IRCT Input to Committee on the Rights of the Child’sGeneral Comment on Article24 CRC

6 January 2012

The International Rehabilitation Council for Torture Victims ("IRCT") welcomes the development of a General Comment on the right of the child to the enjoyment of the highest attainable standard of health (Article 24) of the Convention on the Rights of the Child (CRC).This represents an important step towards full recognition of the right to health and its underlying determinants.

The IRCT submits the following comments in an effort to enhance the General Comment, particularly in areas in which the IRCT has specialised expertise and experience, i.e. the rehabilitation of children being victims of torture and other cruel, inhuman or degrading treatment or punishment (CIDT). We thank the Committee for the opportunity to participate in the process.

The realisation of children’s right to health is directly related to the prevention of physical and psychological harm to the child in the first place and to the health responses to those violations. One of the most severe forms of violence is torture and CIDT as enshrined in Article 37 CRC. Both torture and CIDT have a severe and irreversible impact on the (mental) health and future well-being of a child. This is in particular because children are in a developmental stage of their lives and have not yet developed coping skills comparable to the coping skills of adults. Here the threshold of pain and suffering in particular marks out the difference between adults and children. It is commonly held that the special vulnerability of children renders them more susceptible to the physical and psychological effects of torture.Younger children, in particular, have a lower threshold of pain; and physical or mental abuse may have a much more profound impact on the body and mind of a developing child than on an adult[1].

The IRCT is a health-based umbrella organisation that supports the rehabilitation of torture victims and the prevention of torture worldwide. Our membership comprises more than 140 rehabilitation centres in more than 70 countries. A number of our member centres also provide specialised health support and holistic rehabilitation to children. Securing the (mental) health needs and protection of children has been a priority issue for the IRCT since 2007.Most recent activities are aspecial issue of Torture Journal focussing only on children and torture and cruel and inhuman or degrading treatment or punishment[2]. Moreover, in 2011 the IRCT project “Untold Stories” documented the findings of four (short-term) fact-finding missions to Nepal, Philippines, Sri Lanka and Indonesia.Although thesefour countries visited have ratified the CRC, during the missions we identified a lack of protection of children against acts of torture and CIDT, as well as inadequate health care systemsto address the needs after such horrendous acts.

On the basis of these four missions as well as other studies1[3],[4],[5],[6],[7]the IRCT raises a serious concern that in general health needs of children victims of torture and CIDT are not being addressed appropriately. This includes the rights of children to proper health care and holistic rehabilitation, including physical and psychological health support, but also other measures such as social, legal, vocational and needs to be further elaborated within the framework of this General Comment.

Despite the absolute prohibition of torture, it is still practiced around the world. To our knowledge torture and CIDT against children most often happens in police lock-ups, closed institutions including child care homes, places of detention as well as in the administration of justice (pre-trial detention). For this reason, there is an urgent need to focus on children’s right to health when they are placed in institutional settingsdeprivingthem of their liberty. In these places there should be access to child appropriate health care services, including independent forensic health care. This in order to prevent torture and CIDT and to hold perpetrators accountable. Whenever children have been exposed to torture and CIDT orthe conditions in places of detention amount to CIDT,the State should provide them with holistic rehabilitation.

The former Special Rapporteur on Torture, Manfred Nowak estimated that more than one million children are currently deprived of their liberty and held in police stations, pre-trial facilities, prisons, closed children homes and similar places of detention[8]. The UN study on violence against children from 2006 identified several settings in which violence against children is taking place including in institutional settings, which doamount to torture and CIDT[9]. Further studies show that torture and CIDT in children is widespread in many parts of the world and hidden from the eyes of the general public[10],[11].

Therefore a major aspect in ensuring the right of children to enjoy the highest attainable standard of health is to prevent health hazards, including torture and CIDT in closed institutions as well as places ofdetention, and to provide appropriate health support to children victims of torture.

(1) The basic premises for the realisation of children’s right to health

The realisation of children’s right to health is closely related to premises outlined in the general comment on the right of the child to freedom from all forms of violence[12]. A fundamental premise for the realisation of children’s right to health is to address the widespread and intense violence applied against children in State institutions and by State actors including in schools, care centres, residential homes, police custody and justice institutions, which may amount to torture and killing of children, as well as violence against children frequently used by armed groups and state military forces[13]. InstitutionalStateviolence against children amounts to torture and CIDT. Thus, the realisation of children’s right to health is interlinked to Articles 37, 39 and 40 of the CRC.

In particular, as a basic premise to ensure children’s health, the deprivation of a child’s liberty shall be used only as a measure of last resort and for the shortest period of time, in order to minimize the risk of torture and CIDT and the related heath consequences.

