Doc. 9692

5 March 2003

Improving the lot of abandoned children in institutions

Report

Social, Health and Family Affairs Committee

Rapporteur: Mr Hancock, United Kingdom, LDR

Summary

The most urgent need for children abandoned in institutions is to get them out of those institutions. That is the top priority!

Each State concerned is invited to prepare and publish a map of children’s institutions which must be closed down, for example because they are too big, isolated or run down. A pro-active policy of removing children from institutions has to be adopted; family ties have to be restored and alternatives to placement in institutions promoted.

Children living in institutions have the same rights as all children; at national level defenders of children (eg. Ombudsman) have to be appointed in order for children’s voices to be heard. The various Council of Europe bodies responsible for monitoring the honouring of commitments entered into by States joining the Council of Europe are invited to take account of the rights of children and to consider a policy of de-institutionalisation as an obligation to be fulfilled.

I       Draft recommendation

1.       The Assembly would draw attention to the fact that the UN Convention on the Rights of the Child, the landmark text on child protection, recognises that children are entitled to grow up in a family environment; they should therefore only be placed in institutions as a last resort, where absolutely necessary. In some countries, which are now Council of Europe member states, abandoning children - usually children with disabilities and “economic orphans” – and placing them in institutions used to be accepted as standard practice or on the grounds that it was the only possible solution.

2.       The Assembly notes that this type of practice continues on account of the pressures - often financial - on families, the economic interests which hinder change, and attitudes, which are very slow to evolve.

3.       Overcoming this legacy is a daunting task; the extent of the reforms required should not be underestimated and it is fortunate that many of these reforms have already been launched in the states concerned. They will, however, require a great deal of time, the involvement of all sectors of the community, greater international co-operation and vast financial resources.

4.       The Assembly therefore recommends that the Committee of Ministers of the Council of Europe urge the member states concerned to:

i.       prepare and publish a map of children’s institutions which must be closed down (especially those which are too big, isolated or dilapidated, etc.) and draw up a timetable for their closure;

ii.       promote, in co-operation with civil society, an active policy for removing children from institutions and restoring family ties by introducing alternative arrangements, and especially by returning children to their own families, placing them in foster families or family-type homes, setting up day centres, etc., and promoting adoption within their own country;

iii.       systematically improve the training of staff in children’s institutions to ensure that they are properly qualified, where necessary by means of foreign partnerships;

iv.       introduce policies to provide assistance to families in difficulty or those which have a child with a disability, to prevent the abandonment of children.

5.       The Assembly recommends that the Committee of Ministers ask the member states concerned to ensure that :

i.       the diagnosis of children’s disabilities and the decision to place them in institutions are accompanied by full safeguards for the fundamental rights of children and involve regular re-assessment, and that there are appeal procedures;

ii.       children living in institutions have access to appropriate healthcare and are given the education and training they require to make up for inadequate schooling and social exclusion, so as to ensure that, as young adults leaving the institution on coming of age, they have other prospects than life in the street or a psychiatric hospital;

iii.       abandoned children living in institutions have access to effective representation (Ombudsman, specialist judge, NGO, etc), independent of the executive.

6.       The Assembly recommends that the Committee of Ministers set up intergovernmental activities programmes in its newest member states in support of children living in institutions, in co-operation with the European Union, Unicef, the World Bank, etc., to avoid duplication, prevent efforts from being made in piecemeal fashion and ensure maximum efficiency in the shortest possible time.

7.       The Assembly asks the Committee of Ministers to urge member states:

i.       to take an active part in Council of Europe activities on behalf of people with disabilities - for example, the Partial Agreement in the social and public health field;

ii.       to make use of Council of Europe Development Bank loans to improve the conditions in which children are cared for in institutions;

iii.       to take advantage of 2003, European Year of People with Disabilities, to launch major national information campaigns to make people aware of the rights of children with disabilities in an endeavour to change attitudes and the way in which they and their place in society are perceived.

8.       Finally, the Assembly invites the various Council of Europe bodies responsible for monitoring the honouring of the commitments that must be entered into by states on joining the Council of Europe to consider respect for the rights of all children and a de-institutionalisation policy a binding obligation.

II       Explanatory memorandum by Mr Hancock

Where Do The Children Play?

Well I think it's fine, building jumbo planes

Or taking a ride on a cosmic train

Switch on summer from a slot machine

Get what you want to if you want, ‘cause you can get anything.

I know we've come a long way

We're changing day to day

But tell me, where do the children play?

Well you roll on roads over fresh green grass

For your lorry loads pumping petrol gas

And you make them long, and you make them tough

But they just go on and on, and it seems you can't get off

Oh, I know we've come a long way

We're changing day to day

But tell me, where do the children play?

Well you crack the sky, scrapers fill the air

Will you keep on building higher

‘til there's no more room up there?

Will you make us laugh, will you make us cry?

Will you tell us when to live, will you tell us when to die?

I know we've come a long way

We're changing day to day

But tell me, where do the children play?

From the song by «Cat Stevens»

A.       The urgent need for a de-institutionalisation policy

1.       In a motion for a recommendation (Doc. 8800) dated 8 July 2000, the Social, Health and Family Affairs Committee was asked to address the sensitive issue of the plight of abandoned children living in institutions or on the streets in some Council of Europe member states.

2.       The Rapporteur visited Moscow (see appended programme) from 6 to 9 October 2002. He wishes to thank the Russian authorities for their welcome and for giving him the opportunity to meet certain officials and visit a number of noteworthy facilities for children. Nevertheless, he regrets that he was not able to meet Ms Matvienko, Deputy Premier Minister of the Russian Federation, who is responsible for social affairs, health and culture.

3.       He also regrets that, for procedural reasons, i.e. the need to meet the deadlines set by the Bureau of the Assembly for submitting reports (in the present case 25 January 2003), he will be unable to make further fact-finding visits to other member states.

4.       The following report accordingly describes the situation in only three member states: Romania, Russia and Bulgaria. The Rapporteur especially wishes to thank the consultant, Ms Nicole Delpérée (Belgium), who has prepared it. The aim is not to stigmatise these three countries, but simply to use them as examples to illustrate the various aspects of an immense problem which is found in many central and east European countries.

