Key points

Introduction

A recent United Nations (UN) report estimates there was a record number of refugees last year with 59.5 million people forced from their homes by armed conflicts/wars all over the world. The armed conflict/war in Syria alone has resulted in nearly 3.9 million migrants, with 1.59 million of these refugees in nearby Turkey. A significant portion of these individuals are children. Reports indicate that it is not unusual to see migrant children begging in the streets of Turkey. Of these 59.5 million people, 38.2 million were displaced within their own countries.

There was a 16% increase in displaced people in one year alone from 51.2 million in 2013 to 59.5 million in 2014. Moreover, this trend seems to be escalating and it is likely that the numbers will only increase further this year. The mass refugee exodus from armed conflicts/war all over the world represents a monumental humanitarian crisis and is the worst refugee crisis in years. According to the BBC (British Broadcasting Corporation) “The number of people living as refugees from war or persecution exceeded 50 million in 2013, for the first time since World War Two, the UN says.”

In 2012, worldwide, it was estimated that more than 172 million people were directly affected by armed conflicts. This number (172 million) includes conflict affected residents (CARs) (86.6% of the total at 149 million), internally displaced people (18 million or 10.5%) and refugees (5 million or 2.9%). The actual numbers are likely much higher than this because the figures include only 24 countries for which comparable and validated data were available. Again, most of this population includes families with children and orphans or children without family support.

Migrant, displaced, and orphan children or children without family support are especially vulnerable to violence, exploitation, and abuse. These reports and other current headlines highlight the worldwide problems for child safety. This article deals with several key issues facing global child safety, discusses advocacy, and references some strategies and successful programs for combating the violence toward, exploitation of, and abuse of children worldwide ( Box 1 ).

Introduction

A recent United Nations (UN) report estimates there was a record number of refugees last year with 59.5 million people forced from their homes by armed conflicts/wars all over the world. The armed conflict/war in Syria alone has resulted in nearly 3.9 million migrants, with 1.59 million of these refugees in nearby Turkey. A significant portion of these individuals are children. Reports indicate that it is not unusual to see migrant children begging in the streets of Turkey. Of these 59.5 million people, 38.2 million were displaced within their own countries.

There was a 16% increase in displaced people in one year alone from 51.2 million in 2013 to 59.5 million in 2014. Moreover, this trend seems to be escalating and it is likely that the numbers will only increase further this year. The mass refugee exodus from armed conflicts/war all over the world represents a monumental humanitarian crisis and is the worst refugee crisis in years. According to the BBC (British Broadcasting Corporation) “The number of people living as refugees from war or persecution exceeded 50 million in 2013, for the first time since World War Two, the UN says.”

In 2012, worldwide, it was estimated that more than 172 million people were directly affected by armed conflicts. This number (172 million) includes conflict affected residents (CARs) (86.6% of the total at 149 million), internally displaced people (18 million or 10.5%) and refugees (5 million or 2.9%). The actual numbers are likely much higher than this because the figures include only 24 countries for which comparable and validated data were available. Again, most of this population includes families with children and orphans or children without family support.

Migrant, displaced, and orphan children or children without family support are especially vulnerable to violence, exploitation, and abuse. These reports and other current headlines highlight the worldwide problems for child safety. This article deals with several key issues facing global child safety, discusses advocacy, and references some strategies and successful programs for combating the violence toward, exploitation of, and abuse of children worldwide ( Box 1 ).

Background

The human body cannot survive without meeting its physiologic needs. Obligatory physiologic needs must be met; otherwise, the human body is unable to function properly and will eventually fail, leading to the demise of the individual. The 3 metabolic requirements for survival are air, water, and food; clothing and shelter bestow protection from the elements.

After meeting the physiologic needs, which are the physical requirements for human survival, safety needs are next. Physical safety may be difficult to attain for many reasons including war, armed conflicts, disasters, family violence, and maltreatment (abuse). Once the individual’s physical needs are met, safety needs become the priority. Safety and security needs encompass personal security, financial security, health and well-being, and a safety net to prevent accidents, illnesses, or diseases, with their resultant consequences.

According to Maslow’s hierarchy of need, physiologic needs come first, then safety needs, next is love/belonging, followed by esteem, and, finally, self-actualization. Others group basic human needs into several levels: physiologic needs, followed by safety needs, and then psychological needs. These levels of needs may vary across cultures because of the availability of resources, including during peacetime and war. During times of war, the physiologic and safety needs may become of paramount importance and may merge into a survival mode.

More than a billion people cannot count on meeting their basic needs for food, sanitation, and clean water. Their children die from simple, preventable diseases. They lack a minimally decent quality of life.

From an international perspective, what are the challenges faced in meeting the basic physiologic and safety needs of children?

