Review new nuclear weapons.6 It is noteworthy that the UK, which has been involved in 17 different wars since World War II, has twice the under 5 mortality of Sweden, which has not been involved in a war for almost 200 years.7 8 There is a marked contrast between the amount of money spent on weapons and munitions versus the costs of attain- ing the millennium development goals (MDGs). It has been estimated that the cost of halving the proportion of people without sustainable access to safe drinking water and basic sanitation (MDG7) could be achieved by spending US$18 bil- lion each year over the next decade9 (table 2). SMALL ARMS Prior to the Iraq war much was made of the phrase ‘weapons of mass destruction’. Unfortunately for children the ‘weapons of mass destruction’ are usually small arms which are weapons that can be carried and used by an individual. In many poor countries where internal conﬂict is widespread, small arms are readily available and incredibly cheap. Small arms and light weapons are thought to be responsible for the deaths of at least 1000 people each day.10 They are thought to be responsible for up to 90% of the direct conﬂict deaths each year.10 The most widespread military weapons in the world are variants of the Kalashnikov assault riﬂe (AK-47 and AK-74). It is estimated that there are between 50 and 70 million AK-47s worldwide and they can be purchased in some countries for $12.10 Each year 8 million guns are manufactured worldwide and in the same year less than 1 million guns are destroyed by authorities.10 The number of small arms is therefore rap- idly increasing. In addition, with cleaning and maintenance, small arms are incredibly durable; as an example, there are still models of the Austrian Roth-Steyr pistol in use in Eastern Europe—this pistol was manufactured for the cavalry of the Austro-Hungarian Empire in 1907. Guns can remain in soci- ety for a long period after conﬂict and this is illustrated by the experience in Guatemala where a civil war ended in 1996. Despite the end of the civil war, the rates of gun violence have increased since the end of the war and each day 25 people are killed or seriously injured by gun shots.10 The International Action Network on Small Arms has been working to try and highlight the problem associated with the proliferation in mis- use of small arms worldwide. LANDMINES It is estimated that there are more than 80 million landmines still in the ground worldwide.11 These landmines result in between 15 000 and 20 000 new casualties each year. Landmines remain a problem following the end of the con- ﬂict and more than 90% of landmine victims today are civil- ians, with one in four of these victims a child. Recognition Table 1 Ratio of military to civilian casualties: selected major conﬂicts of the 20th and 21st centuries* Civilian/military deaths 0.16 0.72 1.71 3.09 2.17 7.78 Conﬂict Russo-Japanese War (1904–1905) World War I (1914–1918) World War II (1939–1945) Korean War (1950–1953) Vietnam War (1964–1973) Invasion/occupation of Iraq (2003–) 60 *Total military deaths in selected conﬂicts 39 961 000; total civilian deaths in selected conﬂicts 56 728 000. that landmines affected civilians more than military person- nel resulted in a widespread movement that led, in 1997, to the so-called Mine Ban Treaty. The Mine Ban Treaty has been a major step forward but it is important to recognise that not all countries have ratiﬁed the agreement. It is estimated that there are more than 10 million landmines in both Afghanistan and Angola.12 13 Clearance of land mines is dangerous, demanding and costly. As well as causing direct casualties, the extensive landmines have a major negative impact on farming and the economy. CLUSTER BOMBS Cluster bombs are weapons that can be dropped from the air or ﬁred from the ground and release dozens or hundreds of submunitions, which are in effect smaller bombs. They effec- tively scatter devices that will detonate over a wide area and hence have difﬁculty distinguishing between military targets and civilians. Many cluster bombs fail to detonate on impact and therefore become the equivalent of landmines. They were responsible for more civilian casualties in Iraq in 2003 and Kosovo in 1999 than any other type of weapon. Following the successful 1997 Mine Ban Treaty, many civil society organisations have worked together to ban cluster bombs.14 Over 100 countries have signed the Convention on Cluster Munitions but unfortunately several key countries have so far neither signed nor ratiﬁed the treaty. CHILD SOLDIERS Children are actively being recruited or abducted and forced to ﬁght in wars, a problem that is made worse by the greater availability of small arms. It is estimated that there are more than 300 000 child soldiers worldwide.15 Small arms are not only durable, but the care and use of modern small arms is simple enough that most school age children can use and maintain them. As an example, in Uganda, 90% of the sol- diers in the Lord’s Resistance army consisted of children.13 Children as young as 4 years of age were abducted and forced to be involved in military action. Children are forced to take part by a combination of direct physical abuse, threats and drugs.13 Children who do manage to escape from these armed military groups often have long-term psychological problems.15 DEATH AND DISABILITY Children may die during a war from direct trauma but it is thought that more die from starvation, illness such as infec- tions or a combination of factors involving the loss of their parents in the aftermath of war.16 More than 1.5 million chil- dren are estimated to have died as a direct result of violence in just over a decade.16 The children involved in violent conﬂicts are usually in low-income countries or in disadvantaged com- munities within lower-income to middle-income countries. It is usually impossible to get accurate numbers of children killed in military conﬂicts because those responsible, whether they Table 2 Military expenditure in 2008 Annual estimates Military expenditure, USA Military expenditure, UK Proﬁt from arms sales (BAE Systems) Cost of achieving MDG7 (safe drinking water and sanitation) Billion US$ Reference 607 65 1.8 18 2 2 2 7 Arch Dis Child 2012;97:59–62. doi:10.1136/adc.2009.178186