenwhoengageincollectingandsellingscrapmetalarealsoparticularlyatriskfromERWwhichhavebeenleftbythewar.148InadditiontotheissuesoflandminesinAfghanistan,roadtrafficcollisionspresentasignificantriskforworkingchildren(mostlyboysbetween9and16years)whotraveltocitiesforwork.149

• InAfghanistanaWarChildHollandbaselineassessmentidentifiedthatworkingchildrenmostfearedbombings,car/roadaccidentsandextremewinterastheyarealllivingintemporarysheltersinIDPcamps.150

144Basse,YO,Lucas,N,2013ProtectionofAdolescentGirlsandBoysintheSahelFoodCrisisGeneralReport,PlanWARO,Dakar,commissionedforthe‘BecauseIamaGirl’Report.PlanInternational,January2013.145RevueDocumentaireRépubliqueCentrafricaine–Août2013146Stratégiepourlesinterventionshumanitairesdeprotectiondel’enfant:Mai2014–Décembre2014RépubliqueCentrafricaine147GazaChildProtectionWorkingGroupChildProtectionRapidAssessmentReportOctober2014148GenevaCall&SPADO(2012)AddressingtheImpactofLandminesandExplosiveRemnantsofWarinPakistan.149WarChild(2013)EmergencyPsychosocialSupportforConflictAffectedInternallyDisplacedChildrenandtheirFamiliesinHeratprovince,AfghanistanBaselineStudyReport-August,2013;andWatchListChildrenonArmedConflict(2010)SettingtheRightPriorities:ProtectingChildrenAffectedbyArmedConflictinAfghanistan150Keyinformantsubmission22

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PhysicalharmtochildlabourersinLebanonTherefugeeinfluxintoLebanonhasbeenaccompaniedbyrapidlyincreasinglevelsofchildlabouranditsworstforms,whereboysandgirlsareregularlyexposedtoseverehazards-includingriskstotheirlives-whilstworkingChildrenperformabroadrangeofhazardousjobs:agriculture,construction,automobileshops,carpenters,restaurants&snackbars,blacksmithing,shoe-making,fishing,portering,furniture-making,butchering,ironcollecting,cleaninganddomesticwork.A2012assessmentofoverathousandworkingchildrenidentifiedthemainenvironmentalconcernsandwork-relatedinjuriesforchildren(belowtable).Italsofoundthatwhilstworkingchildrenwereclearlyexposedtonumeroushazards,theywouldgenerallydenyanyseriousnessandboastabouttheirstrengthandendurance,frequentlydismissingwork-relatedinjuriesorillnessesas“minor”.Whenassessorspointedoutsomeobviousmedicalconditions(rednessoftheeyes,swellingsonarmsorlegs,skinorscalpproblems),childrenwouldreactasiftheywereseeingthemforthefirsttime.Thereportalsofoundthatlessthanathirdofchildrenwouldstopgoingtoworkinordertorecoverfromabadinjury.Finally,itisworthnotingtheparticulardangersandinjuriesfacedbychildreninLebanonwholiveandworkonthestreets,includingphysicalinjuriesfromcaraccidents,andcarryingheavyloads.TheInternationalRescueCommittee(IRC)havebeenrespondingtotherefugeecrisisinLebanonsince2012,buildingacasemanagementapproachthatcansupportchildreninlabour.Becausethevolumeofcasesishighandtheeconomicsituationofmanyfamiliesandaccesstoeducationispoor,caseworkershavebeentrainedinharmreductionasakeystrategywhenachildcannotbestoppedfromworkingimmediatelyoratall(unlessthechildisatriskofsevereharm).Todothistheylearnthedifferenttypesofchildlabourthatexposechildrentodifferentrisks,thefactorswhichmakechildrenmoreorlessvulnerabletoeachrisk,whichrisksaremostserious/urgenttoaddress,andhowtoreducethem.Inthischallengingenvironment,caseworkersreportedthatchildlabourcasesrequiredsignificantnegotiationandtime,whichincludednegotiatingwithparentsandemployerstominimisetheriskschildrenareexposedto.Whilesomehavesuccessfullynegotiatedharmreductionstrategies,othersreportedthatitwaschildrenthemselvesthatdidnotwantcaseworkersinvolved,forfeartheymightlosetheirjobs.

Mainenvironmentalconcernsandwork-relatedinjuriesofchildlabourersinLebanon(ILO2014)

Workingenvironmentofchildren Work-relatedinjuriesandillnessesofchildren1. Dustandfumes 1. Minorinjuries2. Loudnoise 2. Neverhurtatwork3. Coldorheat 3. Extremefatigue4. Fireandgas 4. Fractures5. Dangeroustools 5. Burns6. Chemicals 6. Unspecifieddiscomfort7. Lackofventilation 7. Sprains8. Undergroundwork 8. Skinproblems9. Workatheights 9. Amputation10. Incandescentmaterial 10. Fever 11. RespiratoryproblemsBothquestionsalsorecordedresponsesofnoneornotspecified

12. Eyeproblems13. Stomachproblems

Figure11Source:CJones(2014)ChildLabourScopingExercise–InternaldocumentforIRCMay2014;RoulaAbiHabib-KhouryUniversitéSaint-JosephandInternationalLabourOrganizationRegionalOfficeforArabStates.RapidAssessmentonChildLabourinNorthLebanon(TripoliandAkkar)andBekaaGovernorates;InternationalLabourOrganization(ILO),theUnitedNationsChildren’sFund(UNICEF)SavetheChildrenInternational;2015.ChildrenLivingandWorkingontheStreetsinLebanon:ProfileandMagnitude;CJones.2014.ChildLabourTrainingCaseManagementCoachingProgrammeLebanonMayandJune2014.

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InAfghanistanwhenchildrenwereburnedorhadbrokenbonesasaresultoftheirjobsinmanufacturingcompanies,WarChildUKandtheAfghanistanRedCrescentSocietyconductedaseriesofFirstAidtrainingsforkeystaffofcompanieswhoemployedchildrenandyouth.151TheyalsoworkedwiththeHeratIndustrialUnionandsecuredacommitmenttoaskemployerstoagreeonupholdingtheAfghanistanLabourLaws.152

Inaddition,learningfromothercontextsshowsthatreducingthephysicaldangersandharmworkingchildrenfaceshouldinclude:prioritisingaccesstohealthcareandchildren’ssafety;prioritisingcasesbasedonrisk;providingguidanceonhowtorespondtocaseswhereurgentremovalmaybenecessary,andwhenharmreductionstrategiescanandshouldbeused;identifyingharmreductionstrategiesthatworkincollaborationwithchildren,caregiversandemployers;safetyplanningasanimmediateresponsetoreduceharmandprovidechildrenwithbasicskillstoprotectthemselvesindangeroussituations;havingemergencycasefundstopayforprotectiveequipmentandotherincidentalswhichcansupportharmreductionstrategies.153

Children associated with armed forces and armed groups Childsoldiersexperiencearangeofabusesthataffecttheirphysical,psychologicalandsocialwellbeing;theyarealsoacutelysubjectedtophysicaldangersandinjuries.Regularlyexposedtoexplosives,firearmsandcombatsituations,theirinexperienceandlackoftrainingleavethemvulnerabletoseriousanddebilitatinginjuries.Onehistoricalstudyofchildsoldierssuggeststhatyoungchildrenrarelyappreciatetheperilstheyface,sowhenshellingstartstheycanfailtotakecover.154Furthermore,theyareoftenforcedtoplantorexploreminefields.InMyanmar,wheretheuseoflandminesinruralareasisamilitarystrategy,childsoldiershavereportedthatdespitebeingtrainedtohandlemines,theywitnessedmanycasualties.ThiswasalsodocumentedbyGenevaCallin2011,whofoundthatdespitealackofreliabledata,asignificantproportionofchildrenaffectedbylandmineincidentsinareascontrolledbynon-stateactorswerechildsoldiers.ItwasfoundthatinKareni/KayaStateeverysecondchildinjuredbyalandminewasachildsoldier,andinKaren/KayinStateitwasoneinfour.155

Exploitedandforcedtodohazardousjobsandhardlabourascombatantsordomesticservants,childsoldiersoftenexperienceseverehumansufferingrelatedtophysicaltasksandtheirenvironment,suchascarryingheavyloadsorbeingdeprivedoffood.156Whenhealthcareforwoundedchildsoldiersisoftenbeyondreach,traditionalremediesaretheonlyoptionavailable,orchildrenareabandonedbecauseoftheirwounds;thelastingphysicalimpactontheirhealthandwellbeing-iftheyrecover-canbedevastatingforgirlsandboyswhosebodiesarestilldeveloping.

Itisoftenreportedthatthemostfrequentinjuriessufferedbychildsoldiersarelossofhearing,sight,andlimbs.157IntheDRC,inadditiontohealthrisksfromdiseaseslikemalaria,cholera,yellowfeverandmalnutrition,deliberatemutilationandsexualabuseoccurs.Childrenexperienceaplethoraofbluntinstrumenttrauma,stabbings,andgunshotinjuriesresultingfromviolentcombat.However,atthepointthatchildrenenterreleaseandreintegrationprogrammesthroughatransitcentre,“generallyspeaking[thechildren]arenotarrivingwounded…Theymayhavethescarsofbulletandknifewounds,butthesehaveusuallyhealed.”Theprincipaldamagedonetochildrenispsychological.158Thelossoforseparationfromoffamilyandlimitedsupportnetworksaroundthemcanhinderbothphysicalandpsychosocialrecovery.

151Keyinformantsubmission22152IBID153DraftInter-AgencyToolkittoSupportHumanitarianProgrammesMeettheProtectionNeedsofChildLabourer’sinEmergenciesChildProtectionWorkingGroup,2015154TheChildrenandArmedConflictUnit(1997).TheInvisibleSoldiers:ChildCombatants.WeeklyDefenseMonitor|Volume4,IssueNo.26.July1997155GenevaCallHumanitarianImpactofLandminesinBurma/MyanmarreportpreparedbyGenevaCallwithtechnicalassistancefromDCAMineAction,156Tamashiro,T.(2010).ImpactofConflictonChildren’sHealthandDisability.UNESCOBackgroundpaperforEducationforAllGlobalMonitoringReport2011.157Tamashiro,T.(2010).ImpactofConflictonChildren’sHealthandDisability.UNESCOBackgroundpaperforEducationforAllGlobalMonitoringReport2011.158GHumphreys.2009.Healingchildsoldiers.BulletinoftheWorldHealthOrganizationPastissuesVolume87:2009Volume87,Number5,May2009,325-404.Availablefromhttp://www.who.int/bulletin/volumes/87/5/09-020509/en/.AccessedonDecember15th2015.

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Children in contact with justice systems Verylittleevidencefromhumanitariancontextswasidentifiedhighlightingsignificantlinksbetweenchildrenwhoareincontactwiththejusticesystem–eitherastheaccusedorperpetrators,victimsorwitnesses,orregardingtheircare–andphysicaldangersandinjuriesinemergencies.Despitethis,thefollowingissuesshouldbenoted:

• Practitionershaveidentified‘Lossofhome,physicalsafety,anddisplacement’ascontributingsignificantlytochildrencomingintocontactwiththejusticesysteminemergencycontexts.159

• Childrenwhohavebeeninjuredordisabledasaresultofanunintentionalinjuryhavearighttoaccessandbetreatedfairlybythejusticesystemtoseekredress.OnesurveyrespondentworkinginJordanrecalledthecaseofaSyrianchildwhohadbeenhitbycarbeingdrivenbyaJordanian,“childrenwhoareinjured(e.g.incaraccidents)[shouldbe]giventhesameaccesstoservicesandjusticeasadultswould.IfoundthisnottobethecaseinJordanwhereSyrianrefugeechildrenwerenotlistenedtowhenhitbyaJordanianadultdriver,whichresultedinafightbetweenthechildrenandpoliceandsubsequentbeatinganddetentionofthechildren,whichwehadtointervenein.”Roadtrafficinjurieshavebeenoneareainnon-emergencycontextswhereaspectsofjusticeareconsideredaspartofpreventionactivities,includingpreventingcasualtiescausedbylaw-breakingdrivers.IntheUNGlobalRoadSafetyPlan,halfoftheactivitiesinPillar5(PostCrashResponse)arerelatedtojustice,includingcollisioninvestigation,criminalprosecution,civilcompensationandvictims’rights.160

• Wherejuveniledetentioncentresareovercrowdedandpoorlyfinanced;childrenmayhaveinadequateprotectionfromtheelements;lackmedicalcare;beinsufficientlysupervisedbyqualifiedandmotivatedstaff,andliveinfacilitieswhichasunsanitary,basicandunsafe,itcanbeassumedchildrenare

159ChildProtectionMinimumStandardsTaskForce(2015)Interagencyreviewofjusticeforchildreninahumanitariancontext(CPMS14).59%ofsurveyrespondentsidentifiedthisascontributingfactors.160A,Aeron-Thomas(2015)RoadPeaceandtheEuropeanFederationofRoadTrafficVictims(FEVR).JusticeandthePost-CrashResponseintheUNDecadeofActionforRoadSafetyBackgroundbriefingfortheJusticeandPost-CrashsideeventattheSecondGlobalHigh-LevelConferenceonRoadSafetyinBrasilia.Availablefrom:http://www.roadpeace.org/resources/RP_Brasilia_Justice_briefing_2015.pdf

JuvenileDetentioninHurricaneKatrina

Juveniledetentionfacilitiesmustconsiderchildren’sphysicalsafetyandenvironmentsduringacuteonsetdisastersandevacuation,includingDisasterRiskReductionandpreparednessactivitieswherefacilitiesarelocatedinareasaffectedbyemergencies.DuringhurricaneKatrina,negligenceandlackofpreparednessbyresponsibleauthoritiesledtosome150children-includingyounggirlswhowerepregnant,andchildrenwhohadonlyjustbeenarrestedandnotadjudicatedofanycrime-notbeingevacuatedfromjuvenilefacilities,andinsteadbeingevacuatedtoanadultprison.Whereoverthecourseofaweektheywereforcedtoendureterriblecircumstancesandexposedtounacceptablelevelsofphysicalrisk,deprivation,violenceandpsychologicalstress.Childrenreportedbeingdeprivedoffood,drinkingwater,medicalattentionandclothes;exposedtoheatandhumanwaste;beinglockedinroomswithfloodwaterhalfwayupwayupthewalls;shackledandchainedduringevacuationthroughneckdeepwaterwheresomewerenotabletoswim;spendingdaysoutsideinprisongroundsandonahighwaybridgewiththousandsofadultprisoners.Childrencameintocontactwithfloodwaterthroughforcedsubmersion,accidentalswallowingorintentionalconsumptionduetodehydration.Thefloodwatersaroundthejailweresubsequentlyfoundtobecontaminatedwithharmfulbacteria(E.coli),heavymetals(arsenicandlead),herbicides,pesticidesandpetroleumhydrocarbons.Allposingsignificantthreatstolives,healthandwellbeingofdetainedchildren.

Afterevacuationtoyouthfacilitiesinotherareas,childrenweregivenshowers,cleanclothes,hotmeals,water,sleepingquarters,andacompletemedicalandmentalhealthscreening.Thosewithpsychiatricemergencieswereseenimmediatelybyamentalhealthprofessional,othershaddehydrationandsunburn.Amorecompleteevaluationwasgiventhefollowingday.

Figure12R.A.Feinstein.WhatHappenedtoChildreninDetention?CaringforChildreninaJuvenileJusticeSystemAfteraDisaster.Pediatrics.May2006,Volume117/IssueSupplement4.Availablefrom:http://pediatrics.aappublications.org/content/117/Supplement_4/S402.And;JuvenileJusticeProjectofLouisiana(JJPL)(2006)TreatedLikeTrash:JuvenileDetentioninNewOrleansBefore,During,andAfterHurricaneKatrina.Availablefrom:https://www.prisonlegalnews.org/media/publications/jjpl_treated_like_trash_juvenile_prisoners_affected_by_katrina.pdf

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morevulnerabletophysicalhazardsintheirenvironment.• Itshouldbeconsideredthattraditionaljusticesystemsmayplayagreaterroleinvictimsof

unintentionalinjuriesseekingredress,particularlyindevelopingandfragilestates.

Children who are displaced, seeking asylum or refugees NumerousChildProtectionRapidAssessments(CPRA)haveshownthatchildrenwhohavebeendisplacedfromtheirhomesandcommunitiesaresubjectedtounfamiliarandunsafesurroundingswheretheyareatgreaterriskfromavarietyofhazardsincludingroadtraffic,riversandfloodwaters,unstabledebris,fire,ERWandlandmines.161

In2014UNCHRestimatedthat59.5millionpeoplewereforciblydisplacedworldwideasaresultofpersecution,conflict,generalisedviolence,orhumanrightsviolations.Thisfigurerepresentsalevelnotpreviouslyseeninthepost-WorldWarIIera.19.5millionofthemarerefugees,overhalfofwhomarechildren(51%).162Displacementisakeyfactorthatincreaseschildren’svulnerabilitytophysicaldangersandinquires,notonlybecausechildrenareinnewsettings,butalsothephysicalenvironments-particularlyincampsormarginalisedsuburbs-thattheyfindthemselveslivinginwerefrequentlyreportedtobeinherentlydangerousplacesforchildren.InBangladeshifloods,itwasfoundthattheincreaseinsurroundingwaterlimitedlivingspace,forcingfamiliestoshareoneroom,leavingnoopportunitytoseparateoutactivitiessuchascooking.Thisincreasedchildren’sproximitytohazardssuchassharpobjectsinthehome,whichcausedmostoftheirinjuries.163InthePhilippines,theverylocationofbunkhousesfordisplacedfamilies’rightonmajorroadswithnoprovisionforfootpaths,presentedaveryrealdangerofchildrenbeinghitbyvehicles.164InLebanon,informalsettlementshavesprunguptohouseSyrianrefugees,manyofwhicharelocatedonprivatelandwherelandlordscramasmanytentsaspossibleontosmallpiecesoflandwithnofirepreventionin-built.Unsurprisingly,therehavebeenmanyincidentsofburninjuriestochildren.165

161SeeFigure17underAssessmentandSituationalAnalysis162UNHCRGlobalTrends:ForcedDisplacementsin2014,availableathttp://unhcr.org/556725e69.html163ABiswas,ARahman,SMashreky,FRahman,KDalal(2010).Unintentionalinjuriesandparentalviolenceagainstchildrenduringflood:astudyinruralBangladesh164ChildProtectionandEducationCluster(2014).JointNeedsAssessmentTyphoonHaiyan(Yolanda)-AffectedMunicipalitiesinthePhilippinesFinalReport165Keyinformantinterview9

PerilousJourneystoEurope

Since2014refugeesandmigrants-manyofwhomarefleeingwarandpersecutioninSyriaandIraq-havecontinuedtoarriveinEurope,andindoingsofaceperilousjourneysintheireffortstoseeksafety.Althougheachperson’sjourneyisindividual,manywillfirstwalkacrossborderscontaminatedwithlandminesandUXO,arrivingintocampsorlivingonthestreetsofcitieswhereconditionsarefarfromadequate.Parentsandchildrenthenencountertheimpossiblechoiceofstaying,orriskingtheirlivestryingtocrosstoEuropeinunseaworthyboats,wheretheyareinthehandsofviolent,unscrupuloustraffickers.

In2015,therewere1,015,078arrivalsbysea,UNHCRhasestimatedthatonequarterofthosecrossingtheMediterraneanarechildren,manywithouttheirparentsorcaregivers.Althoughchildrenmakeupaquarterofthedemographic,theyaccountforagreaterproportionofliveslostatsea.AscanbeseenfromthetablebelowoftheEasternMediterraneanroutetoGreece,inthelast4monthsof2015andJanuary2016,atotalof991peoplediedwith33%ofthosetragicallychildren.Mostofthechildrenwhodrownedin2015areundertheageof12.AlthoughmediareportsinJordanhavehighlightedanincreasingnumberofSyrian’slearningtoswimastheypreparefortheirjourneyacrosssea,inmanycasesithasbeenfoundthatchildrenwereamongstthefirsttolosetheirlivesbecauseofhypothermiaoralackofchild-sizelifejackets.

September October November December January Total

Totaldeaths 190 221 98 207 275 991

Childdeaths 54 95 36 62 64 331(33%)

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Children with disabi l it ies Injuryistheleadingcauseofacquiredpermanentdisabilityinchildren,placingahugeeconomicandsocialburdenonchildren,familiesandsociety.166Permanentdisabilityimpedestheprogressofeducationandsocialdevelopmentformanychildren,whorequirelong-termcareandtreatmentandplacesignificantstrainonfamilieswhohavetocareforthem,resultingineconomichardshipmanyparentswhohavetoleavetheirjobstotakeupthisrole.167InAsiainjurysurveyshavefoundthatforeverychildwhodiedasaresultoftrafficinjuries,254presenttoahospitalfacility,andfourofthosewereleftwithpermanentdisabilities.168Oftheliteraturereviewed,thefollowingfindingsdemonstratethedevastatingimpactofemergenciesonCWD.

Insomehumanitariancontextslargenumbersofchildrenhavebeendisabledasaresultoftheemergency.ThiswasseeninGazawhereamulti-sectorinitialrapidassessmentofconditionsduringthe2014conflictreportedthatfromover11,100peoplewhowereinjured,3,374werechildren,withpreliminaryestimatesindicatingthatupto1,000ofthesechildrenwillhavesufferedpermanentdisability,requiringsustainedsupportfromthechildprotectionandwelfaresectors.169Howeverinothernaturaldisastercontextsthenumbershavebeenmuchlower.AfterCycloneNargis(Myanmar2008),aninteragencychildprotectionassessmentof16townshipsidentified132,793affectedchildren,ofwhom402weredisabledorseriouslyinjuredasaresultofthecyclone.Thiswasarelativelylowproportionofthetotalaffectedchildren--0.3%--andthenatureoftheGazaandNargisemergenciesaresignificantlydifferenti.e.aerialbombardmentsversuspredominatelyfloodingandwind.Thepost-cycloneassessmentidentifiedgrowingpsychosocialdifficultiesassociatedwithdisabilityasaconcern,including:increasedvulnerabilityforchildrenwithpre-existing

166Acquireddisabilityisthatnotresultingfromcongenitalabnormalitiesandbirthinjury.Linnan,M.(2015)WaterSafetyandChildDrowninginVietnamAreportforSavetheChildrenVietnam167MPeden,KOyegbite,JOzanne-Smith,AAHyder,CBranche,AKMFazlurRahman,FRivaraandKBartolomeos(2008)Worldreportonchildinjuryprevention,WHOandUNICEF168MPeden,KOyegbite,JOzanne-Smith,AAHyder,CBranche,AKMFazlurRahman,FRivaraandKBartolomeos(2008)Worldreportonchildinjuryprevention,WHOandUNICEF169UNOCHAOPTGazaInitialRapidAssessment27August2014

HamperedbynoeffectiveandcoordinatedresponsefromtheEuropeanUnionanditsmemberstates,agencies,professionalsandvolunteersareplayingacrucialroleinreachingoutandassistingrefugeeandmigrantchildren.Advocacyplaysakeyrole.UNICEFand59otherorganisationshavedevelopeda‘CallforAction:ProtectingoftherightsofrefugeeandmigrantchildrenarrivinginEurope’toprotectandpromotetherightsofallchildrenatalltimes.The10-pointplanincludesmeasurestoprotectchildrenduringrescue,interception,transportandtransferoperationsincludingaccesstosaferoutes,specialmeasuresforyoungchildren,peoplewithdisabilities,sickpeopleetc.;andqueuemanagementproceduresthatrecognisethepriorityofvulnerablepeople.ItalsocallsforreceptioncentrestocomplywithChildProtectionMinimumStandardsincludingmeetingchildren’sneedsintheirdesign,functioningandequipment,safetyandsecuritymeasures;accessibilityforchildrenandparentswithdisability;basicservicesincludingfirstaid,child-friendlyspacesandrecreationalactivitiesforchildren,andthereferralofchildrentospecialisedserviceswhenneeded(hospitalisation,specialisedhealthcareetc.).Otheradvocacyhasfocusedonavoidinguncertaintyandsuddenborderclosureswhichexposechildrentolongwaitsintherainandcoldandonensuringsuitablefacilitiesandservices(includingforchildrenwithchronic/severemedicalconditions,theprovisionofwheelchairs,fast-trackaccesstoservicesandtransport,etc.)

