Anniversaries

When you’re a kid you measure anniversaries not as anniversaries. My kids measure major milestones in months.  I remember being a teenager measuring the first flush of love by my “six month anniversary”. Yes, I rely on maths every day to do my job. Don’t be worried.

This last week saw a grim and genuine anniversary. It was the third anniversary of the conflict in Syria and once again children are major victims of the folly of their elders. This conflict often slips from the forefront of Australian media coverage. It’s become a grim but distant reality of a world removed. Anniversaries require commemoration though, right?

Australia is so removed from the reality of hardship that we debate whether a football coach suspended on full pay while somewhere in the middle of a drugs in sport issue is being ‘persecuted’. Our debate on kids’ exploitation reaches depths such as whether monetising a 2 year old’s Instagram account is harmless or perverse. Maybe it’s time to take stock of what is happening beyond our borders and consider debating something of more import than which obnoxious home cooking team sauces their steak better. Human rights are supposed to be something we insist on everywhere, not just in our neighbourhood.

Overwhelmed by Numbers

There’s no shortage of information out there. More than a million kids in Syria are reported to be almost beyond the reach of aid groups or under siege, with 5.5 million kids swept in the conflict. At least 10,000 children are thought to have been killed. 1.2 million kids have become refugees. That number quadrupled in the last year. Will Australians speak up for those kids?

If not those kids, what about those in South Sudan where 3.75 million kids are affected? More than 1 in 10 kids will die before the age of 5 in South Sudan. Maternal mortality is the highest in the world and MSF reports that hospitals are under attack. Will Australians speak up for those kids, I wonder?

Or the Central African Republic where reports continue of children being not only a target, but mutilated (and a warning, even by these standards that link is tough reading). There are up to 6000 child soldiers in the same country. Children being exposed to such atrocities is all the more wrenching because we know that their eyes should be filled with wide-eyed innocence, not horrors we struggle to imagine.

Most of us in developed countries owe our good fortune not just to our intrinsic qualities, but a good deal of providence in how our cards were marked. There is no humanity in denying a need to engage with the bigger issue of protecting the rights of children. My humanity is no way enhanced by neglecting the needs of those in distress. To avoid all efforts is to deny those individuals any safe future.

Kids should just have time for stuff like this. [via Twitter thanks to @GrrlScientist, @PaoloViscardi and @_Crepusculum_]

Kids should just have time for stuff like this. [via Twitter thanks to @GrrlScientist, @PaoloViscardi and @_Crepusculum_]

Encouragingly, in its position in the UN Security Council, Australia is trying to engage with some of these bigger problems. Only recently Mr Gary Quinlan spoke on related issues at the UN Security Council. Perhaps this engagement is the start of broader engagement with the ill effects on children when we expose them to things never meant for them (or anyone really).

Case Studies in Harm

We know all too well the effects on children of being surrounded by the distress of the desperate. Take the case of S.B. [reference below] – over 11 months this 5 year old boy “was exposed to riots, self-harm, suicidal behaviour and violence. He became progressively more withdrawn and anxious, had nightmares, and started bedwetting.” It didn’t stop there.

“He witnessed a significant suicide attempt and became progressively more withdrawn and mute. His condition deteriorated to the point that he refused to eat or drink, and he was admitted to hospital on several occasions for dehydration.”  There’s more description in the paper, but it ends with the following: “Now 12 years of age, S.B. remains under psychiatric care and has on-going features of post-traumatic stress disorder, depression, and adjustment difficulties.” Even some 7 years later (at the time of the article), this looks like a future blighted. That’s just one story.

Close to Home

The thing about S.B.’s case is that is not a description of the effects of being in Syria, or South Sudan, or any other distant shell of a country. S.B. was a child in detention in Australia described in the 2004 Human Rights and Equal Opportunities Commission report. While this case is over 10 years ago, there is no reason I can think of to believe such conditions are not faced by child refugees suffering from the acts of adults in detention in Australian authorised facilities now.

This is not over there. It is not a discussion for a history class mired in the ‘culture wars’. It is something to grapple with now. It is too easy to dismiss the need to speak up for children when it seems like such a big problem on some crackpot continent that we assume is condemned to chaos. Maybe Australians will start to really pay attention if we remember that the rights of children are something we are responsible for right here.

This is perhaps part of the message from this video produced by Save the Children. Kids everywhere want and deserve pretty much the same thing. It’s not what they’re suffering in all those spots in Africa. It’s not what we’re offering refugee children either.

Getting Engaged

Figuring out where to start is a struggle, but as stated previously here and here if you have a role in arguing for the health and wellbeing of children, you have to get into it somehow. There is a lot of grey out there as to which organisations are most effective and how best to raise your voice. There are sometimes questions as to whether aid groups are themselves compromised by the way they do business.

