Health policy journals continue to focus on the usual health system issues while much of the world is engulfed in the fires of war. We have all seen images of children who have been orphaned or wounded in war zones. These tug at the heartstrings, as they should. Yet, systematic scientific information about the magnitude of the impact of child health is lacking. The silence from the health policy research community is deafening.

Wars in the Middle East have been displacing refugee families for several years, and this will continue for some time. Aside from humanitarian concerns, practical issues must be addressed, and for these, we need more information. And once the full impact of war on child health is quantified, perhaps the political process might be influenced. Sometimes this happens, though we know that interests other than health and medical care are at work.

Readers of *INQUIRY*, as well as authors and board members, should have noticed that the journal has gradually become more international in scope. We hope to influence health care systems around the world, not just in the United States. And the impact of war on child health is being felt more strongly outside of the United States. Large communities of refugee families have appeared in several nations. Some nations have shouldered a disproportionate share of the burden. In some cases, children develop through their formative years in camps, living in tents, with few of the services most would consider necessary. Many have been traumatized by combat or orphaned.

Research is needed to quantify the scope and magnitude of care needs of these children. Reports should be produced separately for each nation, as the mix of services needed will vary. Needs should be assessed, and also the services actually provided should be measured, because the latter is likely to be less than the former.

We do not yet know to what extent the health care needs of the children of war will be so large as to skew the resources and priorities of national medical and public health systems. The impact on public health outreach programs is not trivial, nor is the need for primary care services. Providing psychological services for trauma will require some redirection of resources, but how much? And what about social welfare coordination and care management? Will these components of a good medical care system be offered to the children of war?

Will dashboard performance indicators of national health care systems reflect the impact of internally shifting resources? Measures of the accessibility of services should encompass the entire population, including refugee families. Will medical expenditures per capita be affected? Will health outcomes such as long-term disability rates start to suffer?

Program evaluations are needed to test care models that care for the children of war. The care models that work best might vary depending on the circumstances: refugee camp versus ghetto versus full integration into indigenous communities. Perhaps the latter will turn out to be more cost-effective in the end.

Even after the wars end, which might not be in the near future, international terrorism is expected to continue. The children of war are not just found in refugee families. They are found among the citizens of nations far from the combat zones, when bombs explode in cafes and bullets fly in shopping malls. This problem is a defining element of life in this era, yet the silence from the health policy community is deafening.

James E. Rohrer, PhD

Editor-in-Chief, Journal of Primary Care and Community Health, and Health Services Research and Managerial Epidemiology.
