Dr. M. Marzouki*
As a child’s neurologist I have dealt for many years with difficult child problems such as mental handicap, cerebral palsy, psychological disorders, epileptic seizures, etc. This was a frustrating and depressing work for two reasons: 1) I often could not expect any significant positive results before a long time, and once achieved, they were often limited ones; 2) I always had to take on new cases which never seemed to stop, nor indeed decrease.
Due to poor delivery conditions, we were often faced with the risk of severe handicap ratio in every 4,000 new borns every year in Tunisia. More often than not, physicians knew well the most significant causes of handicap in children, being mainly consanguinity, lack of immunisation –especially against measles– and poor conditions of pregnancy and delivery, as well as infections. Many of these causes could have been easily prevented. Ideally, it would have been more helpful for mothers to approach the primary health care workers who could have done much for
them, particularly during the past decade. Among the main health care priorities is the increase of awareness about the risks of consanguinity by not only providing health education to pregnant women, but also immunisation. The results of such health policy are difficult to be directly observed, yet the surveys show that it is the most effective strategy which subsequently lead to lowering the number of handicapped children.
An equally important question, however, is how could we handle the prevention of child abuse in the same way? What measures should be taken, for example, to avoid having the so-called ‘street children’ phenomenon? The preventive measures in handicap are different from medical management in type and level. For instance, when a child has a cerebral palsy due to prematurity, he would need drugs and physiotherapy. But preventing prematurity would need, among other things, health education and pregnancy monitoring. Like cerebral palsy, or seizures, sexually abused street children are merely a symptom, but the causes are derived from elsewhere. Of course it the symptoms that have to be dealt with in an attempt to help the children whose cases require special intervention due to the urgent and often difficult circumstances. In the meantime, we should also maintain a holistic approach to the problem, simply to understand it. What could be a real and effective method for the prevention of child abuse in Africa?
The answer which first comes to mind is: by implementing the children’s rights as stated by the UN, or in the African Charter. I should like to examine the African Charter having been a member of the NGOs expert committee who worked in 1990 in Addis Ababa with intergovernmental expert groups to draft it. In its preamble, the charter “notes with concern that the situation of most African children rights remains critical due to the unique factors of their socio-economic, cultural, traditional and developmental circumstances, natural disasters, armed conflicts, exploitation and hunger.” What are the rights that could prevent child abuse, of all kinds, if implemented? The first group of rights (socio-economic being probably the most important in Africa) are:
survival (Article 5), the right to health (Article 14), the right to education (Article 11), the right to be protected from all form of economic exploitation, (Article 15), the right to leisure, recreation and cultural activities (Article 17), and the right to special measures of protection in case of handicap (Article 13).
The second group is the political rights; the right to non discrimination (Article 3), right to freedom of expression (Article 7), the right to freedom of thought, conscience, and religion (Article 9), the right to freedom of association (Article 8), the right to be protected against torture (Article 16), the right to be protected against harmful social and cultural practices (Article 21), the right to be protected in case of armed conflict, tension and strife (Article 22), and the right of protection of privacy (Article 10).
The third category which some name as private or personal rights include the right to a name and nationality (Article 6), the right to a protected and united family (Article 18), the right to parental care and protection (Article 19), the right to procedures protecting the best interests in case of adoption (Article 24), the right to be protected against sexual exploitation (Article 27), drug abuse (Article 28), sole trickery and adoption (Article 29), and the right to fair trial and special condition of detention in case of crime (Article 17).
I should like to cast doubt about the possibility of implementing the above rights. While at the discussion stage, I recall how anxious we all were not to miss out any rights? What kind of text have we written? It is perhaps appropriate to attempt reading the charter in a different way. For example, not every child has the right to education, rest and leisure, protection against sexual exploitation, drug abuse, sole trafficking and abduction. If we read all the articles of the charter this way, we will have a very good and precise description of African child’s situation. Have we overlooked certain rights while drafting the charter by trying to deny the reality and by attempting to create a Utopian Society? Let us accept, for the sake of the argument, that the charter is not simply a dream but a set of goals that all African states should try to achieve. The question, then, is: how?
The charter is very precise about the establishment and organisation of the African committee on the rights and welfare of child (composition, election, candidates, term of office, bureau vacancies, secretariat, privileges and immunities of the members, mandate, reporting procedures communications investigations, ratification and adherence, amendments and revision of the charter. It is much less precise, nonetheless, on the implementation of the rights themselves? We read in the preamble
that the states should take all appropriate measures to promote and protect the rights and welfare of the African child. What actually are those appropriate measures, and could they really be undertaken by African states?
Is the second set, the political rights, of a different status?
Obviously only a democratic state can protect and promote them given the democratic nature of the rights included.
It must be noted that children are the principal victims of dictatorship and of the democratisation process. The last decade in South Africa is not the only example. How can it be expected that dictatorship is capable of protecting and promoting rights like freedom of expression,
freedom of association, and fair trials. How can it be demanded that the structures which that violate human rights are to protect them.
