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Copyright © December 1998 by Human Rights Watch.
All Rights Reserved.
Printed in the United States of America.
Library of Congress Catalog Card Number: 98-88715
GLOSSARY OF TERMS
I. SUMMARY AND RECOMMENDATIONS
II. THE ODYSSEY OF A RUSSIAN ORPHAN
III. RELEVANT INTERNATIONAL AND RUSSIAN LAWS
IV. THE "GILDED CAGE" OF THE DOM REBYONKA: INFANCY TO FOUR YEARS
V. THE POINT OF NO RETURN: DIAGNOSIS AT AGE FOUR
VI. CHILDHOOD DOOMED:PSYCHONEUROLOGICAL INTERNATY
Photographs of Internaty
VII. THE DYETSKII DOM: TRUNCATED LIVES AND GRATUITOUS CRUELTY
VIII. PROGRESS AND IMPEDIMENTS IN ENSURING ORPHANS' RIGHTS
Before and After Photos of Russian Orphans
This is a joint report by two divisions of Human Rights Watch: the Children's Rights and the Europe and Central Asia Divisions. It was researched and written by Kathleen Hunt, a consultant to Human Rights Watch, who as a journalist investigated the orphanages in post-Ceausescu Romania for the New York Times Sunday Magazine and covered the break-up of the Soviet Union from 19911994 for National Public Radio.
The bulk of the investigation was conducted by Ms. Hunt in Russia, from February 10 to March 9, 1998. Considerable preparatory research was undertaken during January, and follow-up since her return from Russia. The Human Rights Watch Moscow office provided invaluable research and administrative backup throughout this period, and we are particularly grateful to Lyuda Alpern for her full-time assistance.
The report was edited by Lois Whitman from the Children's Rights Division and Rachel Denber of the Europe and Central Asia Division. Michael McClintock, deputy program director and Dinah PoKempner, deputy general counsel, provided additional comments on the manuscript, and Shalu Rozario of the Children's Rights Division and Alex Frangos of the Europe and Central Asia Division provided production assistance.
It is a pity that a vise of secrecy and fear, reminiscent of Soviet times, has tightened around the isolated world of Russia's state orphanages. Many dedicated orphanage staff and foreign volunteers begged us not to reveal their names, or the institutions in which they worked. Russian workers, they said, would be fired for talking to an outsider. Foreign charity workers would be expelled from the institutions and the doors slammed on humanitarian assistance. This would further isolate the system which they felt a desperate need to improve. We have respected these requests.
This report, nevertheless, would not have been possible without the assistance of many who did take the risk to share what they knew about state-run institutions for abandoned children. Of those in Moscow who wish to be named, we especially thank Sergei Koloskov, father of a Down syndrome child and president of the Down Syndrome Association for families with Down syndrome children, Sarah Philips, a former volunteer with the charity organization Action for Russia's Children, and Boris Altshuler, Lyubov Kushnir and Lyudmilla Alexeeva of Rights of the Child, Russia's leading nongovernmental organization dedicated to defending children's rights.
Also in Moscow, we wish to express our gratitude to Dr. Anatoly Severny, of the Independent Association of Child Psychiatrists and Psychologists, Marina Rodman, and Sergei A. Levin. Olga Alexeeva of Charities Aid Foundation shared her expertise and the bounty of her research archives, and Karina A. Moskalenko provided invaluable help with our legal research. Further information and insightswere provided by Equilibre, M?d?cins sans Fronti?res, and Alexander Ogorodnikov, who runs an independent shelter for runaway children.
Several translators labored over the raft of legal documentation assembled, and assisted with lengthy interviews with orphans. We especially thank Lena Sheveleva, Irina Savelyeva, Tanya Morschakova, Maria Armand, and Alexander Bogdanov.
On our two missions outside of Moscow, Human Rights Watch was generously assisted in St. Petersburg by M?d?cins du Monde/Doctors of the World; Alexander Rodin, a former deputy in the city council and now independent advocate for children in orphanages, juvenile detention, and the streets; and Alexander Bogdanov, who assisted in the research gathered from a group of teenaged orphans. Our research outside of Moscow would not have been possible without the help of Eduard A. Alexeyev. Further thanks go to Doctor Mikhail M. Airumyan, president of the independent Russian Association of Baby Houses, and Dr. Olga Y. Vassilieva, deputy director of one Russian baby house in a region north of Moscow.
Across the vast territory of the Russian Federation, we would like to extend our appreciation for the time given by dozens of people whom we interviewed extensively by telephone, gathering background information on institutions in rural and remote regions. There are far too many to mention here, but we especially wish to thank Vera Strebizh of Shans, a children's rights group, and Anna Pastukhova of Memorial Society, both of Ekaterinburg.
For the photographs in this report, we are deeply grateful to freelance photographer Kate Brooks, Sergei Koloskov, Natasha Fairweather, and to the British company Independent Television News for permitting us to view the tape of their cameraman's visit to a shocking psychoneurological internat. Valuable background information was provided by other journalists, including Zoya Trounova, and Sam Hutchinson, who described the inhuman conditions in the orphanages they had visited during the past two years.
Finally, our heartfelt thanks go to the many Russian orphans who talked freely with us. To protect their privacy, the names of all children in this report have been changed as indicated in the footnotes. Our sincerest hopes go to those who spoke with us as well as to those who are too young, or too neglected, to have yet learned to speak. We call on the international community to hasten the day when they can unlock their minds and develop their full human potential.
GLOSSARY OF TERMS
Aminazine: Big tranquilizer (neuroleptic) commonly administered in Russian orphanages.
CAT: The United Nations Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment.
CIDE: Comit? International pour la Dignit? de l'Enfant (International Committee for the Dignity of the Child). Swiss-based organization that published a report on several orphanages and juvenile detention centers in St.Petersburg, 1995.
The Commission: Shorthand reference to the state-run Psychological-Medical-Pedagogical Commission, an interdisciplinary board that evaluates the developmental progress of all orphans in institutions around the age of four. The commission's controversial diagnosis effectively channels abandoned children and children with disabilities into state institutions for the "educable" or asylums for the "ineducable."
CRC: U.N. Convention on the Rights of the Child.
CSI: Christian Solidarity International, a British charity that produced a report in 1991 based on an expert investigation into orphanages and internaty in Russia.
Debil: One who is mildly mentally retarded. According to Russian medical references, debily tend to imitate, and can master primary school skills. But they do not develop more subtle intellectual feelings such as duty, and their behavior is often determined by chance and unregulated feelings.
Dom rebyonka: Baby house. Orphanage for infants 0-4 years old, run by the Russian Ministry of Health.
DRMRP: United Nations Declaration on the Rights of Mentally Retarded Persons.
DSA: Down Syndrome Association (of Russia), an independent nongovernmental organization.
Dyetskii dom: (plural: dyetskiye doma) Children's home, literally. Often used interchangeably with internat to refer to state orphanages in general. The nickname "dyet' dom," and the adjective "dyet-domovskii" are often used pejoratively.
ICCPR: International Covenant on Civil and Political Rights.
ICESCR: International Covenant on Economic, Social, and Cultural Rights.
Idiot: One who has the most profound degree of mental retardation. Russian medical references describe idioty as "helpless and requir[ing] care and supervision. Speech is absent." They are considered "ineducable." Diagnosis is "idiotia."
Imbetsil: One who has a severe degree of mental retardation (between debil and idiot). Russian medical references say the hallmark of imbetsily is their "inabilityto engage in abstract thought and to be taught in school. Their feelings are extremely primitive." Thus, they are ineducable. Diagnosis is "imbetsil'nost."
Internat: (plural: internaty) Boarding institution. Often used interchangeably with dyetskii dom, to refer to orphanages for children five to eighteen years. In this report, unless indicated otherwise, "internat" refers to the institutions for "ineducable" children run by the Russian Ministry of Labor and Social Development.
ISM: International Standards for Medical Treatment, Including Care of the Disabled and Terminally Ill (from the U.N. and the World Medical Association).
Lying-down room: Room(s) in baby houses and psycho-neurological internaty for bedridden children.
NGO: Nongovernmental organization.
Nurse: Training is generally equivalent to nurse's aide in Western medical systems.
Oligophrenia: Mental retardation (from the Greek, "small brain"). Russian medical references indicate that true oligophrenia is hereditary, congenital, or acquired early in life. There are three categories, from mild to severe: debil, imbetsil, and idiot. Applied with a broad interpretation to abandoned infants and young children.
Orphan: Also, "social orphan." Used broadly to include abandoned children with one or both living parents, which is the case for roughly 95 percent of children in state institutions. Some parents have relinquished or been denied parental rights, but a substantial number of children who have run away or been abandoned, have parents who still have legal rights.
Pedagogue: Professional educator, included as personnel category in all state institutions. Some specialize in speech and reading, but the level of skill varies widely.
PME: Principles of Medical Ethics Relevant to the Role of Health Personnel, particularly Physicians, in the Protection of Prisoners and Detainees against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment. (United Nations document.)
Psikhushka: Ironic diminutive for "psychiatric hospital," to which misbehaving orphans can be sent for discipline or treatment.
PTU: Pedagogical Technical Directorate (Ministry of Education system). This is a system of vocational training institutions with dormitory accommodation, for school-aged children who have completed at least six years of standard schooling, and left their children's home.
Psychoneurological Internat: Boarding institution for children five to eighteen years of age, deemed mentally retarded, or oligophrenic at the level of imbetsil and idiot, and thus, ineducable. Run by Ministry of Labor and Social Development.
RFC: Russian Family Code.
Rights of the Child: Independent local nongovernmental organization based in Moscow which advocates human rights protection for children.
Rod dom: Maternity ward in a general hospital in larger towns and cities. Many Russian orphans are abandoned in the rod dom shortly after birth.
Sanitarka: (plural: sanitarki) Cleaning person or orderly. Although they are trained mainly as orderlies, they are often the only institutional staff who are responsible for the day-to-day care of children in baby houses and internaty.
Spets-internat: Special boarding institution. The generic term for institutions housing children with a various categories of physical and mental disabilities. Can refer to spets-internaty for "debil," or lightly retarded children (Ministry of Education), and the psychoneurological spets-internaty for children labeled "imbetsil" and "idiot" (Ministry of Labor and Social Development).
U.N. Rules: U.N. Rules for the Protection of Juveniles Deprived of their Liberty
Vospitatel': (plural: vospitateli) General caretaker of children. Personnel category includes non-academic teachers in children's homes and vocational training dormitories. Education level of a vospitatel' is usually equivalent to a primary school teacher.
Ukol beznorme: Injection. Colloquial term used by children in internaty to refer to medication, such as tranquilizers, administered without orders from a physician.
WHO: World Health Organization. U.N. agency based in Geneva.
I. SUMMARY AND RECOMMENDATIONS
"It took me a while to realize when I went to the baby houses that they only show you all the healthy ones. Then there are the rooms where the others are just lying there. They're all dying, lying on their backs, staring at the ceiling, generally fed on their backs. I've seen them putting the bottle of boiling hot food into children's mouths. It must be burning, but they're too hungry and just swallow it."
- Sarah Philips, long-time orphanage volunteer
February 23, 1998
"When I was little, Svetlana Petrovna put my head in the toilet and beat me on the behind, hips, and arms. At first she would hit me on my hand-that was while I was small, until I was nine years old. After that she could take a slipper and slap us on the lips. Of course, a kid couldn't do anything or say anything. We were so afraid of her."
"They could put you in the bedroom and make you stay there. They also kept food from you to punish you, too. Right now it's the staff that's the worst thing about life here-especially Svetlana Petrovna....There are about six or seven staff who are about the same."
- Kirina G., fifteen, Moscow orphan
February 20, 1998
"They're called children with no prospects, not trainable, not treatable. A colleague called these psychoneurological internaty "death camps." The situation there is terrible."
- Dr. Anatoly Severny, President
Independent Association of Child Psychiatrists and Psychologists, Moscow, February 12, 1998
"I could not say that I am proud of [that psychoneurological internat], ...but in general I believe that everything that can possibly be done in the current conditions is being done...And for these [Down syndrome] children [who may come from alcoholic homes], life in an internat is a paradise."
- Natalia Tsibisova, Director of Residential Institutions,Moscow Committee for the Social Defense of the Population, quoted in the Moscow Times, February 7, 1998
It is seven years since the declining Soviet Union released the last of its most renowned political dissidents, and closed a chapter of notorious human rights abuse in psychiatric hospitals and GULAG prisons. Yet today, in another archipelago of grim state institutions, the authorities of the Russian Federation are violating the fundamental rights of tens of thousands of innocent citizens: children abandoned to state orphanages.
Human Rights Watch has found that from the moment the state assumes their care, orphans in Russia-of whom 95 percent still have a living parent-are exposed to shocking levels of cruelty and neglect. Infants classified as disabled are segregated into "lying-down" rooms, where they are changed and fed but are bereft of stimulation and lacking in medical care.
Once officially labelled as retarded, Russian orphans face another grave and consequential violation of their rights around the age of four, when they are deemed "ineducable," and warehoused for life in psychoneurological internaty. In addition to receiving little to no education in such internaty, these orphans may be restrained in cloth sacks, tethered by a limb to furniture, denied stimulation, and sometimes left to lie half-naked in their own filth. Bedridden children aged five to seventeen are confined to understaffed lying-down rooms as in the baby houses, and in some cases are neglected to the point of death. Those who grow to adulthood are then interned in another "total institution," where they are permanently denied opportunities to know and enjoy their civil and political rights.
The "normal" abandoned children-those whom the state evaluates as intellectually capable of functioning on a higher level-are subjected to cruel, inhuman and degrading treatment by institution staff. They may be beaten, locked in freezing rooms for days at a time, abused physically and sexually. They may be humiliated, insulted and degraded, and provided inadequate education and training.
Staff members may also instigate or condone brutality by older orphans against younger and weaker ones, incidents such as beatings and humiliation. Somechildren describe treatment as outrageous as being thrown out a window while nailed in a small wooden chest. When orphans finally leave their institutions, they suffer its damaging effects and the second-class status as orphans for the rest of their lives.
It is ironic and deplorable that the very state that is charged with the care and nurture of these vulnerable children condemns them to a life of deprivation and cruelty. Moreover, far too many children are consigned to Russian institutions in the first place. Of a total of more than 600,000 children classified as being "without parental care," as many as one-third reside in institutions, while the rest are placed with a variety of guardians. Thousands more are temporarily quartered in various public shelters and institutions under police jurisdiction simply waiting for an available space in an orphanage.
Humane alternatives to institutions exist and should be used, such as sending children with moderate disabilities home with their parents at birth; providing help for families to cope with their children's disabilities; and providing foster care for children who cannot return to their families. As Russian experts told Human Rights Watch in the body of this report, these alternatives do not require additional resources, but rather a reallocation of existing funds now devoted almost exclusively to expensive institutional care.
Abandoned Children as an Underclass
Human Rights Watch has found that from the moment Russian children are left in state institutions, they become victims of long-held prejudices that all abandoned children are in some way "defective." One source of this discriminatory assumption is the tradition that infants born with severe congenital defects have been abandoned in local maternity wards under pressure and warnings from the medical staff that the family will be ostracized for raising a disabled child.
Even if abandoned infants do not display severe physical or mental disabilities, however, they often come from families with chronic social, financial and health problems-including alcoholism-and they cannot escape the stigma applied to that past. A clear summary of this point appeared in an article in the Moscow Times of November 2, 1996, which explored the biases against adopting a baby abandoned by a stranger:
The fear that the child will in some way be "damaged goods" stems from the knowledge that mothers of mentally and physically handicapped children are routinely advised by doctors to put their baby in an orphanage and "try again." Consequently, healthy babies who are given up for financial or domestic reasons are unfairly branded "defective."
The result is that abandoned children are consigned to the status of "orphan," and further labelled in their medical charts with physical and psychological "risk factors" in their medical charts owing to their background. Testimonies collected by Human Rights Watch are corroborated by the findings of expert investigators from the Swiss-based Comit? pour la Dignit? de l'Enfant (C.I.D.E.), published in 1995. They found that while Russian professionals used strict criteria in performing psychological evaluations, they also recorded factors in the child's medical history which would be considered as "risk" factors in the West, but commonly become labels of illness for an abandoned Russian child. According to the C.I.D.E. report, these include:
· babies born to alcoholic parents or whose mothers suffered depression during pregnancy will be labelled encephalopathic and remain so until they come of age.
· orphans will be classed as being mentally deficient.
· children with a single physical malformation (a harelip or speech defect...) become subnormal in the eyes of Russian doctors.
International human rights law forbids discrimination on a variety of grounds, including "birth or other status." Under the United Nations' "Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care," Principle number 4 provides that, "A determination of mental illness shall never be made on the basis of political, economic or social status, or membership of a cultural, racial or religious group, or any other reason not directly relevant to mental health status."
In practice, however, the Russian system violates this principle as well as the fundamental tenets of the International Covenant on Economic, Social and Cultural Rights, by branding children of lower socioeconomic origins and children with genetic abnormalities as a class apart.
It does so by attributing to them a propensity for social deviance stemming from their background, and by imposing upon them a life-long stigma and formal restrictions on participation in society. Abandoned children who are diagnosed as "oligophrenic," or mentally retarded, carry that label in their official dossier from institution to institution. They have virtually no channels through which to seek a reassessment or reversal of this diagnosis, and even "mild" oligophrenics who graduate from technical training schools told Human Rights Watch that they had difficulty appealing for the word to be removed from their file.
Human Rights Watch concludes that the Russian state fails to provide sufficient protection and opportunities to thousands of children who are abandonedto the state at a rate of 113,000 a year for the past two years, up dramatically from 67,286 in 1992. The evidence gathered reveals several systematic disadvantages imposed on young Russian orphans, which violate their fundamental rights to survival and development, and place them in an underclass.
Children abandoned at birth are more likely to be smaller and less developed over time than others, due in part to the significant lack of developmental care in state institutions during the crucial phase of early infancy.
Orphans in Russia have no one to appeal the state's special medical-developmental evaluation, which is performed on virtually all institutionalized children approaching the first year of school and older children at the time of abandonment. As described in greater detail in Chapters IV and V of this report, a diagnosis of severe oligophrenia for orphans means a greater likelihood of premature death in an institution that is little more than a warehouse.
According to this "diagnosis," which is delivered by a state-run commission of doctors, psychologists, and educators based at the Chief Psychiatric Hospital No.6 in Moscow, children in Russian institutions face a "triage" into one of two tunnel-like systems apart from Russian society at large. As explained in Chapter II of this report, in the best case, they are deemed educable, and proceed to a dyetskii dom run by the Ministry of Education, and attend regular Russian schools. In the worst case, they are deemed severely oligophrenic-either imbetsil or idiot-and condemned to a system of "total institutions" run by the Ministry of Labor and Social Development. There they receive little to no education and only a minimum of maintenance until they reach the age of eighteen, when they move on to an adult institution of the same kind. As the later chapters of this report show, independent child welfare experts in Russia denounce these institutions, claiming that the death rate for children is twice that of children living at home.
The comparatively fortunate orphans who make it into the educable group are still more likely to receive harsher discipline than children whose parents have left them only temporarily in state custody and continue to have contact with the orphanage.
Orphans in state institutions are less likely to be referred for needed medical services than are children with parents. Should orphans happen to be transferred to a hospital for services, they are less likely to receive proper medical treatment than children whose families can cajole and bribe hospital staff to carry out their work appropriately.
Failure to Live Up to National Commitments
The Russian government and its predecessor, the USSR, have long taken pride in the education and upbringing of their children. Its separate world of giantorphanages reflects the Soviet philosophy of collective action and discipline that guided the institutions erected to house millions of war orphans during the first half of the 20th century.
Since the break-up of the Soviet Union in 1991, however, the increased access to orphanages by journalists and charitable volunteers has unveiled a tableau of horrific conditions and malign neglect in institutions from the heart of Moscow to remote rural provinces. The Russian and international media have widely disseminated the shocking images from the orphanages during the past few years, and at least two international human rights delegations have issued damning reports of their findings, which are cited in the body of this report. Yet deplorable conditions still persist.
Officially, the Russian authorities, starting with President Boris Yeltsin, have repeatedly declared the rights of children a high national priority. The Russian Federation was among the first nations to sign and ratify the U.N. Convention on the Rights of the Child in 1990, the full text of which is presented in the Appendix to this report. Russia has subsequently submitted two periodic reports of its implementation of the Convention on the Rights of the Child, in 1992 and late 1997.
Also during the 1990s, Russia passed a raft of legislation and decrees affirming children's rights to education, health, and special protection against the hardships and upheaval wrought by economic reform. By mid-decade, President Yeltsin had launched two federal programs, "Children of Russia," and "Fundamental Directions of State Social Policy for Improving the Position of Children in the Russian Federation to the Year 2000." These programs are aimed at increasing the efficiency of state programs for children at the federal and local levels, and helping poorer families to provide a stable environment in which a child may develop.
In practice, however, the reaction of the Russian authorities to the critique of their orphanages has been to block access to the institutions; punish or threaten to fire workers if they speak about abuses; and, in some instances, pardon those who are responsible for the wrongdoing.
Senior officials of the three ministries charged with maintaining the orphanages have impeded the efforts of Russian human rights organizations to investigate reports of neglect and malfeasance. Members of such groups and child welfare experts told Human Rights Watch that senior officials flatly rejected their requests to visit the particularly degrading and unhealthy psychoneurological internaty run by the Ministry of Labor and Social Development for orphans diagnosed as imbetsily and idioty.
Failure to Comply with International Obligations
Although the Russian government has signed the Convention on the Rights of the Child, the evidence gathered and presented in this report shows that Russian policies toward abandoned children violate as many as twenty of the convention's first forty-one articles, which comprise a sweeping array of basic rights. More significantly, our evidence reinforces the concerns recorded in 1993 by the U.N. Committee on the Rights of the Child, in its letter replying to the Russian Federation's first periodic implementation report.
· The U.N. Committee featured as a "principal subject of concern," the "practice of the institutionalization in boarding schools of children who are deprived of a family environment, particularly in cases of abandonment or where children are orphaned."
· Another "principal subject of concern" highlighted by the U.N. Committee was the dire situation of disabled children. Human Rights Watch has learned that severely disabled babies are routinely abandoned at the state-run maternity wards, under pressure from medical personnel who warn the recuperating mothers of a life as social pariahs if they keep a "defective" child.
· Finally, the violence against orphans by institution staff and older children, which Human Rights Watch also documents in this report, gives heightened cause to the U.N. Committee's concern about the "occurrence of maltreatment and cruelty towards children in and outside the family." Now, more than ever, the facts substantiate the committee's 1993 suggestion that "procedures and mechanisms be developed to deal with complaints by children of the maltreatment or of cruelty towards them."
Next spring (1999), the second Convention on the Rights of the Child implementation report of the Russian Federation will come up for review by the U.N. Committee; Human Rights Watch urges the committee to place the systematic violations of orphans' rights at the top of its agenda.
To that end, we call attention to several of the more egregious violations of the Convention on the Rights of the Child, among other international documents that are abrogated on a daily basis in Russian custodial institutions.
Contrary to the precepts set forth in Article 23 of the Convention on the Rights of the Child, specifically concerning children with mental and physical disabilities, Russian orphans with severe disabilities are denied virtually every right to medical care, education, and individual development.
Such orphans are officially classified as "ineducable," and are excluded from opportunities to learn to read, write, and in some cases, to walk. In addition, abandoned babies and children of sound mind, but with physical disabilities, are routinely confined to areas in state institutions known as "lying-down" rooms. They are passed over for corrective surgery of conditions such as cleft palate as a result of the compound stigma of being abandoned and being diagnosed as "oligophrenic" (mentally retarded).
During a visit to the lying-down room of one psychoneurological internat, Human Rights Watch noticed a beaming blond, five-year-old boy walking on the callused sides of his club feet. We asked the sanitarka who was playing with him what his diagnosis was. "Oligophrenia," she replied. But when we asked specifically about his feet, she replied, "Well, it's the same... imbetsilnost."
In addition to the appalling violation of the rights of orphans with severe congenital disabilities, critics of the state's diagnostic procedure also expressed their concerns time and again to Human Rights Watch that too many children were, in fact, wrongly diagnosed. Even the staff at two institutions told Human Rights Watch that they believed that nine to ten percent of the children transferred to them as imbetsily and idioty, actually had the ability to enjoy productive lives.
