Children who live with a physical, sensory, intellectual or mental health disability are among the most stigmatized and marginalized
of all the world’s children. While all children are at risk of being victims of violence, disabled children find themselves at
significantly increased risk because of stigma, negative traditional beliefs and ignorance.  Lack of social support, limited
opportunities for education, employment or participation in the community further isolates disabled children and their families,
leading to increased levels of stress and hardship.  Disabled children are also often targeted by abusers, who see them as easy
victims.  

This report presents the findings of the Thematic Group on Violence against Disabled Children, convened by UNICEF at UN
Headquarters in New York providing comments and recommendations on violence against disabled children to be made available
for the UN Secretary General’s Report on Violence against Children.  In this report, key issues on violence against children with
disabilities will be reviewed.  Some of the issues raised will be familiar to those who work on violence against children.  Other
issues will be disability-specific and even experts and advocates on violence against children may be unfamiliar with them or have
not thought deeply about the implications that such practices have in relation to violence against and abuse of disabled children.

It is important to note that the factors that place disabled children at increased risk for abuse are often related to social, cultural
and economic issues, and not to the actual disability itself.  As such, interventions that address violence and abuse against disabled
children can and should be effective if implemented with concern and resolve.

It should be noted at the outset that:
•        The number of children and adolescents with disability are significant. While calculations vary depending on the specific
definition of disability, using the World Health Organization’s definition of individuals with a disability as individuals having a
physical, sensory (deafness, blindness), intellectual or mental health impairment, some 200 million children -  10% of the world’s
young people – are born with a disability or become disabled before age 19.
•        Disabled children must be included in all programs intended to end violence towards and abuse of children.  Disabled
children cannot wait until issues of violence and abuse are fully addressed in non-disabled children.  The reasons for this are two-
fold:  1) the lives of disabled children are no less valuable than the lives of all other children and the short- and long-term
consequences of violence and abuse for them are no less severe; and 2) violence against children as a global problem will not be
solved unless violence against the world’s million of disabled children is included as part of the overall solution.

Background

According to researchers, children with physical, sensory, intellectual or mental health impairment are at increased risk of
becoming victims of violence.  While the amount of research available on this population is extremely limited, particularly for
disabled children in the developing world, current research indicates that violence against disabled children occurs at annual rates
at least 1.7 times greater than their non-disabled peers. (1)  More targeted studies also indicate reasons for serious concern.  For
example, one group of researchers report that 90% of individuals with intellectual impairments will experience sexual abuse at
some point in the life, and a national survey of deaf adults in Norway found 80% of all deaf individuals surveyed report sexual
abuse at some point in their childhood.

The specific type and amount of violence against disabled children will vary depending upon whether it occurs within the family,
in the community, in institutional settings or in the work place.(4) There are however, several key issues that appear time and
again when such violence occurs.  Most striking is the issue of reoccurring stigma and prejudice. Throughout history many –
although not all – societies have dealt poorly with disability.  Cultural, religious and popular social beliefs often assume that a child
is born with a disability or becomes disabled after birth as the result of a curse, ‘bad blood’, an incestuous relationships, a sin
committed in a previous incarnation or a sin committed by that child’s parents or other family members.

A child born in a community where such beliefs exist is at risk in a number of ways.   A child born with a disability or a child
who becomes disabled may be directly subject to physical violence, or sexual, emotional or verbal abuse in the home, the
community, institutional settings or in the workplace.  A disabled child is more likely to face violence and abuse at birth and this
increased risk for violence reappears throughout the life span.  This violence compounds already existing social, educational and
economic marginalization that limits the lives and opportunities of these children.  For example, disabled children are far less likely
than their non-disabled peers to be included in the social, economic and cultural life of their communities; only a small percentage
of these children will ever attend school; a third of all street children are disabled children.  Disabled children living in remote and
rural areas may be at increased risk.

Settings

Violence in the home and family:
In societies where there is stigma against those with disability, research indicates that some
parents respond with violence because of the shame the child had brought on the family or respond with violence because a lack
of social support leads to intense stress within the family.  Among the violent manifestations of this are:

Infanticide & mercy killings: Disabled children may be killed either immediately at birth or at some point after birth; and
sometimes years after birth.  The rational for such killings is either 1) the belief that the child is evil or will bring misfortunate to
the family or the community or 2) the belief that the child is suffering or will suffer and is better off dead.  Often called “mercy
killings” such murders are usually a response to societal beliefs about disability and lack of social support systems for individuals
with disability and their family, not the actual physical condition of the child him or herself.  In ‘mercy killings’ a parent or
caretaker justifies withholding basic life sustaining supports (usually food, water and/or medication) or actively takes the child’s
life through suffocation, strangulation or some other means, with the intention of “ending suffering.”  

