Lesley Pocock (1)
Dr Manzoor Butt (2)
Dr Thamer Al Hilfy (3)

1. Corresponding author
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2. Maqbool Clinic, Research & Training Centre,
   Dhoke Kala Khan, Shamsabad, Rawalpindi. Postcode: 46300
   Landline: +92-51-4423929
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3. Head of community and family medicine department
   Assistant Professor, Alkindy College Of Medicine, Baghdad, /Iraq
   Mobile. +9647901734108
   E-mail: thamer_sindibaad@yahoo.com, thamer_center2005@yahoo.com
   

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ABSTRACT Our children are our future. Many times have we heard this said but have we thought about the reality of the statement and the kind of humanity and state of condition our global tribe of children will inherit? If we have not got it right up to this point, in the collective history of our global human population, can we really expect them not to do an even worse job, when inheriting a greatly depleted, and more hostile and overpopulated world. Our culture of destruction and violence has not worked and has nearly destroyed the very earth we inhabit, and the lot of every child on this very day, is a 50/50 chance of being severely abused and deprived during their childhood. And when they grow up and realise their constant hunger was not due to a global famine; the shame and the indignity they bore was not due to their own innate unworthiness; and that their childhood was not lost to some great rite or initiation of humanity, or to some great political or religious or national cause, but lost to greed, pettiness, brutalism and ignorance, they will view us just as we unfortunately are. The answer to the many problems facing children are extremely complex, but yet, we would argue, also relatively simple, as a caring, compassionate, equitable and enlightened world could easily turn the situation around, The human political legitimacy principle proposed by the philosopher Lyndon Storey tells us that "political legitimacy is advanced by developing policies that are consistent with all of humanity having an equal opportunity to benefit". Surely all of humanity includes children and the time is ripe to do something now as philosophers such as Storey continue to draw attention to the need for a global policy framework. The need for conscious evolution as a united planetary people, from this point onwards, is becoming increasingly evident and is surely worth considering.1 The Special Rapporteur of the UN in his paper Child Rights 1995 has put it far more succinctly: "There is no way to thoroughly enumerate the various ways in which children around the world are economically exploited and physically mistreated. But the numbers are great -- and the suffering widespread. Behind the hideous imagery -- of children beaten or sexually abused by parents; ravaged beyond their years by hard living and drug abuse on the streets; maimed by landmines or turned into killers by war; stricken with AIDS -- are the all-too-common struggles against disease, hardship, and family or social traditions that compromise children's humanity or subject them to physical and emotional suffering." Whether exploited as child labourers or prostitutes, drafted as young teenagers into armed forces, forced as young girls into a lonely, abusive life as domestic workers, deprived of an education to work on the family farm, or denied adequate nutrition and health care, children need help and protection from an adult world that perpetrates most of the abuse." 2 Whoever has been running the world all these years, has obviously not been doing it very well, and humanity has been downtrodden and exploited in the main, while abuse, disrespect, intolerance, commodity and hype has been made the norm, if not the holy grail. Then there is the dogma of many forms; much of it the same primitive dogma that has contributed to the appalling state we are in, and that has actively worked against enlightenment and advancement of all humanity, for millennia. So it is time for decent people to speak and act with courage; there is little left to lose and much to gain. We are living, conscious pieces of the universe, evolved to the stage where we are the universe contemplating the universe, yet alone out of all the species on this beautiful planet, we prey on and exploit our own children, and pollute, poison and destroy our own habitat and food sources - all for the most senseless and worthless earthly ambitions: money and power. But this paper is not to add further weight of condemnation; the hour is getting late and we need to take on new values, like protect, inspire, respect, empathise, dignify, sanctify, - moral obligation, adult responsibility, - and basic rights and protection for the innocent and powerless of the planet. And it is possibly the family doctor and their ilk, who have the greatest opportunity and most privileged position to do this. And many, many family doctors do. They offer a beacon of rationalism, and a centre of solace, in a mad world, and family medicine encompasses the social, physical, mental and psychological health of a child, and their need for basic amenities, access to nutrition and clean water, a safe living environment and safety from ignorance and brutalism. If we could just open our eyes and minds and assist all who want to change our prehistoric predilections for chaos, and bring up one generation unharmed, that is, break the cycle, then there may be a future for all. But the good people out there need to be assisted and encouraged and this paper's aim is to cut through the dross and distractions of life and shed light on the true state of (in)humanity, and particularly its most vulnerable and aggrieved section, our own children. We therefore also, in this paper, concentrate on pragmatic solutions and set out to provide honest information on the real state of humankind, and its children, on October 22, 2007.

