Children living in war-torn Syria, some as young as 12, are self-harming, taking drugs, and attempting suicide to escape the horrors they have endured after six years of conflict, an international aid group said on Monday.
One in four children, around 2.5 million, are on the brink of developing a mental health disorder, said Save the Children in the most comprehensive report of its kind to document the mental health of children in Syria.
Nearly five million Syrians have fled the country since the war began in 2011, but 13.5 million people remain in need of aid in Syria and almost half are children, according to the United Nations' humanitarian agency, UNOCHA.
Nightmares, bedwetting, anger, suicidal thoughts and depression are a few of the symptoms plaguing Syrian children, who suffer from an endless barrage of trauma from bombings, death and destruction, it said.
Most of the children interviewed for the report were too fearful to play outside, have dropped out of school, or have witnessed the death of a friend or relative.
"About five to six months ago, a child who was 12 years old committed suicide. We never had something like this before, even for older people," Syrian mental health worker Sharif was quoted as saying in the report.
"His dad was killed in a car bomb. They tried to explain to the child that now your dad is a martyr and he is going to paradise, so the child thought that if he died he would see his dad. He hung himself with a scarf."
Psychologist Marcia Brophy, who spoke to 458 Syrian adults and children for the report, said living in a constant state of fear and anxiety, known as "toxic stress", could lead to serious long-term health issues.
"These children, their bodies are in constant 'fight or flight' - and that accumulative level of toxic stress will undoubtedly have huge long-term consequences ... and it could lead to lifelong medical issues as well," said Brophy.
More and more children were self-harming, taking drugs and attempting suicide, Brophy told the Thomson Reuters Foundation, and they were doing so at an increasingly younger age.
"It's incredibly troubling. But it's not really surprising given that these children are living in a highly stressful environment," Brophy said. "It's a way of coping and dealing with a really abnormal, stressful situation."
She said communities should talk more openly about mental health, and aid agencies must make mental health support a priority across all humanitarian situations.
"It's a taboo issue, it's very hard to talk about. Given that this is a protracted conflict situation ... we need to have mental health and psychosocial support integrated into any emergency response," Brophy said.