He was always shy, but the war made it worse. He witnessed a lot, especially bombs and explosions. He changed a lot. He is always afraid, including when it’s something he shouldn’t be afraid of. Sometimes it will be the sound of thunder or the sound of fire. He is afraid of everything.
Zaher A., father of a 10-year-old boy with intellectual disabilities,
Syria, October 2020Footnote 1
Introduction: Armed conflict, disability and mental health
Armed conflict causes acute stress, fear and feelings of helplessness, as well as traumatic losses – of family, home, safety and a sense of normalcy – leaving deep and lasting impacts on the mental health and well-being of both civilians and combatants. These impacts are exacerbated when psychosocial support and mental health services are unavailable or inaccessible.Footnote 2
For people with disabilities, the risks of both acute and long-lasting mental health harms are multiplied. These increased risks from armed conflict are exacerbated by multiple and intersecting forms of human rights violations and abuses based on disability (and often on additional grounds, such as gender, age or ethnicity). Persistent barriers to inclusive and accessible mental health and psychosocial support (MHPSS) services mean that violence and displacement not only intensify existing inequalities but also create further trauma and isolation.
In recent years, the United Nations (UN) has recognized the disproportionate mental health harms of conflict on people with disabilities. For example, the 2021 UN Humanitarian Needs Overview for Syria emphasized the mental health toll of the Syrian conflict on children, noting that many do not know “anything else but years of crisis”.Footnote 3 Signs of psychological distress were found to be highest in households headed by a person with a disability, followed by female-headed households.Footnote 4 However, despite international commitments – by the UN, governments and humanitarian actors – to uphold the protection and well-being of civilians during conflict, the specific mental health rights and needs of people with disabilities remain largely neglected and treated as an afterthought.
Since 2015, Human Rights Watch has documented the impact that armed conflicts and other situations of armed violence have on the mental health of people with disabilities, including children, in Afghanistan, Cameroon, the Central African Republic (CAR), Palestine, South Sudan, Sudan, Syria, Ukraine and Yemen. Our research found that people with disabilities are often at greater risk of mental health harms during armed conflict. They face compounded psychological trauma from being targeted because of their disability, direct exposure to violence, and fear of abandonment or of endangering family members; the loss of loved ones, essential services and livelihoods; and systemic exclusion from humanitarian aid and inclusive education. Conflicts also create new disabilities as a result of injury, mental health trauma and lack of access to essential needs, health care and follow-up support. For those who survive, the erosion of formal and informal support systems further restricts access to MHPSS services, compounding the long-term toll on mental health and well-being.
This article examines the intersection of disability rights, mental health and armed conflict. The analysis is based primarily on research conducted by the authors in their capacity as researchers at Human Rights Watch, who were directly involved in many of the underlying investigations referenced in this article, including field research and remote interviews with children and adults with disabilities, their family members, other witnesses, service providers, humanitarian actors and relevant experts. Apart from these interviews, the research relied on a review of relevant laws and policies, and analysis of documentation produced by UN agencies and humanitarian organizations. The article identifies key patterns driving the immense mental health harms experienced by people with disabilities in armed conflicts and situations of armed violence.
Relevant protections under international humanitarian law (IHL) are central to this analysis.Footnote 5 IHL prohibits violence to life and person, cruel treatment, outrages upon personal dignity, and other forms of ill-treatment that may cause severe psychological suffering. The article further analyzes the protections afforded under international human rights law, including the right to the highest attainable standard of physical and mental health, and examines efforts to ensure emergency mental health services to those impacted by armed conflicts, assessing the extent to which humanitarian MHPSS services meet – or fail to meet – the needs of people with disabilities.
Particular attention is given to Article 11 of the Convention on the Rights of Persons with Disabilities (CRPD), which requires States Parties to take all necessary measures to ensure the protection and safety of people with disabilities in situations of risk, including armed conflict and humanitarian emergencies. As scholarship on the drafting of Article 11 has highlighted, the provision marked a shift from the historical invisibility of persons with disabilities in international humanitarian and human rights law toward recognition of positive obligations to ensure their protection and inclusion in situations of risk.Footnote 6 Article 11 further clarifies that IHL obligations should be implemented consistently with disability rights standards. Read together with Articles 3, 11, 12, 17, 19 and 25 of the CRPD, it supports the view that mental health responses in conflict settings should respect autonomy, personal integrity and inherent dignity.Footnote 7
By taking an intersectional approach, the article will offer a crucial perspective on causes, prevention, accountability, service provision and legal obligations. It concludes with concrete recommendations to strengthen inclusive mental health responses for people with disabilities affected by armed conflict.
The overlooked mental health toll of armed conflict on people with disabilities
This section outlines risk factors and violations identified in Human Rights Watch research and draws on direct testimony from children and adults with disabilities as well as analysis of systemic failures by governments, armed forces and non-State armed groups, and humanitarian actors. The findings demonstrate that mental health harms in armed conflict are neither incidental nor inevitable; rather, they are the result of intersecting factors, such as violence, displacement, abandonment, institutionalization and neglect, that disproportionately harm people with disabilities.
Direct exposure to violence and trauma
Exposure to armed attacks, shelling and bombardment is a primary driver of conflict-related mental health harms, including post-traumatic stress, anxiety and depressive symptoms, according to systematic reviews and meta-analyses.Footnote 8 Violence can take a lifelong toll particularly on the emotional, physical and social development of children, even hindering their brain development.Footnote 9
People with disabilities face the same bombs, bullets and bloodshed as others, but are often less able to flee, find shelter or access timely support, and may be specifically targeted because of their disability, increasing both the likelihood and severity of psychological harm. Human Rights Watch research has documented how such exposure creates trauma and panic reactions among children and adults with disabilities.
In Sudan, reports following the 26 October 2025 takeover of El Fasher, North Darfur, raise serious concerns about the protection of persons with disabilities. Some accounts indicate that persons with physical or psychosocial disabilities may have been perceived as associated with parties to the conflict or otherwise targeted because of their disability.Footnote 10 Under IHL, targeted killings of civilians or others not participating in a conflict, including those with disabilities, are war crimes, as is subjecting them to cruel, humiliating, and degrading treatment or similar outrages that can cause, inter alia, serious psychological harms.