The percentage of diagnostic errors was shown to be strikingly higher in a more in-depth clinical assessment of oligophrenic orphans published in 1991 by the British charity organization, Christian Solidarity International (CSI). CSI concluded that in one group of fifty children they studied, more than one-third were within "normal" limits of standard intelligence tests. On more thorough examination of thirty-four children, the team gathered the startling results that "two-thirds of these 'oligophrenic' children showed evidence of average or better ability."
In view of the known and suspected cases of misdiagnosis among orphans, Human Rights Watch finds the violation of Article 27 of the Convention on the Rights of the Child particularly relevant. It accords children undergoing medical care the right to periodic review of their treatment and surrounding conditions. In practice, however, Russian orphans with diagnoses of oligophrenia have extreme difficulty seeking a re-assessment of their status, which is also a violation of Russian law. Even those classified as "lightly" oligophrenic (debil) carry the burden of that classification in their official file when they embark on their search for jobs and homes.
The most severe discrimination faced by Russian orphans is suffered by children interned in psychoneurological internaty for children with disabilities who are aged five to seventeen years. Article 39 of the convention calls for the promotion of "physical and psychological recovery and social reintegrationfollowing neglect, exploitation or abuse...or any other form of cruel, inhuman or degrading treatment or punishment."
Far from receiving treatment towards recovery or rehabilitation, however, Russian orphans consigned to lying-down rooms suffer further deterioration from neglect. Agitated orphans are confined to barren day-rooms where they are tethered, restrained, and given powerful sedatives without medical supervision.
Such examples of inhuman and degrading treatment and punishment are all too common features of Russian orphanages, both for children with severe disabilities, and as well for those diagnosed as "educable." In the latter case, Human Rights Watch discovered elaborate patterns of dehumanizing discipline in the dyetskiye doma of the Education Ministry, in which the orphanage directors and staff strove to humiliate children in front of their peers, and at times encouraged their peers to take part in the demeaning punishment.
Such choreography of cruelty by orphanage staff is often devised for the purpose of punishment-by-proxy, through which older or stronger children are delegated to maintain order. The resulting disciplinary pattern alarmingly resembles that found in the Russian military and prisons, both state institutions notorious for their elaborate systems of violence and debasement. Whether for punishment or for simple sadism, this practice amounts to a training module in physical and mental violence.
Moreover, the common practice of interning older children in psychiatric hospitals for rule-breaking behavior such as running away from the orphanage is a perversion of medical ethics and an alarming throwback to the gross misconduct of the Soviet psychiatric profession. Children returning from two weeks to several months in the psykhushka report the use of heavy tranquilizers, and appear disoriented and confused to their peers.
These preeminent uses of violence against Russian orphans violate the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, as well as other international standards pertaining to medical ethics and the treatment of persons with mental illness.
This report is based on a month-long fact-finding mission in Russia, during which Human Rights Watch met with more than thirty-one orphans, from some seventeen institutions; six doctors specializing in child development, either working within or outside institutions, four vospitateli working with older orphans and ones with disabilities, three children's rights activists, several journalists, and five Western volunteers who have worked extensively in institutions.
Several of these volunteers were among the first outsiders to enter children's institutions in Russia during the early 1990s, and they undertook a survey of orphans' needs for a new charitable assistance program. As a result of theirresearch, and their in-depth work in a number of institutions, the volunteers interviewed for this report hold the most comprehensive information on the system as a whole, outside government officials.
Some of these volunteers and others interviewed by Human Rights Watch were willing to be named in this report. They requested, however, that we not identify the institutions they described, for fear of being banned from them after the publication of this report.
To protect the orphans and others who fear reprisals by officials, we have changed the names of all locations and people in this report, and indicated in the footnotes. Testimonies have been lightly edited for clarity, but otherwise represent interviews Human Rights Watch conducted either directly or with the help of an interpreter.
Following the discussion of relevant international and Russian laws in Chapter III, each chapter takes a phase of an orphan's life in a Russian institution, and introduces the genre of human rights violations they suffer at that stage. The prejudicial stereotype of abandonment is common to all stages, for example, while some abuses, such as malicious and degrading punishment, are more specific to the context of the Education Ministry's dyetskii dom.
The only way to bring a halt the cycle of discrimination, violence and impunity that endangers abandoned children in Russia is through a joint campaign by the international community, Russian authorities, and children's advocates to abolish all prejudicial practices and investigate reports of wrongdoing.
Human Rights Watch recommends the following reforms:
To the Russian Government
On reducing the number of children consigned to state institutions:
· Stop medical personnel from pressing parents to institutionalize newborns with severe disabilities;
· Develop and implement a plan for the gradual deinstitutionalization of abandoned children and children with disabilities, and reallocate resources now used for institutional care to develop alternative humane, non-discriminatory alternatives;
· Provide assistance to families in caring for children with disabilities-for example, home helpers, day training and education programs;
· Make utmost efforts to locate other relatives who are willing and capable of assuring care for children when it is not in the best interests of the children to remain with their parents, and provide such relatives with assistance where necessary;
· Provide and supervise foster care for children who cannot remain with their families; and
· Make utmost efforts to seek out appropriate opportunities for adoption when it is in the best interests of the child. Human Rights Watch takes no position on the Russian debate over the advisability of foreign adoption, but urges that in seeking alternatives to institutional life, the best interests of the child always be paramount, and that foreign adoption should not be ruled out as an alternative preferable to institutionalization.
On the matter of discriminatory status
· Ensure that all abandoned and orphaned children, whether disabled or otherwise, receive full respect for their human rights and protection against discrimination;
· Immediately stop applying the diagnosis of oligophrenia (mentally retarded) to infants or young children until they can be observed and examined adequately over a period of time;
· Commence investigation, with the participation of independent medical, educational, and mental health experts, into the process of evaluation at the age of four, which channels abandoned children almost irreversibly into educable and ineducable worlds. This investigation should aim to reform the evaluation procedure in order to take into consideration the extremely limited experience of instutionalized children;
· Appoint an independent "observer group" including experts in pediatrics, child development, and neuropsychology among others, to take part in the official evaluations conducted by the state Psychological-Medical-Pedagogical Commission, and vested with the power to challenge diagnoses determined by the commission;
· Establish a mechanism for all orphans to exercise their right to appeal the discriminatory diagnosis of oligophrenia, and to expunge it from their records,if need be. In conjunction with this action, quickly establish a department staffed with medical, educational, mental health and social work experts to process appeals from older children with completed educations;
· For children too young or otherwise unable to file their own appeals for re-assessment of their diagnoses, enlist independent Russian child welfare experts and attorneys versed in children's advocacy, to assist or represent the child in making the appeal;
· Immediately lift any formal restrictions against appealing the diagnosis of oligophrenia;
· Immediately cease to inscribe orphans' official identification documents, including passports, with "dyetskii dom" (children's home), and list only the street address as place of residence;
· Immediately take steps to end the gross neglect, and the physical and psychological abuse by staff working in the custodial institutions of the three ministries involved: Health, Education and Labor and Social Development;
· Immediately undertake a public education effort at the federal, regional and local levels, to dispel the deep-rooted prejudice against children who have disabilities and children who are abandoned by their parents. This campaign should enlist experts and popular personages throughout the Russian Federation, as well as abandoned children, those with disabilities, their relatives and advocacy groups for such children . Making use of all possible media and school curricula, the campaign must have as its goal to debunk the myth that abandoned children automatically inherit physical and mental abnormalities and behavioral patterns such as criminality. It should also raise awareness as to the rights and potential of disabled children;
· Consistent with the 1993 recommendations of the U.N. Committee on the Rights of the Child, immediately undertake a parallel in-service training program for staff of state orphanages to dispel these same prejudices and emphasize the rights of disabled persons. Such training should also inform orphanage staff of the significant advances made in the education and treatment of children with bona fide disabilities. Many staff are plainly unaware of the clinical profile and developmental potential of children with Down syndrome, cerebral palsy and other conditions; and
· In conjunction with public education in the institutions, initiate a program in the psychoneurological internaty to introduce reading to all children. In addition, furnish them with sorely needed children's books and primers, as well as writing paper, crayons and pencils.
On the matter of punishment, abuse and deplorable conditions
· Immediately issue a directive to all ministries and orphanage directors that corporal and psychological punishment of children are strictly prohibited. To end the system of impunity in the institutions, the directive must state that alleged violators will be subjected to investigation. If necessary, they will be disciplined, dismissed or submitted to criminal prosecution;
· In conjunction with the above, commence systematic investigations of conditions in selected baby houses; psychoneurological internaty; orphanages run by the Ministry of Education; dormitories for orphans fifteen to seventeen years of age who are attending technical training institutes;
· Immediately furnish children in state institutions with information about their basic rights, including their right to file grievances confidentially. This information should be conveyed through social workers and members of independent NGOs, and should include guarantees for their protection against retribution in the event that the alleged violator is convicted;
· Immediately establish an effective channel through which orphans may make confidential complaints to an independent outside authority about violence and misconduct committed, or instigated, by the institutional director, staff or other children;
· Immediately appoint an independent, standing commission of experts from the fields of pediatrics, neurology, psychology, and early childhood education, vested with full authority to conduct unannounced visits to institutions and to order official sanctions for violations; and
· In the meantime, expert consultants should be enlisted by each ministry to review and revise the standards of institutional care in accordance with the tenets of international and Russian law. Each of the Russian ministries responsible for children's custodial institutions-Health, Education, and especially the Ministry of Labor and Social Development-should make itscurrent standards for institutional conditions and treatment public and transparent.
On the right to health care
· Ensure, in adherence to Russia's national legislation and international law, that all abandoned children in state custody be provided with necessary medical care. A survey should be undertaken immediately to identify children awaiting surgery to correct cleft palates, heart defects and other problems that threaten a child's survival. These children should be provided with the prescribed services as soon as possible.
On reforming the management and treatment of orphans
· All staff at baby houses, children's homes and psychoneurological internaty should undertake a course of formal training. The course must impress upon all employees that the protection of the children's well-being is of utmost importance and that babies require visual, auditory and tactile stimulation at from the earliest moment possible;
· Develop, with the cooperation of the U.N. Children's Fund (UNICEF) and the World Health Organization (WHO), new training programs for child-care workers which will incorporate the experience and research findings from various countries. These should demonstrate the critical importance of individual attention and sensory stimulation for infants from their earliest days, in order to enable normal intellectual development;
· Encourage existing independent efforts to provide foster care in families, and pursue a policy for the gradual deinstitutionalization of orphans. But given the alarming rates of widely reported domestic violence in Russia, and the potential for misappropriation of large-scale subsidies, the Russian authorities must proceed with extreme care to develop strict screening and monitoring criteria before launching a national program of foster care and domestic adoption;
· Undertake a comparative analysis of the costs of institutional care versus subsidized home care for families who abandon children for reasons of economic hardship. The authorities must make the maximum effort to discourage poor families from leaving their children in state care, which some experts calculate to be at least twice as expensive as subsidizing the child's care at home;
· Undertake a similar analysis of the relative cost of institutional care and subsidized home care for children with congenital conditions such as Down syndrome, cerebral palsy, and other disabilities. The Health Ministry in particular must immediately cease to advise families to abandon their children in the maternity ward, and instead enable them to raise them at home with the help of re-allocated state funds;
· In the meantime, ensure that adequate salaries are offered to orphanage staff, who should be recruited carefully for their professional competence, integrity, and respect for children's dignity; and
· All institutions for abandoned children or children with disabilities should be required to provide access to their financial records, budget, and staffing data to any member of the public upon request. Ministerial budgets for such institutions, including amounts allocated per institution and per child for housing, medical care, food, and clothing should likewise be public records available on demand.
To the United Nations
· The U.N. Committee on the Rights of the Child and UNICEF should strongly urge the Russian government to begin the process of gradually closing the psychoneurological internaty in favor of alternative models such as family sized foster care and adoption;
· The U.N. Committee on the Rights of the Child should investigate conditions in the institutions for Russian orphans run by the Ministries of Health, Labor and Education. This delegation should concentrate on egregious violations of the CRC, including the extreme deprivation of orphans labeled oligophrenic as infants; the denial of corrective surgery to orphans labeled oligophrenic; and cases of misdiagnosis at the age of four which have resulted in the denial of education to tens of thousands of orphans;
· The U.N. Special Rapporteur on Torture should investigate conditions in Russian institutions, including those run by the Education Ministry for children from five to seventeen years old. Various forms of inhuman and degrading treatment and punishment should be investigated, including excessive use of isolation, restraints, sedatives, and psychiatric hospital stays for children who attempt to run away from the orphanage. For older children, the U.N. SpecialRapporteur should place high priority on investigating patterns of punishment-by-proxy: physical and psychological abuse committed by directors and staff through the instigation of favored children against other ones;
· UNICEF and the U.N. Committee on the Rights of the Child should assist the government to develop its campaign to dispel widespread prejudice and ignorance about abandoned children and children with disabilities; and
· UNICEF should develop an information campaign to inform children in state orphanages about the few emergency "hot lines" available for children in some Russian regions.
To the Council of Europe
· The Parliamentary Assembly should appoint a rapporteur or instruct rapporteurs for the Monitoring Committee to investigate conditions in the institutions for Russian orphans.
· The Committee for the Prevention of Torture should investigate conditions in institutions for Russian orphans. Various forms of inhuman and degrading treatment and punishment should be investigated, including excessive use of isolation, restraints, sedatives, and psychiatric hospital stays for children who attempt to run away from the orphanage. For older children, the Committee should place high priority on investigating patterns of punishment-by-proxy: physical and psychological abuse committed by directors and staff through the instigation of favored children against other ones.
To Donor Governments
· Use all available influence to urge the Russian authorities to undertake an immediate investigation into the violations of children's rights in state-run orphanages and to bring offenders to justice;
· Earmark funds for training of various categories of staff for baby houses, psychoneurological internaty and institutions for "educable" children. Projects should include supporting professionals from selected countries with humane child welfare systems to spend several months as resident trainers in Russian institutions;
· Earmark funds to support the work of existing independent treatment centers for children with disabilities, which provide alternative "second opinion"diagnoses and daytime rehabilitation which enables parents to raise their children at home;
· Earmark funds for independent Russian NGOs to work with the government in launching a nationwide public education program to disseminate the U.N. Convention on the Rights of the Child and U.N. standards for persons with disabilities and mental retardation. This program should highlight the equal rights of children who are abandoned and those with disabilities;
· Earmark funds for independent Russian NGOs working in the field of child welfare and children's rights to assist orphans in filing grievances; and
· Establish a strict independent oversight mechanism for monitoring and auditing disbursement of all donated funds to ensure their intended use.
To Nongovernmental Organizations
· Nongovernmental organizations that provide assistance to Russia, including humanitarian groups and adoption agencies, should press for an end to ill-treatment and discrimination against abandoned and orphaned children and for transparency in the management of children's institutions.
II. THE ODYSSEY OF A RUSSIAN ORPHAN1
We did a lot of art in the dom rebyonka (baby house). The children were begging us to hang their paintings over their bed. The staff took the paintings and we never saw them again. They said that these children are being raised in state institutions and would always be in groups the rest of their life. No reason to pamper them with personalized things now, because they wouldn't be allowed such things later in life. And that would only make problems. This mentality is so entrenched.2
Russian institutions are bursting with abandoned children, who now total more than 600,000 children who are defined by the state as being "without parental care."4 During each of the last two years, more than 113,000 children have been abandoned, reflecting a breathtaking rise from 67,286 in 1992. Another 30,000 arereported to run away from troubled homes each year, clogging the urban railway stations and metros, sometimes ending up in shelters and orphanages.5
Since the collapse of Soviet rule in 1991, these children have become the jetsam in Russia's stormy economic transition. Their families are often poor, jobless, ill, and in trouble with the law; this burgeoning class of abandoned children has come to be called "social orphans"-indicating that ninety-five percent of abandoned children have a living parent.6
Official statistics on abandoned children abound, and the figures gathered from various official sources often do not correspond. The institutions that care for children span three government ministries, and the categories listed in statistical tables either overlap or are so vaguely defined as to make a fine breakdown of numbers extremely difficult. 7
According to compilations published by UNICEF in 1997, some 611, 034 Russian children are "without parental care." Of these, 337,527 are housed in baby houses, children's homes, and homes for children with disabilities.8 According toa Russian expert in their field, the latter figure includes children living part-time at home, and the full-time orphan population in institutions is closer to 200,000. Of these, at least 30,000 are committed to locked psychoneurological internaty for "ineducable" children, run by the Ministry of Labor and Social Development.9
The remaining number, according to government tables, are placed in alternative custody, including group homes and other guardianship perhaps with members of a child's extended family. Although some tables list foster care as one of the alternative forms of custody, an international child development specialist told Human Rights Watch that there are only several hundred children living in family-sized settings, and that the standard "foster care" involves larger groups.10 Human Rights Watch commends the few pilot programs in foster care that have begun in Russia and urges speedy development of further projects that provide humane alternatives to large institutions.
It was beyond the scope of this report to conduct a full investigation of the many categories of institutions. But based on reliable sources most familiar with custodial care for abandoned children, Human Rights Watch has focused on three classes of institutions for this report: dom rebyonka, dyetskii dom, and psychoneurological internat.
Archipelago of closed institutions
Orphans in Russia are herded through a maze of state structures operated by three government ministries, which compete for limited state funds and overlap in their mandates for certain categories of orphans and children with disabilities. The Ministry of Health is charged with the care of abandoned infants from birth toroughly four years of age, and houses them in 252 baby houses which are called "dom rebyonka," housing from 18-20,000 children.11
All abandoned infants spend their first three to four years in a baby house, and are then distributed to institutions under the control of either the Ministry of Education or the Ministry of Labor and Social Development.12 Among those under the Ministry of Education, one group of children is deemed to have no disabilities, and the second group contains children diagnosed as lightly disabled, and officially termed "debil."
The most common institution for the "educable" children is called a dyetskii dom (children's home), which generally houses boys and girls. They generally attend regular Russian public schools for the compulsory nine years, where they can earn a secondary school diploma, or they can leave school at the age of fifteen.13
Abandoned children may also live in school-internaty, where they receive their education inside the institution where they live. Following secondary school, these children in the care of the Ministry of Education may receive two to three years of further training in a trade, which they pursue at another boarding institution under the Pedagogical Technical Directorate (PTU). While studying skills such as carpentry, electricity, masonry, and stuffed-animal making, among others, the children are housed in dormitories staffed by the Ministry of Education.14
At the age of five, the second group of orphans under the Education Ministry's purview-the debily-is channeled to spets internaty (or "auxiliary internaty"), where they reside while taking a significantly abbreviated course of education totaling six years, far short of a high school diploma. They are also offeredvocational training, but their program and residence are generally segregated from the non-debil orphans.15
Under Russian law, the state must provide all orphans leaving the care of the Education Ministry with an initial stipend, housing and employment. But the economic crisis since the introduction of market reforms and privatization of apartments makes this increasingly difficult. Indeed, the prospect of life in the outside world is a source of great worry to the orphans and child welfare experts alike.16
The Ministry of Labor and Social Development takes charge of orphans who are diagnosed by a board of state medical and educational reviewers as having heavy physical and mental disabilities at the age of four. Officially labeled "imbetsil" or "idiot," they are committed to closed institutions which often resemble Dickensian asylums of the nineteenth century. There they remain until the age of eighteen. Those who survive to that age are transferred to adult psychoneurological internaty, or asylums, for the duration of their lives. 17
Fragmentary statistics on the mortality rates in the institutions under the Ministry of Labor and Social Development indicate that these orphans are at significant risk of premature death. One leading child welfare advocate in Moscow told Human Rights Watch that estimates from government figures indicate the death rate in these internaty is twice the rate in the general population. He also knows one internat where he said that the death rate rose to as high as three and a half times the rate in the society outside its walls.18
While we were not able to obtain government statistics to corroborate these estimates in Russia, we noted that UNICEF researchers found higher death rates in these psychoneurological internaty across most of the former Soviet bloc.19 A1996 national statistic from Ukraine indicated that "approximately thirty percent of all severely disabled children in special homes-a staggering figure-die before they reach eighteen." 20
While UNICEF acknowledges that many of these children are at increased risk from their underlying conditions, it attributes part of the high mortality figures to crowding, poor hygiene, and low standards of care.21
Soviet-era policies and practices persist in Russian institutions. Renowned for its centralized control, the sprawling system of internaty for abandoned children was inspired by the Soviet philosophy favoring collective organization over individual care, and the ideal that the state could replace the family.22 Regimentation and discipline were integral to this philosophy, and restricted access to the institutions apparently permitted the director and staff to operate with impunity.
While most Russians who left their children in state care during the late Soviet period did so for such reasons as poverty, illness, and family problems, a certain proportion of children came from working parents and students who used the orphanages as weekly boarding institutions and retrieved their children during the weekend.
This was considered normal practice, according to the long-time director of a Moscow baby house, who told Human Rights Watch how university students would house their infants with her sometimes for two to three years:
We had families who had three kids who stayed here, then the parents finished studies and picked up the kids and left to go back home with them. We actually considered it to be fine. They were normal parents. They came and breast-fed them. In only one case the mother threw away (gave up) her child after six months.23
The contrast between the doctor's attitude toward children who had parents to visit them and those who were fully abandoned, illustrated the deep bias against orphans and their parents that endures today.
Orphan care varies broadly across Russia, making it very difficult to draw conclusions about cities, regions, or even classes of institutions. For much of this century, for example, Moscow has been a world apart from anywhere else in the sprawling country, and this gulf has widened dramatically with the lifting of market controls in recent years. In matters of public funding, children's institutions in the capital and several other main cities enjoy higher levels than those in the regions of Mordovia, Tver' and Smolensk.24
But even the USSR, in its idiosyncratic way, was a land of exceptions. Orphanage directors, like the bosses of factories and vast collective farms, enjoyed considerable discretion over their domains. The director's personal commitment to children's welfare worked to the favor or to the detriment of the orphans. Human Rights Watch learned of compassionate, energetic directors with imagination and pluck who sought out child welfare information from the West, and took the initiative to improve their institutions by raising money locally and training their staff.
The result today is a hybrid of the former centralized system and low-grade anarchy, which also applies to the uneven enforcement of laws and standards protecting children introduced by the Russian Federation since 1991. This is complicated by the process of decentralization generally unfolding in the government ministries that oversee the institutional care and the diagnosis of children.
Among the positive consequences of the transitional period of the 1990s has been the initial access to institutions by charities and professionals, bringing assistance and information. The most marked improvement in the physical conditions is seen in the baby houses, which have received substantial assistance from international adoption agencies.
But one of the negative effects of this low-grade anarchy is that while abuses in the institutions may be exposed, children's rights advocates report that many more go unreported and there is an absence of accountability between central and local jurisdictions.
For all these reasons the findings from our mission do not apply to every orphanage in Russia. Variations and exceptions abound in every respect, from the circumstances leading to the abandonment of an infant, to the education, health and course of development enjoyed by or denied a child.
There are general contours to this landscape, however, and the following section is offered to help navigate through the tunneled world of Russian orphans. It presents their odyssey in terms of the best and worst prospects that the state offers an abandoned child. It is followed by a discussion of variations, and the prevailing prejudices and attitudes that foster the violation of these children's rights.
Odyssey of a child
Type 1: Best prospects for a child abandoned at birth and healthy
In this case, a child is born at a state-run hospital or maternity ward and is left there in the hands of the Ministry of Health. The staff of the maternity ward will observe the child, giving him or her various medical and developmental diagnoses based on what it known of the family history and birth.
According to Russian medical practice, all risk factors are listed on any infant's chart under the initial diagnosis, and the high risks of many orphans win them a diagnosis of at least "delayed." Within a few weeks, all infants, except those who require immediate hospital care, are transferred to state-run baby houses where they reside for roughly four years.