What links such behaviors together is that the cause of death is not the child’s disability, but actions taken on the part of the child’
s parent or caretaker.   Importantly, the actions of the parent or caretaker are often not taken in isolation.  The decision to end the
life of a disabled child may be prompted either directly with advice and counsel of medical, social, and religious leaders or family
members.  It may be prompted indirectly through lack of social, economic and medical support networks that leave parents
feeling isolated, depressed and desperate. Cases where parents decide to end the life of a disabled child because they themselves
are ill or aging and fear their child will be subjected to abuse or neglect after their own deaths are particularly heartrending.  That
communities often do not prosecute such forms of homicide or let the perpetrator go with a reduced punishment is recognition
from the surrounding society of the lack of support and encouragement given to caring for and raising a disabled child.  
Importantly, in some societies, there are also often gender differences, with disabled girl infants and girl children more likely to
die through ‘mercy killings’ than are boy children of the same age with comparable disabling conditions.

Physical violence, sexual, emotional and/or verbal abuse of the disabled child in a violent household:  While many parents
are violent towards children where no disability exists, when a disabled child lives in a violent setting his or her disability often
serves to compound and intensify the nature and extent of the abuse.  For example, a mobility impaired child may be less able to
flee when physically or sexually assaulted.  A child who is deaf may be unable to communicate about the abuse he or she faces to
anyone outside his or her household, unless these outsiders speak sign language or understand the home signs the child uses.  
(And when the abuser is the one interpreting the child’s statement to someone outside the household, this further limits the child’s
ability to report abuse or ask for help).  A child who is intellectually impaired may not be savvy enough to anticipate a parent’s
growing anger or know when to leave the room to avoid being struck.

Theory of child induced stress leading to violence:  Several theories of child abuse state that a disabled child faces increased
risk as the result of child-produced stress.  It is hypothesized that this cycle of increasing tensions can begin long before the child
is diagnosed as having a disability.   For example, a child with a hearing impairment may be regarded as disobedient; a child with
vision problems may not make eye contact and appear to be unresponsive, a child with a neurological disorder may be difficult to
comfort or feed.  Other researchers suggest that parents who become violent towards their disabled child are reacting not to the
child’s condition alone, but to the social isolation and stigma they encounter from surrounding family, friends and neighbors.
Parents of disabled children often lack social supports as family and friends distance themselves;  they can find no school willing
to take their child or they live in communities where there are few or no social services to help them with their child’s needs. It is
possible that both child-produced stressors and social isolation are compounded to produce a stressful and potentially violent
situation in a household coping with a disabled child.  It is also true that not all households with disabled children are violent and
even within the same communities there are coping mechanisms in some families that prevent violence, while children with
identical disabilities in other households are subjected to violence.  As with many aspects of violence towards disabled children, at
this point, much more research is needed to allow us to adequately understand the factors that inhibit or foster violence towards
these children.

Neglect as a precursor to violence:  Parents may respond to the stress of caring for a disabled child with neglect rather than
active violence, however when this neglect involves denial of food, medicine and other life sustaining services, it must be
considered a form of violence.  For example:

Neglect in providing basic/life sustaining care: The disabled child in a household may receive less food, medical care or other
services.   This can be subtle, for example, parents or caretakers may wait a few additional days before spending scarce money
for medicine or the child may receive less food or less nutritious food than his or her sibling.  The response can also be direct:
refusal to continue to feed, house or cloth a child after he or she has been disabled. Such neglect can lead to further impairments
in a vicious feedback feed back cycle in which the disabled child continually loses ground developmentally.

Neglect to provide disability-specific care: Disability-specific health concerns are exacerbated through neglect.  For example,
bed sores go unattended resulting in a potentially deadly systemic infection or a disabled child who needs assistance eating will
become malnourished because no one takes enough time to adequately feed him or her.

Refusal to intervene: Family, neighbors, health care professionals or social service experts may be aware that a disabled child is
being abused by parents or caretakers in the home, but are unwilling to intervene, rationalizing such violence by citing stress on
parents or lack of alternative care arrangements.  While deciding when to intervene to stop violence against children in the home
is an issue in many societies, the neglect highlighted here is when a community does not stop violence against a disabled child that
would be considered intolerable if perpetrated against a non-disabled child.  

Gender specific neglect:  Such neglect may be further exacerbated by gender – for example, in a study from Nepal, the survival
rate for boy children several years after they have had polio is twice that for girl children, despite the fact that polio itself affects
equal numbers of males and females. Neglect, in the form of the lack of adequate medical care, less nutritious food or lack of
access to related resources, is the apparent cause of these deaths.

Violence and abuse linked to social isolation.    

Child is shunned within the household, with few family members talking to him or her or overseeing his or her safety

The child is not allowed to leave the house or household compound.  In some cases, the child is kept home to ensure his or
her own safety, as parents fear that the child may be struck by a cart or abused by someone in the neighborhood.  But in many
other instances a child is kept isolated because the family fears the reaction from other members of the community.  Children in
some communities are kept shackled in windowless storerooms, hot household courtyards or dark attics for weeks, months or
years, often with little or no interaction, even by those within the household.  Next door neighbors may not know of the child’s
existence and family members across town may be told that the child has long since died.