5.       The Rapporteur endorses the consultant’s conclusions and wishes to stress a well-known fact: most abandoned children living in institutions have disabilities to start with, or develop them if left for long periods without proper healthcare, education and stimulus (which can also aggravate existing disabilities).

6.       In some countries, children are still being placed in institutions on the strength of disability diagnoses which are often hasty and sometimes mistaken; this is particularly serious if the diagnosis is also final, i.e. not subject to re-assessment or appeal. The fundamental rights of children in institutions cannot be safeguarded if there is no one to defend them. Lack of transparency and the fact that these institutions are not open to inspection by civil society representatives, such as NGOs, do not make it easy to protect extremely vulnerable children against possible ill-treatment and sexual abuse.

7.       The errors of the communist era are fortunately a thing of the past, but attitudes are still slow to change; many parents are still “encouraged” to abandon their children, particularly as families receive very little assistance and often have financial difficulties. Responsibilities are shared between ministries which fail to co-ordinate their actions, and this does not ease decision-making or help to make management of these institutions transparent; funding is also sorely lacking.

8.       Regrettably, helping children in institutions is still not a political priority in European states – and particularly not in the new democracies. Children’s best interests should be the main concern, but actually counts for far less than the economic impact of large institutions, which generate income (funds are often determined by size) and provide employment for locals, who may well be dedicated, but are often unqualified.

9.       Can we really accept a situation in which – because institutions are large or isolated, because qualified staff are lacking, or for any other reason – hundreds of European children are still denied the right to a family environment, the basic healthcare they require, and the education and training they need to find a place in the community.

10.       Children abandoned in institutions have no future; when they come of age and have to leave, lack of training condemns them to life on the streets, in old-people homes or in psychiatric hospitals.

11.       The Rapporteur believes that resistance must be overcome, that some of these institutions, which are a disgrace to our society, must be closed down, that the conversion and renovation of others must be speeded up, and, above all, that alternatives - foster families, day centres and, ideally, adoption in the home country – must be developed.

12.       Medium-term solutions to the problems of children in institutions depend on the politicians, who must make up their minds to do something, and provide funding on a more than generous scale. There must be more international co-operation, and the funds which international organisations provide to help certain countries because of the transition process towards democracy must not dry up, as they frequently do because no one takes over and keeps them coming. On the contrary, the deinstitutionalisation drive must be stepped up – and better co-ordinated to prevent waste and dispersal of effort.

13.       The Council of Europe Development Bank makes loans to cover social projects – as a rule, unfortunately, only to its members1. In recent years, it has financed only three projects to help children. In 1999, it contributed some 2,300,000 euros towards the cost of renovating 10 day centres for people with disabilities, old people and abandoned or maltreated children in Lithuania. It is providing a loan of 10 million euros to cover renovation and conversion of former children’s institutions in Romania, where it also made a special grant of 1 million euros to improve the situation of children in institutions in 1999. Part of the Romanian Social Development Fund’s anti-poverty project - approved in 2000 for a total loan of 21,500,000 euros – is concerned with child welfare.

14.       Unicef and the World Bank have together launched a project, running for several years, to help the central and east European, CIS and Baltic states. This project, “Changing minds, policies and lives”, has received 180,000 dollars in funding (for further information see the http://eurochild.gla.ac.uk/changing site).

15.       The European Union has told Romania that it must do more to help children before it can join. The European Parliament has asked for information on the situation of children in Bulgarian orphanages. The Rapporteur is naturally delighted to see children’s rights becoming a political issue!

16.       At the Council of Europe, the governmental and parliamentary bodies, which make sure that members honour the commitments they have to give on joining, should pay special attention to the situation of children – and particularly those living in institutions.

B.       Illustration of the problems in Romania, Bulgaria, Russia

1.       Introduction

1.       Major political, economic and social changes have taken place in central and Eastern Europe over the past fifteen years or so, and these have resulted in a far-reaching redistribution of income among the population.

2.       This has had an immediate adverse effect on the welfare of some people, especially where housing and associated matters are concerned, as well as access to health care. In such circumstances, it is not surprising that the most vulnerable persons (the very elderly, those who are ill, abandoned children and those with disabilities) are suffering the consequences until such time as society takes new steps to protect them.

3.       During periods of difficulty, children with disabilities, in particular, impose an excessive burden on their parents. In these countries which have done less to adopt a policy of integration of persons with disabilities, or which have had such a policy for a shorter time, than their Scandinavian counterparts, it is all the more difficult for people to consider looking after disabled children in their own family. Thus, in the current circumstances, the authorities need to give quite particular attention to the protection of children with disabilities.

4.       It is in fact undeniable that the countries concerned have all, individually, done a great deal of work to enshrine in their legislation as far as possible the rights of such children. It is unfortunately self-evident that the most serious problems are also those which require the greatest effort, the greatest resources and the most time, so there is still a long way to go to finalise the new policies.

5.       The remarks and proposals below are the main ones drawn from an overview, necessarily a theoretical one, of the present situation. The description is confined to the situation in Romania, Bulgaria and Russia, but the observations and conclusions have a more theoretical and more general scope. It would of course be beneficial to look at these in the light of the experience of the children concerned and of their families.

2.       Romania and the protection of children in difficulty2

2.1       The use of institutions in Romania

6.       In the sixties, Romania’s birth rate fell significantly, a fact which is generally attributed to the country’s economic problems and the despondent mood among the population. In order to combat the demographic effects of this, the authorities implemented a policy of encouraging an increase in the birth rate, at the same time making it possible for families to place their children in institutions at the state’s expense. Hence Law N° 3/1970 on the leaving of children at orphanages.

7.       The state also took action about children who had fallen behind in their schooling. In the absence of remedial lessons in the ordinary education system, a decision was taken to send such children to special schools, in institutions, far from their families, but without any allocation of resources to ensure that such children received an appropriate education.

8.       Similar excesses were experienced by children with physical or mental disabilities, who were placed a long way away from their families in institutions which were far too large, run by untrained staff or staff with inappropriate training, and suffering from a serious lack of resources.

9.       This standard practice of sending children far away from their families, whatever their level of ability or situation (whether or not they had disabilities, and regardless of whether they were orphans or had been abandoned), and the systematic use of institutions3, led to what, collectively, has to be regarded as a dramatic situation and, in individual terms, to the appearance of numerous institutional syndromes. This historical development is the reason for the use in Romanian legislation of the very general term “children in difficulty”, a term which therefore covers a wide range of problem situations. We shall use the same terminology here to refer to all such situations.

