Education Denied: The Potential Consequences of Conflict and Opression on Dementia Risk

Education Denied: The Potential Consequences of Conflict and Oppression on Dementia Risk

A Perspective Piece for World Alzheimer’s Month (2024)

Esra Hassan

Dementia is often regarded as a condition tied primarily to ageing and genetics. However, research increasingly highlights modifiable risk factors have an important role in determining cognitive decline later in life. According to the latest Lancet Commission on dementia prevention, intervention, and care, there are actionable steps that individuals and governments can adopt to reduce dementia risk throughout life. These risk factors are linked with 40% of all dementia cases. These factors range from early-life education to reducing air pollution. Addressing these modifiable risk factors, starting in childhood and continuing throughout life, could prevent or delay nearly half of dementia cases. To reduce dementia risk throughout life, the Commission outlines recommendations to be adopted by governments and individuals, including providing all children with good quality education and reducing exposure to air pollution through strict clean air policies.

While individuals can adopt some of the recommendations to reduce dementia risk, the responsibility largely falls on governments to create environments where these protective measures are accessible. This issue raises a critical question:

What happens to children in regions where education is disrupted due to conflict and war?

For regions especially plagued by conflict and oppressive regimes, achieving these preventive measures is a far greater challenge.

For World Alzheimer’s Month (2024), I wanted to take the opportunity to amplify the voices of the children living in conflict zones and remind us of the ongoing crisis faced by children worldwide. Education is a fundamental right for every child. Yet, as we continue to witness the destruction of educational systems in conflict zones and education bans in regions of oppressive regimes, we must consider the long-term health implications for these children. Much of the global conversation around dementia prevention focuses on wealthier, stable countries, where education and healthcare systems are well-established. However, the cognitive health of children in conflict zones is often neglected. As humanitarian crises persist we must confront the reality that today's educational deficits could contribute to tomorrow’s dementia epidemic in these regions.

Education: A Lost Opportunity for Millions

Across the world, children are growing up amidst war and conflict, where attending school is not a priority, and in many cases, it is not even an option. In these conflict zones, education is often the first casualty. War disrupts schooling, leads to forced displacements, and creates environments where education becomes inaccessible. Schools are destroyed, teachers are displaced, and children are forced to grow up in environments where survival takes precedence over learning. This lack of access to education is not just a crisis of missed opportunities; it has far-reaching consequences for cognitive development, potentially increasing the risk of dementia as these children age.

Education: A Modifiable Risk Factor for Dementia

One of the key findings of the Lancet Commission is that early life education is critical. Education plays a fundamental role in the development of cognitive reserve, the brain's ability to cope with damage and disease. Studies show that people who receive more education are at a lower risk of developing dementia, with inadequate access to education during childhood correlated with an increased risk of dementia later in life. The Lancet Commission highlights that by increasing global education levels, we could reduce dementia cases by a significant percentage. However, in regions where education is inaccessible, particularly in childhood, we are missing an opportunity to build that crucial cognitive reserve, putting future generations at risk. Millions of children around the world are being deprived of this fundamental right. There is a critical need for international organisations and governments to ensure that regions affected by war are included in the global dementia prevention agenda. The global community must step up to provide aid, support, and policy solutions that prioritise not only immediate survival but long-term brain health.

Children in War Zones and the Impact on Education

According to UNICEF, in 2021, 27 million children of primary and lower secondary school age were out of school in 24 conflict-affected countries. More than 25 million children between 6 and 15 years old are missing out on school in conflict zones across 22 countries. In 2022, more than one in six children (468 million), were living in conflict zones. In the Middle East, one in three children are affected by conflict and have the highest proportion of children living in conflict areas. In Africa, there were an estimated 180 million children affected, followed by Asia (152 million), and the Americas (64 million).

South Sudan has the highest rate of out-of-school children at the primary school level, with nearly 72% of children missing out on education. This is followed by Chad (50%), and Afghanistan (46%). In these countries, they also have the highest rate of girls who are out of school (South Sudan – 76%, Afghanistan – 55%, and Chad – 53%). At the lower-secondary school level, Niger (68%), South Sudan (60%), and Central African Republic (55%) have the highest rates of out-of-school children. Nearly three-quarters of girls in Niger and two in three in Afghanistan and the Central African Republic are not in school. In Chad, three times as many girls as boys of primary age in conflict areas miss out on education. Additionally, 4,400 children had fled the Boko Haram violence in the Northeast region of Nigeria to Chad, with many of them remaining out of school. 90% of children arriving from Nigeria to Chad have never been to school. In Sudan, there are an estimated 19 million children currently out of school since the conflict. Due to increased violence and insecurity in the region, over 6.5 million of these children lost access to schools, with 10,400 schools closing in these conflict-affected areas.

The violent mass displacement of Palestinians since October 2023 has led to over 625,000 students without access to education in Gaza and a safe place in early 2024. More than 6,417 students and 296 educational staff had been killed. The UNRWA schools had also closed in the Gaza Strip which left 300,000 children who attended them to miss out on education. Additionally, 75% of all school buildings across the Gaza Strip had been impacted by being directly hit or damaged.

