Children in Out-of-Home Care: Lessons from the Pandemic
This article is part of a feature series exploring how the Covid-19 pandemic and the measures to prevent its spread are impacting the human rights of under-18s.
As the world continues to struggle with the Covid-19 pandemic, the situation in institutions like prisons or care homes has shown how quickly overcrowded facilities can become a breeding ground for an infectious disease. But despite regular media reports on the situation in care homes and prisons, not much attention has been drawn to children who currently reside in care facilities, children who have left, or how to help reduce the impact of this crisis on children at risk of being placed in residential institutions. What risks do they face? And how should governments be responding during – and after – this pandemic?
How did the pandemic affect the orphanages?
Children currently residing in orphanages and other institutions around the world are experiencing worsened conditions. Lockdown and social distancing measures mean that in the majority of cases the child - caregiver ratio has decreased because staff that are not living on the premises are not able to enter the institutions to avoid the spread of infection. In other cases employees simply can't come to work regularly as public transport is paralysed and parts of cities are shut down. Masks and hand sanitisers are difficult to find and it is not possible to ensure whether the children are washing their hands and maintaining hygiene properly. In these circumstances, when most orphanage staff are unable to work, the chance of neglect becomes more acute and the risk of violence and abuse is even higher.
Around the world reports have emerged of numerous residential institutions for children being closed as a result of the pandemic. Understanding that it is not possible to provide adequate care during the current crisis, many local governments have taken decisions to send children from orphanages back to their families. In Bangladesh, upon suggestion from the local authorities some orphanages have closed overnight by sending children home to their guardians “asking them to treat them well”. Cambodia stopped new admissions of children into any residential care facility and in India, children were deinstitutionalised mainly on the basis of the willingness of the child and the family, without a proper home study and a care plan and almost no follow up. In Kenya over 19,200 children were taken back to their families and communities. It is not certain who these children are, why they were in the orphanages or to who and where they have been released.
While returning children to their families and communities without proper planning, support and monitoring is dangerous, and it is of utmost importance that these transitions are carefully planned and managed, the question arises: if these children have living parents, what are they doing in orphanages? And why does it have to take a pandemic to send them back home?
Not quite orphans
Worldwide, the vast majority of children living in orphanages are not orphans - over 80% have a living parent. While it is never in the best interests of the child to live with a family where they experience any form of violence, abuse or neglect, evidence from different regions shows that many of the children will have been sent to institutions because of a lack of adequate support for families who live in poverty. This is particularly common in the case of children with disabilities for whom local support is mostly not available. Alongside poverty, discrimination on the basis of ethnicity, gender or HIV status are other factors fuelling institutionalisation.
While in economically developed European countries children are most often placed in care because of abuse and neglect, in many Eastern European countries, residential care is used as a child protection response. Often, the main reasons for removal of children can be traced to social and economic conditions in the family, such as low income or substandard housing. The European Human Rights Court case of Saviny v Ukraine, where four children were wrongly taken away from blind unemployed parents living in a house without sewage or hot water, perfectly illustrates this issue.
Orphanages are often used as a way to cope with poverty and other forms of household stress. Many rural farmers in Ethiopia, India and Guatemala take out huge loans in an attempt to produce enough of a single crop to compete with bigger farms. When the crop fails due to drought, these farmers face debts, and with no means of supporting their family, often have no other option but to place their children in orphanages. In Vietnam, rural families put their babies into orphanages during the harvest season, essentially using them as extended day-care centres.
In some countries poor families simply can’t afford children’s education. Due to the wave of privatisation of education in the last few decades in Africa, South Asia and other regions, too often the costs of sending children to school are a significant factor in a parent’s decision to place a child in institutional care. In fact, families are lured by promises of orphanages to provide an education and better life for their children which they may not be able to give themselves. In Malawi, for example, over 50% of orphanages reported directly ‘recruiting’ children by encouraging parents to place their children there.
How Covid-19 could make things worse?
Risk of more institutionalisation in the future
With experts estimating that the global total of Covid-19 deaths could eventually reach 10 to 40 million, the current pandemic will leave many children without the care of one or both parents. Furthermore, experts express concern that many children will be abandoned or separated from their families as a result of increased poverty, poor health, family stress, domestic violence, and other reasons. They fear this might cause a jump in new admissions to orphanages and inevitably lead to a resurgence of the institutionalisation of greater numbers of children. Recent history confirms this: following the war in Bosnia and Herzegovina in the mid-1990s, the number of orphanages increased by more than 300 per cent. However, studies show that economic stagnation after the conflict was the reason most of these children ended up in institutional care.
