How can we protect children from abuse by carers working for charities, humanitarian aid agencies or faith-based organizations?
Authors: David Southall
Journal: Journal of the Royal Society of Medicine (2012)

Recent revelations about Sir Jimmy Savile and a possible ‘cover-up’ by high-level government agencies investigating child abuse in North Wales Care Homes should not have been such a surprise. Existing information in the world literature relates to the opportunistic abusive activities of a tiny proportion of those working nationally and internationally,1,2 as well as to subsequent deliberate obfuscation by the organizations involved. Why were concerns debated in private and by government inquiries, such as the one led by Sir Ronald Waterhouse and published in 2000,3 not adequately pursued and investigated? They became no more than gossip. Nobody seemed willing to initiate protection proceedings and, in some cases, allegations have not been passed on to the appropriate statuary bodies, in particular the police child protection system.4 It is encouraging that the Shadow Home Secretary, Yvette Cooper, is advocating for more police investigations and fewer inquiries.5

Child abuse is clearly a crime.6,7 Child sexual abuse is an example of the implicit gain for perpetrators. The term paedophilia, meaning ‘a love of children’, is not an accurate description of the consequences of abuse. It is time this descriptive term was dropped, a better, clearer alternative substituted, such as ‘child sex abuse’, and the criminal nature of such behaviour pursued primarily by suitably trained police officers.

When there are suspicions that a care worker, or groups of care workers, might be abusing children, particularly in an institutional setting, the police child protection system should be urgently engaged to decide if the allegations are real or inappropriate.

Fourteen years ago, I suggested with others that covert video surveillance be used to detect, not only life-threatening physical abuse in hospital (as was found in more than 30 children when this technique was used by police officers, social workers, doctors and nurses8), but in institutions, or even homes, where abuse was suspected. Within months of this proposal, covert video surveillance helped identify sexual abuse in the home of a known sex offender against children. Since then, however, the potential of covert video surveillance has been blocked by inquiries into the work of the hospitals using this technique, with many missed opportunities to protect children. Perhaps the destructive inquiries into this child protection work9 were part of the high-level ‘cover-ups’ now being exposed in other settings?

How then might it be possible to look after and protect vulnerable children, whether they have been ‘taken into care’ because of family problems, including abuse (both physical and sexual abuse of children is more often perpetrated by family members than strangers), or in the international arena, requiring help because of natural or man-made emergencies? Such children, especially when separated from their parents, are extremely vulnerable. Any charity worker or aid worker who has a personality that enjoys wielding the type of power associated with child abuse is potentially dangerous, particularly if the children are craving love and affection because of the circumstances that have led them to need care, including past abuse or the death or loss of a parent or parents.

The head of a charity looking after street children in Pakistan explained that because children were most at risk on the streets overnight, the charity had developed a refuge where they could sleep and be fed. However, no matter how hard the charity tried to find suitable carers willing to work overnight looking after these children, there was so much ongoing abuse by some of the carefully appointed ‘carers’ that the refuge had to close. Numerous inquiries in many different countries have told similar stories.10–15

Even children cared for in foster homes or within their extended families, for example Victoria Climbie, are at some risk.16 However, the benefits of individual pairs/small groups of foster parents over institutional care are wide ranging,17 and a reduced risk of abuse in this situation perhaps relates to the presence of small numbers of collaborative caring parents present with the child at all times, especially overnight.

Such patterns of care must be extended to international situations of extreme poverty, and man-made or natural emergencies. The primary objective is the care of the child, and charities and faith-based organizations should ensure that the possibility of abuse is minimized, and loving care maximized, by small home-type foster care within the child's community. Building orphanages or homes where large numbers of children are looked after by rotations of staff, and sometimes more effort is spent on indoctrination than on parenting, must be phased out.

The selection of charity and care workers involved closely with looking after children in any care system requires more research and development. Doctors should oppose any form of institutional care and promote homes for children with small numbers of constant, long-term, dedicated adults; close monitoring of care settings for any evidence of abuse must become the norm. These are the first steps in making vulnerable children safer.