**1.1 The impacts of living in refugee contexts**

Approximately 28 million children are displaced by armed conflicts and violence around the world [1]. Where violent conflicts and unpredictable circumstances and situations are the norm, the lives of young children and their families are significantly disrupted and parents and caregivers report struggling to offer the sensitive and consistent care that young children need for their healthy development [1]. Only about 3% of humanitarian crisis funding goes toward education and a fraction of that to early childhood needs, parenting skills and protective factors [2]. The challenges refugees face before, during, and after displacement have serious consequences for families. Families with children between the ages of 0 and 8 are the largest group affected by today's global emergencies (war, conflict, natural disasters) and often face the most dire consequences [3]. Apart from death and injury, consequences include displacement, malnutrition, increased prenatal and infant mortality, family separation, sexual exploitation and abuse, trafficking, impoverished living conditions, contagious diseases, reduced life expectancy, and adverse psychological, social, and economic impact. Distinguishing between the effects of emergencies, pre-migration stress, separation from family, displacement stress, socio economic hardships, and acculturation difficulties during resettlement is challenging [4]. Adverse prenatal impacts include exposure to prolonged stress, environmental toxins, nutritional deficits, boredom, and depression. These experiences can chemically alter the epigenetics and the genes in the fetus or young child, which may shape the individual temporarily or permanently [5, 6]. Violence and maternal depression can impair child development and mental health [7]. Prolonged stress during pregnancy and/or early childhood can have even greater toxic stress impact and, in the absence of protective parental and caregiving relationships, may result in permanent genetic changes in developing brain cells. Research shows that toxins and stress from pregnant mothers cross the placenta into the umbilical cord [8], leading to premature and low birth weight babies [9] which increases the stress of parents and caregivers with additional parenting requirements. The severity of the impact depends on diverse factors including previous life experiences, coping ability, severity of the trauma, age, gender, poverty, education and support from family, friends, and professionals [10–13]. These negative impacts undermine the physical, emotional, cognitive, and social development of young children. Apart from physical injury, the loss of family, friends, and neighbors can severely disorient parents and caregivers and the loss of home and possessions disrupts daily routines, further undermining the foundation for a healthy and productive life [14, 15]. According to the Palestinian Counseling Centre, Save the Children [16], even 6 months after the demolition of their homes, young Palestinian children suffered from withdrawal, somatic complaints, depression/anxiety, unexplained pain, breathing problems, attention difficulties and violent behavior [16]. Parents and caregivers experience loss of loved ones that can not only cause trauma, but also result in lost caregiver support. Adverse early experiences often stem from inequity between and within populations. The impacts of poverty, inadequate cognitive stimulation, stunting, iodine deficiency, and iron-deficiency anemia prevent millions of young children from attaining their developmental potential. Though Adverse Childhood Experiences (ACEs) and wellness data has become more prevalent, much of the research samples populations from high-income countries. ACEs can and do affect *all* children and gaps in the data exist. However, a few recent studies on ACEs from countries around the world have begun to shed light on methods for measuring ACEs in low-resource settings to begin establishing baselines for the prevalence and burden of ACEs across contexts [17, 18]. A deeper examination of parenting in emergency and conflict situations remains crucial as research suggests

that traumatic events experienced before the age of 11 are three times more likely to result in serious emotional and behavioral difficulties than those experienced later in life [19]. Healthy parenting is extremely challenging when parents, caregivers and children are exposed to violence, uncertainty and lack services and resources to support their wellbeing, [20, 21]. Having a clear understanding of both adverse and protective factors is essential in proactively supporting families who have experienced refugee contexts.