In Ukraine, children confined in institutions – including many with disabilities – often had to shelter from bombardments in basements without electricity or running water, sometimes for weeks. For one group of children evacuated from the city of Mariupol, the psychological toll was profound: they did not speak for four days, apparently due to trauma, according to one volunteer.Footnote 11
Human Rights Watch’s research between 2023 and 2024 found that many Palestinians with disabilities in Gaza experienced acute psychological distress from conflict-related violence and their inability, or extreme difficulty, to flee danger in the context of the Israel/Hamas armed conflict.Footnote 12 The mental health of children with disabilities was uniquely impacted because of the challenges they faced and the consequent worries, fears and feelings of helplessness. Ghazal, a 14-year-old girl with cerebral palsy in Gaza, said her mental health deteriorated further after losing her home and assistive devices, which would have allowed her some independence, and amid ongoing fears of another attack. The lack of access to medical care, psychosocial support and education compounded her distress. As she stated in 2023:
From the day the war broke out, they destroyed what was inside us. They demolished my house and my room, which held all my memories. They took everything that helped me live, like my devices, my boot, and my wheelchair. How can I go back to how I was without all this?Footnote 13
For Palestinians with disabilities in Gaza, psychological harms have been exacerbated by intense trauma from the hostilities, and repeated displacement. The mental health harms build on years of cumulative harm, including as a result of the Israeli government’s eighteen-year closure of Gaza and repeated rounds of armed hostilities. As an example, during the 2014 Israel/Hamas conflict, Human Rights Watch documented how a woman with a physical disability was unable to flee with the rest of her family when a missile struck her house. She was wounded in the leg, and her electric scooter was destroyed. Years later, she said that she still hears the sound of explosions in her head from that war, becomes frightened whenever she hears ambulances, and avoids “looking at the sky”.Footnote 14 The same woman, who lost her primary support person – her father – during an Israeli military bombardment of Gaza city in November 2023, has been displaced multiple times and reported grappling with suicidal thoughts when Human Rights Watch spoke with her in December 2023.
Persons with visual disabilities often struggle to flee attacks, as they have trouble finding their way around. Bader Mosleh, a 39-year-old man with a visual disability, was killed in an apparent Israeli strike in Gaza on 7 December 2023.Footnote 15 A father of three children aged 2, 8 and 10, he said his biggest fear was how he, as a person who could not see, would be able to protect his family and find his way around. He was unable to flee his home despite the bombardment and the displacement orders, and there was no safe and accessible place for him to go.
Persons with hearing, developmental or intellectual disabilities often cannot hear, know about or understand what occurs during attacks, or are unable to follow instructions. In Cameroon, Human Rights Watch documented that a 43-year-old man with hearing and intellectual disabilities was fatally “shot in the head and the chest” by armed actors because he could not answer their orders, according to a witness.Footnote 16
Such experiences leave deep psychological wounds. Survivors frequently report persistent anxiety, fear and post-traumatic stress long after the fighting has ended. In Gaza, for instance, a Palestinian man with a physical disability recalled experiencing the freeze response – an involuntary, instinctual survival mechanism in which the body is unable to move during an overwhelming threatFootnote 17 – while others fled when an Israeli drone strike hit the mosque where he was praying in 2014. The freeze response typically occurs when fleeing is not perceived as a viable option – an experience many people with disabilities caught in armed conflicts face. During the 2008–09 hostilities, the same Palestinian man said a bullet struck the wall above his head in the hospital room where he lay. When we interviewed him in 2020, he stated that the incidents had stayed with him and that he is startled every time he hears a loud sound.Footnote 18
In Syria, adults and children with disabilities described how military offensives, including airstrikes, had caused terror since 2011. Thara, 18, who lost her leg in a barrel bomb attack when she was 13, said she fears future abuse and airstrikes. When Human Rights Watch interviewed her in 2022, she said, “With every airstrike I feel I might lose my life or another limb. I am still seeing my people being killed, injured and disabled because of this conflict. Psychologically I don’t feel well.”Footnote 19 Thara also dropped out of school after losing her leg due to the fear that she may not be able to run in case of an attack on the school.Footnote 20
Zaher A. lived with his wife and three children, including a 10-year-old boy with an intellectual disability, in a tent in a camp on the outskirts of Idlib. When Human Rights Watch interviewed him in 2022, he said the multiple military offensives in the region particularly affected his son with a disability:
He was always shy, but the war made it worse. He witnessed a lot, especially bombs and explosions. He changed a lot. He is always afraid, including when it’s something he shouldn’t be afraid of. Sometimes it will be the sound of thunder or the sound of the fire. He is afraid of everything.Footnote 21
The sudden attacks and fleeing took a deeper toll on Shahd, 11, who has a hearing disability, than on her five siblings. Her father, Ahmed, described her reactions:
Whenever there was [an] airstrike, the children became terrified, and we started yelling and trying to run to the shelters, and when she saw us in that situation, she started to cry. Now whenever there is something unexpected, even if someone rushes into the house, she starts to cry.Footnote 22
Loss of caregivers or family members
All children depend on their parents or caregivers for support and care. This dependence can be even greater for children with disabilities, as the loss of a caregiver often means not only profound emotional distress but also the abrupt end of crucial physical and emotional support. The combination of grief, instability and isolation can leave these children at greater risk of distress in the aftermath of conflict. Similarly, some adults with disabilities also require caregivers or personal assistants to help them flee attacks but also to provide essential support for daily living and survival. The loss of those caregivers or assistants, through death, injury or displacement in the chaos of conflict, can lead to profound mental health crises.