2.2       A social problem during a period of economic transition

10.       Even more than in the other countries of central Europe, the economic transition led in Romania to an increasing gap between the economic and the social sectors, bringing the risk of an aggravation of the situation of children in difficulty. Hence assistance was provided by the European Union (PHARE programmes), and by various NGOs or foreign foundations (such as the Soros Foundation), with a review of social policy to help such children.

11.       In the sphere of social legislation, a new political will saw a series of laws, orders and decrees adopted, and specific strategies and action plans drawn up. These - undeniably urgent - reforms now need to be continued by the Romanian authorities, which are facing the task of taking over from the NGOs and the European foundations which have been providing input for some of the reforms.

12.       Since 1997, Emergency Orders Nos 26 and 120/974 have brought about the repeal of Law No 3/70 on the leaving of children at orphanages. Subsequently, some major reforms have been carried out. Putting these new statutory provisions into effect and eliminating the practices which prevailed prior to 1997 nevertheless represent a titanic challenge: before that date, in practice, the authorities kept children with disabilities isolated a long way from urban centres, such children usually being regarded as beyond help, so they were kept well away from their own families. This isolation in large rural orphanages, which continued until recently, therefore went on producing significant adverse effects and causing practically irreversible individual damage:

      i.       It made it impossible to recruit skilled staff, so staff numbers remained inadequate to cope with these children’s special needs;

      ii.       It very much reduced contact between families and children, so that children were often forgotten about by their own family;

      iii.       It made it virtually impossible for children in difficulty to return to a normal upbringing and education;

      iv.       It definitively jeopardised any chance of the majority of these children being integrated into society, generally condemning them to special hospitals, or even to psychiatric institutions.

13.       Hence the importance of the 1997 reform, which enabled Romania, through a decentralisation law5, to set up 41 departmental directorates of child protection (DDPEs), which have been given responsibility within their departments for ensuring that each child’s right to a family is respected and that children’s living conditions are made more humane if they remain in orphanages.

14.       It cannot be denied that Romania’s leaders became aware of the need both to prevent families from abandoning their children, by assisting families in difficulty, and to remove from their institutions the children who had been placed in orphanages. Furthermore, the Romanian authorities’ efforts to find solutions to the problem of the abandonment of children benefited from financial assistance from the European Commission, and the co-operation of NGOs, with the help of European or foreign foundations, has enabled initiatives to be taken in support of the efforts to remove children from institutions.

15.       In the legislative sphere, chapter II of Order No 26/19976 outlines the new aims in respect of the protection of children in difficulty:

      i.       The emphasis is laid on respect for the higher interest of the child and on the need for rational continuity in the upbringing of the child.

ii. It is planned to make use of the services of “professional foster parents”, remunerated by the departments. The aim of this is to enable children who have been abandoned or those who have slight disabilities to be taken into the natural families of these foster parents7. The foster parents receive specific training and need appropriate support and supervision.

      iii.       In implementation of this measure, the number of children housed in orphanages has declined by 5,000. At the same time, the new role of “foster parent” has been introduced. A national network of foster parents has been organised. At departmental level, an effort is also being made to set up agencies to prevent the abandonment of children, inter alia by offering a service to mothers in difficulty when they leave the maternity hospital, for example. An effort is also being made at local level to set up mother-and-child centres and day care centres8.

16.       It has to be pointed out that good co-operation is needed between the three key levels in the child protection sphere, namely:

      i.       the Chairperson of the General Council,

      ii.       the Secretary General of the General Council,

      iii.       the departmental director of child protection.

17.       The situation inevitably becomes more complicated when, as is sometimes the case, departments are reluctant to allocate the necessary appropriations to assistance for families in difficulty and for remunerating foster families.

2.3       The solutions envisaged

18.       Thought is being given by those in positions of responsibility in Romania to various solutions, briefly described below:

      i.       For children with slight disabilities:

Integration is regarded as possible for such children, either within family-type homes or in genuine families, with one, or even both of the parents fulfilling the foster parent role.

      ii.       For children with a disability of medium severity:

Generally speaking, this kind of children requires a more professional service; this does not automatically exclude placement in a family.

      iii.       For children with severe disabilities:

The belief is that there should be professional involvement, depending on the case, either in family-type homes or in slightly smaller facilities than these; it is felt that this will enable a more professional job to be done.

Thus the general tendency is towards the closure of large institutions for children, whether they are for orphans or for abandoned children, and whether the children concerned have a disability or not.

2.4       The problem of special schools and of children who fall behind in their schooling

19.       Difficulties with schooling do not even seem to have been appropriately taken into account in the Romanian school system, with the result that schools have no suitable classes for pupils who are experiencing difficulties.

20.       Consequently, children in difficulty at school are classified as “backward” and may even be separated from their families and sent to rural institutions known as “special schools”, although these do not offer an education which caters for the specific needs of such pupils. Their situation is all the more difficult for the fact that contact with their families is often made more complicated by the distance factor, and special schools thus all too frequently contribute to families’ decision to abandon their children.

21.       In other words, the result of this system is veritable social relegation. It seems clear that it would be much preferable to set up remedial classes in urban schools, enabling the children to return to their families every evening. An appropriate school transport system could make this more practicable.

22.       When children who are behind in their schooling reach the age of 16 (the usual age for pupils in year 8), they ought to be placed in vocational schools which have the specific role of teaching them work skills while taking account of their disabilities.

23.       As there is an urgent need for action to be taken, the setting up of sheltered workshops seems to be one way of dealing with certain problems9.

24.       Other schemes, whereby the state finances a work placement, within the framework of contracts drawn up for such pupils when they reach the end of their schooling, should also be encouraged.

25.       Thanks to this kind of training course and to assistance with access to the labour market, it is certainly conceivable that such children should return to normal life, rather than being directed to special schools or psychiatric hospitals.

26.       The important economic role played by the special schools hinders the move away from institutions: such special schools are regarded first and foremost, by local councillors and trade unions, as the region’s main employers, and on this basis, their existence is stoutly defended.

