The life-saving handbook was compiled at the request of Syrian doctors who were struggling to treat children for horrific injuries they had not come across before in a country where health services have been decimated by eight years of war.
Nearly three quarters of child casualties in the world’s five deadliest wars are caused by explosives such as suicide bombs, landmines, unexploded ordinance and air strikes, aid agency Save the Children said in a report on Thursday.
The charity, which helped produce the manual, calculated at least 5,322 children in Nigeria, Syria, Yemen, Iraq, and Afghanistan were killed or maimed by explosives in 2017.
In some cases, it said children were killed when they picked up unexploded ordnance – which is small and sometimes colourful – to use as toys.
Children are more likely to die from blast injuries than adults, the charity said.
It calculated that nearly three times as many children as adult combatants have died from explosives in Syria, where densely populated towns have been shattered by weapons traditionally meant for open battlefields.
Aid group Syria Relief is distributing the handbook to emergency units across northwest Syria, and there are plans to roll it out in Yemen, Afghanistan and Iraq.
“For more than eight years we’ve seen children dying on the operating table from wounds that adults have survived,” said one Syria Relief paediatrician who asked not to be named.
“The tragedy is these deaths could have been prevented with basic training. This manual … will undoubtedly save lives.”
The book was produced by the Paediatric Blast Injury Partnership (PBIP) – a British coalition of doctors and humanitarians – which plans to translate it into other languages and create a smart phone app.
It said most textbooks on treating blasts were based on research on injured soldiers.
“We know children’s bodies are different. They aren’t just small adults.” PBIP member Michael von Bertele, former head of British Army Medical Services, said in a statement.
Children’s thinner skulls and less developed muscle put them at greater risk of brain injury and internal organ damage.
Future growth also has to be factored in when amputating limbs or children can be left with even worse disabilities and lifelong pain.
One in five children worldwide lives in conflict-affected areas, according to Save the Children.
The charity is hosting a global symposium in The Hague on Thursday – the anniversary of its centenary – to discuss how to protect children in war and end impunity for those who commit atrocities on them.