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“It took me a while to realize when I went to the baby houses that they only show you all the healthy ones. Then there are the rooms where the others are just lying there. They're all dying, lying on their backs, staring at the ceiling, generally fed on their backs. I've seen them putting the bottle of boiling hot food into children's mouths. It must be burning, but they're too hungry and just swallow it.”

- Sarah Philips, long-time orphanage volunteer

February 23, 1998

When I was little, Svetlana Petrovna put my head in the toilet and beat me on the behind, hips, and arms. At first she would hit me on my hand—that was while I was small, until I was nine years old. After that she could take a slipper and slap us on the lips. Of course, a kid couldn't do anything or say anything. We were so afraid of her.”

“They could put you in the bedroom and make you stay there. They also kept food from you to punish you, too. Right now it's the staff that's the worst thing about life here—especially Svetlana Petrovna....There are about six or seven staff who are about the same.”

- Kirina G., fifteen, Moscow orphan

February 20, 1998

“They’re called children with no prospects, not trainable, not treatable. A colleague called these psychoneurological internaty “death camps.” The situation there is terrible.”

- Dr. Anatoly Severny, President

Independent Association of Child Psychiatrists and Psychologists, Moscow, February 12, 1998

“I could not say that I am proud of [that psychoneurological internat], ...but in general I believe that everything that can possibly be done in the current conditions is being done...And for these [Down syndrome] children [who may come from alcoholic homes], life in an internat is a paradise.”

- Natalia Tsibisova, Director of Residential Institutions,Moscow Committee for the Social Defense of the Population, quoted in the Moscow Times, February 7, 1998

It is seven years since the declining Soviet Union released the last of its most renowned political dissidents, and closed a chapter of notorious human rights abuse in psychiatric hospitals and GULAG prisons. Yet today, in another archipelago of grim state institutions, the authorities of the Russian Federation are violating the fundamental rights of tens of thousands of innocent citizens: children abandoned to state orphanages.

Human Rights Watch has found that from the moment the state assumes their care, orphans in Russia—of whom 95 percent still have a living parent—are exposed to shocking levels of cruelty and neglect. Infants classified as disabled are segregated into “lying-down” rooms, where they are changed and fed but are bereft of stimulation and lacking in medical care.

Once officially labelled as retarded, Russian orphans face another grave and consequential violation of their rights around the age of four, when they are deemed "ineducable," and warehoused for life in psychoneurological internaty. In addition to receiving little to no education in such internaty, these orphans may be restrained in cloth sacks, tethered by a limb to furniture, denied stimulation, and sometimes left to lie half-naked in their own filth. Bedridden children aged five to seventeen are confined to understaffed lying-down rooms as in the baby houses, and in some cases are neglected to the point of death. Those who grow to adulthood are then interned in another "total institution," where they are permanently denied opportunities to know and enjoy their civil and political rights.

The “normal” abandoned children—those whom the state evaluates as intellectually capable of functioning on a higher level—are subjected to cruel, inhuman and degrading treatment by institution staff. They may be beaten, locked in freezing rooms for days at a time, abused physically and sexually. They may be humiliated, insulted and degraded, and provided inadequate education and training.

Staff members may also instigate or condone brutality by older orphans against younger and weaker ones, incidents such as beatings and humiliation. Somechildren describe treatment as outrageous as being thrown out a window while nailed in a small wooden chest. When orphans finally leave their institutions, they suffer its damaging effects and the second-class status as orphans for the rest of their lives.

It is ironic and deplorable that the very state that is charged with the care and nurture of these vulnerable children condemns them to a life of deprivation and cruelty. Moreover, far too many children are consigned to Russian institutions in the first place. Of a total of more than 600,000 children classified as being “without parental care,” as many as one-third reside in institutions, while the rest are placed with a variety of guardians. Thousands more are temporarily quartered in various public shelters and institutions under police jurisdiction simply waiting for an available space in an orphanage.

Humane alternatives to institutions exist and should be used, such as sending children with moderate disabilities home with their parents at birth; providing help for families to cope with their children’s disabilities; and providing foster care for children who cannot return to their families. As Russian experts told Human Rights Watch in the body of this report, these alternatives do not require additional resources, but rather a reallocation of existing funds now devoted almost exclusively to expensive institutional care.

