The (Very) Silent Frontline

As war continues to steal childhoods in Ukraine (and elsewhere), Robert Schuett and Susanne Schuett argue that mental health support for children is not a humanitarian add-on, but a moral and strategic imperative.

It is a truism to say that children are our future. But what future awaits those already shaped by war?

Meet Anhelina, a six-year-old girl from near Kupiansk, a frontline city in Russia’s war against Ukraine, who lies in bed, paralysed by recurring panic attacks. And then, meet so many, many others. The scale defies comprehension. The suffering is relentless—a reality acknowledged in Ukraine’s Operational Roadmap, Ukrainian Prioritized Multisectoral Mental Health and Psychosocial Support Actions During and After the War, which has been strongly championed by First Lady Olena Zelenska.

Few would disagree that children, in general, are especially vulnerable. They are entirely dependent on adults to meet their basic needs and subject to decisions made by others. They have little to no control over the physical and social environments in which they are born and raised, nor over what is done—or not done—to them.

Children are also largely powerless in defending their own rights, and their voices are too often unheard. And while it is essential to acknowledge this vulnerabilty, we must also recognise that children can be resilient, adaptive, and even empowered, if we build the systems and environments that allow them to be.

Childhood and adolescence are critical periods of development, in which most mental health disorders first emerge. These conditions are often shaped by social factors, with adverse circumstances significantly increasing vulnerability.

Yet in most cases, mental disorders go undiagnosed and untreated, often persisting into adulthood with life-altering consequences. Today, a growing number of young people around the world are facing what can only be described as a generational mental health crisis.

Among them, children affected by war are at particular risk. One in six children globally—nearly half a billion—are growing up in contexts of political violence and armed conflict. For these children, the long-term mental health consequences are compounded by threats such as exploitation, trafficking, and displacement. In Ukraine alone, the scale of trauma among children is staggering, and stories of abuse and psychological harm continue to surface. These are not just humanitarian tragedies. They are warning signs of deep, lasting societal wounds if left unaddressed.

However, despite the scale of suffering, child and adolescent mental health in conflict settings remains a profoundly neglected area of care, research, and policy. Those already marginalised are often pushed even further to the periphery. In Ukraine and beyond, countless children who are not on the frontlines still carry the psychological weight of war. 

The long-term mental health costs of war and displacement on children and adolescents are staggering. The range of consequences spans post-traumatic stress disorder, anxiety, depression, sleep disturbances, behavioural disorders, and deep psychological distress—all of which erode a child’s capacity to learn, relate, and grow. These are not just individual tragedies; they are structural wounds with generational consequences.

War is one of the most devastating forces humanity can endure, violating the rights and dignity of people across all age groups. Among the many armed conflicts unfolding globally, Russia’s invasion of Ukraine stands out—not only for its brutality, but for its scale and duration. Since beginning on 24 February 2022, it has become the longest war in Europe since the Second World War. The conflict has placed an estimated 7.5 million children at extreme mental and physical health risk, including 2.5 million who are internally displaced. And we must not forget: in Ukraine’s eastern regions, children and adolescents have now lived through nearly eleven years of war.

The toll of war on Ukraine’s children is devastating; this is a crisis measured not only in numbers, but in futures lost:

A full one in five children reports losing a close relative or friend since the escalation of the war. More than 2,500 children—including newborns—have been killed or injured since 2022, and the situation is worsening: child casualties rose by 50 per cent in 2024 alone.

Families are fractured, children are separated from their parents, and basic needs are increasingly out of reach. No place is truly safe. Homes, maternity wards, hospitals, and schools have all come under attack. Once safe havens for learning and stability, classrooms now exist in basements and bunkers.

More than 3,000 educational facilities have been damaged or destroyed. These losses are not just structural—they are psychological, developmental, and deeply human. The war has disrupted schooling for roughly 4 million children. More than 1.2 million children are currently missing out on full-time, in-person education.

At the same time, families across Ukraine are facing growing financial desperation. Homes, land, savings, and livelihoods have been wiped out, while costs for rent, food, and utilities continue to rise. Nearly three-quarters of Ukrainians are struggling to make ends meet. The economic collapse reverberates through the lives of children, whose health, security, and education depend on the stability of their caregivers.

The war’s most devastating consequences have fallen on the most vulnerable children—those already living in institutions or struggling with chronic illness. Since the invasion, countless children in care have suffered forced transfers to Russia. This is a rupture of the most basic rights of the child. At the same time, thousands of children with chronic illnesses have experienced dangerous disruptions to their treatment. Their pain, though less visible, is no less urgent.

This is a collapse of childhood, and the mental health toll of war is not only devastating in the present—it perpetuates a vicious cycle with long-term consequences for individuals and society alike. When left untreated, mental health disorders in young people can severely impair their educational attainment, employment opportunities, and increase dependency on social welfare systems as well as the risk of conflict with the law. The result is a higher burden of disease, greater social instability, and deepening inequality—costs borne not only by individuals, but by the nation as a whole.

The longer these conditions persist, the deeper and more enduring the scars will be. Unless we act: decisively, and at scale.

First, the mental health consequences of war for children and adolescents are so wide-ranging and context-specific that no single intervention can adequately address them all.

Second, the severity and nature of trauma will vary from child to child, just as the social, cultural, and economic conditions surrounding them will differ. What is needed is a flexible, adaptive approach: identifying those most at risk, treating families holistically where possible, and fostering resilience at the community level. A diverse, context-sensitive toolbox of interventions must be developed and scaled.

Third, support must be strategic, specific, and scaled. If we are serious about protecting the mental health of children affected by war, five principles must guide national and international action:

1. Age-appropriate: Interventions must be tailored to the child’s stage of development—from prenatal and newborn care through infancy, childhood, and adolescence.
2. Child-centred and caregiver-empowering: Children must be supported to be children—but this is only possible if caregivers are empowered to care. Support should extend to parents and non-familial caregivers such as teachers and residential care workers. Caregivers, too, need care—both for their own wellbeing and their ability to support others.
3. Context-specific: The consequences of war vary across regions, communities, and households. Interventions must be rooted in the lived realities of children and families, and co-designed with the communities they are meant to serve.
4. Psychosocial in scope: This is not just a clinical challenge—it is a social one. Real help must extend beyond medical care to include safety, housing, schooling, relationships, structure, and meaningful daily life. Psychosocial care must connect with the broader conditions that allow children to develop and thrive.
5. Preventive and resilience-focused: The emphasis must shift from late-stage crisis management to early detection, early intervention, and long-term resilience-building—especially for the most vulnerable.

If we are serious when we say that children are our future, then we must work unceasingly toward a world in which every child can survive, grow, and fully realise their rights and potential. If that sounds idealistic, then the (very) silent frontline becomes the de facto graveyard of any decent future.

A companion piece to this post can be read here.

Robert Schuett is co-founder and managing partner at STK Powerhouse, a global risk advisory firm. A former Defence civil servant, he also serves as Chairman of the Austrian Political Science Association and is a long-standing Honorary Fellow at Durham University.

Susanne Schuett is a senior executive at a Viennese outpatient mental health clinic. A psychologist by training, she holds the habilitation (venia docendi) in psychiatry from the Medical University of Vienna and serves on the advisory board of STK Powerhouse.

Photo by Maisa Borges