If, however, children have been deprived of their liberty,their rights to human dignity, physical and psychological integrity and to equal protection under the law,and all other international and regional human rights instruments should be respected. With regard to ensuring that the right to health is respected in a setting where torture potentially happens to children, basic structures need to be in place to screen and document any physical and psychological damages and to provide appropriate health care and rehabilitation.

In cases where torture of children is alleged, they should be immediately examined by forensic health professionals in order to document the violation and to provide appropriate care and redress to the children. An internationally recognized tool for this is the Manual on Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, commonly known as the Istanbul Protocol[14].

Moreover, children who have been victims of torture or ill-treatment should have access to immediate health care in detention and to holistic rehabilitation. Regarding the definition of holistic rehabilitation,the IRCTwould like to draw the Committee’s attention to the ongoing drafting process of the Committee against Torture’s General Comment on Article 14 of the Convention against Torture[15]. Here we would like the Committee to consider inserting a paragraph into this General Comment with a clear definition of holistic rehabilitation along the lines of the below:

All children victims of torture or CIDT should be provided means for as full rehabilitation as possible. I.e.a child who has suffered harm as a result of a violation of the Convention (Art 37) should have full and immediate accessto multi-disciplinary child specific holistic rehabilitation services that include any necessary combination of medical and psychological care as well as legal, social, communal, vocational, educational services, and (interim) economic support. Rehabilitation, for the purposes of this General Comment, refers to the restoration of function or the acquisition of new skills required by the changed circumstances of a child victim in the aftermath of torture or ill-treatment. It seeks to enable the maximum possible self-sufficiency and function for the individual concerned, including full physical, mental, social and vocational ability, full inclusion and participation in all aspects of life, and may involve adjustments to the person’s physical and social environment.

(2) How can the principles of the CRC, in particular articles 2, 3, 6 and 12, be applied to designing, implementing and monitoring interventions to address child and adolescent health challenges and what aspects are specific to a child’s rights approach to health?

Article 39 CRC

The realisation of children’s right to health is closely linked to Article 39 of the CRC that stipulates children’s right to physical and psychological recovery and social reintegration of a child victim of any form of neglect, exploitation, or abuse; torture or any other form of cruel, inhuman or degrading treatment or punishment; or armed conflicts.

In order to promote the implementation of the premise that such recovery and re-integration shall take place in an environment which fosters the health, self-respect and dignity of the child States parties should ensure immediate access for children to proper health care and rehabilitation services in child care institutions and other forms of detention or protection facilities for children. Within the framework of this General Comment, the IRCT would like to emphasize that also for children “as full rehabilitation as possible” should be aimed for and this should be seen from a victim’s and not a State perspective. This means that the degree of recovery by the victim cannot be made subject to available resources with the State but only to the rehabilitation needs of the victim.

Article 37 as well as 3, 6, 12 CRC

In order to implement the premises of articles 37 as well as 3, 6, 12 of the CRC, States parties should, in the context of the administration of justice (pre-trial detention, police lock ups and other detention facilities) and state care institutions:

  • Ensure that children, whenever they are referred to or transferred between places of deprivation of liberty, including police custody, pre-trial detention orany other form of detention facilities or state care institutions such as child care homes (including state accredited NGOs), are examined by a forensic health expert or skilled health professional with specific knowledge of child appropriate methods of (mental) health examination[16], as soon as possible after admission. The interview/examination should as a minimum be carried out on the day of admission.
  • Whenever there are physical or mental health signs or symptoms of violence, torture or CIDT, the health professional should document these and refer without any delay to an independent forensic health specialist;
  • Ensure the monitoring of these institutions, which, as per interpretation of the SPT[17], concerns places of (immigration) detention, including less traditional places, such as, but not limited to, social care homes, psychiatric hospitals and centres for children;
  • Ensure that whenever children are held in detention, they are separated from adults and taken care of by professionals who have been specifically trained to create a child supportive environment;
  • Ensure children’s access to child appropriate health care services including psychological, physical, religious and social and educational assistance;
  • Ensure the provision of a safe and supportive institutional environment that ensures all the underlying determinants of health[18].

(3) What is the normative content of Article 24? What are the specific obligations of States under Article 24? What are the responsibilities of non-state actors under Article 24?

The right to children’s health shouldbe in line with the extensive elaboration of the right to health in General Comment 14 of the Committee on Economic, Social and Cultural Rights. State should ensure that children who are being deprived of their liberty have equal access to all health care servicesthat are available in the society. Moreover, as children in closed institutions might have special (mental) health needs, these special needs shall be addressed appropriately.