Inadditiontoadvocacy,agenciesaresupportinghumanitarianservicesatreceptioncentresintransitcountries,includingwinterisation,heating,clothing,blankets,andchild-friendlyspaceswherechildrencanplayandbenefitfrompsychosocialsupportandwomencanrestandtakecareoftheirbabies.

Figure13Source:UNHCRRefugees/MigrantsEmergencyResponse-Mediterranean:http://data.unhcr.org/mediterranean/regional.php;UNHCRRegionalOverview:https://data.unhcr.org/mediterranean/highlights.php?Country=&Region=&Settlement=;IOMMissingMigrantsProject.FacebookPostFebruary4at3:58pmhttps://www.facebook.com/MissingMigrants/;IOMDeathsintheMediterraneanbyroute,2016http://missingmigrants.iom.int/mediterranean;IOMMixedMigrationFlowsintheMediterraneanandBeyondCompilationofAvailableDataandInformationReportingPeriod2015http://doe.iom.int/docs/Flows%20Compilation%202015%20Overview.pdf;UNHCR,UNFPAandWRC.2015.InitialAssessmentReport:ProtectionRisksforWomenandGirlsintheEuropeanRefugeeandMigrantCrisisGreeceandtheformerYugoslavRepublicofMacedonia;UNICEF(2015)ACallforAction:ProtectingoftherightsofrefugeeandmigrantchildrenarrivinginEurope;IOMandUNICEF(2015)DataBrief:MigrationofChildrentoEuropeMigrationofchildrentoEurope;Pressrelease:Madaral-Youm,TheSyrianObserverMar9th,2016WhyAreSyrianRefugeesInterestedinLearningtoSwim?Accessedon11.3.2016from:http://syrianobserver.com/EN/News/30686/Why_Are_Syrian_Refugees_Interested_Learning_Swim/;CalaisMigrantSolidarity.DeathsattheCalaisBorder.Availablefrom:https://calaismigrantsolidarity.wordpress.com/deaths-at-the-calais-border/(accessedon21.1.2016)

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disabilities;marginalisation;additionalstresscopingwithnewphysicalorpsychologicalchallenges;reducedabilitytoexpressfeelingsorseeksupportforstressresultingfromthedisaster.Itwasalsorecognisedthatcarersofthedisabledandinjuredwhohavingexperiencedthecyclonethemselveswouldbestressedbythedifficulteconomicandsocialcircumstances,andmayfeelresentmentfortheadditionalburdendisabledfamilymembersrepresent,leadingtoabuse,exploitationorneglect.170Inaddition,whileprogresshasmadetoextendpsychosocialprogrammingtobothgirlsandboysofdifferentages,andinsomeinstanceshard-to-reachgroupssuchasminorityethnicorreligiousgroups,thishasnotbeenthecaseforchildrenwithdisabilities,whoinmostplaceslagbehindunderservedandexcludedfromservicedesignanddeliverybypsychosocialactivitiesinemergencies.Fargreaterlevelsofconsultationandparticipationofchildrenandadultswithdisabilitieswillbeneededtoensuretheirinclusioninpsychosocialprogramming,toaddresssomeofthemostpressingdisabilityrelatedimpactsofemergencies.171

InotherchronicandcomplexemergenciessuchasAfghanistan,theimpactofdisabilityonsocietyasawholeisdevastating;here,morethan200,000childrenlivewithpermanentinjuriesanddisabilitiessufferedduringthehostilitiesorasaresultofinadequatemedicalsupport.172ExpertsinAfghanistanestimatethat95%oflandmineinjuriesresultindisabilities,andwhetherchildrenreceivelife-savingassistanceornot,almostentirelydependsonthelocation,transportandproximitytospecialisedmedicalfacilities.AllofwhicharecompromisedinacountrylikeAfghanistan;a2009surveyofminevictimsstatedthatserviceswere‘never’or‘almostnever’adaptedtochildren’sage.173

Empiricaldataontheeffects,extentandcausesofdisabilityinchildrenduringemergenciesisusuallyunavailable.FollowingTyphoonHaiyan(Philippines2014)almostnodataexistedonthenumberofpeoplewithdisabilitieswhohadbeenimpacted,theincidenceoftypesofinjuryorchronicillness,ortheirneeds,capacities,and/orcopingstrategies;andnoreferralpathwaywasputinplace.174Whiledataisweak,twostudiesthathaveanalysedabroadvarietyofsourcessuggestthefollowingfactorscontributetothephysical,psychological,andeducationalvulnerabilityofCWDindisasterandareperhapsthemostchallengingaspectsforCWDinemergencies:175

• Higherpovertyrates;• Elevatedriskofexposure;• Decreasedabilitytotakeprotectiveactionorwithstandtheforceofanemergencyandlowerratesof

evacuation,coupledwithinaccessibleevacuationroutesandthepotentialtobe‘leftbehind’particularlywheremobilityandhealthissuesrenderevacuationsanimpossiblechoiceforparents.Thiswasexperiencedinthe2011Japanearthquakeandtsunami,whereitwasfoundthatthefatalityrateamongpersonswithdisabilitiesweretwicethattherestofthepopulation.176

• Dependenceonassistivedevicesorcaregivers;prosthesisandmedicaldevicesfrequentlyrequiringadjustmentsorchanges

• TheexclusionofCWDfromemergencypreparedness,earlywarningsystemsandresponseplanning;limitedconsiderationofthecommunicationandmobilityrequirementsofCWD.

• Greatervulnerabilitytolifethreateningandtraumaticlossorseparationfromcaregivers;withthelossofcaregivers,thelossoftheonlypeoplewhoknowhowtocarefororcommunicatewithachild.

• Stigmaandsocialdistanceduetosocietalandcommunitybeliefsaboutdisability• Exclusionfrominstitutional/mainstreamsupportservicesandassistanceprogrammessuchashealth

orfooddistributionbecauseofphysicalbarriers,negativeattitudes,andpoortargetingofservices;

170ChildProtectioninEmergenciesTechnicalWorkingGroup,ProtectionofChildrenandWomenCluster(2008).InitialAssessments:ResponsetoCycloneNargis30September2008.171UNICEFEvaluationOffice(2013)EvaluationofUNICEFProgrammestoProtectChildreninEmergencies:SynthesisReport172WatchlistonChildreninArmedConflict(2010)SettingtheRightPriorities:ProtectingChildrenAffectedbyArmedConflictinAfghanistan173IBID174UNICEF(2013).TheStateoftheWorld’sChildren2013:ChildrenwithDisabilities175ChildrenwithDisabilitiesintheContextofDisaster:ASocialVulnerabilityPerspective,L.PeekandLM.Stough.ChildDevelopment,July/August2010,Volume81,Number4,Pages1260–1270;and,UNICEF(2013).TheStateoftheWorld’sChildren2013:ChildrenwithDisabilities176HandicapInternationalAdvocacyBriefingPaper2015.Inclusion:thekeytoessentialdisasterriskmanagement

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• Anincreasedstrainonparents;andextremevulnerabilitytophysicalviolenceortosexual,emotionalandverbalabuse;

• RefugeefamiliesleavingbehindCWDbecausetheyfeartheywillberefusedasylumonthebasisofdisability.

• Institutionsandresidentialschoolsmaycloseand/orCWDintheircareabandoned.

Section Three: Key issues and Lessons Learned The role of chi ld protection and other humanitarian actors Whilstthephrase‘dangersandinjuries’isarelativelynewtermintheworldofchildprotectioninemergencies,usheredinwiththeintroductionoftheCPMSin2012.Theunderlyingconceptsarenotnewandreachrighttotheveryfoundationsofhumanitarianismthataimstoprotectchildrenfrominjuryanddeath.

Inasimilarwaytoother‘newerareasofwork’,theroleofchildprotectionwithinthisbroadcrosscuttingissuehasbeenquestioned,asitnotonlyaffectschildren’sprotection,buttheirhousing,health,accesstoeducationandpotentialtoearnaliving.Experiencefromdevelopmentsettingsshowsthatinjuriesareanissuewheremanykeyactorsplayacentralrole,butthatoftentheoverallresponsibilityandleadershipcanbelackingorvariablebetweendifferentinjuryissues;thissituationwasalsoexpressedbythosewhoworkinemergencies.Withthisinmind,thisnextsectionoutlinessomekeysthatwereraisedinrelationtothedifferentrolesandresponsibilitiesofactorsinvolvedinpreventingorrespondingtodangersandinjuries.

Child protection Childprotectionactorsusearangeofservicesandactivitiesthatdirectlyrelatetosupportingchildrenaffectedbyphysicaldangersandinjuriessuchascasemanagementandreferralmechanisms,psychosocialinterventions,childfriendlyspaces,andcommunitybasedchildprotection.Theyalsouseotherapproachessuchasriskmapping,advocacyandawarenessraisingtomainstreamagreaterunderstandingofdangersandinjuriesduringpreventionefforts.Oneseniorchildprotectionadvisorfeltthattheinclusionofdangersandinjuriesintoresponsetendedtobebasedonthesensitivityofthepersoninchargeoftheprogrammeorconductingtheassessment,butthatwhereitwasacknowledgeditwaseasilyintegratedacrosschildprotectioninterventions.177

Itwasconfirmedthroughthesurveythatchildprotectionactorshaveakeyroletoplayinpreventingunintentionalinjuriesinchildrenduringhumanitariancrisis,85%ofrespondentseitherstronglyagreed(52%)oragreed(33%)thatthisshouldbethecase.178Asignificantnumberalsofeltthatothersectorshaveagreaterresponsibilityforinjurypreventionthanchildprotectionactors.18%stronglyagreedwiththisstatement,and40%agreed;conversely33%ofrespondentsdisagreedorstronglydisagreed.Onesurveyrespondentwentontoexplainthatintheirexperiencewhereinjurypreventionwasseenastheresponsibilityofchildprotection,itwasoftendeprioritisedbycampmanagementorgovernmentdepartments,eventhoughchildprotectionactorsmightnothavethecapacityorremittoaddressenvironmentaldangerssuchaswells,dangersposedbyflooding,roadandfiresafetyincongestedcampsandmarkets,orpoorlighting.Asenioradvisoralsocalledforreflectionuponthispoint,whereintheirexperienceinMalitheyhadfoundthatthroughtheidentificationofchildren,referralmechanisms,andcommunitybasedchildprotectionmechanisms,manycasesofinjuredchildrenwerereported,includingmanywithconflict-relatedinjuries.Thesetriggeredreferralstohealthandotherservices;whilstthiswasvaluableforinjuredchildren,italsoopenedthedoortoavarietyofotherhealth-relatedcasessuchasmalnutrition,whichwereconsideredsomewhatoutsidethemandateofthechildprotectionprogramme.Whilekeepingafocusonchildrenwithdisabilitiesandimpairments,thechildprotectionteamhadtopushbackonsomecases,becauseitwasfeltthatthecommunitywouldtaketheir

177Keyinformantinterview2178Throughoutthesurveytheterm‘unintentionalinjuries’wasusedtoincludetraditionalunintentionalinjuries(cuts,burns,drowning)aswellasinjuriesfromindiscriminateweaponsofwarsuchaslandmines,ERW,beingcaughtincrossfireandotherexplosiveweapons,aspertheconceptualframework.

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traditionalprotectioninterventionslessseriouslyiftheybecamea‘catchall’systemforallchildwell-beingandhealthissues.Thisadvisorfeltasiftherewasanimportantbalancebetweenwhatweshouldandcoulddowithinchildprotection.179

Ontheotherhand,the2015CPWGpaper‘AMatterofLifeorDeath’-whichlooksattheessentialroleofchildprotectionactivitiesthatensurethesurvivalandwell-beingofchildrenduringandafteremergencies-reportsnumerousmisunderstandingsabouttheabilityofchildprotectiontobelife-saving.Theseincludetheconfusingandcontradictorybeliefandpracticethat‘otherhumanitarianactors’areeitherwhollyorpartlyresponsiblefortheprotectionofchildrenthroughactivitiessuchaspreventingviolence,identifyingandrespondingtochildreninjuredbyUXO,caringforchildsurvivorsofsexualviolenceandaddressingtheneedsofchildrenwithphysicalinjuries.Yetevidenceshowsmanyhumanitariansstillfailtosupportprotectioneitherintheirprogrammingresponsesorintheircontributionstodecision-making,andthattheseactivitiesareoftenseenassubordinateto“childsurvival”responses.180

Mine action and safety messaging Mineactionissetofactivitiesaimedatreducingthesocial,economicandenvironmentalimpactofminesandExplosiveRemnantsofWar(ERW)includingUXO.Therearefivepillars:landmineandERWclearance;MineRiskEducation(MRE);victimassistance;Stockpiledestruction;andAdvocacy.IntheUNsystemalone,thereare14differentdepartments,programmes,fundsandagenciesinvolved.181ChildprotectionandmineactionactorsmostcommonlycoordinateunderthewiderumbrellaoftheProtectionCuster,butasseparateAreasofResponsibility.ChildProtectionactorsaremostcommonlyinvolvedinMRE,supportingchildreninjuredbylandmine/UXOthroughcasemanagement,reportingcontaminatedareasfrequentedbychildren,andadvocacy.Thereislittledocumentationonhowbestthishappensinpractice.Althoughsomemineactionactivities,suchasMRE,arecombinedintochildprotectionprogrammes,only35%ofsurveyrespondentshadworkedwithdeminingactors;andin2009,areviewofchildprotectionfunding,foundthatmineactionwasoneoftheprogrammaticareasleastreflectedinthechildprotectionprojectrequestsreviewedforthereport.182

OneexamplewherechildprotectionandmineactionwasfullyintegratedoccurredinSriLanka,whereaspartofUNICEF’sresponse,mineactionandMREpersonnelwereembeddedinchildprotectionteams.Independentlyevaluatedin2010,integrationoccurredonanumberoffrontsincluding:meetingswithinorganisations;theemploymentofstaffwithknowledgeandpreviousworkexperienceinotherprojectareas;cross-trainingofstaffinotherprojectareas(e.g.childprotectionandMREpersonnellearncorecompetenciesineachother’sareasoffocus);integrationofchildprotectionandMREtopicsinchildren’smaterialssuchasbooksandplaykits;childclubactivitiesconductedconcurrentlyonchildprotectionandMRE;selectionofthesamecommunitiesforMREandEducation;referralofindividualsandcommunitiesbyMREandchildprotectionpersonneltootherpartners;collaborationwithchildrightscommitteesandothervillage-basednetworksonbothMREandchildprotectionissues;andvillagevolunteertrainingsconductedjointlybyMREandchildprotectionorganisations.ThisintegrationbetweenMREandchildprotectionhadanumberofpositiveeffectsincludingMREpartnersbeingabletoutiliseittostrengthenskills,connectpeoplewithneededresourcesandtrainings,andconserveUNICEFandNGOresources.Inaddition,theevaluationteamraisedtwoconcernsaroundrolesandresponsibilities.TheintegrationofMREandotherchildprotectionactivitieswasthoughtbysometoendangerthesupportofMREactivitiesbecauseofgovernmentstakeholdersensitivityofdialoguearoundchildprotectionandhumanrightsissues,whichledtoadditionalscrutinyofMREandhinderedgovernmentsupportandapprovals.Furtherinvestigationandpotentialredesignwashighlightedtoaddressthisissue.ItalsoaddedpressuretomineactionpersonnelandNGOswhosometimesfeltoverwhelmedandoverworkedbytheirdualresponsibilitieswhentheywerecalledupontoassistwithchild

179Keyinformantinterview2180ThompsonH(2015).AMatterofLifeandDeath:Childprotectionprogramming’sessentialroleinensuringthewell-beingandsurvivalduringandafteremergencies.2015181UnitedNations(2005)MineActionandEffectiveCoordination:TheUnitedNationsInter-AgencyPolicy. 182CPWG(2011).TooLittleTooLate,CPWG,Geneva

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protectionactivities,especiallyinareasofincreaseddisplacementandresettlementandwheretherewasinsufficientMREcoverage.183

ThereareclearbenefitsforintegratingMREandmineactionactivitiesintochildprotectionactivities,particularlyconsideringaccesstochildrenandworkingwithat-riskandhardtoreachgroups.ExamplesfromotherconflictsettingswerereportedwherethisintegrationdidnotseemtobeaproblemincludingNigeria,Burundi,Darfur,ChechnyaandNepal.However,humanitarianpractitionersshouldalsoconsiderconflictdynamicssensitivelyinanyparticularcontextinrelationtointegratedprogrammes,wherelifesavingMREactivitiesareneeded,butthecontextisviolentlypolarisedanddangerous.ThisishighlightedfurtheroninthereportwhereanexamplefromSyriadescribestheworkoftheSyrianCivilDefenceteamswhoareabletoworkonallsidesoftheconflictbringingvitallife-savingassistancetoinjuredpeopleaswellaspreventativecommunitysafetymessaging,mainlybecauseoftheirneutralityandimpartialityfromanywiderpoliticalorhumanitarianissues.184

Education Formillionsofchildrenallovertheworld,physicaldangerandinjurieshaveabigimpactonschoolgoingchildren.Itisestimatedforeverychildthatiskilledbyaninjury,34childrenneedmedicalcare,ormissschoolorworkbecauseofaninjury.185Combined,injuredchildrenmissmillionsofdaysofschooleveryyearandthosewhoareseriouslyinjuredordisabledoftenfindtheymaybeunabletocontinuewiththeireducation.Schoolsarealsoamajorsourceofinjuriesinchildren,withmanyprovidinginadequatelevelsofphysicalprotectionintheirdesign,construction,managementandmaintenance;particularlyduringemergencieswheretheyareriskofbeinghitbyindiscriminateweapons,ordirectcollapseofschoolbuildingsfromtheimpactofanaturaldisastersuchasanearthquake.

Childprotectionrapidassessmentshavefoundthat“inschools”and“onthewaytoschools”featureamongstthetopfivesituationswherephysicalrisksarehighestforchildren,in7ofthe11analysedassessmentreports.Thisreviewhighlightstheparticularriskschildrenfaceontheirjourneystoandfromschool,mostlyfromvehiclecollisions,butalsofromdrowning,falling,landminesorbeingcaughtincrossfire;andwhereschoolcompoundsarenotsafeandsecure,childrenfacetheriskofinjuryfromsharpobjectsoranimalbites.

However,schools,teachersandeducationactorshavealsobeenhighlightedasavitalpartoftheresponsetophysicaldangersandinjuriesfacilitatinglife-savingawarenessraising,mineriskeducation,andsafetymessaging;actingasaconduitforemergencypreparednessandchildcentreddisasterriskreductionactivitiesthroughGlobalinitiativesliketheWorldwideInitiativeforSafeSchools;186providingsafetemporarylearningfacilities;andwheretheconstructionorretrofitofschoolshasbeendonetoearthquakeresistantstandardssavingthousandsoflivesinthenexturbanearthquakethathappensduringtheschoolday.

Yetmoreneedstobedone:tostrengthentheidentificationofrisksinandonthewaytoandfromschools;topreventavoidableinjuryincidentsoccurringandtoreducethelevelofriskinandaroundschools;toensureinjuredanddisabledchildren(alongwithotheroutofschoolchildren)haveaccesstoeducationandschool-basedinjuryprevention,emergencypreparedness/DRRandemergencyresponseactivitiesthroughaccessiblefacilities,teachingmethods,outreachandworkingwithcommunitiesandothers;toensureschoolsitesarephysicallysafeforchildrentoreturnandthatchildrenfeelsafeenoughtodosoduringandafteremergencies.ThesafetyofschoolswasidentifiedinNepalashavingasignificantpsychosocialimpactonchildrenfollowingthe2015earthquake.Bylawchildrenmustattendschoolandtheycannotrefusetogotoschoolbecauseabuildingisunsafe,itisthereforetheresponsibilityofparents,teachersandothereducationactorstoadvocateandensureschoolsareinrealitysafetoreturntoafteremergencies.

183EvaluationofUNICEFSriLankaMineRiskEducationActivitiesInternationalEmergencyandRefugeeHealthBranchCentersforDiseaseControlandPreventionAtlanta,U.S.A.October-December2010184Thiscanbefoundin:Sectionthree–Keyissuesandlessonslearned–Effectivepreventativeandresponsestrategies–MineRiskEducation185MPeden,KOyegbite,JOzanne-Smith,AAHyder,CBranche,AKMFazlurRahman,FRivaraandKBartolomeos(2008)Worldreportonchildinjuryprevention,WHOandUNICEF186MoreinformationontheWorldwideInitiativeforSafeSchoolscanbefoundhere:http://www.unisdr.org/files/45656_worldwideinitiativeforsafeschools.pdf

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Morecanbefoundonschoolsandeducationanddangersininjuriesinthesectionson“whereinjuriesoccur”,DRR,Mineriskeducation,safetymessagingandriskmapping.

Health Healthservicesandworkershaveakeyroletoplayinpreventingchildinjuriesandcaringforthosewhohavebeenaffected,yetonly40%ofsurveyrespondentsfromthechildprotectionsectorhadworkedwithcommunityhealthservicesoremergencyhealthservicesinthepreventionandresponsetodangersandinjuries;evenless(24%)hadworkedwithrescueservices. Frustrationwasexpressedbyanumberofinjuryandhealthexpertswhowereunhappyabouttheperceptionofinjurieswithinthehumanitarianhealthsector,andtheirrelativelackofprioritisationcomparedtootherleadingcausesofchildhooddeathanddisabilityinemergencies.187Whereotherlargechildhealthinitiativeshavetackledinfectiousdiseases,immunisation,andnutritionaldeficienciesininfantsandbabies-savingmillionsoflives-theirbenefitswillnotbefeltifmillionsmorecontinuetodieeachyearfrominjuries.188

187Keyinformantinterviews1,10,11,16,18,20.188MPedenetal,2008,WHO&UNICEF,WorldReportonChildInjuryPrevention:AnOverviewPresentation.Availablefromhttp://www.who.int/violence_injury_prevention/child/injury/world_report/report/en/

EducationandSeismicSafety

Sincethe2000,therehavebeenatleast34,000fatalitiesofchildreninschoolsacross16majordisasterscausedbynaturalhazardsalone,andmanymorenearmissesbecauseschoolswereclosedatthetimeoftheevent.

Nootherhazardpresentsquitethesamelevelofrisktoschoolchildrenasanearthquakeduringschoolhours.Inthe2005,theKashmirPakistanearthquakekilled17,900childrenandinjured50,000inthe10,000schoolsthatweredestroyed.Duringthe2008Sichuanearthquake,approximately10,000studentswerecrushedintheirclassroomsinmorethan7,000schoolroomsthatcollapsed.Someresearchestimatestherearemorethan100millionschool-agedchildrenexposedtosignificantseismicriskthroughouttheworld.

Aglobalbaselinereportonschoolsafetyidentifiedseveralrelevantandconsistentthreatstosafeschoolfacilities:

• Failuretoassureeverynewschoolisasafeschool;• Multi-hazardawarenessisoftenlacking;• Opportunityforconstructionandretrofitasaneducationalexperienceisuntapped;• Theimpactofconstructiononeducationandfamilylifenotwellunderstood;• Lifelineinfrastructurefailuresinroads,bridges,andtransportationsystemsthreatenschoolattendance;• Failuretoprioritiseschoolre-openingjeopardisescommunityrecovery.

Argumentsforgreaterschoolsafetyinrelationtoseismicactivitycentrearoundthreecoreprinciples1)Childrenhavearighttolifeandaneducation;2)Itismorecost-effectivetoinvestinbuildingseismicsafeschoolsintermsoftheupfrontcostversustherebuildingcostsafteranearthquake,ontopofthepublichealthandsocialcoststhatcanbeavoidedforgenerationstocome;3)Schoolsplayanessentialroleincommunitiesandcanhavemultiplefunctionsafteremergency,iftheyarestillstandingthiscanbeavitallifelineintheresponse.

Figure14MarlaPetal,SavetheChildren,IntensiveDisasterImpactsonSchoolsinAsiainthe21stCentury:AnOverviewasofJan.2016;MarlaPetaletal(2015).EncyclopaediaofEarthquakeEngineering.SchoolSeismicSafetyandRiskMitigation

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Throughtheliteraturereviewforthispaper,itcanalsobegeneralisedthatmanyhealthactorsdonotplaceadequateemphasisonpreventingandtreatinginjuriesinemergencies,includingrehabilitationservicesforthosewhohavebeenseriouslyinjuredordisabled.Healthsurveillancesystemsinemergenciesdonotoftenreflectinjuries,ortheinformationisnotacteduponforpreventionpurposes.Thesedeficitsinhumanitarianhealthprovisionimpressuponustheimportantrolethatchildprotectionactorscanhaveinensuringtheissueisconsidered,datacollectionisimproved,andresponsesaretailoredtochildren’sneeds.