Physiologic needs: world hunger

World hunger is defined as the want or scarcity of food in the world. Food security exists “when all people, at all times, have access to sufficient, safe, nutritious food to maintain a healthy and active life.” According to the Food and Agriculture Organization in 2011 to 2013, 12% of the world’s population or approximately 842 million people were undernourished; 98% of these reside in the developing world.

It is estimated that 1 in 9 people in the world, or 805 million of the world’s 7.3 billion people, are chronically undernourished. Most of the people with hunger, about 791 million, live in developing countries where 1 of 8 people or 13.5% of the population is undernourished; compared with 11 million malnourished people in the developed world. Statistics about world hunger do not include micronutrient deficiencies. Micronutrient deficiency is the deficiency of specific vitamins and minerals, such as vitamin A or D.

Eight Millennium Development Goals (MDGs) were set by world leaders in 2000. The first goal or MDG 1 is to eradicate extreme poverty and hunger. Children are greatly affected by undernutrition. About 45% of all child deaths in 2011, or 3.1 million deaths annually, have been attributed to undernutrition. Undernutrition worsens the effect of any given disease and is an underlying cause of death for most illnesses; it is an underlying cause of death in 52% to 61% of those with pneumonia, malaria, or diarrhea.

“Poverty is the principle cause of hunger.” Harmful political and economic systems, conflicts/wars (CARs, which include refugees and internally displaced persons), population growth, poverty, food/agricultural policy, and climate change are factors cited as contributing to world hunger. Ways to decrease world hunger include decreasing overconsumption, increasing the decline in fertility rates, limiting climate disruption, increasing the efficiency of food production, reducing waste, and changing diets.

Physiologic needs: clean water, sanitation, and housing

The provision of safe drinking water is a basic physiologic need and a critical element in preventing disease. More than 780 million people do not have access to safe water and 2.5 billion people lack access to proper toilet facilities. Improved hygiene leads to less disease, increased school attendance, better school performance, and economic growth, particularly in developing countries.

Lack of clean water and poor or nonexistent sanitation predominantly affects children. “More than 800,000 children under age 5 die each year due to diarrhea, more than the number who die due to AIDS, malaria, and measles combined.” Diarrhea is the fifth leading cause of death worldwide. Nearly half (47%) of children aged 5 to 9 years in developing countries are infested with soil-transmitted worms. Worm infestations and diarrhea can delay and decrease intellectual development, limit children’s growth, and are underlying causes of undernutrition and stunting. “Among all children under age 14, more than 20% of deaths and years lived with illness are attributable to unsafe water, inadequate sanitation or insufficient hygiene.”

Clothing and shelter provide essential protection from the elements. Approximately 42.9 million people worldwide are living in substandard temporary housing; millions of others are inadequately housed at their “permanent home site,” generally living in substandard temporary housing, often living under a tarp, or in a consumable tent, or even without any roof over their heads. Armed conflicts/wars and disasters may force individuals, many of whom are children, out of their homes. Subsisting under such impoverished and desperate conditions leaves these families and individuals, especially children, extremely vulnerable to poverty, malnutrition, disease, lack of education, violence, exploitation, and abuse.

Lack of an official recording of their birth or birth certificate or birth registration is cited as a rights violation. Without a birth certificate, a child may be denied access to certain services and rights provided to citizens of a country, and this has numerous other consequences. For example, reunification of a child or infant with their family after a disaster or armed conflict/war when there is no formal or legal documentation may create difficult and, perhaps, insurmountable problems. Lack of official documentation of birth may lead to problems with or even denial of legal immigration (see Box 1 ).

Child maltreatment

Child maltreatment, formerly termed child abuse; may take many forms: verbal, physical, or sexual abuse; neglect; or medical child abuse (previous terminology, Munchausen syndrome by proxy, or fabricated or induced illness). Child maltreatment, unfortunately, occurs worldwide. Child abuse is not unique to any social, ethnic, religious, political, or economic group; nor to any 1 region or nation.

Protection from violence, exploitation, and abuse

Child protection is the prevention and response to violence, exploitation, and abuse of children in all contexts. Millions of children worldwide experience the worst kinds of rights violations. Millions more are inadequately protected against them. Moreover, these violations are widespread throughout the world, in both underdeveloped and developed countries, and are under-reported and often unrecognized. Examples of the types of violence, exploitation, and abuse that children experience are outlined in Box 1 .

Vulnerable children

Certain children are especially vulnerable to violence, abuse, and exploitation. Children without family support are one group of high-risk children. Displaced and migrant children are at risk. More children are migrating because of family problems, and for social, economic, religious, and political reasons; these may be precipitated by disasters, drought, famine, civil unrest, and armed conflict/war. Children may be exploited and abused if they belong to certain ethnic, religious, political, or social groups, especially minorities ( Box 2 ).

