HUMAN RIGHTS WATCH Publications DEATH BY DEFAULT A Policy of Fatal Neglect in China’s State Orphanages January 1996, ISBN 1-56432-163-0 SUMMARY | RECOMMENDATIONS | TABLE OF CONTENTS SUMMARY “States Parties recognize that every child has the inherent right to life...” “A physician shall owe his patient complete loyalty and all the resources of his science.” “Sie ruh’n, sie ruh’n, als wie in der Mutter Haus” (“They rest, they rest, as if in their mother’s house”) I. SUMMARY AND RECOMMENDATIONS China’s Orphans and Human Rights In response to widespread criticism of its human rights record, the Chinese government has frequently argued that the international community places too much emphasis on civil and political rights, while neglecting the more basic rights to food, shelter, and subsistence rights which China claims to have secured for its citizens more effectively than some democratic countries. In accordance with the country’s post-1949 political tradition, China’s leaders assert that economic well-being forms the basis for the enjoyment of all other rights, and that the protection of economic rights can therefore justify restrictions on civil liberties. In some important respects, China’s record in protecting social and economic rights may serve as a model for the rest of the developing world. Levels of well-being, as measured by social indicators such as literacy and life expectancy, are considerably higher in China than in other countries at comparable stages of development, and in some cases higher than those in much wealthier nations. But China’s claim to guarantee the “right to subsistence” conceals a secret world of starvation, disease, and unnatural death a world into which thousands of Chinese citizens disappear each year. The victims are neither the political activists nor the religious dissidents who dominate the international debate over human rights in the People’s Republic; they are orphans and abandoned children in custodial institutions run by China’s Ministry of Civil Affairs. This report documents the pattern of cruelty, abuse, and malign neglect which has dominated child welfare work in China since the early 1950s, and which now constitutes one of the country’s gravest human rights problems. Human Rights Watch/Asia has now pieced together at least a fragmentary picture of conditions for abandoned children throughout China, including staggering mortality rates for infants in state institutions and the persistent failure of official statistics to track the vast majority of orphans, whose whereabouts and status are unknown The evidence largely official documents cited in detail below indicates that the likelihood of survival beyond one year, for a newly admitted orphan in China’s welfare institutions nationwide, was less than 50 percent in 1989. The documents also show that overall annual mortality at many of China’s orphanages is far higher than that documented in any other country. In Romania in December 1989, for example, when foreigners first visited the grim state orphanages housing abandoned and handicapped children and were outraged by what they found there, a representative of the France-based humanitarian group Medecins du Monde stated that the 1989 death rate from infectious disease and neglect was 40 percent, in one home that was particularly abusive. In the Chinese provinces of Fujian, Shaanxi, Guangxi and Henan, overall annual mortality among institutionalized orphans that year ranged from 59.2 percent to 72.5 percent. When sustained over an extended period, moreover, any of the above annual rates means far higher actual mortality. We estimate that in China’s best-known and most prestigious orphanage, the Shanghai Children’s Welfare Institute, total mortality in the late 1980s and early 1990s was probably running as high as 90 percent; even official figures put the annual deaths-to-admissions ratio at an appalling 77.6 percent in 1991, and partial figures indicate an increase in 1992. Neither institutional welfare policy nor the size of the orphanage system have changed notably since then, while the crisis of abandoned children continues unabated, due in part to China’s one-child policy. In the case of Shanghai, there have been cosmetic improvements at the orphanage itself since 1993, designed to encourage foreign adoption, but there is evidence that many disabled infants and children are now simply transferred to a facility outside the city, where access for outsiders is extremely rare and where, according to numerous reports received by Human Rights Watch/Asia, the children are grossly mistreated. Unlike their Romanian counterparts, the management and staff of China’s orphanages cannot claim that their shortcomings result from a lack of funding or from inadequately paid employees. Dispelling a misconception reflected in nearly all Western media coverage of the