Female Community Health Volunteers and Mothers Groups in Nepal AsmallpilotprojectwhichholdsparticularrelevanceforDRRandresponseconsideringthe2015earthquake,wasinitiated2014in9wardsofoneVillageDevelopmentCommitteetoaddressthepreventionandtreatmentofchildhoodinjuriesthroughtherecognisedsystemofFemaleCommunityHealthVolunteers(FCHV);andacommunity-ledcrècheforyoungchildren.Thereare50,000FCHVinNepalwhohavehadconsiderablesuccessinsupportingimmunisationprogrammes,reducingandtreatingdiarrhoea,andimprovingoutcomesinpregnancyandfamilyplanning,aswellasreferralstootherhealthfacilities.

InthisprojectFCHVwerealsotrainedinchildinjuryawarenessandbasicfirstaid,andgivenbasicfirstaidkits.FCHVwouldthenconductmonthlymothers’meetingsandmassawarenesssession(ashasbeendonewithotherpublichealthissues)toraiseawarenessandgeneratediscussion.Over10%oftheparticipantsinmassmeetingswerechildrenfromchildoradolescent'sclubs.

Althoughnoformalevaluationhasbeenconductedyet,itwasreportedthatinadditiontoincreasedknowledgeandawarenessaboutchildinjuries,communitieswereabletoinitiateenvironmentalchangestoimprovesafety,andmother’sgroupshavetakenonanadvocacyroletopreventinjurieswithintheircommunities.Thecrèchecomponentwasalsoreportedtoimprovechildren’sdevelopmentandskills.

TheprojectwasnotlocatedinareasofNepalthatwereaffectedbytheearthquake,soitisdifficulttotellwhetherthisinterventionwouldhavereducedinjuriesshouldithavebeenaffected.Butincludingtheissueofdangersandinjuriesintotheworkofcommunityhealthvolunteers,surelypresentsgreatopportunitytoaddress,childhoodinjuriesfromthebottomup,whereideallythemessagescouldreacharoundonemillionmothersacrossthecountry.

InotherareaswhereFCHVwereabletosupportaffectedcommunities,onekeyinformantreportedthattheywerelimitedbyagovernmentfocusonotherhealthissues,wheretheywouldhavelikedtodonemoreoninjuryprevention.

Figure15Keyinformantinterview7and3;andPuspaRajPant,UniversityoftheWestofEnglandReportofthePilotProjectonChildInjuryPreventioninNepal,2014

I

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Shelter Thebuiltenvironmenthasaprofoundeffectonchildren’ssafetyandexposuretophysicaldangers.Inemergencies,thesectormostresponsibleforthebuiltenvironmentisshelter.Thissectorisresponsiblefor:meetingtheshortandlong-termshelterneedsofaffectedpopulations;shelter-relatednon-food-items(NFIs);housingconstructionandreconstruction;andsettlementsupportsuchassiteplanning,urbanplanningandpreparednessandriskreduction.189InNepal,aninteragencyconsultationwithchildrenafterthe2015earthquakefoundthatshelterwaschildren’sprimaryconcern,andfor84%itwasamongthetopthree.Childrenspokeoftheinadequacyandinsecurityoftentsandothertemporarysheltersinwhichmanywerelivingbecauseofdestructionordamagetotheirhomes,citingbadweather;insects,snakesandwildanimals;privacyandspace;andsecurityforthefamilyandchildaskeyconcerns.Herechildrenwantedhousesstrongenoughtosurviveanearthquake,onlyafewstoriestallandlocatedinsafeplaceswheretherearenorisksoflandslides.Theyalsowantedbetteraccesswithinandoutsideofhousessotheycouldescapeiftheyneededto.Shelterinthiscontexthadahugeroletoplayinchildren’sperceptionoftheirphysicalsafety,whichinturnaffectedtheirpsychosocialwellbeing.190

Whilstthefinalshelterproductisakeyconcernforhumanitariansandcommunitiesalike,theconstructionprocesscanalsobehazardoustochildren,andthosecarryingitoutshouldconsiderchildren’ssafetywithintheiractions.SuchacasewasidentifiedinIvoryCoastfollowingthepost-electoralcrisis,whereholesleftfrombrickproductionweredangerousforsmallchildrenintherainyseasonandbecameabreedinggroundformosquitos.191

Childprotectionactorswillalsoworkalongsidecolleaguesinshelter,inthedevelopmentofchild-friendlyspacesandotherstructures.192Alargebodyofworkfromtheeducationsector–whominmanyinstancessharephysicalspacesorrunjointactivitieswithchildprotectionactors,particularlyintheearlyresponseperiod–hasmanyrelevantlessons.TheUNICEFCompendiumoftransitionallearningspaceshasreviewedalargenumberofsuchspacesforchildren.Theoveralllearningfromtheprojectsuggeststransitionalspacesshouldpayattentiontothefollowingissuestoimprovephysicalsafety:

• Bedesignedandlocatedastonotincreasepotentialinjuryordeathincaseoffuturehazardevents,foraslongastheyareinusee.g.aftershocks,highwindsorflooding;locatedonsites(alsoconsideringaccesstosites)whichmitigatetheriskse.g.inthecaseofcollapseordamage,andincludinganemergencyexittoasafeoutsidearea,incaseofescape.

• Constructionmonitoringandsupervisionisvitaltoensureconstructionqualitytosafestandards,technicalspecifications,constructiondrawingsandbuildingcodes.

• Firepreventionandemergencyevacuationplansmustbeinbuilttothedesignandoperations.• Non-flammablematerialsarealwaysbetterthenhighlycombustiblethatchorbamboomatsusedfor

floorsorroofs.Combustiblematerialsshouldonlybeusediftreatedtoresistfire,andwheretheyareusedasecondemergencyexitisvital.Inaddition,toxicityandhazardouscomponentsshouldbeconsideredwhenselectingmaterialsandtoxicconstructionmaterialsmustnotbeused. Preventingfiresandguaranteeingchildren’ssafetymustbeatthecentreofthedesignandmaterialselectionprocess.

• Thesurroundingsitemustbeclearedofanyhazards,suchasunstableearthfromlandslides,fallenelectricalwire,glass,sharpmetals,debris,fluidsandsolidandgaseouswastesetc.Specialpreventionmustbetakenifsitesarelocatedclosetootherdestroyedordamagedbuilding,whichmustbeclosedofftoprotectchildrenfrominjury.

189GlobalShelterCluster(undated)Brochure:IntroductiontotheGlobalShelterClusterCoordinatingHumanitarianShelter190Plan,SavetheChildren,UNICEF,WorldVision,GovernmentofNepalCentralChildWelfareBoard,GovernmentofNepalMinistryofFederalAffairsandLocalDevelopment(2015).AfterTheEarthquake:Nepal’sChildrenSpeakOutNepalChildren’sEarthquakeRecoveryConsultation.2015191UNHCR,UNHABITAT,IFRC(2013)ShelterProjects2011-2012192Moreinformationcanbein:Sectionthree–Keyissuesandlessonslearned–Effectivepreventativeandresponsestrategies–Childfriendlyspaces

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• Tentspegsneedtobecarefullyhammeredintothegroundorcoveredwithsandbags,andguideropesorwiresshouldbemadevisiblebyflagstopreventchildrenfrombeinginjuredwhilemovingaroundtheoutsideofthetentstructures.

• Inadditiontosafeconstructionitisveryimportanttodevelopriskawarenessandriskbehaviourinchildren,staff,parentsandthecommunity.Evacuationproceduresandemergencydrillsmustbepartofchildren’slifetocreateawarenessandfosteractiveparticipationinDRR.

• Structuresshouldbedesignedandbuilttoeasilymaintainedbythelocalcommunity,especiallyindisasterproneplaces,wherebettermaintainedfacilitieshavebeenfoundtominimiserisksofdamageandinjury.

• InPakistanwherechildfriendlyspaceshaddirtormudfloors,andwerebuiltonexistinglowgroundlevelexposedtofloodingandwater.Usinganextratarpaulintogivea“sealed”floorprovidedgreaterbenefitstochildren.

• Transitionalspaces,theirWASHfacilitiesandexternalspacesincludingroutestothem,needtobeinclusiveandaccessibleforallchildrenincludingthosewithdisabilities,inparticularaccessramps,child-heighthandrails,reducedstairheights,dooropeningsandaccessiblelatrines.Ingeneralsteepslopesshouldbeavoidedastheyaretypicallymoreatriskfromlandslides,erosion,rockfall,amongotherfactors:theyalsomakeitmoredifficultandexpensivetobeaccessibleforchildrenwithphysicaldisabilities.

• Wherestructuresareraisedprotectionfromfallingforsmallerchildrenisneeded,entrancedoorsandstairsneedtobelockableandprotectthechildrenfromfallingdown,railingsareneededonverandaandstairs.Designsshouldconsidersupervisoryneedsthatsupportssafety,andallowsstafftoseechildrenwhilecarryingoutmultipletasks.193

Water, Sanitation and Hygiene Children’scontactwithwaterandsanitationactivitieshaveledtothedeathandinjuryinmanyinstancesdocumentedinthisreview.ArecentscopingstudybySavetheChildren-‘EmergencyWASHforChildren’-callsforWater,SanitationandHygiene(WASH)actorstogivegreaterprominencetodangersandinjuriesintheiremergencyresponses.Inaddition,asurveyconductedaspartofthestudyfoundthatalthoughmostrespondentshadbeeninvolvedwithchild-focusedhygienepromotionactivities,only29%saidtheyhadprovidedchild-friendlytoiletsinschools,16%haddonesointhecommunity,andonly24%saidtheywereworkingwithchildrenfrom12-18yearsold.NofurtherexamplesweregivenonmakingthebroadspectrumofWASHactivitiessafeforchildren.Thestudyconcludesthekeyissueswhichpreventssaferpracticeforchildreninclude:respondingtocompetingdemands;alackofreadilyavailableresources;andalackofskilledandconfidentWASHpractitionerswithknowledgeandexperienceofworkingwithchildren.ItalsoemphasesthatCPMS#7DangersandInjuriesdoesnotmentionrisksduringtheconstructionofWASHfacilities,whichwerecitedasthereasonforthedeathofaSyrianchildinanIraqirefugeecampwhodrownedinapitofwaterthathadbeendugduringlatrineconstruction.Itrecommendsgreaterattentionto

193UNICEF(2011)CompendiumofTransitionallearningspacesDesignandConstructioninEmergencies2011.Availablefrom:http://www.educationandtransition.org/wp-content/uploads/2007/04/TLS_compendium.pdf;andUNICEFCompendiumofTransitionallearningspaceandUNICEF(2013)CompendiumofTransitionallearningspaceResilientDesignandConstructioninEmergencies2013.Availablefromhttp://www.educationandtransition.org/wp-content/uploads/2007/04/TLS_2013A1.pdf

PhysicalrisksthataccompanyWASH

• Facilitiesdesignedforadultsareoftenunsuitableordangerousforchildren

• Drowninginopenwaterorpitsofwater/latrines;

• BeinginvolvedintrafficcollisionswithWASHvehicles;

• Indoorpollutionfromstoves;• Unfencedrubbishtipsandconstruction

site;• Openwells;• Poisoningfrominsecticidesandchemicals

usedtotreathouseholdwater• Suffocationfromplasticbagsusedto

distributeNFIs.

Figure16Source:SavetheChildren(2014)EmergencywashforchildrenScopingStudy,SavetheChildren

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childprotectionaspartofWASHactivitiesincludingsafeguarding,usingaccessible,translated,materials,betterparticipationofchildren,andconsideringsupplychains.194

Camp coordination and management Theroleofcampcoordinationandcampmanagement(CCCM)istoensureeffectivemanagementandcoordinationofhumanitarianresponseinalltypesofcommunalsettlements,namelyplannedcamps,collectivecentres,self-settledcampsandreceptionortransitcentres,accordingtorelevantstandards.Itsupportstheidentificationofgaps,representationandmeaningfulparticipationofIDPsandhostcommunities,facilitatesinformationsharing,andultimatelyadvocatesforadequateandtimelyinterventionbyrelevantactors.

Insituationsofdisplacement,CCCMcanplayacentralroleinidentifyingandpreventinghazardsandrisksthataffectchildren’sphysicalsafety.OnesuchexampleofpromisingpracticesharedbyakeyinformantworkinginMyanmar,highlightedthiscentralfunctionofCCCM.Followingthedeathsoftwochildrenwhofellintoapitlatrine,CCCM,WASHandtheprotectionclustercametogethertodiscusshowbesttorespondandidentifywhatmorecouldbedonetopromotecampsafety.Aresponseplanwasformedbasedonanassessmentofthecampswhichincludedfocusgroupdiscussionswithchildrenandparentsonhowtomakecommunitiessafer,aCCCMsurveyofthecommunity,andaWASHclusterassessmentoftheconditionofalllatrines.CCCMhavingincreasedtheirawarenesscollectdataonthenumberofdeathsandinjuriesreportedinthecamps.Thisinformationissharedamongagenciesinothersectorswhocantargetresponseswhereneeded.Reportingalsotakesplacewhenincidentsrelatingtosafetyareidentifiedthroughotherclusters,andCCCMplaysacentralroleincoordinatingdatacollectionandliaisingwiththegovernment.Responsesbetweensectorshaveincludedsafetydrillsforchildren,posters,awareness-raisingsessionsinthecommunitiessurroundingsafeandunsafeareas,strengtheningandmonitoringlatrines,andincreasedsupervisionofunsafeareasbythechildprotectiongroups.195

Coordination Asisclearfromtheabovesection,avarietyofactorsandsectorsshouldbeinvolvedineffortstopreventinjuriesduringemergencies.Mostcommonlystatedbysurveyrespondentsasthoseworkedwithduringinjurypreventionandresponseactivitieswere:Localauthorities(83%);communitygroups(83%);theRedCrossMovement(56%);voluntaryorganisations(56%);thepoliceandroadsafetyactors(48%);UNagencies(48%);deminingagencies(43%);healthservices(emergencyandcommunity)(39%);emergencyrescueservices(30%).Otheractorsmentionedwereschools,teachers,socialworkers,communitybasedchildprotectionmechanisms,WASH,CCCMandINGOs.

Whilerespondingtodangersandinjuriesiscross-cuttingandcaninvolvealargenumberofactors,itseems(outsideofmineaction)thattheoverallleadershipneededtotacklethebroadrangeofissueswasoftenvariedormissing.PerhapsthemostsuccessfullycoordinatedapproachidentifiedthroughthisreviewwasfromMyanmar,whichusesCCCMastheleadsectorintherecordingofdataandinitiatingofresponsesfromothersectorstoimprovephysicalsafety.However,thisisinanIDPandcampsituation,andmanypopulationsaffectedbyemergenciesmaybelivingoutsideofcampsorintheirhome-affectedareas.Insuchsituations,itisvitalthatthecommunityplayacentralrole.Onerespondentemphasisedtheimportanceofcoordinatingwithcommunitiesinawaythatenablesthecommunitytodevisethepreventativeactionsthemselves.OnerecalledasituationwhereyoungchildrenweredrowningwhilecrossingariverinSouthSudantoreachafooddistributionpoint;theirparentswereputtingthemincookingpotstofloatthemacrosstheriverandthepotsweretippingover.AftertalkingwiththeprincipalChiefandotherChiefsinameeting,thecommunitywereabletoidentifywhattheyneededtodotopreventchildrendrowning.TheChiefsrequestedplasticsheetstomakecanoesandalsocommittedtobeingattherivertowarnpeopleagainstputtingtheirbabiesincookingpots.Sensitisationwasalsoconductedtenttotent,andtheissuewasdiscussedinSundaychurchservices.TheplanwasreinforcedbypersistingwiththeprincipalChieftoensureactionwastaken,andasaresultnomore

194SavetheChildren(2014)EmergencywashforchildrenScopingStudy,SavetheChildren195Keyinformant21writtensubmission

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childrendrowned.196BoththeexamplesfromSouthSudanandMyanmarhighlightthatsimple,lowcostinjurypreventionactivitiescanbecoordinatedandimplementedinemergencies.

Working with chi ldren and their parents Creatingawarenessamongchildrenandparents,andplacingthematthecentreofresponseswasidentifiedasacrucialelementthroughoutthereview,althoughitwasalsonotedbymanythatduringemergencies,bothchildrenandparentscanlackthecapacitiestheymayhavepreviouslyhad,includingadequatesupervisionandawarenessandknowledgeofdangers.

Childrenwererecognisedasparticularlyimportantagentsintheirownsafety.42%ofpractitionersstronglyagreedand38%agreedthatchildrenareabletoidentifyandpreventdangersandinjuriesinthecontextinwhichtheylive.Only19%ofpractitionerswereunsureordisagreedwiththis,withonerespondentcommentingthatalthough“childrencanidentifydangers,theymaynotbeinapositiontopreventthemiftheirprotectivecirclesarefragile”.Riskmappingwasnotedinavarietyofsituationstobeanimportantactivityforchildrentobeinvolvedin,alongwithdevelopingchild-friendlyawarenessraisingtools.InAfghanistan,children’sShura(children’scouncil)rundiscussionsintheirrespectivecommunitiesonsafetyissuesaffectingchildren;theyidentifyallkindsofprotectionissuesincludingdangersandinjuries,andareachannelforvoicingconcernstorelevantauthoritiesthroughadvocacycampaigns.Theyalsoidentifyanddocumentchildprotectioncasesincludingthoseofinjuredchildren,andrelaythisinformationtoChildHelplineSocialWorkerswhowilldecidewhichserviceororganisationisbestplacedtoimmediatelysupportthechild.197

Similarly,theroleofparentswasconsideredcentral.64%ofsurveyrespondentsagreedorstronglyagreedthatinjurypreventionispredominantlytheresponsibilityoftheparent/carer,whilst28%disagreed.However,aparent’sreducedcapacitiesinemergencieswerealsorecognisedwithonerespondentcommenting“Ifeelthatparentsplayaroleinreducingrisksinandaroundthehomebutcannotbeheldresponsibleforaddressingbroaderrisks,especiallyinthemidstofcrisis.”ThiswasalsohighlightedinBangladeshwheretheincidenceofchildhoodinjurieswashigheramongfamilieslivinginlowersocioeconomicconditions,lowoccupationalstatusandthosewhoweredependentonmicro-creditloansduringaflood,whereitwaslikelythattheeconomiceffectofafloodresultedinparentsbecomingincreasinglyconcernedwithsurvivalstrategiesrelatingtofoodandshelter,motherswerepreoccupiedandoverburdenedanditseemedthatparentsneglectedtheirchildrenbyinadvertentlyexposingthemtovarioustypesofinjuries(drowning,burns,cuts,falls,animalinjuries,amongothers.).198

Alsocommonlymentionedascentraltorespondingtodangersandinjurywerecommunitygroups:83%ofsurveyrespondentshadworkedwiththemonpreventionandresponseactivities.Mothers’groupswerefoundtobecentraltoinjurypreventioneffortsinNepal,asdetailedinfigure15.Supportedbycommunityhealthvolunteers,mothers’groupshaveincreasedtheirknowledgeandawarenessofchildinjuries,broughtaboutenvironmentalchangestoimprovesafety,andtakenonanadvocacyroletopreventinjurieswithintheircommunities.InUganda,youthgroupshavebeenparticularlysuccessfulatidentifyingtherisksandcreatingsolutionstothephysicaldangersfacingdisplacedrefugeechildren.199

Assessment and situational analysis Oftheinteragencychildprotectionrapidassessmentsreviewed,therewerenoticeabledifferencesinthewaythatphysicaldangersandinjurieswereassessedandreported:fiveincludedanassessmentofallriskstophysicalsafety,combiningbothviolentandnon-violentthreatsintheirquestioning‘whatarethemainrisksthatleadtothedeathoforinjuryofchildren?’200Sixreportedviolentthreatsandnon-violentthreats,butas

196Surveyrespondentcomments197ExperienceofWarChildUKAfghanistanKeyinformantsubmission22.198ABiswas,ARahman,SMashreky,FRahman,KDalal(2010).Unintentionalinjuriesandparentalviolenceagainstchildrenduringflood:astudyinruralBangladesh199Thiscanbefoundin:Sectiontwo–Thehumanitariancontext–typesofdangersandinjuries–roadtrafficinjuries200MyanmarRakhineState(2012),PhilippinesCentralMindanao(2014),PhilippinesTyphoonBhopal(2013),KurdistanRegionofIraq(2014),OPTGaza(2014).

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separateissues,201andfiveassessedonlyviolentthreatsbutincludedERW.202Itcanalsobegeneralisedfromtheliteraturethatinmanyassessments(interagencyandagency-specific)beyondreferencestosummaryfindingsondangersandinjuries,veryfewincludeddetailedinformationontheirtypesorcausesofinjuriesdisaggregatedbyageandgender,asrecommendedinCPMS#7.

Thefindingsbelowarecompiledfromthoseassessmentswhereallphysicalthreatswereconsideredalongsideeachotherintheassessmentprocess.Althoughtheresultsinthistablearenotstatisticallycomparable,theyareanimportantvisualindicationofthegravitythataffectedcommunitiesplaceonthedangerspresentinchildren’sphysicalenvironmentandtheriskstheypresenttochildren’sprotectioninemergencies.Inallfiveassessments–whichincludedbothnaturaldisastersandconflict–‘environmentalrisks’203wereratedasthetopthreatfacingchildren;inthePhilippinesMindanaoassessmentasmanyas93%ofsitesreportedthistobethecase.

Ifweconsiderthebelowfindings,alongsideafewkeypointsfromthesurvey:1)lessthan30%ofrespondentsfeltconfidenttheyknewthemaincausesoffatalandofnon-fatalinjuriesinchildreninemergencies;2)96%ofrespondentsstronglyagreeoragreeitisimportanttocollectdataondangersandinjuries;and3)37%ofrespondentsagreedand19%wereunsureofthestatement‘dangersandinjuriesarenotapriorityissueforchildrenintheircontext’;itwouldindicatethereareweaknessesinthelevelandqualityofassessmentinformationneededtomakeevidenced-baseddecisionsonchildprotectionprioritiesandprogramminginemergencies.

201EthiopiaGambella(2014),Tunisia(2011),SouthCentralSomalia(2011),ThailandFlooding(2012),YemenHajjahGovernorate(2012),PhilippinesTyphoonHaiyan(2014).202Syria(2013),NorthMali(2012),PakistanKhyberPakhtunkhwa(2013),Lebanon(2013),Za’atariCampJordan(2012).203Underthetermenvironmentalrisksfellhazardssuchasfreestandingwater,pitlatrines,fires,badroads,rivercrossings,electricitywires,largeholesandditches,quicksand,anddebris.InPhilippinesTyphoonBhopalassessmentinsidehomeassociationenvironmentalrisksalsocoveredissuesthatwouldfallunder‘intentionalinjuries’relatedtoviolence.

Rank 1 2 3 4 5MyanmarRakhineState(2012)%Respondents

EnvironmentalRisks(freestandingwater,areasaroundlatrines)79%

Domesticviolence14%

Civilviolence7%

OPTGaza(2014)%Respondents

49%EnvironmentalRisks(electricity,sewer,firerelated)

47%Car/RoadAccidents

36%Lackofaccesstomedicalcare

34%Communityviolence

22%Returntohostilities

PhilippinesCentralMindanao(2014)%Sites

93%EnvironmentalRisks 47%groupviolence/armedforces

33%ERW 13%Severephysicalabuse

13%Domesticviolence

KurdistanRegionofIraq(2014)%Respondents

45%Environmentalriskschildren’sphysicallivingenvironmentandsurroundings.

37%Others(hunger,lackofhealthfacilities,dangerousanimals,snakes,scorpions,weather)

25%Carorroadaccidents

5%Workrelatedaccidents

4%Domesticviolence

PhilippinesTyphoonBhopal(2013)%Sites

50.3%EnvironmentalRisks(Outsideandinthehome-outsidereferredtopitlatrines,deepholes,ditches,quicksand,debris,ruinedbuildingsetc.Athomereferredtodomesticcorporalpunishment,familyviolenceandsexualviolence).

25.7%Carorroadaccidents

12.2%CriminalActs

2.4%Sexualviolence

1.8%WorkrelatedAccidents

Figure17EverythinghighlightedinboldindicateschildprotectionconcernsthatwouldfallunderCPMS#7DangersandInjuries

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Practitionersdonotknowenoughaboutthephysicalthreatstochildreninemergencies.However,itisclearthatcommunitiesplaceahugeemphasisonchildren’sphysicalsafety.Afundamentalstartingpointmustthereforebeitsinclusioninallchildprotection,healthandeducationassessments,wheredataisdisaggregatedbytypeofinjuriessub-groupsofageandgender.