2.5.       Conclusion

27.       The present situation in Romania provides evidence of a political will for far-reaching change. Significant legislation has undeniably been adopted to protect children who are in difficulty. So reform is under way, and is currently, to some extent, enjoying logistic and financial support from the European Union (e.g. PHARE projects) and from foreign foundations (such as the Soros Foundation). Some NGOs are pointing the way ahead for these reforms.

28.       This assistance is nevertheless temporary, in principle, and it is now for Romania’s institutions and civil society to take over in an appropriate way so as to complete the reforms decided on by the national legislature.

29.       It is easy to define the most urgent tasks, and if these are carried out, it should become easier to protect children in difficulty more effectively, by giving them the treatment to which they are entitled as human beings.

      i.       Help families in difficulty in general, so as to prevent them from abandoning their children; in particular, help families which have a child with a disability;

      ii.       Close large special schools and major psychiatric hospitals10, such closure being accompanied by simultaneous implementation of the reforms mentioned below;

      iii.       Systematically improve staff training, so that staff have the skills they need in order successfully to integrate children in difficulty;

      iv.       Introduce remedial classes in ordinary schools so as to enable children who have fallen behind to catch up; promote the use of school transport for children with disabilities, so that they can return to their families each evening, thus preventing such children from being sent to remote special schools, and providing a valid alternative;

      v.       Set up day centres for children with disabilities who are not attending schools, and provide the necessary transport to make it easy for them to maintain their family links;

      vi.       Give priority to:

      a.       the use of foster families;

      b.       family-type homes;

      vii.       Open vocational training centres for children experiencing difficulty at school, offering them access to the labour market, and consequently, integration into the most normal possible adult life. A specific social integration and vocational training policy should also be put into practice as a matter of urgency in each department;

      viii.       At the same time, study the possibility of reforming the system for adoption abroad, making the conditions more flexible, provided that the requisite guarantees exist.

30.       Statutory texts and decisions in principle already exist: decisions are now being taken to close large orphanages and major psychiatric centres. Some initiatives have been introduced11, and the groundwork has been done. The main thing is to continue the efforts which have begun, and to do so nationwide. The main thing is to achieve continuity, with the action taken coping with the urgent aspect and being part of a long-term overall plan.

31.       It may be hoped that the expected improvement in the level of economic activity12, which remains modest in comparison with the European level, will bring significant improvements over the years ahead where the protection of the rights of Romanian children is concerned.

3.       Bulgaria

3.1       General overview

32.       The situation of Bulgarian children has many parallels with the situation in Romania as described above, even though has Bulgaria never conducted a pro-natal policy like that implemented in Romania or had legislation on the leaving of children at orphanages: but both countries deal with educationally underachieving and disabled children in a rather similar manner.

33.       Here too the public authorities decided to take such children out of their schools, towns and families and to place them in “special schools” well away from the urban centres, and in orphanages. This had the same results as in Romania, via inadequate provision for such children, who were abandoned by their parents, especially when their economic situation worsened (company closures, unemployment and inadequate family resources).

34.       The Bulgarian authorities, too, were well aware that these children and their families were often in a deplorable situation 13. The political will is there to remedy this situation, as reflected in various pieces of legislation, but none of these texts has ever really gone to the heart of the problem.

35.       The Government has decided to prioritise the de-institutionalisation of such boarding-school children, and is therefore planning to transform the institutions by cutting back on or closing boarding schools and developing day centres and community services. It is expressing its concern to normalise as far as possible the situation of children in difficulty.

36.       The first reforms took place in 1997, and in 2000 a Child Welfare Board was set up; agencies have been created to cater for various aspects of child protection.

37.       A plan to improve child welfare in Bulgaria has been funded by an appropriation from the World Bank and Japan, and a plan has emerged to reconstruct institutions in the European framework, with Austrian co-operation.

38.       The current shortcomings in the system were recently highlighted by voluntary associations and private and public persons dealing with disabilities14. All these educationalists, lawyers, special welfare assistants, public officials, etc, stress the difficulty of genuinely implementing the aims of the child welfare legislation in connection with the right of disabled children to study at ordinary schools. In fact there is a consensus that the education system is ill-prepared for this task; specialists consider the requirements of the ordinary school very high, so that disabled children could only succeed in the normal curricula if the State enabled them to follow personalised programmes.

39.       Even if some change has occurred in this area15, teachers are not yet being properly trained to cope with such tasks, and there is a particular shortage of speech therapists and social educationalists. Moreover, there are many architectural barriers to access by persons with physical disabilities; it is also stressed that parents receive no financial support, and that some schools have problems of intolerance vis-ŕ-vis the integration of children with mental disabilities.

40.       On the health front, the medical treatment contracts are frequently flouted: parents accuse doctors of being vague about individual diagnoses and providing insufficient information on the child’s disability and his/her future orientation. These allegations might be due to a shortage of the appropriate medical teams. More seriously, though for the same reason, doctors commit children whom they consider to be “hopeless cases” to closed institutions without prior multidisciplinary consultations, even though the Ministry of Education does have the requisite multidisciplinary teams. However, the standard practice is simply to send the child to a special school, where he/she will remain outside the normal school system, or to change schools.

41.       The same criticism is levelled at nursery schools: even though the law provides for integrating 5 disabled infants into such schools, they are often sent back home on the pretext that no support has been provided.

3.2       Day centres

42.       One of the major demands is therefore the provision of new day centres in order to avoid isolating children with disabilities in special schools.

43.       Some such centres have already been set up. The State-run centres are usually under-funded, and ought to be encouraged to send children to school where they can. The centres set up by NGOs using European funds are well organised, but such European funding is, in principle, temporary and the State is supposed to take over, if it wants the centres to remain open.

44.       One of the major difficulties comes from the compartmentalisation of funds: school funding depends on the educational budget while resources for the centres come under social policy. The fact is that the only way to rationalise financial decisions in this field would be to ensure co-ordination between both ministries and introduce an overall budget.

45.       There is also a social rehabilitation day centre, known as the St Mina National Centre for Social Rehabilitation, which operates in Sofia and is funded by the European Union; it caters for children with physical or sensory disabilities16. It takes in thirty children 5 days a week, and has a team of 14 highly qualified professionals (social educationalist, physiotherapist, speech therapists, nurses,

psychologists, etc) whose salaries are paid by a foreign foundation and from European funds. The Bulgarian State pays for the children’s transport between the Centre and their homes, as well as the provision of wheelchairs.