Even in the best case, children who are closest to normal health at birth become retarded to some degree after these four years of collective living, deprived of individual nurture. An alarming number of less resilient infants seem to succumb to a self-fulfilling diagnosis of retarded.25 This puts them at a distinct disadvantage at the age of four, when all institutionalized children are evaluated by the state Psychological-Medical-Pedagogical Commission of the Ministry of Education for distribution to institutions for children five years old and up.26 The evaluation, which becomes an official "diagnosis" entered into an orphan's record, is often based on the visiting commission's one-time session with the child.27
It is impossible to overstate the crucial importance of this test to an orphan's future. It is a crossroads which routes the child either to a life of limitedopportunities, or to a life of doom. Many Russian experts interviewed by Human Rights Watch sharply criticized this process, and could readily identify children who were certainly misdiagnosed. Although Russian law provides for the child to appeal through his legal guardian, it is almost impossible for a four-year-old in the custody of the orphanage director to lodge a complaint.
In the best case-if the toddlers clear this hurdle-they will be channeled into an orphanage in the Education Ministry system. There they will receive nine years of public education, learn a vocation, and get a job and place to live after the age of eighteen.
In general these children will enter the tunneled domain of state institutions, where they will inhabit a stultifying world apart from society at large. Orphans in Moscow told Human Rights Watch that their public school classmates teased them as "dyet-domovskii" kids. 28 Upon returning to their dyetskii dom after a school day, the orphans are once again in their separate world, where they find a dubious haven. Teenaged orphans in Moscow and St. Petersburg interviewed by Human Rights Watch reported several categories of abuse they had suffered or witnessed. They said that children with no parents are treated more harshly than those whose parents are in touch with them. Punishment by the director and staff may involve physical assault, verbal abuse, public humiliation (for example forcing children to strip in front of peers), isolation in unheated rooms in winter, or standing naked in front of an open window in winter. Runaways from the orphanage are often regarded as abnormal and sent to psychiatric hospitals.29
Brutal treatment is not confined to direct confrontations with adults, however, for they encourage older children to beat up, bully, intimidate and coerce the younger ones.30 Orphans interviewed by Human Rights Watch had abundant episodes to recount, including punishment by proxy. Not only are they brutalized by this, they are socially stunted, and poorly prepared for a decent life as adults in the outside world.
When the orphans graduate from their world of the dyetskii dom, they face a "new Russia" in such social upheaval and economic disarray that it is distressful for those who have grown up in it. Gone is the social safety net of the Soviet era which at least guaranteed orphans housing, employment and a place in the army. Now, as a diplomat in Moscow told Human Rights Watch, "Their passport is marked with "dyetskii dom" so that people always know they were from orphanages. They have no one to turn to when they're unleashed at eighteen. Some have never ridden a metro before or been to a store or anything. A lot of them end up on the streets."31
Type 2: Worst prospects for a child abandoned at birth and disabled
A baby born with physical or mental disabilities in Russia faces the worst prospects if he or she is abandoned at birth. Some of them have only physical disabilities, or minor mental retardation and could learn to walk and talk, read and write. Among these are children with mild Down syndrome, cerebral palsy, and correctable conditions such as club foot and cleft palate.
Numerous parents are routinely pressured at the maternity ward to give up such infants.32 After initial observation they are transferred to baby houses where the children classified with severe physical and mental disabilities are segregated into lying-down rooms. Confined to cribs, staring at the ceiling, these babies are fed and changed, but they are deprived of one-to-one attention and sensory stimulation and are not encouraged to walk or talk. However tentative their diagnosis of retardation was at birth, particularly for those who have only physical disabilities, it becomes self-fulfilling by the age of four.33
In the worst case, these babies fail the diagnostic evaluation of the Psychological-Medical-Pedagogical Commission at the age of four and are handed over to the Labor and Social Development Ministry. There they are interned in closed internaty for imbetsily and idioty, where there is little more than a perfunctory classroom to keep some of the children busy for a few hours a week.
The bedridden children from the baby houses are again confined to cots in lying-down rooms, often laid out on bare rubber mattress covers, unclothed fromthe waist down and incontinent, as we witnessed in one internat and heard in credible reports from volunteers working in many state institutions.34
Human Rights Watch saw children who were considered "too active" or "too difficult" being confined to dark or barren rooms with barely a place to sit. The staff tethered them by a limb if they believed they might try to escape, and restrained others in makeshift straitjackets made of dingy cotton sacks pulled over the torso and drawn at the waist and neck.35
Children with Down syndrome and other hereditary conditions are regularly passed over for corrective-heart surgery that is routine in the West, based on a long-held bias against spending medical resources on children judged as "socially useless."36
The orphans who survive to the age of eighteen move on to an adult internat, again removed from public view. Some, however, are housed in huge centers with hundreds of handicapped people across the age spectrum and where older inmates feed and care for younger or more disabled ones.
Variations on these cases
There are scores of variations on the two types of journeys followed by Russian orphans. For instance, some children are abandoned after living several years at home. As one baby house director told Human Rights Watch, this can occur in the case of severe disability, when a family struggles for a while to raise their child themselves:
If the mother decides to keep the child, after three years, maybe, she loses her job. The state subsdidies are minimal. The man might leave her. While the child weighs under twenty-two pounds, she can carry him. But then the baby grows, more care is needed and she has less money, and her physical and moral strength is getting weaker. We know instances where those cases will be found locked in a dark room in an apartment, because the mother had to goto work to feed her children, because the monthly pension for having a disabled child is really miserable-200,000 rubles (U.S. $30).37
Not all variations are so bleak. Volunteers and child development specialists in Russia told us about an increasing number of children who are being kept an extra year or two in the baby houses in order to improve their chances of passing the commission evaluation and avoid banishment to a psychoneurological internat. In addition, not all the children in baby houses are neglected equally, as certain children have winning personalities or attractive characteristics that encourage the staff to devote more attention to them.38
Finally, all children have their individual constitutions, which miraculously navigate some of them through the harshest circumstances, and help them not only to survive, but thrive.
Prejudice against orphans: a legacy of ignorance and fear
At the heart of the systematic abuse and neglect suffered by orphans in Russia lies a deep tradition of ignorance and fear. Time and again people told us, repeating like a mantra, how the Soviet ideology promoted the quest for the perfect Soviet man. As Dr. Severny explained, "All children and everyone had to meet the standard, and if they did not meet the standard, they had to be kept apart and hidden from the rest."39 Children with disabilities were not seen in public, and the myths associated with them flourished.
The effort to hide such children from the rest of society reflects a "deep, deep prejudice and fear of handicapped people in general," according to a journalist who has worked extensively on the issue of disabilities and orphans in Moscow.40 The process begins in the maternity ward, only hours after the infant is delivered: "That's where the doctors tell the parents, who are already in shock from the birth of a child with difficulties, that the child will never walk, will never talk, will droolall his life. They encourage them to give the child up. They terrorize them. And they also associate disabilities with moral shortcomings of the parents, and make the parents feel guilty for something they must have done."41
One of the most pernicious consequences of this prejudice is that it taints all abandoned children in Russia, despite the fact that the issue has been discussed and debated abundantly in the Russian press for several years. A clear summary of this point appeared in an article exploring local biases against adopting a baby abandoned by a stranger.
The fear that the child will in some way be "damaged goods" stems from the knowledge that mothers of mentally and physically handicapped children are routinely advised by doctors to put their baby in an orphanage and "try again." Consequently, healthy babies who are given up for financial or domestic reasons are unfairly branded "defective."42
That Russians often regard orphans as "not really human" corroborates numerous interviews we had with the sanitarki in Internat X and with press articles we reviewed for this report, in underscoring the notion of genetic determinism that informs both lay people and orphanage staff.43
We found an alarming number of references in the Russian press to disabled orphans as "not really human." A sympathetic explanation was offered to us by a Russian journalist who has followed the problem closely:
I'm sorry to say, you will hear terrible things about orphanages and they are probably true. It is a really large scale problem. The staff sees them as animals. We saw it. Even the nannies who "love" them, treat them mostly-really like pets. They do not really see that there is a person inside who could think, or learn something.
Recently there was an article in a Russian paper about a baby house where kids with defects live. A few days later the readers wrote a reply, that these kidsshould be killed. "We don't want to see them," they said. People are not ready to share any money with those that are disabled. They believe they're not really human beings. It's terrible, I know.44
Such views are hardly the most shocking to be expressed in the Russian press since the appalling conditions of psychoneurological internaty were revealed several years ago. In 1993, an article in a Moscow daily quoted a letter that had appeared in a leading Russian weekly from the mother of a child with Down syndrome. The letter was entitled, "Why Coddle Such Freaks?," and it read, "I am asking the doctor to put my child to sleep. I have been told that we have humaneness in our country," she wrote. "We have humaneness-so we let them live?"45
Fear to expose the truth
Reinforcing the legacy of ignorance and fear of orphans is the pervasive fear of exposing abuses of children's rights, all the way from the time that parents are terrorized into leaving their child in that ward, to the years when the children are beaten up and bullied in the dyetskii dom. One former charity worker who helped distribute private donations to many baby houses summed up what others told Human Rights Watch:
If you expose everything, they will shut down the institution to outsiders. No one says to open it up to scrutiny, because there's no faith in the justice system. No top heads will roll. So keep quiet.
They have a saying in Russian, "Tishe yedesh, dal'sho budesh," which means, "The more quietly you go, the farther you go." The nail that sticks up highest gets hit first. The kids can't talk either; keep them far enough away that nobody knows. These are all stewing grounds for enormous amounts of pathology.46
In another interview, the Russian journalist Marina Stepanova further illustrated the power of an orphanage director to punish staff who share information with outsiders:
We were told last time that the nurses who talked with us were fired, but the director stayed on. When we were there in the winter of 1997, the nurse told me that people came with stuffed animals, and the next day they were for sale in the market. It's quite clear that the kids are being deprived of food. We brought five cartons of yogurt, and the best they will get is two. This orphanage system has to be changed at the top.47
1 For purposes of this report, the term "orphan" refers to children who are abandoned to the state, including the vast majority of "social orphans" whose parents are living. It is used interchangeably with the term "abandoned children." Children with severe disabilities are frequently mentioned throughout this report, because they often become abandoned children and thus enter the population of "orphans."
III. RELEVANT INTERNATIONAL AND RUSSIAN LAWS
States parties shall take all appropriate legislative, administrative, social and educational measures to protect the child from all forms of physical and mental violence, injury or abuse, neglect or negligent treatment...while in the care of legal guardians or any other person who has the care of the child.
- The Convention on the Rights of the Child. Art. 19 (1)
Starting from their abandonment, Russian children in orphanages are deprived of basic human rights at every stage of their life-from the most fundamental right to survival and development, to their rights to humane treatment, health, education, and full enjoyment of civil rights. These rights are interlocking, and their violation has a compounding effect, consigning these children to truncated lives in a permanent underclass. This chapter address the legal basis of these rights, in the major international human rights instruments to which Russia is a party, in non-binding international standards pertaining to medical ethics, disability, mental illness and the treatment of juveniles in detention, and in Russian law.
Abandonment and Disability as a Basis for Invidious Discrimination
There is little doubt that the more than half-million children registered as orphans in the Russian Federation suffer acute social discrimination and endemic denial of their civil, political, economic, social and cultural rights, particularly in comparison with children who live with their families. The simple fact of abandonment or orphanage propels children into an institutional system that prejudices their physical, emotional and mental development; it denies them appropriate health care, education, and puts them at serious risk of physical and mental abuse inflicted or tolerated by state employees in the name of discipline. Most significantly, the fact of abandonment and orphanage stigmatizes them for life, a stigma that is memorialized in official identity documents and from which they cannot escape as they seek employment and a normal life in the community. The stigma of abandonment is reinforced and compounded by the popular assumption that such children must have inherited mental deficiencies and deviant personalities to have caused their parents to abandon them, an assumption particularly likely if they come from poorer or troubled families. Often they are quickly classified as retarded by medical personnel, adding a second burden of discriminatory status as "disabled." Even those considered "normal" graduate intosociety under a heavy burden of educational and social retardation in comparison to their peers, and suffer the stigma of their childhood origin for life.
Children who have genuine physical or mental disabilities, or who are improperly classified as such, suffer discrimination so intense that they are denied the opportunity to develop to the best of their abilities, and indeed, they are often subjected to such extreme neglect, prejudice or abuse that their very lives may be endangered.
International law specifically prohibits invidious discrimination that denies rights to certain classes of people because of inherent social characteristics. Major international human rights instruments to which Russia is a party, including the International Covenant on Civil and Political Rights, the International Covenant on Economic, Social and Cultural Rights, and the Convention on the Rights of the Child, all prohibit discriminatory denial or abridgment of rights on the basis of race, color, sex, language, religion, political or other opinion, national, ethnic or social origin, property, birth, "or other status."48 Discrimination against a child because of circumstances such as orphanage or abandonment, depending on the facts, could fall into the category of discrimination on the basis of social origin or even birth. In any event, such circumstances are embraced by the term "other status," which is intended to be construed broadly as applying to qualities of human identity similar to those of race, sex, language, religion, opinion, national or social origin, property, disability or birth. The international bodies that interpret the covenants on civil and political rights and on economic, social and cultural rights have both laid particular emphasis on protection of the rights of abandoned or institutionalized children, highlighting their understanding that this circumstance should never be considered a permissible basis for discrimination. The Human Rights Committee, for example, has specifically required states to report on "the special measures of protection adopted to protect children who are abandoned or deprived of their family environment" with the understanding that economic, social and cultural measures must be taken to ensure that all children develop in such a way as to be able to enjoy their civil and political rights.49 The Committee on Economic, Social and Cultural Rights and the Committee on the Rights of theChild have likewise highlighted the state's duty to ensure a minimal level of economic, social and cultural rights to all children, including those who are disabled or institutionalized.50
Disability, a quality frequently assumed to be the reason behind parental abandonment in Russia, has been consistently interpreted as an impermissible grounds of discrimination on the basis of "other status." The Committee on Economic, Social and Cultural Rights, a United Nations body which interprets and evaluates state performance under the International Covenant on Economic, Social and Cultural Rights, has concluded that the prohibition of discrimination "clearly applies to discrimination on the grounds of disability." The Human Rights Committee, the body which monitors state parties compliance with respect to the International Covenant on Civil and Political Rights, has enjoined states to provide information specifically on measures of protection for children "who are abandoned or deprived of their family environment." The Convention on the Rights of the Child, of more recent origin than the previous two covenants and the most widely ratified human rights treaty in the world, specifically lists "disability" as a prohibited grounds of discrimination.51 For the above reasons, Human Rights Watch considers that denial or abridgment of fundamental human rights to children who have been abandoned or orphaned, and who may or may not suffer a mentalor physical disability, is a violation of the most basic tenets of international human rights law.
The Decision to Institutionalize The Child
The right to a family52
The starting point for the cycle of abuse these children face is their abandonment by their parents and entry into the closed world of institutional life. The major human rights instruments-The Universal Declaration of Human Rights, and the "international bill of rights" comprising the two covenants on civil and political rights, and economic, social and cultural rights-all recognize the family as "the natural and fundamental group unit of society" which is "entitled to protection by society and the State."53 The Convention on the Rights of the Child specifically provides that the child has from birth "the right to know and be cared for by his or her parents," the right to "preserve family relations as recognized by law without unlawful interference."54 The Committee on Economic, Social and Cultural Rights has interpreted the injunction that states render assistance and protection to the family as the fundamental social unit as requiring that states do everything possible to enable disabled persons to live with their families.55 Two non-binding instruments approved by the U.N. General Assembly, the Declaration on the Rights of Mentally Retarded Persons and the Declaration on the Rights of Disabled Persons, respectively provide that institutionalization of such persons is acceptable only where "necessary" or "indispensable" and otherwise recognizetheir right to live with their family or foster parents, who in turn are due assistance and support from the state.56
Yet instead of providing support, the norm is for state medical personnel to urge parents to abandon children showing any evidence of disability, even when the disabling condition is relatively manageable or susceptible to therapeutic treatment, such as hare lip (cleft palate) or minor cerebral palsy. Indeed, the rationale generally given by medical personnel to the parents is that parents who undertake to raise a disabled child at home risk becoming social pariahs.
Arbitrary deprivation of liberty
Although institutions may, as a last resort, substitute for the family in the case of orphaned or abandoned children, institutionalization inevitably entails an extra degree of restriction of the child's right to liberty. International instruments recognize that institutionalization is a "least favored" option, below keeping the child with the family or placing the child in a foster family or similar environment or encouraging domestic or international adoption.57 In all Russian institutions for abandoned children, boys and girls are generally removed from the greatercommunity and normal social contact; in institutions for the care of moderately to severely disabled children, the restriction of liberty can be extreme, with children locked into rooms, tethered to furniture, or confined to bed until their transition to even more draconian institutions upon adulthood.
The right not to be arbitrarily deprived of liberty is fundamental, recognized in the Universal Declaration of Human Rights,58 the Convention on the Rights of the Child59 and the International Covenant on Civil and Political Rights.60 The right to liberty is derogable under the last treaty only in times of a public emergency declared by the state which threatens the life of the nation;61 limited financial or technical resources do not alone constitute the conditions for such an emergency.62 Detention is "arbitrary" even when sanctioned by existing law where it is imposed in a manner that is unjustified, disproportional, capricious, or without due process. Given that institutionalization may be the only means to protect the health and welfare of some children, at least during a transitional period to more humane community-based alternatives, what sort of controls are required under international law to ensure that decisions to confine the child are reasonable, proportional, and subject to periodic and independent evaluation?
With regard to the child who has been placed in institutions for the purpose of care or treatment of physical or mental health, the Convention on the Rights of the Child requires that he or she has the right to "a periodic review of the treatment provided...and all other circumstances relevant to his or her placement." It further provides, "Every child deprived of his or her liberty shall have the right to prompt access to legal and other appropriate assistance, as well as the right to challenge the legality of the deprivation of his or her liberty before a court or other competent, independent and impartial authority, and to a prompt decision on any suchaction."63 For this right to be meaningful, the child must have recourse to adults who can act independently and in the child's interests to initiate review or challenge of a decision of confinement to any particular institution.64
The importance of an independent advocate for the child's interest is vividly illustrated by the fact that it is generally only those institutionalized children retaining contact with their families or acquiring a friendly advocate within the system that can challenge either a diagnosis as mentally impaired or their placement within the institutional track. The directors of orphanages, while potentially advocates for improperly confined children, cannot be presumed to act independently and in the child's best interests, given that they receive additional state subsidies for children with disabilities and thus have a direct conflict of interest with the child. Nor is there any evidence that Russian children with disabilities are able to challenge the initial decision to institutionalize them with the help of available medical or social service officials, who appear often to pressure parents into abandonment rather than seek support to enable parents to keep disabled children.
The child's right to development
The Convention on the Rights of the Child recognizes "the right of every child to a standard of living adequate for the child's physical, mental, spiritual, moral and social development" in Article 27(1). While primary responsibility for supporting the child rests with parents, "[s]tates parties, in accordance with national conditions and within their means, shall take appropriate measures to assist parents and others responsible for the child to implement this right and shall in case of need provide material assistance and support programmes, particularly with regard to nutrition, clothing and housing" (emphasis added).65 The right of mentally and physically disabled persons to develop to the full extent of theirpotential is likewise well-established in international standards.66 The development of human potential in a physical, mental, spiritual and social sense embraces a wide spectrum of rights, some of which will be briefly discussed below.
The right to life
The child's right to life and survival, recognized by all major human rights instruments,67 is basic to any notion of development. In the context of civil and political rights, it often implicates the right to be free of cruel and inhuman treatment or other forms of life-threatening persecution, and in the context of economic, social and cultural rights, it often implicates the right to health and to basics such as adequate shelter, nourishment and clothing.
The right to health
The right to "the enjoyment of the highest attainable standard" of health is recognized by both the International Covenant on Economic, Social and Cultural Rights and the Convention on the Rights of the Child.68 Both instruments provide that economic, social and cultural rights shall be realized progressively, to the maximum extent of the state's available resources.69 However, there must be no discrimination in the allocation of health care, so that the inferior treatment of abandoned or disabled children is a clear violation of their rights. Moreover, thebodies that monitor implementation of these treaties have time and again drawn attention to the particular care due to vulnerable groups, such as children generally, and abandoned, disabled or institutionalized children in particular.70 It follows that where the state deprives individuals of liberty and assumes a custodial function, its responsibility to provide the means for basic rights such as food, clothing, medical care and physical security is at its highest.
Abandoned children in Russia's institutions frequently receive minimal or no health care, and scant attention to their basic needs, virtually ensuring they will achieve a debased standard of physical and mental development and health. Onthe rare occasions that they are sent to hospitals for treatment, they are relegated to a lower standard of care and attention for lack of a parental or institutional advocate. Misdiagnosis of mental and physical handicaps ensures that many children will suffer debased mental and physical health. In the most severe situations, children who are bedridden are not encouraged to develop motor skills but confined to "lying down rooms," in some cases left to die.71 Moreover, these deficiencies in care and treatment are largely remediable without any extraordinary allocation of resources; training and dedication to rehabilitation and nurture for institutional staff, medical personnel and parents would alone cause an immense and immediate improvement in the situation.
The administration of drugs or commitment of children to psychiatric institutions for non-medical purposes such as restraint, discipline or punishment is a particular abuse of medical ethnics and international law that persists in Russian institutions for disabled or abandoned children.72
The right to education
The right to education is another universally-recognized right considered fundamental to the development of human personality, and the exercising of civil and political rights.73 The provisions of the Convention on the Rights of the Child are particularly detailed, requiring that the right be achieved on the basis of equal opportunity, that primary education be made compulsory and free to all, and that secondary and higher education, as well as vocational education, be encouraged.74 Of particular relevance to Russia's institutionalized children is the Convention's statement that education shall be directed to "[t]he development of the child'spersonality, talents and mental and physical abilities to their fullest potential" and [t]he preparation of the child for responsible life in a free society".75
Children in standard Ministry of Education orphanages told Human Rights Watch that their schooling consisted of regular public school courses in mathematics, history, geography, Russian literature and so forth.76 But further interviews with child welfare advocates indicate that even within the public system, orphans are less likely to receive remedial assistance or private tutoring, and therefore leave school with a sub-standard education.77
Although children who are classified as only slightly retarded (debily) may receive vocational training in adolescence, such training inadequately prepares them for employment in adult life because of their reduced course of study, even when they are capable of achieving more. Indeed, this group rarely can earn high school diplomas since they generally receive only five or six years of compulsory education. Another of the concerns most often voiced during our interviews with a cross-section of Russian orphans and their caretakers was that a rigidly sequestered institutional life failed to prepare them to adapt to normal roles in society, let alone support themselves.
Even the little that these children receive is more than those who are officially labeled-accurately or inaccurately-as seriously handicapped or mentally retarded at age four. These children are deemed "ineducable," and warehoused for life in psychoneurological internaty where little or no physical or mental rehabilitation, or effort at basic socialization is attempted despite the clear requirement that these children be given education to maximize their potential.
And prior to this early triage, few infants and toddlers in Russia's baby houses receive the adult attention, stimulation and preparation in basic social skills that lay the critical foundation for all further cognitive development and capacity for education, making "retardation" in some form all but inevitable.78
Cruel, inhuman or degrading treatment and torture
The prohibition against cruel, inhumane or degrading treatment or torture is a peremptory norm of international law, codified in numerous treaties and not subject to derogation even in times of emergency.79 The distinction between torture and other cruel, inhuman or degrading treatment or punishment is one of degree and purpose: torture is recognized as an "extreme and deliberate" form of such treatment,80 and is intentionally inflicted on a person by officials at their instigation or with their acquiescence for reasons such as punishment or "discrimination of any kind."81 No malevolent intent is required to show perpetration of cruel, inhuman or degrading treatment; it is not a justification that such actions were taken for administrative convenience or lack of appropriate resources.
Children in Russia's institutions for children are subjected to cruel, inhuman or degrading treatment, which in its extreme forms may be described as torture inflicted because of the pariah status that abandonment or disability carry. This sort of abuse can occur in the context of "discipline" in orphanages, or routine administrative practices such as keeping children in isolation, physical restraints, or locked in cold, windowless rooms.
The Convention on the Rights of the Child specifically commands states to take measures to protect children "from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse, while in the care of parent(s), legal guardian(s) or any otherperson who has the care of the child."82 Children who become the victims of "any form of neglect, exploitation or abuse; torture or any other form of cruel, inhuman or degrading treatment or punishment" are entitled under the Convention on the Rights of the Child to "appropriate measures to promote physical and psychological recovery and social reintegration".83 This recovery is expected to take place "in an environment which fosters the health, self-respect and dignity of the child."84 Far from being institutions for the care, protection and treatment of abandoned children, Russian orphanages and internaty are often the locus of further abuse and neglect. The following sections describe a sampling of the treatment we have found violative of international law.
