From Iran to Gaza to Ukraine to Sudan, children today are growing up amid the highest number of violent conflicts since World War II. This reality is reshaping childhood in ways that are profound, cumulative, and often invisible to those not living through it.
For millions of children, conflict means far more than exposure to violence. It means living with persistent fear, absorbing deep psychological trauma, and enduring the loss of parents, siblings, homes, and schools. It also means growing up without the daily structures that provide safety and stability while being cut off from the foundations of healthy development such as nutritious food, nurturing caregiving, quality education, and basic health services.
At the same time, conflict is only one dimension of the crisis. Children around the world are facing a convergence of threats that extend well beyond war.
Who Are the Most Vulnerable
The world’s most vulnerable children are those living at the intersection of poverty, conflict, and instability. These overlapping conditions create environments where basic needs are consistently unmet and risks are constantly compounded.
Children are twice as likely as adults to live in extreme poverty, which limits their access to food, health care, education, and protection. This includes children orphaned by disease, particularly the millions affected by HIV and AIDS, as well as those growing up in conflict zones or displaced from their homes by climate related disasters that are occurring at unprecedented rates.
What makes these children especially vulnerable is not a single risk factor but the layering of many. Poverty, violence, displacement, and lack of services combine and reinforce one another, shaping the trajectory of an entire life.
A Man-Made Disaster
For decades, the global community made extraordinary progress in reducing preventable child deaths. Through simple and low-cost interventions such as vaccines, oral rehydration therapy, vitamin A supplementation, and improved water and sanitation, millions of children’s lives were saved.
As a result of these efforts, under-5 child mortality fell from more than 12 million deaths annually in 1990 to fewer than 5 million in 2024. This progress stands as one of the most significant public health achievements in modern history.
That progress is now in jeopardy due to policy choices that have weakened critical systems supporting child survival. Current estimates suggest that 2025 could become the first year this century in which deaths among children under 5 increase rather than decline, not because solutions are unavailable but because access to them has been disrupted.
Over the past year, the shutdown of key foreign assistance infrastructure has had immediate and measurable consequences. The dismantling of the U.S. Agency for International Development (USAID), the closure of global health programs at the Centers for Disease Control and Prevention (CDC), withdrawal from the World Health Organization, and reductions in support for UNICEF, Gavi, the Vaccine Alliance, and the World Food Program have led to clinic closures, stalled vaccination campaigns, and disruptions in access to clean water, nutrition, and essential medicines.
The result is an increase in child deaths from preventable or easily treatable conditions such as pneumonia, diarrhea, and malaria. If current trends continue, an estimated 4.5 million additional children under 5 could die by 2030, despite the fact that the resources required to prevent these deaths represent only a fraction of 1% of the U.S. federal budget.
What We Were Getting Right
Until recently, the United States played a leading role in advancing global child survival through sustained and bipartisan investment. These efforts combined technical expertise with modest funding to achieve large-scale impact.
Programs supporting children accounted for roughly 0.09% of the federal budget, yet they delivered immense returns in the form of lives saved, stronger communities, and greater global stability. These investments demonstrated that targeted and consistent funding could produce transformative outcomes.
Programs such as the President’s Emergency Plan for AIDS Relief (PEPFAR), particularly its support for orphans and vulnerable children (OVC), addressed not only disease but also the broader economic and social conditions that place children at risk. These programs helped keep children healthy and in school while reducing violence, preventing trafficking, and strengthening families and communities.
Much of this progress began to unravel when these programs were closed in early 2025. Without this assistance, many HIV-affected families are no longer able to afford school fees or basic health care, which places children at immediate risk. As a result, millions of children are being pushed into dangerous circumstances where they are more vulnerable to exploitation, early marriage, and trafficking. For young children living with HIV, the loss of consistent treatment can quickly become life threatening due to their still developing immune systems.
At the same time, broader reductions in foreign assistance have affected programs supporting clean water, maternal and child health, refugee services, and global vaccination efforts. In some countries, services that once ensured access to food, education, and health care have simply stopped.
What Happens Next
The question now is whether Congress will reclaim its leadership role in shaping and enforcing global development priorities because despite the Trump Administration’s disdain for foreign assistance, Congress still understands its moral and practical importance. Congress holds the power of the purse and has both the authority and responsibility to stand up to the Administration and ensure that funds appropriated for fiscal year 2026 are implemented as it intended.
What Everyone Can Do
Policymakers respond to their constituents, and public pressure plays an important role in shaping decisions.
Supporting First Focus on Children and First Focus Campaign for Children — financially or as a citizen advocate — can make a difference.
Because facts are facts: we know how to save children’s lives from preventable disease and malnutrition because we have done it before. The tools and resources already exist. What the world needs now is the political will to apply them. That is where you come in.
Please donate today.