PATTANI: Mentally scarred and afraid to set foot outside his home in Thailand's deep south, Ahmad is one of thousands of children orphaned by a war largely forgotten by the rest of the world.

After years living with the menace of bombs, shootings and curfews, many youngsters in Thailand's insurgency-wracked deep south are exhibiting high levels of stress and trauma.

“When I do go out I stay near my home... I never go far away,” Ahmad, 12, said as he chewed timidly on the collar of his football shirt.

His 15-year-old sister Sunnah said their father's murder by unknown gunmen six years ago marked the end of her childhood and left the siblings, whose names AFP has changed to protect their identity, without parents following the death of their mother in an accident. They now live with an aunt.

“I don't feel safe, especially with strangers,” she said. “I suspect people when they look at me. The soldiers are the worst.”Anger, introversion and fear are common symptoms of depression or post traumatic stress disorder (PTSD), said government mental health expert Pechdau Tohmeena, explaining children are bearing the brunt of the eight-year conflict.

“Fear is the number one issue. Some kids have seen their parents shot in front of them, their family shops burned, relatives beaten or tortured,” she explained at a clinic in Pattani, a city at the heart of the insurgency.

“They hear rumours about the violence. They see helicopters flying overhead with their guns pointing down on them. It's hard to live as a target every day.”More than 5,300 people have died in the region since 2004 in bombings, killings, including beheadings, and shootings by insurgents, as well as military raids targeting suspected militants.

Nearly 60 of the dead have been aged 15 or younger, while hundreds more youngsters have been injured, according to conflict monitor Deep South Watch, the majority caught in crossfire.

On October 31, an 11-year-old boy joined that toll, when he was gunned down in an ambush with his father, in an attack that also left his nine-year-old brother in a critical condition in a district of Yala, one of three southern provinces that have been under a state of emergency since 2005.

It was a bleak reminder of the gauntlet faced by children every day in a region where militants, who are seeking greater autonomy, target civilians and security forces alike.

The number of orphans in the region is a growing concern, with a study by local non-governmental organisation the Pattani Juvenile Observation and Protection Center putting the number at more than 5,000.

Other child welfare groups estimate the figure is two or even three times higher.

While there is little comprehensive research on the mental health effects of the conflict, the available statistics are alarming and experts say they are getting worse.

Nearly 22 per cent of 11 to 18-year-olds had PTSD symptoms, which is believed to be more than double the national average, according to a 2010 study of 3,000 children across Thailand's three southernmost provinces.

Just under 40 per cent showed signs of emotional or behavioural problems including anxiety, loss of confidence, poor attention spans, fear and aggression.

“Some of these kids have grown up only with violence,” said Panpimol Wipulakorn of the Rajanukul Institute, a government mental health agency, who led the survey.

“Some primary school kids even told us what they most need to improve their lives is a gun, that is not the normal response of a school child.” Even school does not provide a sanctuary, with militants deeming government-run institutions legitimate targets.

More than 150 teachers have been killed by insurgents and hundreds of schools have been torched over the past eight years.

The situation is so severe that all 321 schools in Pattani province closed temporarily from November 27 to press for greater protection from the attacks.

“Conflict situations are detrimental to child development,” said Andrew Morris of the United Nations Children's Fund, “and the longer that conflict carries on the bigger the impact will be.”

The stress of childhood in a war zone plays out in later years, with teenagers experiencing high rates of drug and alcohol use, according to experts.

There are some positive signs that mental health is creeping up the agenda.

Eight years ago, when the insurgency started, there was just one government psychiatrist for the entire three southern provinces, now there are 40.

But as violence rages, there are mounting fears that an angry and emotionally damaged new generation will enter the insurgency, a possibility that has not escaped the attention of the government or the militants.

“Both sides want them... and if these kids continue to grow up in conflict, the threat is that in 10 or 20 years there still won't be peace here,” said Pechdau.