Many of the "normal" administrative practices found in institutions for mildly or severely disabled children amount to cruel, inhuman or degrading treatment. Tying children in sacks, tethering them to furniture, confining them needlessly to beds, warehousing them in barren and windowless rooms, denying them available food, keeping them in unsanitary accommodations or in inadequate clothing, denying them appropriate medical treatment-all these practices constitute cruel, inhuman and degrading treatment. Negligent practices that facilitate sexual and physical abuse of children either by other children or by staff also violate the state's duty to protect children in its care from cruel, inhuman or degrading treatment. Commingling of older children with younger, or boys with girls without proper supervision is common in Russian institutions, and sometimes facilitates such abuse.
We received numerous credible accounts of beatings being used as punishment for institutionalized children. In extreme cases, these incidents clearly amount to torture. It is noteworthy that even international standards on juveniles detained in the justice system forbid corporal punishment, placement indark cells, closed or solitary confinement, or any other type of punishment that may compromise the physical or mental health of the child.85
With regard to discipline, the Convention on the Rights of the Child provides that states parties shall "take all appropriate measures to ensure that school discipline is administered in a manner consistent with the child's human dignity and in conformity with the present Convention."86 That obligation is broader than the requirement that discipline not be "cruel, inhuman or degrading"; discipline must also comport with the Convention's aim to ensure the full development by each child of his or her individual potential and respect for the human rights of others.87 Yet the abuse of discipline is frequently extreme, involving elaborate orchestrations of humiliation by institutional personnel in ways that enlist other children to participate as abusers.
A signature feature of the violence used against Russian orphans, especially in the homes for "normal" children run by the Education Ministry, is the orchestration of corporal punishment by the director through the agency of older children. Human Rights Watch is deeply alarmed by the patterns of cruelty and malicious violence that orphans described during interviews in Moscow, St. Petersburg and Novgorod region-patterns mirroring the findings of lengthy investigations into the deadly hazing and gang-rule in the Russian military and prisons.88
Cruel, inhumane or degrading treatment may consist of verbal as well as physical abuse, or exposure to contempt and ridicule. In this sense, it is closely tied to violations of the individual's right to privacy, honor and reputation, a rightwhich pertains to children as well as adults.89 We encountered numerous instances where institutional staff openly discussed with us, in front of the child concerned, details of parental abandonment or disability in humiliating terms; even though personnel may have meant no harm, this was undoubtably cruel, or degrading for the child concerned. Even more obvious forms of humiliation and violations of privacy were reported by children in institutions under the Ministry of Education, including staff and directors stripping children naked, publicly mocking them, or ridiculing them as homosexuals.90
Human Rights Watch finds that few children bring formal complaints of physical and psychological violence by institution staff and older children, in part because they are uninformed of their rights and because they have no access to independent sources of legal advice. Given that the perpetrator is often the director or a staff member, the children also have little faith that the system would deliver justice. Those who do file complaints fear the real risk of retribution from the staff either directly, or indirectly through the favored children. Finally, some of the children we interviewed echoed a disturbing version of the famous rationalizations used by relatives of Stalin's victims: if the orphanage staff punished or beat them, there must have been a reason for it.91 Yet the right to make complaints of ill-treatment and have them addressed is a premise of human rights law, deriving from the state's obligation to "ensure" rights.92 Directors of institutions in theory shouldbe able to act in the interests of children with regard to such complaints, yet even if they are not implicated in the abuse, they may have a conflict of interest because of their relatively autonomous role in hiring and directing all institutional personnel. This points again to the need for children to have access to an independent advocate, separate from institutional personnel, who can intervene where necessary to protect the child's safety and pursue cases of abuse at all levels of the relevant administrative department and justice system.
Specific standards applicable to children with mental or physical disabilities
Children with mental or physical disabilities are doubly vulnerable, and thus recognized in international law as entitled to an especially heightened degree of protection. Some of the standards applicable to this group that are particularly relevant to the abuses discussed in this report are treaty obligations of Russia; others are non-binding standards approved by the U.N. General Assembly, which are nevertheless authoritative in state's duties with regard to the internationally recognized rights of the mentally or physically disabled discussed above.
The Convention on the Rights of the Child has explicit provisions on children with mental or physical disabilities at Article 23. It provides that states parties recognize such children "should enjoy a full and decent life, in conditions which ensure dignity, promote self-reliance and facilitate the child's active participation in the community." Moreover, states are obliged to "ensure the extension, subject to available resources, to the eligible child and those responsible for his or her care, of assistance" and such assistance "shall be provided free of charge, whenever possible". Assistance "shall be designed to ensure that the disabled child has effective access to and receives education, training, health care services, rehabilitation services, preparation for employment and recreation opportunities in a manner conducive to the child's achieving the fullest possible social integration and individual development, including his or her cultural and spiritual development." The institutional care that Russia offers children with disabilities is not merely inadequate, but is also not a cost-effective method of delivering services and support to children who could often be better served by remaining in a family setting.93
The Declaration on the Rights of Mentally Retarded Persons and the Declaration on the Rights of Disabled Persons, discussed above, contain importantstandards, including the principle that such persons have the right to, wherever possible, live with their families or in foster families and participate in community life;94 the right to medical treatment, education and rehabilitation to enable them to develop to the maximum their potential and capability;95 and the right to legal safeguards against abuse, due process and the assistance of a guardian or legal representative.96
Another important standard adopted by the U.N. General Assembly in 1990 is the Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care (hereinafter Mental Illness Principles).97 Diagnosis of the abandoned or disabled child as imbetsil and idiot is tantamount to a determination of mental illness. These Principles, explicitly founded on the International Covenant on Civil and Political Rights and the International Covenant on Economic, Social and Cultural Rights, set out detailed standards of protection, care, treatment and medication especially relevant to children in psychoneurological internaty.
Central to this instrument is the patient's right to be treated "in the least restrictive environment and with the least restrictive or intrusive treatment appropriate to the patient's health and the need to protect the physical safety of others."98 The mentally ill individual has the right to be treated and cared for, as far as possible, within his or her own community, and if treatment is in a mental health facility, that facility should be located near the patient's home or family,and the patient has the right to return to the community as soon as possible.99 "Medication...shall never be administered as a punishment or for the convenience of others."100
The Mental Illness Principles address the prejudicial effects of status as abandoned or disabled on the cycle of diagnosis and further discrimination. Under Principle 4(2), "A determination of mental illness shall never be made on the basis of political, economic or social status, or membership of a cultural, racial or religious group, or any other reason not directly relevant to mental health status." With regard to Russia's practice of keeping children institutionalized without further meaningful evaluation after the critical triage at age four, Principle 4(4) states "A background of past treatment or hospitalization as a patient shall not of itself justify any present or future determination of mental illness."
This instrument is also very explicit on the limits of use of physical restraints and involuntary seclusion. Neither may be used except "when it is the only means available to prevent immediate or imminent harm to the patient or others" and restraint and seclusion "shall not be prolonged beyond the period which is strictly necessary for this purpose." A personal representative of the patient must be notified of any incidents of restraint or seclusion; such incidents shall be recorded in the patient's medical record; and patients subject to such measures shall be kept "under humane conditions and be under the care and close and regular supervision of qualified members of the staff".101 The Mental Illness Principles are especially strong on the right of redress for abuses. Every patient and former patient has a right to make complaints, and states are obliged to provide mechanisms for monitoring compliance with the Principles, submission, investigation and resolution of complaints, and institution of disciplinary or judicial proceedings for professional misconduct or violation of a patient's rights.102
One of the most recent standards adopted by the U.N. General Assembly is the Standard Rules on the Equalization of Opportunities for Persons with Disabilities(Equalization Rules).103 These Rules are unique for the particular emphasis they lay on involving the families of persons with physical and mental disabilities in virtually every aspect of public policy, education and treatment, and in recognizing the importance of organizations of persons with disabilities in these functions and in advocacy. Rule 1 emphasizes "awareness-raising" in the sense of public education and education specifically directed at children and teachers to dispel prejudices that impair children with disabilities in enjoying their rights, to inform on the programs and services available to them, to emphasize their equal rights, and to educate the public and professionals on the potential of persons with disabilities. The Rules also provide for equal medical care for infants and children with disabilities in relation to other members of society (Rule 2.3); equal educational opportunities (Rule 6); and the state's duty to enable them to live with their families (Rule 9.1).
Finally, international standards of medical ethics pertaining to the detained are also pertinent to the situation of institutionalized children. The Principles of Medical Ethics relevant to the Role of Health Personnel, Particularly Physicians, in the Protection of Prisoners and Detainees against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (hereinafter Principles of Medical Ethics) speak to several of the particular abuses suffered by children in Russia's orphanages. Principle 2 enjoins health personnel from engaging "actively or passively, in acts with constitute participation in, complicity in, incitement to or attempts to commit torture or other cruel, inhuman or degrading treatment or punishment"; and principle 5 bars the use of restraints or drugs if not based on purely medical criteria and not necessary for the health and safety or protection of the person in detention.
Russian law forbids the kind of discrimination that abandoned children face. Its generous entitlements-at least on paper-to children, to children in institutions, and to children with disabilities is at variance with the sordid conditions and neglect in which they often live.
The Constitution of the Russian Federation is the primary document that enshrines the ban on discrimination, which is repeated in relevant laws on education, health care, and the rights of people with disabilities. It also upholds the right of all citizens to such social and economic benefits. Article 19 states unequivocally:
(1) Everyone shall be equal before the law.
(2) The state shall guarantee the rights and freedoms of the individual and citizen without regard to gender, race, nationality, language, origins, property or official position, place of residence, religious orientation, convictions, membership in public associations and other circumstances. Any restrictions on the rights of citizens on social, racial, national, linguistic or religious grounds shall be forbidden.
Article 39 of the constitution guarantees the right to social security "in case of disease, disability, loss of a breadwinner [kormilets], for the rearing of children and other circumstances established by law"; Article 40 upholds the right to housing and mandates that the underprivileged receive housing free of charge; Article 41 upholds the right to health care free of charge in state and municipal establishments; and article 43 upholds the right to primary and secondary education that is accessible and free of charge.
Article 38 places the family "under the protection of the state."104 The family code in Article 54 declares the right of the child to be reared in a family "to the degree that this is possible."105 Article 123 of the family code sets out three forms of caring for abandoned or orphaned children-adoption, wardship (pod opyeku, or popechitel'stvo), or foster care (priyemnaya semya); or, in the absence of these opportunities, care in an institution. The family code does not declare affirmatively that a family environment is the preferred solution for placing and rearing abandoned children. Numerous laws and regulations, however, attempt to support rearing abandoned children or children with disabilities in the family by offering a variety of financial benefits in the form of monthly support payments, extra days off from work, and the like for families caring for children with disabilities and for foster families.
As stated above, Russian law regards education and health care as fundamental human rights, and basic laws on health care and education shouldserve to protect children with and without disabilities in orphanages from discrimination and poor care in both areas. The Fundamentals of Legislation of the Russian Federation on Health Protection (the Health Protection law)106 declares unequivocally that health protection is an inalienable right, and forbids discrimination on any grounds in the sphere of health care (Article 17).107 It specifically bans discrimination based on a person's "illness," and provides for non-specified sanctions for such discrimination. Article 20 of the Health Protection law requires medical care to be free of charge in state and municipal health systems. The law supports single-parent families and families with children with disabilities by opening the door to special entitlements.108
The law also specifies the rights of particular groups, including minors, servicemen, "invalids,"109 the elderly and the like. The section on the rights of minors (Article 24) enumerates various rights, such as "dispensary observation and treatment" . . . medico-social aid . . . sanitary-hygienic education . . . instruction and labor in conditions meeting their physiological needs . . ." It also establishes that parents or guardians may apply to the state to institutionalize minors with "physical or mental handicaps" at the expense of the state. The section on the rights of invalids generally enumerates the services and medicines to which they must have access free of charge. Of special relevance is Article 27(4), which allocates four extra working days per month to "one of the working parents or person acting in loco parentis for taking care of disabled children and invalids from childhood before they reach eighteen years of age."
The Federal Law on Education110 guarantees "accessible and free" primary and secondary education (Article 5.3). Secondary professional education and higher education are also free, but admission is on a competitive basis. While orphans and "handicapped individuals" can compete, the law makes no provision for supplemental assistance such individuals may need to compete fairly. The law mandates that the government is to provide financial assistance to children for the education of children in impoverished families and those handicapped since birth (Article 40.7).111
Guarantees to education for people with mental disabilities are weaker than those set out in the U.N. Convention on the Rights of the Child (Article 23) and in the United Nations Declaration on the Rights of Mentally Retarded Persons. Article 5.6 of the education law promises that the state will "create a situation in which they will receive an education based on special pedagogical methods, which will correct their developmental problems and advance their social adaptation." For this purpose, Article 50 .9 envisages "special educational establishments and classes." The Declaration on the Rights of Mentally Retarded Persons emphasizes the rights of people with disabilities to development "to the maximum of their potential and capability," and to "fullest possible social integration."
Children (with and without disabilities) in orphanages should also benefit from Russian laws that protect them as target groups as children, abandoned children, and people with disabilities. In July, the Russian Duma sought to strengthen the protection of children's rights by adopting the Law on Basic Guarantees of the Rights of the Child.112 Article 4 of this law declares that the aim of state policy on children is to realize their constitutional rights, by, inter alia, not permitting discrimination, and by assisting in the "physical, intellectual, mental, spiritual and moral development of the child." Article 8 of this law mandates "minimal social standards of indicators for a child's quality of life," which relate to social services responsible for guaranteeing accessible free primary and high school education, free medical services, professional orientation, and the like. Notably, Article 8.3 grants children in "establishments" such as health care establishments and educational establishments113 the right to a periodic review of services-by agencies authorized by the local government-provided to them in these establishments.
The Law on Additional Guarantees for the Social Protection of Child-Orphans and Children without Parental Guardians brings together in one piece of legislation provisions for budget allocations for orphans and abandoned children and a restatement of their rights to education, medical services, housing and judicial protection that were previously enunciated in many different laws. Examples of these include the right to free professional education, to circumvent entrance examinations for professional schools where admissions are on a competitive basis,an annual cash grant to purchase educational materials, and an additional student stipend not lower than 50 percent of the monthly minimum salary.
In its preamble, the Law on Social Protection for Invalids in the Russian Federation114 defines "social protection as "guaranteeing invalids the same rights and opportunities for realizing civil, economic political, and other rights and freedoms envisaged in the . . . [C]onstitution, and also with universally recognized principles of international law. . ." as other citizens. It further defines social protection as "a system of economic, social, and legal measures by which the state guarantees invalids the conditions for overcoming or compensating for limitations on their abilities and which are directed towards creating opportunities for them to participate in society equally with other citizens." Article 19 of the same law obliges the state to provide invalids free general education and professional training. Much of the law discusses the particular benefits and entitlements that accrue to invalids and the families or guardians who care for them.
Russian law criminalizes the "failure to fulfill obligations in child rearing", if this is combined with cruel treatment. Under Article 156 of the Russian criminal code,115 this may apply to parents, teachers, or staff of "educational, medical, or other establishment responsible for the care of a minor." Offenders are punished by a fine from fifteen to one hundred minimum monthly salaries or up to two years of imprisonment.
IV. THE "GILDED CAGE" OF THE DOM REBYONKA: INFANCY TO FOUR YEARS116
You'll see a child lying on a cot staring at the ceiling, obviously in terrible need of love-I have heard the staff say in all innocence to me, "We told the mother 'don't bother to come to visit.' The child doesn't understand anyway."117
Of all the institutions for abandoned children in Russia, the 252 baby houses for orphans from zero to four years of age have greatly benefited from a flood of international charity. Yet beyond the playrooms and dormitories brimming with donated toys and bright new furnishings, the minimal care and therapeutic intervention in most baby houses prompted one baby house doctor with decades of experience to describe the average institution as a "gilded cage."118 The evidence gathered by Human Rights Watch indicates that at this early stage in orphans' lives, their rights are systematically violated by prejudicial stereotypes; segregation and severe neglect of babies with disabilities; denial of medical services; abuse of sedative drugs; and deprivation of the opportunity for individual development.
Lying-down rooms-gross neglect of infants with disabilities
In a world apart from the daily life of Russians, the lying-down rooms of the baby houses are yet another world removed. According to a volunteer who has visited a vast number of baby houses, they all had at least one, lined with fifteen to twenty bedridden children.119
Throughout our interviews with volunteers and regular visitors to Russian baby houses, the extreme neglect of those who are segregated away in the lying-down rooms was frequently described. The pattern is captured in the following testimonyby a photographer who has visited more than a dozen baby houses and psychoneurological internaty since 1997:
About twenty kids were lined up in cribs. Bottles were propped up against the crib and they were in a vegetative state. In one there was a kid six years old the size of a two-year-old. All this goes on in the same institutions where other kids are running around. They're clearly neglected by comparison.120
One volunteer showed Human Rights Watch a photograph of an eight-year-old girl who was allowed to stay unusually long in her baby house while volunteers searched for a home for her:
This little girl has mild cerebral palsy in her legs and because of this, she's about to be diagnosed as retarded and sent for life in an internat of the Ministry of Labor and Social Development. Look at this! They make her sleep sixteen hours a day. She's eight years old and she's made to stay with three-year-olds. She gets no stimulation.121
Compounding a stigma with multiple diagnoses
The lying down rooms of the baby houses are only the most ghastly product of a conundrum of stigmatization that begins before the baby opens his or her eyes. First the baby is abandoned and diagnosed with developmental delays. Then, the addition of further diagnoses compounds the original stigma of abandonment. The long-time director of a Moscow baby house succinctly described this conundrum of "abnormality":
All the babies are problematic, maybe some more or less, but they're all problematic. Because if you understand: take the situation when the mother wants to throw away the baby. If parents are normal they'd never allow it. So that means that the families are not normal. And what can the state do if the children have no mothers? Of course we try to do our best.122
Starting from behind with a provisional diagnosis of zaderzhka (delay), Russian infants soon acquire a raft of conditions in their medical charts which they may be unable to shed as they move through the state institutions.
The philosophy of health care in Russia is different from the U.S. It's more like Europe by the way doctors are trained to address relatively minor things more seriously than in U.S. They make a list of diagnoses, but are simply describing "risk factors," to let other doctors know: maternal risk factors, infant risk factors.123
But Dr. Rybchonok went on to say that children in Russia are especially put at risk by the ambiguity of the records, because very often the records "are not dated." He explained:
There's a signature of the physician, but there's no date. But what's more important, there's almost never a date when the diagnosis was first given, or a date when the condition was resolved. It's very unclear if the child had problems chronically or just after birth. Mostly they copy the previous list of diagnoses and then don't date it.124
Repeatedly Dr. Rybchonok stressed to us, " If this diagnosis is not true, it's really a disaster for an individual."125
Doctors and the other experts in child development whom we interviewed for this report frequently criticized this diagnostic tradition. We were therefore particularly dismayed to note that a concise critique of this practice of "over-diagnosing" was presented as long as three years ago to the Council of Europe by an expert team who visited Russia in June 1994.126
The experts reported that Russian psychological norms are based on very strict criteria. Apart from these norms, however, factors that in the West are considered as being simple medical risks, will, in Russia, be labeled as illnesses:
· babies born to alcoholic parents or whose mothers suffered depression during pregnancy will be labelled encephalopathic and remain so until they come of age.
· orphans will be classed as being mentally deficient.
· children with a single physical malformation (a harelip or speech defect...) become subnormal in the eyes of Russian doctors."127
Human Rights Watch also found that these early diagnostic practices interfere with a child's right to full development and in certain cases, to life, itself. Moreover, abundant information gathered in Russia indicated several crucial incentives behind "over-diagnosing" that suggest violations of basic medical ethics.
According to a former charity worker who distributed assistance to impoverished baby houses and has travelled widely in Russia since 1991, one legacy of the Soviet medical bureaucracy encourages hospital staff to avoid any risk of sanctions for errors detected under their care. For example, she recalled the case of a child she knew well who had a medical chart with a catalogue of conditions including oligophrenia and encephalopathy.
A doctor told me that they have to cover their butt. They could lose their job, so they write many diagnoses. And you know the penal system here. It's a "better safe than sorry" system.128
A second factor that encourages exaggerated diagnoses, is the Russian law which until recently, prohibited international adoption of "healthy" children. "Thedoctors in the system wanted the kids adopted, so they'd say that this child has a tumor and then "wink" at you.129
Finally, a widely cited incentive for over-diagnosing is the extra financial subsidy and salary increment that the state grants to institutions that care for children with disabilities. The entitlement to these subsidies was confirmed by children's rights activists as well as by staff of state institutions.130
One volunteer who worked in a Moscow baby house for a year and a half recalled to Human Rights Watch,
Once, in a rare honest moment with the acting director, she told me, 'We are considered as a medical facility because more than half our children are considered to have medical defects.' So they could finagle more money for the place. 131
Another baby house director told Human Rights Watch, however, that the subsidy does represent the greater burden shouldered by the staff in dealing with disabled children, even though the salary levels remain very low and do not attract specially trained personnel:
A pedagogue in a baby house who works here, for the Ministry of Health, will get a 20 percent higher salary than from another ministry. Yet what should we be talking about if the salary of a doctor is only $100 a month? Of course, all these places with "problematic kids" get higher pay because we have to deal with all the kids, including the problematic ones.132
Debilitating effects of institutional deprivation
It is by no means only the "problematic kids" who suffer setbacks from institutionalization in Russian baby homes. Dr. Rybchonok, who has examined avast number of children from Russian institutions, described the broader impact of deprivation:
I see children who've been institutionalized after parents lost their parental rights. If the kids lived with their parents even two years, they are very different. They don't look like institutionalized children. They've been loved. Even in an alcoholic family, the child could be smaller than normal and could be abused. But the child still looks different.
Those children who have lived all their time in an institution are really special. Because of being exposed to sensory deprivation after two years, they have no social skills, they don't grow that well, some are off the growth chart. That's the big impact. That's the negative side of the institutions. If someone's trying to find that situation, look at the last century. There's a high risk of disability, attachment disorders. That's just through sensory deprivation.133
Recent research on the developmental challenges of children adopted from orphanages in Eastern Europe and the former USSR shows promising evidence that children can make remarkable recoveries from the deprivation of institutional life.134
But most of Russia's orphans, including those deemed officially "normal," will never enjoy the opportunity to leave institutional life for a family environment where they can catch up on their time lost. The majority of Russia's orphans will be stuck for all their formative years within the tunnel of state institutions, only to emerge when they reach the age of eighteen. Moreover, those who have been wrongly diagnosed as "ineducable" will lose any opportunity to catch up.
Human Rights Watch asked a long-time director of a baby house to compare specifically the developmental opportunities for orphans reared in Russian institutions with those of children raised in families. She replied:
There's a big difference. First of all, the deprivation of a mother is the lack of personal love. If you talk about a baby in his mother's hands, touching him, it's been scientifically proved that this influences his development.
However good our conditions are here, we're still like a "gilded cage." The kids are still humiliated-some because they always lived in a "collective" place. Everything is always done altogether in line, never in private, to sit at a table to eat. It's always this public, "grown-up" behavior, and in our point of view, it affects the child's mind. It affects the development of their nervous system.
Also in small "collectives," it becomes a struggle to survive. They become aggressive. It's natural, if someone has to struggle to survive.
They have no attachment. They have nothing of their own-not his toy, or her toy. They don't even have personal clothes. There is no face that a child wants to see all the time. Or even, he constantly has to see a face he doesn't want to!
