Grave violations against children in Syria were the highest on record in 2016, said UNICEF in a grim assessment of the conflict's impact on children, as the war reaches six years. Verified instances of killing, maiming and recruitment of children increased sharply last year in a drastic escalation of violence across the country. At least 652 children were killed—a 20% increase from 2015—making 2016 the worst year for Syria’s children since the formal verification of child casualties began in 2014. A total of 255 children were killed in or near a school. More than 850 children were recruited to fight in the conflict, more than double the number recruited in 2015. Children are being used to fight directly on the frontlines and are increasingly taking part in combat roles, including as executioners, suicide bombers or prison guards. There were at least 338 attacks against hospitals and medical personnel.

"The depth of suffering is unprecedented. Millions of children in Syria come under attack on a daily basis, their lives turned upside down," said Geert Cappelaere, UNICEF regional director for the Middle East and North Africa speaking from Homs, Syria. "Each and every child is scarred for life with horrific consequences on their health, well-being and future."

Beyond the bombs, bullets and explosions, children are dying in silence often from diseases that can otherwise be easily prevented, according to the report, entitled "Hitting Rock Bottoem" (PDF). Access to medical care, lifesaving supplies and other basic services remains difficult. The most vulnerable among Syria's children are the 2.8 million in hard-to-reach areas, including 280,000 children living under siege, almost completely cut off from humanitarian aid.

After six years of war, nearly 6 million children now depend on humanitarian assistance, a twelve-fold increase from 2012. Millions of children have been displaced, some up to seven times. Over 2.3 million Syrian children are now living as refugees in Turkey, Lebanon, Jordan, Egypt and Iraq.

Inside Syria and across its borders, coping mechanisms are eroding, and families are taking extreme measures just to survive, often pushing children into early marriage and child labor. In more than two thirds of households, children are working to support their families, some in extremely harsh conditions unfit even for adults.

UNICEF appealed to all parties to the conflict, those who have influence over them, and the international community for an immediate political solution to end the conflict in Syria; an end to all grave violations against children, and attacks on schools and hospitals;the lifting of all sieges and unconditional and sustained access to all children in need; and providing refugee host governments and communities with sustainable support for vulnerable children, regardless of their status. (UNICEF, March 13)