A/HRC/43/CRP.6 camp, interviewees described being denied food and prevented from accessing medical care, including for their infant children. Some of these children bore visible shrapnel injuries, suffered acute malnutrition and eventually perished. The impact on medical care in Syria will likely endure long after the conflict has ceased, in particular for those boys and girls who have suffered disabilities because of the war. 74. Regarding the mental health of those affected by over eight years of armed conflict, the impact of the war on children and their caregivers has been enormous. Numerous accounts were received by the Commission detailing the negative effects on the mental health of boys and girls. Children have described to the Commission the impact of losing their parents, siblings and friends. The witnessing of extreme violence, long periods of detention as well as the experience of torture and ill-treatment compounds the trauma that is experienced when living under siege for years, while fleeing or in protracted displacement. The Commission has documented the disruption of the normal everyday reference points for children, including the destruction of social, familial and schooling routines. Many boys and girls have described how they suffer from serious sleeping disorders, as well as feelings of insecurity, abandonment, revenge, frustration and fear. Several generations of children are used to living in distress with devastating psychological and developmental consequences for children and their caregivers. 75. Pre-existing gender roles have been exacerbated as a result of the conflict. Girls have been forcibly married due to protection concerns and have been prevented from attending school, which further entrenches their role in society. Boys have been compelled to take up the role of the main breadwinner, especially in female-headed households. While armed groups created financial incentives for boys to join their ranks, others engaged in petty jobs to secure an income for their families such as selling peanuts or working in mechanic shops. The lack of educational opportunities and economic hardship further exacerbated this situation. Moreover, children have been used for other forms of work that is highly detrimental to their development, including boys being used as smugglers, as workers at construction sites or as porters. Homeless children have also regularly been forced to beg. All these outcomes are highly detrimental to the survival and development of children and expose them to additional forms of violence and exploitation. 76. The conflict in Syria has further amplified pre-war challenges for individuals, most acutely children, to obtain valid civil documentation. Financial constraints and widespread corruption among Government officials have prevented parents from initiating birth and marriage registration procedures, which in turn, obstructed children’s right to a legal identity and a nationality. These documentation challenges also impeded children’s right to access education, medical care or property. Children whose parents went missing as a result of widespread arrests and detention, often amounting to enforced disappearances, have faced particularly acute challenges.50 77. Girls and boys born in former opposition-controlled areas also faced numerous obstacles to obtain civil registration, since documents provided by armed groups are not recognized by competent Government authorities. The situation of displaced children, in particular girls and boys persisting in al-Hol or al-Roj camps with familial links to ISIL fighters, is particularly precarious. Of some 45,000 children who were at al-Hol camp at the time of writing, including those born as a result of rape, a large number lack birth registration documents, either due to lost documents or an inability to register. This, in turn, jeopardizes their rights to a nationality, hinders family reunification processes and puts them at a higher risk of exploitation and abuse. The situation of those born in other camps is also problematic as births were never officially registered with competent authorities, resulting in lack of civil documentation and rendering children effectively stateless. Moreover, stripping parents of their nationality has negatively impacted children, including their ability to exercise basic human rights. Proposals by States to repatriate children without their mothers may also run counter to the principle of the “best interests of the child.” 78. While more than half of the population remains displaced, numerous challenges persist regarding the sustainable return of internally displaced persons and refugees, in 50 18 See A/HRC/42/51, paras. 92-93.