46.       Parents contribute to the operational expenses if they can afford to do so, and otherwise the Centre resorts to sponsorship.

47.       In this way the children enjoy appropriate reception facilities, which are set out in detail in individual development programmes drawn up in co-operation with the parents. Most of the work is done with the parents’ co-operation, and particular stress is laid on keeping them fully informed: all the parents work with the team and have meetings with the specialists.

48.       This excellent facility enjoys temporary funding in that it depends on European aid. This also raises the problem that either the public authorities or private funds will at some stage have to take over financial responsibility.

49.       Another success story is the St Sofia Bridge Project, which was launched in 1995 for street children17. This is a PHARE Project (run with European funds) aimed at taking in homeless children whose families can no longer look after them (whence the name “street children”). Over 90% of these children are Gypsies, which is typical of the situation in Bulgaria18.

50.       The “Faith, Hope and Love Centre” does its utmost to provide neighbourhood schooling for the children (with a 50% success rate) and to instil a sense of family belonging in them (this being the Centre’s philosophy).

The work is excellent, but here again the funding is not guaranteed for the future.

51.       We might also mention the Vidrare Boarding School for Mentally Retarded Children and Teenagers19, which is supported by a Dutch partnership and operates in an area with a 30% unemployment rate.

52.       The boarding school caters for 92 children, most of them suffering from mental and/or physical disabilities and 23 of whom are bed-ridden. 60% of them are Gypsies (Gypsy families are large and poor).

53.       The age bracket catered for is 3 to 18 years (although some of the residents are as old as 25 because there is no appropriate structure for the older ones, apart from the psychiatric hospital).

The institution has a highly dedicated, 56-strong staff.

54.       Staff point to problems arising out of the following factors:

      a. the distance from the city centre means that it is difficult to recruit qualified staff;

      b. the level of salaries does not match the difficulty of the work;

      c. families often give up on their children because the school is so far from the city;

      d. there is no appropriate structure for young people over the age of 18;

      e. the school is under-resourced.

A new day centre might solve some of the problems.

55.       The Bulgarian Association for Persons with Intellectual Disabilities20 is opening a series of day centres with State co-operation and European funding. There are currently 20 such centres taking in severely mentally retarded children from 3 to 18 years of age, aimed at avoiding institutionalising such children and providing them with schooling as part of an integrated education system.

56.       This NGO has trained a large number of specialised educationalists. Given that the European funding will stop in July 2003, action plans will have to be drawn up and submitted to the Bulgarian Government.

3.3       Psychiatric aspects

57.       Psychiatrists have an important role to play in the treatment of a whole series of mental disabilities21.

58.       In the university clinics22 psychiatrists conduct rehabilitation programmes using the trifocal intervention method (child-family-society), which is based on the “Teach division” prototype (E. Spoplen, 1978).

59.       The following problems have been noted:

      a. difficulties with integrating the children in the school environment;

      b. the shortage of specialists to look after them;

      c. the lack of training for teachers, who refuse to cater for children with special needs;

      e. the shortage of day centres.

3.4       Current political will23

3.4.1       The basic texts

60.       The basic texts raise no particular problems and have attracted overall political consensus:

3.4.2       Action under the implementing regulations for the Education Act

61.       Officials consider that all reception centres, schools and assistance structures should fulfil the conditions for integrated education and training of children with special needs or chronic illnesses; all children in difficulty are entitled to individual assistance from teachers to meet their special educational needs.

3.4.3.       Under the Persons with Disabilities (Protection, Rehabilitation and Social Integration)

      Act

62.       Pre-school facilities and general and vocational schools are required to provide opportunities for integrated education for children with disabilities in ordinary or special classes. The Act provides that pre-school - and schoolchildren should only be placed in special schools after all the possibilities for integrated education and training have been exhausted.

3.4.4       Recent political action

63.       In 2000 Bulgaria set up a Child Welfare Board, and the Ministry of Employment and Social affairs drew up a priority strategy to support children with disabilities. At the municipal level, the social welfare services have set up child welfare units. As in Romania, foster parents are trained in order to avoid institutionalising the children.

3.4.5       Difficulties encountered

64.       As the discrepancy between the political intentions and the actual situation might suggest, the policy is coming up against many difficulties:

      a. there is inadequate co-ordination of welfare protection for children with disabilities between the ministries involved (education and social affairs);

      b. better policy streamlining is needed between the national ministry, which sets the objectives, and the local authorities, which distribute the budget;

      c. disability should be diagnosed earlier: more often than not, GPs fail to detect disabilities and the children are subsequently considered as “hopeless cases”, leaving the sole option of institutionalisation;

      d. the needs in terms of mother and child welfare, which have long been underestimated by public health officials, must be met.

3.5       Conclusion

65.       Bulgaria’s efforts to normalise and integrate persons with disabilities should be encouraged under the human rights protection programmes.

66.       A start has been made on a series of important and difficult changes, and we should urgently prioritise assistance for families in difficulty in order to prevent any further abandonment of children.

4.       Russia

4.1       General overview

67.       The economic transition in Russia is creating unprecedented social difficulties, with increasing unemployment, lack of resources and limited access to medicines and health care. For part of the population these difficulties are combined with an attitude of despondency, or indeed alcoholism, destroying all family links.

4.1.1       Child abandonment

68.       According to some statistics a large number of Russian children are being abandoned24, in a variety of different situations:

      a.       Social orphans are children from underprivileged backgrounds who are in public authority care because their families have failed to meet their needs or because of alcoholism or violence, etc, in the family. “Social orphans” are sent to orphanages and are considered as “children at physical or psychological risk”; such situations are liable not only to handicap them socially, as an indication of a deficient social and economic background, but also to lead to their being written off as “encephalopathic” (“brain-damaged”) until they come of age. Such discrimination originates in old prejudices that equated abandoned children with impaired children, and is probably linked to the habit of abandoning children born with severe congenital defects to maternity wards in the past; the hospitals were apparently very understanding25 vis-ŕ-vis the parents, fearing the marginalisation that might stem from maintaining a seriously disabled child in the family. The practical consequence is that a number of healthy children are currently considered mentally deficient.

      b.       Children suffering from a simple physical malformation, e.g. a harelip, or having a speech defect are liable to be diagnosed as abnormal children and declared retarded, or even oligophrenic. Abandoned children who are declared medically abnormal clearly cannot appeal or easily obtain any reassessment of their condition.

      c.       Children with severe disabilities at birth are fairly often institutionalised, which prevents their families from being marginalised and relieves their parents of any guilt they may feel for the disability.

