As I mentioned in my introduction blog post, I’ve been interested in the topic of poverty and homelessness in Pakistan and the effect the two have on Pakistan’s children. Pakistan has it’s issues revolving around affordable housing for low income people, leading many to live within slums, or katchi abadis, with inadequate water and sewerage systems. Living in poor conditions can really take a toll on a person’s health, not only physically but mentally, and the health of children living in poverty is what I’m interested in writing about today.
First of all, I’d like to talk about Pakistan’s overall health care system. According to The World Health Organization’s (WHO) Biennial Report on Pakistan, the country does have “a well-developed and multi-tiered health infrastructure” in place, but access to healthcare is where the difficulties lie. It is mentioned by WHO that security-compromised areas in the north, as well as many natural disasters that followed a huge earthquake that struck Muzaffarabad in 2005 are some of the reasons behind poor accessibility to health services (Abid). There’s also an issue of access depending on location. Urban areas typically have more health resources than rural areas.
Then there’s the issue with funding. Only 0.5% of Pakistan’s GDP is spent on health (WHO). (For some perspective, the U.S. allocates 17.6% of its GDP toward health care) (Kane). Most people in Pakistan must pay for health expenses out of pocket. Pakistan receives a lot of foreign assistance for health, and is the 6th largest recipient of official aid in the world. In 2007, Official Development Assistance (ODA) was given to Pakistan with a value of 2.2 billion US dollars (Abid).
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Of course, without an accessible health care system many people will suffer, especially those living in poverty. Street children in Pakistan are effected greatly without access to healthcare. One reason being that sexually transmitted diseases are very common among street children and very few of them get the attention and care they need. The AZAD Foundation, a Pakistani NGO that works with street children found that 4 out of every 10 street children they examined were infected with STD’s. (IRIN) Sexual exploitation is a very big issue among street children. For many of them, sex is the only commodity they have to offer in exchange for food, shelter and drugs, otherwise known as “survival sex” or “transactional sex.” It is not uncommon for them to exchange sex for as little as a dish of rice. A lot of them are also forced into gangs where they are pimped out for cash. Living this lifestyle can become a vicious cycle because many of these children start off in the sex industry at a young age and when they grow up it becomes the only way they know how to make a living. Sometimes they go on to become the leaders of gangs themselves, leading other young street children to do the work for them. A UNICEF evaluation report on street children mentioned that 80%-90%of street children are victims of sexual and physical abuse by adults and older children within their own gangs. (Aman)
And the authorities aren’t any help; police officers are guilty of partaking in sexual acts with street children as well. An NGO that works to protect the rights of street children, the Initiator Human Development Foundation (IHDF), found that policemen account for 60% of the sexual abuse that Pakistani street children are subjected to. (AFP) It’s really heartbreaking to think that the people who should be keeping them from harm are the ones inflicting it. Luckily, IHDF provides medical facilities, along with shelter, vocational training, and rehab to street children, and has been doing so for the past 16 years. There are a few other NGO’s, such as Nai Zindagi, that help provide medical assistance to street children. Nai Zindagi is an NGO supported by UNICEF that runs Project Smile which is open 8 hours a day, 6 days a week. It provides them with a safe location to go that has food, counseling, clothing, and trained health and social care professionals who can refer them to more intensive medical care and drug treatment. Treatment for drug abuse is definitely a big need for these children.
Many street children have drug addictions and start using at a very early age. Reasons for drug use vary from being used as a coping mechanism, to reducing hunger, to peer pressure. Drugs are very accessible on the street. Heroin is a common drug among the children and it is used to help them fall asleep and keeps them from feeling hungry. Unfortunately using heroin by injection can lead high risk of HIV/AIDS. Between sexual abuse and intravenous drug usage, about 49 percent of street children are at risk of HIV/AIDS.
Apart from heroin it seems that inhalants are the number one choice for street drugs among the children, due to the cheap cost. A lot of them sniff volatiles for a high and they are easily accessible, especially because volatiles are common byproducts of many industries in urban areas. There are serious long term effects for using solvents such as irreversible brain damage, and respiratory depression, as well as sudden death. It is said that the children abuse solvents more than drugs, because of the cheapness. In a scholarly article by the Journal of Urban Health researchers found that over four fifths of the children they sampled began their drug usage because of peer pressure. Peer pressure is a big factor because most of the street children don’t have any contact with family, so street gangs become their families. Knowing this statistic has been helpful in that Project Smile (run by UNICEF as mentioned above) has begun teaching peer outreach and communication skills to the children, as well as effective ways of reducing risks associated with drug use and sexual behaviors. Thankfully in the past couple decades more research has gone into the topic of the effects that living on the streets has on children of Pakistan, and has led to the development of many NGO’s that can help them, even if the national health care system can’t.
Abid, Ni’ma Saeed. WHO-Pakistan Biennial Report 2012-13. Rep. N.p.: n.p., 2013. WHO Eastern Mediterranean Regional Office. World Health Organization, 10 Apr. 2013. Web. 4 Apr. 2016.
World Health Organization. Pakistan. WHO EMRO | Health System Strengthening | Programmes | Pakistan. N.p., n.d. Web. 04 Apr. 2016.
Kane, Jason. “Health Costs: How the U.S. Compares With Other Countries.” PBS. PBS, 22 Oct. 2012. Web. 04 Apr. 2016.
“Number of Street Children on the Rise.” IRIN. N.p., 04 May 2005. Web. 07 Apr. 2016.
“Children Sexually Abused on Pakistan’s Streets.” Dawn. AFP, 26 Aug. 2011. Web. 07 Apr. 2016.
“Most of the Street Children Are Boys.” The Express Tribune. N.p., 28 May 2010. Web. 7 Apr. 2016.
Aman, Aslam. EVALUATION OF SOCIAL REINTEGRATION OF STREET CHILDREN PROJECT. Rep. Islamabad: UH&H Consulting (Pvt.), 2012. UNICEF. Web. 25 Mar. 2016.
Sherman, S. S. “Drug Use, Street Survival, and Risk Behaviors Among Street Children in Lahore, Pakistan.” Journal of Urban Health: Bulletin of the New York Academy of Medicine 82.3_suppl_4 (2005): Iv113-v124. Web.