A number of countries are in the process of progressively closing orphanages and reintegrating children in their families and communities, a process known as deinstitutionalisation reform. However, the urgency of the situation caused by the Covid-19 pandemic has left many governments unprepared. Despite the international consensus that family-based care is the priority for children, the approaches have currently diverged. Firstly, pandemic-struck orphanages and other types of residential care are calling for more funding to support their efforts. Majority of orphanages in Africa and South Asia are heavily reliant on donations - from home and abroad. For example, in Zimbabwe 80 percent of orphanages were initiated by faith based groups and are receiving funding from overseas. Only 42 percent of India’s Child Care Institutions receive funds through government grants and depend heavily on donors for their daily essentials. Now that the foreign donations are drying up due to the pandemic, residential institutions need funds to take care of children remaining under their care. Although it was banned by the UN General Assembly in 2019, many still rely on orphanage volunteering and tourism which is a major drive of cash into these facilities - another source of funding to suffer due to current restrictions on the entry of visitors.
The current crisis proves that orphanages are not a sustainable option of alternative care. While it is important that children currently stuck in residential care get the best possible support, these institutions are never going to replace family-based care. By providing more aid and donations to orphanages and other types of residential care, we are not treating the root cause of the problem - helping out vulnerable families and avoiding separation. It just perpetuates the cycle of institutionalisation - because once established, orphanages are difficult to reform or replace with better forms of care. Instead, government money and donations could go to support vulnerable families and community-based alternatives which are cheaper (see: ‘A more optimistic scenario’ below).
Vulnerable children - even more vulnerable
Research has largely demonstrated that institutional care is harmful for all individuals, in particular for children, causing long-term effects on their health and psychosocial development. Even in the absence of a global threat, children with disabilities are usually overrepresented in residential care, and due to the pandemic, many of them are now facing immediate, life-threatening dangers. At least 13 children were infected with the Covid-19 in Belarusian orphanage with a total of 170 children and young adults with severe disabilities. Meanwhile in eastern Kazakhstan, the media reported that 4 children living in a state residential institution for children with disabilities have died and others have been hospitalised due to infections other than coronavirus, most likely due to neglect, as the institution has been under lockdown since early April.
The UN Special Rapporteur on the rights of persons with disabilities highlighted that due to the Covid-19 pandemic the situation of people with disabilities in institutions is particularly grave due to the high risk of contamination. Specific underlying health conditions and weak immune systems mean they are more likely to become infected with and develop severe illness as a result of Covid-19. The UN Committee on the Rights of Persons with Disabilities and disability rights advocates are now calling for ‘emergency deinstitutionalisation’ and immediate provision of housing and support in the community for children and adults with disabilities in institutions and orphanages during the Covid-19 pandemic.
Lack of guidance and scrapping the safeguards
When the Covid-19 pandemic broke out, residential care providers in many countries reported the lack of comprehensive official guidance from governments regarding preventive measures, managing symptoms or how to ensure quarantine measures inside the institutions. Since then various resources have been developed to support practitioners and government officials in their immediate response in regards to alternative care or children at risk of separation during the pandemic. Despite this, there is still concern that some of these guidelines may be misinterpreted, or worse, the government could simply use Covid-19 as a pretext to scale down on certain protections.
While the conversation is concentrated too much on provision of alternative care, other important considerations may unintentionally go to the background. During a webinar for child care practitioners an UNHCR representative in Ethiopia suggested that if parents from a refugee camp get sick with Covid-19 and there are no relatives to take care of the child, he or she will most likely be placed in an Interim Care Centre - essentially providing the ground for unnecessary family separation, which should always be the last resort. Lessons from other pandemics might not be applicable in the case of Covid-19 either. During the Ebola outbreak the aim was to separate children from sick parents as soon as possible, while during the current pandemic children and parents, including in limited settings like refugee camps, should isolate together, unless parents are severely ill and can’t take care of the child or are taken away for treatment.