issue to date, Human Rights Watch/Asia’s research confirms that many Chinese orphanages, including some recording death rates among the worst in the country, appear to enjoy more than sufficient budgets, including adequate wages, bonuses, and other personnel-related costs. Expenses for children’s food, clothing, and other necessities, however, are extremely low in institutions throughout the country. The crisis, both nationwide and in Shanghai, is known to the top leadership of China’s Ministry of Civil Affairs. Conditions at the Shanghai orphanage are well known to the local political elite and by members of the Politburo. But the government reaction has been to maintain a facade of normalcy, to punish dissenters who have sought to expose abuses and, in certain crucial cases, to promote those responsible for the abuses. A Nationwide Crisis Abandonment of children surged in China during the 1980s, in part due to the one-child population control policy and in part due to policies restricting adoption by Chinese couples who are not childless. The national statistics on mortality cited in this report do not contain a gender breakdown, but anecdotal and journalistic reporting on orphanages nationwide reveals that the vast majority of children in orphanages are, and consistently have been during the past decade, healthy infant girls; that is, children without serious disabilities who are abandoned because of traditional attitudes that value boy children more highly. The financial and social problems that these children are perceived to constitute are made more acute by the fact that Chinese couples are not permitted to adopt them, for the most part. Reports of inhumane conditions in Chinese orphanages have attracted growing international concern in recent years, prompted chiefly by the country’s greater openness to foreign press coverage and charitable work financed from abroad, as well as a dramatic increase in overseas adoptions from the People’s Republic. Although some scattered allegations have succeeded in bringing to light grave abuses against China’s orphans, there has been virtually no effort to place these charges in context through systematic research on the country’s institutional welfare system. The Chinese government’s own statistics reveal a situation worse than even the most alarming Western media reports have suggested. In 1989, the most recent year for which nationwide figures are available, the majority of abandoned children admitted to China’s orphanages were dying in institutional care. Many institutions, including some in major cities, appeared to be operating as little more than assembly lines for the elimination of unwanted orphans, with an annual turnover of admissions and deaths far exceeding the number of beds available. In any case, the majority of abandoned children in China never reach the dubious security of a state-run orphanage. Many are sent instead to general-purpose state institutions, where they are confined indiscriminately with retarded, disabled, elderly, and mentally disturbed adults. Although the statistical evidence is unclear, the limited eyewitness information available suggests that death rates among children held in these facilities may be even higher than in China’s specialized orphanages. In addition, Chinese official records fail to account for most of the country’s abandoned infants and children, only a small proportion of whom are in any form of acknowledged state care. The most recent figure provided by the government for the country’s orphan population, 100,000 seems implausibly low for a country with a total population of 1.2 billion. Even if it were accurate, however, the whereabouts of the great majority of China’s orphans would still be a complete mystery, leaving crucial questions about the country’s child welfare system unanswered and suggesting that the real scope of the catastrophe that has befallen China’s unwanted children may be far larger than the evidence in this report documents. Evidence From Shanghai In addition to nationwide statistics on the condition of China’s institutionalized children, Human Rights Watch/Asia has recently obtained a large quantity of internal documentation from one of the most prominent specialized orphanages in the country, the Shanghai Children’s Welfare Institute. Based on these documents, which include medical records and other official files recording the deaths of hundreds of children, and on the testimony of direct witnesses who left China in 1995, Human Rights Watch/Asia has concluded that conditions at the Shanghai orphanage before 1993 were comparable to those at some of the worst children’s institutions in China, several of which have already been exposed in journalistic accounts in the West. Since 1993, a program of cosmetic “reforms” has transformed the Shanghai Children’s Welfare Institute