Of course, we recognize these problems, but it is physically difficult to meet their individual needs. We try to give them individual attention. Some staff take the children home for a few days, so they will see what a home is like.135
But while Dr. Vassilieva believes that this brief exposure to family life benefits children by providing them "some kind of 'fresh air,'" it also causespsychological complications. "Because there's a lot of stress for the child. They see 'home' children and can't answer why they don't have a home, themselves."136
The problem for the majority of children is that they will rarely even visit a private home, and this, Dr. Vassilieva believes, impedes these children in their adult life:
The opportunity for the orphans is much lower. It's very heavy for them. We're now raising the kids of the kids we had before. The grown-up kids don't have the impulse to establish a family. They have a couple of marriages, and then leave their children.137
Orphans denied personal possessions
The "collective" philosophy criticized by Dr. Vassilieva is a pillar of Russian institutions, and it contravenes the basic precepts of the Convention on the Rights of the Child protecting the individual development of a child. The following is one volunteer's graphic account of the concerted policy in her Moscow baby house to deprive children of individual possessions. The experience of Theresa Jacobson has been corroborated by a number of others interviewed by Human Rights Watch.
It was one of the better baby houses, because there were a lot of private aid groups there. But they'd keep a lot of the donations locked up in a storage room downstairs. A lot of stuff we brought, we wouldn't see. "It's not necessary to give out the toys at once," they would say. "Save some for a rainy day." Part of this is this due to the Russian mentality, that they never know what will happen. So they keep huge packages of toys in storage...
Also, there was a norm of two toys per child. But it was for a child as part of the group. Not for an individual. Toys were kept in a glass case, and brought out when we came. I brought a cassette player for one little boy who was blind and just lying there, out of it. They came up with excuse after excuse for why they never used it. It disappeared.
The Anglo-American school gave a toy to each child each year, but then found that the toy only went to the "collective." A child was not allowed to have her own little teddy bear on the bed. The rooms were bare.138
Although there has been a deluge of toys donated to baby houses since international charities began to assist them in the early 1990s, the children's beds in many baby houses are still bare. In addition to eyewitness accounts by numerous people interviewed by Human Rights Watch, we observed this irony first hand during a visit to a well supported baby house in Moscow.
Reminiscent of the peculiar practice in Romanian orphanages to display newly acquired developmental toys in places only accessible to the staff, the staff of the Moscow baby house called our attention to their bright array of Montessori toys stacked in the glass cabinet just inside the play room. They stopped our tour briefly to demonstrate how the toys worked, and then put them back and closed the cabinet door.
More significant was the apparent absence of rapport between the toddlers and the staff who stood stiffly at several arms' lengths from the children. This distance contrasted sharply with the rapport Human Rights Watch observed on a visit to another well appointed baby house outside Moscow, where the staff and children played and embraced easily during and after their lunchtime meal.
Another notable feature of the Moscow baby house we visited which confirmed patterns described by regular visitors to state institutions, was the extraordinary silence and orderly atmosphere for a building full of small children. Even as a group of preschoolers was piling on their snow suits for their afternoon recess, there was barely a sound in the cloakroom, either among the children, or between them and the two women from the staff who were supervising them.
The abuse of sedative drugs
There is a high premium placed on orderliness and quiet and we learned that Russian orphans pay a high price for this. Human Rights Watch heard repeated references to the use of strong tranquilizers such as aminazine in the state institutions, and noted the sharply critical findings of an international team ofinvestigators in 1991, who also stressed the high risk of liver damage to the orphans.139
We were also told by the staff of an internat for disabled orphans that they regularly give the children aminazine when they are agitated and it is time for them to go to sleep.140
One former volunteer who regularly worked for a year and a half in a Moscow baby house described most vividly how her suspicions about routine sedation were reinforced when she returned for a visit after giving birth to her own baby:
They have very clear ideas about children and sleeping. I came in after my baby was born. They asked how much the baby sleeps. And when I answered, "Not much," they told me, "Oh that's very, very bad, the baby needs sleep. We can give you injections that you can give to put the baby to sleep." I'm positive this is what they do to get them to sleep, especially the ones that they call "nervous." The staff was horrified that my child slept so little.141
Discrimination against orphan babies requiring medical care
When orphans in a Russian baby house need medical treatment in a hospital, they face a new hurdle of discrimination. Human Rights Watch learned about routine practices regarding orphans from a volunteer, one of whose tasks it has been to arrange for medical care for children in the baby houses:
The baby house staff put the baby in an ambulance. Sometimes someone will accompany the child, and then drop the child off just inside the hospital door. The child is left completely alone and can languish [in the hospital] for three months. Not even a representative from the baby house will come to see the child. I've been in the hospitals many times, many times, and seen this. They definitely discriminate against the baby house children. They put all the dom rebyonka children into one room, so they're given completely second-class treatment.
How was this treatment "second-class?" You know how it is in a Russian hospital. The family of the patient has to bribe the doctor, bribe the nurse, in order to be sure to get what you want done. The staff know that these are only dom rebyonka children, so no one's relatives are going to give them anything for their treatment. So they put them aside and deal with the others.142
It is crucial to note that some significant variation does exist in the treatment of orphan babies throughout the vast Russian Federation, and the performance standard seems to be set by the director of a given baby house. Human Rights Watch learned of at least two baby houses in Moscow and one in a town in the Volga region where visitors described positive reforms in child care, including the smaller, more intimate children's cottage approach.
But Human Rights Watch also obtained sufficient testimony from Russian and foreign experts to raise serious concerns that discrimination in the health sector against babies and older children in state institutions included being bypassed for corrective surgery-for heart defects, cleft palate-that would improve the child's chances of surviving to adulthood.
Arranging for corrective surgery, like many services in the former Soviet Union, can require a great deal of time for diagnostics, paperwork, and scheduling of the procedure. Financing should not be a problem, as Russian law guarantees the provision of medical care free of charge to children in the custody of the state. But procedures are increasingly costly, since market reforms have driven up the prices on medical services along with everything else. Without parents who can physically make the rounds to the myriad authorities to pressure them for the procedure within their legal rights, the children are at the mercy of the orphanage director and staff to take up their plight. In unusual cases, a charity volunteer can find the extra time to do the extensive work on the child's behalf. 143 As Dr. Vsevolod Rybchonok explained to Human Rights Watch, "They're just second-class people. That's why those patients are kicked out to the internaty. And these kinds of services, like heart surgery, are very expensive now. "144
One of the most egregious cases recalled by volunteers in the orphanages was that of Alina,145 age five, from one Moscow baby house:
She was a cleft palate case. A simple cleft palate. It had grown so badly because no one treated it when she was little. Her mouth was a nightmare. She couldn't eat, and of course, she was diagnosed as an imbetsil because she couldn't talk.146
The director of the baby house in charge of this case did not acknowledge the case in an interview with Human Rights Watch, or that such a potential problem exists. She described the system in positive terms:
Actually those babies who should be operated on are operated on. But actually the kids who are intellectually very bright but have physical problems, they are very well adopted by foreigners. We've had several babies with no legs who were adopted, treated and made prostheses in Sweden.147
Rationale of budget and staff limitations
The lack of public funds is a constant lament in Russian institutions for orphans across the board, and the staff and directors we interviewed laid the blame for human rights violations in the institutions on the nation's financial crisis.148 Salaries, if paid at all, are so low that only the least-skilled people apply for jobs. Also because salaries are so low, Human Rights Watch learned that two or three staff positions will be filled by one person, who will work three strenuous shifts in a row, rather than the single six-hour shifts regulated for those assigned to the most severely disabled.149
Russian human rights activists and independent child development specialists, however, reject the "financial crisis" claims, insisting that the state provides sufficient funds but the directors allocate too little to the actual care of the children. For instance, in an interview with Human Rights Watch, Dr. Anatoly Severny explained that one government ministry channeled 2,500 rubles ($400) per child per month to one internat he knows, but the daily allocation per child is only 17 rubles (three U.S. dollars) for food and 17 rubles (twenty-five cents) for medicine. 150 Furthermore, he and other advocates claim that since institutions do receive higher subsidies for sicker children, there is an incentive to keep as many children in the institutions as possible, despite the child's potential. Some even claim that the funds are plainly misused, allegations that time did not allow us to corroborate.151
On the other hand, Human Rights Watch learned that the acute poverty in some regions of Russia can inflict real economic deprivation upon orphans. In one rural region where winter food shortages are acute, one baby house director made desperate calls to the local factories to beg for basic milk and bread to feed the children.152
Financial shortages, nevertheless, do not explain the wanton neglect of disabled children left in lying-down rooms. This, according to a wide range of health professionals, orphanage volunteers, human rights advocates and journalists interviewed by Human Rights Watch, goes straight back to the prejudicial stereotype of orphans, and the general attitude of the baby house staff.
Sarah Philps, a volunteer with four years of experience in Russian state institutions, told us:
It's attitude, more than anything else. Attitude, plus no feeling at all of responsibility by anyone who looks after them. I know this sounds extreme, but I've seen it again and again. So we are not talking about money at all. We are talking about no conscience, no soul.
They'll say there's no staff, no staff. But meanwhile, you're very much aware that fifteen women are sitting in the back having lunch, leaving one person there to feed all the children. In another former Soviet republic, by contrast, they shared the feeding shift and everyone takes turns putting a kid on their knee and feeding him. It's also symptomatic of the terribly rigid adherence to their roles. If there's only one vospitatel', then none of the others will do that work.153
Despite the debates over budgets and attitudes, the evidence collected by Human Rights Watch indicated that life in Russian baby houses further retarded orphans' growth, denying them the basic right to develop their full potential. The first clear impact of this deprivation is documented in the following chapter on the controversial state commission that determines the course of an orphan's future.
V. THE POINT OF NO RETURN: DIAGNOSIS AT AGE FOUR
The diagnosis that's been given by pediatric neurologists sticks to children for the rest of their life. This is a disaster for the children.154
This evaluation commission is our greatest shame.155
As the linchpin in the life of a Russian orphan, the test by the state-run Psychological-Medical-Pedagogical Commission, with the consequence it carries, is the single policy most criticized by advocates for children abandoned to state institutions in Russia. Just as in the notorious orphanage system of Ceausescu's Romania, which international and Russian child development experts cite for comparative reference, the evaluation of all children at the age of four is the basis for the triage of orphans as they are consigned to state institutions for the rest of their childhood.
Among the flaws in the evaluation procedure most often cited in our interviews with doctors, child development specialists, and human rights advocates were:
· the brevity of the examiners' one-time session with the child;
· the intimidating presence of a panel of strange doctors to a child who has limited exposure to life outside the walls of an institution;
· the inappropriate questions often used to measure the intelligence of such a sheltered child;
· the misdiagnoses and the virtual impossibility of revoking them;
· the dire consequence of a "life sentence" in a psychoneurological internat;
· the discrimination against "light" oligophrenics seeking higher education, jobs and housing.
The disadvantages confronting the four-year-old orphans are similar to those they face at the moment of abandonment, when they can be given a provisionaldiagnosis of delayed or retarded.156 But the evaluation performed at four years of age marks a point of no return. A diagnosis of serious oligophrenia-as imbetsil or idiot-will condemn the child to life in a psychoneurological internat, where his or her rights to education, health care, and protection from harm will be permanently denied. Based on independent investigations in into the accuracy of diagnoses, published in 1991, from 30 to 60 percent of orphans diagnosed as oligophrenic may be wrongly ascribed.157 And Human Rights Watch learned from the staff of two internaty for severely disabled orphans that perhaps 10 percent of their children could have "useful lives."158 Conservatively then, at any time in Russia, at least 3,000 of the 30,000 children in internaty could be there by mistake, and untold thousands more who have diagnoses of lighter oligophrenia-debil-may be wrongly marked as well. Neither these children, nor those who have severe congenital disabilities, should be subjected to such violations of their most fundamental rights.
Introduction to Russia's Psychological-Medical-Pedagogical Commission
During its month-long mission to Russia, Human Rights Watch made at least half a dozen attempts to interview a member of the Psychological-Medical-Pedagogical Commission or, at a minimum, to obtain a copy of the clinical and educational standards used to evaluate the children. We never succeeded. The resistance we encountered harkened back to the Soviet protection of even the most innocuous of public documents as state secrets.159
Interviews with orphanage staff and others allowed us to piece together information on the composition and procedures followed by the commission. Headquartered at Chief Psychiatric Hospital No. 6 in Moscow, the Russian Psychological-Medical-Pedagogical Commission is an arm of the Institute of Corrective Pedagogy, operated by the Ministry of Education. It is affiliated with the Ministry of Health, which is effectively a partner in the process.
The panel for a given evaluation can vary from two to several members, and should include at least one education specialist and a psychoneurologist. According to a Russian child development expert, the original concept behind the commission was to classify children in order to prepare them for more efficient rehabilitation. The children were all compared at a certain age level, and it was thought that if a child could not be trained, he or she would have to be separated from the rest. There was no interest in integrating them with the mainstream of children.160
A Human Rights Watch interview with a Ministry of Labor and Social Development official who had served for many years on the Psychological-Medical-Pedagogical Commission in her previous position with the Ministry of Education corroborated this view. "The Ministry of Education takes care of children who can be trained and the system of the Ministry of Development (sic)-we cover kids who cannot be trained," Valentina V. Terekhina told Human Rights Watch.161 When we asked what happens to children at the time of their important diagnosis at the age of four, if they are classed as imbetsil or idiot, she repeated:
So it's the same. If you take the children in the baby houses who have potential to be trained, they go to the Ministry of Education. Those who cannot be trained, such as Down syndrome for example, they are transferred to invalid houses of [the] Social Welfare [Ministry] (sic)...We cover the children of very very low intellectual capabilities, and practically speaking, those who cannot take care of themselves-daily care-because their intellectual level is so low, low, they cannot even do that.162
The very act of judging a wide spectrum of children with correctable disabilities as "ineducable" is a fundamental form of discrimination, and an abrogation of the basic right to education set forth in the International Covenant on Economic, Social and Cultural Rights, and the Convention on the Rights of the Child. Moreover, the hostility of state officials to the mounting criticism of the commission by independent Russian specialists poses a particular obstacle to transparency and reform. In our first attempt to obtain the public standards used for the evaluation, a Ministry of Health official, Valentina B. Chumichova, lambasted Russia's leading children's rights advocates and independent child psychiatrists as people who "need to break the whole system of health and education for orphans."163
She also criticized the advocates' goal of transferring disabled orphans to the jurisdiction of the Ministry of Health, which they consider a more appropriate authority than the Ministry of Labor and Social Development for the health, development and dignity of vulnerable children.
Valentina B. Chumichova's comments reveal stark insights into the official attitude toward the neglect and cruelty that is widely documented in state institutions for children. "All the problems in our system are caused by lack of money. If a person gets only 300,000 rubles ($50), he cannot be loving to a child. Because if you get this salary and go out into the street and see a kitten, you're going to kick it when you pass it."164
The Ministry of Health official further expressed the deep-rooted cynicism found among many government officials working in social welfare when she questioned the motives of the vocal human rights groups. "They only raise this problem because it's very modna [chic] right now, not because they're worried about children."165
Human Rights Watch also contacted a Ministry of Health official named Svetlana R. Konova, who is involved with the operation of baby houses. To our request for the standards or tests used to evaluate orphans at the age of four, she replied, "It's not so secret but I should not give information without the permission of my boss."166
Further calls were placed to Chief Psychiatric Hospital No.6 in Moscow, where we reached Lyubov A. Andreeva, a deputy to the head of the commission. She, too, advised Human Rights Watch that she needed permission from her superior before she could meet with us. On the matter of testing standards, however, she went on to say, "We have no standards. We have very professional staff, all good pedagogues and doctors. And they know all about this problem."167
As Human Rights Watch requested details, the official answered, "We use three methods-Wechsler, Rubinshtein, clinical razbor [classification], and other methods. We use a program designed by a scientist at the Scientific Institute of Psychiatry in Moscow to determine the intellectual level of the kids."168
Human Rights Watch obtained a contrasting view of the official testing standards from a child development specialist working with one of Moscow's few innovative foster care programs. "The methods the commission uses are not so modern," she said.169 Moreover, she criticized the format of the evaluation, which creates an intimidating environment for a four-year-old. "Imagine, many adults come here and sit down. It is frightening to the child. They ask something and the child's scared. What level of development can he show the adults?"170
A hazardous turning point: intimidation, inappropriateness and error
It is difficult to overstate the significance of this examination, which for some children, is a matter of life and death. The deterioration of children committed to these internaty is of grave concern to doctors who examine them. Dr. Vsevolod Rybchonok, who has conducted general medical examinations on several thousand children during the last few years told us:
If they're transferred to special institutions [internaty], it's like a prison to the brain. There's a total lack of sensory stimulation. There's no input, nocompetition with other children if the others are even more retarded. It's just a process of slowing down, slowing down, then idling-and then-stop.171
It is impossible to know the total number of misdiagnosed Russian orphans who have been warehoused in the fetid psychoneurological internaty under the Ministry of Labor and Social Development. According to Dr. Severny,
"About nine to ten years ago some people from Moscow State University surveyed children in auxiliary internaty operated by the Ministry of Education for children diagnosed as lightly debil. What I was told by the people who did that survey, was that they found 80 percent of the diagnoses were inaccurate-in other words, not oligophrenic. That is the only survey I know of and it was not published. Nobody's heard anything from the survey team since."172
In 1991, evidence of unfounded diagnoses was again a finding of an investigation conducted by an international team of child development experts in several orphanages in Moscow and St. Petersburg.173 The team, sponsored by the nongovernmental organization Christian Solidarity International (CSI), found that among fifty children in one group tested in St. Petersburg, "one-third of the children classified as oligophrenic scored within normal limits."174 After doing a more thorough test on some children, the team found the results even more striking and disturbing. Of the thirty-four oligophrenic children aged six years and over, two-thirds showed evidence of average or better ability.175
The CSI investigators concluded that both of the psychologists on the team were "concerned about the large numbers of children assigned questionable diagnoses. These were usually expressed in negative, denigratory terms such as'debilitated oligophrene,' 'imbecile,' idiot.' Once imposed in early childhood, these labels are seldom reviewed and reversed."176
It was clear to the director of a large baby house in a region north of Moscow that orphans were at a serious disadvantage when it came time for the fateful evaluation. "It's very difficult for orphans who have no parents who can appeal the process. They are limited in opportunity at the stage of the commission evaluation, compared with kids with families. It's a human pain for us, as well as a professional one."177
Inappropriateness of the test
Two of the leading factors that critics blame for inaccurate diagnoses are the setting and criteria used, which they argue are inappropriate for testing children who have spent their first four years of life in confinement. Again, Dr. Vsevolod Rybchonok told Human Rights Watch:
They just look at the child and ask a couple of stupid questions and then make the diagnosis, while the child can be frozen in front of the strangers. I've seen that a few times. Coming from their little narrow world, the kids don't like it if you ask direct, bold questions...Then one of the doctors will say, "That's a mentally retarded child." Unfortunately the children don't live in this world [that we live in]. They're living outside this world.178
A long-time volunteer in the institutions echoed this view:
I know the people who do the psychiatric evaluation. They test the children on concepts. They test if they can walk. Now here was a child whose legs were bound up and was not allowed to walk. They go around and look at these children, who've never been outside these four walls. It's just a land of the absurd. 179
Not only can the queries be inappropriate to the child's stultified upbringing, but the combined effect of an orphan's earliest diagnoses with the neglect in the baby house can confound even a careful examiner. One psychiatrist working in an internat told us, "We have an orphan who got a job in our institution. I supervise her. She's debil. But everything is mixed up-what's the result of congenital retardation and what is neglect? It's hard to tell after a certain point."180
Justice denied: the right to appeal diagnosis
Under Russian law, orphans have a right to appeal their diagnoses, particularly since "the development of intelligence is very unpredictable and at certain stages intelligence can change noticeably," we were told by an official of the Ministry of Labor and Social Development.181 Valentina V. Terekhina went on to explain to Human Rights Watch:
I used to be a member of the commission myself and if there are (sic) any suspicions that we are not right, then the decision is made in the interest of the child...The management of all institutions have all rights to apply to the commission for a new examination of the child. And actually those children who have parents and they don't agree with the diagnosis have the right to appeal it.182
In practice, it is nearly impossible for a four-year-old in state care to appeal his or her diagnosis. One international charity worker described this bind to Human Rights Watch, and further expressed her concern that some diagnoses are made to discipline difficult children, "Parents have the right to insist that their kids get a reassessment. But what if the child has no parents. I asked this of someone from a regional children's home and she just looked at me. Obviously this hadn't occurred to her."183 The charity worker went on:
The children I know who were sent to internaty are not all mentally handicapped. One was sent to a mental institution because the director was offended by the family. One older child was sent to a mental institution because he was smoking.184
While scores of specific cases of misdiagnosis are well known to the concerned staff and charity workers we interviewed, many children will never get to tell what their experience was, having been delayed and handicapped, and never taught to speak.
But another group, interviewed by Human Rights Watch, is capable of describing the terrible impact on their lives, and some even recall their encounter with the Russian Psychological-Medical-Pedagogical Commission. Now in their teens, these orphans are in a category of luckier oligophrenics, because they were diagnosed as only "lightly" debil and thereby spared the damning judgment of being ineducable. They have instead been channeled to special institutions run by the Ministry of Education, which provide minimal classroom schooling, followed by vocational training in a Pedagogical Technical Department (PTU).
As Human Rights Watch learned during a visit to a relatively well-organized PTU several hours northeast of Moscow, the discriminatory diagnosis of "oligophrenia" remains in the orphans' official files and stalks them into adulthood. According to a report by a leading charity in Moscow, it prevents them from applying for a driver's license.185 Moreover, the compound stigma of abandonment and "small brain" is recorded in black and white in their personal file, which follows them from institution to institution, and can only hamper their efforts to establish themselves in society and earn a living.186
In a meeting with about ten articulate girls and boys and two resident vospitateli who were unusual in their strong advocacy for the children, Human Rights Watch noted the "Catch-22" that traps these orphans in several respects. The children said that they wished to apply to have their diagnosis lifted from their file, but they must have finished eight years of standard school in order to apply to the commission for a re-analysis. As light oligophrenics, however, they have onlyhad access to the equivalent of six years of standard school. According to the vospitatel' at the PTU, there are no teachers available to help them make up the extra two years.187
Even if there were a remedial school for these children, the vospitatel' explained that they would still need individual tutoring, "because if they haven't had the chance to catch up to the level of standard education by a certain stage, kids don't learn as well. We know two boys who were eager and willing to catch up, but it turned out to be too hard."188
The children, between fifteen and eighteen years of age, are now enrolled for about two years at the PTU to receive training toward trades including carpentry, sewing, and baking. They are angry that their basic rights are restricted because of the prejudicial diagnosis of oligophrenia in their files.
The fact that the children are so aware of their rights is extraordinary enough, and they owe it to the exceptional vospitatel' who instituted a program "on social pedagogy and social protection" six years ago. This again illustrates the dramatic and somewhat random variation in protection afforded orphans in Russia.
Intimidation in front of the Psychological-Medical-Pedagogical Commission
The following accounts in their own words best convey the bewilderment and injustice these adolescents feel about their fateful tests and the label of oligophrenic, which some told Human Rights Watch they received when they were very little, and others when they entered or transferred institutions:
Many of us could have studied in regular school. When I was tested in first grade, I studied for two years there. But then I was sent to an internat (for debily) because I didn't do well in school. I was asked idiotic questions by the commission and I didn't want to answer. For example, "What's the weather like outside?" I said to them, "Don't you see for yourselves what the weather is like outside?" 189
I remember the commission asked me how to put all the cups and plates on the table. Then they asked, "What are they called?" I answered, "They're calleddishes." A lot of things I answered. They try to ask you a lot of "trick" questions, like what's the difference between a bird and a plane?190
For Lyuda P., the procedure was mystifying:
I was six years old. They made me sit at a huge table. A lot of people were sitting there. I had studied first grade in a regular school. Then they came and got me and said to say "good-bye" to everybody and wave your hand. I was taken to the commission and answered two questions. I don't remember them now.191
The vospitatel' also found the procedure both intimidating and cursory. She highlighted for Human Rights Watch the extreme vulnerability of an orphan by recounting the experience of her own "healthy" son, whom she accompanied on the general pre-school evaluation administered to Russian children:
My own son was tested after kindergarten before going to school-all kids are tested. I was told they do the testing for four days. But they really conducted their test for one and a half hours. And of course parents and children are nervous. The questions are not always worded clearly. They ask questions about clothes, transportation, animals, and comparative questions. A child who could read a poem perfectly at home, may be silent in fear.192
Imagine, I was standing right there next to my child and he was still confused. I'm a pedagogue, myself, and I think the examiners should get involved in the world the children live in, observing and watching a kid. And then, only after that, decide. But instead, after only for an hour-they just cross out their lives! 193
Ruined lives: misdiagnoses by the commission
The staff of Russia's 252 baby houses and the volunteers who work with them know scores of children who have pending diagnoses as severe oligophrenia. They know them by face, by name, by age, condition and their real potential. There is a frantic air among some of these care givers and advocates to prevent the orphans from being transferred to psychoneurological internaty.
