Six years of violence and bloodshed have spawned a mental health crisis among Syria's children whose impact will be felt for decades, international charity Save the Children said on Tuesday.
In a report it called the largest mental health survey inside Syria during the war, the group found children increasingly crippled by fear or anger.
Most of the children - two-thirds of whom had lost a loved one, had their houses bombed, or been injured - exhibited severe emotional distress and lacked psychological support, it said, "with parents themselves struggling to cope".
The effects ranged from sleep deprivation and withdrawn behavior to self-harm and suicide attempts. Some had lost the ability to speak.
The research drew on interviews in seven provinces with more than 450 children, parents, teachers, and psychologists, mainly in rebel-held areas including Idlib and Aleppo, and in Kurdish-controlled Hasaka.
The conflict has killed hundreds of thousands of people, made more than 11 million Syrians homeless, and created the world's worst refugee crisis.
Some children had been forced to join armed groups to survive, Save the Children said.
"They have seen their friends and families die before their eyes or buried under the rubble of their homes," the report said. "They are the next generation who will have to rebuild their shattered country."
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