For children who find themselves orphaned or abandoned, the emotional harm is compounded. According to the UN Children’s Fund (UNICEF), conflict and displacement can also undermine solidarity and empathy, disrupting the support networks that help children cope with disabilities.Footnote 23 The UN Inter-Agency Standing Committee (IASC) notes in its guidance on MHPSS that separation, grief and the breakdown of caregiving systems in emergencies greatly heighten the risk of depression, anxiety and post-traumatic stress.Footnote 24
In Gaza, Human Rights Watch documented cases in which children with disabilities lost one or both parents during airstrikes, leaving them without essential care and at increased risk of neglect and trauma. Nour Ghandour, a 14-year-old Palestinian girl with Down syndrome, was seriously injured during an apparent Israeli airstrike on her home in Khan Younis in Gaza in December 2023. She survived with a severe arm injury while her parents and two of her siblings were killed.Footnote 25 Her surviving sister, Doaa, said that Nour cried out at night for her mother and father:
Sometimes she starts crying and calling out for her mama and baba [dad]. Some days, before she goes to sleep, she tells me she hopes to see them in her dreams. One night, I heard her say, “Oh mama and baba, I am so sad you both left me. Both of you! Why did you both leave me?”Footnote 26
Five-year-old Muhammad, who has cerebral palsy and concurrent epileptic seizures, lost his father in a strike in Gaza in December 2023. Muhammad’s father, an emergency nurse, attended to Muhammad’s complex medical needs on top of his regular parental duties. Muhammad is also lactose- and gluten-intolerant and cannot chew on his own, relying entirely on blended food. Following his father’s death, his mother now struggles to care for him amid repeated displacement. His uncle, a young man in his twenties, feels a profound sense of responsibility: “Before we left Jabalia, my brother told me: ‘If I die, the responsibility is on you to take care of my child.’” He added that it was difficult to fulfil that responsibility due to lack of medicine and the specific food that Muhammad needs amid Israel’s blockade and displacement while living in a tent.Footnote 27
The bombardments and sieges in Syria have orphaned many children or left them with a single surviving parent; some of these children had pre-existing disabilities. As men were killed, detained or went missing, women frequently became the sole heads of household. Female-headed households in Syria were already less likely than others to be able to meet essential needs due to gender-based structural barriers, and in 2020 their ability to do so steeply deteriorated.Footnote 28 This sudden loss of a caregiver compounded the grief and instability for children with disabilities and placed heavy psychosocial and economic strain on surviving caregivers as they struggled to secure food, medication and accessible services.
In 2019, the UN Commission of Inquiry on Syria noted that the fragile economic situation, among other factors, contributed to child marriage, a practice that carries unique and profound mental health harms.Footnote 29 Amina from Syria became a single mother after her husband died in prison; she has a son and six daughters, including Aya, a 12-year-old who acquired a physical disability after being injured during an airstrike on Taftanaz, Idlib governorate. At the time of her interview in 2022, Amina had married off four of her daughters at the ages of 14 and 15 because she was unable to find work and provide for them.
Adults with disabilities who rely on family for essential support and who have experienced social isolation also experience immense distress from losing family members. Raisat, a single woman with a disability and a breast cancer survivor in her forties, lost both parents in Gaza in 2024. She described the pain: “My parents were everything to me and it’s hard to continue living without them.”
In Sudan, a 31-year-old man who acquired a disability after being injured in a shelling, described how in September 2025 his mother tried to push him in a wheelbarrow while fleeing the siege of El Fasher, but became exhausted.Footnote 30 He urged her to go ahead and then pleaded with passing travellers to help take him back to the city. They initially refused, but eventually, a man driving a donkey cart allowed him to climb aboard, and he returned to El Fasher, where he was reunited with his father. On October 26, as shelling intensified and the Rapid Support Forces took control of El Fasher, the man and his father again attempted to flee. Unable to continue pushing him, his father went ahead while the man followed behind; an explosive weapon fell nearby, separating them and causing the man further injuries. When interviewed in February 2026, the man had been reunited with his mother but had no information about his father’s whereabouts, a source of ongoing distress.
Families also sometimes have to make the heartbreaking decision to flee without family members with disabilities in order to escape faster. In such cases, abandoned people with disabilities also lose their caregivers and crucial family support, as described in the next section.
Displacement, abandonment or fear of being a burden
Fleeing attacks and displacement can have a profound impact on people with disabilities and their mental health. The Office of the UN High Commissioner for Refugees (UNHCR) has reported that when displacement is forced, people with disabilities are disproportionally impacted.Footnote 31 In Gaza, repeated displacement orders by the Israeli army have, according to Médecins Sans Frontières (MSF), negatively affected Palestinians’ mental and physical health.Footnote 32
People with disabilities are at heightened risk of abandonment during armed conflicts and displacement, particularly when family or caregivers face extreme stress, danger or lack of resources. UNICEF has investigated several recent conflicts in which families or caregivers who were overwhelmed abandoned children and adults with disabilities.Footnote 33 Such separation or fear of being abandoned can cause intense psychological distress, including anxiety, grief and lasting feelings of worthlessness and insecurity.
Sometimes children with disabilities are left behind in the panic of an attack. In Syria, the uncle of Omar, a 10-year-old with intellectual disabilities, described an instance when his parents mistakenly left the boy behind while fleeing an attack:
[Omar] has no fear, and he doesn’t understand [the danger]. He doesn’t react like other children. Once, early in the morning, … a jet flew over our houses. … We all ran to the cave, and then we realized Omar was not with us. His parents ran back to the house to fetch him, and just a few seconds later, their house was struck by a missile, completely destroying it. They had saved him at the very last minute.Footnote 34
In Cameroon, a 65-year-old farmer said his family fled without him when soldiers arrived, recalling: “I couldn’t run, because of my disability, and my family left me behind.”Footnote 35 The daughter of a 75-year-old man in Cameroon said that she had to abandon her father, who is blind and has a mental health condition, at home in the deserted village, with little access to food and water, because she could have otherwise been killed by armed forces if she did not escape in time.Footnote 36
In the CAR, Hamamatou, a 13-year-old girl with a physical disability, said her older brother carried her on his back through an attack until he became too tired to continue. She urged him to “save yourself” and he promised to return if they did not kill him. He never came back.Footnote 37 Ambroise, a 27-year-old with a physical disability in the CAR, woke up to gunshots to find himself alone at home after his parents had fled in the night: “I stayed alone for a day until a young boy passed by. I started crying when I saw him and begged him: ‘Please help me! If you leave me, I will die.’” The boy helped him get to safety.Footnote 38
In Sudan, a 39-year-old man described fleeing El Fasher to Tawila but having to leave behind his 41-year-old brother with a physical disability, who could not walk. “My brother said to us, ‘I am finished, I will die here, please just leave with your children and leave me here.’ We couldn’t take him, there were no cars, no camels.”Footnote 39 The same witness described seeing injured people and people with disabilities asking for help while trying to flee El Fasher on 27 October 2025: “There were injured people on the ground, people who had lost limbs, asking for help, and you just couldn’t help them.”Footnote 40
Such accounts illustrate the impossible choice that families face between saving themselves and staying to help a relative with a disability. Often, people with disabilities say that they tried to stay behind for fear of slowing others down or becoming a burden on their families and friends.