They also mourn the many they knew who could not be saved beforehand, as well as the children with severe congenital disabilities who are condemned to psychoneurological internaty. One exemplary case is that of the little girl with a cleft palate mentioned in the previous section of this report, who was rejected for corrective surgery. Because Alina could not talk, she was diagnosed as an imbetsil. Her case neatly depicts the ways in which the Russian system denies orphans with disabilities their most basic rights.
Human Rights Watch learned more about Alina in an interview with a volunteer from her orphanage who had followed her for more than a year. Alina was three years old when Theresa Jacobson met her. Her medical chart indicated the following conditions:
· Multitudinous developmental defects;
· Psychomotor delays, speech delays;
· Organic brain paralysis;
· Bilateral cleft palate and lip;
· Premature birth.194
She took on the baby's case to try to get her cleft palate corrected, and possibly prevent her from going to an internat for the ineducable. Ms. Jacobson recalled the little girl's case with frustration and sadness:
Alina seemed to all of us quite bright. Her major problem was that she couldn't speak because of the huge crack in her palate. She basically grunted her way through life. Also, because of the huge crack in her palate, her harelip was so bad she had no upper lip. It was a huge gaping hole to her nose that turned into the hole for her mouth. When she would eat porridge, it would go up through her nose. She couldn't swallow. She was very underweight, and I think, malnourished. The saddest part, she had bright blue eyes. I'd tell herto come here and do things and she'd understand and do them. But she could only grunt.
I spent a lot of time trying to get surgery for her, and we went through several stages. First they said she had a congenital defect of the heart valve, and because of the risk that she would die under anesthesia, they couldn't do the surgery on her cleft palate. Then she was too underweight for the minimum requirement for surgery. She was only eleven kilograms at age five.
So it was just a vicious circle. Then, at one stage, I decided to get her heart condition evaluated at the Bakalev Heart Institute, and found that the valve problem had corrected itself. I had a heart surgeon who looked at her and said he'd come to do the facial surgery in case there was an emergency. We'd even been able to get a British facial surgeon interested. Then around this time I had to leave my volunteer work for personal reasons. Alina was returned to the orphanage with no explanation.195
According to others familiar with Alina's case, the doctor responsible for her baby house was aware of her problem. But during an interview in Moscow with Human Rights Watch, Dr. Elena Petrenko made no sign of recalling the case. To our query about potential flaws in the Psychological-Medical-Pedagogical Commission procedures, she denied there that were problems and described the process as always taking place "in a very friendly atmosphere."196
She added, "It depends on the level of the baby's intellectual development. Age does not play any role. For example a baby has to put together four pieces of a picture...Also, the commission tries to see if the child thinks clearly."197
Contrary to some views of the commission as a vehicle for one-hour, snap decisions, the doctor underscored the active participation by the staff of baby houses in making this momentous decision in the orphan's life:
They really listen to us because we've been watching the children all along. We actually decide where the child goes and actually it's a very formal procedure. We discuss with them those kids we're not sure of, but it's the interest of the baby that takes priority. I don't see any potential for problems. The same commission comes every year. They know the hospitals. I think the interest of babies is number one.198
Later in the interview, Human Rights Watch again asked if the doctor recalled any cases in which she did not feel satisfied about the diagnosis. She repeated her conviction that the commission gave children the benefit of the doubt, a view that sharply diverged from the observations of doctors, other institutional staff and charity workers we interviewed:
No, we stand by the diagnoses. Actually the commission works in the interest of the babies, not against them. In fact they're given even better diagnoses so they can be put in a better orphanage, even if they find out later that the child cannot manage there.199
When asked specifically about how the baby house handled conditions such as cleft palate, the doctor's reply again contradicted the experience of many others interviewed for this report:
Actually, those babies who should be operated on, are operated on... What we do actually when we get babies with any conditions, we contact the medical institute and they fix up all the problems. If the baby is really sick he is sent to the hospital.200
The doctor may have been convinced that Alina was an imbetsil because her chart contained, rightly or wrongly, conditions such as "microcephalus" and "organic brain paralysis." This of course only serves to illustrate the fact that imbetsily do not generally get corrective surgery.
A leading analyst of the Russian orphanage system, was however, plainly shocked by the doctor's statements and challenged their veracity. "There was grossmisconduct in that case of the child with a cleft palate and hare lip, who never got the surgery and ended up in an insane asylum."201
Most likely, with her difficulty in eating and speaking, Alina's condition worsened after her transfer, and it is this terrible deterioration of wrongly diagnosed children-not to mention correctly diagnosed children with disabilities-that distresses Russian child welfare experts. One baby house director told Human Rights Watch that it was so wrenching to see the babies from his institution decline after arriving in the Ministry of Labor and Social Development internaty, that he avoided going to them.
Ninety percent of what we developed with the children who we send there, is lost there. This is why we keep them here at our baby house till they're seven, eight years old, to keep developing them. But then comes the time. Even right now, we have some fine, intelligent children who have problems, but only physical ones.202
Dr. Airumyan's deputy director, Dr. Olga Y. Vassilieva joined our interview and quickly mentioned an eight-year-old boy named Misha.
There's a child here who is incontinent, but smart. He could work, say, as an accountant. If he goes to the regional internat, in the best case he'll be in a wheel chair. Most likely, he'll be bedridden.203
Three years ago they said they "lost three children," whom they regretted sending to the regional internat of the Ministry of Labor and Social Development. The stories of these and several other Russian orphans are recounted below by people who knew them in their baby houses.
Timka was a little boy who had a defect in the spinal column, and the related complications because of it-paralysis, incontinence, etc. He was a nervous little boy who had difficulty with speech. Then at the age of five he started to speak normally, and he sang very well. He understood everything. He used towatch the American television show Santa Barbara on Russian television and would retell all the episodes to the staff! He had 100 percent potential for a useful life.
Then Timka went to the internat. After three to four months I saw him there. He was lying in bed-dressed only above his waist, lying on a rubber sheet. He recognized me and couldn't say my name. It shows there's no continuity for these children between our work here, and over there at the internat. That was three years ago.204
Tassia was a little girl who had a spinal defect that caused the usual complications with movement and urination. But she could walk. And she would sing and take part in music here. Then she went to the internat three years ago, and there was a nurse who went to visit her there. Tassia asked the nurse to please take her back home here to the baby house. Now, last September (1997), the nurse went to see Tassia and saw that they only put her on the potty, and she just sits there.205
Fedya was a little boy who was transferred to the internat in the same group with Timka and Tassia. He also suffered from a spinal defect that paralyzed him and he was incontinent. But he had potential for a useful life. He went to the internat three years ago.206
Tolya was a little boy from a baby house here in Moscow. He had a physical disability, but he could talk and reason. They diagnosed him as an imbetsil and whisked him away to an internat, where he just went downhill. That internat was one of the worst and it's since been closed.207
This little girl only has light cerebral palsy in her legs and she is so bright. But Nina has been diagnosed as oligophrenic and unless something is done to change it, she is headed for a psychoneurological internat soon.208
On rare occasions, someone in the charity community manages to arrange to transfer a child who has been wrongly relegated to a psychoneurological internat, out to an orphanage within the Ministry of Education. Another volunteer with experience working in Moscow baby houses told Human Rights Watch of one such a child who was adopted:
Seriozh came from a baby house here in Moscow and he had only a slight physical disability. But they said he would never walk and he was diagnosed as imbetsil and sent to an internat. Then an American family managed to adopt him from that internat and I hear he's doing really well-and speaking fluently! They rescued him from that place.209
Even in the extremely rare instance when a child is "rescued" from a warehouse existence, Dr. Olga Vassilieva stresses how difficult it is to overturn the discriminatory diagnosis after all. The case she cites again illustrates how the Russian state routinely fails the children in its care. The story also highlights the need for system-wide remedies, not merely private initiatives:
There was a girl in this region who is now eighteen, who started here in our baby house. Then her mother took her, and she was put into an orphanage in another region. Finally she ended up in a psychoneurological internat, even though she was only debil. She happened to have a good staff person who helped her there. Now she studies at a cultural college, and she even had her own exhibit of paintings! But it was so hard to cancel her diagnosis. It took two people to handle her case.210
At any given time in any year thousands of abandoned children in Russian state institutions are approaching the test that will determine to what extent their basic rights to education, health, and indeed life, will be observed. Those who fail due to real or purported disabilities face a fate similar to the unfortunate children remembered above. Their internaty, and the inhuman treatment within their walls, are described in the chapter ahead.
VI. CHILDHOOD DOOMED:PSYCHONEUROLOGICAL INTERNATY
Photographs of the Internaty
They're called children with no prospects, not trainable, not treatable. A colleague called these internaty "death camps." The situation there is terrible.211
I could not say that I am proud of [that psychoneurological] internat, . . . but in general I believe that everything that can possibly be done in the current conditions is being done . . . And for these [Down syndrome] children [who may come from alcoholic homes], life in an internat is a paradise.212
The desperation among those trying to prevent misdiagnosed children-indeed any children-from being shunted into the total institutions run by the Russian Ministry of Labor and Social Development is well founded.
While physical conditions in baby houses have improved significantly during the past four years, mainly with the help donated by Western charities and adoption agencies, many of the psychoneurological internaty for orphans classed as imbetsily and idioty have sunk into squalid obscurity.
In the course of our research we learned of at least half a dozen institutions run by the Ministry of Labor and Social Development for orphans classed as imbetsily and idioty where visitors reported alarming conditions. Our own visit to one such internat in February 1998 confirmed that Russian orphans with disabilities are:
· segregated in lying-down rooms where they get a minimum of maintenance and the weakest are effectively left to die;
· confined to barren and dark rooms for control and discipline;
· strait-jacketed in a cloth sack tied at the neck;
· tethered by a limb;
· given excessive sedatives;
· commingled by age and gender;
· denied their right to education.
Human Rights Watch site visit to Internat X
Given the time constraints during our mission to Russia, Human Rights Watch elected to visit an institution that two of our key sources had seen. They asked that we not identify it, for fear of losing access to it.
We shall call it Internat X, a one-story building housing some 145 orphans. It had a lying-down room for forty bedridden children from age five to seventeen, and an empty room with boarded-up windows where twenty to thirty of the most difficult children to control were penned up all day.
Internat X also had several rooms with desks and cabinets which were used as classrooms for some of the other children, but no formal education or rehabilitation were offered to these orphans.
Arriving unannounced on a freezing Sunday in February, we were accompanied by two Russian contacts who had been to the internat before. There we saw scenes corroborating the numerous news reports and interviews with staff and volunteers in other internaty who relentlessly referred to the "utter neglect of the children's human needs."213
We also witnessed the use of restraints and isolation. There was no evidence of education or training for the children. Privacy was nonexistent.214 And the staff told us of the regular use of sedative drugs when children are agitated.215 There was not a shred of dignity left in the orphans' lives.
Human Rights Watch did not find the staff of Internat X to be wantonly cruel; in fact we noted concern and compassion among some of the women who were onduty that day. As it was a Sunday, the director, a physician, was away. The only medically trained staff to supervise the sanitarki was one nurse.
With a staff-to-children ratio of 3:40 (versus the official standard of 1:10), the internat was clearly understaffed. A young sanitarka in the lying-down room told us that she was the only one in charge of all forty children during the overnight shift. The sheer physical demands of cleaning the bedridden children are enormous.216
Of greater significance is the staff's ignorance of the true medical and mental state of the children in their care. They speak bluntly and derisively of the children in their presence, while admitting at times that the children indeed understand what they say.217
They furthermore lack any kind of training to provide appropriate rehabilitation for them, and are largely gripped by a deterministic view that the children's physical and mental condition is unalterable.218
The violations of the basic rights set forth in both international and Russian law are so abundant and self-evident in Internat X that to enumerate them by category would diminish the interplay of prejudicial stereotypes, orphanhood and neglect. The following section, therefore, highlights the human rights abuses we documented within the context of the internat. (Photographs of the children, taken around the time of our visit, appear at the end of this chapter.)
The Lying-Down Room
The children lay in two rows of tightly packed little beds, running the length of a long room with bare walls. Wearing huge, faded cloth diapers, they lay directly on rubber-covered mattresses. The air was warm and thick, and the odor of human waste, mingled with disinfectant, stung the eyes.
The orphans were in the process of getting changed when we walked in and one large, bedridden boy with a bright, alert face smiled at us as he propped himself up on his strong arms and swooped the clean diaper around his waist. The staff said that they change some of the kids seven times a day. "Only a few are toilet-trained, but how could they be? They can't even sit up to sit on the potty."219
Human Rights Watch asked the nurse and a sanitarka about the children's conditions and the nurse replied, "Well they all have oligophrenia." When we returned a blank stare, she repeated, "Oligophrenia. You know-imbetsil and idiot." When probed for more specific conditions, she replied, "Well, some have cerebral palsy, Down syndrome, nervous system trauma. And very often we don't even know what they are here for."220
Motioning to two withering little girls with translucent skin and vacant eyes, the nurse went on:
For example, we have the two little girls who can't eat. We try to feed them, and try to prepare special things for them, but they just throw up everything. They can't take milk, which we have, but they can take yogurt. But we don't get yogurt, and we only have milk. We don't know what to do with them and don't know what's wrong with them.221
Noticing a beaming blond, five-year-old boy walking on the callused sides of his club feet, we asked the sanitarka who was playing with him what his diagnosis was "Oligophrenia." But when we asked specifically about his feet, she replied, "Well, it's the same... imbetsilnost."222
Lying on a nearby bed was another boy with twisted feet, the one who had proudly changed his own diaper. He chatted and responded to one of the Russians accompanying Human Rights Watch, while a staff member explained the organization of the 145 orphans currently here. Her description reinforced our concerns about discriminatory labeling:
We have the children divided into four groups. They're divided by their behavior. All ages are mixed together, according to their behavior. We have them divided, like we divide ourselves up, between the smart and the dumb ones. The smart ones have a room with a television to watch, and some books and a teacher. The stupid ones don't have these things because they don't understand, anyway.223
Human Rights Watch asked if any of the children could read, and all the staff quickly replied, "No, no one reads." But after a pause to reflect, one of them corrected herself:
No, wait a minute, there are two kids, a brother and sister who are fourteen years old. They were raised at home. The father went to prison and the mother-something happened to her. They can read. When the boy's old enough we're planning to send him to live in town, where there's a place with small apartments. Some of the kids can do work; they work as cleaners, and they can make paper bags.224
One of the other staff added that "they even get money for it, so it's interesting for them." With that, her face flushed and she added, "Some even get married!"225
The staff mentioned another child whom we had noticed when we were walking through the lying-down room. He had a deep voice and appeared to be well into his teens from the waist up, but his lower limbs seemed shriveled under his blanket. With a tone of affection the staff appeared to marvel at the boy's "intelligence":
He talks, understands everything. I can ask him who worked the night shift. He always knows everything that's going on. He has two grandmothers and his father, and they come for special days. He knows about it and remembers, in fact, he'll remind me when they're coming next, and it will be three months from then.226
Later, as we were preparing to leave, we stopped by the boy's bed and one sanitarka said loudly:
He has relatives who visit him, all except his mother. His mother couldn't stand to look at him. She was afraid of him, and she's still afraid to look at himand can't come here to see him. Can you imagine, a mother who can't look at her child?227
The frank, demeaning language spoken in front of the children is a nearly universal feature of Russian custodial institutions and it is spoken not only by the poorly trained sanitarki, but by the doctors and nurses, as well.228 It both reflects the prejudicial stereotype against abandoned children, and reinforces its debilitating consequences.
Confinement in a dark room
Like many psychoneurological internaty run by the Ministry of Labor and Social Development, Internat X has a stark room where twenty to thirty of the "most difficult" children spend the entire day under the supervision of a sanitarka.229 The only items in the fourteen-foot by twenty-foot room are a string of benches lining the perimeter, a blanket on the floor and a row of plastic potties. Planks of wood have been nailed over the windows.
A regular visitor to Internat X corroborated what Human Rights Watch saw in the dark room, in an interview in Moscow:
Inside there's no light, no toys, a couple of benches. They spend all day in confinement there. One time a group of ten or so kids were sitting on the blanket on the floor. It was soaked with urine and the potties were full. The smell was absolutely atrocious. It's suffocating, oppressive.
The kids are all covered with rashes, sores on hands, arms, faces and scalp. They have cuts and scars on their foreheads. Last time I was there the woman in the day room told me, "we're not hitting them anymore."230
As Human Rights Watch approached the dark day room, accompanied by a sanitarka and nurse, a dozen children rushed at us, smiling and waving their hands to greet us at the door. Their heads had been shaved and their clothes were tattered. Clamoring to come near us, a couple of them swiftly wrapped their arms around our waists and hugged us hard. Another child came close and smiled with a gesture to stroke his soft, fuzzy head. Others stroked our hands. Few said anything, although a few told us their names.
There were other children in the room, including two small ones rocking themselves on the bare floor. On the bench to the right, a tall, gaunt adolescent girl stared intently with her hands clasped and slightly twisting her torso. "She's one of the most aggressive ones who attacks the others," said the sanitarka on duty in the room.231
In the center of the room stood Galina Kirilova, who appeared to be in her fifties. "I've worked here thirty-seven years, since 1960. Sure it's difficult, but you get used to it," she told Human Rights Watch. Turning with a flourish to scan the children around her, she went on. "Look, these are the rubbish of the place. The worst."232
Asked for the number of boys and girls in her care, the sanitarka guffawed. "Hah! I don't know. I don't even notice. They're all the same!" 233
None of the other staff accompanying Human Rights Watch on our tour of Internat X knew all the names of the children in the dark room that day, and no one knew all their ages. On occasion the staff members disputed the age of certain children among themselves. We asked the children their ages, and many did not know.
In replying to our query concerning the boarded-up windows, the staff told us that they put children here who misbehaved in the dark day room for punishment and applied restraints:
They've tried to break the window and one time one of the children ran away through it and we had to chase him during the night in the village. So it's bad, but we had to hammer wooden boards up over the two windows.
When it's a cloudy day, it's dark in there. They're in there all day. And it makes them nervous. They're nervous. They have to be tied or else they would break the window and try to run away. It's very hard to control them. They're the worst group we have.234
The staff of Internat X were equally forthright about the use of sedative drugs when we asked what they did at night if the children were too active and did not want to sleep, one of the sanitarki immediately replied, "Oh, we give them tablets. We have aminazine. We give them pills to calm them down."235
Some of the children have "too much energy," said Iliana Danilova, the nurse. "In summer we try to take them out for some fresh air for an hour, at least those who can move. The stupid ones have so much energy and so they need exercise."236
Our arrival in the classroom for some thirty "smart" girls came after more than an hour of interviews in other areas of Internat X, which allowed time for the teacher and girls to prepare for guests. The girls, ranging from about eight to seventeen years of age, sat at attention in several rows of tightly packed desks while the teacher stood in the middle.
A pleasant room with cascades of potted plants placed high above the children's reach, the classroom had as its focal point a large television mounted high on the front wall. A few cabinets displayed a limited selection of books and toys, and several pictures and drawings hung on the walls.
The teacher told Human Rights Watch that she mainly played games with the girls. When we inquired about basic education such as reading, she selected one child and instructed her to pick up the grammar-school book in English entitled"ABCs." The orphan, a mature, dark-haired young woman, struggled through a few pages and then the teacher thanked her, adding a shrug. "The others cannot read, because they cannot remember the letters," she told us. Alla Sergeyeva, the sanitarka, added, "They can't be taught to read."237
Seeking to demonstrate other skills among the group, the teacher then pointed out two sisters seated with their hands folded at their desks. She said she wanted them to sing. "There, there. These are seventeen and thirteen years old. Their father killed their mother and now they're here."238
After a pause of shyness, the flush-faced sister in front took the lead and began to belt out a Russian pop song, demonstrating a good voice and an entertainer's flair. Besides these brief performances, the atmosphere in the room was static. Yet it was clear that some of the children had potential for education and training and were receiving neither.
One of the older girls, for instance, approached us with a doll dressed in a turquoise gown she had sewn by hand, without patterns. The teacher and sanitarki praised her and encouraged her to go and get more things to show us. She returned with another doll's dress and a full-sized white robe designed like the lab coats worn by the staff. The articles were meticulously measured and stitched, with matching designs and creative details. As we were leaving she asked if we could bring some plain-colored fabric and a sewing machine the next time we came.239
The scene with this adolescent girl highlighted the stunted abilities and contradictions that are rife in the Russian institutions. While the teacher and sanitarka told Human Rights Watch that they had taught her to sew, it was up to the girl to teach herself to make the clothing. After insisting that the orphans cannot learn anything, the staff admitted that the lack of stimulation they provided the children was a partial cause of their dearth of skills: "So you see, they can do things. But there is really nothing to do in the place."240
The scene in the classroom for smart boys was similar, with the rows of desks, the cheery plants, bright walls and large wall-mounted television looming above. Sitting at a desk just inside the door, the teacher shouted, "Okay, all of you,shut up now and listen to what they have to say," to some thirty boys, some of whom had reached adult height; the youngest was a child of five.
There were even fewer materials for education in the boys' room; indeed the only book was a Soviet era adventure story entitled Brigantina, which one of the taller boys volunteered to read aloud.
The children expressed lively curiosity toward their visitors, and one boy interrupted with excited questions about the flora in the United States. Apparently the self-appointed horticulturalist for the internat, the boy knew a great deal about plants and trees, and pointed to some sacks of seeds which he would be planting in spring to beautify the grounds of the internat.
Except for the fact that the windows were not boarded shut, the two day rooms for eighty "dumb" girls and boys provided the same interminable idleness as the dark room for the "most difficult" children. At the time of our visit we saw about fifteen boys and girls ranging in size, in each of their respective rooms.
The sole furnishings in each room were two benches; neither room had a single toy, table, or chair. A door led to a bathroom next to the girls' room where a sanitarka kept watch over a girl as she was sitting on the potty, through the open door. A crowd of girls sat in filthy, ragged clothes on the floor of the fifteen-foot-square room. On one end of a bench against the right wall, a bone-thin girl sat dangling her crossed legs and staring straight ahead. A long frayed rope anchored her by the ankle to the bench, to "prevent her from running away."241 Her torso and arms were sheathed in a dingy cotton sack pulled over her head and drawn at the waist and neck. Without the sack, the staff said "she would break windows or something."242
On the opposite end of the five-foot-long bench a sixteen-year-old girl was also tethered by a rope that was knotted around her wrists. The hair on her head had begun to grow out from its last shave, and she wore a black dress and white boots. The staff told Human Rights Watch that if she were not tied, the girl would undress herself.243
In the barren room for some forty "dumb" boys, none of them was restrained and most of them were running around. The numbing environment here and in thepurported classrooms for the "smart" orphans was corroborated by the experience of a regular visitor whom we interviewed in Moscow:
These kids are supposed to have modified education, but in the two classrooms there were no education materials at all, except desks and chairs. No materials. One time I went, the kids were sitting in a room, about twenty kids, watching TV. One time, the light was off and they were just sitting there. There's absolutely nothing to do.244
Both of the Russians who joined Human Rights Watch on the visit remarked about improvements in the internat since their last visits in 1997, although this was hard to imagine. Both said that the children in the lying-down room had been lying motionless and staring into space, and it was silent save for the incessant crying. As one noted:
Now there is a radio playing music in the room. The children seem to notice that there are visitors, and seem to make more eye contact. More important, there appears to be more contact between the staff and the children-they did not treat them like humans before.245
Unmarked graves and abuse of authority
Indeed Internat X has a troubled past, and some visitors hold the director accountable for it. Some twenty-four children (out of the population of 145150) died in a single year two years ago.246 A Western news agency reporter who visited the place with a colleague in early 1997 was stunned by the steady sobbing of the neglected children.247 Following their visit they learned that one of the staff whohad talked with them was fired, and then that food they had brought did not reach the children.248
In June 1998, four months after we saw Internat X, Human Rights Watch received a report from a regular visitor there that one of the emaciated children-a nine year old girl-had died. The visitor, Sylvia Jackson, thought that the girl had not been getting enough food, and used to go there to wash her. She watched her deteriorate, and saw the girl shortly after she died in the internat.
