The young have rights too / by John Bland

Lifestyles and health The young have rights too inderella - persE?CUted and re- duced to a drudge by her step- sisters; Charles Dickens' Oliver Twist suffering tribulations in the or- phanage ; or Dickens again , describ- ing Dotheboys Hall , the monstrous school run by Wackford Squeers in Nicholas Nickleby : folktales and literature show us that child abuse has always been one ugly facet of human society. In recent decades, more attention has been focused on the problem than ever before . Nevertheless, the Conference on Bat- tered Children and Child Abuse held last December in Berne, the Swiss capital, was described as the first- ever examination of child abuse on a global level. Convened jointly by W HO and CIOMS, the Council for International Organiza- tions of Medical Sciences, the meet- ing brought together over 1 00 medi- cal , child-care and legal specialists from 30 countries . In a keynote ad- dress, Professor lhsan Dogramaci , Executive Director of the International Paediatrics Association in Paris, said : "Unfortunately, data on child abuse are sparse. I believe only 40 countries regularly compile information on this topic, and among those I understand there are many variations in reporting systems and quality of data . Perhaps it is some indication of how important a problem child abuse is, however, that in 1980 it was conservatively estimated that over 1 00 babies were battered to death in the United King- dom by those primarily responsible for them . Another estimated 8,000 children suffered what were cal led non-accidental injuries . "I am sure that, were equivalent data available from other countries, then we would see that the problem is not limited to the United Kingdom but rather that it is an extended prob- lem that crosses all socio-economic 10 by John Bland and cultural demarcations. Indeed, child abuse, including child neglect, exploitation of children and mistreat- ment of children crosses all national boundaries ." Initially the conference spent con- siderable time on a not entirely suc- cessful attempt to define child abuse. All agreed that it ranged from "bat- tered babies" to sexual abuse or Assaults on children occur at all ages. How can socie ty protect youngsters who accept a regular beating as part of everyday life 7 Photo Keystone © exploitation in prostitution and por- nography, to employment of young- sters in hard or dangerous jobs, and to subjection to psychological stress - which in turn might embrace alcohol- ism in the family or the hazards of modern warfare . But abuse might also include kidnapping by one parent, harmful traditional practices like child marriage or a bias in favour of boys to the detriment of girls, or the simple denial of affection . The participants did agree that there was an urgent need to teach physicians and other health workers, schoolteachers, policemen, social workers and the public at large how to recognise the symptoms of regular and systematic child battering or abuse. In the industrialised world, there may be a lower incidence of intellec- tual and nutritional deprivation, and there are usually strict controls on exploitative child labour. But urban stresses and social disruption - espe- cially the breakdown of the family unit - appear to foster a greater degree of intra-family violence than in the developing world . On the other hand, child labour, child prostitution and vagrancy seem to be much more prevalent, and more socially accepted, in the Third World. As Professor D.S. Obikeze, of the University of Nigeria, Nsukka-Anam- bra State, Nigeria, expressed it : "Whenever there is scarcity, children as a voiceless minority group are among the first to suffer maltreat- ment, denials and deprivations." He also singled out for mention child marriage (sometimes below the age of ten), child fostering with distant relatives or even complete strangers, and child pawning - giving a child out as security for money borrowed or services rendered . Significantly, a 1982 United Nations report estimated the global number of child labourers, aged between 10 and 14, at 145 million . Dr Richard D. Krugman, of the C. Henry Kempe National Center, Uni- versity of Colorado Medical School, Denver, USA said that between 2,000 and 5,000 children in the United States alone die each year from child abuse. But the numbers of severe W ORLD HEALTH, July 1986 cases of physical abuse had been reduced thanks to laws requiring doc- tors to report suspected cases to enforcement officials. "We are see- ing fewer severely battered children," he commented. But he added that the US in the past decade had seen a 576 per cent increase in reported cases of sexual abuse, partly because "we look for it more, and we find it." The address by Dr Amal Shamma', of the Berbir Medical Centre in Beirut. Lebanon, on the effects of war on children is summed up elsewhere in this issue of World Health. What can be done to resolve the problem? Certainly the two sponsors of the meeting are well-placed to tackle it: WHO with its 166 member states, and CIOMS-established jointly by WHO and UNESCO in 1949-now with a membership of 64 international and 26 national organizations, thus representing a substantial propor- tion of the biomedical scientific community. Mr John Bland is the Editor of World Health magazine. The participants recommended that there should be far greater coordina- tion and a more systematic exchange of information on the subject of child abuse. In turn this will call for focal points to be identified in each country - preferably in government-to pro- mote and protect children's rights, needs and Interests . This focal point should gather information, assess the magnitude of the problem, suggest approaches to primary prevention and identify the roles of the concerned individuals and bodies . Some speak- ers referred to this person as a Chil- dren's Ombudsman. Above all, it will be vital to increase the awareness of both health profes- sionals and the general public . WHO was invited to establish a team or task force capable of responding to re- quests for technical cooperation from countries wishing to develop new policies for combating child abuse and neglect. The conference further recom- mended a five-year action plan to "draw the attention on all levels of society to the magnitude globally of a problem that has been with us for WoRLD HEALTH, July 1986 centuries." Participants felt that lack of public awareness was probably the greatest obstacle; television, radio and the print media should play a greater educational role in respect of all concerned-and that included both abused and abusing. One of the working groups formed during the Berne conference acknow- ledged that many organizations have already accumulated experiences and perfected approaches to the problem. But they went on : ''What has been lacking, with the exception of a few countries and limited international ef- forts, is to pull together these experi- ences, subjecting them to an analytic Persistent ill-treatment or neglect on the part of adults w ill damage a child for a lifetime. Photo Keystone © review in order that they may be more widely disseminated and adapted in other settings . What also appears to be lacking are comprehensive national strategies and a coordinated global effort to provide technical and moral support for the national efforts ." So much for the words. Now the time is ripe for action to be taken in defence of the world's Cinderellas and Oliver Twists. • 11