A 33-year-old man with a physical disability from Sudan, who had no family and relied on a friend to flee El Fasher upon the takeover by the Rapid Support Forces, said he had urged his friend to leave him behind while fleeing. “I am already a dead man walking”, he recalled saying. “I didn’t want to reduce his chances of survival.”Footnote 41
Following an attack that hit her home in northern Gaza, Ghazal, the 14-year-old girl with cerebral palsy, had to be carried by her family after she lost all her assistive devices. As they grew tired and Ghazal realized that she was slowing her family down, she told her parents to leave her behind. “I felt at that moment that death was near”, she said. “I gave up and sat on the ground in the middle of the road, crying. I told them to go on without me.”Footnote 42 Her mother said she was contemplating leaving Ghazal behind due to the immense stress she felt: “I was confused: whether to stop while we were under bombardment or to leave Ghazal behind and walk.”Footnote 43
In Ukraine, during Russian forces’ shelling of Kharkiv in 2022, staff at a children’s neurological hospital faced similar impossible decisions. Before the attacks, 190 children, from infants to teenagers, were residents at the hospital or its hospice unit. When the shelling began, those who could be discharged were, and staff moved the remaining children who had high support needs to the hospice basement for safety.Footnote 44 One of the nurses explained why evacuation was not feasible: “The children [left behind] require constant care. The last evacuation … to Lviv was on a bus not equipped to transport children with [serious] health conditions. We need to evacuate them, but how?”Footnote 45
Lack of effective advance warnings of attacks also contributes to the difficulties that people with disabilities face when trying to evacuate on time. In Syria, since Thara J. lost her left leg in a January 2015 barrel bomb attack when she was 13, she experienced dozens of airstrikes and shelling attacks and there was never an advance warning that would have allowed her more time to flee. She had difficulty moving quickly with crutches and worried about exposing her family to risk when they stayed behind to assist her during an attack, saying:
I feel that I am a heavy burden on my family; they have to help me escape, which puts them at risk. But when I decide to stay at home, my family will stay home with me. The scariest thing when I hear an airstrike is knowing that I might lose someone I love.Footnote 46
Feeling like a burden or believing that one’s presence could put the whole family at risk during a conflict can have a profound psychological impact. In April 2019, Nujeen Mustafa, a disability rights activist from Syria, described to the UN Security Council the difficulties she faced as a child with a disability fleeing attacks in Aleppo city.Footnote 47 She said her mother often had to carry her to the bathroom to hide, since it was nearly impossible to carry her down five flights of stairs to reach shelter. “Every day, I feared that I could be the reason that my family was one or two seconds too late”, Mustafa said. Like many people with disabilities interviewed by Human Rights Watch, Mustafa did not have access to an assistive device – in her case, a wheelchair. “Many people with disabilities cannot depend on their families to help them reach safety”, she explained. “Often, because their family members have been killed or have already left.”
For people with disabilities with caregiving responsibilities, often women with traditional gender roles, displacement carries an additional mental health toll. A single mother of five whose leg was amputated after she was struck by a bullet during a government attack on the Bor camp in South Sudan in 2014 said that the poor living conditions in the camp greatly affect her morale:
Now, I am thinking too much. Not about my disability but about how I can support my children. It is too much, and I sometimes think that it is better for me to die because no one is supporting us. … [T]here is no water, no soap, the plastic sheet[s] that make up the shelter are broken, and I don’t know how I can support my children.Footnote 48
Women with disabilities may also face additional fear and isolation because restrictive gender norms limit their options for seeking help or protection. As Nujeen Mustafa, mentioned above, explained:
Being a woman and having a disability makes it doubly more difficult. For example, a man can ask for help from a male friend to flee. But in a society like Syria, a woman cannot. If you don’t have an immediate male relative, you cannot just call on a friend to carry you.Footnote 49
Interruption of services (health care, assistive devices)
In many conflict-affected countries, mental health and rehabilitation services were already scarce, under-resourced and often inaccessible to people with disabilities prior to the outbreak of hostilities.Footnote 50 Community-based supports were limited, specialist services were concentrated in urban areas, and institutional settings frequently operated with inadequate oversight, raising concerns about neglect and human rights violations.
Armed conflict routinely erodes these already fragile and exclusionary essential services, such as health care and rehabilitation, which are crucial to the survival and well-being of people with disabilities. The World Health Organization (WHO) highlights that individuals with disabilities often face significant barriers in accessing health services, including rehabilitation and assistive technologies; these barriers are frequently exacerbated in conflict settings.Footnote 51 Women and girls with disabilities are disproportionately affected by conflict-related sexual violence and typically face additional barriers in accessing life-saving services including medical care, accessible information and safe spaces.Footnote 52
Research links the loss of these support systems to heightened psychological distress, including anxiety, depression and feelings of isolation among people with disabilities.Footnote 53 For instance, more than a decade of conflict in Syria has decimated the health-care and social services infrastructure – more than one third of essential infrastructure has been destroyed or damaged, including half of the health-care facilities.Footnote 54 Families interviewed by Human Rights Watch cited insurmountable barriers: hospitals that were too far away, transportation that was too dangerous, and crucial early-intervention or rehabilitation services that simply did not exist.
