Institutionalisation and the Children of Sex Trafficking Victims in Nepal

By Elizabeth Willmott-Harrop

18 September 2013

The following is an edited version of desk research, undertaken prior to a field trip to Nepal to undertake a programme evaluation for a project supporting the children of female trafficking victims, repatriated from India to Nepal.

According to the NGO Asha Nepal, between 8,000 and 12,000 women and young girls disappear from Nepal every year, trafficked into sex slavery in the brothels of India and private households in the Middle East[1].

A study by the University of Southampton for DFID in 2003[2] revealed that girls trafficked from Nepal to India for sex work are:

• Typically unmarried, illiterate and very young.
• The majority of trafficked girls are in the narrow age band of 13-18 years.
• The key routes into sex trafficking include employment-induced migration to urban areas; deception (through false marriage or visits); and abduction.
• Half of traffickers were persons familiar to trafficked girls and 22% were relatives.
• Exit from trafficking was through rescue, escape or release; the majority of girls (80%) were rescued in police raids on Indian brothels.
• One of the outcomes of sex trafficking is a return to sex work upon return to Nepal. According to Terre des hommes, since 2005 “the expansion of the local sex industry has resulted in a rapid growth in the trafficking of women and children for prostitution inside the national borders of Nepal. The number of persons internally trafficked may exceed the number trafficked persons outside the country. The majority of persons trafficked into local commercial sexual exploitation are children, some as young as 8 or 9 years of age.”[3]

Law enforcement and corruption

Set against a backdrop of severe gender discrimination, Nepal has a poor history of law enforcement against human trafficking for exploitation, of protection of trafficking victims, and even of acknowledging that trafficking is a concern for the country with very few cases recorded by official figures[4].

Human Rights Watch notes that in Nepal “Trafficking, domestic violence, dowry-related violence, rape, and sexual assault remain serious problems. Sexual violence cases are often settled in private and, even when complaints are filed, police rarely carry out effective investigations”[5].

The US Department of State in its annual Trafficking in Persons Report says of Nepal that “The incidence of trafficking-related complicity by government officials remained a problem. Observers report that traffickers use ties to politicians, business persons, state officials, police, customs officials, and border police to facilitate trafficking, including the paying of bribes for protection and favors”[6].

In a very difficult climate, Asha Nepal undertakes advocacy work and provides legal support to some trafficking victims, as do other organisations such as SASANE which trains survivors to become paralegals[7]. This work both empowers victims, hold the government of Nepal and police accountable and acts as a preventative measure.

Re-trafficking of victims

Reuniting the children of trafficking victims with their families and communities, potentially exposes them to the trafficking their mothers’ faced, especially:

a)     Where the original trafficking network began in the community – often family members, neighbours and community members are the first point of contact in the trafficking of a victim[8]:

“Often family members figure among the intermediaries. As in the case of parents, they may be ignorant of the impact of their intervention or may be fully cognisant of the fact that they are contributing to the exploitation or trafficking of a child”[9].

The US Department of State also notes of Nepal that:

“Limited protections for victims negatively affected law enforcement efforts. Victims were often intimidated in their communities not to pursue a case, and they did not want to prosecute due to concerns for personal and family safety, particularly as their traffickers may have been family members.”[10]

b)    Where debt bondage still exists leading to re-trafficking of the mother or trafficking of the child.

Debt bondage “occurs when a victim is illegally bound to financial debt determined by the trafficker / trafficking network.  The victim is then obliged to carry out the trafficker’s wishes, often labour or sexual exploitation, until the debt is deemed settled.  The debt commonly covers the inflated cost of travel arrangements, accommodation, food, a work arrangement fee and miscellaneous trafficker fees … debt bondage is the most common tool used to control victims, placing them in exploitation for an indeterminate period”[11].

All bonded labour is forced labour[12] but not all forced labour is bonded labour, as other means of coercion, such as violence, can also be used[13].

