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N Engl J Med. Protecting the Children of Haiti
Protecting the Children of Haiti (N Engl J Med., extract, edited)
Published at www.nejm.org February 17, 2010 (10.1056/NEJMp1001820)
Protecting the Children of Haiti
Satchit Balsari, M.D., M.P.H., Jay Lemery, M.D., Timothy P. Williams, M.S.W., M.Sc., and Brett D. Nelson, M.D., M.P.H., D.T.M.&H. T
Haiti has long had difficulty in protecting its children from harm. The earthquake that struck the country on January 12 destroyed much of the capital, Port-au-Prince, as it killed many government officials and United Nations (UN) workers and left as many as 230,000 people dead and many thousands injured. In the wake of this sweeping disaster, the plight of Haiti's children has acquired new and terrible dimensions.
On January 24, we went to Haiti as members of a team sent by the Fran?ois-Xavier Bagnoud Center for Health and Human Rights at Harvard University to conduct a multisite rapid assessment of child-protection needs in the post-earthquake environment, where it was already evident that children were at grave risk of abandonment, abuse, and trafficking. The focus was on the current systems and practices for identifying and caring for unaccompanied children and for tracing those who had been separated from their families and reuniting them with parents or guardians. Longer-term interventions to promote the welfare, rights, and safety of this population were also examined.
In 9 days, we interviewed more than 25 stakeholders in Haiti, including government officials, local staff members, humanitarian aid workers, and representatives of domestic and international nongovernmental organizations and UN agencies. We visited field hospitals, clinics, shelters, and orphanages, along with observing risk-assessment practices and participating in meetings of UN "clusters" (groups focused on individual service sectors).
Children constitute almost half of Haiti's population of 9 million. Before the earthquake, an estimated 350,000 children lived in "orphanages," yet only 50,000 of them had no living parents.1 Desperately poor families have often felt compelled to place children in residential care facilities, only to return later and find that they have been given away for adoption. Throughout the world, many families have historically relinquished their children when they reached a tipping point due to unmanageable birth rates; parental death, disability, or unemployment; physical insecurity; displacement; or natural disasters.2 In pre-earthquake Haiti, many families had already reached such a crisis.
Local officials estimate that there are about 350 registered orphanages in the country and about twice as many unregistered and unregulated ones. Even most registered institutions do not meet international UN guidelines. A related long-standing threat to child protection has been the common practice of sending children away as restav?ks (Creole for "stay with") to live with others in exchange for work. An estimated 150,000 to 500,000 restav?ks work essentially as unpaid domestic laborers, with little or no access to education or recreation and subject to physical, mental, and sexual abuse.3 The restav?k situation and the practice of institutionalizing children reflect the extreme destitution of Haitian families. Thus, the earthquake occurred against a background of economic extremity driving family separation, aggressive trafficking networks, inadequate law enforcement, and a growing global demand for adoptive children.
(...)
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<cite cite="http://content.nejm.org/cgi/content/full/NEJMp1001820?query=TOC">NEJM -- Protecting the Children of Haiti</cite>
Protecting the Children of Haiti
Satchit Balsari, M.D., M.P.H., Jay Lemery, M.D., Timothy P. Williams, M.S.W., M.Sc., and Brett D. Nelson, M.D., M.P.H., D.T.M.&H. T
Haiti has long had difficulty in protecting its children from harm. The earthquake that struck the country on January 12 destroyed much of the capital, Port-au-Prince, as it killed many government officials and United Nations (UN) workers and left as many as 230,000 people dead and many thousands injured. In the wake of this sweeping disaster, the plight of Haiti's children has acquired new and terrible dimensions.
On January 24, we went to Haiti as members of a team sent by the Fran?ois-Xavier Bagnoud Center for Health and Human Rights at Harvard University to conduct a multisite rapid assessment of child-protection needs in the post-earthquake environment, where it was already evident that children were at grave risk of abandonment, abuse, and trafficking. The focus was on the current systems and practices for identifying and caring for unaccompanied children and for tracing those who had been separated from their families and reuniting them with parents or guardians. Longer-term interventions to promote the welfare, rights, and safety of this population were also examined.
In 9 days, we interviewed more than 25 stakeholders in Haiti, including government officials, local staff members, humanitarian aid workers, and representatives of domestic and international nongovernmental organizations and UN agencies. We visited field hospitals, clinics, shelters, and orphanages, along with observing risk-assessment practices and participating in meetings of UN "clusters" (groups focused on individual service sectors).
Children constitute almost half of Haiti's population of 9 million. Before the earthquake, an estimated 350,000 children lived in "orphanages," yet only 50,000 of them had no living parents.1 Desperately poor families have often felt compelled to place children in residential care facilities, only to return later and find that they have been given away for adoption. Throughout the world, many families have historically relinquished their children when they reached a tipping point due to unmanageable birth rates; parental death, disability, or unemployment; physical insecurity; displacement; or natural disasters.2 In pre-earthquake Haiti, many families had already reached such a crisis.
Local officials estimate that there are about 350 registered orphanages in the country and about twice as many unregistered and unregulated ones. Even most registered institutions do not meet international UN guidelines. A related long-standing threat to child protection has been the common practice of sending children away as restav?ks (Creole for "stay with") to live with others in exchange for work. An estimated 150,000 to 500,000 restav?ks work essentially as unpaid domestic laborers, with little or no access to education or recreation and subject to physical, mental, and sexual abuse.3 The restav?k situation and the practice of institutionalizing children reflect the extreme destitution of Haitian families. Thus, the earthquake occurred against a background of economic extremity driving family separation, aggressive trafficking networks, inadequate law enforcement, and a growing global demand for adoptive children.
(...)
[For Free Full Document, follow the link below]