This is even though attacks on educational premises and UN premises violate international humanitarian law.

In the East Democratic Republic of the Congo (DRC), UN figures from last year highlight that 5.3 million people were displaced with over 800,000 people forced to flee their homes in North Kivu since March 2022. This has meant that approximately 750,000 children have been disrupted in Eastern DRC. UNICEF figures between 2022-2023 further highlighted that nearly 1,700 schools have been forced to close due to persistent insecurity in North Kivu and Ituri. For example, local and national NGOs in these provinces show that 119 schools have been attacked, occupied or temporally used by armed groups. With nearly 240,000 displaced children living in surrounding camps, violence by armed groups has prevented children from attending school with the majority of displaced children living in camps unable to attend school at all. Nearly 300 schools cannot operate because they are used as shelter for those displaced by the conflict. A small minority of children have been able to access Temporary Learning Centres.

In Ukraine, since the start of the war, at least 3,400 schools have been damaged and over 400 schools have been destroyed across Ukraine. In 2023, more than 40% of children in Ukraine were not able to go back to school full-time, relying on online or hybrid learning due to the lack of bomb shelters in schools or the threat of air strikes.

Since the Taliban regained control in 2021, girls have been banned from secondary and higher education. In Afghanistan, 75% of girls are out of school. Nearly 1.4 million girls are forbidden from going to school past the age of 12. This year, Afghan women and girls continue to be excluded from all aspects of education and, now public life. Following this oppression, scholars and activists globally are condemning this exclusion as gender apartheid (“the commission of inhumane acts with the intent to maintain institutionalised, systematic oppression and domination of one gender group over another”) (Malala Fund).

Side note - Air Pollution

Air pollution is another significant risk factor for dementia. The Lancet Commission emphasises the need for governments to adopt strict clean air policies to reduce exposure. However, in conflict areas, air pollution becomes an inevitable consequence of bombings, destruction, and prolonged warfare. The climate cost of the first 60 days of Israel’s military retaliation, for example, was reported to be the equivalent of burning at least 150,000 tonnes of coal. Dust from collapsed buildings, fires, and ongoing military activity severely compromises air quality. In countries like Syria, Iraq, and Yemen, where bombings have been frequent, the airborne particles from explosives settle into the atmosphere, exacerbating respiratory and cognitive health issues. Children born and raised in these environments not only face the immediate dangers of conflict but are exposed to pollution levels that may increase their risk of dementia later in life.

“It is not just the pollution caused by war activity, during the development and testing of hardware, weapon systems and procedures, but also during war operations and subsequent reconstruction, which need serious consideration to avoid gradual deterioration of the environment and in particular the quality and temperature of the air” (Protopsaltis, 2012).

Weapons can have multiple effects, particularly on the environment and the quality of air humans breathe, before, during and after every such event. In conflicts, large volumes of military waste are produced and abandoned that contain polluting materials that not only contaminate the environment but also expose people to chronic health risks. White phosphorous for example is toxic but can also damage habitats through fire, contributing to air pollution. Moreover, there is the illegal exploitation of Congolese resources for the prosecution of war (OHCHR). Resource extraction from mining pollutants used to finance conflicts has been linked to an increased risk of health conditions. This exploitation puts many children at risk, who often work in these conditions.

Conclusion

As we commemorate World Alzheimer’s Month, it is important to consider that dementia is a public health issue that can be shaped by early-life experiences, such as education and the environment around us. The interruption of education in conflict zones and oppressed regimes will have a profound impact, not just on individuals but on entire societies. The children who miss out on education today are likely to face a range of challenges throughout their lives: lower economic opportunities, poorer health outcomes, and greater social instability. The intersection of humanitarian and public health crises is evident. Dementia prevention should not be an afterthought but a critical part of global health planning, particularly in areas affected by long-term instability. The Lancet Commission has shown that providing good quality education to children and reducing harmful noise and air pollution exposure is important for reducing dementia risk, but in conflict zones and oppressed regimes, millions of children and girls are denied this crucial foundation. These children are being left behind and let down. This leaves a significant population at heightened risk for dementia, perpetuating cycles of inequality that ripple across generations.

Esra Hassan, GMBPsS, MSc, BSc

PhD candidate in Dementia and adolescent research

@Es_H018

* This is a personal blog and is not endorsed or affiliated with any organisation.

*This perspective piece was written and edited with the assistance of ChatGPT.

Bibliography

https://www.thelancet.com/commissions/dementia-prevention-intervention-care

https://www.unicef.org/education-under-attack

https://theirworld.org/news/education-for-marginalised-syrian-children-refugee-camps-conflict-zones/

https://www.alzint.org/get-involved/world-alzheimers-month/time-to-act-on-dementia/

https://www.ucl.ac.uk/news/2024/jul/nearly-half-dementia-cases-could-be-prevented-or-delayed-tackling-14-risk-factors#:~:text=These%20new%20risk%20factors%20are,brain%20injury%2C%20air%20pollution%20and

https://malala.org/newsroom/malala-fund-works-to-end-gender-apartheid-in-afghanistan#:~:text=Malala%20Fund%20has%20joined%20Afghan,from%20public%20life%20and%20spaces.