Traumatised by war, hundreds of Lebanon's children struggle with wounds both physical and emotional

In the war that has escalated since September, Israeli airstrikes have increasingly hit residential areas around Lebanon. Israel accuses the Lebanese militant group of hiding its capabilities and fighters among civilians. It vows to cripple Hezbollah, which began firing into northern Israel after Hamas' Oct 7 attack triggered the war in Gaza. But children have been caught in the midst.

With more strikes on homes and in residential areas, doctors are seeing more children affected by the violence. More than 100 children have been killed in Lebanon in the past six weeks and hundreds injured. And of the 14,000 wounded since last year, around 10% are children. Many have been left with severed limbs, burned bodies, and broken families  scars that could last for a lifetime.

Ghassan Abu Sittah, a renowned British-Palestinian surgeon who is also treating Hussein, sees that long road ahead. This is his worry: “It leaves us with a generation of physically wounded children, children who are psychologically and emotionally wounded." At the American University of Beirut Medical Center, which is receiving limited cases of war casualties, Nahle said he operated on five children in the past five weeks  up from no cases before. Most were referred from south and eastern Lebanon. A few miles away, at the Lebanese Hospital Geitaoui, one of the country's largest burns centres, has increased its capacity by nearly 180% since September so it could accommodate more war wounded, its medical director Naji Abirached said. About a fifth of the newly admitted patients are children.

Abu Sittah, the reconstructive surgeon, said most of the children's injuries are from blasts or collapsing rubble. That attack on a space they expect to be inviolable can have lingering effects. “Children feel safe at home, " he said. "The injury makes them for the first time lose that sense of security  that their parents are keeping them safe, that their homes are invincible, and suddenly their homes become not so.” One recent morning, children were playing in the courtyard of a vocational school-turned-shelter in Dekwaneh, north of Beirut, where nearly 3,000 people displaced from the south are now living. The parents were busy with an overflowing bathroom that serves one floor in a building that houses nearly 700 people.

Only playtime brings the children, from different villages in the south, together. They were divided in two teams, ages ranging between 6 and 12, competing to get the handkerchief first. A tiny girl hugged and held hands with strangers visiting the shelter. “I am from Lebanon. Don't tell anyone,” she whispered in their ears.

The game turned rowdy when two girls in their early teens got into a fist fight. Pushing and shoving began. Tears and tantrums followed. The tiny girl walked away in a daze. Maria Elizabeth Haddad, manager of the psychosocial support programs in Beirut and neighbouring areas for the US-based International Medical Corps, said parents in shelters reported signs of increased anxiety, hostility and aggression among kids. They talk back to their parents and ignore rules. Some have developed speech impediments and clinginess. One is showing early signs of psychosis.

“There are going to be residual symptoms when they grow up, especially related to attachment ties, to feeling of security,” Haddad said. “It is a generational trauma. We have experienced it before with our parents...They don't have stability or search for (extra) stability. This is not going to be easy to overcome.”

Children represent more than a third of over 1 million people displaced by the war in Lebanon and following Israeli evacuation notices, according to UN and government estimates (more than 60,000 people have been displaced from northern Israel). That leaves hundreds of thousands in Lebanon without schooling, either because their schools were inaccessible or have been turned into shelters.

Hussein's father says he and his son must start together from scratch. With help from relatives, the two have found a temporary shelter in a home  and, for the father, a brief sense of relief. “I thank God he is not asking for or about his mother and his siblings,” said Hassan Mikdad, the 40-year-old father.

He has no explanation for his son, who watched their family die in their home. His two sisters  Celine, 10, and Cila, 14  were pulled out of the rubble the following day. His mother, Mona, was pulled out three days later. She was locked in an embrace with her 6-year-old son, Ali.

The strike on Oct 21 also caused damage across the street, to one of Beirut's main public hospitals, breaking solar panels and windows in the pharmacy and the dialysis unit. The father survived because he had stepped out for coffee. He watched his building crumble in the late-night airstrike. He also lost his shop, his motorcycles and car  all the evidence of his 16 years of family life.

His friend, Hussein Hammoudeh, arrived on the scene to help sift through rubble. Hammoudeh spotted young Hussein Mikdad's fingers in the darkness in an alley behind their home. At first he thought they were severed limbs  until he heard the boy's screams. He dug out Hussein with glass lodged in his leg and a metal bar in his shoulder. Hammoudeh said he didn't recognise the boy. He held the child's almost-severed wrist in place.

In the hospital now, Hussein Mikdad sipped a juice as he listened to his father and his friend. His father turned to him, asking if he wanted a Spider-Man toy  an effort to forestall a new outburst of tears. He said he buys Hussein a toy each day. “What I am living through seems like a big lie...The mind can't comprehend,” he said. “I thank God for the blessing that is Hussein.”