You would think that once a ceasefire is signed and people return home, it is "over". For many, one of the horrors of war is only just beginning. Brown University's Costs of War project estimated that, in the post-9/11 era, deaths by suicide among US service members and veterans are at least four times higher than the number killed in combat operations. It is a stark reminder that the battlefield can follow people long after the last shot.

Post-traumatic stress disorder (PTSD) is a recognised mental health condition that can develop after a person experiences, or witnesses, terrifying or life-threatening events. Symptoms may include intrusive memories and flashbacks, nightmares, severe anxiety and a persistent sense of threat, alongside strong efforts to avoid reminders of what happened. These reactions do not always appear immediately; some people manage day-to-day until a sound, smell, anniversary or stressor pulls them back into the event.

Films and documentaries often focus on soldiers, but PTSD is not confined to combatants. Civilians caught in bombardments, people who have survived displacement, journalists, humanitarian workers, and children who have watched family members injured or killed can all carry trauma. In conflict settings, fear is compounded by deprivation, bereavement and separation. Trauma is not only what happened; it is also the meaning the event took on, and what the body learned it had to do to survive.

This is where Malta's context matters. Our country has long held to neutrality, but neutrality has never meant indifference. In recent years Malta has welcomed people fleeing conflict and persecution, including families and children who enter our schools and communities. Many arrive with visible injuries, and those rightly draw attention. But trauma is frequently invisible. A child may sit quietly in class and still be living with nightmares, hypervigilance, panic or emotional numbness. UNHCR guidance for teachers working with refugee children notes that trauma may present as withdrawal, irritability, concentration difficulties, sleep disruption, or exaggerated startle responses.

If we want integration policies to be humane and effective, psychosocial support must be treated as essential infrastructure, not an optional add-on. That begins with our "eyes on the ground": educators, school leaders, learning support educators, counsellors, youth workers and others in daily contact with children and families. Classrooms can be stabilising environments, but staff need practical tools to recognise stress responses, reduce triggers, communicate sensitively, and know when and how to refer.

So what should Malta do, in practical terms?

First, embed baseline trauma awareness into professional development for education personnel and relevant frontline workers. This is not about turning teachers into clinicians. It is about equipping staff to notice patterns (sleep disruption, concentration collapse, dissociation, agitation), to respond without shaming, and to document concerns appropriately.

Second, formalise multidisciplinary protocols and referral pathways. The education system already has experience in assembling teams around specific needs, such as individualised educational programmes. PTSD and complex trauma can present differently from typical learning difficulties and may coexist with grief, anxiety, depression, safeguarding concerns, or chronic health conditions. Clear protocols should set out early warning indicators, culturally and linguistically appropriate assessment, safeguarding steps, and referral routes into mental health and social care services.

Third, collaborate deliberately with specialist NGOs and services that already work on trauma, migration and child protection. Malta does not need to reinvent the wheel. Organisations working daily with refugees and trauma survivors understand barriers such as language, trust, stigma, transport and family instability. Structured partnership arrangements can turn goodwill into predictable pathways.

Fourth, support the supporters. Staff exposed to pupils' trauma narratives can experience secondary traumatic stress, compassion fatigue and burnout. Trauma-informed systems therefore require supervision structures, access to specialist consultation, and realistic caseloads - otherwise the system quietly loses the very people who provide stability.

Finally, reflect on school culture. Where schools feel like relentless production lines - lesson to lesson, assessment to assessment - there is little space for children to regulate emotion, rebuild trust and learn again. Predictable routines, psychologically safe classrooms and structured opportunities for expression are not "soft". For many pupils, they are the foundation on which learning becomes possible.

Malta can continue to do the right thing by those who arrive at our shores, while also being honest about what it takes to sustain that commitment. The first step is to acknowledge that trauma does not end when the fighting ends. The next is to build the professional systems that help people heal.

References

• Costs of War Project, Watson Institute for International and Public Affairs, Brown University (Suitt, 2021): 'High Suicide Rates among United States Service Members and Veterans of the Post-9/11 Wars'.
• Mayo Clinic (updated Aug 16, 2024): 'Post-traumatic stress disorder (PTSD) - Symptoms and causes'.
• NICE Guideline NG116 (published Dec 5, 2018; last reviewed Apr 8, 2025): 'Post-traumatic stress disorder: recognising, assessing and treating PTSD in children, young people and adults'.
• UNHCR (Teaching About Refugees): 'Guidance on working with refugee children struggling with stress and trauma' (and related teacher guide materials).
• OECD (2022): 'Supporting the social and emotional well-being of refugee students from Ukraine in host countries'.