Throughout the history of mankind, children have been facing wars.
With the growing knowledge of trauma and the prolonged impact of
exposure to stress, we now know much more of the psychological,
social and developmental costs to both adults and children. The
Community Stress Prevention Center (CSPC) was established in 1981,
following massive attacks on the northern part of Israel from South
Lebanon. The main aims of the center were:
To study the phenomena of civilians (mainly children) living under
constant threat to their lives, to develop psychoeducational
preventive programs aiming to help teachers to help children
before, during and after an incident. To build a library of
knowledge and information on these issues. To train
educationalists, psychosocial and medical staff, community workers,
community leaders and laymen in the field of stress prevention and
stress inoculation, and to organize response teams to arrive at the
scene and provide consultation support and, sometimes, direct
intervention with affected children or adults.1
Childhood is devastated by war. For children who grow up in an
environment of continuous or, even, intermittent stress, this
colors their existence. They may assume that the world is not a
safe place, and that parents - the primary source of children's
security - cannot be relied upon for protection at all times, since
they leave their children in times of danger (fathers are
conscripted), allow separations from them (for example, for
evacuation), and let horrific things happen.
The heaviest psychological price paid for war is the trauma of
bereavement. Being orphaned, wounded, crippled or having one's
house destroyed, cause mental suffering and, in many cases,
irreversible mental damage. The concept of "bereft families"
includes increasing numbers of children exposed to the traumatic
experience of losing loved ones as a result of war or terrorist
While trauma is a direct injury, the stressful situations of war
create indirect injuries. Children are influenced by the moods of
their parents and absorb feelings of worry, pain, anger and
frustration. Family functioning is disrupted by prolonged absences
of fathers and sons serving in the army. When families live near
the border, where frequent dangerous incidents occur, they are
affected by the constant turmoil and lack of security. The
necessity to take refuge in shelters from bombings destroys the
daily routine and often disturbs the night's sleep. In emergencies,
there is liable to be an evacuation. This means that children are
separated from their parents: they are uprooted and taken to a
The intensity of the experienced stress is determined by additional
• Proximity to the incident, enabling one to see or hear the
incident and imposing a strong chance of personal injury.
• Identifying with the injured, because of the same age or
sex, or similar
• Knowing the injured.
• Repeated incidents within a short period of time.
• Living in a border area or near a hostility zone.
Proximity to the place of the incident increases the stress, but
geographical distance from the place of the incident does not
always provide protection from stress and anxiety, since immediate
reports on television and through other media narrow the
psychological distance and increase the general feeling of
insecurity. Thus, children living in different regions become
directly or indirectly involved. This involvement can explain why
psychological investigations have not identified any significant
difference between the anxiety level of children in the center of
the country and that of those living in border settlements (Ziv,
Yisraeli & Verbenhaus, 1972).
"Circles of vulnerability," which become removed further from the
point of the incident, can be compared to a pool full of frogs
where someone throws a stone: the frogs in the middle will react
with great fear whereas the others, feeling the shock waves, will
develop reactions of anxiety (Ayalon, 1987).
Large groups of children throughout the country, exposed to the
shock waves of enemy attacks, are in danger of developing stress
reactions that are liable to affect normal functioning and to cause
suffering to some of them, as well as to their families.
Once the battles subside, the stress does not completely disappear.
Even in times of calm, there are elements of emergency. Living in a
situation of "neither peace nor war," imposes a constant emotional
burden and exposes both children and adults to messages rich in
internal conflict on behavioral, emotional, and moral levels.
These contradictions are liable to bring about conflicts in the
morals and values of the society and to challenge the norms of
wartime, such as violence and depreciation of the value of human
life and property in everyday life. All of these add up to the
mental conflict caused by conflicting values (Kubovi, 1980).
Signs of Distress in Children
Under these conditions of threat, children tend to exhibit signs of
distress, expressed in behavioral changes at home and with friend",
in play, in drawings and in writing. Thus, one can detect signs of
insecurity, anxiety, dependence, difficulty in concentration,
frustration, anger, and aggression.
Stressful situations create two basic reactions: fight and flight.
Flight reactions are accompanied by fear and anxiety and are
frequently expressed through behavioral regression. Fight reactions
are accompanied by anger, intensified by children's exposure to
adults' violent way of settling international and regional
conflicts. The functional disturbances arising from these two types
of reactions are described below.
