Violence against children is recognized by experts as a public health issue. There are widespread reports of an increase in abuse of children (and women and other vulnerable adults in the home) as a result of COVID-19 social isolation measures. Families are facing significant socio-economic stresses and children are no longer permitted in school and confined at home. Child helplines are unable to dispatch support to those who call, though some are doing their best to provide virtual psychosocial support. Children are highly vulnerable and have very little recourse to support, whether formal or informally provided.
Recent research suggests between 5 and 6 million children live in institutions, though this is a likely underestimate. A large percentage of these children are with disabilities, many immunocompromised and making them especially vulnerable to COVID-19. Long term residential care settings present particular COVID-19 risks to residents and require specific mitigation measures. Children with disabilities – whether in an institution or not – are facing a broad range of challenges with COVID-19 public health measures (social distancing, closure of caregiving agencies, maintenance of therapeutic regimes, psychosocial stresses). Some long-term residential institutions are closing and sending children to households without proper support and preparation being provided to the families. There are already known cases of many children ending up on the streets as families are unprepared or worse, unwelcoming. Finally, residential quarantine centers are being set up in some countries, presenting acute risks to children reminiscent of the Ebola crisis.
There are increasing reports of institutions, many large, being summarily shut down in response to COVID-19, with many children and families completely unprepared or supported for the placement. Kenya has issued a Government order directing these closures, which have also been anecdotally reported in Bangladesh, Russia, Rwanda, Uganda, Ukraine, and in some countries of Latin America. Foreign donors to institutions being hit by the economic crisis are also, in some cases, reported to be withdrawing funding from institutions and shutting them down. In other cases, administrators of institutions assume that foreign donations will dry up and are choosing to send children away and close their facility.
Reintegration of children is challenging and resource-intensive in the best of times – at present, these sudden placements are significantly adding to the already high stressors on families, compounding the public health issues noted above and placing the children at risk.
COVID-19 is projected to hit low resource countries hard. COVID-19 mortality will affect adults and those of older ages disproportionately. Many children will lose parents and caregivers to the pandemic. Family-based alternative care systems (kinship care, foster care, kafalah and adoption) will be strained, and some global organizations and donors will be advocating to build ‘orphanages’ to house children as was seen after the progression of the HIV epidemic.
It is critical to begin advocacy and programming efforts to determine how to address the needs of children who have been deinstitutionalized without warning, as well as to support their families. In many cases, there may be no need for a girl or boy to return to institutional care with those supports. Placing a child back into an institution after a brief period of family-based care can have serious repercussions for that child.
Refugee and asylum seeking children, and their families, are facing health and protection challenges as overcrowded camps, lack of health facilities, and exclusion from local services hit them badly, illustrated starkly in Greece. Street-connected children and children/families on the move are likely to face internment and violence as they will be seen as defying social isolation and distancing directives. Child labor may increase as a result of household confinement and the death of parents and/or caregivers. Children in prison face many of the same health risks as those in institutions and may lack access to legal supports. All children will have little to no access to health, education, nutrition, and police/interior supports. Informal community child protection mechanisms and access to kinship networks will be highly constrained by social isolation measures.
Article by Philip S Goldman, Marinus H van Ijzendoorn, and Edmund J S Sonuga-Barke on behalf of the Lancet Institutional Care Reform Commission GroupView Document