A Children’s Pandemic

A month of Pandemic measures and I already wince at a handshake or touched face on Netflix. Just yesterday, New York was bustling, packed and confident. Now it is cautious, dispersed and masked. If our relationship with the world around us has been instantly transformed, what about the impact upon children in their formative years?

It may be the single blessing of this ruthless pandemic that children are least vulnerable to the virus. But sadly not the potentially deadly ricochets and aftershocks it leaves in its wake. This week the UN Secretary General reported that health and food system impacts will increase other childhood diseases and malnutrition. The number of children living in extreme poverty is projected to increase from 386 to as much as 450 million as a direct result of a new Covid19-induced economic crisis. Extreme poverty is always a killer and likely to take more children than the virus itself. Perhaps reversing 2-3 years of global progress on preventable childhood deaths.

There is barely a child on the planet whose life has not been affected by the Pandemic in some way. 1.5 billion are at home and not school. At least tens of millions of children will be born into this crisis, mostly in conditions that would have been different if it weren’t for the pandemic. Children cannot see their friends and suffer major disruptions to learning, life and play. Sports tournaments, excursions and hackathons all shelved, teenage romance on hold. A recent study suggested that prolonged quarantine in general can make a person 4 times more likely to have poor mental health. The pandemic shocks touch all children .

Fortunately many children have the shock absorbers of a safe home, loving family and freedom from poverty, social exclusion or war. If just one from the set is missing, the impact of the pandemic is likely to be deeper and life-changing. There is now a new single thread of additional vulnerability tying together children in tightly packed slums in African cities with those in camps in Syria and Yemen. It extends to the low income children in rich countries like the UK and US and those at risk of severe acute malnutrition in the poorest countries. It also hits the approximately 5% of the world’s children with disability and the 15-20% in seriously dysfunctional, neglectful and violent homes. This pandemic has been merciless in piling more pressure on to those least able to absorb it.

The bottom billion have no means for social distancing or hand washing. Their health systems often have just a few ventilators and Intensive care beds. They are not thinking of flattening the curve, but rather a couple of dozen cases flattening their entire health system. Prevention of other childhood diseases is already disrupted, including vaccination programmes on hold in 23 countries. 30 million conflict affected children are dependent on humanitarian assistance which is likely to be battered as supply chains buckle and aid financing and fiscal space contract. 40% of the world’s children don’t even have hand washing facilities.

Remote learning is a great solution for most children, but even here in New York city it is estimated that 300,000 low income children don’t have the digital means to participate. School closures will widen the two main learning gaps. The first between countries with high performing education systems who have the agility and means to switch and those countries which cannot run their education system effectively at the best of times. The second gap is between the learning outcomes of wealthy and poor children within countries. 368.5 million of those poor children have also been cut off from essential school feeding programmes which are often the only source of nutrition. Children in need of special learning support at school or dependent on relationships with teachers and friends to mitigate the pain of violent and neglectful homes are suddenly adrift. All against a rising backdrop of increased reporting of intimate partner violence and child abuse from India to Greenland to Australia and all points in between.

If the Coronavirus was a pantomime villain waiting behind a curtain for an opportune moment to pounce, it did so with precision. Thus far, dwindling internationalism has made us too weak to address the Pandemic in the whole. But you cannot partially address a pandemic. Even during the Cold War, the USSR and the West realized this and joined forces to end smallpox. And thats what our polarised world needs to do now. If everyone is not safe, no-one is safe. The virus shows our interdependence and in the end, maybe thats its virtue.

This is not insurmountable. WHO, UNICEF, the Red Cross, scientists and artists have joined forces in the Solidarity Fund to mobilise resources for a vaccine and for prevention and response work in low and middle income countries. Scientists shared the genetic sequencing on the virus very early on and are collaborating across borders despite nationally-minded governments. There is also a global initiative to galvanise leaders into more collaborative and internationally-minded policy-making in response to the pandemic.

We have also seen national governments and societies prioritise children. 83 countries have adapted their social protection systems to help shield poor families and children from the crisis. Health, education and social work systems have often adapted to maintain basic services. Armies of school and health volunteers are helping minimise the impact of the pandemic upon children.

We should now see maintaining supply chains, aid flows and health systems in poor and humanitarian contexts as a first line response for us all, even though it seems far away. Look how far the virus has already travelled. We may also need to invest in social protection to help the bottom billion socially distance, particularly those in densely packed and poorly resourced urban slum and refugee/migrant camps.

In wealthy and poorer countries alike we should support adaptions for teachers and social workers to have exactly the same amount of contact with children as they had before the crisis and for school feeding programmes to be delivered to homes. When adapting education we need to prevent remote learning widening the gap between wealthy and poor.

Albert Camus may have appreciated the importance of teacher contact and continued learning. In 1957 he dedicated his Nobel Prize for literature to the teacher who was there for him in the midst of poverty and adversity. His masterpiece The Plague is once again a bestseller and remains a testimony to our interdependence and collective strength in the face of this crisis. In it, he wrote: “No longer were there individual destinies, only a collective destiny, made of the disease and emotions shared by all.” .