Parents of children with disabilities in Syria described how the lack of basic and specialized services affected not only their children’s mental health but also their own psychological well-being. A father of a boy with autism explained that the most difficult challenge for him and his family was the lack of information about his son’s disability and guidance on how to support him:
It feels like I am just sitting there, unable to do anything. I am looking at my child, and I do not know how to support him. What can I do? Will he grow up with no access to education or support? I have so much fear about what will happen.Footnote 55
International funding appears to have typically focused on physical rather than mental health in places like Afghanistan, which has been devastated by forty years of armed conflict. It is estimated that half the population experiences depression, anxiety or post-traumatic stress, which can have a disastrous impact on people’s mental health and the well-being of their relatives and friends.Footnote 56
Gaza’s health-care system has collapsed amid Israeli forces’ repeated strikes on hospitals and medical facilities and personnel, cutting of water, fuel and electricity, and detention of Palestinian health-care workers. In 2024, with the intensity of Israeli military attacks on Gaza and the constant displacement of the population, MSF reported that people with mental health conditions such as bipolar condition or schizophrenia no longer had access to their regular treatment since the only psychiatric hospital had ceased functioning. Key rehabilitation centres also incurred significant damage.Footnote 57 By September 2025, nearly two years after the start of the armed conflict, mental health professionals described a shift from acute psychological reactions – such as fear, panic and anxiety – to chronic trauma fatigue, “where people live in a state of emotional numbness, loss of meaning and internal fragmentation”.Footnote 58
Assistive devices and medicines also become scarce during armed conflict, compounding the harms faced by people with disabilities. Human Rights Watch has documented cases of entire hospitals and pharmacies being shelled or looted, leaving essential items such as wheelchairs, hearing aids and crucial drugs unavailable. During violence in Cameroon, hundreds of homes were destroyed. One single mother with a physical disability did not have access to an assistive device while struggling to flee so she used a small tree branch as a cane to support herself.Footnote 59 A young man with an artificial leg that broke while fleeing into the forest after clashes was forced to leave the artificial leg behind.Footnote 60
Children who require medications can face terrible outcomes when access is disrupted. A 4-year-old Yemeni girl with epilepsy went from one seizure every two weeks to two a day when war made her medication unaffordable. “It’s hard to feel useless”, her father said.Footnote 61 One Syrian mother said that after fleeing to northern Syria, her only hope of support for her two deaf daughters vanished when they could no longer travel for cochlear implant follow-ups.Footnote 62
Mental health impact of physical injury, new disabilities
Physical injuries during armed conflict, especially burns and amputations, take an enormous toll not only on a child’s physical health, but also on their psychological well-being. Many of these injuries result in new and permanent disabilities. Every new injury or trauma caused by armed conflict – whether a bomb-blast wound or the lasting effect of witnessing violence – carries the potential to create both physical and psychosocial disabilities. Academic literature estimates that more than one fifth of conflict-affected populations experience mental health conditions such as post-traumatic stress, depression or anxiety at some point in time. Conflicts also produce large numbers of people with physical disabilities, increasing the demand for rehabilitation, assistive technology and psychosocial support.Footnote 63
In Gaza, the human toll has been staggering. In July 2025, the UN reported that 25% of children injured in Gaza had acquired a disability.Footnote 64 In January 2025, UNICEF estimated that Gaza has the highest number of child amputees per capita anywhere in the world.Footnote 65 As of September 2025, 42,000 children had been injured.Footnote 66
Dr Haytham Ahmed, an emergency doctor at Nasser Hospital in Khan Younis, Gaza, discussing children who have had their limbs amputated and are unable to receive reconstructive surgery and rehabilitation, including mental health support, said: “We are talking about children who are dealing with extreme trauma, horrific fears and physical harms. They will need therapy and psychosocial support for life.”Footnote 67 Dr Jeelani, a child orthopaedic surgeon who was on a medical mission to Gaza, echoed this:
The psychological trauma is massive and it’s not quantifiable. Children are resilient to physical injuries: with adequate treatment, they bounce back really well compared to adults. But the psychological aspect of it, I don’t know how you quantify it in a place like Gaza. It’s not just their own injuries and lack of treatment, but they are seeing things they shouldn’t see. There are children there who had told me they have seen 10 bodies [of Palestinians killed in Israeli attacks], they shouldn’t be seeing this kind of stuff.Footnote 68
Khuloud, a Palestinian mother, described the changes in her 9-year-old daughter Sara, whose hip and legs were seriously injured:
Her own injury and everything she witnessed, all of that hit her psychologically. I can see a change in her. Sara is getting more nervous, pulling her hair and biting her nails, and her voice has gotten really loud since the attack happened. She is loud with me, raises her hand, and then she feels bad about it. She is not the same child.Footnote 69
Months of “violence, displacement, starvation and disease on top of nearly eighteen years of a blockade have caused relentless mental harm to children in Gaza”, according to Save the Children.Footnote 70 In June 2024, UNICEF estimated that almost all of the 1.2 million children in Gaza were in need of MHPSS, twice the figure compared with before October 2023. UNICEF shared particular concerns for the mental health of children who are exposed to repeated traumatic events, children who have been maimed or have lost parents or close family members, and children with disabilities.Footnote 71 Yet MHPSS services, which were already difficult to access prior to the current hostilities, have grown even scarcer since the start of the Israeli military’s attacks on Gaza.Footnote 72
In Syria, the UN has reported that approximately 28% of the country’s population are estimated to have a disability – nearly double the global average.Footnote 73 A 2021 nationwide needs assessment found that 19% of Syrian children aged 2–17 have a disability,Footnote 74 and another assessment published in February 2022 found that 21% of children aged 2–4 in Northeast Syria have a disability.Footnote 75 The latter report cited a “chronic lack of data on persons with disabilities at the IDP [internally displaced person] site level”, suggesting that the actual number may be even higher given that more than 6 million Syrians are internally displaced.Footnote 76
Human Rights Watch has documented how violence inflicts life-long damage across conflicts. In Myanmar, Rohingya who fled to Bangladesh included many people who had acquired disabilities from military attacks.Footnote 77 One Rohingya refugee family told Human Rights Watch that while they were trying to flee, their 17-year-old son was shot in the neck and is now paralyzed. The father said:
I thank the doctor who gave my son a wheelchair, but I can’t use it because the roads are very dangerous and keep getting worse. It is time for my son to study, but he can’t walk, and his life is being destroyed in front of me.Footnote 78
Similar stories emerge from every conflict. In Ukraine, Yemen and elsewhere, Human Rights Watch has documented children losing limbs to landmines and airstrikes. A 16-year-old Syrian boy who stepped on a landmine explained that a prosthetic leg would help him “a lot”, saying:
It will help me to come and go without having to ask other people for help. It will help me emotionally. Today, I cannot go, I cannot do anything alone. I need to have my father there to help me, even to walk.Footnote 79
Children whose mental health has been severely harmed may acquire a psychosocial disability. In South Sudan, a father said his daughter was traumatized after seeing the dead bodies of her aunt and cousins as they fled an attack. He said that after the war, the girl “started to insult everyone and run away from home for many days at a time”, and was subsequently given anti-anxiety medication.Footnote 80
Across conflicts, psychological distress is pervasive and enduring. In Syria, for instance, nearly half of all children display symptoms of post-traumatic stress and about 7.5 million children and adolescents are currently in need of mental health support.Footnote 81 In Afghanistan, it is estimated that half the population experiences depression, anxiety or post-traumatic stress.Footnote 82 Yemen’s conflict has produced widespread distress: over half of displaced children surveyed by Save the Children reported persistent sadness or depression.Footnote 83 These conditions often persist long after hostilities end, and without adequate psychosocial support, many survivors lack access to the services and support needed to recover and participate fully in their communities.