In some cases, debt bondage is passed down within families in Nepal, for example among agricultural bonded labourers where “the number of children taking over their parents role as haliya or kamaiya labourer has accelerated” in the country[14].

It is common in countries affected by severe poverty for children to be sold into bondage as settlement of a debt[15].

The International Organization for Migration (IOM) case files reveal that trafficked persons were still subject to continuing control by their traffickers after exit[16].

This includes situations where the traffickers continue to threaten victims or their family members, where the victim owes debts, or where the family or local community members are involved in trafficking and the trafficked persons are subsequently returned to those families and communities. In a number of cases, trafficked persons were directly threatened and felt compelled to return to their traffickers as a result[17].

According to the IOM “the secondary trafficking of previously trafficked persons is a substantive issue”. Those most vulnerable to re-trafficking are women, children and young adults. Those who have been trafficked under the age of 18 are often vulnerable to re-trafficking in adult life. Furthermore, victims are frequently re-trafficked within two years or less of having exited a trafficking situation[18].

Victims who return home may be more vulnerable to re-trafficking where they return from an international trafficking situation, there are economic and social difficulties in the country of origin, where conflicts are on-going or recent, and where there are significant gender inequalities in the country of origin[19].

As you can see, many of the risk factors for re-trafficking apply to girls trafficked from and returned to Nepal. This makes the status of trafficking victims and their children extremely vulnerable on their return to Nepal.

In the section on aftercare, the UN Guidelines for the Alternative Care of Children 2009 (UN Guidelines) specify that[20]:

“The process of transition from care to aftercare should take into consideration children’s gender, age, maturity and particular circumstances and include counselling and support, notably to avoid exploitation.”

Social stigma of victims of trafficking for sexual exploitation

It is worth noting the two categories of:

• an adult female victim of trafficking for exploitation
• a woman who has chosen a life of prostitution.

There are heated debates about the concept of “choice” as applied to prostitution (and as applied to males as well as females), with perhaps little distinction between the two categories on many levels.

As Vidyamali Samarasinghe (right) notes in her book Female Sex Trafficking in Asia, The Resilience of Patriarchy in a Changing World:

“It was difficult to draw a line separating trafficking from free choice or voluntary prostitution, especially in the context of Nepal and Cambodia…

“…The question is whether the systematic gender ramifications that propel women to ‘choose’ prostitution, especially in Asia, are any different from those that push women and girls who seek employment and find themselves coerced into the commercial sex industry…

“…The ‘willingness’ to become a prostitute has become a debatable issue since, a number of females who were first forced into the trade may subsequently continue to work as prostitutes as ‘willing victims’ ”

Children of trafficking victims will already have been highly vulnerable to abuse or neglect, either living within a brothel environment or being separated from the mother.

This vulnerability is compounded by social stigma which is a huge barrier to the reintegration of trafficked women, and has obvious impacts on their children.

Some children of trafficking victims may already have experienced institutionalisation. It is usual for example for the children of sex workers in India to be institutionalised:

“The stigma of being a sex worker makes it invariable for them to send the children to an institution, which is an attempt to keep the children away from the brothel environment and also to hide their identity as a sex worker.” [22]

The University of Southampton notes that “at the post-trafficking stage activities focusing on both community integration and fostering social independence are required”[23].

However, while the women concerned have escaped their exploitation, the “legal and social labelling of women”[24] continues to pervade their lives. Trafficking victims in Nepal are characterised as “morally and socially degraded and/or as a criminals responsible for HIV/AIDS transmission”[25].

This characterisation contributes to various forms of social stigma and rejection enforced by social actors including health officials, police personnel, judges, family members, school teachers, NGOs, friends and neighbours, a Priest and politicians that trafficked women encountered, according to one study[26].

Trafficked women have limited access to family puja (religious ritual in the home), marriages, health posts, schools, temples and water taps. Legal consequences can include being considered a non-citizen by state institutions[27].