How many states in the continent are truly interested in taking the appropriate measures to protect the children against arbitrary detention. Probably none.
We should perhaps , therefore, have written in the charter that children’s rights can be protected and promoted only in democratic states, and that all measures should be taken nationally and internationally to overthrow dictatorships.
Where does this leave the social and economic rights? We admit easily that African governments, especially in potentially rich countries like Zaire, Nigeria, Kenya and Algeria have, due to corruption, a considerable responsibility in the economic chaos which left millions of children’s right to survival jeopardised due to its terrible consequences. Naturally, the economic world system is to be blamed for many more millions of children’s starvation, deprivation of health care and education. Many countries in Africa share a critical economic situation, which is going to worsen, because of the continuous flow of capital from south to north, much more significant than all aid received by the south from the north. The so-called liberalisation of the economy means less resources are invested in education, higher costs for health care, increasing unemployment and social disorder.
As physicians, we are currently seriously concerned by the reoccurrence of infant mortality not only in the horn of African, but also in central and western parts of the continent. In such difficult circumstances, it seems irrelevant to condemn the child’s labour because it is the only way of survival for millions of children in Africa, Latin America and Asia alike. The extreme poverty and the lack of democracy are not the only threats to children’s right. It is common knowledge that a lot of customs and practices are disastrous to the life, health and dignity of the child and are equally harmful. What appropriate measures should be taken to change a whole culture? Information only cannot change the behaviour. It is just a little part of a complex system of causes.
Last but not least, democracy without development leads nowhere. People will express freely not only their thoughts but their anger and revolt, and dictatorship comes back sooner or later. Development without democracy has proven to be nonsense because one can not go without the other. When both fail, wholly or partially like in North Africa where we are facing a wave of Islamic fundamentalism, cultural conflicts which are not good for children’s interests, continue to arise. The right wing, the conservative part of the culture will become stronger and more aggressive than ever. Substantial changes cannot be expected to occur unless as many causes as possible are examined simultaneously.
In the United States, for example, some 20 million people stopped smoking during the last 20 years not simply because they were informed about the dangers of smoking, but because of the holistic approach to the problem which employed education, political lobbying, new laws, and economic measures.
So is the prevention of child abuse possible? It is of course possible to talk of secondary prevention, but it is merely a question of words, i.e., it only touches on symptoms. The only effective prevention is the primary one which deals with the complex set of political, economic and cultural causes. What is it we could do as professionals, and can we do anything meaningful? Of course, we can state that the decision-makers nationally and internationally, in the ‘upper room’ are some sort of
half-god figures whom we cannot reach and that we have no influence on their decisions. It is partly true. What influence can we have on things like the movement of financial capitals? Surely none.
Do we have to give up any hope about a real and effective prevention? I do not agree. I have no solution for everybody but I think we must continue to be good professionals, each in his field as this is our only choice. I also think that professionals in Africa should be involved in the democratisation process, for more social equality, directly as human right activists or indirectly by supporting the democratic movement.
Promoting democracy means promoting new values since democracy is not simply a political regime, it is also a culture. ‘They’ cannot watch the wood fire burning the children and sit on the other side of the wood giving same aid to very few victims and waiting for some of the new cases. At the upper level either, something can be imagined.
The international networks of human rights activists, humanitarian NGOs and media have not been used in an appropriate way so far. For many people, NGOs are just fund givers, while Africa needs development not charity. This international network could be used more effectively by political lobbying in the rich countries, for a Marshall plan to address, for example, the real problems of Africa.
I have proposed to Peter Lachman, and Philista Onyango, the Chair of the African network to work on a project of twining children from rich countries with those from poor countries, ideally former colonies, at secondary, primary school level. The purpose of this project is not to pick the pocket money of children in Europe or the United States but it is to increase the solidarity between children in the world, some of
them being the decision makers of the future. I wish that the next conference of IPSCAN could organise brainstorming workshops, and discuss the feasibility of the project.
Now, what conclusion can we draw? Obviously, the prevention of child abuse in Africa is much more difficult and complex than the prevention of any health problem. Children in rich and democratic countries are abused, and the problem of prevention may be easier. But in Africa the very basic needs are not met, and their rights are massively violated.
Many African states which are either too weak or too corrupted, or both, can only take the inappropriate measures. It is therefore evident that the world’s economic system does not give much chance to Africa, unable to compete before long time with the rest of the world.
The main problem of the civil society is to survive and it cannot do much for the children. Should we give up any hope that any significant improvement of the child’s situation could occur? I think we have a lot of reasons to be pessimistic and sceptical, but we must take on the challenge and not forget that great work has been done and is still being done despite very difficult circumstances. It is probably foolish to believe that we can change the world, but it is surely a crime not to try to change it. So let’s keep trying.
*President of the Arab Commission for Human Rights, ex-President of the Tunisian Human Rights League, Professor of Public Health at the Faculty of Medicine in Sousse.