Equity, poverty and love

InsiderBy Benjamin Perks18 November 2015

UNICEF/NYHQ/HartleyA young girl from girl from the Roma ethnic group stands in a field near the town of Podgorica in Montenegro. 

“…….seeking but a moment’s rest among the long-forgotten haunts of childhood, and the resorts of yesterday; and dimly finding fear and horror everywhere….” [1]
–Charles Dickens  Martin Chuzzlewit  London,1843

Everyone knows poverty drives inequity. Here in Montenegro one of the ways we address this is by supporting dramatic expansion of pre-school education for the poorest 3-6year olds, who are currently 10 times less likely to attend which ensures worse life prospects and an inter-generational cycle of poverty.

But is childhood adversity: violence, neglect and dysfunctional parenting, also a driver of inequity?

152 years passed between Dicken’s writing Martin Chuzzlewit and the discovery of a neurobiological explanation of how and why broken childhoods haunt and destroy adult lives-even into old age.

The Adverse Childhood Experience (ACE) study, launched in 1995, continues to demonstrate in many countries huge inequity between adults who were affected by high levels of child abuse, neglect or dysfunctional parenting, and those who were not. High childhood adversity leads to markedly worse outcomes in health, education, employment and crime. It is much more prevalent than we thought and occurs across wealth quintiles.

In addition to being one of the world’s finest novelists, Charles Dickens also gave an authentic voice to those whose childhoods had been pulled apart by the desolate loneliness and crushing injustice of childhood adversity and inequity as he had experienced first-hand himself [2]. As with Dickens, the passion of many UNICEF staff to tackle childhood inequity stems from our own childhood memories and in my case the experience of growing up in loveless institutional children’s homes has always been a major driver of my work.

At any given time across the region of CEE/CIS we have a million children in state care, a fact that will place them on a lifelong path of inequity.They come into state care because of childhood adversity or because they are abandoned, mainly into large-scale children’s homes. A placement in a children’s home is a secondary trauma for any child. It does not provide healthy attachment with an adult and this is particularly catastrophic for children under 5 when brain development is most active and dependent on consistent interaction with an adult.

Comparative brains scans as well as measurements of development-inhibiting cortisol levels between those in institutional care and those in strong families reveal a neurobiological inequity that will eventually translate into long term economic and social inequity.

A children’s home is a place where a child lives in a state of neglect – unequal not just in terms of poverty, but in terms of love, affection and attention. This is why 21 countries in our region have joined forces with the UN Human Rights Commission and UNICEF to eradicate placement of children under 3 in large scale institutions. In Montenegro there will be a complete end to placement of under 3s in state care by 2017. There is a similar campaign in Latin America where around 240,000 children live in state care.

The right to family life is being secured through stronger social work systems, which can keep families together, and promotion of fostering and other family based alternatives for children who cannot be cared for in the biological family. This has already yielded a 40% decrease in the number of children in institutional care in the past five years in Montenegro.

Children in state care are just the tip of the childhood adversity iceberg, the overwhelming majority of childhood adversity is suffered by children in families. We are thus working with health, education, justice and social work sectors to build systems which protect children and promote better parenting through pregnancy until adulthood. We work with government and women’s groups to break the taboo on childhood adversity-learning the lessons from similar efforts in the UK and Scandinavia a couple of decades ago. I recently did a TedX talk on this & was inundated with messages from Montenegrin adults who had been affected by childhood adversity and many had never told anybody. We launched the first study on child abuse in the parliament recently and next year we will launch and measure the impact of a public campaign on childhood violence and adversity. The aim is to reduce the space in which adversity is unreportable and invisible or even acceptable.

But how can we close the equity gap for adolescents whose lives have already been plagued by adversity?

Neuroscience may have taught us the bad news that when childhood adversity collides with adolescent brain development-it can put children on a lifelong negative trajectory : inequity, gangs, violence, but it has also taught us that the character and decision making skills required to prevent such a trajectory can be learnt thoughout childhood: grit, optimism, integrity and self-control for example . In collaboration with the Government, Birmingham University and ING, we are working with youngsters who have experienced high levels of adversity to teach these characteristics. We hope that this will help them to make better decisions , get back on track and close the equity gap between them and children from more stable backgrounds.

As international civil servants it is easier to talk about poverty than it is to talk about love. When we talk about adverse childhood experiences we are talking about love, a lack of love, or children being violated by those who should love them. We need to find ways of talking about childhood adversity as a major driver of inequity-despite the discomfort.

I would never want to lose sense of who I am and where I come from. Every month I join a group of young people who grew up in children’s homes in Montenegro and help them draw out their own potential to build better material and emotional future.  I see my own reflection in their eyes and hope they will have a better tomorrow.

[1] Dickens, C. The Life and Adventures of Martin Chuzzlewit (1843), Chap. 25

[2] Tomalain C. Charles Dickens A Life 2011 Viking

Benjamin Perks is the UNICEF Representative in Montenegro