Children growing up amid polycrises: implications for child development and children with disabilities

Introduction

The nature of humanitarian crises affecting children is rapidly changing. Armed conflict remains a threat to child survival and well-being—over 473 million children now live in areas affected by armed conflict.¹ Climate change is impacting hundreds of millions of children globally. More than 40 million children are being forced to migrate within and across borders. Pandemics, economic inequalities and the rise of authoritarian governments further challenge the global health and well-being of children. These multiple, converging and prolonged stressors have come to shape children’s everyday experiences and developmental trajectories,^2–4 not as individual crises but as polycrises.

Children with disabilities are consistently among the most affected and least protected populations in polycrisis settings. They are less able to flee attacks, rehabilitation services and educational supports are disrupted, assistive technology is often unavailable and humanitarian responses frequently overlook disability in needs assessments, shelter design and protection programming.⁵

Definition of polycrisis

We use the term polycrisis to describe situations in which children experience multiple, interacting forms of conflict—armed, environmental, structural, political, economic and migratory—simultaneously or sequentially. Polycrises can be considered in the context of syndemics, in that they result in cumulative exposure, chronicity and mutually reinforcing harms (table 1). Resulting inequities are not merely the residue of polycrises—they function as persistent crises in their own right. Using the framework of child rights, polycrises violate the rights of children to life and optimal survival and development, in particular, children with disabilities.^{6 7}

Table 1. Pathways through which polycrises affect child development.

Pathway	Description
1. Direct pathways	Children exposed to armed conflict and environmental disasters face immediate risks of injury, illness, disability and death.3
2. Indirect pathways: disruption of caregiving and essential systems	Among the most damaging consequences of polycrises for child development occur indirectly, through prolonged disruption of caregiving and the systems that support them.9 10 In conflict-affected countries, half of primary-aged children are out of school and even those who attend often do not learn—a finding documented in the Democratic Republic of Congo and among Syrian refugee children in Lebanon.1
3. Relational pathways	Family separation, bereavement, displacement and community fragmentation undermine children’s sense of safety, belonging and identity.3 4 6 Everyday violence—organised crime, gender-based violence, gang recruitment, family separation at borders—erodes the relational scaffolding on which development depends.
4. Structural and cultural pathways	Structural violence rooted in poverty, racism, colonial legacies and environmental injustice amplifies exposure to harm and constrains recovery. Latin American colleagues described the experience of Emberá children, an indigenous community in Colombia, displaced by armed conflict and extractive industry in Colombia: forced migration from ancestral territories has been followed by loss of mother-tongue language, changes in caregiving practices, exposure to street begging in cities and rising rates of suicide among community leaders.

Impact of polycrises

Case studies presented at a recent meeting of the International Society for Social Pediatrics and Child Health (ISSOP) and International Developmental Pediatric Association (IDPA) illustrate the impact of humanitarian crises on children and, in particular, children with disabilities.

Climate change. Climate change was presented as a conflict multiplier that intensifies resource scarcity, drives displacement and exacerbates social and political tensions. Children forced to migrate due to climate change face a dual transition—displacement from home compounded by the ordinary developmental transitions of childhood and adolescence. Many travel without documentation, encounter discrimination and language barriers on arrival, and resettle in areas themselves affected by climate stress or violence.

Immigration. The impact of a series of US immigration measures—family detention, separation of children from their parents, restricted access to public insurance and nutrition programmes—on the physical, mental and behavioural health of immigrant children was discussed. Practical clinical responses include a clinic at Children’s Hospital of Los Angeles that integrates trauma-informed medical, behavioural, social-work and legal support for immigrant families, distribution of a ‘Red Card’ that explains the rights of families and how to respond to law enforcement, and partnerships with community organisations.

Case studies shared how children with disabilities in Afghanistan and refugee children in Türkiye, incarcerated migrant families in Australia and the USA, and indigenous children in Guatemala were affected and unable to access specialised rehabilitation services. Participants discussed how resilience in polycrisis contexts is collective and relational rather than individual. Families, kinship networks, faith and cultural communities, and social solidarity serve as critical buffers against harm. Indigenous perspectives emphasised how reciprocal relationships with land, language and community are foundational to well-being. Palestinian colleagues drew attention to the concept of ‘ṣumūd’ (steadfastness)—a form of individual and collective resilience expressed through survival, embracing life, sustaining language and culture, and serving community—that resists the framing of resilience as a passive, biological property of the individual child.