The orphanage misinformed the visitor of the burial time, and when she arrived, it had already taken place, she told Human Rights Watch. At the site, she saw a lot of unmarked graves, and she learned that the other children from the orphanage were made to dig the grave for the dead child.
According to Ms. Jackson, the director of Internat X told her that she does not report deaths to the authorities in order to keep the $300 allocated to the deceased child per month earmarked for her institution.249
Discovery of Internat Y
In February 1998, during Human Rights Watch's mission to Russia, yet another psychoneurological internat run by the Ministry of Labor and Social Development in a region north of Moscow was exposed by a cameraman from the British network Independent Television News (ITN). The footage was ghastly, and it corroborated our findings from Internat X.
From the driveway, Internat Y is a two-story, beige brick building. From 224 to 230 children, aged five to eighteen years, are housed here, and all are diagnosed as imbetsily or idioty. The cameraman threads through the dimly lit corridor on the first floor, and then stops and turns to a closed door. As it opens a gale of children's shrieks and giggles bursts from inside, and a group of adolescents with shaved heads emerge like zombies, blinded by the glare. At the sight of the cameraman some of them begin to clap their hands and their screeches turn to grunts and growls. The sanitarka, tells them, "Stop it. Enough. We have a guest here."
The children appear unwashed, with bruises and scratches on their skin and scalp. Their clothes are torn and filthy, and the camera focuses on a pair of tatteredslippers. The cameraman was told that the children were wearing their only clothes.250
Within minutes about ten children gather in the corridor, including a spastic girl with contorted legs who has crawled out of the room. According to the Russian cameraman, "It was hot like a sauna and the smell was horrible."251
While most of the children smile and point at the camera, a tall, solidly built girl named Marina M. stands against the wall, staring sullenly with down-turned mouth. The staff say that she is thirteen years old and "a Down." Her nose runs and she is biting her puffed, red lips. Her cotton sweatshirt is askew, and falls off her left shoulder. To the right, a girl gazes with her mouth agape.
Upstairs, the cameraman enters a lying-down room much like those in Internat X, as well as baby houses across Russia, and finds rows of children half the size for their age, with spindly legs, lying on small beds. Some are sitting up and rocking themselves. The internat's one staff doctor, who has been summoned from home by the director on this Saturday, strolls among the rows of bedridden orphans, none of whom has a stuffed animal or toy.
As the doctor approaches the frail children to demonstrate the severity of their disabilities, she abruptly hoists them up by the shoulders and pokes at their heart and other organs. One child has loose stomach skin which the doctor points out to the cameraman by pulling at it while she talks to him. There is no appearance of any relationship between the staff and children, and no spontaneous effort to comfort the children as the doctor performs the brief demonstrations.
One child she approaches is lying motionless, face down. At eight years old, Tanya is the size of a child less than half her age. She suffers from a heart condition and has very red hands, and groans as the doctor pulls her up to face the camera. Her tongue lies limp in her open mouth, and she is barely conscious. She will die before she reaches adulthood, says the doctor, in front of the children.
Sitting folded over in front of Tanya is a little girl with bright eyes, who rocks and bounces, trying to play with the camera man.
After viewing the ITN tape in Moscow, Human Rights Watch interviewed the Russian cameraman for information about any education or activities provided to the ambulatory children who did not appear for much time on his tape. "They showed me some classrooms, and showed me some games they play," he said. "Some got education. But there are so many children with different mental conditions. With the difficult children, it's rough for them."252
The cameraman saw no activities going on in any of these rooms, albeit, it was a Saturday when he visited. When he inquired about the children's names and conditions, the staff replied, "I don't know." As poor as the conditions were, however, the cameraman told Human Rights Watch that the internat was the only place in town where officials found money in the empty public coffers to pay the staff.253
The director, who had been reluctant to allow the cameraman into the internat in the first place, did not tell the him the annual mortality rate among the 224 children. Rather he said that the "prospects" for half of the orphans were "okay," but for the other half, "the prospects were "not okay."254
Those who do reach the age of eighteen will move to a "mental hospital for adults," the staff said to him. Wincing, the camera man told Human Rights Watch that he had been on assignment to several such state institutions, including one for mentally retarded adults. He said, "There-it will be even worse."255
Within a week of ITN's visit to Internat Y, Human Rights Watch interviewed two Russian welfare workers who had visited that same internat several times. Confirming the description of gross neglect that was obvious from the video footage, they added their own concerns about the deterioration of children's condition upon entry, and the commingling of older children with little ones. The scene they described was chaotic:
When I went, there was a woman who cut long bread in half and just handed it to the children and they just grabbed pieces off of it. Some were on beds without a pillow, or cotton sheets-just on bare rubber sheets. Others were crawling on the floor, rising up to grab the bread. They were half naked, wearing only shirts. These were the "invalids," the ones who couldn't really walk. Because the ones who could walk went into the stalovaya (dining hall)to eat and feed themselves. These "invalids" were fed in their place, and there were old children with young children, boys and girls all in the same room.0
Another periodic visitor to Internat Y was particularly jolted by the debilitating effect that the institution had had on several children she had known before they were committed there:
WORKER No. 2:
The first time I went there I cried all the way back from the place. When you get there you see only those kids who are "invalids." And because the baby houses are under the Ministry of Health, and the internaty are under the Ministry of Labor, there's a really big difference. At the baby house where the children came from they really got treatment. But at the internaty, all they do is feed them. It's horrible there.
There's a dreadful smell, you really need a respirator. They're all naked from the waist down and they wet the bed. You can imagine the smell. There are rubber sheets under them. Or they put them on the potty on the floor. There are older kids who have no continence and don't feel when they're wetting themselves. What I saw there was such a nightmare.
I saw kids just sitting on pots, some were on beds, some were crawling. Some of the deeply disabled ones were sitting on potties and some were fed with bottles.1
In view of the debilitating neglect depicted in the footage shot by ITN on February 28, 1998, it is difficult to imagine that it was much worse when Worker No.2 made her first trip there. "The first time I went in September 1995, it was really bad there. Last time it was better, they'd finished a renovation and it was better."2
Human Rights Watch commends action taken by the Russian authorities to improve the physical environment for some of the children under its care. But we conclude from interviews with a range of doctors, institution staff, volunteers and journalists who have visited all of the internaty in Moscow and various outlying regions, that the state fails to allocate appropriate resources to the critical developmental needs of these children.
One doctor who has directed a large baby house for more than twenty-five years and is familiar with Internat Y and other institutions in Russia told Human Rights Watch, "Internat Y is bad, but there's one like it in every region of Russia. And not only one."3
Additional reports from visitors to other internaty heighten the need to put an end to commingling of different age groups. One charity volunteer described to Human Rights Watch how older orphans of the psychoneurological internat change and clean the bedridden ones:
In the internaty, a lot of the main caretakers are the older inmates. If they're put to work feeding and taking care of the kids, there's potential for abuse. Everything I say here, I have seen ten times. In some you'll get a fifteen-to-sixteen-year-old perfectly normal child, wrongly diagnosed, looking after these children who are "becoming" imbetsily themselves.4
A Western journalist who traveled to a number of internaty for feature articles on the state of internaty echoed this observation to Human Rights Watch as well:
You must remember that the people who are changing the babies and clothes are often the older "debily," who are not qualified. I saw a big guy pick up a child by his hands and feet to transfer him to the next bed to change.5
During our mission to Russia, a third internat for orphans with disabilities was featured in a lengthy article in the Moscow Times on February 7, 1998, about children with Down syndrome. Human Rights Watch interviewed the journalist, who asked that we not identify the institution, despite the fact that her research indicated that it was "one of the smaller and better ones in Moscow."6
Clean, fitted with new curtains and a new coat of paint on the walls, Internat Z is home to 150 children. Although the staff are overworked, they know the names of all the children.
It is especially noteworthy that Internat Z does provide education to the children who are classed as imbetsily and debily.7 The journalist found that most of these older children had learned to read and write, and one of them had just started working as full-paid member of the staff there. The child had somehow inherited an apartment as well, and was going to live outside. The younger children with lighter disabilities were taking music lessons, and at the time of her visit, they were making Christmas cutouts. 8
Yet even in this "good" internat, the journalist told Human Rights Watch, there was no education at all provided for the children with the severest classification as idioty. And she described the lying down room to Human Rights Watch as "just horrific":
There were three tiny children. They looked about eighteen months old. Completely emaciated, wasted legs. One was in a straitjacket; the other two were dying-completely lifeless. Then there were four or three older children lying in beds with cerebral palsy as far as I could tell.
There were four children in a playpen with no toys. One was screaming, screaming, screaming. And two other were prostrate, face down and hunched over, like in fetal position.9
General observations on abuses of orphans classed as imbetsily and idioty
Malign neglect of medical needs
As in Russia's baby houses, children in the internaty of the Ministry of Labor and Social Development are often passed over for needed medical or surgical treatment. Dr. Anatoly Severny, a child psychiatrist and leading critic of the cycle of discrimination against abandoned and disabled children, described the problem in an interview with Human Rights Watch:
In the internaty they really don't treat the children as if they're people. These children are viewed as hopeless. Recently a colleague of mine who is a psychiatrist in an internat transferred a child to an infectious disease hospital. The hospital refused to place that child in intensive care, because supposedly there is a directive not to spend money on expensive medicine for children with a mental disability. The child had cerebral palsy and had a lung infection. In Russia there's always been a system of "unwritten rules": supervisors give oral instructions and nothing is written.10
Human Rights Watch interviewed Dr. Severny's colleague, who provided further details on the eight-year-old boy who was denied medical care:
When we tried to explain they were violating the child's rights, and that he should be in intensive care, they said, "We just do what we can do." And they refused. It's true that he has severe pathology. The boy had pneumonia, respiratory infection, cerebral palsy, and he has a problem swallowing food so that it goes down his windpipe. He's very skinny because he cannot be fed, and he looks more like five years old. But he is responsive, he reacts. We called every day to check on the child, and he's still alive!11
Again, as Chapter IV of this report documented the malfeasance and neglect concerning medical referrals from baby houses, this case illustrates the disadvantages of abandoned and disabled children in internaty who are truly without parents:
The surgeons refuse to operate on the heart because the operations are expensive. If this child lives in a family, the parent insists on surgery and sometimes gets it. Sometimes they obtain money somewhere, but those in internaty never get such operations. Children with disabilities like this will not be cared for even when they're in the maternity hospital. Really, these children are not examined properly. We can't get special medical care for them.12
A similar case in Internat Z was featured in the Moscow Times article on February 7, 1998. In the following excerpt, the chief psychiatrist at Internat Z expresses the prejudice that denies orphans like Tanya Chekhovskaya a life-saving heart operation:
Tanya smiles as Lydia Petrovna, the chief psychiatrist at the internat, or home for disabled children where she lives, declares to a visitor that the girl suffers from acute mental retardation; "the worst kind of oligophrenic (small brain); an idiot."
Tanya smiles as the doctor explains that Down Syndrome children go through phases of being "evil, sullen, and withdrawn," as well as times when they are happy to dust furniture if lavishly praised.
Tanya even smiles as the doctor describes how the Moscow cardiological center deemed her "unsuitable" for a heart operation on which her long-term survival depends because the center does not waste resources on disabled children.
As Petrovna continues describing how children with Down syndrome are incapable of playing with toys, let alone learning to speak, Tanya slides out of her chair and begins to explore the room, chattering happily to herself as she moves. She discovers a piece of patterned paper in the trash can. "Ineducable Tanya" repeats, after she hears them spoken, the names of each of the colors."13
Excessive use of strong drugs
The reports of sedatives being used in Internat X were substantiated by a Moscow psychiatrist interviewed by Human Rights Watch. She explained how, in the previous internat where she worked, every evening a nurse gave the children a psychotropic drug-tizercine, relanium or aminazine-all without a doctor's prescription. "There's a slang term for that-ukol beznorm-which means 'injections without doctors' orders.' "14
Dr. Anatoly Severny told Human Rights Watch that children he has seen in institutions have also told him about the administration of "ukol beznorm."15 Asked about the drugs that are commonly used, Dr. Severny told us:
The regular ones are: aminazine-a neuroleptic-haloperidol, and neuleptil, which especially retards strongly, and is given for restless behavior. Other drugs are ceduxen, relanim, nazepam, rudotel. These drugs can actually retard the child further. You can quite surely say that this is a common practice. For internaty, that's for sure.16
Russian Orphans classed as imbetsily and idioty are subjected to a lifetime of malign neglect, deprived in some cases of their most basic right to life. The malfeasance on the part of the Russian authorities, notably the Ministry of Labor and Social Development, is all the more deplorable in light of the remarkable recoveries achieved by a group of orphans who were permitted to enter the care of several ordinary volunteers from Russian society.17 The dramatic results of this effort are presented in Chapter VIII of this report.
But first, the unique genre of corporal punishment and gratuitous violence encouraged in orphanages for school-aged children is documented in Chapter VII.
VII. THE DYETSKII DOM: TRUNCATED LIVES AND GRATUITOUS CRUELTY
The director or a teacher does not always punish the children directly. They can get the older kids to punish the other kids. One of our teachers would just say, "Okay, now you two fight each other! They could do this for punishment, maybe, but also for amusement.18
Or for pure sadism. Sadism.19
Like most of the baby houses in Russia, some of the orphanages run by the Education Ministry for school-aged children have been the beneficiaries of charitable donations since 1991 and have seen significant improvements in furnishings, clothing and supplies. These improvements were corroborated during Human Rights Watch's mission to Russia, through extensive research and interviews with six Russian children's advocates, four orphanage teachers, and thirty-one Russian orphans, who represented at least seventeen dyetskiye doma of the Ministry of Education. We also interviewed a Western journalist who had visited five dyetskiye doma six baby houses and three internaty.
The orphans and their teachers we interviewed resided in institutions in Moscow, St. Petersburg, and a third town some miles north of the capital. In Moscow, we arranged our interviews through local children's rights advocates who had collected the orphans' initial testimonies of abuse at the hands of several orphanage staff. We interviewed four teenaged children and two vospitateli from Orphanage A, and a girl from Orphanage M.
In St. Petersburg, a different independent children's rights advocate informed us of particularly abusive orphanages in that city and its environs. Based on that information, Human Rights Watch made an unannounced visit to a group of orphans aged fifteen to seventeen who had "graduated" from a variety of local dyetskiye doma in the area and were taking vocational training until the age of eighteen. They resided in a large state-run dormitory-Dormitory X-which wevisited three times. In the course of those visits, Human Rights Watch conducted interviews with fifteen boys in a group setting, and seven individually.
The third group of teenaged orphans Human Rights Watch interviewed were referred to us through children's rights advocates in Moscow who had received reports of their grievances from a sympathetic child welfare worker in their region north of Moscow. Also aged fifteen to seventeen and taking vocational training, the orphans in that region had been diagnosed as debil or "lightly oligoprhenic," in the state orphanage system and raised in institutions run by the Ministry of Education for children with mild disabilities. We interviewed about ten of them in a group setting, along with two vospitateli who were unusually active in informing these children of their rights under Russian law and attempting to appeal their stigmatizing diagnosis of oligophrenia.
Human Rights Watch concluded that the standard orphanages run by the Russian Education Ministry were relatively clean, with only two to three beds per room, and provided adequate food. The children had access to a local public school and sometimes even had extracurricular activities in the dyetskii dom.20
Yet from our investigation, a dark tableau of abuse, dereliction of responsibility, and gratuitous cruelty also emerged. Orphanages for school-aged children breed their own genre of brutalizing punishment. It is distinct from the discipline found in the baby houses or the internaty, but well known in the Russian bastions of gang-rule: the military and the GULAG prisons.
First, Human Rights Watch received reports that adult staff members of Russian orphanages had abused children by:
· slapping or striking them
· shoving their heads in the toilet
· squeezing a hand in a vise
· squeezing testicles while interrogating them
· stripping their clothes off in front of peers
· locking them in a freezing, unheated room for days
· engaging them in sexual relations
· sending them to a psychiatric institute to punish them for misdeeds such as attempting to run away.21
Secondly, Human Rights Watch heard reports that older or stronger orphans, goaded by the adult staff had maliciously abused younger or weaker ones by such measures as:
· beating them on the neck, forehead and cheeks
· throwing them out the window in a wooden chest
· wiring a metal bed to electricity and shocking a child forced to lie on it
· forcing a child to beg or steal for them.22
The variations on acts of corporal and psychological punishment fell into two broad patterns. In the first instance, adult staff members, with the informal consent of the orphanage director, strike and humiliate children. Then, in an elaborate version of this direct abuse, the adults engage other orphans with them to punish a child "collectively."
For children who hardly have a positive alternative social role model from the world beyond the institution, the orphanage staff set an unconscionable example of degrading discipline. In doing so, the adults helped reinforce a survival-of-the-fittest hierarchy among the orphans, which they fostered in a second pattern to control and punish children by proxy.
This proxy pattern was particularly insidious because the favored children, delegated to "govern" like minor feudal lords, developed a repertoire of vicious and injurious punishments which the older, stronger orphans inflicted upon the younger or weaker ones. In Russian, this is known by its familiar colloquial term "dyedovshchina," or hazing, which is taken from military slang; it was not surprising to Human Rights Watch when orphans in St. Petersburg spontaneously used dyedovshchina to describe the gratuitous violence in orphanage life.
It is worth remembering that this practice of hazing as a means of internal control is understood by Russians as malicious and even deadly; it is not to be confused with the typical roughhousing among fraternity brothers at universities in the United States. A brief catalogue of frequently used punishments appears later in this chapter.
As the testimonies herein depict, orphanages for school-aged children in Russia violate the essential tenets of international human rights law, which prohibit cruel,inhuman and degrading treatment, and guarantee the right to live in dignity.23 Moreover, while it offers children a nominal public school education, the state orphanage system fails to prepare them for the responsibilities of creating homes and families, and finding a decent place in society.24
While numerous experts interviewed by Human Rights Watch stressed their alarm at the lack of appropriate social training to prepare institutionalized children for life as adults on their own, 25 the evidence assembled here shows that state orphanage system does acquaint children with the pecking order of the streets. Indeed one orphan told Human Rights Watch that he planned to be a "vor v zakonye" (Russian mafiya boss) some day, while he was flanked by two meeker looking orphans whose admiration was apparent.26
Several boys in the St. Petersburg dormitory we visited told Human Rights Watch matter of factly that they made their pocket money by picking pockets in the market.27 One of them said plainly, "We all learn to steal," as he showed us some rooms with considerable furnishings that he and his friends had stolen from shops while distracting salespeople.28
One of the reports that we found most disturbing from the orphans we interviewed in Moscow and St. Petersburg was the psychological abuse with which the adults infused their discipline. "Humiliation" was the word the children we interviewed repeated like an intrusive memory-from the denigrating curses that staff members use, to public shaming in the presence of their teenaged peers. Further, children who had grown up in one St. Petersburg dyetskii dom reported to Human Rights Watch that their director had encouraged orphans to ridicule certain children as homosexual, thereby reinforcing an intolerance that runs deep in Russian society.
Although knowledgeable people we interviewed knew of dyetskiye doma where physical and psychological abuse were not routine, the findings in this report call attention to discernible patterns detailed to us by people living and working in some institutions. Moreover, their testimonies, which included cases of sexual abuse and institutional corruption, signaled the need for a thorough, independent investigation across the Russian Federation.
Russian children's rights activists and an attorney we interviewed shared the concern of international child welfare experts that far more abuse takes place in institutions run by the Ministry of Education and Ministry of Labor and Social Development than ever gets reported. One expert told Human Rights Watch that the several reports we received about official action taken against abusive orphanage staff were "definitely the exception," and that:
I have no doubt that abuse is going on in places far from Moscow that we will never hear about. There is no standard means for children in institutions to make a confidential complaint about abuse by staff. 29
A leading Russian children's rights expert based in Moscow also told Human Rights Watch that the only way for many orphans in the more remote regions of Russia to expose abuse in their dyetskii dom is to run away from it and report it. She continued:
Most of the dyetskiye doma are fully closed institutions, and almost no one gets access to them. No NGOs, no private citizens, only government control. Even children living in homes do not complain to officials when they are abused by their parents because they feel ashamed about it and they are scared and do not know what they can do. The orphans live in isolation. They do not know their own human rights and rights in general. They get a very bad education and no one gives them information about the structure of society.30
Furthermore, a Russian lawyer who is experienced in juvenile law told Human Rights Watch that even some children's advocates felt a disincentive to talk about abuses in the dyetskyei doma, because they need to maintain a working relationship with the orphanage directors in order to obtain information for legal cases they prepare on behalf of the children. Some advocates fear that they would lose the directors' cooperation if they were to expose abuses.31
In sum, one of the great impediments that children's advocates face in attempting to glean a picture of Russian state institutions is the lack of access and the de facto reliance on the few children who escape and seek out some independent nongovernmental group or even the Russian media, to report the abuse in their orphanages. The interviews conducted for this report indicated that children in orphanages tolerated a certain level of neglect and abuse. The cases that reached the stage of official investigation in Moscow and St. Petersburg involved particularly egregious offenses or repetitious cruelty that prompted children or sympathetic staff members to seek out known human rights advocates or outlets in the mass media.32
Adult perpetrators of crimes against children in their care must be prosecuted under Russian law, which provides criminal penalties for those who endanger the welfare of a minor. And the system encouraging minors to inflict abuse upon each other must be dismantled.
Corporal punishment by orphanage director and staff
In order to speak candidly with school-aged orphans in Moscow, Human Rights Watch arranged to meet a group of four teenagers in the apartment of a former member of their orphanage staff who had supported the children's complaints about abuses in their dyetskii dom. We shall call it Orphanage A. Our meeting was organized through the leading children's rights group in Moscow, Rights of the Child, which had learned of frequent corporal punishment by staff members. In our individual interview with Masha K., sixteen, she told us that as in baby houses and internaty, abandoned children in dyetskiye doma who had no parents were more likely to be mistreated:
That teacher in my orphanage was a very cruel woman. She used to work in a kolonia [prison] for kids and really loved to beat up children. That was hermethod with me. She'd catch me by my hair. There was another girl in my class whom the teacher would grab by the hair and bang her head against the wall. That girl also had no parents. There were very poor children there, and we had refugee kids, too. The director was very energetic as a director, but as a person-terrible.33
Human Rights Watch conducted a separate interview with Kirina G. from the same orphanage. Small boned and slender, Kirina G. told us that she had been abandoned at birth, and spent the first three years of her life in a baby house before being transferred to Orphanage A where she has lived ever since. Kirina G. also described how the staff of her present orphanage treated children without parents more harshly, knowing that there was no one who would complain:
"When I was little, Svetlana Petrovna put my head in the toilet and beat me on the behind, hips, and arms. At first she would hit me on my hand-that was while I was small, until I was nine years old. After that she could take a slipper and slap us on the lips. Of course, a kid couldn't do anything or say anything. We were so afraid of her.
"They could put you in the bedroom and make you stay there. They also kept food from you to punish you, too. Right now it's the staff that's the worst thing about life here-especially Svetlana Petrovna. She's been here six or seven years. There are about six or seven staff who are about the same."34
In another individual interview with a girl from Moscow Orphanage A, Irina V., we were told what she witnessed in their orphanage:
I saw what happened to Kirina G. She was very afraid of the group vospitatel' and would lie to her about her grades. Svetlana Petrovna said, "If you lie to me again, I'll put fekali [excrement ] in your mouth." She lied the next time and Svetlana Petrovna beat her all over. Her lip was bleeding.
Svetlana Petrovna also once put Valentin T.'s head in the toilet. It was summer 1994 when we were on vacation and we went to the summer camp.Valentin T. left and went into the neighborhood near us and Svetlana Petrovna took him to the outhouse and-as he said-she put his head in the toilet.