Abandoned Children as an Underclass

Human Rights Watch has found that from the moment Russian children are left in state institutions, they become victims of long-held prejudices that all abandoned children are in some way “defective.” One source of this discriminatory assumption is the tradition that infants born with severe congenital defects have been abandoned in local maternity wards under pressure and warnings from the medical staff that the family will be ostracized for raising a disabled child.

Even if abandoned infants do not display severe physical or mental disabilities, however, they often come from families with chronic social, financial and health problems—including alcoholism—and they cannot escape the stigma applied to that past. A clear summary of this point appeared in an article in the Moscow Times of November 2, 1996, which explored the biases against adopting a baby abandoned by a stranger:

The fear that the child will in some way be “damaged goods” stems from the knowledge that mothers of mentally and physically handicapped children are routinely advised by doctors to put their baby in an orphanage and “try again.” Consequently, healthy babies who are given up for financial or domestic reasons are unfairly branded “defective.”

The result is that abandoned children are consigned to the status of “orphan,” and further labelled in their medical charts with physical and psychological “risk factors” in their medical charts owing to their background. Testimonies collected by Human Rights Watch are corroborated by the findings of expert investigators from the Swiss-based Comité pour la Dignité de l’Enfant (C.I.D.E.), published in 1995. They found that while Russian professionals used strict criteria in performing psychological evaluations, they also recorded factors in the child’s medical history which would be considered as “risk” factors in the West, but commonly become labels of illness for an abandoned Russian child. According to the C.I.D.E. report, these include:

· babies born to alcoholic parents or whose mothers suffered depression during pregnancy will be labelled encephalopathic and remain so until they come of age.

· orphans will be classed as being mentally deficient.

· children with a single physical malformation (a harelip or speech defect...) become subnormal in the eyes of Russian doctors.

International human rights law forbids discrimination on a variety of grounds, including “birth or other status.” Under the United Nations’ “Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care,” Principle number 4 provides that, “A determination of mental illness shall never be made on the basis of political, economic or social status, or membership of a cultural, racial or religious group, or any other reason not directly relevant to mental health status."

In practice, however, the Russian system violates this principle as well as the fundamental tenets of the International Covenant on Economic, Social and Cultural Rights, by branding children of lower socioeconomic origins and children with genetic abnormalities as a class apart.

It does so by attributing to them a propensity for social deviance stemming from their background, and by imposing upon them a life-long stigma and formal restrictions on participation in society. Abandoned children who are diagnosed as “oligophrenic,” or mentally retarded, carry that label in their official dossier from institution to institution. They have virtually no channels through which to seek a reassessment or reversal of this diagnosis, and even “mild” oligophrenics who graduate from technical training schools told Human Rights Watch that they had difficulty appealing for the word to be removed from their file.

Human Rights Watch concludes that the Russian state fails to provide sufficient protection and opportunities to thousands of children who are abandonedto the state at a rate of 113,000 a year for the past two years, up dramatically from 67,286 in 1992. The evidence gathered reveals several systematic disadvantages imposed on young Russian orphans, which violate their fundamental rights to survival and development, and place them in an underclass.

Children abandoned at birth are more likely to be smaller and less developed over time than others, due in part to the significant lack of developmental care in state institutions during the crucial phase of early infancy.

Orphans in Russia have no one to appeal the state's special medical-developmental evaluation, which is performed on virtually all institutionalized children approaching the first year of school and older children at the time of abandonment. As described in greater detail in Chapters IV and V of this report, a diagnosis of severe oligophrenia for orphans means a greater likelihood of premature death in an institution that is little more than a warehouse.

According to this "diagnosis," which is delivered by a state-run commission of doctors, psychologists, and educators based at the Chief Psychiatric Hospital No.6 in Moscow, children in Russian institutions face a “triage” into one of two tunnel-like systems apart from Russian society at large. As explained in Chapter II of this report, in the best case, they are deemed educable, and proceed to a dyetskii dom run by the Ministry of Education, and attend regular Russian schools. In the worst case, they are deemed severely oligophrenic—either imbetsil or idiot—and condemned to a system of "total institutions" run by the Ministry of Labor and Social Development. There they receive little to no education and only a minimum of maintenance until they reach the age of eighteen, when they move on to an adult institution of the same kind. As the later chapters of this report show, independent child welfare experts in Russia denounce these institutions, claiming that the death rate for children is twice that of children living at home.