Professional responsibilities

Child health professionals and organisations have responsibilities to respond beyond providing direct clinical care. These include documenting developmental harms; translating evidence into policy-relevant knowledge; supporting children, families and frontline colleagues; and advocating for the rights-based protection of all children. Professional bodies have shown that it is possible to address the human costs of conflict, displacement and structural violence through rights-based approaches that hold both perpetrators and enablers to account—as illustrated by the American Academy of Pediatrics’ public stance on family separation at the US–Mexico border in 2018, the Royal College of Paediatrics and Child Health’s sustained advocacy on child poverty and refugee health, and the work of international consortia documenting the impact of armed conflict on children.³

Professional training must integrate biopsychosocial and developmental perspectives, disability inclusion, planetary health and cross-sector collaboration. Such training is distinct from trauma-informed or adverse-childhood-experience-informed approaches because polycrisis contexts involve chronic, system-wide instability and structural violence that require sustained, adaptive and context-sensitive responses rather than time-limited interventions.

Call to action

In response to the need to advance the rights of children with disabilities impacted by humanitarian crises, we provide the following framework for strategic action.

Guiding principles

The principles of child rights should guide responses to children in polycrisis settings:

1. Non-discrimination and equity (Article 2).⁶

2. The best interests of the child (Article 3).⁶

3. Life and optimal survival and development (Article 6).⁶

4. Meaningful participation of children (Article 12).⁶

Interventions should be tiered at three levels

Individual and family level

• Provide trauma-informed, culturally safe and disability-inclusive clinical care.

• Ensure assessments of children with disabilities include physical, mental and behavioural health needs in the context of prevention, treatment and rehabilitation.

• Establish continuity of educational, rehabilitative and assistive-technology support in response to polycrises.

• Orient families to their legal and human rights.

Community and service-system level

• Integrate cross-sectoral services focused on the child.

• Ensure disability-accessible care.

• Train professionals in the principles of child rights and Social Paediatrics.

• Invest in refugee-specific and migrant-specific services.

Societal and policy level

• Protect child-focused systems—schools, hospitals, water and sanitation, social protection—during polycrises and recovery, consistent with international humanitarian law.

• Establish child and disability-inclusive humanitarian conflict, migration and climate adaptation policies, with consideration of child development outcomes in policies.

• Take action related to the structural determinants of conflict, inequity and oppression—poverty, racism, colonial legacies, land dispossession, extractive economies and environmental injustice.

• Ensure continuous monitoring of child well-being across crisis cycles, including life-course functioning, participation and developmental outcomes.

• Implement principles of polycrisis governance, aligning health, education, social protection, disability inclusion, and migration and climate policies with child health and development.

Evidence-informed priorities

1. Practice

   Integrate biopsychosocial, developmentally informed and rights-based approaches into routine care for children affected by polycrises, with explicit attention to functioning and participation of children with disabilities, as articulated in the International Classification of Functioning, Disability and Health (ICF).⁸

2. Systems

   Invest in continuous monitoring of child well-being systems using child rights-based metrics that enable early identification of developmental risk, guide preventive intervention and support accountability in dynamic crisis contexts.

3. Policy

   Develop integrated child rights-based policy architectures that align health, education, social protection, disability inclusion, conflict, migration and climate adaptation.

4. Professional leadership

   Professional associations should actively contribute to policy generation, translate evidence into normative guidance and support the ethical engagement of their members in prevention-oriented, rights-based responses to polycrises.

Conclusion

Polycrises—chronic, interacting environments of armed conflict, climate disruption, displacement, structural violence—affect children through direct, indirect, relational and structural pathways. Children with disabilities are disproportionately affected and routinely excluded from humanitarian planning and response. Disability inclusion must be included in the development, implementation and evaluation of clinical care, systems development and policy generation. Paediatric and child health providers have a professional and ethical duty to contribute to these efforts and to hold perpetrators and enablers of harm to account. Responding to the challenges of polycrises and oppression requires rights-based, intersectoral and disability-inclusive action at the family, community and policy levels—sustained over time.