Nine-year-old Ghaida Mazen used to be polite and obedient child. But when she lost her friend Ayesha, 8, to Houthi rebel shelling in Taez last August, everything changed.
"We did not shock her with the news of the killing but she found out from her friends and then she started to ask questions such as, ‘Where is Ayesha now? What is she doing?’ After about a month of deep thinking about her friend, she became aggressive," her mother Basma told The National.
Ghaida started hitting her friends without reason, and no longer shows respect to her parents and relatives, her mother said. Her family now keeps her at home to avoid problems with the neighbours.
The war in Yemen has taken a heavy toll on children, with nearly 1,400 killed and more than 2,000 injured since March 2015, according to the United Nations Children’s Fund. Nearly 10 million Yemeni children face fear, pain and deprivation brought on by the war, Unicef said in a report last year, and the recruitment of child soldiers has also increased exponentially, particularly by the Iran-backed rebels. The UN documented nearly 1,500 cases of children below the age of 18 being recruited in the war in the last two years.
While it is hard to quantify the psychological trauma suffered by Yemeni children, it represents a familiar story of the emotional damage inflicted on young people in the region’s ongoing conflicts.
Taez city and the surrounding province has witnessed some of the most intense fighting of the Yemen war, with the Houthi rebels and their allies entrenched in a deadlock with fighters supporting the government.
Most of the families in Taez province are struggling to provide their children with food, much less take care of their mental health.
And across Yemen, words such as "surrender", "sniper", "shoot", "enemy", "kill", "Kalashnikov" and "arms and ammunition" can often be heard as children play together.
They can also be seen imitating their surroundings in their games, with some making their own replica assault rifles with discarded cans or wood.
Wael Hasan, a psychologist working in Taez, said the children often speak the language of fighters while interacting with one another. He said this is an indicator that they need psychotherapy to help them overcome the traumas of war — such as death, violence and fear — that they are struggling to grapple with.
"There are less than ten psychologists in Taez province and it is difficult for all the affected people to get proper treatment," said Dr Hasan.
He called on international organisations to "focus on the victims of psychological trauma and open centres to help victims for free".
Dr Hasan also warned that the next generation of Yemenis will suffer serious consequences if children today, who are dealing with psychological problems, are not helped.
Bed-wetting is a key symptom of trauma in children, and one faced by many Yemeni children, including six-year-old Amr Khalid.
His family fled the fighting in Taez city to Al Turbah 70km away but the memories of the conflict stayed with him.
"My child was normal and he did not wet his bed at night as he is six years old. But because of the shelling that targeted the city during the last year, he began to wet his bed again," his mother Asma said. "The paediatrician confirmed that bed-wetting was a result of the shelling and we should keep Amr far from the sounds of war."
Taez city’s residents cannot avoid hearing the sounds of the war that surrounds them, especially when the Houthis launch shells into residential areas in the city.
Unicef, together with other humanitarian groups, has provided child protection services in Yemen such as psychosocial support and helping children and families deal with the effect of conflict and displacement.
But the conflict is just the latest in the Middle East and North Africa to affect a generation of young people.
More than 70 per cent of Syrian children suffer from "toxic stress" – a severe form of psychological trauma that can cause permanent and irreversible damage, a study by charity Save the Children said in March.
Increased aggression, bed-wetting, loss of speech and substance abuse are some symptoms of psychological trauma caused by the violence, according to the report which said that "78 per cent of children feel grief and extreme sadness some or all of the time".
And in Gaza, the UN estimated that nearly 400,000 children needed psychological support after Israel’s brutal assault on territory in the summer of 2014.
Back in Ghaida’s family home in Taez’s Al Roudha neighbourhood, where Houthi rockets regularly fall from across the front line, her family are struggling to cope with her change in behaviour.
Her father, Yasin, 39, is struggling to help his daughter. He used to work at the electricity corporation but has not received his salary for six months.
"When we ask Ghaida to do anything, immediately she shouts at us ... most of the time she does not obey," said Ghaida’s mother, Basma. "My neighbours told me that Ghaida needs psychotherapy but there is no proper psychologist in Taez and we are waiting for the war to end, so we can treat her."

Source: The National