Excessive long-term health costs of war on wartime children

Editors’ note: This column is part of the Vox debate on the economic consequences of war.

Around the world, armed conflict has become a serious threat to the lives of millions of people. Because of their loss in human life and their long-term detrimental effects on physical and mental health and human capital, as well as institutional capacity, social capital and economic growth, they make significant sense in all aspects of economic and social life in conflict-torn countries. A 2022 World Bank report predicts that by 2030, two-thirds to three-quarters of the world’s extremely poor will be living in an environment of conflict. 80% of all human needs are responsible for conflict. Moreover, many war-torn countries are caught in a cycle of violence. The last three decades have seen more than 90% of the 39 countries that have had civil wars in the 21st century.

Russia’s aggression in Ukraine in 2022 and the brutality of the war are again at the center of the lasting effects of the armed conflict on the population, especially children (Justino 2022). As a result of the Russian aggression, millions of Ukrainian children have fled their homes and schools and taken refuge in bomb shelters, underground metro stations, parking lots and often as refugees in other countries (Angrist et al. 2022, Baker 2022).

There has long been a view that short-term fluctuations in income and consumption from armed conflict result in temporary but not permanent loss of well-being (Davis and Weinstein 2002; Brakman et al. 2004; Miguel and Roland 2011). Over the past decade, however, there has been evidence that adverse momentary shocks, especially those experienced early in life, can have profound long-term effects. Children are particularly at risk for the effects of armed conflict, due to the age-specific nature of human capital and physical and mental health investments, as well as the extreme hardships caused by armed conflict in the formative years of children (Angrist 2022, Brooke et al. 2022).

In addition, it has been shown that wartime resources, as well as post-war mitigation investments, create significant long-term differences among wartime children. As many as 426 million children worldwide are being affected by armed conflict (bystby et al. 2020).

Examining the historical episodes of the conflict, existing studies provide strong causal evidence on the potential long-term inheritance of cervical and early childhood exposure to wartime children’s war on human capital, health, and labor market outcomes. Studies have examined, for example, the impact of Allied bombings on German children during World War II. More than 1.5 million tons of high-explosive bombs were dropped on Germany during an operation in the offensive area of ​​the Allied Air Force (AAF) bomber command (Davis 2006). It has significantly disrupted daily life, exacerbated by the uncertainty of air strikes and the destruction of homes, schools, hospitals and other public spaces.

However, the intensity of bombings across the city has changed significantly, as shown in Figure 1. Indeed, target cities are not necessarily chosen for their significance in combat efforts, but for their visibility from the air, determined or significant by weather conditions. Landmarks such as cathedrals. Moreover, the distance to RAF’s air base at Mildenhall in the United Kingdom – which was later used in the war by American aircraft – contributed significantly to the intensity of the bombing of a particular city.

Figure 1 WWII destruction across West Germany

Note:: The darker the region, the greater the destruction during the war.
Source: Information on regional boundaries was obtained from the Federal Office for Building and Regional Planning (Bundesamt für Bauwesen und Raumordnung, BBR).

Using a unique historical city-level dataset on the severity of the bombings and the devastation caused by Germany in World War II and the data from different waves of the German socio-economic panel, in a pair of papers (Akbulut-Yuksel 2014, 2017) I admire the Allied Air Force. The difference between city-by-cohort in the intensity of the uterus and childhood exposure to air strikes. The variable of treatment in the design of this study is an interaction between wartime destruction in a given city and an indicator for under five years of age during World War II, which ages are fundamental to long-term health outcomes.

Akbulut-Yuksel (2014), I see that even after 40 years, large-scale physical destruction has had a detrimental effect on education, health and labor market outcomes. War-torn children have completed 0.8 years of schooling in the worst-affected areas, with significant destruction of schools and disruptions to education. Moreover, as adults, these wartime children are shorter than a centimeter; Exposure to war has erased half a century of improvement in personal height.

Furthermore, exposure to WWII catastrophe has resulted in a four percent-point higher mortality rate in the later life of children from disadvantaged families (Akbulut-Yuksel 2014). Their satisfaction with their health is six percentage points lower and they earn 9% less. The estimated adverse health effects of war were most severe for wartime girls, people with lower socioeconomic status, and those who lost their parents during the war years and lived in the most affected cities, suggesting that wartime resources be depleted. The lasting effects of war (Akbulut-Yuksel and Yuksel 2017, Justino 2022).