If you’re in Australia though you may be in a position to contribute to the Australian Human Rights Commission National Inquiry into Children in Immigration. Or you may choose to look overseas and support UNICEF or MSF. Or maybe it is as simple as trying to encourage personal contact with refugee stories as described here.

What is all too clear is that it’s not just a story for page 12 of the paper (or the 28th link on the web browser). It’s a story that is happening right here. If adults can’t agree on the need to speak up for kids then would we ever speak up for anything?

Note:

The case study included in this post is described in more detail in this paper:

Newman LK, Dudley M and Steel Z. Asylum, Detention and Mental Health in Australia. Refugee Survey Quarterly 2008;27:110-27.

A hat-tip also to @Colvinius who first shared the Save the Children video (at least in my timeline).

Protecting Kids

Working in a kids hospital is mostly joyful. Obviously it is sometimes sad. Then every now and then it is deeply distressing. While meeting families dealing with terrible illness and sometimes death very much features, the worst cases I recall have been those where children have been victims of some form of abuse. Whether through neglect, some form of inflicted harm or non-accidental injury these are the cases that send the teams retreating into silence.

New News of Old Deeds

In Australia at the moment, details emerge daily of horrifying child abuse within institutions stretching back decades as part of a Royal Commission into Institutional Responses into Child Sexual Abuse. Recently, cases involving homes run by The Salvation Army have been receiving coverage. Previously the Catholic and Anglican churches have been under the spotlight. More institutions will follow.

The stories of abuse revealed would shake most people. What is equally shocking is the response of the institutions involved at all points in the timeline when evidence of abuse emerged. The motifs emerging have become all too common. The most vulnerable targeted by those in whom no trust should have been placed. Evidence emerging but the focus being on support for the perpetrator who is moved on or protected from prosecution. Stories have even emerged of other people in positions to help, including the police, returning children to homes they’d managed to escape.

3 Wise copy

This poster was actually for those working on the Manhattan project [and stumbled on via wikipedia]

This spreads the taint far further than those few bad apples. The temptation, now that the various institutions are seeking to make the effusive apologies and payouts so clearly warranted, is to believe that this Royal Commission will allow a resolution of old stories so that everyone can finally move on. The hope seems to be that we are dealing only with a chapter of history, and we are taking the final steps to display that past behind glass cases in a museum.

The Here and Now

The stories emerging date back as far as the 1950s. Clearly times were different. It’s easy to think that people didn’t speak up at the time because that’s not how society worked.  Those of us who weren’t around have to use whatever available cultural touchstones we have to understand those times. Viewed through the haze of ‘Happy Days’ reruns or the lauded reconstruction of ‘Mad Men’, maybe it’s easy to assume it all arose from a different set of values.

However, we’re speaking of times over the ensuing decades too. This is a time well within the lifespan of my parents. Pondering that makes me wonder if values really have shifted so drastically. These cases of abuse happened within institutions that clearly harboured some disturbed individuals. They also counted in their number many people doing lots of good, and yet many of those people didn’t speak up. Would the shift in attitudes that has happened be enough to protect children now?

Actions and Words

When I look at the system I work in, the intent to protect is clearly there. As a health practitioner in NSW, there is  guidance available as to how to go about reporting any concerns of harm in children and I’ve been trained appropriately. The problem is recognised, spoken about and a framework is well and truly in place. The talk is all there.

I’ve actually had occasion to report a couple of cases. The reporting side is fairly straight forward and the system that is in place should ensure that cases are unlikely to be swept to a dark corner without concerns being raised. These are good steps to preventing future institutional abuse. Our problem locally seems to be that we haven’t set up a system that allows for action to be taken.

Early last year, an excellent (but sobering) series from Lisa Pryor illuminated all too clearly a system that cannot act through an overwhelming lack of resources. When working in medicine outside the hospital, we define a disaster as pretty much any situation where the number of casualties you have to deal with exceeds your available resources. That story covered in the link meets that definition many times over.

The benefits of intervening to remove children from risk are not disputed. The long term effects on individuals exposed to abuse are well known. The evidence is there that we are not providing the necessary resources to those prepared to take on this gruelling job and I don’t see much of an outcry. I’m struggling with why we don’t make the link between the horrors emerging in the Commission and the need to complete the construction of a system that can meaningfully prevent history repeating.

The staff of DOCS are seeing stories like this every day. We’re also hearing stories from staff in detention centres of significant concerns that treatment of children in those situations amounts to abuse (there’s more on that here). Staff there are already flagging the Royal Commission they expect to come. Is a system that can see and hear the evil but not act really learning the lessons from those old institutions?

Without the ability to act on concerns, without the capability to step in to stop things happening where a flag is waving, have we really done enough to prevent more stories emerging?