Institutionalisation of Children in Nepal

The repatriated children of sex trafficking victims as well as their mothers, may face institutionalisation on their return home, in various types of settings.

Save the Children defines “an institution or residential care home for children” as:

“A group living arrangement for more than ten children, without parents or surrogate parents, in which care is provided by a much smaller number of paid adult carers. Typically in Europe this would be one carer to six children of a similar age during the day and fewer staff at night”[28].

A 2008 study (left)[29] reveals that over 1,000 child centres are operating in Nepal, with 366 centres in Kathmandu District.  A centre hosts about 15 children on average. There has been a large increase in the number of new child centres, with 61 per cent of child centres in the Kathmandu Valley being less than five years old.

Researchers found that the Nepal government’s Minimum Standards of Care for Residential Child Homes 2003 (now replaced by Nepal’s Comprehensive Standard for Operation and Management of Residential Child Care Homes[30]) were not in place in the majority of child centres and “the smaller the centre, the worse it is for the children … Smaller homes with good caretaker ratios and that are integrated with the community tend to be ‘better’ than larger homes, but only when they are well regulated and fit into a broader system of alternative care”[31].

Poor practices at children’s homes reported in the study included:

• Inadequate food
• Restriction of movement
• Practices such as ‘hitting children’, ‘isolating them’ and ‘locking them inside the toilet’ –  mentioned by the child centre staff themselves
• Being made to work in the kitchens while staff looked on
• Failure to develop and regularly update a care plan for each child
• No opportunity to participate in child committees

Children’s homes need clear guidelines and principles in the above areas and covering all aspects of a child’s care and staff conduct. These guidelines must adhere to:

• Nepal’s Comprehensive Standard for Operation and Management of Residential Child Care Homes[32]
• The UN Convention on the Rights of the Child[33]
• The UN Guidelines for the Alternative Care of Children 2009 (below)[34].

Harm from Institutionalisation

Numerous studies have criticised the harmful effects of institutionalisation on children[35] and the ethics concerned in establishing institutions over family-based care. These observations include:

• Early institutional care is detrimental to all developmental domains of children[36].
• Features of institutional care that contribute to developmental delays include low staff to child ratios/interaction, low levels of staff experience and autonomy, strict routines, poor provision of books and play equipment, children’s lack of personal possessions and individuality (eg, birthday celebrations), and children’s lack of ‘everyday’ experiences and trips outside the institution[37].

• Although it should be noted that studies have also shown that children post-institutionalisation were found to develop attachment behaviours when in a normative family environment[38].However, while “young children placed in a caring family environment by the age of six months will probably recover and catch up on their physical and intellectual development. Those children placed in a family after six months of age are likely not to recover completely from their intellectual deficits”[39].
• All young children with experience of institutional care may be permanently affected “leading to a greater probability of poor intimate relationships, antisocial behaviour and mental health problems”[40].
• The cost-per-user for institutional care is six times more expensive than providing social services to vulnerable families or voluntary kinship carers, and three times more expensive than professional foster care[41].
• The very existence of institutions encourages family placement of children into care, and draws funding away from family and community-based services[42].
• Even well-run care institutions can cause lasting psychological and behavioural problems, for example, caused by being separated from parents and siblings[43].

Institutionalisation of those under three years old

Due to the evidence of harm outlined above, the UN Guidelines stress that institutionalisation in any form is not acceptable for children under the age of three years old:

“In accordance with the predominant opinion of experts, alternative care for young children, especially those under the age of 3 years, should be provided in family-based settings”[44].

These comments are reflected by Save the Children which states that:

“Regardless of the quality of institutional care, ‘normal’ child development requires the opportunity for frequent and consistent one-to-one interaction with a parent or foster parent. This is especially important for the under-threes because the early years are critical for brain development. Therefore, it is recommended that no child under three years should be placed in a residential care institution without a parent/primary caregiver”[45].

When is institutionalised care acceptable?

