By Afshan Khan, UNICEF Regional Director for Europe and Central Asia
Alex* spent the first 10 months of his life in a residential institution in Bucharest, Romania with 200 other young children. Paid staff would feed Alex with a bottle, and he was seldom held.
At 10 months Alex weighed six kilos, well below the healthy weight for a baby his age. He couldn’t sit and could barely hold up his own head.
I met Alex during a recent trip to Romania. He’s now a tall, well-spoken 16 year-old who likes comic books, drawing and animals. After he completes secondary school, he plans to attend Bucharest’s Academy of Economic Studies.
What was behind the turnaround? At 10 months, Alex ended up in a supportive and loving foster family.
“If well looked after, children show a difference in about six months,” Alex’s foster mother Michaela told me at their small home on the outskirts of Bucharest. “After they receive care and affection, they change. You see it in their eyes and on their faces.”
In the 1990s, thousands of children like Alex were found languishing in institutions across Romania. We saw horrifying images of children wasting away and chained to their cribs, broadcast around the world.
Earlier this year, images of severely neglected children and young people in institutions – first in Belarus and then Hungary – once again shocked the world, with a stark reminder that too many children are still being denied their basic right to a family environment. More recently, media attention has focused on Ukraine, where tens of thousands of children are still in institutional care.
UNICEF estimates that at least 2.7 million children live in residential facilities worldwide. But this is most likely an underestimate, as many children in residential care are invisible. Too often official records only capture a fraction of the children living in residential care. Children in privately owned centres are often not counted or monitored, making these girls and boys extremely vulnerable to neglect, abuse, violence and exploitation.
Central and Eastern Europe and Central Asia is the region with the highest rate of children in residential care – with over five times the global average.
The most vulnerable children, especially children living with disabilities, are overrepresented in large institutions. UNICEF estimates at least half of all children living in public residential care in Central and Eastern Europe and Central Asia are children with some form of disability, in some countries children with disabilities account for 70 percent of children in care.
The negative consequences of institutional care on a child cannot be overstated. The lack of personal care and love severely damages a child’s interpersonal and cognitive development, as well as her ability to form healthy relationships in life.
Simply closing institutions is not the solution. Reforms are needed across multiple sectors including health care and education so that the rights of all children are fully respected, and the cycle of institutionalization is broken.
The ‘medical model’ of disability remains a deeply rooted belief in many countries in the region. Societies deem families and caregivers incapable of taking care of children who need special support. For many, a large institution is still an acceptable, and even ideal, place for a vulnerable child.
Information campaigns at national and community levels are needed to address these widespread misconceptions, stigma and discrimination that exist towards the most vulnerable, especially children with disabilities.
Governments must invest in community support programmes and inclusive education. Ensuring children with disabilities are included in mainstream schools and pre-schools is the bedrock of any national effort to end institutionalization.
Parenting programmes can help caregivers provide specialized support on their own, day care facilities allow single parents to work without putting children at risk of separation, and cash assistance helps families living in poverty stay together.
Respite care, which provides periodic support by trained health care providers, is needed to support parents and caregivers of children with disabilities. Properly trained medical staff, social workers and psychologists can help prevent baby abandonment, particularly among young mothers or mothers in crisis and direct them to where they can receive support.
For children who cannot remain with their families, alternative care options such as foster care and small group homes that are integrated into the community are the next best option.
These support services which help prevent children with disabilities from being abandoned also provide a foundation for children to be transitioned out of institutions and back to their biological families, or into community care settings – similar to Alex’s experience growing up with his foster family.
Decades after the exposure of conditions in Romanian institutions caused global outrage, Alex and his foster mother are proof that societies can change. The time has come to give millions of children who remain in residential institutions a fair chance in life.
*Name changed to protect child’s identity.
Afshan Khan is UNICEF’s Regional Director for Europe and Central Asia, and the Special Coordinator for the Refugee and Migrant Crisis in Europe. You can follow her on Twitter at @AfshanKhan_
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