What are children frightened of in times of increased security
tension, war, and terror? Are their fears different from those
related to the normal process of growth and change? Through careful
observation of children's signs of distress during tense security
situations, six basic characteristics of fear can be
Fear due to circumstances: Fear as a result of threat is called
"healthy fear" and is common to both adults and children (Janis,
1975). It has the function of indicating the presence of danger and
warns the person to be careful, thus ensuring survival. However,
when circumstances interfere with taking the appropriate means of
defense or inhibit flight reactions, then physical symptoms of
confusion and psychological problems ensue, accompanied by
regression in behavioral patterns.
Increased imaginary fears in young children: The fear of war is
mixed with many other characteristic fears, and can cause
difficulty in distinguishing between real and imaginary dangers.
With growth and development, fears of war become more concrete.
Even though the confusion caused by alarming incidents disappears
once the threat is past, physical and behavioral symptoms can
persist for some time.
Fear caused by the behavior of those around the child: Young
children experience the world through the significant adults in
their life. Overreaction on the part of adults will cause the
children in their care to be afraid, whereas an atmosphere of peace
and security in times of conflict will calm children. It is,
however, difficult to request that parents remain calm in a
dangerous situation. Some adults try, "for the child's sake," to
pretend all is well, but their denial of fear can make coping all
the more difficult. When these adults try to hide or deny their
anxiety, they usually require that their children play the part of
the hero, thus increasing a feeling of helplessness. Not only do
children fail to receive support when they need it, but they are
also denied the opportunity of verifying their perception of things
- that their parents are worried or annoyed. Instead of being
allowed to indulge in their emotions, children are likely to suffer
shame or guilt and to feel confused and isolated. An open
discussion of feelings and thoughts, combined with expectations of
improvement and a better future, may counteract these fears.
Fear of separation from parents: Fear of separation or abandonment
is normal during the first years of every child's life. It is
heightened by the unavoidable separation from conscripted family
members. These fears are intensified in times of war, when children
suspect that following the departure of their fathers, they will
also lose their maternal support.
Fear of death: Concerns about death preoccupy the child at various
developmental stages. However, the issue still remains mysterious
and unknown. In times of war, younger children are exposed to the
experience of loss of life, without having the means of dealing
with the information and the fear aroused by it. Cases of death
around them may increase the feeling of their own vulnerability.
The loss of loved ones forces many children to confront bereavement
and increases their concern for children their age having a similar
fate. Preparing children to cope with the subject of death,
expressing feelings of distress and mourning, comforting those
bereaved, and understanding the reactions of bereavement have
become an urgent social-educational issue (Smilansky, 1978).
However, frequent exposure to death can cause flattening of
emotions, apathy and depreciation of the value of life.
Traumatic fears: In some extreme cases, exposure to
life-threatening incidents or loss of loved ones is likely to cause
post-traumatic stress disorder, which includes at least three of
the following symptoms: remembering details of the disaster as if
they were actually happening; phobic avoidance of places or
activities arousing memories of the traumatic event;
oversensitivity to sounds; nervousness; flattening of emotions;
disruption in one's sense of identity; memory impairment or trouble
concentrating; sleep disturbance; hyperalertness for repeated
disaster; regrets and guilt about surviving when others have not;
and suspicion and alienation with regard to society and its
institutions. These symptoms are not likely to diminish or
disappear without special treatment (Ayalon, 1989).
Long- Term Effects
Long-term mental damage is hard to gauge, since it is not always
possible to distinguish between the effects of war and those of the
various life events shaping children's personalities. Factors such
as denial (conscious or subconscious) and social desirability
decrease the hidden mental scars, unnamed and unclassified by
conventional psychological measurements.
Studies from the time of World War II attest to long-term disorders
in children to the occurrence of agitation and confusion in parents
and other "significant adults" looking after them. Nervousness,
bed-wetting, and other anxiety reactions that appeared in children
after aerial bombings were related to reactions of overanxiety in
their parents (Freud & Berlingham, 1942).
Follow-up studies with mentally affected children as a result of
the civil war in Northern Ireland indicate that in only a few cases
do the symptoms of fear and withdrawal persist and become chronic.
In most of these cases, children were found to be oversensitive, to
have previously exhibited signs of distress, and to have had some
kind of developmental difficulty (Fraser, 1973). Most children with
a normal ability to adapt calmed down with the passing of the storm
and gradually returned to normal. Thus, the conclusion drawn is
that special attention should be devoted to children defined as
"high risk" (such as the physically weak or mentally handicapped;
children who have suffered desertion, abuse or the loss of a
parent; or those who have been uprooted from their homes).