In its 2009 report[46], Save the Children comments that:

“Some forms of care institutions have a role to play in providing short-term care for vulnerable children who require specialist services or who are waiting for a suitable longer-term alternative – eg, older teenagers or children with severe disabilities… For adolescents who do not want to be placed in an alternative family, a small group home within the community may be the most appropriate short-term placement”.

The UN Guidelines on alternative care also notes that:

“The use of residential care should be limited to cases where such a setting is specifically appropriate, necessary and constructive for the individual child concerned and in his/her best interests”[47].

Advice on residential settings include:

“Where residential care is in the best interests of the individual child, it should be based in a small group home where no more than six to eight children are cared for by consistent adults in a family-like setting within the community”[48].

The UN Guidelines advice on residential settings includes[49]:

“Facilities providing residential care should be small and be organized around the rights and needs of the child, in a setting as close as possible to a family or small group situation. Their objective should generally be to provide temporary care and to contribute actively to the child’s family reintegration or, if this is not possible, to secure his/her stable care in an alternative family setting…

“The competent national or local authority should establish rigorous screening procedures to ensure that only appropriate admissions to such facilities are made.

“States should ensure that there are sufficient carers in residential care settings to allow individualized attention and to give the child, where appropriate, the opportunity to bond with a specific carer. Carers should also be deployed within the care setting in such a way as to implement effectively its aims and objectives and ensure child protection”.

Staff ratios

Poor care-giver to child ratios inhibit social interaction and influence the way staff respond to the needs of the children in residential care, which has been found to significantly influence the children’s attention-seeking behaviour.[50]

Save the Children advises that staff to child ratios must be sufficient[51]:

• to ensure that children’s care and protection needs are met
• so that the child can become bonded and attached to their carer
• so that the carer has sufficient time to give each child some individual attention on a daily basis.Care of young babies requires a staff:child ratio of 1:1 or 1:2 if the child’s needs are to be fully met
• with older children, a nominal ratio could be one staff member for five young people, with available back-up support such as a senior staff member with relevant childcare experience who would be available when a carer has to attend a meeting or if there is an emergency within the care environment. Back-up support should always be available.

However Save the Children recognises that:

“In resource-poor countries … it may be difficult to set staff:child ratios and other elements of quality childcare. Yet, the critical role of childcare personnel must be appreciated and careful consideration of staff:child ratios in different contexts must be made.

“…Comparison was made with African families that have ten children. However, such families have a mixed age range of children, with differing abilities and, often include two adult carers (eg, mother and father), which gives a carer:child ratio of 1:5”[52].

Staff procedures

The UNICEF/Terre des hommes study recommends “screening of professionals working with and for children, accountability of care staff, as well as training and awareness-raising on child rights and child protection”.[53]

And similarly, in terms of staff policy and capacity, the UN Guidelines make clear that[54]:

“All agencies and facilities should develop a staff code of conduct, consistent with the present Guidelines, that defines the role of each professional and of the carers in particular and includes clear reporting procedures on allegations of misconduct by any team member.

“All alternative care services should have a clear policy on maintaining the confidentiality of information pertaining to each child, which all carers are aware of and adhere to.

“As a matter of good practice, all agencies and facilities should systematically ensure that, prior to employment, carers and other staff in direct contact with children undergo an appropriate and comprehensive assessment of their suitability to work with children.

“Conditions of work, including remuneration, for carers employed by agencies and facilities should be such as to maximize motivation, job satisfaction and continuity, and hence their disposition to fulfil their role in the most appropriate and effective manner.

“Training should be provided to all carers on the rights of children without parental care and on the specific vulnerability of children, in particularly difficult situations, such as emergency placements or placements outside their area of habitual residence. Cultural, social, gender and religious sensitization should also be assured. States should also provide adequate resources and channels for the recognition of these professionals in order to favour the implementation of these provisions.