The long-term adverse health effects of prenatal and postnatal exposure to war have been documented in a wide range of physical and mental health outcomes, even after 60 years of war. Akbulut-Yuksel (2017), I found that individuals who experienced WWII destruction during pregnancy or infancy had higher BMI and obesity as adults due to significant nutritional deficiencies in their formation years. Further, these individuals also show higher incidence of chronic health conditions in adults, such as stroke, hypertension, diabetes, and cardiovascular disorders.

In a recent study with Erdal Tekin and Belgi Turan (Akbulut-Yuksel et al. 2022), we further demonstrated that exposure to war in childhood negatively affects not only physical health but also long-term mental health. We have seen that a standard deviation increase in the devastation caused by war in the first five years of a person’s life is related to a decrease in the standard mental health score of about 10% during the 60’s and 70’s. This translates into a 3.3 percentage point increase in the likelihood of diagnosing clinical depression.

Similar evidence of the long-term physical and mental health effects of the war on children has been found in survivors of the Vietnam War. We show that Vietnam wartime children, especially girls, who were exposed to war before their adolescence, are significantly more likely to be as active and physically restricted in their daily activities as adults (Akbulut-Yuksel et al. 2022). In addition, our findings indicate that wartime girls are more likely to develop PTSD later in life than their older counterparts, who did not experience warfare as children, supporting the findings of WWII research showing a legacy of lasting physical and mental health exposure to childhood warfare.

These studies provide mounting and compelling evidence on the potential impact of Russian aggression that could result in human capital and physical and mental health of Ukrainian children facing war and mass destruction (see also Bruck 2022, Angrist 2022, Baker 2022, Justino 2022). While countries can be successfully rebuilt through humanitarian assistance and post-war reconstruction efforts, the effects of physical and mental health persist for a long time, even in countries with strong post-war institutions that can mitigate some of these adverse effects (Baker 2022).

There is no doubt that the trauma, fear and suffering that Ukrainian children are experiencing will have a profound effect on their physical and mental health, an effect that can last a lifetime. Taken together, the results of WWII, the Vietnam War, and other historical episodes emphasize the importance of child-priority policies (Brück 2022, Angrist et al. 2022). Such policies are essential not only to improve the well-being of children at war and their children affected by war, but also to facilitate peacekeeping operations.


Akbulut-Yuksel, M (2014), “Large-scale physical destruction of children in war and the long-term effects of war”, Human Resources Journal 49 (3): 634–62.

Akbulut-Yuksel, M (2017), “Childhood War: The Long-Term Impact of War on Health”, Journal of Health Economics 53: 117-30.

Akbulut-Yuksel, M, and M Yuksel (2017), “Differences in the long-term effects of war”, Economics and human biology 27 (A Part): 126–36.

Akbulut-Yuksel, M, E Tekin and B Turan (2022), “WWII Blues: The Long-Term Impact of War on Mental Health”, Miami.

Akbulut-Yuksel, M, Z Zimmer, S Pandey and TK Toan (2022), “Unknown Stories of Children in War: Results of the Vietnam Health and Aging Study”, Miami.

Agrist, N. S. Jankov, P. Goldberg and H. Patrinos (2022), “Loss of human capital in Ukraine”, VoxEU.org, 28 April.

Baker, S. (2022), “Lessons from History for Our Response to Ukrainian Refugees”, VoxEU.org, 29 March.

Brackman, S. H. Garetsen and M. Schram (2004), “Strategic bombing of German cities in World War II and its effects on urban growth”, Journal of Economic Geography 4 (1): 1-18.

Brück, T, M Di Maio and S Miaari (2022), “Hard Way Learning: The Impact of Conflict on Education”, VoxEU.org, 19 April.

Davis, D., and D. Weinstein (2002), “Bones, bombs, and break points: the geography of economic activity”, American Economic Review 92 (5): 1269–89.

Davis, R.G. (2006), Bombing of European Axis Powers. A Historical Digest of the Combat Bombing of 1939-1945Maxwell Air Force Base, AL: Air University Press.

Justino, P. (2022), “The War in Ukraine: Civil Weakness, Resilience and Resistance”, VoxEU.org, 14 April.

Miguel, E. and G. Roland (2011), “The Long-Term Impact of the Vietnam Bombing”, Journal of Development Economics 96 (1): 1-15.

Uststby, G, SA Rustad and AF Tollefsen (2020), Children Affected by Armed Conflict, 1990-2019Oslo: Peace Research Institute Oslo.

World Bank (2022), Fragility, conflict and violence.

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