On planet earth 2007 we witness the great debasement of all. The hour is getting late and perhaps it is not the time to be destroying the last natural place, or cutting down the last stand of trees, or exploiting, commoditising and abusing each other and our own young, but time to take a stand and to take on new values like protect, inspire, respect, dignity, sanctity, moral obligation, adult responsibility, and unquestionable rights for the innocent and powerless.

While the many problems outlined above by the Special Rapporteur of the United Nations, are complex, oppressing and widespread it is also not that hard to fix things - it just takes people to do the 'right thing' every time they are faced with a choice and to think about the wider, global ramifications of what they do.

"But the more direct injustices are perpetrated largely by adults, and manifested in the large numbers of children exploited as labourers and prostitutes or maimed by war - and these require further public exposure and protective laws that are actually enforced.2 "

In the last decade, an estimated two million children have been killed in armed conflict, many of them by some of the 100 million landmines thought to be concealed in 62 countries. A total of perhaps four to five million more have been disabled as a result of their experience in war, and more than 12 million have been made homeless. 3

Changing the attitudes of adults unfortunately will take quite a few more millennia of continuing enlightenment or perhaps the short, sharp, shock, which we are most likely in for.

Fortunately there is a wide range of organisations and institutions committed to peace, equality and human development but these do not necessarily extend to the realm of family or national politics, to enshrine basic rights. Also all humans do not have the capacity to comprehend the longterm results of their actions of their practices, and cultures so rights need to be enshrined in law and disseminated into communities via public education and practices.

Those with the intellectual capacity to look at issues of problem solving on a global scale, that is an academic approach, need to - this can fall to family doctors, teachers and on the macro scale academics looking at all the issues that cause intra-human conflict.

Laws need to enforce what is issued via public education as we have managed, for example, to identify murder, globally, as an antisocial act, and plants and animals seem to have worked out the need to protect their offspring,- why not the same for a human child? The progenitors of the seed usually do their utmost to ensure the optimum survival of their offspring, but unfortunately child abuse and neglect while proliferated by poverty and inequity, occurs almost equally where this is not a factor, leaving us with almost a unique situation of endemic acts of violence against our own young.

Coupled with human society's primeval urge to prey on human society and exploit and conquer, and no doubt our unrecorded history (our REAL history) has been just as littered with such abuse; so we have to look at the fundamental basis of our society, those who perpetuate the atrocities, which are often part of the basic structure of many societies.

The rights of women and status of women are linked very closely to the status of children. An empowered mother would fight to save her children from the many forms of abuse, and a society that supports a mother's rights, also supports children's rights. Educating and empowering women and girls can only improve the situation on so many fronts.

So we need to respond on a personal, familial, community, national and global level to combat those who have a vested interest in the disempowerment of women and children, those who would prosper from such and those who refuse to see. Human thought and action, on a personal scale is the essence of the process.

An academic focus on the very nature of the problem is one we have sought to develop through Child Watch where we encourage articles such as this, looking at the global issues working against children and their rights and empowerment, as a necessary step to identifying and solving the problems. Coupled with this is the need to rescue those children who are living their lives in abject misery.

Creative responses

While the problems for the children of planet earth are immediate and every day and if we are to break the pattern that they go on to abuse and degrade their own children, having 'learned the ways of the world' then frankly we need to think and act creatively

Such responses need to look at a broad range of issues: dignity, rights to a safe and secure environment, adequate nourishment, rights to education, a future, a habitable planet.

At least if society is educated then we have a yardstick to respond by. Educating society that children are people too, - provides a moral and practical basis to the protection of children. Treating children with dignity, shows children and other adults the same.

And educating children about their own rights provides them with some measure of protection and dignity, at least to gauge their own lives against.

While with Child-Watch we provide small missions like ridding blind institutionalised girls of lice and scabies in impoverished nations, approaches such as "Scholarships for Life' have a more longterm affect. 4The main Child-Watch mission therefore is to 'buy' children out of slavery and provide them with an education. Slavery is not necessarily a sign of parental or familial neglect it may be a necessary means of survival for far too many children and their families, with the responsibility therefore falling to those who are benefiting from the child labour or those who are necessitating it through unfair national or cultural denial of basic rights.

In many poor countries, children work to supplement meagre family income or otherwise to help the family business. Although they may not always work under the most desirable conditions, most are not being intentionally exploited by their families. The real issue in such cases is not whether the children work or not, but whether the conditions under which they work are just, and whether they are being denied other basic rights because of their work -- such as the right to education, to freedom from abuse, and to proper health care.

