VII. Health Impacts
Cumulative psychological harm
The combined impact of physical violence, degrading and threatening language, isolation, and the abusive conditions of employment, can have significant psychological consequences for child domestics. Two of the domestics Human Rights Watch interviewed, Zahra H. and Rasha A., told us they had considered suicide to escape abusive work situations, and several broke into tears recalling abusive treatment by employers.  In addition, an educator working with child domestics described one of the children we interviewed as having "severe psychological problems" as a result of the abuse she had suffered both at home and while working. 
For some children the impact of physical violence paled in comparison to long hours of work, the denial of food, and verbal abuse and other treatment like lack of access to "good" clothing that targeted their dignity. For example, fifteen-year-old Saida B., who was frequently beaten by her first employer, told Human Rights Watch that it was not the worst place she had worked: "The second house where I worked was the worst. [The employer's] twenty-one-year-old son used bad curses, and they didn't feed me well, or give me good clothes." 
Isolation from family and peers further exacerbates the psychological impact of physical and verbal abuse and abusive work conditions. Isolation from parents negatively affects a child's self-esteem and sense of identity, and inhibits normal childhood development.  For instance, Anti-Slavery International notes that an employer rarely assumes a parental role other than in a disciplinary way, and fails to encourage the child, or guide the child to develop personally.  A 2001 study of child domestics in Morocco found that they appear to experience punishment from employers differently than punishment by mothers, and noted that "[t]his may be due to the fact that a petite bonne usually cannot seek comfort after she has been punished."  According to Bharati Pflug, the author of the background report on child domestic workers at the 2002 ILO meeting on Action to Combat Child Domestic Labour, the isolation of child domestics from their peers and family, "when compounded by verbal, physical abuse and harassment can at times result in personality disorders."  Younger children may feel the impact of isolation more strongly, even in the absence of physical abuse. Hiba Kh., twelve, had been working only two months when we interviewed her, and described her work conditions as relatively good. "They don't hit me," she said. "[But] I wish there were children in the house, and music. I want to sing and play but there is only the employer and her husband. I want to be a singer when I grow up, like [Lebanese pop star] Nancy Agram." 
Health impacts compounded by inadequate nutrition and health care
The working conditions described above often result in poor health. This is exacerbated when child domestics are given food that often is insufficient in quantity and quality to meet the nutritional demands of their growing bodies. A 2001 study of child domestics in Casablanca found that 75 percent of the girls under fifteen surveyed reported physical ailments related to their work, and more than 22 percent reported psychosomatic ailments.  Zahra H., seventeen, told us that when she began working at eight "I would eat in the kitchen, the same food that they ate but less than them. It didn't satisfy me but I didn't say anything because I was afraid they would hit me.  Najat Z., eleven, told us, "I ate lentils or loubia [bean stew], and the family ate meat."  In the most extreme case we encountered, Shadia A. told us that her first employer,
didn't let me break [the Ramadan] fast with them but would make me work during the iftar (fast-breaking meal) and I would have to snatch bits of food from the kitchen while she wasn't looking. She would tell her children to watch me so that I wouldn't eat, but the eleven-year-old would try to sneak me food and help me. [The employer] would curse me and I was afraid of her but I didn't know where else to go. The employer didn't pay me and didn't even let me eat when I had my [menstrual] period [and wasn't fasting]. 
Child domestics' separation from their families and their lack of access to their already grossly inadequate wages leave them dependant on their employers for medical care, yet only one child Human Rights Watch interviewed reported receiving medical attention when sick. Shaima J., fourteen, told us, "Once I was sick and they took me to a doctor and took the money from my wages because the medicine was expensive. I know because my father complained about it. Another time I had an eye problem and they took money for that."  More typical were girls who said that their employers gave them non-prescription medicine when they were ill but did not take them to the doctor, and girls who received no medical attention at all. Zahra H. told Human Rights Watch that when she became sick during her most recent job: "I kept working. They would say I was a liar. I would get very sick and tired during Ramadan because of fasting and because there was lots of cooking and dishes to wash."  Najat Z., eleven, told us, "When I got sick they said, 'you are lying, you aren't sick!' and they didn't give me any medicine and I had to work anyway." 
 Human Rights Watch interviews with Zahra H., Casablanca, May 17, 2005, and Rasha A., Marrakech, May 20, 2005.
 Human Rights Watch interview with NajatOulami, teacher, Association al Aman pour le développment de la femme, Marrakech, May 20, 2005.
 Human Rights Watch interview with Saida B., Casablanca, May 17, 2005.
Maggie Black, Child Domestic Workers: A Handbook for Research and Advocacy (London: Anti-Slavery
International, 1997) (discussing the impact of employment on a child domestic's physical, intellectual,
and psycho-social development), p. 14.
Sommerfelt, DomesticChild Labor in Morocco, pp. 39-40.
Bharati Pflug, An Overview of Child Domestic Workers in Asia, ILO-Japan-Korea Asia Meeting on Action to Combat Child Domestic Labour, October 2-4, 2002, Chiang Mai, Thailand (Bangkok: ILO-IPEC, 2003), p. 26.
 Human Rights Watch interview with Hiba Kh., Marrakech, May 20, 2005.
Forty-one percent reported general fatigue, 15.1 percent headaches, 10.3 percent backaches, 2.1 percent eczema of the hands, 3.4 percent allergies, 2.7 percent stomach aches, 11 percent depression ("repli sur soi"), 2.7 percent "bedwetting," and 8.9 percent difficulty sleeping. Regional Office for Greater Casablanca, Study of Girl Domestics, p. 58.
Human Rights Watch interview with Zahra H., Casablanca, May 17, 2005.
Human Rights Watch interview with Najat Z., May 20, 2005.
Human Rights Watch interview with Shadia A., Casablanca, May 27, 2005.
Human Rights Watch interview with Maha R., Casablanca, May 18, 2005. Human Rights Watch interview with Shaima J., Casablanca, May 18, 2005.
Human Rights Watch interview with Zahra H., Casablanca, May 17, 2005.
Human Rights Watch interview with Najat Z., Marrakech, May 20, 2005.