4.1.2       Categories of institution

69.       The various institutions are often presented as a maze of State structures depending on three different ministries with various overlapping responsibilities, which are in competition for limited State funds. The care provided for orphans varies greatly in quality from one institution to the next, depending on the interest and resources of the local authorities and the generosity of the charities involved26.

70.       Some establishments have much more dedicated staff27; however, the neuropsychiatric institutions (internaty) currently pose the worst problems in terms of children’s rights.

      a.       First of all there are the Dom Rebyonka, which depend on the Ministry of Health and take in abandoned infants (from birth to 4 years of age). The children are subsequently assigned to two different types of institution under the supervision of the Ministry of Education;

      b.       Children deemed to be normal are assigned to the Dom Dyetskii (children’s homes) and attend ordinary Russian state schools; or else they may live in boarding schools, where they also attend classes. Such schooling continues until the age of 13, when the children may begin a three-year vocational training course in a PTU (Pedagogical Technical Unit) type institution. There is also a “pets internaty” (auxiliary boarding school) with a shorter programme of education for less gifted children. At the end of their school career these children leave the institution and are entitled to a grant, housing and employment. This legal provision can cause problems because school-leaving is a matter for the Ministry of Education while employment usually depends on market conditions and housing has now been privatised, so that leaving the institution often means returning to the street;

      c.       Children diagnosed at the age of 4 as having severe physical or mental disabilities are examined by a Board of State physicians and educationalists. The children may then be officially labelled “idiots” and be assigned up to the age of 18 to institutions run by the Ministry of Labour and Social Development, usually closed institutions (psychoneurological institutions [internaty]). After the age of 18 they are transferred to asylums (adult psychoneurological institutions [internaty]) for the rest of their lives.

4.2       Potential remedies

70.       A number of problems have been noted, providing pointers to the necessary improvements:

4.2.1.       Decision to institutionalise the child

71.       The primary cause of discrimination lies in the decision, which has irreversible effects, to institutionalise the child; if we could invert the proposition and restore family responsibility and entitlement to public assistance we could prevent the often-tragic abandonment of children to the institutions.

4.2.2.       Committal to closed institutions (internaty)

72.       Committal to such an institution shuts the child in completely and precludes any parental support for the child right from the outset: it reinforces and institutionalises the abandonment. If, on the contrary, day centres could be created not only would the necessary openness be restored but also the parents would be able to work normally and continue to look after the disabled child within the family28. This would involve reallocating to the parents some of the financial resources currently earmarked for the institutions.

4.2.3.       Psychoneurological diagnosis

73.       This official diagnosis29 recorded at the age of 4 establishes whether the child is normal or not, whether he/she will receive normal education or be placed in an institution (internat) and therefore deprived of normal education.

74.       This is a difficult diagnosis to establish because:

      a.       children who have been in an institution since birth often suffer from institutional syndrome; furthermore, it may be difficult for a young child to provide valid responses before a selection board which he/she is bound to find intimidating. It is therefore no wonder that many such diagnoses are erroneous.

      b.       there is practically no remedy (appeal or review) against a diagnosis (establishing “idiocy”), which will therefore accompany the child throughout his/her life, excusing in advance any negligence committed against such “undesirable persons”.

75.       If diagnoses could be regularly revised and adjusted, and also treated in isolation from the initial decision to commit the child, this discrimination could be eliminated, something which the Rehabilitation of Persons with Disabilities Act has not completely succeeded in doing.

4.2.4.       Access to health care30

76.       The closed institutions (internaty) are often accused of failing to provide proper access to all the necessary types of health care, medical treatment, etc, for abandoned children. Moreover, since these children are considered as hopeless cases, they receive less treatment aimed at promoting their development (in some recorded cases they are left permanently supine or given sedatives).

77.       The officials responsible must therefore be encouraged to use methods capable of improving the situation of the disabled children, even in cases of severe disability.

4.2.5.       Access to education

78.       The internaty are also accused of failing to provide proper access to education for disabled children31. An education system tailored to the needs of such children must obviously be developed32.

4.2.6.       Human resources

79.       Deficient training for personnel33 on the various means of treating disabilities, understaffing and the low salary levels in this sector sometimes leads to a wholly inappropriate attitude to disabled children, and possibly also ill-treatment and punitive systems.

80.       Ill-treatment may be attributable to ignorance, inadequate training, administrative practices and the frequent lack of resources rather than to malice on the part of certain staff members. However, whatever the cause, violent behaviour (physical or psychological violence) is obviously inadmissible, particularly when directed against children. The other category of ill-treatment concerns serious negligence in treatment and the abuse of sedatives, which are global problems linked to the dearth of human and material resources34.

A radical reform is therefore needed.

4.3       Conclusion

81.       There is certainly much to be said about the deficiencies of the Russian system for protecting the rights of children with disabilities, especially in connection with the situation in the internaty.

82.       We might first of all conclude that it is important:

      i.       for the State to provide children in institutions with effective defenders, as happens in most Council of Europe member states. These children have rights, even before the Council of Europe bodies, but they have to be allowed to assert these rights. Such a defender may be a family member, but that would require the families to be made to feel responsible rather than guilty, with the public authorities and the community at large providing them with financial assistance and the requisite services and facilities. The defender might also come from a body outside the executive (a specialised judge, ombudsman, press representative, specialist NGO, specialised lawyers, etc). The main thing would be to strike a balance, based on respect for human dignity, between legitimate discretion and the necessary openness.

      ii.       to press on with a de-institutionalisation policy, facing down any resistance and reducing the role of the large internaty. This programme should be complemented with new day centres, small reception units and an appropriate education system.

      iii.       to enhance the qualifications of staff responsible for disabled children, possibly with the help of foreign partnerships, as has happened in Bulgaria and Romania.

5.       Conclusion

83.       The situation of children with disabilities differs from one State to the next, and in large States like Russia it also varies from one region to the next.

