Introduction
Throughout history children, i. e. human beings below the age of eighteen years, have been exposed to violations. ’ There is a gradual transition between neglect, maltreatment and torture of children? Corporal punishment by parents, teachers or public authorities, hard labour or misuse as ‘professional’ beggars are still common. New- born infants, especially female babies are constantly left behind or killed. In many places female adolescents and young women are exposed to mandatory virginity testing.

Several kinds of mutilations have been practiscd, e. g. castration of boys (eunuchs), uvulectorny, female circumcision. The last- mentioned is ‘a hot topic’ at the present timc4 The sexual exploitation of children is also ancient, as are incest, other forms of assault - rape and prostitut: ion. The specially vulnerable groups are adopted children, disabicd children 5 and, 01’ course, the street children. ’ In recent years a cruet effort has been organized, ‘the social and ethnic cleansing operations’, to kill the street ci~ iidrct~ by ‘the death squads,‘- the national police, the military or private ‘organisations’. Another horrible ill- treatment is kidnapping of children or ‘voluntary’ sate of children for adoption, labour (slavery), prosti tut- ion or organ transplants. At the present time there is an enormous need for organs, especially l‘ rom children and young adults and it is really ‘big business’ . 77 ’ Furthcrmorc . judicial physical punishment e. g. flogging, caning and amputation (nose, hand, foot) is applied to children under the age of eighteen - as is the death pcnaity.

Prosecuted children
Children and adults are persecuted. There are miilions of chi idren as refugees. Several of‘ these are unaccompanied. The serious implications are spectacular: poor nutrition, housing, hygiene, health care, schooling and education. ” During war several children ‘disappear’- forced disappearances- some of-‘ thcse arc con~ puisoriiy adopted without Icgal permission, thus forced to assume another identity i. e. false name and birth date. ” Children witness the raid of their home, arrest. interrogation, assault, rape, torture or execution of parent- s, other t’arnily nmnbers and friends. In addition, even small children are misused as witnesses in court cases or are retained as hostages. 2,124s As described by Primo Levi, the former prisoner in a German concentration campl$ uring the World War II: ‘We were not able not to see’.

Children as victims during war
Finally children themselves are arrested. Both boys and girls are interrogated, imprisoned, subjected to the most awful forms of physical torture e. g. tearing out nails, burning including electric torture, amputations, sexual assaults. They are also subjected to psychological forms of torture e. g. threats towards relatives, sham execution, sexual humiliation. lXJ7 Let mc again quote Prim0 Levi in relation to this sadism of the torturer: ‘The enemy must not only die, but must die in torment’. l6 There is also evidence of children born in prison or camp of women raped by the police or military staff. Besides being victims the children are, unfortunately, also misused as child soldiers i. e. young combatants under the age of eighteen. Some of these are only ten, thus creating infantile perpetrators. Moreover children, patrioticaIly indoctrinated? are forced to die as martyrs.

The health of child survivors
The health problems for the child survivors are multiple. The consequences of extreme violence may be physical signs e. g. wounds, burns, fractures of teeth and bones, amputations or other forms of mutilation, hearing loss and buzzing in the ears or serious neurological sequelae as paralysis, especially because of spinal injuries, and epilepsy.

In the long view we will have a lot of chronic disabled children. It is estimated at for every child killed as a result of involvement in extreme violence, there will be a further three disabled children. The repercussions of extreme violence concerning the mental health are gloomy. Anxiety with intimidating flashbacks, nightmares, depression, introversion living in their own world of fantasy and social withdrawal, dependency and clinging behaviour toward the relatives; and sometimes aggressiveness, nocturnal enuresis, poor appetite, abdominal pain, headache and tics have been noted. 1517, lS The children lose their illusions and become mistrustful and disillusioned without confidence or faith in other human beings 19. Some commit suicide. Longitudinal studies have shown long many- have implemented this decision? standing serious complaints, at times throughout their lives. 20 Prirno Levi has made this laconic observation: References ‘Anyone who has been tortured remains tortured’? In the medical literature this phenomenon or syndrome is described as ‘the post- traumatic stress disorder’.However, in my opinion, the best evidence is presented by the excellent writers e.g. Brink, Jung Chang2 H . Isabel Allende,Doris Lessin Levi16 Taslima Nasrin3’ 52g, Primo 33,34 , Salman Rushdie31’35 2Y Anatolij Rybakov and Elie Wiesel .

Rehabilitation of child survivors
The adult population all over the world has to face these -miserable children. It is a challenge for health professionals and the responsibility is medical as well as psychological, social, ethical and legal.

The children need the help of paediatricians, child psychologists and psychiatrists, nurses, social workers and educators comprising physiotherapy, ergotheraphy, schooling and playing. Legal assistance should be available. It is seldom possible to provide such assistance. Starvation and massacres of children must be tackled pragmatically. Later on the child victims should, if possible, be offered rehabilitation by a team of expert health professionals. In the meantime, and during the entire rehabilitation process, it is important to know that the majority of children do not like excessive sentimentality or pity, they wish to know the authentic truth e. g. on their family, the medical prognosis for themselves or the present situation of their native country. Many children have lost their original faith. They exhibit a realistic outlook to life, as said by Isabel Allende: ‘God helps the good, when they are in 24 majority...'.

References
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Joergen Cohn, Professor of Paediatrics, Coordinator of the Medical Group, Amnesty International, Norway, The University of Tromsoe, MH-Breivika, N-9037, Tromsoe, Norway.