Background Millions of children and adolescents are exposed to wars, affecting their psychological well-being. This review focuses on psychosocial interventions in low and middle-income countries (LMICs) in the Middle East, where mental health services are limited. Aims Our primary aim was to evaluate the effectiveness of trial-assessed psychosocial interventions in reducing post-traumatic stress disorder (PTSD) symptoms in children and adolescents aged ≤18 years who were exposed to war in LMICs in the Middle East. Changes in other psychological conditions and symptoms were evaluated where reported. Method PubMed, Cochrane Library and Ovid were searched without year restriction, in December 2021. Previous review reference lists were also checked. Only studies published in English were included. Each study was evaluated for risk of bias and results are presented as a narrative synthesis. Results Three group-based interventions were identified and evaluated across six studies: ‘Teaching Recovery Techniques’, ‘Writing for Recovery’ and ‘Advancing Adolescents’. Two studies took place in post-war settings, and four in a context of ongoing conflict. Positive experiences and improved social skills were indicated following most interventions, but Teaching Recovery Techniques was the only programme associated with a statistically significant reduction in PTSD score. Differences in follow-up interval limited comparability of outcomes. Conclusions This review highlights a paucity of evidence for effective treatment options for children and adolescents affected by war from LMICs in the Middle East. Promising indications of reductions in PTSD symptoms, specifically from Teaching Recovery Techniques, require further rigorous evaluation and long-term follow-up.

Despite the vast amount of research that supports investing in early childhood development and education in emergencies (ECDEiE), this area of programming continues to be underprioritized and underfunded. We applied a strategic problem-solving framework to systematically address the challenge of low access to ECDEiE in the global context. Specifically, we addressed three root causes of this problem: low prioritization of ECDEiE across sectors; the lack of a systematic characterization of the ECDEiE institutional and programmatic landscapes; and limited consensus on strategic advocacy for ECDEiE. To address these issues, we applied a mixed methods approach. We administered an online global stocktaking survey to 118 respondents, including those working in humanitarian aid, ECDEiE, government, and academia. We also reviewed the gray literature (N=218 documents). We discuss our six main findings in order to inform strategic initiatives that could be used to increase access to ECDEiE globewide.