84.       Rather than repeating the conclusions already drawn from the three analyses, I might usefully set out three final caveats:

      i.       It would be a mistake to underestimate the extent of the reforms initiated;

      ii.       It would also be a mistake to underestimate the usefulness of the support provided by the European funds and of the interest shown in children with disabilities by foreign NGOs: this support will certainly be even more useful in the future;

      iii.       Lastly, it would be a mistake to postpone unnecessarily the drastic reductions needed in the role of the large neuropsychiatric internaty.

Appendix

PROGRAMME

Of the visit of Mr Mike HANCOCK,

Rapporteur of Social, Health and Family Affairs Committee

(Moscow, 6-9 October, 2002)

(Secretariat of the Council of Europe: Mrs Meunier, Secretariat, Parliamentary Assembly and Mrs Grimmeissen, Secretariat, Partial Agreement Division in the Social and Public health field)

October 6, Sunday       Arrival of the members of the delegation

October 7, Monday

10.00-11.30       Meeting with Mrs Galina N. Karelova, First Deputy Minister, Ministry of Labour and Social Development of the Russian Federation

14.00-15.00       Meeting at All Russian Society of Disabled People: Mr O. Lomakine, President and Mr Klepikov, Vice-Chairman

16.00-17.00       Meeting with Mr O. Mironov, Commissioner on Human Rights in the Russian Federation

October 8, Tuesday

09.30-10.30       Meeting with Mr Vladimir R. Pashuto, Deputy Chairman and Mrs A.V. Aparina, Committee on Labour and Social Policy, State Duma

13.00-16.00       Visit to the Social Rehabilitation Centre for minors “OTRADNOYE” – Moscow, 127273, Dekabristov Street 22.A

18.00       Russian charitable Fundation: “No to alcoholism and drug addiction” (NAN)

October 9, Wednesday

9.00-11.00       Visit to the Centre for Temporary Detention of Minors 13a Altufievsko shausse, Moscow

14.30       Departure of members of the delegation

Reporting committee: Social, Health and Family Affairs Committee

Reference to committee: Doc. 8800 and Reference No. 2570 of 26 January 2001.

Draft recommendation unanimously adopted on 28 November 2002.

Members of the committee: Mrs Ragnarsdóttir (Chairman), Mr Hegyi, Mrs Gatterer, Mr Christodoulides (Vice-Chairmen), MM. Alís Font, Arnau, Mrs Belohorská (alternate: Mr Tkáč), Mr Berzinš, Mrs Biga-Friganović, Mrs Björnemalm, Mrs Bolognesi, MM. Brînzan, Brunhart, Cerrahoğlu, Colombier, Cox (alternate: Ms Mc Cafferty), Dees (alternate: Mrs Zwerver), Evin, Floros, Flynn, Ms Gamzatova, MM. Geveaux, Giertych, Glesener, Gönül, Gregory, Gusenbauer, Gustafsson, Haack, Herrera, Hladiy, Hřie, Hörster, Jacquat, Ms Jäger, Mr Klympush, Baroness Knight (alternate: Mr Hancock), MM. Kontogiannopoulos, Lomakin-Rumiantsev, Ms Lotz, Ms Luhtanen, MM. Makhachev, Małachowski, Manukyan, Mrs Markovska, MM. Marty, Maštálka, Mrs Milotinova, MM. Mladenov, Monfils, Ms Nowiak (alternate: Mr Wikiński), MM. Olekas, Ouzký, Padilla, Podobnik, Popa, Poty, Provera (alternate: Mr Piscitello), Pysarenko (alternate: Mr Zhvaniya), Rigoni, Rizzi, Mrs Roseira, MM. Santos, Seyidov, Mrs Shakhtakhtinskaya, MM. Slutsky, Surján, Telek, Ms Tevdoradze, Ms Topalli, MM. Truu, Turjačanin, Vella, Mrs Vermot-Mangold, MM. Vesselbo, Vis, Van Winsen, Mrs Zafferani, Mr Zidu, ZZ (alternate: Mr Ionescu)

NB: The names of those members present at the meeting are printed in italics.

Secretaries to the committee: Mr. Newman, Ms Meunier and Ms Karanjac

1 The CEB currently has 35 members: Albania, Belgium, Bulgaria, Croatia, Cyprus, the Czech Republic , Denmark, Estonia, Finland, France, Germany, Greece, the Holy See, Hungary, Iceland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Moldova, the Netherlands Norway, Romania, San Marino, Spain, Poland, Portugal, Slovakia, Slovenia, Sweden, Switzerland, «The former Yugoslav Republic of Macedonia», and Turkey.

2 ROMANIAN PARLIAMENT: Protection of children in difficulty, Romanian legislation, vol 57, Bucharest, 2001. The Romanian legislative texts and regulations on the protection of children in difficulty which are published in this volume are:

United Nations Convention on the Rights of the Child, ratified by Law No 18/1990,

Emergency Order No 26/1997 on the protection of children in difficulty,

Law No 47/1993 on legal declarations of abandonment of children,

Emergency Order No 25/1997 on the legal arrangements governing adoption,

Order No 56/1994 on the updating of the rules relating to the expenditure stemming from the rights granted to children at day nurseries, crčches and specialised educational establishments, as amended by Law No 146/1994,

Emergency Order No 12/2001 on the setting up of the national child protection and adoption authority,

Government Decree No 216/2001 on the organisation and operation of the national child protection and adoption authority,

Government Decree No 586/1990 on the improvement of the protection, education and rehabilitation of children and young people with disabilities and of orphans,

Government Decree No 331/2001 on the indexing of the maintenance allowance for foster children and children in care,

Government Decree No 543/2001 on the allocation of additional sums from the state budget in support of child health care programmes in 2001,

Government Decree No 539/2001 approving the governmental strategy on the protection of children in difficulty (2001-2004) and the operational plan for the implementation of the strategy,

Government Decree No 552/2001 approving programmes of national interest relating to the protection of the rights of the child,

Government Decree No 611/2001 approving the programme of national interest relating to the protection of children entitled “the social integration of street children”.