Government action can also go wrong, and it is not just developing countries that are affected. In the UK, in response to Covid-19, temporary regulations relating to the alternative care were brought in without parliamentary scrutiny, taking away most significant safeguards from children without parental care. Social workers visits to children in care can now be conducted by phone or video call “as soon as reasonably is practicable” instead of every six weeks. Suitability of foster carers can be assessed in the absence of health information and criminal records checks and adult care-givers working in children’s homes do not need to be qualified for the time being. The changes to 10 sets of regulations can be extended, with no upper time-limit. In fact, four years ago, the Government tried unsuccessfully to grant local authorities the power to opt out of their children’s social care duties – the move which was widely and strongly opposed by parliamentarians, social workers, children’s lawyers and charities back then. NGOs are pointing out that Covid-19 pandemic is just an excuse to these ‘temporary’ changes and are calling for a wider scrutiny and a withdrawal of the emergency measures.
A more optimistic scenario
An opportunity to prioritise family-based care
While some governments are using the circumstances of the pandemic to silently pass emergency legislation compromising human rights, perhaps this time should be used as a unique opportunity to change things for the better. Authorities could help to close institutions properly and support the transition to family-based and community-based programmes and services for children, including those who find themselves orphaned or homeless after the pandemic.
There is a wide consensus at the UN that institutional care is not compatible with a human rights approach. In 2017 The Committee on the Rights of Persons with Disabilities stated that the size of children’s homes does not matter - it is the institutional nature of care that is the issue, and should be abolished. A small, clean and safe care home is still an institution which does not give an opportunity to children to establish long-term emotional bonds with a significant adult. In 2019 the UN General Assembly in its resolution recognised the critical need to invest to keep families together and urged member states to direct budgets towards supporting families and tackle the issues that cause them to be vulnerable in the first place. Where that’s not possible, the governments should commit to provide high-quality, family and community-based alternative care for children.
While community-based alternatives are cheaper than institutional care in the long run, additional costs arise during the phase of transformation, therefore such reform often requires significant political will. However the current pandemic has actually made some governments to either take the first steps or expedite the ongoing reform. For example, the Bulgarian government included additional funding of BGN 20 million (approximately 10 million euros) for municipalities to expand their social support services and cover more vulnerable beneficiaries, including children with disabilities. The Ukrainian government plans to increase the number of social workers across the country from 3,000 to around 11,000 in order to help vulnerable families cope during the pandemic.
Proper support should be provided to those offering family-based care to children released from orphanages at the start of the pandemic in order to avoid institutionalisation. In India, experts are suggesting the goal is for children to remain in their placement after the lockdown ends, if possible, or move to other family placement such as kinship or foster care as appropriate. That means completing the paperwork/procedures for placement, and avoiding readmission to child care institutions (CCI) after lockdown ends. Others are calling to find family members of children orphaned or stranded as a result of the virus before considering moving children to a CCI.
Experts agree that children can be best served through family reintegration, adoption, kinship care, foster care, kafalah, and other family-based care models (not forgetting that families themselves may take different and diverse forms, including married and unmarried parents, single parents, same sex parents and others). Furthermore, evidence shows that new placements in institutional care and new residential facilities are not required, including in crisis and emergency response - where resources are properly invested in prevention, family strengthening and alternative care.
Kinship care, provided by relatives or friends of the family, is the most widely used form of out-of-home care globally for children who are unable to live with their parents. It was a crucial protection and survival strategy for children during Ebola outbreaks in West Africa. Many children were sent to live with relatives both after their parents had died, and as part of preventative strategies to remove them from highly affected regions. Despite predictions that communities would collapse under the strain of crisis, families and wider groups showed remarkable resilience and absorbed most children in need of care.
However, kinship families are often extremely poor and receive minimum to no support. Due to vulnerability of older people to Covid-19, some grandparents might not be able to care for their grandchildren. Children living with aunts, uncles and older siblings, however, are more likely to be discriminated against, and those cared for by more distant relatives or friends of the family are generally seen to be particularly at risk. Evidence suggests that discrimination worsens when resources are scarce, therefore it is essential that extended families and communities are properly supported during this time of global crisis.
National cash transfer programmes have been shown to benefit the poorest children in many countries, and can help preserve families and support relatives caring for children. Between 2015 and 2017, emergency cash transfers provided by USAID in Sierra Leone reached approximately 360,000 vulnerable people during and in the aftermath of the Ebola epidemic. They rebuilt livelihoods of families facing extreme poverty and helped them during economic stagnation caused by the epidemic. Cash transfers, as a form of emergency social protection allowing to buy basic necessities, food and cover healthcare bills, were earlier used to support vulnerable families in AIDS-affected countries with positive consequences not only for people living with HIV but also their children, broader families and communities.