“Training in dealing appropriately with challenging behaviour, including conflict resolution techniques and means to prevent acts of harm or self-harm, should be provided to all care staff employed by agencies and facilities.

“Agencies and facilities should ensure that, wherever appropriate, carers are prepared to respond to children with special needs, notably those living with HIV/AIDS[55] or other chronic physical or mental illnesses, and children with physical or mental disabilities”.

Intercountry adoption

Institutionalised care is not viewed as a last resort for children according to international law, recognising the fact that reunification of the child with its family is more likely when the child remains proximate. In fact international law holds that intercountry adoption is a last resort, along a continuum of care which includes institutions and foster care:

• Article 4b of the Hague Convention on Protection of Children and Co-operation in Respect of Intercountry Adoption says that an intercountry adoption shall take place only if the competent authorities “ have determined, after possibilities for placement of the child within the State of origin have been given due consideration, that an intercountry adoption is in the child’s best interests”.[56]
• Article 21b of the CRC says States Parties shall “Recognize that inter-country adoption may be considered as an alternative means of child’s care, if the child cannot be placed in a foster or an adoptive family or cannot in any suitable manner be cared for in the child’s country of origin”[57].
• Other legal instruments such as article 24b of the African Charter on the Rights and Welfare of the Child[58] explicitly define intercountry adoption as a “last resort”.

However “due consideration” (Hague Convention) and “suitable manner” (CRC) contained within the legal definitions above, are subjective terms which thus allow for intercountry adoption in preference over institutionalisation.

It should also be born in mind that we are concerned with children affected by trafficking and indeed intercountry adoption is itself a trafficking issue[59].

Family and Community-based care models

The government of Nepal, according to its May 2012 reply to the UN Committee on the Rights of the Child, has:

“Initiated a process of formulating policies for promoting alternative care models including Kinship Care, family preservation and support schemes, Foster Care and Sponsorship as well as domestic adoption and other forms of community based care models that are appropriate in the community context.

“Currently many new services in Nepal are being piloted to provide alternative care to children without parental care. For example Peer Group Homes, Independent Living Arrangements, Foster Care, Kinship Care, and Day Care Centers have been successfully piloted. Many of these services are run by child focused organizations by mobilizing resources internally and externally.

“The lessons learned from these efforts have been gathered to feed into the process of policy formulation and defining an overall goal for creating positive changes for ensuring the best interest of children who are in need of care and protection.”[60]

Important factors for consideration regarding domestic child care solutions, include that children in care should always maintain contact with their parents or relatives, except where not in their interest, and children should return to their families whenever possible.

The UN Guidelines state that “All decisions concerning alternative care should take full account of the desirability, in principle, of maintaining the child as close as possible to his/her habitual place of residence, in order to facilitate contact and potential reintegration with his/her family and to minimize disruption of his/her educational, cultural and social life”[61].

Save the Children has identified that for children who cannot remain within their own families, “family-based care that is well monitored and supported is the best form of alternative care”.[62].

Family-based care options for vulnerable children may include:

• extended family/kinship care
• fostering
• support for child-headed households.

It is vital that these alternatives to institutionalisation are sustainable and secure, so that the breakdown of such placements does not further traumatise a child who has already gone through so much.

The key recommendations of Save the Children regarding the role of donors in ensuring that funding is directed at preventative community and family support and at family-based alternative care include:

• supporting de-institutionalisation efforts and the development of good quality family-based care alternatives
• promoting the training and accreditation of social work professionals
• initiating or expanding social protection programmes
• developing community-based services that support families to care for their children[63].

The UN Guidelines also reinforce that[64]:

“Organizations and authorities should make every effort to prevent the separation of children from their parents or primary caregivers, unless the best interests of the child so require, and ensure that their actions do not inadvertently encourage family separation by providing services and benefits to children alone rather than to families.

“Separation initiated by the child’s parents or other primary caregivers should be prevented by:

(a) Ensuring that all households have access to basic food and medical supplies and other services, including education;

(b) Limiting the development of residential care options and restricting their use to those situations where it is absolutely necessary”.