Do no harm Allinterventionsinemergencieshaveunintendedconsequences,includingnegativeones.Donoharmistheprinciplethat“Thoseinvolvedinhumanitarianresponsemustdoalltheyreasonablycantoavoidexposingpeopleaffectedbydisasterorarmedconflicttofurtherharm”.TheCPMSmakereferencethatthisincludes“inparticulartheriskofexposingchildrentoincreaseddangerorabuseoftheirrights”.204Asacentraltenetofhumanitarianassistance,itisrelevanttoallthosewithapresenceinemergencies.

Abroadconcept,itencompassesdiscussionsonissuessuchasconflictsensitivity,aswellthefundamentalelementsofhowhumanitarianassistanceisplannedandprovided,andhowthatimpactsthephysical,psychologicalandsocialsafetyofaffectedpopulations.Whileitisunrealistictoexpectthatalldangersandinjuriescanbepreventedinemergencies,humanitarianactorsmuststrivetolimitthenumberandseverityofinjuriesthathappenasaresultoftheirinterventions,aswellastheconsequences.

Manychallengespersistinemergenciesthathaveadirectbearingoninjuryprevention(asdetailedinsectionfour).Thisreviewfoundthatconsiderationofchildren’sphysicalsafetyandprotectioninhumanitarianactivitieswasinsufficientorlackinginanumberofplaceswhichthenledtothedeathsandinjuriesofchildrenandtheirparents.Inadditiontotheexamplesreportedinthemainbodyofthisreport,someofthecircumstanceswherehumanitarianprogrammeshavefailedtotakeadequatesafetymeasuresinclude:

Childprotectionservices.Childfriendlyspacesareperhapsthemostwidelyusedchildprotectioninterventioninemergenciesanddespitebeingintendedasaplaceofsafety,wheretheyarenotwell-builtormaintained,theypresentthegreatestriskofphysicalinjurytochildren.Raisedonanumberofoccasionsthroughtheinterviews,surveyandliteraturereview,CFSwerefoundtobepotentiallyhazardousdueto:standingwater;muddyfloors;beinglocatednexttobodiesofwaterwhichchildrenwouldplayin(presentingbothariskofdiseaseanddrowning);brokenglassornailsonthefloorofthecompound;youngchildrenusingoutdoorplayequipmentthatistoobigforthemtousesafelyorpoorlyconstructed;inadequatelevelsofstaffingtosuperviselargenumberofchildren;thefrequentuseoftemporarystructuresandtheirappropriatenessintermsofsafetyinwindandrain,cold,noiseandheatetc.;andbeinglocatednexttobusyroadsorinplaceswheretherewasnosafepassage.ThemajorityoftheseissuescentrearoundthesafeconstructionandmaintenanceofCFS,whichmustbethoughtaboutinadvanceduringplanningandsitingphases.Theyhaveadequatetechnicalinputfromshelterexperts,andincludesufficientallocationinbudgetsandjobdescriptionstokeepCFSsafeandsecure.MoreonthiscanbefoundinthesectionsonShelterandChildFriendlySpaces.

Inactiveconflictwhereexplosiveweaponsareused,extrathoughtandriskassessmentneedstobegivenontheoperationandlocationofchildprotectionservices.ThiswashighlightedinSeptember2015inAleppoSyria,whenamortarattackkilledsixchildrenattendingaUNICEF-supportedCFS,andatleast13others.205WorkinginunpredictableanduncertaincontextslikeSyriaandIraqwherebombardmentsareadailyoccurrenceplacesadditionalresponsibilitiesuponchildprotectionworkerstoensurechildren’sphysicalsafety.

InAfghanistan,WarChildUKhavemainstreamedprotectionfromphysicalthreatsintochildsafeguardingproceduresundertheirbroadprogrammingwhichincludeschildcasereportingformsandstructuredreportingandresponse/referrallineswhicharewellcommunicatedtoallstaffandpartners,whoaretrainedtwiceyearly.Thesystemislinkedtothe‘ChildHelpline’,mannedbysocialworkersandavaluablesourceofinformationforthoseseekingadviceorrequiringcriticalassistanceforchildren.Itofferswell-connectedand

204CPWG(2012).Minimumstandardsforchildprotectioninhumanitarianaction,CPWG,Geneva;205UNICEF,HSinger,Pressrelease16thSeptember2015.Accessedon5thJanuary2016.Canbefoundat:http://www.unicef.org.uk/Media-centre/Press-releases/Mortar-attacks-which-killed-children-in-Aleppo-reprehensible----UNICEF/

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coordinatedaccessforchildrentotheorganisation,relevantserviceproviders,communityleadersandrelevantgovernmentagenciesthatdirectlydeliversocialprotectionandresponseservices.206

Otherhumanitarianservices.Insomeinstances,temporarystructuresthatarepoorlyconstructedormaintainedhavecauseddeathandinjuryinchildren.OnekeyrespondentrecalledacasefromtherefugeecampsinEthiopia,whereasmallchildwaskilledwhenatemporarystructurewasblowndownbythewind.Aspreviouslymentioned,thedesignandlocationofshelterandIDPsettlements,evacuationcamps,bunkhousesortransitorysitescampscanbeparticularlydangerousforchildren,especiallyiflocatednexttoroadsorunprotectedopenbodiesofwater.207WASHservicesandfacilities-suchasopenpitlatrines,WASHtruckcollisions,unfencedholesleftduringconstructionandunfencedgarbagepitswerealsoraisedashavingcausedharmtochildren.Watersafetyduringevacuationortransport.Onehealthpractitionerwithaparticularfocusondrowningpreventionspokeoftherisksassociatedwithinadequatesafetymeasureswhenworkingincountries,suchasBangladeshandMyanmarwheretransportationbyboatiscommonplace.Citingpotentialissuessuchasthesafetyandmaintenanceoftheboat;thepresenceofsafetyequipmentsuchaslifejacketsinadequatenumbersforthenumberofoccupants;trainingofboatpilots;andthestandardsoflifejacketsthemselves.208WastedisposalfromhealthserviceswasalsoidentifiedinNepalandEthiopiatobearisk.InEthiopia,childrenwereabletoaccessmedicalwastewhichwaspotentiallycontaminatedorcontainedsharpobjects,andwheresexualhealthprogrammeshaddistributedcondomsandtheywereveryaccessibletothecommunity,childrenhadstartedplayingwithnewandthenusedcondoms.HerechildprotectionactorshaveworkedwithhealthservicesandGBVactorstotakeremedialaction,includingtoimprovethedistributionanddisposalofcondomssochildrenarenotabletoaccesstheminappropriately.209

Watersafetyinstructioncarriesconsiderableriskofharmingchildrenthroughitsveryintervention.Factorssuchasthecapacityandstandardofinstructorsandthelevelsoftrainingandmonitoringthatarepossibleinmanycountriesaffectedbyemergenciesareinadequate;themodificationofrisk-takingbehaviourinchildrenwhohavelearnttoswim,particularlywhenthereislimitedexperienceofopenwaterrequiresexamination;andteachingyoungchildrentoswimonalargescalehasdirectlyassociatedrisksintermsofchildrendrowningduringlessons.

TheseriskscanbeminimizedwithriskmanagementstrategiesthatarebasedonevidenceandeffectivenessfromLMICsettings,

206Keyinformantsubmission22207ExamplesfromthePhilippines,Nepal,Uganda,Ethiopia,SouthSudan208Keyinformantinterview18209Keyinformantinterview1andNepalRedCross(2015)NepalGorkhaEarthquake-2015InternalRealTimeEvaluationofEmergencyHealthResponseServiceofNepal;andHealthandPopulationSector(2015).

UNHCRSafeRoadUseCampaign

UNHCRworksinsome125countriesandmanages6,500vehiclesglobally.TotakestepstoaddressthelargestcauseofdeathsandinjuriesamongstUNstaff,andinconjunctionwiththe‘UNDecadeofRoadSafety’,UNHCRlauncheditsinauguralorganisationalwide‘SafeRoadUseCampaign’in2015,whichaimstotoachievezeroroadfatalitiesandinjuriesamongstaff,partnersandallotherroadusers.

Thecampaignraisesawareness,trainingandstandardsamongststaff.Itsitsalongsideotheroperationalactivitiessuchascentralisedfleetmanagementandvehicleinsuranceschemeofwhichaportiongoesannuallytoroadsafetycampaigns;mandatoryreportingofanyincidentandimproveddatacollection.

Challengesincludesignificantunder-reportingandthecollectionofdisaggregateddata;althoughotherroadusersaredisproportionallyaffected,thecampaignforthemomentfocusesonimprovingstaffsafety,notthatofotherusers.

Figure18Source:Keyinformant10andUNHCR.PressRelease:10June2015.UNHCRincampaigntocutglobalroaddeathtollfromoneevery30seconds.Availableat:http://www.unhcr.org/557854286.html

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andshouldformthebasisofrigorousmonitoringprograms.210

Roadsafety.Historicallythebiggestkillerofaidworkers,theimpactofroadcollisionsinvolvingvehiclesusedduringhumanitarianresponsehasanundocumentedyetpredictablybigimpactonchildrenand‘otherroadusers’.Althoughreferencesareunderstandablyrare,sixkeyinformantsinadditiontotheliteraturereviewhighlightedcaseswherechildrenhadbeenhitbyagencyvehiclesinRwanda,thePhilippines,Kenya,Iraq,Somalia,MacedoniaandDemocraticRepublicofCongo.

OnelargeNGOrecorded47roadcollisionincidentsinvolvingminororseriousinjuriesbetweenApril2013andOctober2015acrossitshumanitariananddevelopmentoperations,althoughtheyacknowledgeddeficienciesindisaggregateddatacollection.211Ofthese,37involvedseriousinjuriestoeithervehicleoccupantsorotherroadusers,andofthese-whereagewasindicated-12involvedchildrenbeinghitbyvehiclesusedbytheorganisation.212

Keyinformantsnotedchronicunderreportingamongstagencies;agenerallackofattentiontootherroadusersbeyondagencystaff,drivenbyacultureofblameandcontrolofhowincidentsarehandledatthefieldlevel;theuseofrentaldrivers,particularlyinemergencieswhenfleetsgrowexponentially;howdeathsandinjuriesareclassified,coupledwithoperationalconstraintsinmanyfragilestates;alackoffinancialincentivetopreventaccidentsthatinvolveotherroadusersintermsofcostandimpacttotheorganisation;andasensethattherewasafeelingamongagenciesthatroad

210Linnan,M.(2015)WaterSafetyandChildDrowninginVietnamAreportforSavetheChildrenVietnamThesurveysexaminedallcausesofdeath(CD,NCDandinjury)andnon-fatalinjurytoshowtheproportionalburdenofinjurycomparedtoCDandNCD.Thefirstsurvey,doneinVietnamin2001wascalledtheVietnamMulti-CentreInjurySurvey(VMIS2001).SubsequentsurveysweredoneinBangladesh,Cambodia,China(JiangxiProvince,BeijingCapitalRegion),PhilippinesandThailand.211Keyinformantinterview20212IBID

Figure19:Theperceivedeffectivenessofpreventionstrategies

Communityidentifiedandownedactivities(e.g.safetydrills,clean-upcampaigns,buildingfencesorbridges,adequatelightingetc.)

43.5veryeffective43.5effective13%unsure2%noteffective

Usingschools,emergencyeducationorrecreationactivitiestodeliverinjurypreventionmessages

33%veryeffective63%effective4%noteffective

Communityriskmappingsofdangersandinjuriesfacingchildreninacommunity

33%veryeffective58%effective8%unsure

Integratinginjurypreventionactivitiesintopublicandnon-publicservices


Safetyadvicetoparent/carersthroughone-to-onesessions


Safetyadvicetochildrenthroughgroupsessions


Safetyadvicetochildrenthroughone-to-onesessions


Publiceducationormediacampaignsonhomeandcommunitysafety

17%veryeffective61%effective13%unsure9%noteffective

Providingsaferhomeequipment,orspecificsafetyequipmentforthehome

13%veryeffective42%effective42%unsure4%noteffective

Safetyadvicetoparent/carersthroughgroupsessions


Providingsafespacesforchildrenwithoutadditionalinjurypreventionstrategies

8%veryeffective25%effective33%unsure25%noteffective8%notatalleffective

Providingleafletsorwrittenmaterialswithoutadditionaladvice

46%unsure46%ineffective4%notatalleffective

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collisionsinvolvingotherroaduserswereacceptablecollateraldamagewhenoperatingonaday-to-daybasisinhumanitarianprogrammes.213Ofcourse,thislastpointisnotthecaseinanycircumstance;liveslost,injuredordisabledunnecessarilyaspartofhumanitarianoperationshaveahugeimpactontheabilityofchildrenandtheirfamiliestorecoverfromanemergency.Thereisaveryrealneedforhumanitarianactorstotakeseriouslythehumanitarianimperativetoprotectthelivesofthepeopletheyaretheretohelpinallaspectsoftheiroperations.

Someagenciesareindeeddoingthisthroughsaferoadusecampaignsandtheimprovementofreportinganddatacollection.Oneintervieweeemphasisedtheimportanceofcreatingamandatoryandopenculturetoencouragereporting;centralcollectionandanalysisofdata;theprohibiteduseofbullbarsoncars;improvedtrainingfordrivers,andusingfull-timedriversasimportantinimprovingroadsafetyforbothstaffandotherroadusers.214

Effective prevention and response strategies Thesaying‘preventionisbetterthancure’isonethatwasconfirmedby85%ofsurveyparticipantswhobelievemostchildhoodinjuriesinhumanitariansettingsarepreventable.Whenaskedtoratetheeffectivenessofdifferentpreventativestrategies,findings(Figure19)indicate:1.Workingwithcommunities,communitystructures,parentsandchildrenisanessentialpartofsuccessfulpreventionstrategies.

2.Areasonablelevelofuncertaintyexistsamongstpractitionerssuggestingthereisaneedformorethoroughmonitoringandevaluationofpreventionactivities.

3.Preventingdangersandinjuriesismoreeffectivewhendonealongsideorintegratedwithotherinterventions.Conversely,itisnotsoeffectivewhenrunasastand-aloneactivity.

Furthersurveyfindingsandcommentsfromrespondentssuggestedthefollowingenablingfactorssupporteffectivepreventionstrategies:

• Communityriskmappingasthebasisofthedesignanddevelopmentofanycampaignoninjuryprevention.

• Consideringtheimportantdifferencesinthepossibilitiesofpreventativeactionbetweenthedifferenttypesofrisksofinjury.

• Combiningstrategiesthatcompleteandreinforceeachother.• Notfocusingonthetypeofactivity,butratheronhowtheactivitiesareimplemented.• Thevalueofgroupsessionswherepeoplecanlearnfromandencourageeachotherandpeoplecan

bereachedmorequickly.• One-to-onesessions-althoughpotentiallyunfeasibleforlargenumbersofchildren-arebeneficialfor

childrenwithadditionalprotectionconcerns,suchaschildsoldiers,children/parentsofchildrenwithdisabilities,unaccompaniedchildrenandothers.

213Keyinformantinterview10and20214IBID

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Disaster Risk Reduction ThebenefitofaddressingdangersandinjuriesduringDisasterRiskReductionisclear.Whetherrealorimagined,thephysicalthreatstolifeandwellbeinginemergenciescanbedifficultforchildrentocopewith,andtheyneedaphysicallysafeenvironmentinwhichtosurviveandthrive.DRRcandirectlyaddresssomethephysicalthreatsindisasterproneareasandincreasechildren’sresiliencetobettermanageoncedisasterstrikes.Whetheridentifyingrisksorreducingvulnerability,children’sparticipationinDRRisincreasinglyrecognisedasgoodpractice,alongsideparents,governmentofficials,teachers,andotheradultsinthecommunitywhohavetheprimarydutytoensurethephysicalsafetyofcommunitiesandreducevulnerability.

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Thesurveyfoundthat90%ofparticipantsstronglyagree(44.5%),oragree(44.5%)thatinjurypreventionshouldbeakeypartofDRRactivities.ThereviewidentifiedanumberoffindingsaboutthetimingofDRRinterventions,withmanyactionsbeingbornoutofacrisisitself,wheretherewaspotentialofanotheremergencyhappeninginquicksuccessiontoworsentheimpactofthefirst.ThiswasinseeninHaitiwhichwashitbyamassiveearthquake,tropicalstormsandcholerainclosesuccession;inNepalwhere2largeearthquakeshitwithinweeksofeachother;andinthePhilippines,followingTyphoonHaiyanwheremanywereconcernedthatasecondtyphoonwouldhitatanymoment.DRRaspartofanongoingresponsecanbevitallyimportantinsavinglivesandpreventingfurtherinjury,itcanalsoallowactivitiestoincorporatethelatestlearningfromaparticularcontextaswasseeninNepalwhenfollowingthefirstearthquake,messagesweremodifiedtoinclude‘notrunningduringtheactualshakingoftheearthquake’,and‘notplacingheavylooseobjectsoverheadlikeflowerpotsorbags’.215Inaddition,twokeyinformantsfeltDRRwasmoresuccessfulonceanemergencyhadbeenexperienced,asthishelpedagenciesandcommunitiestohaveaclearerviewofwhatwouldhappenandtherisksthatchildrenwouldface.216HoweverinNepal,manychildrenwerealsounhappythattheyhadonlyreceivedsafetytrainingaftertheearthquake,asmanywantedtoknowhowtoprotectthemselvesbefore.217

215Surveyrespondent216Keyinformantinterview3andsurveyrespondent217Plan,SavetheChildren,UNICEF,WorldVision,GovernmentofNepalCentralChildWelfareBoard,GovernmentofNepalMinistryofFederalAffairsandLocalDevelopment(2015).AfterTheEarthquake:Nepal’sChildrenSpeakOutNepalChildren’sEarthquakeRecoveryConsultation.2015

LearningfromChildren’sexperiencesinNepalInNepalachildren’sconsultationconductedsoonaftertheearthquakefoundthatpreparednessandriskreductionwereconsiderableconcernsforchildren.Manyfelttheywereunder-preparedbecausetheydidnothaveenoughinformationorunderstandingwhatearthquakeswereandwhattoexpect;orthattheyhadnotfullyunderstoodhowtoprotectthemselveswhichledtomisconceptionsandinsomecasesdeadlyconsequenceswhereachildhadmisunderstoodthe“drop,coverandhold”drillandranbackinsideacollapsingbuilding,onlytobecrushedbyit.Onekeyinformantattributedthistoinadequateearthquakedrills.Theyfeltthatchildrenhadbeengiveninformationbuthadnotdevelopedpracticalsafetyandlifeskills;anotherfeltthatitwasthewayitwasoftentaughtandthereshouldbeafocusonwhyyoutakeanaction,notontheactionitself.

Almostallchildrenwantedtoknowmoreabouthowtoprotectthemselves,withgirlsandboysfeelingthatschoolsandteachershaveanimportantroleinimprovingpreparedness.However,theyalsowantedbetterbuildingdesigns,developmentplanningandschoolcurriculums.Theysuggestedthefollowingmeasurestoprepareandprotectthemselvesfromfutureearthquakes:

Actionsthatchildrenshouldtake Actionsthatothersshouldtake:•Movetoasafeopenspaceandavoid •Ensurehomesandotherbuildingsaregoingnearoldtreesordamagedbuildings earthquake-resistantanddesignedwith•Avoidlandslide-proneareas childreninmind,e.g.lowdoorhandles/latches•Remainalertandprepareagrabbagwith forchildrentoreachemergencyitems(clothes,foodandmedicines) •BiggardensinschoolsandhousesforInformationwewouldlikesothatwecanbemore evacuation.preparedforearthquakes: •Includeearthquakepreparednessinschool•Howtoprotectourselvesduringanearthquake curriculumsandcoursebooks.•Howtobuildearthquake-resistanthomes •Teachersshouldbetrainedinpreparedness•Whatanearthquakeisandwhyithappens andsafety,andshareitwiththeirstudents•TheimpactofpreviousearthquakesinNepal

Figure20Plan,SavetheChildren,UNICEF,WorldVision,GovernmentofNepalCentralChildWelfareBoard,GovernmentofNepalMinistryofFederalAffairsandLocalDevelopment(2015).AfterTheEarthquake:Nepal’sChildrenSpeakOutNepalChildren’sEarthquakeRecoveryConsultation.2015;keyinformant3.

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“Thetimetoteachisbefore”ImportantstepsforwardintheEducationSector

TheComprehensiveSchoolSafety(CSS)FrameworkisapackagedapproachforsafetyineducationthathasbeendevelopedaspartoftheGlobalAllianceforDisasterRiskReductionandResilienceintheEducationSector(GADRRRES)andTheWorldwideInitiativeforSafeSchools.Thegoalsoftheframeworkare:•toprotectlearnersandeducationworkersfromdeath,injury,andharminschools•toplanforeducationalcontinuityinthefaceofallexpectedhazardsandthreats•tosafeguardeducationsectorinvestments•tostrengthenriskreductionandresiliencethrougheducationItusesthreefoundationalpillarstoensureeducationpolicyandpracticeisalignedwithdisastermanagementatnational,regional,district,andlocalschoolsitelevels:1.SafeLearningFacilities2.SchoolDisasterManagement3.RiskReductionandResilience Education.Amulti-hazardriskassessmentunderpinsallplanningforCSS,ideallyaspartofnational,subnational,andlocalmanagementsystems.

Aspartofthispackage,emphasisisplacedonteachinginadvancetopreventphysicalhazardsendangeringchildren’slives.Asarelativelynewapproach,feedbackfromoneNGOwhohassupportedCSSinTurkeyrevealedtheneedtoconsiderallhazardsnotjustthosetraditionally‘expected’,thatwhileCSShadbeensuccessfullyimplementedandconsideredmanynaturalhazardsinthecontext,ithasfailedtohighlighttherisksofconflictacrosstheborderinSyriaandtheinfluxofrefugees.

Figure21Source:Keyinformantinterview11,andTheGlobalAllianceforDisasterRiskReductionandResilienceintheEducationSector,andTheWorldwideInitiativeforSafeSchools(2014).ComprehensiveSchoolSafety:Aglobalframeworkinpreparationforthe3rdU.N.WorldConferenceonDisasterRiskReduction

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WhenDRRisplannedandimplementedinadvanceonanemergency,itcantargetcommunitiesthatcanintegrateactivitiesandtrainingintotheirdevelopmentstrategiesorresponseplansiftheyknowathreatisimminent.ThiswasseenintheDadaabRefugeeCampsinKenyawherechildprotectionactorsinitiatedmessagingtopreventpotentialfamilyseparationsandinjurypreventionsensitisationpriortoextensiveflooding;218andaformerprojectinNepalwhichsupportedchildrentodeveloptheirownideastoreducephysicalrisksintheircommunitiesandschools.219Followingsensitisation,children’sclubswereformed,anddisastermanagementcommitteesincludedtheactiveparticipationofchildren,teachers,schoolmanagementcommitteesandparentteacherassociations.Participatoryvulnerabilityassessmentshelpedchildrentoidentifythemostphysicallyvulnerableandriskyareas,andtousethisinformationtodevelopcommunityandschoolsafetyplans.Resourceswerethenmoreeasilymobilisedthroughadvocacy.Manystepsweretakentoimprovethephysicalenvironment.Lessonslearnedincluded:

• Participatoryvulnerabilityassessmentshelpidentifyvulnerableareasinacommunityandwaystoreducephysicalvulnerabilitytodisasterrelatedrisks.Itisalsoapowerfultooltogeneratetheresourcesneededtomakeschoolsandcommunitiessafer.

• Bymakingplansforimplementingsafetymeasures,theparticipationandmobilisationofduty-bearer’sincreases,andrisksandvulnerabilitiesareshared.

• Communitiesandschoolscanbemadesaferbymobilisinglocalresources.Asmallinitiativecansavethelivesandlivelihoodsofthousands.Inthisprojectitwasdonethroughpersistentadvocacywithdutybearerstofundsafetymeasures,andchild-ledinnovativeactionwheretenrupeesfromeveryfamilyandonerupeefromeverychildwascollectedtoestablishemergencyfundstopromotesafercommunitiesandschools.220

UNICEFhaveidentifiedthefollowingchildprotectionDRRactivitiesthatsupportthereductionofvulnerabilitytophysicaldangersandinjurieschildrenfaceduringemergencies:

• Ensurethatchildprotectionsystemsandnetworksarelinkedtothenationalandregionalearlywarningsystemsforhazards.