Monitoring human rights
The breakout of the Covid-19 pandemic meant that in order to adhere to quarantine and isolation measures, social services supervising alternative care arrangements had to adapt, generally resorting to online or phone calls instead of visits. However, as we have seen with the UK case, limiting or removing vital safeguards such as monitoring visits puts children at grave risk. It is fair to say that some abuse or neglect cases in family-based care or community care can go uncovered for years - meaning every child in care without a proper monitoring procedure is now at risk. However it is even more challenging to uncover abuse and neglect in orphanages, institutions and residential care due to their closed nature and lack of access to complaint mechanisms. Many orphanages worldwide are not even registered officially (in Haiti 85% of orphanages are unregistered and unmonitored, and in Ghana 140 of the 148 orphanages around the country are unlicensed) making them essentially invisible. More than ever the governments now need to guarantee that measures taken to prevent human rights violations of children who remain in residential care during the pandemic from taking place.
If children suffer from violence and neglect in both public and private institutions or in the community, do they have access to independent complaints mechanisms or lawyers? Emergency helplines are rarely accessible for those in residential care, especially if you’re a child with a disability. Complaining to staff is often not effective either - some can complain for years and nothing happens, or worse - you can get punished. Even if their voices make it outside, stereotypes that children in care are ‘problematic’ mean that their accounts may be considered unreliable - evidence of abuse provided by children is too often disregarded by law enforcement bodies.
Monitoring of institutions is an international obligation for States who have ratified the Convention on the Rights of the Child, and is essential in detecting and thereafter investigating and prosecuting individual instances of human rights abuses. Independent monitoring has proved the most effective mechanism so far to uncover and bring justice to victims of violence, abuse and neglect in orphanages - most cases in Eastern Europe to have reached the European Court of Human Rights or national courts have actually emerged after the independent monitoring.
Because of the emergency situation with pandemic when physical monitoring is not possible, some organisations are getting creative. Last week, a coalition of disability rights organisations launched a major international monitoring initiative entitled “Covid-19 Disability Rights Monitor” to conduct rapid independent monitoring of state measures concerning persons with disabilities.
However, not just people with disabilities, but everyone, including children living in residential care, should be benefiting from a similar tool at the moment. State monitoring agencies, their sub-contracts, and too often even ombudspersons, are usually poorly trained and lack the knowledge of rights based approach. Independent monitoring based on human rights goes beyond health or quality of care or other formal inspection regimes and is crucial more than ever before, because statistics show that in confinement, at home or in an institution, violence and discrimination cases soar through the roof. Such monitoring should be regular, more widely accepted and whoever conducts monitoring visits should be trained in international human rights standards. If this wasn't the case before pandemic, then it definitely should be the case now.
Furthermore, it is important that the harm caused to children from abuse and neglect in alternative care during the times of Covid-19 is not written off. Monitoring is just the first step to securing justice for children for violations they suffered in care. A lot of international child protection organisations involved in deinstitutionalisation reform are very much focused on prevention of violence, and these are good intentions - but what do we do with those cases where things didn’t quite go according to plan? Using better prevention measures next time is, frankly, not enough - that’s why a deeper focus is needed on access to justice and redress. Evidence shows how incredibly difficult it is for children to use legal mechanisms: from lack of legal capacity, to the time limitations to bring a legal challenge. It is much more challenging for children to access justice when their rights are violated as a result of their placement in an institution because their guardian - is the perpetrator of the crime. Thus it is unsurprising that only the most grave cases of human rights violations in care institutions make it to the very end (see Campeanu v. Romania). It is also a reason why there have been so many movements led by care leavers worldwide demanding redress for harms they suffered while growing up in care (see an example from Australia).
The principle of access to justice should be at the core of guaranteeing these children their rights. We must ensure that those children who remain in care during the pandemic and those who have left, but never got justice, have accessible legal and quasi-legal complaints mechanisms to provide remedy for the violations they have suffered.
A call to action
More than ever now is the time to fundamentally rethink how to support vulnerable children, families and communities. The current public health crisis is a brutal reminder that residential care for children is not only a dated concept, but a dangerous one. The pandemic could easily result in unintentional readmission of children to orphanages and further institutionalisation. This is why human rights advocates have been calling for “emergency deinstitutionalisation” and immediate provision of housing and support in the community for children and adults with disabilities living in institutions. But it could be a powerful response to the current crisis applied to all children stuck in orphanages, because institutions can never – and should never try to – replace family-based care.
What will the pandemic teach us? Not to lose focus. By focusing on consequences we are not addressing the root causes of the problem. Temporary solutions can quickly become permanent solutions. Let’s adhere to international human rights standards.