The comparatively fortunate orphans who make it into the educable group are still more likely to receive harsher discipline than children whose parents have left them only temporarily in state custody and continue to have contact with the orphanage.

Orphans in state institutions are less likely to be referred for needed medical services than are children with parents. Should orphans happen to be transferred to a hospital for services, they are less likely to receive proper medical treatment than children whose families can cajole and bribe hospital staff to carry out their work appropriately.

Failure to Live Up to National Commitments

The Russian government and its predecessor, the USSR, have long taken pride in the education and upbringing of their children. Its separate world of giantorphanages reflects the Soviet philosophy of collective action and discipline that guided the institutions erected to house millions of war orphans during the first half of the 20th century.

Since the break-up of the Soviet Union in 1991, however, the increased access to orphanages by journalists and charitable volunteers has unveiled a tableau of horrific conditions and malign neglect in institutions from the heart of Moscow to remote rural provinces. The Russian and international media have widely disseminated the shocking images from the orphanages during the past few years, and at least two international human rights delegations have issued damning reports of their findings, which are cited in the body of this report. Yet deplorable conditions still persist.

Officially, the Russian authorities, starting with President Boris Yeltsin, have repeatedly declared the rights of children a high national priority. The Russian Federation was among the first nations to sign and ratify the U.N. Convention on the Rights of the Child in 1990, the full text of which is presented in the Appendix to this report. Russia has subsequently submitted two periodic reports of its implementation of the Convention on the Rights of the Child, in 1992 and late 1997.

Also during the 1990s, Russia passed a raft of legislation and decrees affirming children's rights to education, health, and special protection against the hardships and upheaval wrought by economic reform. By mid-decade, President Yeltsin had launched two federal programs, "Children of Russia," and "Fundamental Directions of State Social Policy for Improving the Position of Children in the Russian Federation to the Year 2000." These programs are aimed at increasing the efficiency of state programs for children at the federal and local levels, and helping poorer families to provide a stable environment in which a child may develop.

In practice, however, the reaction of the Russian authorities to the critique of their orphanages has been to block access to the institutions; punish or threaten to fire workers if they speak about abuses; and, in some instances, pardon those who are responsible for the wrongdoing.

Senior officials of the three ministries charged with maintaining the orphanages have impeded the efforts of Russian human rights organizations to investigate reports of neglect and malfeasance. Members of such groups and child welfare experts told Human Rights Watch that senior officials flatly rejected their requests to visit the particularly degrading and unhealthy psychoneurological internaty run by the Ministry of Labor and Social Development for orphans diagnosed as imbetsily and idioty.

Failure to Comply with International Obligations

Although the Russian government has signed the Convention on the Rights of the Child, the evidence gathered and presented in this report shows that Russian policies toward abandoned children violate as many as twenty of the convention's first forty-one articles, which comprise a sweeping array of basic rights. More significantly, our evidence reinforces the concerns recorded in 1993 by the U.N. Committee on the Rights of the Child, in its letter replying to the Russian Federation’s first periodic implementation report.

· The U.N. Committee featured as a "principal subject of concern," the "practice of the institutionalization in boarding schools of children who are deprived of a family environment, particularly in cases of abandonment or where children are orphaned."

· Another "principal subject of concern" highlighted by the U.N. Committee was the dire situation of disabled children. Human Rights Watch has learned that severely disabled babies are routinely abandoned at the state-run maternity wards, under pressure from medical personnel who warn the recuperating mothers of a life as social pariahs if they keep a "defective" child.

· Finally, the violence against orphans by institution staff and older children, which Human Rights Watch also documents in this report, gives heightened cause to the U.N. Committee's concern about the "occurrence of maltreatment and cruelty towards children in and outside the family." Now, more than ever, the facts substantiate the committee's 1993 suggestion that "procedures and mechanisms be developed to deal with complaints by children of the maltreatment or of cruelty towards them."

Next spring (1999), the second Convention on the Rights of the Child implementation report of the Russian Federation will come up for review by the U.N. Committee; Human Rights Watch urges the committee to place the systematic violations of orphans' rights at the top of its agenda.

