ALEPPO, Syria — What really pains journalists and photographers who visit Syria are the scenes of children in the camps and on the streets. Instead of going to school, they are selling cigarettes or handkerchiefs as the war rages around them. Many youngsters aged 9-14 have become their families’ breadwinners after losing a parent in the war.

Many of the children in Aleppo and Idlib have been out of school for three years now, without much-needed assistance. According to a 2014 report by UNICEF, around 2 million children are in need of psychological support or treatment, with 5.5 million children affected by the war, some of them stuck inside Syria and others living abroad as refugees.

Scores of children have been killed in the brutal shelling by Syrian regime forces since the start of the war in early 2011. On Nov. 30, the Syrian opposition released an estimate of 16,446 children under the age of 16 have been killed so far in the war.

Child soldiers are also being recruited by extremist organizations such as the Islamic State, though there are no official estimates of the number of recruited children.