into an international showcase for China’s social policies, while an administrative reorganization of the city’s welfare system has largely concealed the continuing abuse of infants and children. Ironically, the Chinese government has praised Shanghai’s municipal orphanage extensively as a national model for the care of abandoned and disabled children. In addition to frequent flattering coverage in China’s official media, the Shanghai Children’s Welfare Institute receives considerable financial support from Chinese and international charities and hosts a steady stream of private and official visitors. Behind the institution’s glossy official image, however, lies a pattern of horrifying abuse. The brutal treatment of orphans in Shanghai, which included deliberate starvation, torture, and sexual assault, continued over a period of many years and led to the unnatural deaths of well over 1,000 children between 1986 and 1992 alone. This campaign of elimination could be kept secret through the complicity of both higher- and lower-level staff, and because the city’s Bureau of Civil Affairs, responsible for the orphanage, also runs the crematoria, where starved children’s corpses were disposed of with minimum oversight, often even before a death certificate had been filled out by the attending physician. In addition, officials of various Shanghai municipal agencies knowingly suppressed evidence of child abuse at the orphanage, persistently ignored the institute’s high monthly death figures, and in 1992, quashed an investigation into orphanage practices. Conditions in the Shanghai orphanage came close to being publicly exposed in the early 1990s as a result of pressure by concerned orphanage employees, local journalists and sympathetic Shanghai officials. By 1993, however, virtually all the critical staff members were forced out of their positions and silenced. The orphanage leadership was assisted in its efforts to cover up the truth by three of the city’s top leaders: Wu Bangguo, Shanghai’s Communist Party secretary; Huang Ju, the city’s mayor; and Xie Lijuan, deputy mayor for health, education, and social welfare. Wu, Huang, and Xie were fully informed of the abuses occurring at the Children’s Welfare Institute, but took no action to halt them or to punish those responsible, acting instead to shield senior management at the orphanage and to prevent news of the abuses from reaching the public. Meanwhile, Wu Bangguo and Huang Ju have risen to positions of national prominence in China’s ruling Politburo. The cosmetic changes at the Shanghai orphanage since 1993 have been engineered by Han Weicheng, its former director. Although he was a major perpetrator of abuses there, Han was promoted to an even more senior position within the municipal welfare bureaucracy. At about the same time, the orphanage was opened to visitors and large numbers of children from the city’s orphanage began to be transferred to another custodial institution, the Shanghai No. 2 Social Welfare Institute. Located on Chongming Island, a remote rural area north of Shanghai, the No. 2 Social Welfare Institute, which is ostensibly a home for severely retarded adults, has been transformed since 1993 into a virtual dumping ground for abandoned infants delivered to the orphanage. While the city government has aggressively promoted the adoption of healthy or mildly disabled orphans by visiting foreigners, reports from visitors to the orphanage in 1995 indicate that infants with more serious handicaps are generally diverted to the Chongming Island institution within weeks or months of their arrival. Human Rights Watch/Asia has not been able to ascertain the mortality rates of children at the No. 2 Social Welfare Institute, but has collected credible reports of severe mistreatment and of staff impunity. Extreme secrecy surrounds the functioning of the Chongming Island institution, raising serious suspicions and fears as to the likely fate of children transferred there. Perversion of Medical Ethics Some Western observers have charged that the phenomenally high death rates among China’s abandoned children result from neglect and lack of medical training on the part of orphanage employees. Anecdotal evidence from foreign charity workers and adoptive parents has painted a grim picture of decrepit and poorly financed institutions run by demoralized and unskilled nursing staff. However, medical records and testimony obtained by Human Rights Watch/Asia show that deaths at the Shanghai orphanage were in many cases deliberate and cruel. Child-care workers reportedly selected unwanted infants and children for death by intentional deprivation of food and water a process known among the workers as the “summary resolution” of childrens’ alleged medical problems. When an orphan chosen in this manner was visibly on the point of death from starvation or