Preventive treatment can decrease the time required for
War and incidents affecting security are particularly traumatic for
children who have been directly exposed to death through loss of a
parent or sibling, an attack by terrorists, a serious injury, the
destruction of their home, or an attack on their settlement. These
destructive events are likely to imprint themselves on the child's
personality and to affect him or her for many years. Countless
testimonies confirm that children suffering from direct injury
carry their pain throughout their adult lives like a fire in their
souls. The consequences of this pain permeate their lives and are
transmitted to the next generation (Nathan, 1981).
The "survivor's syndrome" may appear after years of apparently
normal adaptation, as a reaction to stimuli that arouse
recollection of the original incident. This syndrome may become
apparent in various behavioral, cognitive, and emotional
expressions, such as nightmares, unrelenting ideations, fears
associated with the place of the incident, expectation of
reoccurrence of the incident, suspicion of others, feelings of
guilt toward the victims, and various kinds of depression. Even
when there are no immediate signs of suffering following a
traumatic incident, one should not ignore the need for
intervention, support, and rehabilitation among the victims and
A typical reaction of a society in constant conflict due to the
security situation is denial of fear. "Playing the hero" receives
widespread social applause. This happens at the cost of suppression
and ignoring of emotions counter to this image, and of social
disapproval of anyone showing signs of fear. The same expectation
is also directed at the bereaved family. The long-term effects of
such denial are evident in the decrease of emotional investment in
relations, and the tendency to become hardened in order to prevent
showing signs of weakness.
Despite the child's great sensitivity during the first
developmental stages, most children display invulnerability to
surrounding pressures, especially if they receive consistent
support and calm from parents. There are additional factors
enhancing the invulnerability of the child in emergency situations
and in war.
Young children tend to take the environment for granted. They have
nothing to compare it with, so they adapt to changes imposed upon
them by the threatening environment as if these were everyday
changes dictated by their parents. To determine adaptability, a
distinction must be drawn between children who are objectively
aware of the dangers and those who do not perceive the full extent
of the situation, due to their age and personality, and whose
feelings depend, to a large extent, on their parents'
Factors Enhancing Adaptation
Suppression and Denial: The use of these defense mechanisms helps
children avoid confronting the stress. Ignoring it, diverting one's
attention, or creating the illusion of immunity by saying, "It
won't happen to me," are efficient mechanisms for decreasing
anxiety whenever there is no possibility of controlling the
Compensation: Staying in the shelter, in the permanent presence of
adults, is likely to compensate the anxious child for his or her
fears. Perceiving the shelter as a safe place enhances the feeling
of security. Children enjoy the permanent presence of an adult
(parent or teacher), as well as being together with others. The
common worry about security is likely to cause some distortion of
specific childhood problems, such as learning difficulties and
Support Systems: The component of support in the stress equation
plays a most positive role in coping. In border settlements - where
there is a high degree of cohesiveness - inhabitants feel more
secure, in spite of the security dangers, than do those in
settlements where communal cohesiveness is low (Ayalon, 1983). The
small and tightly-knit group allows expression of interpersonal
distress and gives the individual a kind of "security net,"
offering a "soft fall" in hard times.
Active Cooperation in the Adult World: Children's reactions to war
are not always connected with fear and withdrawal. Children who
desire change and adventure often greet these novelties in their
life with excitement and curiosity. Many children mature early,
assume responsibilities, carry out family and community tasks, and
become aware of and interested in political matters. To increase
their own coping skills, therefore, children and young people
should be directed toward helpful communal activities.
The BASIC Ph Model
We suggest a multimodal model to understand mental resilience in
stressful situations. The model was developed through ongoing work
with a population living in the shadow of constant threat on their
lives. It was developed by observing and interviewing people under
stress and it can be seen clearly that every individual has his or
her own special combination of coping activities and
In our research of coping mechanisms we found different coping
styles. There are those whose preferred type of coping is
cognitive-behavioral. The cognitive strategies include
information-gathering, problem-solving, self-navigation, internal
conversation or lists of activities. A second type will demonstrate
an emotional or affective coping mode and will use expressions of
emotion: crying, laughter or talking with someone about their
experiences; or through non-verbal methods, such as drawing,
reading or writing. A third type will opt for a social mode of
coping, and receive support from belonging to a group, having a
task, taking a role and being part of an organization. A fourth
will use imagination to mask the brutal facts by day-dreaming,
pleasant thoughts, or divert their attention using guided imagery;
or try and imagine additional solutions to the problem that go
beyond the fact - improvisation. Type five will rely on belief and
values to guide them through times of stress or crises. Not only
religious belief is meant here, political stances or feelings of
"mission" are also intended, as well as the need for
self-fulfillment and strong self-expressions. Ph-type people are
those who mainly react and cope by using physical expressions
together with body movement. Their methods for coping with stress
are relaxation, desensitization, physical exercise and activity.
