Meanwhile, in South Sudan and Somalia, thousands of children have been recruited to join armed forces, while in Nigeria and Cameroon, the terrorist group Boko Haram has forced more than 100 children to act as suicide bombers—nearly five times the number from 2016.

“Children are being targeted and exposed to attacks and brutal violence in their homes, schools, and playgrounds,” said Manuel Fontaine, UNICEF director of emergency programs. “As these attacks continue year after year, we cannot become numb. Such brutality cannot be the new normal.”

In response to the findings, UNICEF called on all parties to the conflicts in the nations described to “abide by their obligations under international law to immediately end violations against children and the targeting of civilian infrastructure, including schools and hospitals,” while also demanding that states with influence over such parties make greater efforts to protect children in these regions.

The report echoes remarks from UNICEF’s representative for Yemen released earlier this week. Meritxell Relaño, the agency’s representative, concluded that “2017 was a horrible year for the children of Yemen,” pointing to the cholera epidemic, a growing potential for famine, and a blockade enforced by the U.S.-backed, Saudi-led coalition that cut off civilians from necessary food and medical aid.

Recounting a meeting with a Yemeni mother and her dying 7-year-old son, Relaño said: “He was like skin on bones. I asked why they had not come sooner and the mother told me that she could not afford to ride the bus to the hospital. The levels of poverty in the families [have] now reached levels that are unsustainable.”

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