medical neglect, orphanage doctors were then asked to perform medical “consultations” which served as a ritual marking the child for subsequent termination of care, nutrition, and other life-saving intervention. Deaths from acute malnutrition were then, in many cases, falsely recorded as having resulted from other causes, often entirely spurious or irrelevant conditions such as “mental deficiency” and “cleft palate.” The vast majority of children’s deaths recorded at the Shanghai orphanage thus resulted not from lack of access to medical care but from something far more sinister: an apparently systematic program of child elimination in which senior medical staff played a central role. By making unfounded diagnoses of mental retardation and other disorders, these doctors have helped to disseminate the widespread belief which appears to be quite inaccurate that virtually all of China’s abandoned children are physically or mentally handicapped. Worse, the Shanghai orphanage’s medical staff then used these supposed disabilities as a justification for eliminating unwanted infants through starvation and medical neglect. Such unconscionable behavior by doctors in China’s most advanced and cosmopolitan city points to an ethical crisis of immense proportions in the country’s medical profession. This corruption of medical ethics reflects broader trends in Chinese law and health policy, including recent debates in the National People’s Congress, the country’s nominal legislature, on legalizing euthanasia for the incapacitated elderly. Official press reports indicate that the Chinese government may also have given serious consideration to allowing euthanasia for handicapped children, but has declined to do so for fear of the international repercussions. The medical evidence suggests, however, that just such pseudo-eugenic practices may have been carried out at the Shanghai Children’s Welfare Institute. At the very least, the city’s abandoned infants, even when not genuinely disabled, became the victims of a policy of deliberate and fatal neglect resulting in their wholesale death by default. Reports from the Shanghai orphanage also indicate that medical staff there misused their authority in other ways. In several cases, children who were accused of misbehavior or were in a position to expose abuses at the orphanage were falsely diagnosed as “mentally ill” and transferred to psychiatric hospitals against their will; in one case, a teenage girl named Chou Hui was imprisoned for four months to prevent her from testifying that she had been raped by orphanage director Han Weicheng. Many other children were given powerful drugs without any apparent medical justification, in order to control their behavior. Human Rights Watch/Asia calls on the leaders of the Chinese medical profession to denounce these gross ethical violations and to take urgent steps to improve standards of medical ethics in China. RECOMMENDATIONS The Need for a Worldwide Response The enormous loss of life occurring in China’s orphanages and other children’s institutions calls for immediate action by the international community. The United Nations and its specialized agencies must take the lead in investigating conditions in China’s child welfare system and in bringing these abuses to an end. Governments throughout the world must make the treatment of China’s abandoned children one of their highest priorities as they continue to press for improvements in the country’s human rights record. The People’s Republic of China ratified the United Nations Convention on the Rights of the Child in December 1991, and submitted its first implementation report to the U.N. Committee on the Rights of the Child in 1994. The Chinese government has thus submitted itself voluntarily to international monitoring on the treatment of its minor citizens. Nevertheless, the evidence compiled in this report shows that China’s policies towards abandoned infants and children are in clear violation of many articles of the convention. Human Rights Watch/Asia urges the Committee on the Rights of the Child to place conditions in the Chinese child welfare system at the top of its agenda for the coming year. Specialized agencies working on children’s issues in China, such as the United Nations Children’s Fund (UNICEF) and the World Health Organization, should also make a thorough reform of the country’s orphanage system their highest priority. We further call for an immediate investigation into abuses against institutionalized children in China by the Special Rapporteur on Extrajudicial Executions, who investigates patterns of deliberate state action resulting in death. Action by the United Nations and its agencies must be accompanied by a strong response from national governments. Bilateral pressure on China to ensure the rights of abandoned infants and children should be given