Expending energy is an important component in many modes of
The initials of the BASIC Ph model stand for:
Beliefs, attitudes, meaning;
Affect, verbal and non-verbal;
Social skills, roles and support;
Imagination in creative problem-solving and in the use of attention
Cognition, information and problem-solving;
Ph, action and relaxation.
Our research has shown that it is possible to enhance coping
skills. As it is the adults who make war, they should support the
children of war.
Over the past 18 years, we have studied the impact of the security
situation on children and adults living on Israel's northern
border. Starting in 1979, we developed programs to assist teachers
and parents help their children to cope with the security problems.
The programs are geared to all age groups from kindergarten to
These programs were implemented in most educational institutions
and a follow-up study revealed a decrease in the level of fear,
more openness towards sharing feelings, decrease in physical
symptoms of anxiety and an increase in cooperative and coping
behavior (Lahad, 1986).
In 1993, following an evacuation of children from northern
settlements, in particular Kiryat Shmonah, we conducted a major
study on the impact of this evacuation on children and their fears,
coping and wishes to leave the region. The results of this study
showed that children who were evacuated together with their parents
coped better than those who left separately and, furthermore, even
those who stayed under bombardment in town showed fewer signs of
anxiety than those who left town without their parents, following
the return to normal (Shacham, 1996). We were able to advise and
work with the formal and non-formal educational systems after the
operation and assist in full mental rehabilitation. We also found
that the mobilization of coping resources is gradual. The cognitive
resource is quite constant, whereas mobilization of the system of
beliefs resources grows rapidly when stress escalates. After every
incident along the northern border, both large and small, we
implemented the principles of the BASIC Ph model, as discussed in
this article, with very good results in maintaining the resilience
of the children and, whenever necessary, facilitating their
1 Our organization is a nonprofit charitable organization assisting
all the population of the North of Israel, regardless of religion,
nationality or race. We are currently serving as advisers to UNICEF
psychosocial projects throughout fonner Yugoslavia and training
Ayalon, O. (1983). "Face to Face with Terrorists" (Hebrew). In A.
Cohen (Ed.), Education as a Meeting Place (pp. 81-102). Haifa:
Ayalon, O. (1987). "Living in Dangerous Environments." In B.
Germain, H. Brassard & S. Hart (Eds.), Psychological
Maltreatment of Children and Youth (pp. 171-182). New York:
Ayalon, O. (1989). "Mental and Community Treatment of Terror
Victims." In C. Desberg,
Y. Itsikson & G. Speller (Eds.), Short-Term Psychology (pp.
206-229). Jerusalem: Agnes.
Fraser, M. (1973). Children of Conflict. Harmondsworth:
Freud, A., & Berlingham, D. (1942). War and Children. New York:
Janis, I. (1975). "Healthy Fear."' In I. Markowitz & R.
Rabinowitz (Eds.), The Individual and the Community in Emergencies.
Jerusalem: Ministry of Interior.
Kubovi, D. (1980). "Therapeutic Teaching, Applications in
Emergencies." In A. Raviv, A.
Klingman & M. Horowitz (Eds.), Communities under Stress and
Crisis (Hebrew). Tel Aviv:
Lahad, M. "BASIC Ph." In S. Jennings (Ed.), Dramatherapy Theory and
Practice, Vol. 2. London: Routledge, (1992).
Lahad, M. (1986) in the Israeli Journal Chavat Da'at. Jerusalem:
Ministry of Education.
Nathan. (1981). Second Generation Holocaust Survivors (Hebrew)
Holocaust Research Institute. Shacham (1996) "Stress Reactions and
Activating Coping Resources." Doctoral thesis, Newport
Smilansky, S. (1978). "The Concept of Death in Israeli
Schoolchildren (Hebrew), Options, Vol. 9. Ziv, A., Yisraeli, R.,
& A.Verbenhaus (1972). "Anxiety Level of Children under Stress"
(Hebrew). in Community Stress Prevention, Vol. 2 (eds.) Lahad M.
& Cohen A.