• Workwithgovernmentandpartnerstodevelopandimplementnationalandlocalpolicies,legislation,systemsandservicestoreducechildren’sriskstophysicalharmindisaster-proneareas.

• Advocateforadherencetorelevantinternationalinstrumentsforchildren’sprotection.ThesecouldincludetheConventionontheProhibitionoftheUse,Stockpiling,ProductionandTransferofAnti-PersonnelMinesandonTheirDestruction,TheConventiononClusterMunitions,andtheConventiononCertainConventionalWeaponsanditsProtocols.221

Inaddition,surveyrespondentsidentifiedthefollowingeffectivedeliverymodesinDRR:

• Child-tochildandawarenesscampaignsforchildrenonthedangerstheymayfaceduringanemergencyorinnewsurroundings(suchascrossingroads,burns,andothers)enablesasignificantreductionofrisks;

• Positiveparentingclassesandimprovingparent’sawarenesscanbesuccessful;• School-basedDRRandawarenessreacheslargenumbersofpeople,throughchildrenandtheirparents.

Awareness raising and advocacy Awarenessraisingandadvocacywerecitedthroughoutthecourseofthisreview,formingacentralroleinbothchildprotectionandinjurypreventionprogrammes.85%respondentstothesurveyagreedorstronglyagreedthat“moreattentionshouldbegiventoinjurypreventioninthecontextwhereIwork”and100%ofrespondentsbelievethat“childprotectionactorsshouldbeinvolvedinadvocacyorcampaignsonlocalsafetyissues”.

218Surveyrespondent219DhrubaGautam.2010.DFID,ActionAid.GoodPracticesandLessonsLearnedDisasterRiskReductionthroughSchools220DhrubaGautam.2010.DFID,ActionAid.GoodPracticesandLessonsLearnedDisasterRiskReductionthroughSchools221UNICEF(2012)DisasterRiskReductionandChildProtection-TechnicalNote

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Inadditiontogeneralsafetymessagesdiscussedbelow,awarenessraisingcontributessignificantlytosavinglivesandtheadequatetreatmentofinjuries,informingchildrenandtheirfamiliesofhowandwhentoseektreatment.IntheimmediateaftermathoftheNepalearthquakes,thegovernmentdeclaredfreetreatmenttoallinjuredpersons.Yetthiskeymessagewasnotincludedintheinter-clustercommonmessageframework,orthekeymessagesforCFSvolunteers;oneevaluationfoundthatmanyinjuredpeopledidnotseekmedicalattentionbecausetheydidnotknowthathealthcarefeeshadbeenwaivered.Giventhatnotseekingtreatmentforinjuriescancausepermanentandlifelongcomplicationsanddisability,itisvitalthesekindsofmessagesarealsoincludedinchildprotectionandwiderawarenessraisingefforts.222

IntheCentralAfricanRepublic,wherethesituationisbothvolatileandresourceconstrained,communitybasedawarenessraisingtopreventchildrenbeingharmedintheircommunitiesisacentralcomponentofWorldVision’schildprotectionprogramme.Campaignsabouttheimportanceofsafecommunityenvironmentsforchildrenandhowtocreatethemarecoupledwithmessagesonanti-discrimination,socialcohesionandnotinvolvingchildreninthewar.Facilitators-chosenfromthelocalarea-areabletocontinueworkingwhensecurityispoorandhavebeenmorereadilyacceptedbycommunitieswherereligiousandethnicsensitivitiesareparticularlypronounced;conflictsensitivityhasbeenveryimportantinthiscontext.Facilitatorsaretrainedandsensitisedtothevarietyofdangersthatchildrenface,althoughtheyusesometools,itismuchmoreimportanttheyhavestrong‘softskills’aroundknowledge,approachandtalkingwithchildrenandcommunities.Theprojecthasengagedlocalartiststodevelopimages,andworkwiththeatregroupstocommunicatewithcommunities.223First,facilitatorsworkwithlocalleaderstohelpthemunderstandtheextentandhowdangersleadtoinjuriesinchildren.Oncelocalleadersareconvinced,theythentalktothevillagersandmobiliseactiontoreducethedangers.Althoughtheconsequencesofthehazardsareeasytorecognise(brokenlimbs,childrenbeingkilledbygrenades),villagerswithoutthetime,knowledgeormeanstoaddressthem,oftendeprioritisedangers.Multi-sectorserviceprovisionhasalsohelpedbuildtrust:whenvillagersseetheirbasicneedsmetandimprovementsinchildren’slives,theyaremorewillingtocollaboratecloselyonraisingawarenessandpreventingotherdangersandchildprotectionneeds.224

Thislastpointwasreiteratedinasynthesisevaluationwhichfoundthatawareness-raisingprogrammesthatarenotintegratedintointer-sectoral(e.g.healthoreducation)programmeswerelesseffectivebecausetheywereperceivednottoaddressthecommunities’immediateneeds.Programmesseekinganexpandedfocusonavarietyofissueswereidentifiedasbeingparticularlyeffectivebecausetheyweremeetingtangiblepressingneeds.Similarly,inrelationtochildinjuryprevention,‘environmentalmodifications’(e.g.erectingrailingsonsmallbridgesandfencingoffpublicponds,installingtrafficsigns,puttingupdangerwarningsigns,andprovidingcommunalroadlighting),werefoundtobemoreeffectiveinchangingnormsandbehaviourthanawarenessraisingbecausetheyweremore‘tangible’,visibleandappreciatedbycommunitymembers.225

Mine Risk Education MREisthemostwidelyimplementedandevaluatedapproachtoawarenessraisingaroundissuesofphysicalharmandinjuriesinemergencies.PredominatelylimitedtolandminesandUXO,evaluationsofMREactivitieshavewiderlessonslearnedforbroadereffortstopreventphysicalharminemergencies.226

RecentfindingsfromaglobalevaluationofsixcountrieswhereMREhasbeenimplementedreportthatMREhasresultedingreaterawareness,modifiedbehaviourandincreasedreportingwhichhasledtothesaferemovalofexplosives.However,italsofoundthatlandminesandUXOcontinuetobeusedinlargequantities,222UnitedNationsOfficeoftheResidentandHumanitarianCoordinatorNepal.(2015)AgreedCommonMessages-23rdJune2015;NepalRedCross(2015)NepalGorkhaEarthquake-2015InternalRealTimeEvaluationOnEmergencyHealthResponseServiceofNepal;andHealthandPopulationSector(2015).AReportonPostDisasterNeedsAssessmentandRecoveryPlanofHealthandPopulationSector.June10,2015223Imageshavebeendevelopedforthefollowingissues:Childrenpickingupandplayingwithgrenades,childrenassociatedwitharmedforcescominginthevillagestoplaywithotherchildrenandtheybringweapons,childrenplayingtheforest–whogetlostandinjured,roadandmotorbikesafety,interpersonalviolenceinfamiliesandgender-basedviolence.224Keyinformantinterview225UNICEFEvaluationOffice(2012)ProtectingChildrenfromViolence:ASynthesisofEvaluationFindingsSummaryJune2012226UNICEFevaluationsfocusheavilyinthissectionforanumberofreasons,UNICEFhavecompletedandpublishedanumberofwell-documentedreports,UNICEFSynthesisEvaluations(Violence–2012,CPiE–2013)haveextractedlearningfromavarietyofsources,UNICEFhasaclearfocusonchildren,andistheleadforMREwithintheUN.

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fundingisdecreasingandinfourofthecountriescasualtylevelsarestableorincreasing,includingamongchildrenunder18insomeinstances;andinonlytwocountriesaretheydecreasing.Goodpracticewasidentifiedinanumberofthecountriesandisalsoreiteratedthroughtwodetailedcasestudiesbelow:227

• IntwocountriesMREhasappropriatelytargetedspecificgroupswhichfacethehighestrisks;inAfghanistanthisisadolescentboys,andinSriLanka,specificlivelihoodsgroups.Inaddition,WarChildUKinAfghanistanconductedfour-daytrainingMREprogrammesforstreet,workingandIDPchildren.228

• InSriLankacombiningMREwithalternativelivelihoodoptionswasfoundtobeeffectiveatreducingriskyincome-generatingbehaviours.Thiswasalsoemphasizedin2012synthesisevaluationwheredespiteMRE,childrenandadultswerefoundtocontinuallyengageinriskybehaviourprimarilyforsocioeconomicreasons,despitetheirawarenessofthedangers,suggestingprogrammescentredexclusivelyonawarenessraisingandcommunitymobilisationarelesseffectiveunlessstrategicallylinkedtointer-sectoraleducationandlivelihoodprogrammes.229

• InPakistanMREbecameanentrypointintopeacebuilding,byengagingreligiousandcommunityleadersaroundthemessagethatMREisrelevantforallchildrenregardlessoftheirclass,ethnicgrouporreligion.

• CommunitymonitorsandvolunteerMREmultipliershelpinreachinghighnumbersofat-riskpeople.

227UNICEFEvaluationOffice(2013)EvaluationofUNICEFProgrammestoProtectChildreninEmergencies:SynthesisReportDecember2013.Mine/ERWriskeducationandeffectivenessMREhadbeenimplementedin6oftheevaluationcountries:Afghanistan,Colombia,Myanmar,Pakistan,SouthSudanandSriLanka.228Keyinformantsubmission22229UNICEFEvaluationOffice(2012)ProtectingChildrenfromViolence:ASynthesisofEvaluationFindingsSummaryJune2012

Mine Risk Education (MRE) “Activitieswhichseektoreducetheriskofinjuryfrommines/unexplodedordnancebyraisingawarenessandpromotingbehaviouralchange,includingpublicinformationdissemination,educationandtraining,andcommunitymineactionliaison.”

Figure23(UNICEF,2005.AnIntroductiontoMineRiskEducation.InternationalMineActionStandards(IMAS).MineRiskEducationBestPracticeGuidebook1).

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Figure24Source:UNICEFCambodiaMREReport2013(Internalprojectdocument);andUNICEFandC.M.A.A,2013,ImpactAssessmentofFloodinmine/ERWcontaminatedareasintheprovincesofBattambang,Pailin,andBanteayMeanChey

MREinSyria

UNICEFhasplacedasignificantfocusonMREinSyriainpartnershipwiththeMinistryofEducation.AjointMREtoolkitwasdevelopedin2013thatincludesavarietyofawarenessraisingmaterialsandtrainingguide.Atrainingoftrainerswasheldfor‘Mastertrainers’,whorollitoutthroughschools;theprogrammehasfocusedmainlyingovernment-controlledareasinandaroundDamascusbuthopestoexpandtootherareas,andtoincreaseitsusebyotherorganisations.Onemillionchildrenhavebeenreachedthroughthisprogrammesofar.Thematerialsarealsointegratedintopsychosocialactivities.Challengesandlessonslearnedinclude:

• Operationalconstraintsmeanthetoolkithasnotyetbeenthoroughlyevaluated,andrigorousmonitoringofmessagecontentandtheeffectivenessoffacilitationisextremelydifficult.

• Itisdifficulttotellhowchildren’sresponsediffersafterreceivingthemessages.• ChildrenattendingschoolsandPSSactivitiesarethebetter-resourcedchildren.Morecommunity-

basedmobilisationisneededtoreachthemostvulnerableandoutofschoolchildren.• Theoperatingenvironmentisextremelychallengingandactiveconflictandpoliticalconstraints

preventhumanitarianaccesstomanyareas,resultinginopportunisticprogrammingwhereaccessallows,andsignificantgapsinthelocationsservedbychildprotectionactivitiesandMRE.TherearenowcomprehensivedatasetsfromWHOshowingtheareaslikelytobehighlycontaminatedbyERW,butthegapbetweenthisdataandwhereorganisationsareabletooperateleavehugeareasunderservedofthislife-savingintervention.

• RiskeducationfocusingonlandminesandUXOismissingsomeofthebigriskstophysicalsafetyinthiscontext.

• MREcannotbeinisolationofotherinterventions.• Toincreasecoverage,theMREtoolkitisintendedforuseacrossavarietyofdifferentcontextsin

Syria.Themessagesdevelopedaresufficientlyrobustbutthematerialsandformatneedtobedevelopedforlocalactorsfromdifferentareastofeelcomfortableusingthem.

PostFloodMREinCambodia

In2013,flashfloodinguncovered174mines/ERW,whichgaveUNICEFandthegovernmentanopportunitytobuilduponexistingeffortstostrengthenthemonitoringandsurveillancesystemonaccidentsandinjuriescausedbylandmine/ERWs.Inpreparation,aMine/ERWImpactAssessmentFormwasdeveloped,andfollowingtraininginNovembertheassessmentwasconductedinthreeflood-affectedprovinces.TheresultsoftheimpactassessmentsupportedadvocacytosecuregreaterfinancialcontributionbythegovernmentandUNICEFtosupportMREactivitiesinin2014.Despitechallengestoimplementationfrominfrastructuredestruction,governmentelectionsandtheinstallationofanewgovernment.MREactivitiesfollowingthefloodsweresuccessfulonanumberoffronts:MREcoordinationactivities;MREsessionsinaffectedcommunitiesreachingstudentsandout-of-schoolchildren;refreshertrainingforteachersinheavilyminedfloodedareasfocusingonlandmine/ERWwashedbyflashedfloods;andthedestructionofmines.AswellasorganisedMineAwarenessDayandInternationalDayofPersonswithDisability;supporttoMREagenciesinemergencyandongoingactivities;newMREmaterials;capacitybuildingofMREoperatorstoenforceminimumstandardsandfieldmonitoring;andthedevelopmentofanMRETVprogrammeairedonseveralchannelsforthreeweeks.Thekeymessageoftheprogrammewas“Floodwaterbringsalonggarbage,treebranchesandothermaterialsandlandmine/ERW”,includingtoareaspreviouslythoughtsafeorcleared.Atleast,50to60thousandspeoplewerereachedbytheprogrammewhichisnowusedtoeducatefloodaffectedpopulationswhoarelivingclosetocontaminatedareas.

FutureplansincludecontinuingtoprotecttherightsofCWDandstrengthensystemssothatCWDandtheirfamiliesarebetterprotectedandsupported.Continuedsupporttostrengthennationalmonitoringandsurveillancesystemsonaccidentsandinjuriesprovideaccuratedataforplanningandmonitoring,measuringprogrammeimpactsandfacilitateadvocacyandawarenessraising;continuedsupporttonationalpartnerstocoordinateandenforceMREminimumstandards,developnewmaterialsandtrainingandcontingencyplanning.

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• Havingaccesstouptodateinformationoncausalityfigureshelpstargetpreventativeprogramming.• Broadinteragencybuy-inisneededfromthebeginningofthemessagedesignphasetoprevent

duplicationofmessagedevelopmentacrossorganisations.230

MREinSriLanka

AnindependentevaluationofMREactivitiesimplementedbyUNICEFSriLankaanditspartnersthroughanoverallapproachofcombiningchildprotectionandMREduringtheconflictfound:

• Partneringwithpre-existingvillagestructuressuchasVillageChildRightsMonitoringCommitteesandchildclubswascost-effectiveandsustainable,andallowedMREactivitiestotakeplaceinareaswhereNGOswerenotabletoaccessespeciallyduringemergencyperiods.However,somecommitteesandclubsdidnotfunctionduetodisplacement,movement,and/orresourcelimitations.Inaddition,greaterincentives,clearTORs,knowledgeandcapacitytoconductMREactivitieswereneeded.

• School-basedMREwasthoughttobesuccessfulinreachingschool-goingchildren.Educationandhealthpartnersexpressedaneedforgeneralinjurypreventionandsafetyeducation.ItwassuggestedthiscouldincludeMREalongsidesessionsonthepreventionoffalls,snakebites,drowning,andothers.

• Involvinglandmine/ERWinjurysurvivorsinMREandmineactionprojectshelpedsurvivorsfeelempoweredthroughtheirinclusionandresponsibility,andhappytocontributetoprotectingtheircommunities.InonelocationchildrenblindedbylandminesconductedMREactivitiesincoordinationwithchildren’sclubs.

• Whenexpensivecommunicationprojectswerethoughtnottoberesultinginsignificantbehaviourchange,andeffortswereunderwayacrossanumberofdifferentsectorstoaddressdifferentkindsofsocialandhealthissuesthroughcommunication.Inter-sectorcollaborationwasrequestedtoconductabroadsurveyonthepreferredsourcesofinformationfordifferentkindsofissues,keyinfluencers,useoftechnology,andpreferredinformationmethods,theresultsofwhichwouldbeusedtoprovidecommunitieswithmessagesonawiderangeoftopics.

• ItwasvaluableforNGOstoreportlandmineandERWinjuriesandincidentstoacentraldatabase.However,challengesexistedbetweenMREstaffandhospital/healthpersonnelwhowouldnotreleaserequestedinformationoninjuriesforreporting.TrainingwasneededforMREandhealthpersonnelsotheycouldomitidentifyingdataandensuredatasharingbetweenactors.

• Wherepovertyhadforcedchildrentodropoutofschoolandconductlivelihoodactivities,theywerefoundtobeata“doublerisk”becausetheywereconductinghigh-riskactivitieswithoutreceivingschool-basedMREmessaging.Anotheridentifiedvulnerablegroupwerechildren(formerly)associatedwitharmedforcesandarmedgroups,astheymighthavereceivedtraininginlandmine/ERWuseduringtheirtimewitharmedgroups,andmaybeatparticularrisk.

• ItwasimportantforMREactivitiestotakeaccountofconcernsraisedbycommunities,boththoserelatedtoMREandthosebeyonditsscope.Itwasfoundthatalthoughlandmines/ERWwereoftennottheprimaryconcernofaffectedcommunities,particularlywheredisplacementandsurvivalweresignificantfactors,theywereoftenindirectlyrelatedtocontaminationandhigh-riskbehavioursuchaspovertywhichresultedinchildlabourandschooldropout.Aslongascommunity’sprimaryconcernswentunaddresseditwasmoredifficulttoadvanceMREprogramming.

• TheHumanitarianDeminingUnit,asmilitarypersonnel,werebetterplacedthanNGOstoprovidecertainMREactivitiessuchaslandminesigngardens,answeringtechnicalquestions,havingaccesstophotosofnewlyfoundcontaminants,withoutbeinghinderedbymovementrestrictions.Manywerealsofoundtodeveloppositiverelationshipsinthecommunitiestheyserve,playingwithchildandyouthclubsandcollaboratingwithNGOstoorganisesportsclubsforlocalyouth.However,alackoffemalefacilitators,facilitatorswhocouldspeakthelocallanguage,andthedeminingunitwearingmilitaryuniformcreatedbarriersbetweentheirwell-intentionedMREactivitiesandcommunities.

230Keyinformantinterview19

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Injury survei l lance InjurysurveillancehasbeensuccessfullylinkedtoMineRiskEducationinasmallnumberofcountries,usinghospital-basedinformationitcanleadtoabetterunderstandingofthescaleoftheproblem,andcanbeintegratedintoexistinghealthinformationsystemstomonitorchangesresultingfrommine/UXOuseandpreventativeinterventions.Thedatageneratedisabletoguidenationalpolicyoninjuryprevention,helpwithidentificationofcontaminatedareas,victimassistanceandcreatinganevidencebaseforadvocacyandpubliceducation.Figure25highlightsthecaseofEritreawhereUNICEFhasworkedwiththegovernmenttointegratelandminesandUXOintoanationalinjurysurveillancesystem.ReferencetotheEritreancasestudycanprovideyouwithmoreinsightonhowUNICEFsuccessfullyinstitutionalizedtheISSmodel.Moreinformationcanbefoundatthefollowingwebsite:http://www.who.int/violence_injury_prevention/publications/surveillance/landmines/en/

Safety messaging and risk education WhereMREhastraditionallycoveredaspecificsetofactivitiesfocusedonlandminesandUXOandisguidedbytheInternationalMineActionStandards(thestandardsinforceforallUNmineactionoperationsandinternationallaw).Syria-oneofthemostdangerousplacesonearthtobeachild-hascreatedasituationwherechildrenfacelife-threateningriskseverydayandfromallangles.Outofthishugeneedforphysicalsafetyhavecomeanumberofinterventionstoaddressbroaderriskeducation.

SafetyMessaginginNorthernSyria2013

SafetymessagesforriskeducationweredevelopedbySavetheChildrenin2013inresponsetoabroadrangeofdangersthatchildrenwerefacinginactiveconflict.ThemessagestooktheformofICE(InCaseofEmergency)messagesforchildren,parentsandcaregiversondifferenttopics,suchashowtobehaveifcaughtinshelling,andotherphysicalhazardssuchaslandmines,gunfireandchemicalattack,alongsidemessagesonhealth,hygieneandthepromotionofpsychosocialwellbeing.Themessageswereusedinover50primaryschoolssupportedbySavetheChildren,11ofwhichfunctionedasCFSforstructuredrecreationalactivitiesandpsychosocialsupportactivitiesintheafternoon.Themessageswerefacilitatedbyteachers;inthiswayeducationandchildprotectionactivitieswerewellintegrated,andreachedcommunitieswhereitwasnotpossibletoimplementchildprotectionprogrammes.Althoughnoformalevaluationhasbeendone,thetoolshavebeenwell-receivedandpositivefeedbackreportedbyteachersandchildrenasthiswastheonlyavailabletoolwithsuchmessages.231

RiskEducationandtheSyrianCivilDefence‘TheWhiteHelmets’

TheSyrianCivilDefenceareaneutralandimpartialhumanitarianorganisationofSyriancitizens,whooutofacivicdutyanddesiretosupporttheircommunitiesduringtheconflicthavebecomerescueworkers,playingthemostimportantoflife-savingroles.MembersareengagedinawidearrayofactivitiesthatdirectlyprotectthebesiegedpopulationsofSyriasuchasmakingareassafe,firefightingandsearchandrescue.Theyarealsoinvolvedincommunityengagementandawareness,andwiththesupportofMaydayRescue,havedevelopedandrolledoutaCommunitySafetyManual.Themanual-likealloftheirwork–takesan‘allhazards’approach,consideringallnaturalandman-madehazardsalongsideeachother.Althoughthelistisextensive,riskscoveredinclude:

• Aircraftbombingswarningof‘doubletap’bombings(whereaircraftbombandthenreturnwhilstpeoplehavegatheredtobombagain)

• Chemicalweaponsattackswarningtostayupwind,removeclotting,turnoffairconditioning,goupstairs

• Burnsandhowtopreventthespreadoffireonyourself• Howtosafetyevacuatetheinjured• Howtokeepsafeinaduststorm,mountainorforestfire• Firesafetyandhomeheating

Toreachchildren,themanualhasbeenadaptedintoanimatedvideosandcolouringbooks.Maleandfemalevolunteersconductsessionswithchildreninschoolsandcommunitiesandsimulateemergencies,where

231Keyinformantsubmission26

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childrenactoutwhattheydoshouldiftheyfindthemselvesconfrontedwithaparticulardanger.Theorganisationisalsopilotingyouthengagementthroughcivildefenceactivitiesandlearningaboutsafetyinthehomeandcommunity,afterwhichtheycangraduallybecomemoreinvolvedincommunityawarenesssessionsandday-to-dayactivities.

ThesuccessofthesafetyinterventionstheSyrianCivilDefencearerunninghavebeenattributedtoanumberoffactors:impartialityandacceptancebypartiesonallsidesoftheconflictallowsittoconductitswork;theupstandingrolethatitsmembersplayinthecommunity;agrassrootsapproachrequiringlittlerelianceonoutsideactors;outreachinschoolsandcommunities;targetingofgroupswithspecificdemographics;amanagementstructuremeaningthatsupportisthere,butrulesandregulationsarelimitedandrescueworkersarefreetorespondtotheissuesmostseriousandimmediatelypressingintheircommunities;trustbetweenthetwomainpartners.