To that end, we call attention to several of the more egregious violations of the Convention on the Rights of the Child, among other international documents that are abrogated on a daily basis in Russian custodial institutions.

Contrary to the precepts set forth in Article 23 of the Convention on the Rights of the Child, specifically concerning children with mental and physical disabilities, Russian orphans with severe disabilities are denied virtually every right to medical care, education, and individual development.

Such orphans are officially classified as "ineducable," and are excluded from opportunities to learn to read, write, and in some cases, to walk. In addition, abandoned babies and children of sound mind, but with physical disabilities, are routinely confined to areas in state institutions known as "lying-down” rooms. They are passed over for corrective surgery of conditions such as cleft palate as a result of the compound stigma of being abandoned and being diagnosed as "oligophrenic" (mentally retarded).

During a visit to the lying-down room of one psychoneurological internat, Human Rights Watch noticed a beaming blond, five-year-old boy walking on the callused sides of his club feet. We asked the sanitarka who was playing with him what his diagnosis was. "Oligophrenia," she replied. But when we asked specifically about his feet, she replied, "Well, it's the same... imbetsilnost."

In addition to the appalling violation of the rights of orphans with severe congenital disabilities, critics of the state's diagnostic procedure also expressed their concerns time and again to Human Rights Watch that too many children were, in fact, wrongly diagnosed. Even the staff at two institutions told Human Rights Watch that they believed that nine to ten percent of the children transferred to them as imbetsily and idioty, actually had the ability to enjoy productive lives.

The percentage of diagnostic errors was shown to be strikingly higher in a more in-depth clinical assessment of oligophrenic orphans published in 1991 by the British charity organization, Christian Solidarity International (CSI). CSI concluded that in one group of fifty children they studied, more than one-third were within "normal" limits of standard intelligence tests. On more thorough examination of thirty-four children, the team gathered the startling results that "two-thirds of these 'oligophrenic' children showed evidence of average or better ability."

In view of the known and suspected cases of misdiagnosis among orphans, Human Rights Watch finds the violation of Article 27 of the Convention on the Rights of the Child particularly relevant. It accords children undergoing medical care the right to periodic review of their treatment and surrounding conditions. In practice, however, Russian orphans with diagnoses of oligophrenia have extreme difficulty seeking a re-assessment of their status, which is also a violation of Russian law. Even those classified as "lightly" oligophrenic (debil) carry the burden of that classification in their official file when they embark on their search for jobs and homes.

The most severe discrimination faced by Russian orphans is suffered by children interned in psychoneurological internaty for children with disabilities who are aged five to seventeen years. Article 39 of the convention calls for the promotion of "physical and psychological recovery and social reintegrationfollowing neglect, exploitation or abuse...or any other form of cruel, inhuman or degrading treatment or punishment."

Far from receiving treatment towards recovery or rehabilitation, however, Russian orphans consigned to lying-down rooms suffer further deterioration from neglect. Agitated orphans are confined to barren day-rooms where they are tethered, restrained, and given powerful sedatives without medical supervision.

Such examples of inhuman and degrading treatment and punishment are all too common features of Russian orphanages, both for children with severe disabilities, and as well for those diagnosed as "educable." In the latter case, Human Rights Watch discovered elaborate patterns of dehumanizing discipline in the dyetskiye doma of the Education Ministry, in which the orphanage directors and staff strove to humiliate children in front of their peers, and at times encouraged their peers to take part in the demeaning punishment.

Such choreography of cruelty by orphanage staff is often devised for the purpose of punishment-by-proxy, through which older or stronger children are delegated to maintain order. The resulting disciplinary pattern alarmingly resembles that found in the Russian military and prisons, both state institutions notorious for their elaborate systems of violence and debasement. Whether for punishment or for simple sadism, this practice amounts to a training module in physical and mental violence.

Moreover, the common practice of interning older children in psychiatric hospitals for rule-breaking behavior such as running away from the orphanage is a perversion of medical ethics and an alarming throwback to the gross misconduct of the Soviet psychiatric profession. Children returning from two weeks to several months in the psykhushka report the use of heavy tranquilizers, and appear disoriented and confused to their peers.