Lack of access to education and its impact on mental health
Education systems are similarly disrupted and fractured as a result of armed conflict. UNICEF warns that crises exacerbate the challenges which children with disabilities encounter, often leading to their exclusion from quality learning opportunities compared to their peers without disabilities.Footnote 84 Girls and young women with disabilities are disproportionately affected by lack of access to education in humanitarian settings.Footnote 85
The lack of safe schooling removes a key supportive environment because schools can provide stability and access to support to protect psychological well-being.Footnote 86 Evidence also shows that learning is closely linked to improved mental health and psychosocial outcomes, while integrated MHPSS in schools contributes to better educational engagement and achievement,Footnote 87
In Bangladesh, all Rohingya refugee children who fled from Myanmar in 2017 had been denied access to formal, quality education. In 2025, foreign donor cutbacks in humanitarian aid from the United States and other countries led to the suspension of thousands of “learning centres” for school-aged children.Footnote 88 Estimates of the number of affected Muslim Rohingya children with disabilities vary, but available information indicates that, at minimum, tens of thousands of children were affected and that the vast majority were completely excluded from any education whatsoever.Footnote 89
In Syria, Human Rights Watch found that children with disabilities have very limited access to both formal and informal education offered by humanitarian organizations. According to UN data, 72% of children with disabilities in northern Syria are not attending school compared with 40% for children without disabilities.Footnote 90 Similarly, in Gaza, 97% of schools have been damaged or destroyed, according to the UN Office of the High Commissioner for Human Rights, and hundreds of thousands of children – including those with disabilities – have had multiple school years severely disrupted.Footnote 91
In Syria, Dib Al Hadid, a mother of seven children, including a 13-year-old boy who has intellectual and physical disabilities, explained that constant displacement and lack of access to support and education affected her children’s mental health,Footnote 92 saying: “Most of my kids have a lot of difficulties psychologically. Especially when it comes to any loud sound; you can see the fear in their eyes. They have no hopes for the future.”Footnote 93
Several parents believed the lack of access to meaningful intervention, support and education further exacerbated the developmental and psychological impact on their children with disabilities. One Syrian father noted that after his autistic son lost access to educational services and support, he saw “a lot of aggressiveness, even when I try to speak and engage with him. Whatever he finds on the ground around him, he throws that at me. We are very worried; we do not know what to do.”Footnote 94
A Syrian mother with a son who has an intellectual disability said she regularly took him to a public special school for children with disabilities that provided free early childhood intervention services. “Teachers there were not only teaching him, but also teaching and helping me, giving me hope, explaining what was going on”, she recalled.Footnote 95 However, due to fighting in the area and inaccessible roads, she said in 2022 that she had stopped taking her son to that school and could not find another school that would accept him. She added that not going to school had impacted his mental health: “From my perspective, it changed him a lot. His situation became worse. He became very angry; he started hating staying at home.”Footnote 96
Institutionalization or confinement
In much of the world, even before the outbreak of hostilities, residential institutions and psychiatric hospitals are overcrowded, under-resourced and subject to limited oversight. People with disabilities, particularly those with psychosocial or intellectual disabilities, have long been confined in such facilities, facing neglect, inadequate medical and psychosocial care, poor living conditions and, in some cases, ill-treatment.Footnote 97 Armed conflict often entrenches or worsens this chronic institutionalization, as oversight mechanisms collapse, humanitarian access is restricted and community-based alternatives become even more scarce.Footnote 98
Armed conflict and other situations of armed violence also increase the risk that people with disabilities will be institutionalized or confined (formally in State or private institutions, or informally in their homes), often because community supports break down and services are unavailable.Footnote 99 This places them at heightened risk of abuse, neglect and mental health deterioration.Footnote 100
Stigma toward people with psychosocial disabilities is often intensified in crisis contexts, and where services are lacking, families or communities sometimes resort to extreme practices such as shackling and prolonged confinement.Footnote 101 Shackling inflicts serious physical and mental harm, often causing post-traumatic stress and lasting psychological and emotional scars.Footnote 102 In Gaza, in the context of occupation, Human Rights Watch documented in 2020 the case of “Hala”, an 18-year-old woman who had been chained since she was a child as she started displaying signs of a mental health condition.Footnote 103 Hala’s mother said that as they did not have access to quality mental health care and psychosocial support for their daughter, they decided to chain Hala’s hands and one of her feet during the day to prevent her from breaking household objects or fleeing the house, only unchaining her at night, when she slept with her mother inside a locked room. That year, the UN Office for the Coordination of Humanitarian Affairs (OCHA) described the situation in Gaza as a mental health crisis, stating that the mental health system is under-developed, frequently inaccessible to those requiring care, and lacking proper resources, including human resources.Footnote 104
Two humanitarian workers in Syria said that the chaining of children with disabilities existed prior to the Syrian civil war but increased after the conflict started.Footnote 105 They attributed this to a lack of access to services and support. According to Syria Civil Defence, a non-governmental organization, this abuse is more frequent among children who have psychosocial disabilities and have also lost their parents in the war, with only extended family to care for them.Footnote 106
Even without chains, armed conflict can create de facto confinement. In Gaza, for instance, prolonged closure and shelling have left many people with disabilities unable to leave their homes. Some wheelchair users reported being “trapped in their homes” during bombardments because they could not power or navigate in their chairs.Footnote 107 Furthermore, in many displacement camps that Human Rights Watch has visited around the world, latrines and showers lack ramps or handrails, meaning that people with disabilities need to crawl across unsanitary ground to reach these basic facilities, exposing them to health risks.Footnote 108 Such situations breed despair.