The obligations of the State to protect include inter alia the duties of States to adopt legislation or to take other measures:

  • to ensure children’s access to (mental) health care and holistic rehabilitation services provided by third parties;
  • toensure that children are examined by medical practitioners and other health professionals that meet appropriate standards of education and training,including on handling children, as soon as possible after admission. The interview/examination should as a minimum be carried out on the day of admission.
  • to ensure forensic examination and documentation according to the standards of the Istanbul Protocol in possible cases of torture and CIDT;
  • to ensure the monitoring by an independent body of all closed institutions in which children are being deprived of their liberty.

(4) What are the priority concerns in general and in particular regions of the world for the implementation of article 24?

Although the IRCT recognizes there are other concerns within the scope of this article, we wish to suggest that the Committee introduce an additional section (e.g as section VII. 9 in the proposed structure of the General Comment) to state the urgency to address the health needs of children deprived of their liberty/in closed institutions and subjected to torture and CIDT.

(5) Which concrete measures should be put in place to implement Article 24?

Health care in detention and rehabilitation services of tortured children

Tortured children should have access to immediate health care in detention and rehabilitation support. With regard to the provision of rehabilitation measures for children that have been subjected to torture, the IRCT recommends the following criteria:

A. Appropriateness of services

Rehabilitation services for torture victims must be able to effectively address their clinical and holistic rehabilitative needs and, where relevant, the needs of their families. Services must be respectful of medical and other professional codes of ethics and be culturally appropriate. They should be scientifically and medically appropriate and of good quality. This requires the State to promote evidence-based treatment methods that are continuously monitored and evaluated through objective outcome assessment tools.

B. Accessibility of rehabilitation services

Rehabilitation services must be practically accessible to torture victims. This entails physical, economic and information accessibility, a non-discrimination requirement, a promptness and capacity requirement, removing legal status barriers as well as special attention to vulnerable groups and populations. In the experience of the IRCT, victims of torture are more likely to access rehabilitation services if these services enjoy a status and perception as independent either within or outside State structures.

C. Safety and personal integrity

Torture victims must be able to access rehabilitation services without fear for their or their family’s safety and personal integrity. This includes protection against reprisals or repeated torture or ill-treatment; a strict non-discrimination approach; and insurance that there will be no breach of confidentiality by the rehabilitation service providers regardless of their professional ethical obligations.

Documentation and monitoring of cases of torture and CIDT committed against children

Few cases of torture and cruel and inhuman or degrading treatment or punishment against children are documented. The issue is largely hidden in both international and national agendas. Additionally, monitoring of State-run institutions (including institutions run by NGOs accredited by States) are poor or non-existing. In order to prevent health risks, there is an urgent need to call upon states to implement proper documentation and monitoring mechanisms of cases of tortured children, and of the conditions in child care homes and other forms of institutions where children are deprived of their liberty.

Documentation of tortured children is often blurred by a lack of distinction between child abuse and child torture. In order to properly document both issues, there is a need for training professionals working with children exposed to these two types of violations in the differentiation between child abuse and child torture as outlined by UNICEF[19].

Complaints mechanisms for children deprived of their liberty

Children and their families often lack an opportunity to file a complaint or raising their voice when exposed to torture and CIDT when deprived of their liberty and in the custody of State care institutions or detention facilities. At the same time, children in institutional settings are at high risk of being exposed to health risks. In order to prevent violations of the right to health in these settings, States parties should ensure independent complaint mechanisms for children placed in institutional settings.

For further questions please contact:

Miriam Reventlow,

Line Baagø-Rasmussen,

Joost den Otter,

International Rehabilitation Council for Torture Victims

Borgergade 13, P.O. Box 9049, DK-1022 Copenhagen K, Denmark

Tel +45 33 76 06 00 | Fax +45 33 76 05 00 | |

1/5

[1]Amnesty International. Hidden scandal, secret shame. Torture and ill-treatment of children. London: 2000.

[2]Torture: Journal on Rehabiliation of Torture Victims and Prevention of Torture. Thematic issue on children and torture, Volume 19, no.2, 2009.

[3] UN General assembly A/61/299 Sixty-first session Item 62 (a) of the provisional agenda. Promotion and protection of the rights of children (see

[4]Quiroga, José: “Torture in Children” pp. 66-87 in Torture, Vol. 19, no. 2, 2009

[5]Dan O’Donnel and Norberto Liwski: “Child Victims of Torture and Cruel, Inhuman or Degrading Treatment”, Innocenti Working Paper, UNICEF, June 2010

[6] United Nations Secretary-General’s Study on Violence Against Children [United Nations]. (2006). World report on violence against children. Geneva. Available:

[7]Secretary General’s study on violence against children, United Nations, 2006.

[8]Interim report of the Special Rapporteur on torture and

other cruel, inhuman or degrading treatment or punishmentA/64/215 2009

[9] Secretary General’s study on violence against children, United Nations, 2006.

[10] Quiroga, José: “Torture in Children” pp. 66-87 in Torture, Vol. 19, no. 2, 2009.