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In the midst of war, children are killed or die of malnutrition and disease. They are separated from family members. They are forced to flee their homes and their communities. They witness the torture and killing of their parents and other relatives.

Children are used as civilian shields to protect military forces or as army pack animals. They are imprisoned. They are beaten, wounded, or raped. If fathered by enemy soldiers, they may be rejected by their own mothers.
Children are forced to become soldiers, army slaves, or prostitutes under threat of violence or starvation. As soldiers, they are forced to kill people, even family members or friends. Those who survive war may be physically and psychologically maimed for the rest of their lives.

As a result of war, children grow up without families or homes, without communities or homelands, without a sense of their own—or others’—humanity.

Statistical data document the magnitude of these tragedies. But, as I have heard it said, statistics are people with the tears washed off. In these photographs and oral testimonies from the war in Sierra Leone—one of many current civil wars—David Parker conveys, with tears, the impact of war on children.
From a public health perspective, these tragedies can be overwhelming. But so were many other public health challenges that have now been successfully met.

Direct services must be provided to children who have been affected by war. In addition, public health approaches, such as documentation, research, awareness-raising, and advocacy for effective preventive policies and programs, must be planned and implemented in order to minimize the impact of war i on children and to prevent war itself.
In addition to the challenges facing public health professionals in nations at war are challenges for public health professionals in the United States, given our collective capabilities and experience, our nations role as the leading world power, and our shared humanity.

With values, vision, and leadership, we can reduce the impact of war on children—and, one day, eliminate war.

Sierra Leone, a former British colony founded in the late 18th century for slaves freed by the British during the American revolution, is a small country on the west coast of Africa—nested between Guinea and Liberia. Number one in infant mortality in the world, Sierra Leone has a per capita annual income of approximately $US 160, and life expectancy remains at 38 years. 1 Only an estimated 34% of the population has access to potable water, and only about half the nation s children are vaccinated against polio.

Sierra Leone, which has struggled with democracy since gaining its independence in 1961, has been torn apart by one of Africa’s most brutal wars since 1991. Fighting against the government is a group that calls itself the Revolutionary United Front (RUF). Despite its name, the group appears to have only one objective—control of the nation’s vast diamond resources.

In 1996, Tejan Kabbah, the democratically elected president was ousted in a military coup. He was subsequently reinstated by the Nigerian-led West African peacekeeping force, ECOMOG. At present Sierra Leone has a fragile piece brokered by the United Nations.

In a nation with 4.5 million people, the conflict has resulted in the deaths of 75,000 people and left almost 3 million homeless. As part of its attempt to gain power, the RUF has conducted a campaign of terror, perpetrating some of the most brutal mutilations that have taken place anywhere in the world in recent years.
In late February and early March 2000, I had the opportunity to visit Sierra Leone with World Hope Inter national, a nonprofit medical aid organization. At that time, thousands of women and girls were still being held by the RUF. Most, if not all, were sexual slaves and victims of sexual terrorism. An unknown number of children were armed.
Much of the med¬ical infrastructure of Sierra Leone had been decimated. Hospitals had been looted. Health care workers reported that equipment that could not be moved was destroyed. I heard varied accounts about starvation in the country, but most of the people I talked to, including relief workers, agreed on several points: the country had little food, and the food supply was expected to dwindle even further during the rainy season; most people suffered from some degree of malnutrition; and severe infant and child malnutrition, a common sight, was rare before the war.
I spoke with dozens of people over a two-week period. Among them was not one person whose life had not been affected by the war. Most reported that they had seen acts of terrible brutality perpetrated against family members and neighbors. Many had their hands, arms, or legs cut off by machetes and were then left to bleed to death or struggle to find help. The stones told here are typical of the stories of the many children who have been displaced by wars. The photographs only begin to tell the story of starvation and suffering.