Heightened risks for children, especially those with intellectual or psychosocial disabilities
According to the World Bank, research indicates that all children living in conflict and crisis zones are at high risk of depression, anxiety and other mental health conditions.Footnote 109 Children and families interviewed in a number of countries reported signs of psychological distress in children such as anxiety, sadness, extreme agitation or frequent trouble sleeping. Lack of access to services and education exacerbate conflict’s impact on mental health.Footnote 110
These global findings are reflected in Human Rights Watch interviews that investigated the emotional toll of hostilities on children with disabilities. The research underscored how children with disabilities are disproportionately affected: they endure all the ordinary dangers of war plus the added barriers they face because of their disability. For example, a teacher in Cameroon said that children with disabilities “suffered more than others. … They were particularly traumatized by the violence they witnessed.” Even if they could not hear the gunshots, she said, the deaf students “felt them, felt the panic, they saw the terror in the eyes of their families trying to escape to safety. Some of these children have trouble sleeping, and they cannot concentrate or do their homework.”Footnote 111
In Syria, virtually every family interviewed described severe psychological harm to their children with disabilities. One father of a 13-year-old with developmental disability said, “Most of my kids have a lot of difficulties psychologically. … You can see the fear in their eyes. They have no hopes for the future.” He added that his son had become much more withdrawn and isolated than before the war: “He sits alone, doesn’t want to interact with any other kids.”Footnote 112 As previously mentioned, another Syrian parent said his 11-year-old daughter Shahd, who has a hearing disability, cries and panics “whenever there is something unexpected, even if someone rushes into the house”, because she associates it with past airstrikes.Footnote 113 In the CAR, 17-year-old Suleiman, who has intellectual and physical disabilities, witnessed his uncle’s killing as he fled, and now suffers nightmares. “My uncle’s death in front of my eyes continues to scare me”, he said. “When I sleep, I have nightmares that bring back the images.”Footnote 114
Children with intellectual or psychosocial disabilities are at especially high risk of neglect, abuse and trauma during war. They are often unable to process danger in the same way as other children, so they may be left behind (as in the case of Omar described above) or be unable to understand evacuation orders, which can place them directly in harm’s way. In displacement camps, they are often overlooked in aid distributions and cut off from schooling or psychosocial support programmes.Footnote 115
Caregivers of children with disabilities can also be profoundly affected. Their mental health and well-being directly influence their ability to continue providing care, particularly under conditions of displacement, loss and insecurity. These caregivers often shoulder the dual burden of sustaining daily survival while advocating for their children with disabilities’ access to health care, assistive devices and other essential services – tasks made significantly harder in conflict settings.Footnote 116
International standards on mental health and psychosocial support in armed conflict: Gaps in inclusion and implementation
In 2023, the UN General Assembly adopted Resolution 77/300 on MHPSS, recognizing mental health as an integral component of humanitarian response and calling on States and humanitarian actors to integrate MHPSS across sectors in emergencies, including in situations of armed conflict.Footnote 117 Recognizing the long-term harm caused by a lack of timely psychosocial services, the UN, governments and international humanitarian agencies have committed to including mental health support as a core component of humanitarian response.
In 2007, the IASC, the UN system’s highest-level humanitarian coordination forum, developed the IASC Guidelines for Mental Health and Psychosocial Support in Emergency Settings (IASC MHPSS Guidelines).Footnote 118 The Guidelines provide a framework for humanitarian actors to provide mental health support in emergencies, emphasizing integrated, culturally appropriate and rights-respecting support.
Adopted prior to the entry into force of the CRPD, the IASC MHPSS Guidelines did not fully reflect the Convention’s rights-based approach to disability.Footnote 119 Subsequent inter-agency guidance has increasingly sought to align humanitarian practice with the CRPD. In 2019, the IASC adopted the Guidelines on Inclusion of Persons with Disabilities in Humanitarian Action, which sought to ensure that humanitarian actors identify and respond to the needs and rights of people with different types of disabilities.Footnote 120 In 2024, the IASC issued an Information Note on Disability and Inclusion in MHPSS (IASC Information Note on MHPSS), providing specific guidance on making MHPSS services accessible and inclusiveFootnote 121 Major humanitarian donors, including the European Union, have also introduced policies requiring that the humanitarian programmes they fund, including those focused on mental health, be inclusive of people with disabilities.Footnote 122 Additional initiatives, including WHO’s QualityRights Training: Humanitarian EditionFootnote 123 and the Minimum Service Package for MHPSS,Footnote 124 further articulate standards to ensure that mental health services in humanitarian contexts are rights-based, community-oriented and inclusive of persons with disabilities.
