The World Health Organization (WHO) estimates that 40 million children aged below 15 years fall victim to violence each year. The ensuing traumas vary according to the gravity of the violence and the child's personal experience and can, in the long run, have medical and psychosocial consequences.

The magnitude of the problem at the global level is so great that the World Mental Health Day, this year, has been devoted to the theme "The Effects of Trauma and Violence on Children and Adolescents". The World Mental Health Day, commemorated on 10 October, is sponsored by the World Federation for Mental Health.

Although the problem of violence, in general, and of violence against children, in particular, is widely acknowledged in the WHO African Region, there has yet to be conducted a large-scale survey on the true dimension of the problem in terms of epidemiology, physical and psychical manifestations, case management and preventive action.

WHO defines violence to children as child maltreatment in all its forms i.e. physical and/or emotional maltreatment, sexual molestation, abandon or neglect, commercial and other forms of exploitation, causing actual or potential harm to the health of the child, their survival, their development or their dignity in the context of a relation of responsibility, confidence or power.

Child maltreatment is often accompanied by verbal violence which consists in denying children their personality, hurling abusive words at them or forbidding them to enquire about their rights and/or to carry out their activities. This psychological violence results in discrediting and depriving the child and can cause the child to be misunderstood or be delinquent. The ensuing traumas could be medical, causing physical wounds, shock or serious lesions. They could also be psychiatric, leaving behind emotional memories of a painful event deep-rooted in the brain.

At a WHO consultation held in Geneva, in 2001, on the health sector's response to sexual violence, a study conducted in many countries in the Region showed that 36% of girls and 29% of boys say they have been victims of sexual abuse at tender age. In 1991, Save the Children, a nongovernmental organization, published a document on 700 cases of sexual abuse of children in a single country.

Sexual violence has serious consequences such as unwanted pregnancies, sexually transmitted diseases (STDs) including HIV/AIDS, and indirect consequences like alcoholism, drug addiction, sexual deviance, and difficulty in or refusal of sexual intercourse. Sexual violence can also cause fear, anxiety, depression as well as disorders relating to behaviour, sleep, feeding, and speech, and may even result in suicide, or suicide attempt.

Female genital mutilation, considered not only as a form of sexual violence but also as a violation of children's rights, involves partial or total removal of the clitoris and other sex organs of girls. They lead to serious infections, profuse bleeding, and septicaemia, painful sexual intercourse, difficult menstruation, impaired urine retention, risks of sexually transmitted infections, including HIV/AIDS, painful delivery and depression. The scope of the problem of female genital mutilation is such that WHO has drawn up a responsive plan of action for the African Region.

Children falling victim to violence do so mainly within the family, within the community, at the institutional level or as a result of war. In times of war, children exposed to various forms of violence undergo traumas that can interrupt their process of development, trigger serious psychical disorders and turn them into delinquents and lifetime criminals.

Children who are themselves not victims of, but do witness, the perpetration of violence can subsequently grow violent themselves. According to experts, such children are more likely to beat up their partners when they become adults compared to their counterparts brought up in non-violent homes.

The greater the trauma suffered from violence, the more serious are the ensuing problems, mental and psychosocial, in particular. The situation is further aggravated by weaknesses in prevention activities, and especially by lack of access to affordable treatment. The social and monetary cost of violence is estimated at several millions of United States Dollars.

In 1997, WHO identified violence as a public health problem, and its prevention as a global priority. The Organization has therefore urged its Member States to urgently take strategic decisions and make choices that can impact positively on integrated and comprehensive management of violence including the treatment of mental and behavioural disorders. WHO has also recommended that Member States develop and/or strengthen mental health policies, promote multidisciplinary and multisectoral approach to care within the community, promote the education of communities including families and consumers, develop human resources, establish a community-based surveillance system and support violence prevention and management research.

Countries are urged to respect the human rights of children and make violence control a priority so as to reduce and even eradicate this scourge and its attendant traumas.

For further information, please contact: 
Flavienne Issembe: Information and Communication Unit 
Dr Custodia Mandlhate - Division of Noncommunicable Diseases 
Dr Colette Delhot - Division of Reproductive and Family Health 
WHO Regional Office for Africa, B.P.6, Brazzaville, Congo. 
Tel: (1-321) 95 39352 / 95 39329 / 95 39179 / Fax: (1-321) 95 39513 
E-mail: issembef [at] afro.who.int (issembef[at]afro[dot]who[dot]int) -teixeiram [at] afro.who.int (-teixeiram[at]afro[dot]who[dot]int) 
- mandlhatec [at] afro.who.int (mandlhatec[at]afro[dot]who[dot]int) - delhotc [at] afro.who.int (delhotc[at]afro[dot]who[dot]int)