These preeminent uses of violence against Russian orphans violate the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, as well as other international standards pertaining to medical ethics and the treatment of persons with mental illness.

This report is based on a month-long fact-finding mission in Russia, during which Human Rights Watch met with more than thirty-one orphans, from some seventeen institutions; six doctors specializing in child development, either working within or outside institutions, four vospitateli working with older orphans and ones with disabilities, three children's rights activists, several journalists, and five Western volunteers who have worked extensively in institutions.

Several of these volunteers were among the first outsiders to enter children's institutions in Russia during the early 1990s, and they undertook a survey of orphans' needs for a new charitable assistance program. As a result of theirresearch, and their in-depth work in a number of institutions, the volunteers interviewed for this report hold the most comprehensive information on the system as a whole, outside government officials.

Some of these volunteers and others interviewed by Human Rights Watch were willing to be named in this report. They requested, however, that we not identify the institutions they described, for fear of being banned from them after the publication of this report.

To protect the orphans and others who fear reprisals by officials, we have changed the names of all locations and people in this report, and indicated in the footnotes. Testimonies have been lightly edited for clarity, but otherwise represent interviews Human Rights Watch conducted either directly or with the help of an interpreter.

Following the discussion of relevant international and Russian laws in Chapter III, each chapter takes a phase of an orphan's life in a Russian institution, and introduces the genre of human rights violations they suffer at that stage. The prejudicial stereotype of abandonment is common to all stages, for example, while some abuses, such as malicious and degrading punishment, are more specific to the context of the Education Ministry's dyetskii dom.


The only way to bring a halt the cycle of discrimination, violence and impunity that endangers abandoned children in Russia is through a joint campaign by the international community, Russian authorities, and children’s advocates to abolish all prejudicial practices and investigate reports of wrongdoing.

Human Rights Watch recommends the following reforms:

To the Russian Government

On reducing the number of children consigned to state institutions:

· Stop medical personnel from pressing parents to institutionalize newborns with severe disabilities;

· Develop and implement a plan for the gradual deinstitutionalization of abandoned children and children with disabilities, and reallocate resources now used for institutional care to develop alternative humane, non-discriminatory alternatives;

· Provide assistance to families in caring for children with disabilities—for example, home helpers, day training and education programs;

· Make utmost efforts to locate other relatives who are willing and capable of assuring care for children when it is not in the best interests of the children to remain with their parents, and provide such relatives with assistance where necessary;

· Provide and supervise foster care for children who cannot remain with their families; and

· Make utmost efforts to seek out appropriate opportunities for adoption when it is in the best interests of the child. Human Rights Watch takes no position on the Russian debate over the advisability of foreign adoption, but urges that in seeking alternatives to institutional life, the best interests of the child always be paramount, and that foreign adoption should not be ruled out as an alternative preferable to institutionalization.

On the matter of discriminatory status

· Ensure that all abandoned and orphaned children, whether disabled or otherwise, receive full respect for their human rights and protection against discrimination;

· Immediately stop applying the diagnosis of oligophrenia (mentally retarded) to infants or young children until they can be observed and examined adequately over a period of time;

· Commence investigation, with the participation of independent medical, educational, and mental health experts, into the process of evaluation at the age of four, which channels abandoned children almost irreversibly into educable and ineducable worlds. This investigation should aim to reform the evaluation procedure in order to take into consideration the extremely limited experience of instutionalized children;

· Appoint an independent “observer group” including experts in pediatrics, child development, and neuropsychology among others, to take part in the official evaluations conducted by the state Psychological-Medical-Pedagogical Commission, and vested with the power to challenge diagnoses determined by the commission;

· Establish a mechanism for all orphans to exercise their right to appeal the discriminatory diagnosis of oligophrenia, and to expunge it from their records,if need be. In conjunction with this action, quickly establish a department staffed with medical, educational, mental health and social work experts to process appeals from older children with completed educations;

· For children too young or otherwise unable to file their own appeals for re-assessment of their diagnoses, enlist independent Russian child welfare experts and attorneys versed in children's advocacy, to assist or represent the child in making the appeal;

· Immediately lift any formal restrictions against appealing the diagnosis of oligophrenia;