As for child labour, while experts agree that there are few accurate statistics available, the best estimates from the ILO are that there are nearly 80 million children under 15 working as labourers. It is also estimated that the number of children under 18 involved in prostitution exceeds two million, one million of whom are in Asia and 300,000 in the United States. 2

One creative response to this kind of complex dilemma has come from Bangladesh. In reaction to United States Congressional legislation mandating a boycott of companies in the garment industry that use child labour, companies in the garment industry in Bangladesh began ousting children from their jobs -- as many as 50,000 in a four-month period. The result was that many of the children were worse off than they had been when they were working, having taken other, less desirable jobs or living in the street -- but not going to school. 3

In July 1995, after negotiations with non-governmental organizations (NGOs), as well as UNICEF and the International Labour Organization (ILO), the Bangladesh Garment Manufacturers and Exporters Association (BGMEA) signed a Memorandum of Understanding stipulating that BGMEA would ask "that no under-aged worker will be terminated until the appropriate school programmes for the workers can be put in place".3

"Poverty cannot be accepted as a pretext and justification for the exploitation of children," wrote Vitit Muntarbhorn, until 1995 the Special Rapporteur on the sale of children, child prostitution and child pornography. "It does not explain the huge global demand with, in many instances, customers from rich countries circumventing their national laws to exploit children in other countries. 'Sex tourism' has spread its illicit wings wide, and paedophiles search for their victims in all parts of the globe. The problem is compounded by the criminal networks which benefit from the trade in children, and by collusion and corruption in many national settings". 2

Iraq represents the depths to which we have sunk as a global community and is a constant source of shame, and deserves a focus of its own.

Despite the country's rich resources, Iraq's human development indicators are now among the lowest in the Region. In 1989, health care in Iraq reached approximately 97% of the urban and 79% of the rural population. Subsequently, these gains were halted and during the 1990s there was a rapid increase in infant mortality rates and deterioration in other health indicators. Health outcomes are now among the worst in the Region, with high maternal and child mortality. At present the infant mortality rate is 108 and the under-five mortality rate 130.5 per 1000 live births. The country is suffering from a double burden of disease. There are major infections, such as diarrhoeal diseases, acute respiratory infections, malaria, tuberculosis and leishmaniasis. 5

Educational reform is one of the high priorities in the re-building of Iraq. Enrolment and attendance rates have diminished progressively, including a rate of only 50% of girls attending in rural areas. Family poverty is a major cause of drop-out.

These figures, derived from several surveys, confirmed the serious nutritional status of young children in Iraq. About one in every five children was underweight (low weight for age) in 2000, and almost one third of children under 5 were chronically malnourished (low height for age). Malnutrition declined in 2002 and Iraq was approaching the levels at the beginning of the sanctions in 1991. The recent Iraq multiple indicator rapid assessment survey (IMIRA) conducted in 2004 however does not confirm the improvements. It shows that malnutrition (weight for age) affects up to 13% of children and malnutrition (height for age--stunting) affects 25%. Also, the UN Millennium Indicators Database gives a rate for moderate and severe child malnutrition in Iraq of 15.9%. Iraq is one of only three Arab countries (with Yemen and Comoros) in which incidence of low birth weight exceeds 10%. Although more than 40% of adult males are overweight, chronic malnutrition is common, as is anaemia in children, adolescents and pregnant women. 5

The orphans of Iraq also deserve a special mention, not only as one section of society in greatest need, not just of food and shelter, but love and kindness, and especially as they are an integral part of the future of Iraq and its people, - and what an opportunity for us to get it right.

And we all like a happy ending, which is why we focus our final chapter on our colleague, and a family doctor, Dr Manzoor Butt who works in impoverished areas of Pakistan, and treats the poorer members of the community and who has developed many strategies aimed at the multiplicity of factors that can lead to poor health and impoverished lives, particularly of women and children of the region.

Dr Butt is an example of an ordinary person (indeed a hero in our midst) who makes the right decision every time he is faced with a dilemma or problem. This can extend to training of Female birth attendants and women's health workers, to deal with obstetrics and gynaecological cases for women whose religion or culture prevents them from being treated by a male doctor, taking proactive and practical steps to counter malnutrition in his patient population, providing modern medical care where 'traditions and cultural practice' may be harmful to human health, providing access to making an income by purchasing, for example a sewing machine for impoverished female family heads, to allow them to work for a living when no other means was available; and by recognising that blind institutionalised girls and other insitutionalised children plagued by lice and scabies, deserve dignity and relief , and then taking the steps to provide such. Mostly our colleague stands up for what is right, every time , and often at great personal cost.

And while one person cannot do it all, one good person can make a huge difference. So on this day, in the history of humankind, we encounter our final opportunity to address the full scope of our humanity, before our current choices put an end to the age of man and an end to our place in the unfolding of the universe.

1. Storey, L Humanity or Sovereignty (page9)
   
2. United Nations Department of Public Information * DPI/1765/HR--December 1995
   
3. UNICEF website
   
4. www.Child-Watch.org
   
5. Country Cooperation Strategy for WHO and Iraq 2005-2010
6.