AlthoughtheSyrianCivilDefenceForceisnotatraditionalchildprotectionactor,theyarecertainlyprotectingthelivesofchildrenfromdangersandinjuries.Wherethecontextofwarisasignificantbarrierfortraditionalhumanitarianorganisations,therearelessonstobelearnedfromtheirapproachtocommunitysafetyincluding:

• Identifyingandaddressingsafetyconcerns‘fromthebottomup’,whichishelpedbymembersbeingfromthecommunitiestheyworkin;

• Takingan‘allhazards’approachtosafety;• Involvingyouthinameaningfulway,givingthemasenseofpurposeinanotherwisediresituation;

Community r isk mapping Riskmappingwasnotedinavarietyofsituationstobeanimportanttoolinthisareaofchildprotection,particularlyasitisanactivityinwhichchildrencanplayacentralrole.InNepalriskmappingwasdoneinchildren’sgroupstoidentifyplacesandactivitiesthatweredangerousforchildren.Lookingatallthedifferentplacesinthecommunity(e.g.home,CFS,markets,busstops),childrenpickedfromasimpletrafficlightsystemofgreen,amberandred.Redshowsplaceswherethechildfeelsunsafeandatrisk.Greeniswherethechildfeelssafe,andamberindicatessomelevelofrisk,whereprecautionisneeded.Resultswerefoundtovarybyageandgender:youngchildrenidentifiedredplacesasisolatedplacessuchabusstops,andsomeschool-agedchildrenidentifiedschoolsasredasdespitethegovernmentidentifyingcertainschoolsassafeforusefollowingtheearthquake,childrenfeltthebuildingswereunsafebecausetheyhadcracksinthewalls.Insomecases,unaccompaniedchildrenidentifiedextendedfamilies/fostercareasredbecauseoftheriskofexploitation;andadolescentgirlsmarkedcommunaltentsasredbecausetheylackedprivacy.InsomeparentingsessionswhereriskmappingwasdoneaspartofCFSactivities,parentsidentifiedroadsandareasoflandslidesasparticularlydangerous.Wheredangerswereidentified,differentactivitiesandmessagesweredevelopedbydifferentclustersontheissuesthatwerebeingraised.OnesuchexamplewasanactivitybytheChildWelfareBoardtoconductavulnerabilityassessmentinall14affecteddistrictsincludingCWD,injuredchildrenandtrafficking.Thishasledtotheidentificationofvulnerablechildrenineachdistrict,towhomthegovernmenthasagreedtoprovidespecialistassistance.232

AslightlydifferentformofriskmappinghasbeendevelopedbyWarChildUKinUgandaandisnowinuseinJordanandAfghanistan.TheChildSafetyReportCardisaformofsurvey,aimingtoensurethatchildrenreflecttheirfeelingsofsecurityandinsecurityintheirhome,schoolandcommunities.Itisbasedonchildfriendlyparticipatoryresearchmethodsincludinggroupdiscussions,drawings,rankingandparticipatorycommunitymappingmethodologies.Childrenarealsotrainedonhowtoadministerasurveywithotherpeerchildren.Astheyareanonymousandchildfriendly,theyhaveprovenaneffectivemethodforenablingchildrentodescribetheirexperiencesandexpresstheirviewsinasafewaythatmakessensetothem.233

Community-based chi ld protection Thereviewfoundthatcommunityengagementinidentifyingandprioritisingtheissuesandsafetyofchildrenwasafundamentalcomponentofanyresponse.Quiteoftenitwasfoundthatthesupportofexistingreligious

232Keyinformantinterview6233WarChildUK(2015).LessonsLearntReport:WarChildWorkingtowardsqualityprogrammingforchildrenaffectedbyarmedconflict.

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andcommunityleadersandgovernmentmandatedcommunitycouncils/structureswasneededforsuccessfulprojects,andcouldeffectivelybeintegratedintoresponses.

Alsonotedabove,WorldVision’sapproachinCARcentresoncommunitybasedchildprotectionwhichhasapromisingfocusonpreventingdangersandinjuriesandcreatingsafeenvironmentsforchildreninruralandisolatedcommunities,wherecampaignsandactivitiesareruninconjunctionwithlocalauthorities,communityleadersandyouthgroups,whooncetheyhavebuiltarelationshipwiththefacilitators,andhaveconfidenceinthemandtheorganisation,areveryopentocollaboratingandtakingactiontoreducechildren’sexposuredangers.InDadaabRefugeeCampsinKenya,a‘SafePlacesScheme’wasintroducedintothecommunityinresponsetotheviolenceanddangerschildrenfacedonadailybasis.Thepremisebeingthattrainedfocalpointssuchasshopowners,youthvolunteers,religiousandcommunityleaders,weresituatedinplaceschildrenhadidentifiedtobeunsafeinthecamp(e.g.tapstands,markets),andfunctionedassomewheretheycouldgoincaseofurgentneedandassistanceastheymovedthroughthecamps.Althoughthesafeplaceswerepredominatelysetupinresponsetoviolenceandabuseagainstchildren,focalpointswouldalsotakeactiontomakethephysicalenvironment(intheidentifiedunsafeplace)assafeaspossible.TheprogrammealsoworkedwithcampmanagementagenciesandUNHCRonintegratingfloodpreparednessintoactivities.Earlyfeedbackhighlightschallengesinfindingpeopleintherightareaswhoweresufficientlycommittedtochildren’sprotectiontoplaytherole;therewerealsomanyunsafeplaces,somanyfocalpointswereneeded,makingitalargeprojecttomonitorandsupport;onestaffsharedconcernsthatpeoplewouldnotuseitastheypreferredtoreportitinanofficeandnotwithinthecommunitywhereconfidentialityandimpartialitymightbeaconcern.

Self-helpwasanoteworthyconceptinbothNepalandUganda;inNepalcommunity-basedwomen’sgroupsandchildprotectioncommitteeshavedevelopedself-helpactionplansbasedonriskmappingdonebychildrenandparents,groupsthenmeetandholdactivitiessuchasstreettheatretoaddressissues.AndinUgandaamongstSouthSudaneserefugeesitwasfoundthatthebottom-upapproachesalwaysworkbest,lettingthecommunityidentifyissuesofconcernanddeveloptheirownactionplans,whichtheygoontoimplementunlessbreakingthelaworpresentingasafeguardingissue.234

Capacitywasalsoidentifiedasakeychallenge.InNepal,manychildprotectioncommitteeswerenotmatureenoughtoidentifyanddirectlysupportchildren;heretheyplayedastrongerroleinmonitoringreliefandsupporttovulnerablechildrenaswellasinawarenessraisingofchildprotectionissuesinthecommunity.InEthiopiaithasbeenimportanttoraiseawarenessofdangersandinjuriesincommunitiesasa234Keyinformantinterview6and15

SupportforchildreninEritrea

InEritrea,where20%ofthe75,212personswithdisabilitiesarechildrenandaccesstoeducationremainsachallenge,UNICEFhaveruna“DonkeysforSchool”projectthatincludedtransportationfor900CWDtoandfromschoolinremotenorthernregions,althoughlimitedfundinghasaffectedtheproject,itledtoincreasedperformanceandenrolment,andareductionindropoutsamongCWD.ItalsoincludedCFSpromotioninwar-affectedschools/communities;theprocurementof950recreationalkitsforchildrentoreducetheirexposuretolandminesandERW;theprocurementof4,500firstaidkitstostrengthentheimmediateresponseforminevictims;andtheprovisionof300differentmobilitydevicesincludingwheelchairs,tricycles,auxiliaryandelbowcrutches,walkingframesandbabywalkers.Theprojecthasbeenunderpinnedbypolicysupportforchildreningeneral,andanationalpolicyforpeoplelivingwithdisabilitiestoimproveaccess,opportunitiesandinclusionofCWD;aninclusiveeducationpolicytostrengthenthemainstreamingofCWDintonormalschools;andanationalplanoninjury,violenceanddisabilityprevention;furthermoresystemsstrengtheningsupportthroughtheprovisionofspecialisedequipmentfortheNationalPhysiotherapyCentre,hasdirectlycontributedtotheremovalofsomeoftheinstitutionalbarriersforthetimelytreatment,referralsandrehabilitationofCWD.

Figure25MSeedat,AvNiekerk,ASukhai(2013).UniversityofSouthAfricaInstituteforSocialandHealthSciencesandMRC-UNISA:SafetyandPeacePromotionResearchUnit.TheEritreanNationalInjuryPreventionandSafetyPromotionResponse:Strengths,GapsandRecommendations.DraftNovember19th2013

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waytostrengthentheirrecognitionandreportingofsafetyissuestocampauthoritiesandrelevantserviceproviders.

Support for survivors of explosive weapons Childrenwhoareinjuredandleftdisabledbylandmines,ERWandotherexplosiveweaponshavespecificneedsandrequirecomplexrehabilitation,healthcareandpsychosocialsupportthatmusttakeintoconsiderationtheirage,growthanddevelopment.Educationandeconomicstrengtheningactivitiesarevitallyimportantforthehealthyrecoveryofchildrenfromtheimpactofexplosiveweapons,buttheymayneedadaptingtoensurechildren’sfullaccesstoservices,suchastheprovisionoftransport,physicalaccessibility,andsupportforsocialinclusion.Furthermore,childrenwhohavefamilymemberskilledorinjuredfaceadditionalphysical,socialandeconomicburdenswhichcanhastentheirwithdrawalfromschoolandincreasetheirvulnerabilitytoexploitationandabuse.235

Regardlessofthesecriticalneeds,supportisfartoooftenunavailableandvictimassistancecontinuestostandoutasakeyareaofweaknessinmineactionprogramming.Themajorityofmineactionassistanceandfundingisdedicatedtoclearanceactivities:in201085%ofglobalmineactionfundswereallocatedtoclearance,withonly9%goingtovictimassistanceinterventions.Moreover,theage-sensitiveactivitiesthatareconductedremainfocusedoncollectingdisaggregateddata,ratherthanonactionsdesignedtoaddressthespecificneedsofchildren.236In2009aHandicapInternationalsurveyofmorethan1,600survivorsfrom25affectedcountries,foundthatalmosttwothirdsofrespondentsreportedthatservicesforchildsurvivorsoflandminesandERWwere“never”or“almostnever”adaptedtoaddresstheirspecificneedsorensurethatserviceswereageappropriate,237hardlysurprisingwhenglobalactiontoimprovevictimassistancemakeslittlereferencetothespecificneedsofchildvictims,238andtheInternationalMineActionStandardsaddressclearance,ERW/mineriskeducationandstockpiledestruction,butdonottackletheissueofvictimassistance.2392014and2015haveseentheintroductionofanumberoftoolstosupportstrengtheningassistancetochildvictims,theseincludechild-focusedguidanceforvictimassistancefromUNICEF,atechnicalpapersubmittedbythegovernmentsofColombiaandAustriatotheMaputoReviewConference,andaGuideforComprehensiveassistancetoboys,girlsandadolescentlandminevictims.240

Althoughage-sensitiveassistanceremainedamongtheleastmeasuredandreportedaspectsofvictimassistance,asmallbutincreasingnumberofactivitieswerereportedbyStatesPartiestotheMineBanTreatyandConventiononClusterMunitions,whoalsoexperiencehumanitariancrisis:

• InColombia,alocalvictims’associationheldworkshopswithchildrenofvictimstoidentifytheissuestheyarefacing.Whereage-sensitiveassistancewasavailable,mostreportedserviceswereforchildsurvivorsratherthanthechildrenofpeoplekilled.Inaddition,thegovernmentdevelopedanewschemeforpaymentorreimbursementofassistanceservicestomine/ERWsurvivorsthatwasintroducedtocoverchildrenandadolescents.

• InEritreaanintegratedlandmine/ERWinjurysurveillancesystemhasbeendevelopedaspartofeffortstoeffectivelymonitorandevaluateinjuriesatthenationallevelunderHealthManagementInformationSystems(HMIS),whichnowshowsinjuriesareamongstthetopfivecausesofmorbidity.

• InSudan,ahomefordisabledchildrenopenedaprostheticworkshopwithequipmentandrawmaterialssuppliedbytheICRC.

235SOTWC236UNICEF.2013.TheStateoftheWorld’sChildren2013:ChildrenwithDisabilities;andLandmineandClusterMunitionMonitor(2015)TheImpactofMines/ERWonChildren,November2015237SOTWC238BoththeMaputoActionPlan(AplanfromStatesPartiesofthatAnti-PersonnelMineBanConventiontoreaffirmtheircommitmenttoendingsufferingandcasualtiescausedbyanti-personnelmines)andtheBangkokSymposiumonLandmineVictimAssistance:EnhancingaComprehensiveandSustainableMineAction,2015,lackanyfocusonthespecificneedsofchildren.239UNICEF.2013.TheStateoftheWorld’sChildren2013:ChildrenwithDisabilities240LandmineandClusterMunitionMonitor(2015)TheImpactofMines/ERWonChildren,November2015

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• InChad,followingageneralefforttoincreaseaccesstorehabilitationservicesforsurvivorslivinginremoteareas,ICRCconductedaninformationcampaigntoraiseawarenessaboutaccessingservices,givingprioritytothoseinmostneed,especiallywomenandchildren.

• InIraq’sKurdistanregion,healthcarefacilitieswereoverwhelmedbythenumberofrefugeesinneedenteringfromSyriaduring2014,especiallywhencombinedwiththeincreaseininternaldisplacement.UNICEFandUNHCRmonitoredabordercrossingbetweenSyriaandIraqtoidentifyfamilieswithvulnerableordisabledchildrenforreferraltospecificservices.

• InSomalia,theInstituteforEducationforDisabledPeopleprovidedinclusiveeducationopportunitiesforchildrenwithdisabilities,butlessthan1%ofchildrenwithdisabilitiesattendschoolofanykind.

• InAfghanistanagovernment-runinclusiveeducationprogramhasbeenoperatingsince2008,whichhasincreasedtheenrolmentofchildrenwithdisabilities.Inclusiveeducationtrainingforteachers,childrenwithdisabilitiesandtheirparentssupportattendance,andaninclusiveChildFriendlyEducationCoordinationWorkingGroupnowdiscussesactivities,challenges,andthewayahead.241

First Aid Firstaidishelpthatisimmediatelygiventoasickorinjuredpersonuntilfullmedicaltreatmentisavailable.Usingappropriatetechniquestotakeimmediateaction,whilewaitingforprofessionalhelpcanconsiderablyreducedeathsandinjuriesandtheimpactofdisasters.Itisavitalsteptoreducingseriousinjuriesandimprovingthechancesofsurvival.Forthoselivinginconflictordisasteraffectedareas,notonlyisfirstaidawarenesslacking,butvulnerablecommunitiesoftenhavenoaccesstotraininginbasicfirstaidtotreataninjuryorkeepsomeonealive.242Firstaidisalsoabasiclife-savingskillthatchildrencaneasilylearnsotheyareabletoreactquicklytoalife-threateningsituationsuchableeding,brokenlimbsorsuffocation.Thisnotonlyhasphysicalhealthbenefitsbutalsoimportantpsychosocialbenefits

WherechildprotectionactorsareworkingwithchildrenorprovidingservicesthatgatherchildrentogethersuchasCFS,children’sclubs,oryouthclubs,thereisaresponsibilitytokeepthosechildrensafe.Firstaidcanbeanimportantelementofthisworkthathasmuchbroaderbenefitsforsocietyingeneral.InthePhilippinesfollowingTyphoonHaiyan,thePhilippineRedCrossaspartofbroadereffortstointegratetheChildProtectionMinimumStandardsintotheirimmediatereliefprogramme,trainedfemaleandmaleyouthvolunteerswhoweretrainedintheIFRCCommunityBasedHealthandFirstAidprogrammeincludingmodulesoncaringforinjuries,violencepreventionandresponse,andpsychosocialsupport.Youthvolunteerswerethenabletoattendreliefdistributions,whichwereoftenheldatschools,andwhiletheparentswaitedinline,theywereabletoorganiseactivitiesforchildrenandyouth.Theseincludedsettingupstationswhereyouthvolunteersprovidedbasicfirstaidforchildren’swoundsandcuts,conductingviolencepreventionsessions,andreachingouttoparentswithinformationonlocalreferralsforchildprotectionconcerns.Oneyouthvolunteercommented,"It’ssoimportantforkidsandadultstolearntomanagetheirstressandknowhowtohandlebasicinjuries(…)ThroughthePhilippinesRedCrosstrainingIlearnedthatviolenceisnevertheanswerandwecanalltakeactiontocareforoneanother”.243

AnotherexamplecomesfromTerredeshommespsychosocialprogrammesinDarfur,whereFirstAidtrainingwaspartofthemandatoryinductionfortheCFSfacilitators,togetherwithCFSmanagement,communicationwithchildrenandthepsychosocialapproach.ThetrainingwasdoneinpartnershipwiththeSudaneseRedCrescent,andwasthenextendedtoparentsandcommunitymemberswhowereactiveintheCFSandwhowerealsosupportinganyactivitieswithchildren.Itenabledthosetrainedtotakecareofsmallinjurieswhich

241LandmineandClusterMunitionMonitor(2015)TheImpactofMines/ERWonChildren,November2015;MSeedat,AvNiekerk,ASukhai(2013).UniversityofSouthAfricaInstituteforSocialandHealthSciencesandMRC-UNISA:SafetyandPeacePromotionResearchUnit.TheEritreanNationalInjuryPreventionandSafetyPromotionResponse:Strengths,GapsandRecommendations.DraftNovember19th2013242InternationalFederationoftheRedCrossandRedCrescentSocieties(IFRC)(2011).InternationalfirstaidandresuscitationguidelinesforNationalSocietyFirstAidProgrammeManagers,ScientificAdvisoryGroups,FirstAidInstructorsandFirstResponders.243Keyinformantsubmission25

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occurredinandaroundtheCFSoronthewaytoandfromitandalsotorefermoreseriouscasestotheclinicsinthecampandtown.244.

Importantconsiderationsfortheintegrationoffirstaidintochildprotectionactivitiesinclude:a)havingalladultandyouthfirstresponderstrainedinthepreparednessphase;b)includingfirstaidinoutreachservicesintheresponsephase;c)providingfirstaidservicesaspartofprogrammeactivitiesforchildren,especiallyinlargegroupevents.245

Case management and referral services CasemanagementandreferralsystemsareanintegralcomponentofmanyCPiEprogrammes,andmany(63%)respondentshadusedthemforchildrenwhohavebeeninjuredinemergencies.Therewaslimiteddocumentedpracticeonhowbesttosupportseverelyinjuredchildrenthroughcasemanagementinthecontextofemergencies.Mostofthefindingsfromthissectionaretakenfromkeyinformantinterviewsandtheresultsofthesurvey,whichaskedparticipantsabouttheavailabilityandqualityofservicesforsurvivorsofinjury.246

Ofcourse,nodefinitiveconclusionscanbedrawnfromthedatabelowonservicesglobally,butbroadtrendscanbeobserved:

• Inmanyplacesservicesareavailablebutpoorquality;thisisparticularlytrueofemergencymedicalcare,supportforeconomicinclusion,accessibleeducation,accessiblehousing,accessiblewaterandsanitation,informationonavailableservicesandtrainingforserviceproviders.

• Inmanyplacesservicesarenotavailable;thisisparticularlytrueofcontinuingandpreventativehealthcare,physicalrehabilitation,ortho-prosthesis/assistancedevices,legalsupport,supportforeconomicinclusion.

• Formanyservicesbetween30%and50%ofrespondentsdidnotknoworwereunsurewhatqualityandavailabilitywaslike;perhapsthisalsopointstoknowledgegapswithinhumanitarianstaffonkeyservicedeliverymechanismsforseriouslyinjuredanddisabledchildren.

• Forallbutoneservice(emergencymedicalcare),availableandgoodqualityserviceswereonlyidentifiedbybetween4%and13%ofpeople.

244Keyinformantsubmission26245Keyinformantsubmission25246Thesurveyaskedpractitionersfromtheircurrentormostrecentfieldexperience,whichservicesareavailableforsurvivorsofinjuryandwhataretheylike.Theserviceswerechosenbecausetheyformanimportantpartofreferralsystemsforchildrenseriouslyinjuredordisabledinanemergency.

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Thereviewidentifiedthatinmanyresourceconstrainedenvironments,referralmechanismsforseverelyinjuredchildrenrelyheavilyuponagencyledservicesincludingthoseprovidedbyINGOs,UNICEF,UNHCR,InternationalOrganisationofMigration(IOM)andtheRedCrossMovement.INGOsoftenidentify,registerandmakereferralstothemostrelevantpartners.Socialservices,localauthoritiesandlocalhealthcentresorhospitalswerealsonotedaskeyservicesaswereparents,hostfamiliesforseparatedchildren,CBCPMandCFS.

Surveyrespondents,keyinformantinterviewsandtheliteraturereviewemphasisethefollowingchallenges:

• Themeanstorespondisoftenlimited,emergencymedicaltreatmentisoftennotavailable,healthfacilitiesmayhavebeendestroyed,orarepoorlyequippedwithmaterialsandmedicinetoassistchildrenwhohavebeeninjured.Doctorsandnursesmayhavebeendisplacedorfled,anditcanbedifficulttoaccessspecialistcareinregionalorcapitalcentres.

• Refugeechildrenfaceparticulardifficultiesaccessingtreatmentoftenrelatedtotheirregistrationandstatusgrantedbythehostcountry.

3%

29% 35%28%

38% 36%

8%23%

4%

29% 25%31%

17%19%

16%

29% 32%

48%

36%

48%13%

30%21%

4%

4%12%

10%

12% 5%12%

13%

10%3%

21%15%

28%

19%23%

12%27%

20%29%

30%

14%

8%12%

4%

5%5%

8%8% 4%

5%

17% 8%8%

8%5%

8% 5% 4% 8%10% 13% 8% 4% 4% 5% 4% 4%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Whatreferralservicesareavailableforchildrenwhohavebeeninjuredandwhataretheylike?

Notavailable Available-poorquality

Available-goodquality Don'tknow/Notsure

Available-toofaraway Available-notadaptedforagesofchildren

Available-notadaptedforgender

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• Wheninjured,childrenareseendirectlybyhealthservices,thisoftenmeanschildprotectionactorsarenotinformedofthecaseanditscircumstances.Thismissesopportunitiestoidentifyotherprotectionconcernssuchasdisability,separationorabuse;andmisses’informationonthecausesofinjuriesinchildren,whichisimportantforprevention.

• Costandtransportwerenotedasaconsiderablechallenge,travellinglongdistancesformedicaltreatmentandrehabilitationserviceswasoftennotpossible,orrequiredahugeinvestmentbyfamilies.

• InCARiswasnotedthatwhereconflictanddisplacementsareongoing,andtransportandmovementoverlongdistancesisdifficult,itisadvantageoustotryandkeeptheresponseforinjuredchildrenwithinthesamedistrictasmuchaspossible,unlessthecaseisseriousanditismoreappropriatetoseekmedicaltreatmentfurtherafield.247

• Healthworkersoftendonotknowhowtotalktochildrenandsharebadnewsabouthealthmatters.Insomecases,thishasresultedinchildprotectionworkersaccompanyingchildrentohealthappointments,takingupaconsiderableamountofcaseworkers’time.248

• Onechildprotectionadvisorcommentedthatglobally,qualitypsychosocialservicesforchildrenwhohavebeenseriouslyharmedbyfireburnsorexplosiveweapons--exceptinthepresenceofHandicapInternationalandMedicinesSansFrontiers--aremissing.249

Keyconsiderationsinreferralpathways:

• Payadequateattentiontothepsychosocialeffectsoftheinjuryeventortheimpactofinjuries.• Thepreventionoffamilyseparationhastobeacorecomponent--before,duringandafteraninjury

event.• Itisimportanttocollectdatathroughcasemanagementsystemsthatcanbesharedwithother

partnersinthereferralpathway,aswellasbeingusedforadvocacywithactorswhohavearoleinpreventingdangersandinjuries.

• Havingchildfriendlyproceduresandadequateemergencycasefundsfortransportandincidentalswerealsovalid.250

• Insituationswhereopportunitiestoreferchildrentoservices,includingformedicalemergencieswereextremelylimited,developingnationalstaffandengaginggreatercommunityawarenessandleadershipwereessentialtopreventsomeprotectionproblemsbecomingunnecessarilyserious.InSudanitwasreportedthatmanychildrenwithphysicalinjuries,hygieneormedicalproblemsarosefromlivingincamps,couldeasilyberesolvedthroughreferraltolocalmedicalclinicsorraisingparentalawarenesstofacilitateaction,thechallengeitnotedwasensuringthatstaffandlocalcommunitiesnoticetheseindicatorstoactinadvanceofpotentialprotectionproblems.251

247Keyinformantinterview8248Surveyrespondent249Surveyrespondent250Surveyrespondent251O’Leary,Dr.P,UniversityofBath,UniversityofSouthAustralia,JasonSquire,Terredeshommes,2009,Capitalisationofproject:Pakistan,SriLanka,Sudan&Nepal,Terredeshommes,Lausanne.