· Immediately cease to inscribe orphans' official identification documents, including passports, with "dyetskii dom" (children's home), and list only the street address as place of residence;

· Immediately take steps to end the gross neglect, and the physical and psychological abuse by staff working in the custodial institutions of the three ministries involved: Health, Education and Labor and Social Development;

· Immediately undertake a public education effort at the federal, regional and local levels, to dispel the deep-rooted prejudice against children who have disabilities and children who are abandoned by their parents. This campaign should enlist experts and popular personages throughout the Russian Federation, as well as abandoned children, those with disabilities, their relatives and advocacy groups for such children . Making use of all possible media and school curricula, the campaign must have as its goal to debunk the myth that abandoned children automatically inherit physical and mental abnormalities and behavioral patterns such as criminality. It should also raise awareness as to the rights and potential of disabled children;

· Consistent with the 1993 recommendations of the U.N. Committee on the Rights of the Child, immediately undertake a parallel in-service training program for staff of state orphanages to dispel these same prejudices and emphasize the rights of disabled persons. Such training should also inform orphanage staff of the significant advances made in the education and treatment of children with bona fide disabilities. Many staff are plainly unaware of the clinical profile and developmental potential of children with Down syndrome, cerebral palsy and other conditions; and

· In conjunction with public education in the institutions, initiate a program in the psychoneurological internaty to introduce reading to all children. In addition, furnish them with sorely needed children's books and primers, as well as writing paper, crayons and pencils.

On the matter of punishment, abuse and deplorable conditions

· Immediately issue a directive to all ministries and orphanage directors that corporal and psychological punishment of children are strictly prohibited. To end the system of impunity in the institutions, the directive must state that alleged violators will be subjected to investigation. If necessary, they will be disciplined, dismissed or submitted to criminal prosecution;

· In conjunction with the above, commence systematic investigations of conditions in selected baby houses; psychoneurological internaty; orphanages run by the Ministry of Education; dormitories for orphans fifteen to seventeen years of age who are attending technical training institutes;

· Immediately furnish children in state institutions with information about their basic rights, including their right to file grievances confidentially. This information should be conveyed through social workers and members of independent NGOs, and should include guarantees for their protection against retribution in the event that the alleged violator is convicted;

· Immediately establish an effective channel through which orphans may make confidential complaints to an independent outside authority about violence and misconduct committed, or instigated, by the institutional director, staff or other children;

· Immediately appoint an independent, standing commission of experts from the fields of pediatrics, neurology, psychology, and early childhood education, vested with full authority to conduct unannounced visits to institutions and to order official sanctions for violations; and

· In the meantime, expert consultants should be enlisted by each ministry to review and revise the standards of institutional care in accordance with the tenets of international and Russian law. Each of the Russian ministries responsible for children's custodial institutions—Health, Education, and especially the Ministry of Labor and Social Development—should make itscurrent standards for institutional conditions and treatment public and transparent.

On the right to health care

· Ensure, in adherence to Russia's national legislation and international law, that all abandoned children in state custody be provided with necessary medical care. A survey should be undertaken immediately to identify children awaiting surgery to correct cleft palates, heart defects and other problems that threaten a child's survival. These children should be provided with the prescribed services as soon as possible.

On reforming the management and treatment of orphans

· All staff at baby houses, children's homes and psychoneurological internaty should undertake a course of formal training. The course must impress upon all employees that the protection of the children's well-being is of utmost importance and that babies require visual, auditory and tactile stimulation at from the earliest moment possible;

· Develop, with the cooperation of the U.N. Children’s Fund (UNICEF) and the World Health Organization (WHO), new training programs for child-care workers which will incorporate the experience and research findings from various countries. These should demonstrate the critical importance of individual attention and sensory stimulation for infants from their earliest days, in order to enable normal intellectual development;

· Encourage existing independent efforts to provide foster care in families, and pursue a policy for the gradual deinstitutionalization of orphans. But given the alarming rates of widely reported domestic violence in Russia, and the potential for misappropriation of large-scale subsidies, the Russian authorities must proceed with extreme care to develop strict screening and monitoring criteria before launching a national program of foster care and domestic adoption;

