Thousands of children every year are killed in conflict and maimed for life. Always more vulnerable than adults, in war zones children lose the protection of community and family and are exposed to a multitude of threats. For these children there is no such thing as a normal life.
They die from diseases which are not significant elsewhere because there are no medicines and they are already undernourished. They have no education so no prospects and they are easy prey for those who are uninhibited by the total absence of local law enforcement. They are more likely to be abused sexually and trafficked as forced labour. They are often forced into marriages or must assume the role of parent. They witness appalling atrocities.
Children in war zones are the same as children the world over: they dream of growing up and becoming teachers, and doctors, drivers and shopkeepers but children in war zones rarely realize their dreams.
In 2009 the UN estimates more than a billion of the world's children live in countries torn apart by conflict. Last year 18 million children were living away from their homes, forced away either as refugees crossing an international border or as internally displaced persons.
The International Committee of the Red Cross marks Universal Children's Day, November 20, by urging the global community to fully respect existing international humanitarian and human rights law which offers protection to children in armed conflicts.
Kristin Barstad, the ICRC's Advisor on children and war says, "Children's vulnerability increases in time of conflict. International humanitarian law is there to protect civilians, children in particular and... these fundamental rules must be respected. Those who do not respect them must be held accountable."
International Humanitarian Law which includes the Geneva Conventions stipulates that children held by enemy forces and/or living under occupation are entitled to health and education and must be protected against any and all forms of abuse. Likewise civilians who do not take part in the hostilities must not under any circumstances be targeted. Additionally, human rights law, the Convention on the Rights of the Child specifically refers to the need to protect children against the effects of armed conflict.
This year, Universal Children's Day is the 50th Anniversary of the day on which the UN General Assembly adopted the Declaration of the Rights of the Child. Three decades later, in 1989 the Convention on the Rights of the Child was signed and has now been ratified by 191 States. Another 20 years on, millions of the world's children remain in danger, with almost no capacity to realize productive, healthy lives in safe and secure communities.
Decades of conflict in Afghanistan have left a country with very little infrastructure. The consequences for Afghan children are terrible. More than 30 percent of children aged under five in Afghanistan are underweight, immunization rates are low and for most there is no easy access to medical care. The combination of deprivations is deadly: the mortality rate for children under five in Afghanistan ranks second in the world. Twenty five percent of children die before they reach the age of five and more than half of the country's children are stunted. Life expectancy for both men and women is just 44.
Even when medical facilities are within reach, many people are afraid to seek it out because of the dangers.
Dr Alan Karibean was the specialist in charge of the paediatric ward at Mirwais Hospital in Kandahar, Afghanistan's second largest city. Many of the women here have taken the risk and travelled great distances with their children for medical care.
"The typical diseases we see are diseases associated with poverty in most countries world-wide," Dr Karibean says," And because of the conflict related issues, the economic issues that trickle down, malnutrition follows. I do believe that's one of the most important factors that increases the severity of the illnesses."
For now the outlook for Afghanistan is grim. Most of the population do not have access to safe water. Literacy rates remain low and girls continue to lag behind boys in school enrolment. Landmines and unexploded ordnance are a serious risk for children.
The ICRC Surgical Hospital for weapon-wounded was set up in February of this year to treat victims of the conflict in the north-west territories of Pakistan. The hospital has 60 beds with 120 local staff and 20 expatriate personnel, including eight nurses and two surgeons. The on-going conflict in the north-west has displaced an estimated two million people since 2008.
Children and young people are particularly vulnerable to bomb blast and weapon injuries. Sham Sullah is 15 years old from a rural village in north Waziristan. He was hit in the leg by a bullet and was brought to the tented hospital after treatment at a local clinic. He was operated on to save his leg, and is now receiving specialist care and physiotherapy. Inspired by his treatment at the hospital, Sham Sullah says he wants to be a doctor one day.
To the south west of Tskhinvali, the regional capital of South Ossetia lies an area known locally as 'Shanghai'. It was the scene of heavy fighting between Georgian and Russian forces in 2008. The surrounding forest areas now appear peaceful but are potentially deadly, particularly for children.
Azmat Kobesor, 12 and Roman Dzhabier 11 were playing when they found what they thought were fireworks. It was in fact an unexploded weapon. They put a match to it and it blew up injuring both of them. Azamat lost his thumb in the accident and Roman suffered shrapnel wounds to his face and eyes.
"I remember even when I was in hospital, I could see the explosions. I would see it in my dreams," says Azamat.
Anna Sanakoeva from the ICRC in Tskhinvali says, "Even if children know something is dangerous, they still go and they have to touch, they have to feel, this is in the nature of children. The other thing is, that in every post conflict there is this situation with unexploded ordinance - the clearance takes place to a greater or lesser extent but still the danger exists for many, many years after the conflict."