3 The diagram below shows the provisions made for children in various institutions:

4 Followed by Laws Nos 108/98 and 102/99 on decentralisation.

5 Romania has 600 institutions divided between its 41 administrative departments.

6 Cf new Article 22: “The local government authorities are under an obligation to give support and assistance with a view to preventing situations which would jeopardise the safety and development of the child and to strive to:

7 The benefits of this measure are clear:

a)       Behaviour of the children: Children from institutions who are placed in foster families “gradually” return to a behaviour which is close to normal. It can also be deduced from this that, in a considerable number of cases, the disabilities linked to the institution syndrome are reversible.

b)       Behaviour of the families: The success of this formula derives from the fact that integration into the foster family, which has other children, occurs spontaneously and naturally. Where it would be useful, the tolerance of the family circle with respect to the disability is improved by the action of psychologists and social workers.

c)       Behaviour of those close to the family: Tolerance in the immediate circle is acquired gradually, and is sometimes more difficult to win when the child is a member of an ethnic minority (gipsy children).

8 The list below shows the proposals made for Maramures by the departmental directorate of child protection (DG Ms Anna Moldovan):

8.       Increase in the responsibility borne by civil society.

9 Some encouraging experiments are in progress, but more are needed. For example:

10 It is sufficient to visit certain children’s psychiatric hospitals to be able to see clearly the defects of the system and the inadequacy of this kind of facility, the presence of staff members who are generally willing and very courageous notwithstanding:

1.       concentration of large numbers of children with severe physical and mental disabilities;

2.       complete lack of space and of skilled staff;

3.       inadequate skills of staff members;

4.       frequent lack of appropriate treatment;

5.       flagrant lack of resources.

It has been noted that, where the closure of such centres has been planned, problems may well arise, in that no alternatives have been provided for by a date 18 months prior to the planned closure.

11        The institutions visited were:

1.       Baia Mare:

-       Centre for the placement of pre-school children with disabilities, Dragos Voda street No.9 (45 children aged from 3 to 9),

-       Centre for the placement of children with disabilities who are attending school, Barbu Delavrancea Street No.2A (169 children aged from 7 to 17),

-       Valea Borcutului centre for the placement of children who are attending school (72 children aged from 7 to 18),

-       Family-type homes (10 children per home, 41 divided between four homes, aged between 3 and 13);

2.       In Sighetu Marmatiei:

-       Centre for the placement of children from birth to the age of 3, Dragos Voda street No.37 (119 children),

-       Centre for the placement of children with severe disabilities, Avram Iancu street No.28a (240 young people aged 3 to 18+),

-       Barsana family-type home (8 children),

-       CALINESTI centre for community services for children and families: day centre for children with disabilities, vocational training centre, leisure centre for children from institutions.

12

Standard of living

GNP.

Per capita GDP

Year 2000 in euros

Romania

40 billion

1,800 euros

European Union

6,500 billion

21,300 euros

United States

11,300 billion

33,00 euros

13 INCLUSION EUROPE: Human rights for persons with intellectual disability, Bulgaria, September 2001, p. 17: in 1999 and 2000, 9252 disabled or abandoned children were placed in homes including “special boarding schools”.

14 PARTNERS BULGARIA FOUNDATION: Round Table, Sofia, 29.4.2002.

15 INCLUSION EUROPE: Human rights for persons with intellectual disability, Bulgaria, September 2001, p. 17: The following are the statistics on numbers of teachers trained for “Special pedagogy”: 1996: 118; 1997: 269; 1998: 383; 1999: 217; and 2000: 286.

16 This day centre is directed by the psychologist-speech therapist Rumiona Dafova, address 138 bd. De l’Europe, Sofia.

17 Directed by Ms Nadya Nedkova, the Project is run from the “Faith, Hope and Love Centre”, 30 ul. Svobodna, Nadezhda 2, 1220 Sofia.

18 Since the end of the communist era many Gypsy families has been facing difficult situations. The Gypsy community totals 800 000 individuals, most of them illiterate, and many of the families have 7 or 8 children. The community used to be semi-nomadic, making their living from their leather and textile work. Having become more geographically stable, they are now in a situation of extreme poverty. Gypsies used to receive offers of jobs and housing, but are now rejected by both the State departments and the private sector; their children no longer attend school, which means that their families are not entitled to child allowances. Parents who are unable to house and care for their children leave them at the “Faith, Hope and Love Centre”.

19 Directed by Mr Eugeni Georgiev Dimitrov, and located in Vidrare in the outer suburbs of Sofia.

20 BAPID has its headquarters at 20, ul. Sofrony Vrachansky, 1003 Sofia.

21 There are two university-type psychiatric clinics in Bulgaria for children and teenagers, in Sofia and Varna. Qualified specialists in these clinics diagnose cases of “general development disorders” and “child autism”.

22 Particularly the Sofia Clinic, Medical University, Psychiatry Faculty, 13 ul. Lunnapaprat, 1003 Sofia.

23 See Ms Vessela BANOVA, Vice-President of the Child Protection Agency, 2 ul. Triaditza, 1051 Sofia.

24 Some NGOs estimate the number of abandoned Russian children at over one million.

25 This attitude may be linked to the concern in Soviet society to replace the family and solve such serious problems through collective organisation.

26 President Putin has intervened to demand a solution to the problem of Moscow’s 50 000 street children, and the city’s mayor, Mr Luzhkov, and his deputy, Ms Irena Osokina, have drawn up a strategy to remedy the situation.

27 Particularly in the institutions in the Ural (Yekaterinburg area), which were, it is true, visited some time ago but which maintained good conditions, apart from a lack of training for physiotherapists and occupational therapists.

28 Article 54 of the Family Code enshrines the right of the child to be raised in his/her family.

29 It should be noted that a negative diagnosis leads to extra subsidies and creation of additional workstations.

30 The Constitution guarantees equality before the law (Art. 19), the right to social security (Art. 39) and the right to medical treatment in State and municipal health care institutions (Art. 41).

31 We cannot discount the possibility that the funding system, which depends on the severity of the disability, sometimes distorts impairment assessment, thus hampering to the child’s potential development.

32 Article 43 of the Constitution and Section 53 of the Federal Education Act do in fact guarantee access to education for all.

33 Salary levels are an obstacle to staff recruitment, which explains the recourse to persons without specialised skills.

34 Article 156 of the Russian Social Welfare (Disabled Persons) Act provides for criminal sanctions in such cases. The penalties concern cruel behaviour by persons responsible for under-age children (parents, teachers, tutors or medical staff).