· Undertake a comparative analysis of the costs of institutional care versus subsidized home care for families who abandon children for reasons of economic hardship. The authorities must make the maximum effort to discourage poor families from leaving their children in state care, which some experts calculate to be at least twice as expensive as subsidizing the child's care at home;

· Undertake a similar analysis of the relative cost of institutional care and subsidized home care for children with congenital conditions such as Down syndrome, cerebral palsy, and other disabilities. The Health Ministry in particular must immediately cease to advise families to abandon their children in the maternity ward, and instead enable them to raise them at home with the help of re-allocated state funds;

· In the meantime, ensure that adequate salaries are offered to orphanage staff, who should be recruited carefully for their professional competence, integrity, and respect for children's dignity; and

· All institutions for abandoned children or children with disabilities should be required to provide access to their financial records, budget, and staffing data to any member of the public upon request. Ministerial budgets for such institutions, including amounts allocated per institution and per child for housing, medical care, food, and clothing should likewise be public records available on demand.

To the United Nations

· The U.N. Committee on the Rights of the Child and UNICEF should strongly urge the Russian government to begin the process of gradually closing the psychoneurological internaty in favor of alternative models such as family sized foster care and adoption;

· The U.N. Committee on the Rights of the Child should investigate conditions in the institutions for Russian orphans run by the Ministries of Health, Labor and Education. This delegation should concentrate on egregious violations of the CRC, including the extreme deprivation of orphans labeled oligophrenic as infants; the denial of corrective surgery to orphans labeled oligophrenic; and cases of misdiagnosis at the age of four which have resulted in the denial of education to tens of thousands of orphans;

· The U.N. Special Rapporteur on Torture should investigate conditions in Russian institutions, including those run by the Education Ministry for children from five to seventeen years old. Various forms of inhuman and degrading treatment and punishment should be investigated, including excessive use of isolation, restraints, sedatives, and psychiatric hospital stays for children who attempt to run away from the orphanage. For older children, the U.N. SpecialRapporteur should place high priority on investigating patterns of punishment-by-proxy: physical and psychological abuse committed by directors and staff through the instigation of favored children against other ones;

· UNICEF and the U.N. Committee on the Rights of the Child should assist the government to develop its campaign to dispel widespread prejudice and ignorance about abandoned children and children with disabilities; and

· UNICEF should develop an information campaign to inform children in state orphanages about the few emergency "hot lines" available for children in some Russian regions.

To the Council of Europe

· The Parliamentary Assembly should appoint a rapporteur or instruct rapporteurs for the Monitoring Committee to investigate conditions in the institutions for Russian orphans.

· The Committee for the Prevention of Torture should investigate conditions in institutions for Russian orphans. Various forms of inhuman and degrading treatment and punishment should be investigated, including excessive use of isolation, restraints, sedatives, and psychiatric hospital stays for children who attempt to run away from the orphanage. For older children, the Committee should place high priority on investigating patterns of punishment-by-proxy: physical and psychological abuse committed by directors and staff through the instigation of favored children against other ones.

To Donor Governments

· Use all available influence to urge the Russian authorities to undertake an immediate investigation into the violations of children's rights in state-run orphanages and to bring offenders to justice;

· Earmark funds for training of various categories of staff for baby houses, psychoneurological internaty and institutions for "educable" children. Projects should include supporting professionals from selected countries with humane child welfare systems to spend several months as resident trainers in Russian institutions;

· Earmark funds to support the work of existing independent treatment centers for children with disabilities, which provide alternative "second opinion"diagnoses and daytime rehabilitation which enables parents to raise their children at home;

· Earmark funds for independent Russian NGOs to work with the government in launching a nationwide public education program to disseminate the U.N. Convention on the Rights of the Child and U.N. standards for persons with disabilities and mental retardation. This program should highlight the equal rights of children who are abandoned and those with disabilities;

· Earmark funds for independent Russian NGOs working in the field of child welfare and children's rights to assist orphans in filing grievances; and

· Establish a strict independent oversight mechanism for monitoring and auditing disbursement of all donated funds to ensure their intended use.

To Nongovernmental Organizations

· Nongovernmental organizations that provide assistance to Russia, including humanitarian groups and adoption agencies, should press for an end to ill-treatment and discrimination against abandoned and orphaned children and for transparency in the management of children’s institutions.

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