Children outside of family care are at high risk for becoming victims of violence, abuse, and exploitations. Children who are outside of family care include children separated or unaccompanied because of disaster or armed conflict/war, children trafficked for forced labor and/or sexual exploitation, child soldiers, children associated with groups or armed forces, children working as live-in domestic servants, abandoned children, children living on the streets, children heading households, children in institutions, and children in detention. A residential facility in which a group of children is cared for by paid personnel is termed residential care, residential institution, or institution.

Children with disabilities are particularly vulnerable to rape, sexual, and physical abuse. Where children live may place them at risk. Living in an area of civil unrest or war, during and after a disaster, in migrant communities, rural areas without adequate law enforcement protection (such as the rural communities where school children were abducted by terrorist groups such as Boko Haram), and in urban slums, especially if an unaccompanied minor, increase the vulnerability of the child to exploitation and abuse.

Family separation

Being lost and alone and separated from family and community is frightening, even more so during a disaster or armed conflict/war. Moreover, such separation from family greatly increases the vulnerability of the child to illness, violence, exploitation, and abuse. More than 1 million children have been orphaned or separated from their families by armed conflict in the last decade. Efforts should be made to identify children separated from their families as soon as possible and to reunite them with their parents, older siblings, or members of their extended families via family tracing and various tracking programs. If reunification is not possible, then alternative arrangements should be made to provide a safe and nurturing environment for the child that does not expose the child to exploitation or abuse.

Child abandonment

An abandoned child, as defined by the United Nations Children’s Fund (UNICEF), is a child who does not live with either their mother or father, who does not know where his or her next meal is coming from, and who does not know where he or she is spending the night. Worldwide, there are 153 million orphans. Greater emotional difficulties and lags in cognitive development have been associated with being an orphan or abandoned. More than 400 million abandoned children live on their own on the streets of cities throughout the world, struggling to survive each day. Every 2 seconds a child becomes an orphan and every 14 seconds a child is orphaned by AIDS. Street children are exposed to all sorts of violence, abuse, and exploitation. In some countries, “Street children are routinely detained illegally, beaten and tortured and sometimes killed by police.”

Child labor

Although the number of children in child labor declined by about one-third between 2000 and 2012, there are still an estimated 215 million child laborers. Moreover, many of these child laborers, an estimated 115 million, are doing hazardous work. Although the highest number of child laborers are working in Asia and the South Pacific, the highest proportion of children involved in child labor or 1 in 5 children is in sub-Saharan Africa. Most child labor is involved in agriculture; although domestic work, work in factories, mines, and other dangerous occupations are not unusual. Child laborers experience deterioration in their health, a negative impact on their growth and may even have serious limb and/or life-threatening injuries. Children are even used as child soldiers.

Armed conflict/war creates an even greater use of child labor. During the Syrian crisis, children are contributing to the family income in over three-quarters of surveyed households in that country. In Jordan, nearly half of all Syrian refugee children are sole or joint family breadwinners. Children as young as 6 years old are working. The greatest vulnerability for child laborers are those children involved in an armed conflict/war, those who are sexually exploited, and those involved in illegal/illicit activities including child trafficking and organized begging. Children may be forced to plant land mines and other explosives or bombs. Child laborers are generally isolated from contact with their families, often forced to endure a slave-like existence, frequently without adequate food, clothing, or shelter; and are often severely abused.

Armed conflicts/wars: child soldiers

Unfortunately, the many armed conflicts/wars around the world create additional avenues for violence toward, and the exploitation and abuse of, children. Around the world, thousands of children; both boys and girls, are recruited or forced to serve as part of a rebel group or government forces during armed conflicts/wars. These children are forced to provide labor, serving as cooks, porters, messengers, spies, or used for sexual purposes, often enduring gang rape, and are even forced to clear or lay landmines and take up arms as child soldiers. Children are not only exposed to the brutalities of war, but may be forced to commit atrocities against their own families, friends, neighbors, and community. Estimates indicate that there may be some 300,000 child (<18 years old) combatants/soldiers with some as young as 7 years old in more than 30 conflicts throughout the world, which is about 10% of the combatants in ongoing conflicts.

A study done by the Save the Children organization noted the following: the use of child soldiers in more than 70% of conflict zones studied; 25% of the irregular combatants in Columbia from 1990 to 2000 was a child; girls less than 18 years old participated in armed conflicts in at least 39 countries; and, in Nepal, children aged 13 years or more are recruited as combatants, and children as young as 10 years old are used as porters, spies, informants, and bomb planters by Maoist insurgents.