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Nepal Reaching children with disabi l it ies after the earthquake In2011,conservativeestimatesreckonedtheretobeatleast207,000CWDlivinginNepal,whilstothersestimatebetween50%and85%ofallout-of-schoolchildrentobedisabled.Notonlyhasthe2015earthquakeworsenedthesituationformanychildrenwithpre-existingconditions,ithascausedasubstantialnumberofnewinjuries--over22,000--leadingtothepermanentdisabilityofanestimated1,500peoplewhowillrequirelongtermcareandrehabilitation,including40amputeesand200spinal-cordinjuries.

Forchildrenwithimpairments,accessandmovementaroundmountainousaffectedareasisextremelychallenging;compoundedbymonsoonrainsandlandslides,boththespaceCWDhavetoliveinandaccessserviceshasbeenreduced.Priortotheearthquake,thegovernmentwasaimingforasystemofinclusiveeducation,andwhileattitudesandbeliefs,andthesuitabilityandqualityofequipmentandsupportcommonlyholdbackCWDfromattendingschool,therewereatleastsomeschoolsineveryareawhichwouldacceptchildrenwithphysical,hearing,visualorintellectualimpairments,wherestaffhadreceivedsometraining.

FollowingtheearthquakePlanInternationalidentifiedCWDasoneofthemostvulnerablegroupsaffected,puttinginplacemeasurestoreachchildrenwhohadbeennewlydisabledalongsidechildrenwhohadpre-existingconditionstoensureinclusivityinchildprotectionandeducationactivities.Inchildfriendlyspaces(CFS)andtemporarylearningcentres(TLC)trainingwasgiventoteachersandvolunteersoninclusivepracticesandpsychosocialactivities,riskreductionandaccesstoservicesforCWD,aswellasensuringphysicalstructureswerepracticalforCWD.Inaddition,mobileteamswereorganisedtoaccess‘hardtoreachchildren’inisolatedcommunities,andad-hocsessionswithchildrenandcommunitymeetingswereorganisedwhenitwasdifficulttoplanregularstructuredactivities.

Volunteershaveconductedriskmappingwithchildrenineverycommunitytosupporttheidentificationandreductionofrisks,andbuiltthecapacityofvillagechildprotectioncommittees(VCPC)underthechildprotectionsystemofNepal,tomonitortheprovisionofservicestoidentifiedvulnerablechildren;hopingwhentheyarematureenoughtheywillreceivetrainingontheidentificationandreferralofvulnerablechildrentoserviceproviders.

Thefollowingchallengesandlessonslearnedhavebeenhighlightedduringthisprocess:

• Unclearregulationsonaccessibility,coupledwiththephysicalbarriersinmanyruralmountainousareashasmeantitisdifficultforCWDtoaccessCFSandTLCs.

• Availabilityandsharingofreliabledata,attheclusterlevelhasbeenchallengingwithdifferentandconflictingdatasetssharedbydifferentagenciese.g.thenumberofCWDandtheservicestheyarereceiving.Thecomplexissueofdisabilityhasbeenchallengingtobringoutinassessment,whenonlyoneortwoquestionsareasked,andmuchessentialinformationismissing.Deeperassessmentsareneededinordertotakeagenuinelyinclusiveapproach.

• Capacity.AlthoughHandicapInternationalhaveplayedalargeroleindevelopingguidelinesandtrainingorganisationsandclusterpartners,thosewhoworkedwithCWDbeforetheemergencyandarerespondingsubsequently,arenotfamiliarwithemergenciesandlocalpartnersarenotfullyfamiliarwithemergencyfocusedinterventionssuchasCFS/TLC/helpdesksetc.

• AgencieshavehadtoworkhardwithCFSvolunteerstoensuretheyhavethesoftskillsrequiredtoidentifyandaddressrisk,movingfromafocusondistributiontotheskillsneededtoworkwithvulnerablechildrenandtheirfamilies.

• OnlyafewspecialisedprovidersforCWDareabletosupportonthingslikemakingschoolsinclusive,supportwithdevices,etc.Serviceprovisiontendstobelimitedtogeographicareas.

• Thereisaneedforspecificguidelinesfororganisations,familiesandchildrenonworkingwithCWD.Goodreferralmechanismsareessential.

• Peopleoftenconsideronlyphysicaldisabilitywhenthinkingaboutdisabilityanditneedstobemuchbroadertoincludesensory(visionandhearing)andintellectualdisabilities.

Figure26Source:HumanRightsWatch,2011,FuturesStolenBarrierstoEducationforChildrenwithDisabilitiesinNepal.Keyinformantinterview6.InjuryRehabSubClusterSituationReportfromInjuryRehabSubCluster:01/07/2015

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Child Friendly Spaces and Children’s Clubs252 CFSareafrequentlyusedchildprotectionstrategythat78%ofsurveyrespondents‘agreed’(48%)or‘stronglyagreed’(30%)canbeaneffectiveconduittopreventinjuries.Theycanactasaprotectivespaceforchildrenawayfromthephysicaldangersfrequentlypresentinemergencies–the‘SafeHaven’effect.Inmanywarzones,thegreatestthreatstochildrenarisenotfromtheriskofattackbyarmedgroups,butfromtherisksassociatedwithbeingleftaloneinadangerousenvironment.253OneCFSevaluationinSudanreportedthatallparentsinfocusgroupdiscussionsidentifiedphysicalprotectionasoneofthekeybenefitsofCFS,commenting“forme,knowingthatmychildrenareinside(…)Playingandlearning,notgoingtotheriverwheretheymightdrown,andtherearecrocodiles,snakesandscorpionsisthemainthing”,and“beforetheywouldgointotheNiletoplay–someevendrowned.Butnowtheyhaveasafeplace”.254AnotherrelevantfindingfromareportondrowningandwatersafetyinVietnam,suggeststhatevidenceforyoungerchildrensuggeststhatalthoughthe‘safehaven’effectisoftenunrecognised:“Whenchildrenaregroupedwithadultsprovidingsupervision,theyareprotectedfromdrowning.Itdoesn’tmatterwhattheservicesbeingdeliveredarefor—whetherforsocialisation,cognitivedevelopment,educationorotheroutcomes.Fundamentallythebasicservicebeingprovidedissafety”.255ThiswasalsofoundtobethecaseinUganda,whereacomparativestudybetweentwocampsshowedsignificantdifferencesinthereportingofphysicaldangersbyparentsofchildrenwhohadbeenattendingaCFSinonecampandthoseintheothercampwhohadnotbeenattendingaCFS:256

CFSgroup Comparisongroup(noCFSintervention)Caregiversweremorelikelytoreportthattheirchildrenweresafeathome“mostofthetime”(86%)

Caregiverswerelesslikelytoreportthattheirchildrenweresafeathome“mostofthetime”(60%)

Lessthan1%ofcaregiversreportedthattheirchildrenwere“never”safeathome

13.6%ofcaregiversreportedthattheirchildrenwere“never”safeathome

52.8%ofchildrenreportedbeingsafe“mostofthetime”

22.9%ofchildrenreportedbeingsafe“mostofthetime”

15.3%ofchildrenreportedtobe“never”safeinthecamp

49.2%ofchildrenreportedtobe“never”safeinthecamp

CFSgroupreportedreductionsinthefrequencyofchildren’sexposuretotheserisksfromone-yearprior

Comparisongroupreportedthattheriskswerepresentatthesamefrequency

Levelsofchildreninvolvedinroadaccidents;housefiresstartedbychildren;andchildrenbecominginjuredfromdangerousobjectswereallreportedlymuchlessthantheyearprevious

ChildrennotinCFShadmoreinjuriesfromsteppingonandplayingwithdangerousobjects,suchasmetalsheeting,nails,andbrokenglassfoundinthecamp.

InthisevaluationtheprimaryreasonsfortheCFS’ssuccesswasthereductioninchildren’sexposuretodanger.Girlsandboysweresupervisedinsteadofbeingleftaloneorinthecareofotherchildren,andtheyhadactivitiestokeepthemoccupied,reducingthetemptationtorunaroundontheirown.Theonlyspecificphysicalsafetypreventionactivitymentionedintheevaluationwerecampclean-ups,organisedbychildwelfarecommitteestoremovedangerousitemsforchildren.257

CFScanalsobeamechanismfromwhichpsychosocialsupportcanbeprovidedtochildrenwhoarevulnerabletophysicaldangers,suchaschildrenwithpre-existingdisabilities,ortochildrenwhohavebeeninjuredordisabledasaresultofanemergencyandwhowillneedimmediateandintensivepsychosocialsupporttocopewiththeirinjuries.GoodpracticefromAfghanistanrecentlyhighlightedthroughareporton‘InclusioninChildFriendlySpaces’,describeshowcharismaticcommunityleadershavebeenusedtosupporttheinclusionofdisabledchildreninCFSbymakinghomevisitstoinformparentsabouttheCFS,theiroverallfunctionand252CFShereincludesCFS,childcentred-spaces,safespaces,childprotectioncentersoremergencyspacesforchildren253KKostelny,MWessells(2008),ChristianChildren’sFundandTheColumbiaGroupforChildreninAdversity.TheProtectionandPsychosocialWell-BeingofYoungChildrenFollowingArmedConflict:OutcomeResearchonChild-CenteredSpacesinNorthernUganda.254WarChildHolland,SudanKostiChildFriendlySpace:EvaluationReportCatherineGladwell,September2011255Linnan,M.(2015)WaterSafetyandChildDrowninginVietnamAreportforSavetheChildrenVietnam.256KKostelny,MWessells(2008),ChristianChildren’sFundandTheColumbiaGroupforChildreninAdversity.TheProtectionandPsychosocialWell-BeingofYoungChildrenFollowingArmedConflict:OutcomeResearchonChild-CenteredSpacesinNorthernUganda.257IBID

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benefits.Astheleadersweretrustedcommunitymembers,theirencouragementandsupportwasnotonlyhelpfulinattractingmorechildrentotheCFS,butalsoallowedobservationsofvulnerablechildreninthehomesthatwerenotaccessingCFS.Thiswasoftenonlyrevealedduringdoor-to-doorvisitsbecauseparentsdidnotallowthemtoleavethehome,orattimeshidthemawaybecauseofcertainphysicalormentaldisabilities.258AnotherexamplefromPlanInternationalinearthquake-affectedregionsofNepalhasfocusedonreachingvulnerablechildrenincludingthosewithnewandpre-existingdisabilitiesandtheircaregiversthroughamobileCFSprogramme,wheremobileteamsofCFSfacilitatorswalktomountainousruralvillagestoidentifychildren,deliverPSSactivities,andsupportaccesstoservicesforvulnerablechildrenincludingchildrenwithdisabilities.Twosignificantchallengesinthiscontexthavebeentheroughhillyremotetrackswhichhaveinplacesbeenaffectedbylandslides,andarenotappropriatetosupportthemobilityofchildrenwithdisabilities;aswellastheattitudesofsomecommunitymembersthatpreventCWDaccessingCFS.Inaddition,thereisanalmostcompletelackofspecialisedservicesintheremoteareasthatCFSfacilitatorscouldreferchildrenontooncetheyhadidentifiedchildrenthroughmobileactivities.However,toaddressthisissue,Planhasallocatedfundstoprovideimmediatespecialisedassistancetochildreninabsenceofanyservicesprovider.259InIraqatoolhasbeendevelopedbyHandicapInternationaltosupporttheinclusionofallchildreninCFS,coveringawarenessandadvocacy,participation,accessibility,communication,andcoveringdifferenttypesofimpairmentssuchasphysical,intellectual,sensory,visualandhearing.260

AnotherimportantroleofCFSistheirabilitytoprovideactivitiesandsupportthatfocusesonriskreduction,linkingchildrenandtheirfamiliestopreventativeservices,messagingandawarenessraising.CommentsfromthesurveyfocusedonCFSbeingabletopreventincidentswithinthemselves,ratherthantheirroleinpreventingphysicaldangersandinjurieswithinthecommunity.Forinstance,onesurveyrespondentnotedthatCFScanbereallyeffectiveinprotectingchildrenfrominjuriesiftheyareproperlyrun,ifnottheycanbethecauseofadditionalincidents,anothercommentingthatCFScanbeonlyeffectiveIfthereisappropriatemanagement,careandsupportforchildren.However,someexamplesofgoodpracticecanbefoundintheliteraturereviewandinterviews.RiskpreventionimplementedthroughemergencypsychosocialactivitiesandCFSdocumentedafterthe2008KosifloodsinIndiadocumentedthatchildrenattendingCFSreportedbeingencouragedtotalktoeachotherandexpressthemselves,aswellasformingayouthcommittee.Thishelpedaddressgenderdiscriminationandprotectionissuessuchaschildmarriage,andalsosupportedpracticalstepstoreduceriskinthevillagesuchasregularlycheckingthewaterlevelsintheriverandlisteningtotheradiotocheckiftherehadbeenabreachofthedam.261Inanotherexample,UNICEFinBangladeshhassetuppermanentChildFriendlySpacesaspartofthecommunity-basedchildprotectionsysteminfloodandcyclone-proneareas,toprovidecommunityoutreachandsupport,alongwithresilienceprogrammesandactivities,suchasswimmingclasses.262DespitethepotentialthatCFShavetoprovidemessagesandotheractivitiesonriskandinjurypreventiontochildren,onesurveyrespondentusedcaution“inmyexperience,usingCFSinfrastructurecanbeinappropriate(assometimestheyareunsafethemselves),andnotallchildrenofthecommunityattendtheCFS.Andthemostimportantpeopletoprotectchildrenandensurethattheenvironmentisnotharmfularetheparentsandtheotheradults”.

VeryfewrevieweddocumentsorevaluationscoveringCFSactivitiesincludeddetailedinformationonhowCFShelpimprovechildren’sphysicalsafety,beyondgeneralcommentsaboutCFSas“somewheresafewherechildrencancomeandaccesspsychosocialandrecreationalactivities”.Forinstance,inNepal,aplaceofgreatphysicaldangerforchildrenintheaftermathoftheemergency,interagencykeymessagesforCFSfacilitatorsonlybrieflyreferencednotplayinginbuildingsorrubble.Whiletheylistedmanymessagesongoodhygieneandstayinghealthy,theydidnotcontaininformationonhowtoseeksupportifachildwasinjured,theimportanceofkeepingwoundscleanetc.;orpreventativemessagesforparentsonkeepingchildrenaway

258AnnAbraham,MarianGamboa,TrungLe.GeorgeWashingtonUniversity’sElliottSchoolofInternationalAffairs.(2013)InclusioninChildFriendlySpaces:AStudyonBarriersandGoodPractices.259Keyinformantinterview6260DanielleRichard(2015)HandicapInternationalDisabilityInclusioninChildFriendlySpaces,Iraq261SavetheChildrenandRedRIndia,2010,ReducingRisksasEquals:RegionalReviewofChildCenteredDisasterRiskReductioninSouthAsia262UNICEF.2012.UNICEFandChild-CentredDisasterRiskReduction

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fromroads,openwaterandrivers,keepingsheltersuncluttered,safecookingpracticesandorstayingawayfromlandslidesetc.263

WhileCFSarevaluabletoolforchildprotectionactorstoprotectchildrenfromphysicalharm,particularlyforyoungerchildrenwheresupervisionisvital.ThereisalackofdocumentedbestpracticeaboutotherwaysinwhichCFScanhelppreventandrespondtoinjuries,includinghowtoreachchildrennewlyinjuredchildren,howtoreachyouthwhoexhibitrisk-seekingbehaviourandcommunitybasedriskreductionactivities.

Psychosocial distress and support interventions Experienceofhowphysicaldangersandinjuriesaffectchildren’spsychosocialwell-beinginemergencies,andhowthiscanbesupportedthroughpsychosocialinterventions,ismostlyfoundintheintheareaoflandmineandUXOsurvivorassistance.ThepsychosocialimpactonchildrenwhohavebeeninjuredbylandminesandUXOsisrecognisedtobedevastating,andrequiresimmediateandcontinuoussupportastheycopewithandadapttooftenlifechangingdisability.

Althoughreactionsvarygreatlyitisreportedthatmanyfeeloverwhelmed,fearful,anxious,traumatised,sufferfromalossofself-esteem,sleepdisorders,phobias,guilt,confusion,uncertainty,numbness,detachmentandaninabilitytospeak.Children’sreactionsdependonmanyfactorsincludingageandthelevelofsupporttheyreceivefromothersinthecommunity.Wheretheyexperiencenegativereactionssuchdiscrimination,bullying,stigmatisation,overprotection,pity,andexclusionfromschool,playandeconomiclife,thiscanhavenegativeconsequencesontheirrecoveryanddevelopment.264

In2014,arelativelysmallstudyof78Iranianchildrenwithlandmineinjuriesfromremnantsofthe1980-1988Iran-Iraqwarwaspublished.Thestudyfoundthat47.4%ofchildsurvivorswereaffectedbypsychologicaldisorders,includinganxietydisordersin34.6%(thisconsistedof25.6%withPTSD,and9%withgeneralisedanxietydisorder);mooddisorders,includingmildtomoderatedepressionin6.4%;cognitivedisordersin2.6%;andotherdisorders3.8%.Italsofoundthat12%haspreviouslyvisitedhospitalforpsychiatricdisorders,anddiscoveredsignificantassociationsbetweenthetypesofpsychologicaldisorders,ageofcasualty,durationofinjuryandlimbamputation,with40.9%ofchildrenbetweentheagesof5and9havingamentaldisorder;twothirdsofgirlssufferedfromanxietydisorders(despitethemonlymakingup14.1%ofsurvivors);and37.8%ofamputeesdiagnosedwithanxiety.Morethanonethirdofthesurvivorshadneverreceivedmentalhealthtreatment.WithhigherratesofPTSDreportedthaninpreviousstudies,therewasaclearlinkinthisgroupofchildrenbetweenamputationandPTSD,indicatingthatamputationanddisabilityindailyroutinetaskscauseavarietyofmentaldisorders.265

DespitelevelsofoftenseverepsychosocialdistressinchildrenaffectedbylandmineandUXOblasts,apsychosocialstudyofchildsurvivorsofUXOaccidentsinLaoPeople’sDemocraticRepublic,where168childsurvivorsand158parentsofchildsurvivorswereinterviewed,notoneofthechildsurvivorshadreceivedpsychologicalsupport.Withonlyonesmallmentalhealthunitinthecapitalcityprovidingpsychologicalcareandsupportservices,childrenandparentsreliedheavilyontraditionalhealingpracticesinthetreatmentofphysicalandemotionalsuffering.Thesewerefoundtohaveplayanessentialroleinsupportingthepsychologicalrehabilitationofchildsurvivorsandtheirfamiliesbybringingtogetherchildren,parents,extendedfamilyandothercommunitymembers;reinforcingsocialrelationships;helpingtoreintegratethechildintothecommunityandprovidinganopportunityforfamilyandcommunitymemberstoprovidemoral

263UNICEFNepal.KeyMessagesforCFSFacilitators.1stMay2015.Availablefrom:https://www.humanitarianresponse.info/en/operations/nepal/document/key-messages-nepali-and-english264UNICEF(2014).AssistancetoVictimsofLandminesandExplosiveRemnantsofWar:GuidanceonChild-focusedVictimAssistance.Chapter5.4Psychologicalandpsychosocialsupport;andUNICEF(2013).TheStateoftheWorld’sChildren2013:ChildrenwithDisabilities265MAHemmati,HShokoohi,MMasoumi,SKhateri,MSoroush,EModirian,MPZNKermany,MHosseini,andBMousavi.13.11.2015.Mentalhealthdisordersinchildandadolescentsurvivorsofpost-warlandmineexplosions.MilMedRes.2015;2:30.Availablefrom:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4644284/#CR14

72

andmaterialsupport.88%ofparentsinterviewedsaidtheirchild’shealingwasassistedbyaceremonyofsomesort.266

Whileliteraturefrequentlyreferstotheimportanceofphysicalsafetyinensuringchildren’spsychosocialwell-being,italsorecognisestheoftennegativeimpactonchildrenwhentheirsafetyiscompromised,ortheybecomeinjuredordisabled.267Thewaysinwhichphysicaldangerandseriousinjuryaffectchildren’spsychosocialwell-beingandthepsychosocialsupportavailabletothoseaffectedinemergenciesarepoorlydocumented,asarepracticesofriskreductionandpreventionthathavebeenintegratedintopsychosocialresponsesasapracticalmeasuretoimprovechildren’swell-being(beyondeffortsinLandmineAction).Onekeyinformantrespondedthat“Childrenarenotgoingtofeelsafeafteranearthquakeiftheythinkfurnitureisgoingtofallonthemandtheyhaven’tlearnedpracticalstepssuchasfixingfurnituretowalls”.ThissameintervieweesuggestedthebenefitsthatcouldcomefrompracticalriskpreventionandreductionmessagesbeingembeddedinPSSmessages,wheremessagesagreeduponbyriskreductionandPSSexpertsatthenationallevelcouldberolledoutduringemergencies.268

Section Four: Avai lable technical expertise Thefollowingsectionincludesspecificinformationonavailabletechnicalexpertiseincludingtoolsandresources,websitesandorganisationswithaspecificfocusondangersandinjuries.TheseareinadditiontoresourceslistedinCPMS#7DangersandInjuriesandavailableinanumberoflanguages.

MineActionandExplosiveWeapons

• MainstreamingMineActioninChildProtection:KeyActionsforChildProtectionActors.Availableat:http://cpwg.net/starter_pack/mainstreaming-mine-action-cp/

• MineActionStandards.Generalwebsite-http://www.mineactionstandards.org/• MineActionStandardsinEnglish(alsoavailableinEnglish,Persian,Arabic,Chinese,French,Russian,

Spanish,Armenian,Ukrainian).Availableat:http://www.mineactionstandards.org/standards/international-mine-action-standards-imas/imas-in-english/

• UNICEFAssistancetoVictimsofLandminesandExplosiveRemnantsofWar:GuidanceonChild-focusedVictimAssistance,November2014.Availableat:http://mineaction.org.Includeschaptersondatacollectionandanalysis;Emergencyandcontinuingmedicalcare;Rehabilitation;Psychologicalandpsychosocialsupport;Socialandeconomicinclusion;andLawsandpolicies.

• UNICEFEmergencyMineRiskEducationToolkit:EmergencyMREHandbook.July2008.FirstEdition,NewYork.Availableat:http://www.unicef.org

• RepublicofAustriaandRepublicofColombia(2014).“StrengtheningtheAssistancetoChildVictims,”MaputoReviewConference.June2014,www.maputoreviewconference.org

• RepublicofColombia,PresidentialProgramforIntegratedActionagainstAntipersonnelMines,“GuideforComprehensiveassistancetoboys,girlsandadolescentlandminevictims–Guidelinesfortheconstructionsofplans,programmes,projectsandprotocols,”Bogota,2014.Availableathttp://www.accioncontraminas.gov.co

SpecificInjuryIssues

• WHOFactsheet#373AnimalBites.http://www.who.int• WHOFactsheet#347Drowning:http://www.who.int• WHOFactsheet#344Falls.http://www.who.int• WHOFactsheet#292HouseholdAirPollution.http://www.who.int• WHOFactsheet#365Burns.http://www.who.int• WHOFactsheet#358RoadtrafficInjuries.http://www.who.int266UNICEF2014.AssistancetoVictimsofLandminesandExplosiveRemnantsofWar:GuidanceonChild-focusedVictimAssistance.Chapter5.4Psychologicalandpsychosocialsupport267UNICEFPsychosocialSupportofChildrenPsychosocialSupportofChildreninEmergencies.2009268Keyinformantinterview11

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• WHOFactsheet#347SnakeAnti-venoms.http://www.who.int• WHOFactsheet#266ClimateChangeandHealth.http://www.who.int• WHOViolenceandInjuryPrevention(VIP)TEACHVIP2.Onlinetrainingmodulesdesignedarounda

classroominstructionmodel,withPowerPointpresentationsandsupportinglecturenotes,addressingawidevarietyoftopicsrelevanttoinjurypreventionandcontrol.TeachVIP2isthesecondedition.Theonlinecontentcanbeaccessedasaguestthroughtheportalhttp://teach-vip.edc.org/.Therearesixmodulesonunintentionalinjuries(Roadtrafficinjuries,Drowning,Fallinjuries,Burns,ChildpoisoningandWorkplaceinjuries),inadditiontoaselectiononviolenceprevention.Moreinformationcanbefoundhere:http://www.who.int

• WHOwebsiteChildInjuriesandViolence:http://www.who.int• CIPRB(ACentreforInjuryPrevention,HealthDevelopmentandResearchBangladesh)areaworldleading

injurypreventionorganisationbasedinBangladesh.http://www.ciprb.org/Throughresearch,innovation,andprogrammingwhichtheirapproachesbenefitothercountries,particularlyinAsia,wheresimilarprogrammesareunderway.Theirfocusondrownings;burns,maternalhealthissuesandroadtrafficinjuries,haveledtothedevelopmentofanumberofspecificinjuryresearchcentres:CentreforBurnPreventionandResearch;InternationalDrowningResearchCentre-Bangladesh(IDRC-B);RTIResearchCentre.(RoadTrafficInjuries)

• OrganisationssuchasNileSwimmers,theRNLI,SwimVietnamareorientatedarounddrowningpreventionandteachingwatersafetyandswimmingskills.NileSwimmers(http://www.nileswimmers.org/)workstopreventdrowninginAfrica,andcurrentlyworkinSudan.