Despite these commitments, research shows that people with disabilities continue to face exclusion and difficulties accessing humanitarian aid, including MHPSS. This is due in part to inconsistent implementation, a lack of trained personnel and neglect of accessibility and reasonable accommodation in service design. Human Rights Watch research in Syria found that MHPSS services, already scarce before the conflict, were generally not inclusive of children with disabilities. This exclusion compounded the devastating psychological impact of the conflict, particularly among children with disabilities, who were worried that their presence put family members at risk or feared being abandoned during attacks. Two organizations providing psychosocial support services to children in Syria confirmed that their programmes were not accessible to all children with intellectual or psychosocial disabilities. A staff member from one organization explained that the organization was not prepared to serve children with high support needs because “a child with a ‘severe’ intellectual disability needs intensive care and very qualified and specialized facilitators to maintain the principle of ‘Do no harm’”, which the organization could not offer at the time.Footnote 125 A representative of another non-governmental organization, Violet Syria, said that many of the organization’s educational activities and child-friendly spaces exclude children with disabilities due to lack of trained staff inside Syria: “Our staff often complain that they do not know how to [support children with disabilities], that they need special approaches and special modules, and we do not have enough capacity for this.”Footnote 126
The lack of accessible MHPSS services and education opportunities has severe consequences for children with disabilities and their families.Footnote 127 Several parents interviewed in Syria described how the lack of access to meaningful interventions and education exacerbated their children’s psychological distress and caused great despair to parents. The father of a 4-year-old boy with autism living in a makeshift camp near the Syria–Turkey border said there were no support or educational services available for his son:
He does not know how to communicate with us, we do not know how to communicate with him, and there is nowhere to look for support. Recently, we see a lot of aggressiveness, even when I try to speak and engage with him. Whatever he finds on the ground around him, he throws that at me. We are very worried; we do not know what to do. I was hoping that by coming to this area, we will have access to education for him, but there is nothing.Footnote 128
All but one of the twenty Syrian parents interviewed in 2022 said they and their children had no access to MHPSS services. The only parent whose child did have access said the programme closed in 2019.Footnote 129
In Gaza, where nearly the entire population has experienced intense trauma from constant exposure to violence, death and destruction, and repeated displacement, Human Rights Watch found in 2024 that MHPSS services were largely unavailable to children with disabilities. As early as 2020, Human Rights Watch documented that Israel’s closure of Gaza had already severely restricted the availability of MHPSS services.Footnote 130
Conclusion
Across conflicts, Human Rights Watch has found that people with disabilities experience distinct and disproportionate mental health harms from the direct effects of violence but also from systemic neglect, abandonment, institutionalization and the breakdown of essential services. Testimonies from children and adults reveal the depth of suffering: fear of being left behind, grief over the loss of caregivers, despair at the collapse of education and health systems, and trauma from confinement or displacement.
Not all mental health harms in armed conflict are inevitable; many are consequences of policy failures and violations of international humanitarian and human rights law. Many concerning the rights of people with disabilities have been brought to light since the adoption of the CRPD. Addressing these harms requires more than emergency relief – it demands sustained commitment to inclusion, de-institutionalization and community-based support systems that uphold autonomy and dignity.
To move from neglect to inclusion, governments, the UN and humanitarian actors should urgently recognize and address the specific mental health harms experienced by people with disabilities in armed conflict. This means ensuring their active participation in the design, implementation and monitoring of MHPSS services, so that responses are inclusive, rights-respecting and grounded in the lived experiences and priorities of those most affected. Ensuring the mental health and dignity of people with disabilities in conflict is not only a humanitarian imperative, but a fundamental test of the collective commitment of States, the UN and humanitarian agencies to human rights and equality.
Meeting this test requires more than recognition – it requires meaningful action. The devastating impact of armed conflict on the mental health of children and adults with disabilities, and the lack of access to inclusive MHPSS services, underscores the urgent need for the UN, governments and humanitarian actors to commit sustained attention and investment to closing these gaps. The following steps are crucial to achieving this goal.
Inclusion and targeted response
To ensure that people with disabilities can access MHPSS services on an equal basis with others, donors, governments and humanitarian agencies should mainstream disability inclusion across all MHPSS programming and fund and develop targeted interventions that address the specific rights and needs of people with disabilities.
Mainstream MHPSS programmes should be designed to be inclusive of, and accessible to, people with all types of disabilities, including psychosocial disabilities. Programmes focused on specific groups – such as women or children – should likewise include members of those groups with disabilities. In addition to these inclusive approaches, targeted and tailored MHPSS services, with targeted investments, should be developed specifically for people with disabilities. Programmes directed at persons with disabilities, regardless of the sectoral type of support (nutrition, shelter, WASH (water, sanitation and hygiene) etc.), should integrate cross-cutting MHPSS approaches in recognition of the multisectoral nature of mental health and psychosocial support. These services should not segregate people with disabilities but should help ensure that mental health services are rights-respecting, equitable, inclusive and responsive to diverse support needs.
Consultation and participation
People with disabilities, especially those with lived experience of armed conflict, should be meaningfully consulted and engaged as partners and agents of change in the design, implementation and evaluation of MHPSS programmes. Their lived experiences and expertise are crucial to ensuring that services are rights-based, relevant and effective.
Humanitarian actors should establish structured mechanisms to integrate these perspectives, including advisory committees and co-design workshops. Engagement should be accessible to people with all types of disabilities, including psychosocial disabilities, and should provide accommodations including communication support, flexible scheduling, and safe spaces in which to participate.
Organizations of persons with disabilities (OPDs) can play a central role in facilitating consultation, supporting capacity-building and monitoring programme implementation. Humanitarian agencies should partner with OPDs to identify participants, co-develop engagement strategies and ensure that the voices of hard-to-reach individuals are included. By embedding lived experience and OPD collaboration into MHPSS programmes, humanitarian actors can strengthen the relevance, inclusivity and effectiveness of services.
Monitoring and data collection
Effective monitoring and reporting on MHPSS should reflect the diversity of disability experiences and identify specific challenges faced by people with different types of disabilities. All MHPSS data should be disaggregated by age, gender and disability. Data collection should assess barriers to access and identify concrete measures to remove them.
Training and capacity-building
Organizations and agencies providing MHPSS should ensure that staff and front-line workers receive training on disability rights and inclusive practices. Such training should emphasize supported decision-making, accessibility, reasonable accommodation and non-discriminatory approaches to psychosocial support. Staff should also be familiarized with practical tools and guidance such as WHO’s QualityRights Training: Humanitarian Edition, which provides a rights-based framework for ensuring that MHPSS services are inclusive, equitable, and responsive to people with disabilities in humanitarian settings.
Implementation of the IASC Information Note on MHPSS
Donors should require their implementing partners to apply the IASC Information Note on MHPSS. This document, developed with the leadership and expertise of disability rights experts and people with lived experience, provides concrete guidance on ensuring that MHPSS programming in emergency settings is accessible and inclusive. Notably, its second objective calls for de-institutionalization and the replacement of long-stay residential and psychiatric institutions with community-based, rights-respecting MHPSS services.
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