New child protection unit opens in Lahore hospital: Lancet

Nov 30, -0001
Pakistan is taking firm steps to try to help abused children, say experts. Kristin Elisabeth Solberg reports for the Lancet on the country's new child protection unit, believed to be the first of its kind in south Asia.

A text message arrives in Pakistani children's rights activist Naeem Zafar's phone: "Reported an abandoned child from Cardiac ICU". It is from one of the members of the recently established Child Protection Unit at the Children's Hospital Lahore, alerting the rest of the team of a new case of an abused or neglected child.

A few years ago, the abandoned child, a skinny 12-year-old boy who has rheumatic heart disease and whose parents are nowhere to be seen, would have been unnoticed. But thanks to the new Child Protection Unit, abused and neglected children arriving in the hospital are now discovered, reported and, ultimately, helped.

The unit was launched earlier this year, but child protection has been on the hospital's agenda since 2004, when the voluntary child protection committee was launched. Since then, a quarter of the hospital staff have been trained to spot cases of abuse and neglect. The work has already yielded results. Last year, 155 cases were detected at the hospital, up from 88 the previous year. Before 2004, no cases were reported.

The public hospital's commitment to child protection is truly pioneering in Pakistan, says Naeem Zafar, a paediatrician and the chief architect of the programme. "There was not only nothing before this, but there was really no concept of child protection in hospitals and in the general public", he told The Lancet.


Reliable statistics do not exist, but violence against children is still believed to be widespread in Pakistan. Children face corporal punishment in schools and madrassahs; they face neglect and physical, emotional, and occasionally sexual abuse in their homes or workplaces; or they risk becoming victims of trafficking.

Zafar's plan for a hospital unit to help such children was born 6 years ago, when a 9-year-old girl was brought to his ward. The child had been left to die by an Islamic shrine, and had multiple injuries to the scalp, legs, and feet. Her body was covered with cigarette burns. It was a clear case of abuse. "She stayed with us for 2 months. The first 15 days she was very sick. The next month and a half she stayed because we just didn't know what to do with her", Zafar recalls. He realised that hospitals should and could be instrumental in detecting and helping children like the 9-year-old girl.

The Child Protection Unit has been noticed internationally. "It's very inspiring, what they are doing", says Bernadette Madrid, chair of the training and education branch of the International Society for Prevention of Child Abuse and Neglect, which has helped fund the training of the unit's multidisciplinary team. "This is the start of a long haul for a movement for children's rights in Pakistan."

But Zafar's team faces a few cultural challenges, Madrid says. He points to the general acceptance for corporal punishment in Pakistan, the fact that rape cases are surrounded by stigma, and that the reporting of abuse is low. "That's really the challenge: how do you reach those children?" Madrid says.

Training of hospital staff is one way, and it remains a key task for the new unit. Health professionals are trained to spot the signals; to see the reasons behind their patient's symptoms. "Few of the cases come with complaints of abuse. They come with children falling down stairs or falling off the roofs", Zafar says. "We tell [the health professionals]: look, these are the cases, and this is how you will spot them."

One of the trained doctors, Mohammed Nasir Rana, an assistant professor in the accidents and emergencies department, says he is more likely to detect and report cases of abuse after the training. "Everyone is becoming more aware about these issues", he says, adding that he refers one child almost every week to the unit.

Once the Child Protection Unit is up and running, Zafar hopes to replicate the work in other hospitals across Pakistan. For now, 14 other hospitals have established child protection committees, which is a promising first step. Across the country, more than one thousand health professionals have been trained to spot cases of abuse and neglect, helping more than 300 children in the past year alone.

Despite the project's relative success, Zafar realises that child protection is a never-ending task. "Even in this hospital, we can detect more cases", he says. "Probably about ten times as many." SAMAA MONITORING




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