• FIAFoundationisanNGOsupportinganinternationalprogrammeofactivitiespromotingroadsafety,theenvironmentandsustainablemobility.http://www.fiafoundation.org/TheyworkalongsideUNICEFonanumberofinitiatives.Someoftheirkeyresourcesare:TenStrategiesforKeepingChildrenSafeontheRoad:http://www.fiafoundation.org;SafetoLearn:SafeJourneystoSchoolareaChild’sRight(JointFIAUNICEFpublication):http://www.fiafoundation.org;FIA10GoldenRulestoRoadSafety:http://www.fia.com(availablein29languages);FIARoadSafetyFactsheethttp://www.fia.comavailableinthreelanguages.

• WHOHealthStatisticsandInformationSystemsgivethelatestglobal,regionalandcountry-levelcause-specificmortalityestimatesfortheyear2012theyareavailablefordownloadfromhttp://www.who.inttheyareavitalsourceofinformationoninjuriesforanypre-orpost-emergencydatareview.

DisasterRiskreduction,PreparednessandRiskMapping

• RiskRED(RiskReductionEducationforDisasters).FamilyDisasterPlanhttp://toolkit.ineesite.org• INEEDisasterRiskReductionTeachingandLearning:DisasterPreventionEducation.Isawebsitecontaining

aselectionofresourcesondisasterprevention,includingdisasterawareness,childfocusedDRR,disasterandemergencypreparednessactivitiesetc.http://toolkit.ineesite.org

• WarChild(2014)Toolkitforchildsafetyreportcards.Availableat:https://www.warchild.org.uk• SavetheChildren(2008)Child-ledDisasterRiskReduction:APracticalGuide• CBMandDisabilityinclusiveDRRNetworkforAsiaandPacific(2013)DisabilityinclusiveDisasterRisk

Management:Voicesfromthefield&goodpractices.Availablefrom:http://www.cbm.org.Includesachapteronmakingsurethatchildrenoutofschoolareequallypreparedfordisasters.

• HandicapInternational(2012)DisabilityInclusiveCommunityBasedDisasterRiskManagementAtoolkitforpracticeinSouthAsia.Availablefrom:http://www.preventionweb.net

ChildprotectionandpsychosocialsupportservicesincludingChildFriendlySpaces

• WHOPsychologicalfirstaid:Guideforfieldworkers.Casescenario5.3Accident.Providesagoodexampleofanaccidentcrisiseventyoumaydealwithinyourroleasahelperandhowtocommunicatewithaffectedpopulations.Page49-52.AvailableinEnglishat:http://apps.who.int.Alsoavailableinotherlanguages

• UNICEF2009.APracticalGuideforDevelopingChildFriendlySpaces.Availableat:http://cpwg.net

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• HandicapInternational(2013).T.Calvot,G.Pégon,S.RizkandAShivji.PracticalGuide:Mentalhealthandpsychosocialsupportinterventionsinemergencyandpost-crisissettings.Availableat:http://www.hiproweb.org/

• HandicapInternationalIraq,D.Richard(2015).DisabilityInclusioninChildFriendlySpacesHandicapInternational-Iraq2015.Availablefrom:https://www.humanitarianresponse.info/

OtherSectors

• Shelter:UNICEF(2011),CompendiumTransitionalLearningSpaces(TLS)DesignandConstructioninEmergencies.Availablefrom:http://www.educationandtransition.org/

• Shelter:UNICEF(2013),CompendiumTransitionalLearningSpaces(TLS)ResilientDesignandConstructioninEmergencies.Availablefromhttp://reliefweb.int/

• Shelter:NepalEducationCluster(2015).GuidanceNote:WinterizationandMaintenanceofTemporaryLearningCentres.Availableathttps://www.humanitarianresponse.info/

• WaterandSanitation:SavetheChildren2015EmergencyWASHforchildrenScopingStudy,2014.Availablefromhttp://www.elrha.org/

• Health:Internationalfirstaidandresuscitationguidelines2011ForNationalSocietyFirstAidProgrammeManagers,ScientificAdvisoryGroups,FirstAidInstructorsandFirstResponders.InternationalFederationoftheRedCrossandRedCrescentSocieties.From:http://www.ifrc.org/

Childrenwithdisabilities

• HandicapInternational(2015)DisabilityinhumanitariancontextViewsfromaffectedpeopleandfieldorganisations.Availablefrom:http://www.alnap.org/

• HandicapInternational(2010).DisabilityChecklistforemergencyresponse:GeneralGuidelinesfortheprotectionandinclusionofinjuredpersonsandpeoplewithdisabilities.Availablefrom:http://www.miusa.org/

• HandicapInternational(2012).Howtoincludechildrenwithdisabilitiesinchild-friendlyspaces.From:https://www.sheltercluster.org

• WHO(2010).Community-basedrehabilitationguidelines.AvailableinEnglish,French,Chinese,Spanish,Russian,Arabic,Thai,KoreanandTajik.Availablefrom:http://www.who.int/disabilities/cbr/en/

• D.Werner(2009).DisabledVillageChildren.Aguideforcommunityhealthworkers,rehabilitationworkers,andfamilies.Availableonlinefrom:http://www.dinf.ne.jp/orasapdffilefromhttp://hesperian.org/.Thisresourcecontainslotspracticalguidanceonday-to-daycareandsupportfordisabledchildren.

• CBMandDisabilityinclusiveDRRNetworkforAsiaandPacific(2013)DisabilityinclusiveDisasterRiskManagement:Voicesfromthefield&goodpractices.Availablefrom(addressabove)Includesachapteronmakingsurethatchildrenoutofschoolareequallypreparedfordisasters.

• HandicapInternational(2012)DisabilityInclusiveCommunityBasedDisasterRiskManagementAtoolkitforpracticeinSouthAsia.Availablefrom(addressabove)

• HandicapInternationalIraq,D.Richard(2015).DisabilityInclusioninChildFriendlySpacesHandicapInternational-Iraq2015.Availablefrom(addressabove)

Section Five: Challenges Asignificantnumberofspecificchallengeshavealreadybeenoutlinedthroughoutthisreview.Togainanunderstandingoftheoverallchallengesfacingpractitioners,surveyparticipantswereaskedaboutthechallengestheyfacewhentakingactiontopreventsdangersandinjuries.Thefollowingfindingshighlightanumberofconcerns.

75

Capacityandresourcesbothintermsofhumancapacityandfinancialresourceswerethekeybarriers.Alsohighwasthebeliefthatotherissuesaremoreofapriority.Thiswasconfirmedinearlierfindings,andcanalsobeseenacrosssectors,directlyrelatedtothisisalackofdataandtriedandtestedapproachestotackletheissues.

Inaddition,anumberofsurveyrespondentsandkeyinformantsmentionedthattherewasalackofinterestandlethargyincommunities,leadingtoindifferenceabouttheissues.Limitedsupervisionandparentalresponsibilitiesarealsoimportantinhibitingissuesthatcanbeespeciallypronouncedincampsettingsandprotractedcrisis.Despiteknowingtherisks,affectedpopulationswilloftencontinuetoengageinriskybehaviourthatendsupininjury,whilsttheyareoftenfocusedonmeetingstheirimmediateneedssuchasfoodandshelter.Withoutthetimeormeanstobeabletopreventthem,dangersgetdeprioritisedwhichpromptsasenseoffatalismandhelplessnessaroundtheissue.

BeyondtheissueoflandminesandUXO,humanitarianagenciesareoftenalsoguiltyofthisfatalism.Focusedonwhatareperceivedtobethebiggestconcernsforchildreninemergenciessuchascommunicablediseasesorotherprotectionconcerns,dataoninjuriesisoftennotcollectedorcriticallyexaminedandactedupon--evenwithinagencieswhoareresponsiblefortakingactionondangersandinjuriesintheirwork.Thissenseof‘tunnelvision’onotherissueshighlightstheneedforstrongerevidence.Togobeyondthis,itwassuggestedbyonesurveyrespondentthatlimitedaccountabilitytoaffectedpopulations,particularlyaroundissuesofsafety,leavepeopleunawaretheycanaskfor,orexpectthatphysicaldangersareidentifiedandrisksaddressed.

Ithasrecentlybeenreportedthatchildprotectionoftenunderestimatesitsimpactasalifesavingintervention;269thiscancertainlybesaidaboutpreventingphysicaldangersandinjuriesinchildren.Inanumberofchildprotectionrapidassessments,environmentalorphysicaldangerswerehighlightedthebiggestriskthatcanleadtodeathorinjuryofchildren,yetsubsequentstrategiesassociatedwiththeresponseeitherfocusonlandminesandUXOordidnotincludemeasurestoaddressthisorsupportchildrenwhohavebeen269ThompsonH(2015).AMatterofLifeandDeath:Childprotectionprogramming’sessentialroleinensuringthewellbeingandsurvivalduringandafteremergencies.2015

68%

68%

55%

50%

41%

36%

32%

27%

27%

9%

Lackoffunding

Lackofcapcity-stafftraining&knowledgeoninjurypreven~on

Lackofcapacity-staff~me

Otherissuesaremoreofapriority

Lackoftriedandtestedprogrammingapproaches

Lackofdata

Lackofna~onalpoliciesandstrategies

Difficulttoaccesscommuni~tes/families

Lackofcoordina~on/mul~-agencyworking/informa~onsharing

Languageproblems/poorliteracy

Whatarethebarrierstoeffec~veac~ontopreventandreducephysicaldangersandinjuriesfacingchildrenin

emergencies?

76

affected.Includingdangersandinjuriesascentralisedcomponentofchildprotectionprogrammescanhelphighlightthebenefitofchildprotection’slife-savingnature.

Thereisoftenalackofcommitmentfromotheractorstoaddressingdangersandinjuries.Withmanycompetingprioritiesduringemergencies,itishardforchildprotectionactorstoprioritisedangerandinjurieswithoutcommitmentfromothersectors.Evenifchildprotectionactorsidentifytheissuesthroughtheirdailycontactwithchildren,theymaynotbetheoneswhocanrespondwithoutthesupportofothersectors.Alackofclarityalsoexistsaroundthedifferentroleandresponsibilitiesofchildprotectionandotheractors,whiledangersandinjuriesareacrosscuttingconcern,therelatedfocusonthespecificneedsofchildrenisoftenmissingfromothersectorresponses.

Weakcoordinationbetweenclustersontheissueofchildrenwithdisabilitieswasnotedbythreesurveyparticipants,particularlybetweenhealth,childprotection,MHPSS,mineaction,andCCCM.Inmanyplaceslittleornocentralisationandsharingofdatahappensparticularlyaroundtheissueofchildrenwithdisabilities.

Weakdatacollectionandinjurysurveillanceisahindrancetotheissuegaininggreaterprominencewithinclusters.Dataisneededontheextent,typesandcausesofinjuries,disaggregatedbyage,genderanddisability,takinganallhazardsapproachinallcontexts.InthecaseofchildrenaffectedbyERW,dataandmonitoringissignificantlybetterbutthisdoesnotstretchbeyondtheissueoflandminesandUXOinmanyplaces,anddoesnotincludeotherhazardsassociatedwithconflictorthetraditionaldangersandinjurieswhichkillvastnumbersofchildreninemergencieseachyear.

Atthegloballevel,thereisalackofdocumentationofprogrammepractices,evidenceofsuccessfulpreventativeandresponsestrategiesandmonitoringandevaluationofeffortstoaddressdangersandinjuriesinemergencies.Whilstmuchevidenceexistsinnon-emergencies,thishasnotbeenusedortranslatedintopracticeinhumanitariansettings.Thesignificantamountofresearchthatglobalinjurypreventioneffortscontributetoreducingunnecessarydeathswouldbewellplacedinhumanitariancontexts.

Shortfallsinfundingarealsoagraveconcernbothdirectly-intermsoflimitedfundingforvitalchildprotectionservices,MRE,riskeducationactivities,orinadequatefundingforrehabilitationservicesforseriouslyinjuredordisabledchildren-andalsoindirectly,wherefundingshortfallsinothersectorssuchasCCCMorwaterandsanitationhaveaknockoneffectoftherebeingenoughresourcestoplaceemphasisonsafetyinthemidstofsomanycompetingneeds.Donorprioritysettingdoesnotallowagenciestoberesponsiveenoughtobeneficiariesneeds.

Section Six: Recommendations and Conclusions

For al l humanitarian workers Dangersandinjuriesareamultiandcrosssectorissue.Theywarrantstrongcoordinationbetweendifferentstakeholders,andmainstreamingtoensureeffectiveintegrationintoresponsestrategies.Childrenandfamiliesoftenengageinrisk-takingbehaviourwhentheirbasicneedsarenotmet.

• Aresponsetophysicaldangersandinjuriesincludinga‘donoharm’approachshouldbemainstreamedwithinallhumanitarianinterventions.

• Allhumanitarianrespondershavearesponsibilitytocollectinformationonphysicaldangersandinjuriesaffectingcommunitiesafteranemergency.

• Allhumanitarianrespondershavearesponsibilitytoensurethatthesupporttheyaregivingtoaffectedcommunitiesdoesnotinadvertentlycreatephysicaldangersthatcankillandinjurechildren.Identifyhowthismayhappenandputinplacemeasurestopreventit.

• Inparticular,allhumanitarianrespondershavearesponsiblyforroadsafety,asdriverorpassenger,andtoprotectnotonlythemselves,butalsothelivesofotherroadusers.

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• Allhumanitarianrespondershavetheresponsibilitytoensurecost-effectivenessthroughthedeliveryoftheirservices,byintegratinginjurypreventionandcontrolaspectsfortheefficientuseofresources.

Surveyrespondentssuggestedtheprinciplewaysofdoingthisshouldbe:

• Childprotectionactorshaveresponsibilitytosupportvulnerablechildren,theirfamiliesand

communitiesinidentifyingandaddressingphysicaldangersandinjuriestheyfacealongsideotherchildprotectioninterventions.

• Healthserviceactorshavearesponsibilitytoconsider,treat,supportandpreventunintentionalinjuriesequallyamongstthesignificantpublichealthconcernspresentinemergencies.

• Sectorsprovidingkeyservicesforemergencyaffectedpopulationssuchascampcoordinationandmanagement,shelter,waterandsanitationandeducationhavearesponsibilitytoensurethatservices,facilitiesandjourneystoaccessthosefacilitiesarephysicallysafe.

Humanitarianassessmentandinformationgatheringprocessesarefallingshortofprovidinglevelsofinformationusefulenoughtoinstigateinjurypreventionactivities.Injurysurveillanceprovesagreatopportunitytogather,analyseanddisseminatemoreinformationoninjuriesinchildrenbutnationalinjurysurveillancesystemsareoftennotestablished(asopposedtodiseasesurveillancesystems)ortheydonotincludesufficientlevelsofinformationtobeusefulforpreventionactivities.Datasharingbetweenactorscanbechallenging.

• Coordinationshouldfocusonestablishingorstrengtheningfunctionalinformationcollection,monitoringandsharingsystems;awarenessraising;advocacyandpreventativestrategies.

• Anonymiseddatashouldbeavailablefrominjurysurveillancetoinformcoordinatedpreventionactivitiesconfidentially.

• Nationalongoinginjurysurveillancesystemsshouldbeestablishedorstrengthened.• Assessmentsshouldincludephysicaldangersandinjuries,beyondageneralnumberofinjured

persons.

81%

62%

48%

43%

38%

33%

33%

29%

24%

24%

19%

19%

19%

10%

5%

Trainingorcapacitybuildingforchildprotec~onstaff

Trainingorcapacitybuildingforotherserviceproviders

Examplesofgoodprac~ce/successfulapproaches

Morefunding/donorinterest

Improvedtoolsandguidance

Improvedcoordina~onbetweensectors

Standardizedbutadaptableeduca~onalmaterials

Supportforworkingwithpartnersandcommuni~es

Supportforpilotprogrammes/packagesofinterven~on

Assistancewithplanninginjurypreven~onac~vi~es

Buildingadeeperevidenceandresearchbase

Be�erdatagatheringonincidence

Strongandsuppor~vena~onalpoliciestoreduceinjuries

Futuresupportandackonstobelerpreventandrespondtodangersandinjuriesfacingchildreninhumanitariansemngs

78

• Datashouldbedisaggregatedbyage,genderanddisability.• Takean‘allhazards’approachwhendesigningassessmentframeworkandconsidernaturalhazards

alongsidemanmadehazards.• Injuryspecialistsshouldcometogetheratthegloballeveltorectifydeficienciesinthereportingof

injuriesacrossemergenciesinWHOmemberstates.Healthstatisticsandinformationsystemsshouldbettercaptureinformationandreflectthebalancebetweentheemergency(i.e.flooding)andthetypeofinjury(i.e.drowning);informbetterpolicymaking,especiallyinDRR.

‘Thetimetoteachisbefore’!DisasterRiskReduction(DRR)iscriticaltoreducingthephysicalrisksthatchildrenfaceinemergencies,andemergencypreparednesscanensurethatfamiliesarereadyforemergencieslesseningtheimpactofemergenciesandinjuriesoncetheyhavehappened.Theybuildresilienceandnaturalcopingmechanisms.MoreemphasisshouldbeplacedandresourcesallocatedtoDRRandpreparedness

• UselearningonhowchildrenwereinjuredinpreviousemergenciestoinformongoingorfutureDRRandpreparedness.

• Effortsshouldfocusondevelopingpracticalriskreductionlife-skillsaswellasraisingawareness;thereshouldbegreateremphasisontranslatingknowledgeintolife-skillsthathelppreventinjury.

Dangersandinjuriesaffectchildrendifferentlydependingonage,gender,socioeconomicstatus,disability,familystructureandethnicity,amongothers.Certaingroupsaremoreatrisktospecificinjuriesinspecificcontextse.g.youngchildrentodrowning,adolescentstoroadcollisions,girlstoburnsandboystofallsandroadcollisions.Responseservicesforchildrenwithdisabilitiesareoftennotavailable,inadequateornotageappropriate.

• Effectiveresponsesneedtounderstandthesedifferencesandtargetpreventativeeffortsandresponsesatdifferentgroupsofchildren.

• Ensurechildrenwithdisabilitiesareconsulted,providedwithinformation,aresupportedtoaccessservicesincludingeducationpsychosocialservicesandchildfriendlyspaces,andwaterandsanitation.

• Investinspecialistpsychosocialserviceswherethelevelofseriousinjuryandnewlyacquireddisabilitiesarehighandchildrenwillrequirespecialisedsupporttorecoverfromlifechangingimpairments.

• ConsiderpairingPhysicalRehabilitationSpecialists(suchasaPhysiotherapistsoranOccupationalTherapists)withPsychosocialWorkers/CounsellorsorPsychologiststodevelopmultidisciplinarycareplansandteamsforchildrenwhoareseriouslyinjured.

• Furtherresearchisneededontheimpactofnewlyacquireddisabilitiesonchildreninemergencies.

For chi ld protection practit ioners Dangersandinjuriesarecloselyrelatedtoavarietyofotherchildprotectionconcerns.Specificgroupsofchildrenfaceincreasedphysicaldangerswhentheyareaffectedbyissuessuchaschildlabour,associationwitharmedforcesandarmedgroups,separationfromfamilyandcaregivers,disabilityandimpairment,andcontactwiththejusticesystem.Wheredangersandinjurieshavebeenincludedinchildprotectionassessments,communitieshaveconsistentlyidentifiedthemasamajorconcerninpost-emergencycontexts.

Childprotectionassessments(bothrapidandlonger-term)mustincludephysicaldangersandinjuriesanddisaggregatedatacollectionbyage,genderanddisabilityasaminimum.

• Developanevidencebaseforhowbesttoassessdangersandinjuriesinemergencies.• Childprotectioninterventionssetuptorespondtochildprotectionissuesmustmainstreamactivities

toaddressandreducetheimpactofphysicaldangersonvulnerablegroupsofchildren.• Generalsafetymessagesshouldbemainstreamedintoawarenessraisingeffortsbasedonfindingsof

assessmentofthekeyconcerns.

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• Childrenwhohavebeenseriouslyinjuredoraredisabledshouldbesupportedasapriorityat-riskgroup.

• Practicalsafetymeasureswillneedtobeprovidedformanychildrenwhoareinvolvedinrisk-takingbehaviour.

• Focuscoordinationwithothersondataandassessment,advocacyandawarenessandsupportandreferralsforindividuals.Shareinformationamongstpartnersondangersandinjuriesandencourageduty-bearerstoincreasetheirownawarenessandsafetymeasurestheycantake.

• Keeppreventativeprogrammesinemergenciessimpleandeasytoimplement,localandcost-effective.Bewareofover-burdenedchildprotectionteamsandotheractors.

Itisimportanttounderstandthepre-emergencycontextofdangersandinjuriesinacountryaffectedbyanemergency.Emergenciescanexacerbatepre-existingdangers,createnewrisksandchangepeople’sbehaviourandknowledgeinanygivensituation.Non-emergencycontextshavedevelopedabodyofevidenceontestedandevaluatedinjurypreventionstrategies.Althoughmanyhavenotbeenrelatedtohumanitariancontextsthepotentialforinnovationandlinkagesisevident.

• Identifythemainphysicaldangersandinjuriespresentbeforeanemergency.Usegloballyandnationallyavailablestatisticsandinjurysurveys,whereavailable.

• Identifywhoinparticulartheyaffect(age,gender,disability).• Identifyanykeyresearchintodangers,injuriesandpreventionstrategiesthathavetakenplacein

country,consultwithcolleaguesinthedevelopmentsector.

Children,theirparentsandcommunitymembersarebestplacedtoidentifyhazards,risksanddangers,aswellasinjuredanddisabledchildren,andtheyshouldbecentraltoeffortstoaddressthem.

• Assesscommunities(includingchildrenandparents)capacitiesafteranemergencytobeinvolvedinarangeofpreventionandresponseactivities.

• Involvechildrenandyoungpeopleinassessmentandriskmappingasabasisforactionthroughchildprotectionactivities.

• Involveyouthinpreventativeandsafetyinitiatives,notonlydoesitencourageownership,effectivenessandsustainability,itcanalsocomplementotherobjectivessuchaspeacebuildingandviolenceprevention.

• Engagelocalleadersandlocalauthoritiestoidentifyandaddresskeysafetyandchildcareissuesthataretheirresponsibility.

• Encouragechildren,parentsandcommunitygroupstodevelopself-helpactionplanstoaddressissues.

ChildprotectionactorsimplementingCFSneedto:• EnsureadequateexpertiseandresourceswhenbuildingCFS,includingsiting,structuralintegrityand

budgetaryallocationformaintenanceforthedurationoftheCFS’slifetime.• Ensureadequatestaffingandsupervisionforthenumberofchildrenpresent.

For donors • IncreasefundingforMREprogramming,safetymessagingandageappropriateservicesforchild

victimsofindiscriminateweaponsofwar.Includesignificantresourcecommitmentsfortherehabilitationandsupportofchildrenleftdisabledduringwar.

• Ensureadequatechildprotectionfundingduringemergencyresponses;ensurebudgetsareflexibleenoughtoallowforthesupportofcommunity-drivenresponsestodangersandinjuries.

• Supportsufficienthumanresourcecapacity,intermsofdevelopingunderstandingandknowledgeamongkeystakeholders,andensuringappropriateworkloadsacrossserviceandresponsedelivery,whichenablesallhumanitarianstoplayaroleinidentifying,preventingandrespondingdangersandinjuriesinhumanitariancontexts.

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• Ensuresufficientbudgetsandadvocateforsafedevelopmentofinfrastructureandfacilitiesincludeallocationsforsafedesign,siting,buildingpractices(includingdisabilityfriendlyaccess)andmaintenance.

• Useemergenciestobuildbackbetterandlocateschoolsandotherservicesawayfrommainroads,rivers,thecoast,amongothers.