Dr Paul Reavley shares a powerful look at the realities children face in modern conflict, highlighting the devastating impact of blast injuries, the urgent need for specialised care, and the gaps in frontline treatment while calling for better protection, training, and global action to safeguard children in warzones.
Picture a scene. You are in the Emergency Department of a deployed field hospital in a warzone. You receive a pre-alert. An eight-year-old girl has been injured in a blast.
You prepare. Your team, your equipment, your mind.
She has lost both legs and one arm. She is unconscious. Arterial tourniquets have been applied to her limbs to stop her bleeding to death, but she has already lost more than half of her blood volume. She will die soon.
The patient arrives and the emotional window opens. That human connection we have with children. You see your own child in front of you. Three limbs missing.
A record number of children are living in conflicts globally and this scene is the reality for far too many. I’ve seen first-hand what it does to them. How their lives can be changed in an instant.
Today, more than one in five children globally – 520 million – live in areas affected by conflict. The UN’s latest annual report on Children and Armed Conflict has found that the number of children being killed and maimed in these conflicts has reached unprecedented levels. In 2025, at least 6,266 children were killed, representing an increase of around 34% compared to 2024. 7,958 children were maimed, nearly a 10% increase from 2024.
The report found that the surge in child deaths and injuries has been driven in part by the rise in tech-driven warfare. High-tech explosive weapons, including drones and unmanned or AI-supported targeting systems are increasingly available, exposing children to new and severe risks. They are being used in places where children should be safe and protected –their homes, schools, playgrounds, hospitals, markets.
And even when the strikes end, explosive remnants of war quietly hide, threatening to claim yet more eyes, limbs and lives of not just children now but of those yet to be born. The very things that make children children — gathering to play, their natural inquisitiveness and naivety of youth — make them more likely to encounter these unexploded remnants of war.
Children’s smaller bodies and developing organs mean they are more severely injured by blasts and seven times more likely to die from them than adults. They are physically, physiologically and psychologically distinct from adults and thus require different treatment. They are still growing, so will need repeated surgeries, and new prosthetics as they get bigger. They need specialist mental health support to cope with the psychological trauma of injury and a lost childhood.
Yet, many children aren’t getting these interventions. Up to 85% of children injured in conflict die before anyone can reach them with treatment. And even when children make it to a healthcare facility, many clinicians lack the specialist training, knowledge and confidence they need to treat them.
Imagine a different scenario to the scene painted above. You are in a tent, or a basement, or a bombed-out hospital. The child is carried in by parents with no warning. You are resource limited. Your staff are inexperienced. You have never seen injuries like this before.
A month ago, when you went to bed you were a family doctor and when you woke up in the morning your country was at war. Now you treat conflict injuries.
The chances of whether that child survives or dies will be determined by the knowledge, experience, training and resources that are available to people who are on the frontlines of these deadly conflicts.
Through a partnership with Save the Children, Imperial College London and a host of medical and operational experts, we’re making sure clinicians working in conflicts have the tools they need to give children the best chance of survival. We must equip medics and communities with the knowledge, skills, mental resilience, and facilities to care for the most severely injured children in the world.
But improving treatment is only one part of the solution. Children shouldn’t be exposed to these deadly weapons in the first place.
All parties to conflict must stop using explosive weapons in populated areas, where children live, play and go to school.
And critically, children’s unique risks and rights must be accounted for at every stage of conflict. They hold a distinct legal status under international law, with special protections that recognise their heightened vulnerabilities. We need all states to fully adhere to international law – with a child-sensitive interpretation – and to act decisively when it is violated, with diplomatic, political and legal consequences, not impunity.
Additional note: In 2025, Save the Children released the report, Children and Blast Injuries, the devastating impact of explosive weapons on children.
BIO
Dr Paul Reavley is a Consultant Paediatric Emergency Physician at Bristol Royal Hospital for Children, a former British Army medical officer, and co-founder and chair of the Paediatric Blast Injury Partnership — a coalition between Save the Children UK, Imperial College London and leading medical specialists responding to blast injuries in children. The Partnership was formed in 2017 and advocates for children living in areas of conflict and supports clinicians treating the injuries of war. Central to the partnership is the Paediatric Blast Injury Field Manual and the Paediatric Trauma Resuscitation Course, which are used in conflict settings around the world. Imperial College London research is also helping to develop more suitable prosthetics and surgical equipment for children.