This role of prevention also applies to supporting families at risk of family breakdown through trafficking.

Family Reunification

Asha Nepal notes that “‘reintegration’ is one of the most important components of services that trafficked survivors need”[65]. This is firmly placed within the context of “community awareness and counter-discrimination acceptance, support not blame”.

A programme working with former trafficking victims and their children must consider:

• The importance of community reintegration for the mothers and their children.
• The synergy between this community reintegration process for both mother and child as individuals, and the process of reintegrating the relationship of the mother and child concerned.
• The continued vulnerability of the mothers and children to re-trafficking when returned to their community.
• The return of the mother and child to a situation which may have precipitated trafficking in the first place (eg the need to escape domestic abuse, poverty etc).
• The further denial of already precarious human rights of the women and children concerned, due to the impacts of social stigma.

Regarding the promotion of family reintegration, The UN Guidelines state that[66]:

“In order to prepare and support the child and the family for his/her possible return to the family, his/her situation should be assessed by a duly designated individual or team with access to multidisciplinary advice, in consultation with the different actors involved (the child, the family, the alternative caregiver), so as to decide whether the reintegration of the child in the family is possible and in the best interests of the child, which steps this would involve and under whose supervision.

“The aims of the reintegration and the family’s and alternative caregiver’s principal tasks in this respect should be set out in writing and agreed on by all concerned.

“Regular and appropriate contact between the child and his/her familyspecifically for the purpose of reintegration should be developed, supported and monitored by the competent body.

“Once decided, the reintegration of the child in his/her family should be designed as a gradual and supervised process, accompanied by follow-up and support measures that take account of the child’s age, needs and evolving capacities,as well as the cause of the separation.”

In the section on aftercare, the UN Guidelines specify that[67]:

“Children leaving care should be encouraged to take part in the planning of aftercare life..  Special efforts should be made to allocate to each child, whenever possible, a specialized person who can facilitate his/her independence when leaving care.

“Aftercare should be prepared as early as possible in the placement and, in any case, well before the child leaves the care setting.

“Ongoing educational and vocational training opportunities should be imparted as part of life skills education to young people leaving care in order to help them to become financially independent and generate their own income.

“Access to social, legal and health services, together with appropriate financial support, should also be provided to young people leaving care and during aftercare”.

Psychological support for children and their mothers

The IOM notes that “Many trafficked persons experience numerous and concurrent trauma-related outcomes, in particular changes in identity and relationships.

Changes in identity involve changes in all structures of the “self”, including identity deprivation and the “feeling that the perpetrator is still there even after the rescue”. Changes in relationships may be manifested as traumatic bonding, extreme relationships, passivity and helplessness, as well as hostility and anger”.

In Asha Nepal’s study Looking Towards Tomorrow, 78.6% of the trafficking survivors interviewed “felt sad and tired and/or angry and directed their anger at their trafficker and revenge.

“Taking into account that 75% of the respondents have been back in the community for ten years or more, the levels of potential psychological stress are high. It is probable that such problems affect their life style, relationships, work and leisure activities”.[68]

The report further notes that “Access to counselling is limited and may be further limited due to the skills of semi qualified counsellors in some cases … there is a clear need for more access to qualified counselling skills including relationship counselling, both outreach and centre-based[69].

The UN Guidelines talk of offering counselling to children: “Carers should promote the health of the children for whom they are responsible and make arrangements to ensure that medical care, counselling and support are made available as required[70].

The UNICEF/Terre des hommes study noted that “Despite the recognition that children suffer from psychological issues, none of the centres reported having professional child counsellors on the payroll or a retainer. A third of centres reported having no private space for the biological family or relatives to meet with the child … Only 10 per cent of centres reported having a special ‘counselling room’. Centre staff did not seem to be aware of the importance of providing professional support to children who experienced psychological problems”[71].