at least as high a priority as demands to free political and religious detainees or to end torture and ill-treatment in the country’s prisons. Protecting the lives of China’s orphans must remain at the top of the agenda in any future human rights dialogue with the Chinese authorities. Despite the Chinese government’s generally hostile attitude towards Western human rights organizations, Human Rights Watch/Asia believes that many government and Communist Party officials will recognize the need for immediate action to resolve this humanitarian crisis. Other branches of the Chinese government must hold the Ministry of Civil Affairs and its officials fully accountable for the atrocities being committed against China’s orphans. Human Rights Watch/Asia calls on the authorities to take immediate steps to bring an end to these abuses and offers its full cooperation to the Chinese authorities in formulating the necessary reforms. A list of the organization’s recommendations follows. Ending Impunity in Shanghai Most Chinese citizens familiar only with official media reports on the Shanghai Children’s Welfare Institute accept the authorities’ claim that conditions for the city’s orphans are exemplary. This report shows that the fate of most abandoned children in Shanghai is, in fact, much the same as elsewhere in China. Until 1993, the majority of infants brought to the institute died there within a few months of arrival, and the minority who survived to older childhood were subject to brutal abuse and neglect. Indeed, the only genuinely unique feature of the Shanghai orphanage appears to be its success since 1993 at generating revenue for the municipal Civil Affairs Bureau. The city’s newly reorganized child welfare system now presents the municipal orphanage as its acceptable public face, serving as an advertisement for both charitable giving and profitable foreign adoptions, and a ban on negative media coverage of the Children’s Welfare Institute has been in force since 1992. Human Rights Watch/Asia believes that the spectacular financial success of the Shanghai policies is the real motive behind official praise of the city’s child welfare system as a national model. We fear that efforts to duplicate the Shanghai experience elsewhere in China are likely to further worsen conditions for the country’s abandoned children, and to strengthen the vested interest of the Ministry of Civil Affairs in obstructing genuine reforms. Any attempt to improve the treatment of Chinese orphans must therefore begin by reopening the official investigation into misconduct within the Shanghai Civil Affairs Bureau, launched in 1991 and abruptly terminated the following year. Above all, such an inquiry would seek the widest possible publicity for any evidence of wrongdoing uncovered and would pursue appropriate legal sanctions against bureau employees found responsible for abusing children and causing avoidable deaths. Such an inquiry will confront the fact that a number of people associated directly or indirectly with abuses at the Shanghai orphanage continue to hold positions of authority, and many have since been promoted or otherwise risen in status. The beneficiaries of this apparent impunity range from ordinary staff members such as the child-care worker Xu Shanzhen, certified as a “model worker” in early 1995 despite her brutal abuse of a retarded child, to the former Communist Party secretary of Shanghai, Wu Bangguo, who reportedly ordered media coverage of the scandal suppressed and has since been appointed vice-premier of China. However, these obstacles make it all the more imperative that swift action be taken at the most senior levels to break the cycle of impunity. Human Rights Watch/Asia urges the Chinese authorities to take the following immediate steps:
Public Accountability Despite the urgent need to resolve these outstanding problems in Shanghai, the above measures represent only the first stage of what should be a nationwide campaign to improve conditions for children in China’s welfare institutes. A critical factor in the success of any such effort will be the Chinese government’s willingness to expose these institutions to intensive public scrutiny, not only from concerned foreigners but, even more importantly, from China’s own citizens. The deceptive policy of “openness” introduced by the Shanghai Children’s Welfare Institute in 1993 must be replaced by genuine transparency in order to prevent future abuses from going undetected. Human Rights Watch/Asia believes the following measures are likely to produce immediate and substantial improvements in the quality of care for children in state custody, even without fundamental reforms in management and law:
Management Reforms Although the steps outlined above are likely to bring about a sharp reduction in some of the worst abuses within the child welfare system, basic changes in institutional management are equally important in order to guarantee that these initial improvements last. These include administrative measures to strengthen the outside monitoring of children’s treatment, as well as improvements in the selection, training and discipline of institute staff. Human Rights Watch/Asia recommends that the Chinese authorities undertake the following reforms:
Legislative Reforms The phenomenon of child abandonment is not unique to China, and many of the factors which lead parents to abandon their children are beyond the government’s power to remedy, at least in the short term. Rural poverty, prejudice against the disabled, traditional attitudes towards female children, and the pressures generated by the country’s stringent population policy all contribute to the problem. It must be stressed, however, that whatever the reasons for the orphanhood or abandonment, once such children are accepted into state care, the government has an unshirkable duty to provide them with adequate care and protection. For the foreseeable future, China will need to maintain a system of state-run foster care for some orphans, particularly the severely disabled. However, Human Rights Watch/Asia believes that relatively minor legislative changes would enable most children now living in welfare institutions to be placed for adoption with Chinese families. An effective domestic adoption program would eliminate the need for institutional care for virtually all of China’s abandoned children. Human Rights Watch/Asia urges the Chinese authorities to take the following steps:
TABLE OF CONTENTS
A Nationwide Crisis Evidence From Shanghai Perversion of Medical Ethics The Need For A Worldwide Response Ending Impunity in Shanghai Public Accountability Management Reforms Legislative Reforms II. SOCIAL WELFARE IN MODERN CHINA
The Dual Function of the Civil Affairs Authorities The Elite Priority: “Preferential Care” and “Settlement”
The Reforms of 1956-1957: “Segregated Management” The Great Leap Forward: Hubris and Collapse The Early 1960s: From Utopianism to Tokenism The Cultural Revolution: “Obstruction and Sabotage” The Era of Reform: “Self-Payment” and “Socialization”
Guangxi Zhuang Autonomous Region III. CHINA’S ORPHANS: THE OFFICIAL RECORD
Urban “Child Welfare Institutes”: Death Camps For Orphans
Preferential Care Death Rates: Exclusion of Infants Missing Orphans In the 1990s Chinese Adoption Policy IV. UNNATURAL DEATHS AT THE SHANGHAI ORPHANAGE
Mortality Statistics, 1960 92 An Outline of the Attritional Process
“Summary Resolution” and “Consultation” Medical Staff and Standards of Treatment Epidemiologic Aspects
Documentation of Deaths
List of 207 Infant and Child Deaths (1992) V. ABUSE AND ILL-TREATMENT AT THE SHANGHAI ORPHANAGE: 1988-1993
Tying of Children’s Limbs Improper Medication Beatings, Torture, and Physical Abuse by Staff: Yue Yi; Hong Na; Liang Jie; Wu Lanyin; Lu Yi Rape and Sexual Abuse by Staff: Fu Qing; Xiang Wen; Wang Guang Lack of Medical Care and Medical Negligence: Huo Zhen; Gan Rui; Wei Zhi; Zhang Yansong Use of Forced Child Labor Illegal Detention: Ai Ming; Zhu Yan
Qiu Zhen Qin Gaoming VI. THE COVER-UP IN SHANGHAI
Appeals to Higher Authority, August 1990-December 1991 The Authorities Strike Back, December 1991-March 1992 The Investigation Collapses, March-August 1992 Aftermath, August 1992-1994 VII. DEVELOPMENTS IN SHANGHAI, 1993-1995
Eyewitness Accounts from 1995
Eyewitness Accounts from 1995 APPENDICES TABLES
3.2 Distribution of Minors in Ministry of Civil Affairs Institutions, Year-End 1993 3.3 Official Population Statistics on China’s Child Welfare Institutes, 1989 3.4 Death Rates in China’s Child Welfare Institutes, 1989 3.5 Staffing Ratios in China’s Child Welfare Institutes, Year-End 1989 3.6 Expenditure on Personnel in China’s Child Welfare Institutes, 1989 92 3.7 Children’s Living Expenses in China’s Child Welfare Institutes, 1989 92 3.8 “Respecting-the-Aged Homes” in China, Year-End 1993 4.1 Deaths at the Shanghai Children’s Welfare Institute, 1960 64 and 1978 91 4.2 Breakdown of 1989 and 1992 Cases of Infant and Child Death by Recorded Cause 4.3 Summary of Twelve Cases 4.4 Official List of 153 Infant and Child Deaths at the Shanghai Children’s Welfare Institute, December 1988 December 1989 4.5 Medical Condition of All New Admissions to the Shanghai Children’s Welfare Institute, January February 1992 4.6 List of 207 Infant and Child Deaths at the Shanghai Children’s Welfare Institute, November 1991 October 1992 Human Rights Watch January 1996 ISBN 1-56432-163-0 To order the full text of this report click HERE. For more Human Rights Watch reports on China click HERE. To return to the list of 1996 publications click HERE. Or, to return to the index of Human Rights Watch reports click HERE. 
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