She also did this with Julia B. That was last November (1997). One evening Julia B. came back a little drunk and decided to go to the teacher and tell her what she thought of her. The teacher took her to the shower and physically put her head in the toilet.35
Dmitri P., fifteen, lived with his family until the age of thirteen, and has since lived in Moscow Orphanage A as well. He told Human Rights Watch:
I see kids punished almost every day. Slapped. Kids could be humiliated verbally with words that are too bad to say. I personally haven't been punished physically by the teacher, but I have been punished verbally.36
Like nearly all Russian children, Dmitri P. became too embarrassed in front of foreign visitors to pronounce the "bad words" used to humiliate them, including the young children. One of the others from his orphanage agreed to write the following list for Human Rights Watch: pizdiuk (cunt), pridurok (jerk, said very angrily), suka (vulgar term for bitch), and kozyol (literally, "goat;" but in the prison world, it is the worst possible insult to Russians, connoting "passive homosexual").
In St. Petersburg's Dormitory X which we visited, children we interviewed told of excessive physical punishment as well. One child from Orphanage C described to Human Rights Watch how the director and a teacher in his orphanage severely punished a boy named Mitya K. for the alleged theft of humanitarian aid received by the orphanage:
The director and the teacher locked Mitya K. in the hardware storage room of our orphanage, and then put his hand in a vise and turned it. He experienced a lot of pain, and they had to send him to the hospital by emergency ambulance.37
Another boy from Orphanage C told Human Rights Watch that, "The director grabbed me by the balls and squeezed while he was asking me questions."38
Isolation in a frigid room
Anya D., sixteen, from Moscow, had been put in Orphanage M by her parents, and later got them to take her home after complaining of the physical abuse taking place there. But in 1996, in the midst of the real estate boom in Moscow, her mother sold her four-room apartment and moved to a rural area in the surrounding region. "My mother's an alcoholic, and she claims she put 40 million rubles (about $8,000 at the time) in a bank account for me and my brother, but it's not true. I'm from Moscow, and I didn't want to live out there, so I came here."39
Human Rights Watch interviewed Anya D. at a small, privately run refuge for runaways in Moscow, where she described Orphanage M where she had lived from the time she was eight to eleven years old. She told us how the staff punished orphans who tried to run away:
There was a punishment there: they would put kids for two to three days in a freezing cold room with no food and lock the door. It was on the third floor at the end of the building. They would lock the door from the outside. There was no heating there.
They warned us, if you escape, we'll put you in the "komnata" [the room]. There was a boy who was eleven years old, who ran away for a day. He was caught outside and brought back and put in the cold room. The vospitatel' put him in the room. I saw them going there. Two men dragged the boy. He was resisting, and crying, of course.
He was in there for two days, only wearing his indoor clothes and slippers on his feet. When he came out, he was freezing. I can even say that he couldn't think clearly. He was crying. When his parents came, he told them everything, and they applied to the court. I don't know what happened after that.40
Other children in Orphanage M were similarly confined to the unheated isolation room during the Moscow winters, as Anya D. recalled:
One girl went in because she was rude to the vospitatel'. We were watching TV, and the girl said something and had an argument with the vospitatel'. The vospitatel' said, "If you're going to argue with me, you'll go into the room."
So they started to fight with each other and the girl swore at the vospitatel'. Then the vospitatel' grabbed her and pulled her to the room, and left her in there for five days. It was winter. She was really pale.41
In another instance, teachers struck students for answering questions incorrectly, according to Anya D.:
If you give a wrong answer in class, they can hit you with a stick. I was eleven and got hit fifteen or twenty times. This wasn't when I misbehaved, but when I gave a wrong answer to my lessons. It went on the whole time I was there. We had five teachers and two were nice, three were bad.42
Corporal punishment sharpened by public shaming
Kiril V.'s Story
In February 1997, a young Moscow teenager we shall call Kiril V. accused staff members of Orphanage A of stealing yogurt that was intended for the orphans, and then grabbed a couple of yogurt containers and ran off to another part of the building.43
In an interview with another orphan, whose testimony was corroborated in a separate interview with a teacher from the orphanage, Human Rights Watch was told that Kiril V. was punished for stealing the yogurts by three members of the staff-the psychologist, the teacher of household tasks, and the deputy director of the orphanage. Together they threw him out a window on the first floor of theorphanage.44 Another teacher on the staff witnessed it, and sought help from the Moscow advocacy group, Rights of the Child, in filing a complaint.45
Kiril V.'s story continues, because he complained to the director about being thrown out the window by the staff. His subsequent punishment exemplifies the peculiar practice of publicly shaming children by stripping them or exposing them in some way to their peers, as orphans in both Moscow and St. Petersburg told us. Public shaming was a recurring motif in our interviews conducted with some thirty-one children housed by the Russian Ministry of Education. In the following testimony, a fifteen-year-old orphan in Moscow named Masha K. told Human Rights Watch how she witnessed Kiril V.'s public mortification in Orphanage A:
I was having a German class with a group of five kids when Kiril V. came into the room. It was a big room-and maybe the teacher who is in charge of him had learned that he had complained to the director about being thrown out the window. She walked in after him and said, "You don't have any right to complain about goods. You're wearing German stuff (donations). You don't like it? I'm the one who gets it for you."
Kiril's very small, and she grabbed him and she took off all his clothes-his briefs, too. Because all the clothes were donated by the German group. He was naked. And she threw the stuff out. He cried because he was very ashamed and so upset and confused. After that she called all the kids together to a meeting to make an announcement. You know it's a tradition for us to call her "Mom"-even though we don't mean it for affection-and she told Kiril, "From now on you can't call me Mom. You don't deserve to."46
Such public humiliation appears to have been a signature punishment in this Moscow orphanage for years. Irina V., sixteen, recalls another incident involving the same staff member:
It was at the summer camp about four years ago when Kirina G. tried to smoke. To punish her, Svetlana Petrovna dragged her in her panties only, to the boy's shower to humiliate her.47
Human Rights Watch heard reports of even more elaborate rituals of wanton cruelty in our meetings and interviews with about fifteen teenaged orphan boys taking vocational training at a Pedagogical Technical Directorate (PTU) in St. Petersburg. The boys had "graduated" from seven Ministry of Education dyetskiye doma in and around St. Petersburg, and described a barrage of violence at the hands of their orphanage directors and staff throughout their childhood.
Children who had spent time in Orphanage C recounted to us how a teacher used the punishment of stripping to convey a stern warning to the others:
The teacher would punish children by bringing everyone into the classroom, and then making the ones who did something wrong get undressed and stand in front of the open window when it was very cold. Several children would be stripped and have to stand like that while the others had to watch the child in front of the window as a threat.48
Piotr C., who had lived in Orphanage C, told Human Rights Watch about a teacher in that orphanage who would grab a girl or boy and force him or her to crawl on all fours in front of everyone. Then she would make the others join in on it:
For punishment, a teacher named Alexandra Kalugina would strip off a child's clothes until he was completely nude, and make him get down on all fours. Then the rest of the children had to kick the child and sit on him like a horse-to humiliate him. The kids could push and kick and pull hair and ride him like an animal. She was an active sadist.49
Piotr C. told us that this same staff member later ordered children to punish another child, which resulted in that child's injury. That incident was reported andshe left the orphanage.50 Based on the reports received from these children and those interviewed in Moscow, many abuses go unreported, but some extreme incidents, especially causing injury to a child, have been punished.51
Nikita M., also from St. Petersburg, complained to Human Rights Watch about the constant ridicule he suffered from his orphanage director at Orphanage B, who, according to others from the same institution, told the children that Nikita was gay. The boy himself did not go into details, except to say:
I was crying a lot of the time, because the director was shaming me. It was very tough for me, because he was trying to humiliate me and isolate me from other children.52
Murky areas of misconduct founded on humiliation of this kind were impossible for Human Rights Watch to corroborate case by case. However, we were alarmed by the level of detail and consistency in the testimonies taken from children in different cities, interviewed individually, and by their apparent role as a prelude to overt physical punishment.
For instance, in further interviews with other children who had lived in Orphanage B one child described to us the progression from verbal abuse to physical violence against Nikita M., seventeen, whom the director alleged to be homosexual:
The director suspected Nikita of being "malchik-devochka" [passive homosexual] and this was why the director hated him. He was very aggressive to him and accused him in front of the other kids of being homosexual. One time the director told me that he saw Nikita with another boy playing "house," and Nikita was playing the passive role. The way the director told me, Nikita was asking the other kid to play the game and wanted the boy to play the father and Nikita would play the mother.
Now, then there was some humanitarian aid we received and it was stolen in the orphanage. So the director decided to check the classrooms, in case it was the kids who stole it. While he was checking the rooms, he found Nikita and Sergei C. in a classroom and at that moment, Nikita was naked and masturbating. Sergei C. was dressed. The director told Nikita to put his clothes on and follow him to the study. Then the director told me to come in with them to be a witness.
So the director started to ask Nikita about this situation where he was naked with the other boy and Nikita started to cry. Then Nikita insulted the director who hit Nikita on the neck. Nikita cried some more and the director told both of us to leave.53
According to Pavel N., after the incident in the study, Nikita filed a complaint against the director. To this, the director of the orphanage called a meeting of the orphans aged twelve to fourteen years, to validate his actions against Nikita and to enlist the orphans to punish Nikita for him:
The director told to us that every time he punished Nikita it was "za delo" [for a real reason]. Nikita was there and he was crying. Then the director told us, "I can't punish Nikita, but you should do what you think you should" and left the room. When he left, the kids-the lyubimchiki ["favorites"]-pushed Nikita into a corner and hit him on the arms and the legs. Nikita shouted loudly enough that the director could have heard him from the hallway, but he did nothing. Finally one of the teachers heard the noise and came and stopped the violence.54
Punishment-by-proxy and vicious hazing
The progression from verbal debasement to beatings instigated by adults provided a graphic illustration of the practice of punishment by proxy which was repeatedly described to Human Rights Watch. In the process, the orphans learned a code of cruelty which the older children used against the younger and weaker ones. At times, the children told us, the staff pitted them against each other fortheir own entertainment.55 In any case, the orphanage staff must bear direct responsibility for allowing the abusive treatment to flourish.
Many of the punishments meted out by St. Petersburg children themselves had ironic nicknames, as Human Rights Watch was told by orphans interviewed in Dormitory X. Among the most egregious was a torture applied to a sixteen-year-old boy named Grigory Z., who told us how the older boys in his orphanage had given him the "electric chair":
They did a torture called "electric chair" on me. I was laid on a metal bed, naked. Then someone takes wires that are connected to 220 volt electricity and touches the metal bed. The power runs through it and the kid lying on the bed shakes.
Also, the older orphans used to play something called "Russkii Fashist" when I was small. They came to our dormitory where we were sleeping and told us to use our pillow like a shield and run around the room while they beat on us. They'd also tell kids, "You have to fight with your friend. And if you don't fight him really hard, or it doesn't look real enough, then we'll beat you up."56
Another extremely dangerous practice which was reported to Human Rights Watch by children raised in St. Petersburg orphanages was the appalling act of forcing a smaller child into the small wooden chest [tumbochka] that they each have for their clothes and throwing him out a window. 57
One of the orphans interviewed in St. Petersburg described yet another gratuitous punishment that involved standing for hours in a half-crouch:
The older ones also punished the smaller kids like this: they'd make the small ones stand at attention, or with their legs bent and their hands stretched out in front. Then they'd put one or two pillows on our hands. We'd have to stand there for one to two hours. How can anyone take this without falling down? And when a small kid fell down or dropped the pillow, someone would hit himon his head and forehead. After that, they would start all over again until the child sometimes fainted.58
Hanging a fellow orphan from an open window was another form of intimidation among orphans interviewed by Human Rights Watch in St. Petersburg. Misha T., seventeen, said he was a victim:
The older kids held me and Anatoly Z. upside down out the window of the fourth floor, just to scare us. In our orphanage we called this kind of intimidation "in the wind." 59
As training sessions for sadistic bullying, these gratuitous punishments can also become a conduit to crime, as Fyodor T., fifteen, told us:
The oldest kid in our orphanage was Anton M.-he's in prison now for theft. He beat me very often for refusing to steal some equipment from the hardware storage room of the school. He also beat me very cruelly when I wouldn't steal a walkie-talkie from a policeman. He demanded from me that I bring him money, and made me beg for money on the street and bring it to him. When I didn't do that, Anton M. beat me very cruelly.60
As in the Russian military, this form of violent hazing can lead to accidental death, as one orphan in St. Petersburg recounted to us with a degree of regret:
One boy named Piotr A. even was killed accidentally in my orphanage, Orphanage F, when some older kids made him steal eggs from the refrigerator. But the refrigerator was old and it had only three legs, so it fell over on top of him. The other boy who was with him was very scared and ran off, and didn't tell anyone about it all day. When they finally found Piotr A., he was dead.61
Code of Cruelty
The following are a selection of malicious punishments with their nicknames, used by older orphans on younger ones. They are described by the boys Human Rights Watch interviewed in St. Petersburg during February and March 1998:
"Makaronina" ("little macaroni"): They make you rock your head to the left and right, and while you do that, someone strikes each side of your neck.
"Fashka" (no real translation): You have to fill your cheek with air and someone hits you on the cheek. It's very painful because your teeth cut the inside of your cheek.
"Locya" ("deer"): You have to stand with your palms crossed, facing out, on your forehead. And someone beats you with his fist. Your knuckles hit your forehead. It's very painful.
"Oduvanchik" ("dandelion"): In this one, the older kids beat with their fists on top of head of younger ones.
"Velociped" ("bicycle"; well known in the army): When someone's in bed, you take balls of cotton and put them between their toes. Then you set fire to the cotton and the person kicks his legs as if he's peddling a bicycle.
Psychiatric hospital as punishment
One of the most abhorrent hallmarks of the Soviet Union was the psychiatric profession's collaboration in the punishment of political dissidents.62 Today, based on an alarming number of reports from orphans and institution staff, Human Rights Watch has found that children in the care of the Ministry of Education who misbehave can be sent to closed psychiatric hospitals for "treatment" and discipline. The children even used the sardonic diminutive "psykhushka" for such hospitals, a holdover from Soviet times.63
During one of our visits to the dormitory of orphans who had lived in a variety of St. Petersburg dyetskiye doma, we asked them what the staff of their orphanages did when children ran away. Several of them instantly replied, "They're sent to the psykhushka! They think you're abnormal for running away so they send you there."64
One of the boys, Piotr C., told Human Rights Watch:
When I was in Orphanage C, the administrator sent me many times to the psykhushka for punishment. I tried to run away to the region where I had lived before.65
In Moscow, the teenaged children from Orphanage A whom we interviewed echoed what we were told in St. Petersburg about children who tried to run away, or even about children who broke something. According to Dimitri P., fifteen, the staff of Orphanage A would "yell at you and send you to a psychiatric hospital."66
"I was told about many kids from other groups in my orphanage, They call the hospital and an emergency car comes. I've seen the ambulance come for a kid three times with my own eyes. And then I'd hear about it when the child comes back from the hospital."67
A vospitatel' from that same orphanage in Moscow also told us how he had tried to intervene to prevent a child from being sent:
I twice had to accompany them in the emergency vehicle to psychiatric hospital Number 6 on Donskoi Proezd. And once, around October orNovember 1997, a car came to get a child and we managed to protect him from being taken.68
According to orphans and children's rights advocates who monitor the Education Ministry's institutions, the children return from their internment in the "psykhushka" in a terrible state. Dmitri P., fifteen, from Orphanage A in Moscow, described it as follows:
They really feel withdrawn, isolated. Because they've been there for two or three months. Some come back to normal. But they get drugs-round pills-to calm down. I don't remember the name of the drugs now. The kids, after they come back from the hospital they've had drugs, and they're very confused.
They can spend three months there. In summer kids would go to camp and our friend Kiril V. would spend all the time at the hospital. They lied to him that he was going to a sanitorium and so he packed his swim suit and everything for a vacation. Then he found out he was going to the hospital.69
Human Rights Watch condemns the use of psychiatric lockups and powerful drugs to discipline children whose behavior is deemed "abnormal" by institution staff. But it is also impossible to know to what degree the children sent to psychiatric hospitals do have a need for legitimate psychiatric care. Dr. Anatoly Severny, one of the leading Russian advocates for the protection of institutionalized children, told Human Rights Watch that one cannot conclude that all children are systematically committed to psychiatric hospitals simply for punishment:
Breaking the rules of behavior can be seen by an orphanage director as a psychological or psychiatric problem. But what can they do? They're not provided with enough medical staff and educational staff, and the personnel are not taught either biology or pedagogy. So, children are sent to the psychiatric clinic to calm down. As a doctor, I can't say it's a "system" to treat healthy children that way. You would need wide-scale research so we would know how and where and what they do. But nobody does this research. We'revery scared to say "generally." But the children are certainly singled out if their behavior is not "normal."70
The use of psychiatric hospitals to discipline children who misbehave was corroborated by a Western charity working in Russia whose staff visited the orphanages in St. Petersburg during autumn 1997. In an interview with Human Rights Watch, an official of the charity recounted the words of one orphanage director which summarized these harmful practices. The charity worker reported to Human Rights Watch:
This is what the director told me: "One child was sent to the psychiatric hospital last fall (1997). The girl ran away, so obviously she was psychologically disturbed. We sent her away last fall and she hasn't come back so I guess she really does have problems. Another one had a behavior problem. He didn't do his homework. He hasn't come back."71
Based on considerable experience working in Russia, the charity official told Human Rights Watch, "They really do fill [the orphans] up with drugs."72
Corruption, abuse of authority, and alleged crime
During our mission to Russia in February-March 1998, Human Rights Watch received numerous reports from human rights activists and children from orphanages in Moscow and St. Petersburg alleging abuse of authority and financial corruption among the directors and staff of dyetskiye doma.
Of all the cases, Human Rights Watch was most alarmed by reports we received about Dormitory X in St. Petersburg. According to orphans interviewed in that high-rise dormitory, the children who had reached the age of eighteen and not yet obtained lodging from the state, were permitted to move from the "orphan" floor of the dorm to live temporarily on another floor. One of the orphans we interviewed summarized the conditions on that floor as follows:
It's horrible there. They call it the "otstoinik," which means the reservoir where the rancid water stays. The kids live like homeless people, and theyspent the allowance we get when we leave the system on "sexodromes" [huge beds].73
At the time of our unannounced visit to Dormitory X in February 1998, the building itself was a crumbling, concrete wreck with a rattling elevator and empty light sockets. But the floor delegated for the "graduates" was particularly squalid.74
The orphans interviewed by Human Rights Watch reported that the director of Dormitory X permitted older adult males from outside to live in vacant rooms in the building. The children had observed that some of these people were the directors' friends and had reportedly made advances to the girls living in the "otstoinik." The orphans we interviewed, who were friends of the girls in the "otstoinik," told Human Rights Watch that the girls were in a "complex" position to turn down the men's advances, because of their connection with the director.75
Yuri T., a seventeen-year-old orphan, told us:
When the police come to look for something criminal, the director takes them only to the floors where we [the current orphans] live, and makes a signal to the criminal guys on the lower floors so they escape through the windows there.76
Many of the incidents of misconduct by orphanage staff which were reported to Human Rights Watch were not as injurious as the potential corruption of minors in Dormitory X in St. Petersburg. But they did represent an appalling abrogation of responsibility to the children in their care. Often orphans told Human Rights Watch in interviews that the director and orphanage staff were siphoning off humanitarian donations of food and clothing intended for the orphans. Valery P.'s story of Orphanage G. in St. Petersburg was representative:
The administration of our orphanage constantly took the humanitarian donations for themselves and sold them. Especially chocolate and other food. They stole it, and they used big trucks for transferring the large quantity of things. All the children saw this. All of us got the worst things from the administration-like shoes and clothes that looked so poor that we just couldn't wear them outside.77
Grievances and impunity
One of the people interviewed by Human Rights Watch in St. Petersburg was Alexander Rodin, a former member of the city council and independent children's advocate who has exposed the abuses in orphanages and juvenile detention centers for more than eight years.
While Rodin considered the criminal action against the directors of Orphanages B and C in St. Petersburg to be important victories, he pointed out to us the mixed benefits for the children:
The director of orphanage C was an ex-Soviet military officer, and he was sentenced to a one-year term. But now the new director of this orphanage is a friend of the former director, and the St. Petersburg officials have changed the orphanage's status to an institution for juvenile delinquents.78
Rodin went on to stress the importance of an orphanage director's power, not only to commit abuses, but also to cover them up:
The problem with all the institutions is that the director hires all the personnel. That means that doctors and nurses are required to write papers according to what the director wants. So if something is done by the director, they can't report it because they will be fired. Also if a kid has to go to a local medical center for an injury, he brings the records back and the director keeps them all. He can destroy them, hiding any chance of implicating the staff.79
In interviews with thirty-one orphans and experts in Russia, Human Rights Watch found that the fear of retribution was only one deterrent to exposing abuses within the institutions. For instance, ignorance of grievance procedures also stand in the way of many children we interviewed, as does the doubt that much will come of their complaints anyway:
We really don't know about the channels and mechanisms for changing things. If we knew what mechanism there was we would use it. We tried to protect the small kids at our place when the staff took their fruit away. We wrote a letter and sent one copy to the director and one to the municipal department. Well, of course, the municipal department told us, "You didn't catch anyone doing it. So you saw someone doing this, but you didn't catch anyone."80
Once we called for a TV crew to come, and they interviewed us and we answered their questions. The teachers were busy when they arrived, so the crew went with us and interviewed kids personally. It helped a little, but not so much. Some high officials saw it on TV and asked a high official named Zernova what was going on. So because those top officials yelled at her, she came to the orphanage and talked to the staff, and it helped a little. Before, they would really yell and humiliate us, and not even think about who was around. Now they say things to us only after they look around to see who's there. They're more careful with yelling and humiliation.81
The financial interest in orphanages
Financial interests were also a recurrent theme in the critiques Human Rights Watch received of Russian state orphanages. The government blames its lack of resources for its inability to train and pay for qualified staff, while critics, including some institution staff, claim that it is more a matter of misappropriation of the current budget.
One doctor summarized what Human Rights Watch heard from numerous knowledgeable people working in institutions:
It's a very expensive system. But the child only gets 25 percent of all the funds that are allocated. Seventy-five percent goes to keeping the system going. For instance, a Ministry of Labor official recently told a roundtable gathering in January (1998) that they budget 2,500 rubles ($400) per child per month in the orphanage.
But we know from colleagues who work in internaty that they spend only from 500 to 600 rubles ($100) a month specifically on the care of each child. So when I went to the Ministry of Labor to confirm how much was spent on children, they refused to say. But I heard myself at the roundtable [conference] that they budget 2,500 rubles.82
A psychiatrist working in an internat corroborated Dr. Severny's calculations with the following report:
We are supposed to spend on each child 17 rubles (three U.S. dollars) a day for food and 1.7 rubles for medicine.83
The psychiatrist also told Human Rights Watch that the actual number of staff they are budgeted for on her service is kept "top secret," and only the administrator knows the figure.84
The potential for financial mismanagement concerning the state pension accounts for orphans is another matter that concerns children's rights advocates, as Dr. Anatoly Severny summarized for us:
Starting from the age of sixteen years, the children in the psychoneurological internaty get a pension from the state because they're considered officially as invalids. This is supposed to be used for their care in the internat. But where does the pension go? There's a legal problem. By law the court can rule a person not capable of taking care of himself. Officially, they don't have legal rights to manage their own affairs like a pension.
So, on one hand the state gives the pension. But we don't see where that money goes. That's one reason the ministries want to maintain the system as it is. The ministries receive a huge amount of money.85
Human Rights Watch condemns the use of violent punishment-physical or psychological, whether administered by officials or children acting at their behest-of children in institutions operated by the Ministry of Education. Moreover, rather than condoning or turning a blind eye to the savage hazing among school-aged orphans within some institutions, the Russian authorities are obliged to protect the children it has accepted in its custody. They must halt all forms of cruel, inhuman, and degrading treatment immediately, investigate existing reports of corruption and other wrongdoing, and further conduct unannounced investigations in distant regions where few children's rights activists are available to advocate on behalf of abused orphans.
In the following section of this report, Part VIII, we present some recent progress as well as systemic impediments relevant to the future protection of orphans' rights in Russia.