Abuse by support staff within the home – Parents and caretakers of disabled children must often call upon informal networks
of family, friends and neighbors or formal networks of in-home nursing and attendant care to help with child care, rehabilitative
or medical support.  

In such instances: Physical, sexual, verbal and emotional abuse may take place by caregivers without the parent’s knowledge or
while the parent is away.

Parents may be aware of or suspect abuse, but feel there are no alternatives to help with the care of the disabled child and thus be
unwilling to admit, confront or cancel the services they receive.  

Barriers to intervention: Social service and child advocacy agencies may be aware that a disabled child is the victim of violence
or neglect, but choose to keep that child in the household because there are few or no alternative foster care or safe, temporary
residential care facilities that are disability accessible or willing to take in a disabled child The response of disabled children
themselves to on-going violence within the home is dictated by a number of factors. They may be:

•        Unaware that the abuse and neglect is unacceptable – in part because unlike the non-disabled child, they have little contact
with others outside the household.
•        Be aware that this type of behavior is unacceptable, but be unable to physically contact or communicate with individuals
outside the household who could help them
•        Be aware that this type of behavior is unacceptable, but fear loss of relationship with care giver or family member.   While
this is an issue for many children in violent households, for disabled children dependent on their abusers for physical care,
communication with the outside world or other disability-specific concerns, these issues are more complex.
•        Be aware that this type of behavior is unacceptable, seek to alert authorities, but are not listened to or believed.

Violence in Educational and Custodial Settings

Millions of disabled children around the world spend part or all of their lives in institutional settings, be it in schools within their
communities, disability-related residential schools, institutions or hospitals, or in the criminal justice system.  In all cases, being
disabled increases and compounds their risk for becoming victims of violence.

Non-residential schools:  Sadly, victimization of disabled children in school can begin even before the child enters the
schoolhouse door:

•        
Traveling to and from school:  Because educational facilities for disabled children are rare, many children travel long
distances to school.  Reports of physical and sexual abuse by those responsible for transportation to and from school are
common.  For example, a recent study in the United States reported that 5% of all disabled students reporting sexual abuse were
abused by bus drivers on their way to or from their schools. (7)   
•        
Physical threat of violence: Disabled children are often bullied, teased or subjected to physical violence (being beaten,
stoned, spit upon, etc.) by members of the community on their way to and from school
•        
Victims of crime: Disabled children are often targeted by predators on their way to and from school.   For example,
perpetrators of violent crimes, including robbery and rape, often target students on their way to schools for the disabled, believing
them to be more vulnerable and less likely or able to report crime or abuse.  Students with sensory impairments (deafness or
blindness) and students with intellectual disabilities seem to be at particular risk.

Violence Inside the Classroom

•        Teachers: Disabled children are often beaten, abused or bullied by teachers, particularly untrained teachers who do not
understand the limitations of some disabled children.  Children with intellectual disabilities and children with hearing impairments
are particularly at risk, but reports worldwide find that all disabled children are potential victims. Sexual abuse by teachers is also
widely reported for both male and female students.
•        
Fellow students: Teachers that humiliate, bully or beat children not only directly cause harm to the child, but model such
behavior for other children in their classroom, who may follow the teacher’s lead in physically harming, bullying and socially
isolating the targeted disabled child. Sexual abuse by fellow students is also a concern and is often linked to physical violence and
bullying behaviors by such classmates.
•        
School staff: Individuals who work as teacher’s aides or attendants for disabled children, or help transport, feed or care
for such children, are often underpaid, overworked and largely unsupervised.  While many who undertake such career choices do
so out of the best of motives, others choose these jobs because it allows easy access to the most vulnerable of children.  A study
from the US, found that 11% of all those working as teachers’ aides, transportation staff or school janitorial staff in programs
that served disabled children had previous criminal records, many related to child abuse or sexual abuse.
•        
Lack of reporting mechanism:  Few schools have mechanisms in place that allow students, parents or caregivers to
complain about violence or victimization.  This is all the more serious because in many communities there are only a handful of
schools or educational programs that are available for disabled children.  Parents/caregivers or children may hesitate to complain
about violent or abusive behavior in the school, fearing that they will be dismissed from a program when no alternative exists.  Of
equal concern, few schools have systems in place to allow school staff to report abuse they have observed on the job.

•        
Violence in Residential schools:  In a number of countries, children with specific types of disabilities, (particularly
children who are deaf, blind or intellectual impaired) are educated in residential schools, where they may live away from their
families for months or years.   In addition to the potential for victimization noted above for disabled children in the classroom,
additional concerns for violence against disabled children must be noted for residential schools:
•        Housing at residential schools: Children who live in dormitories or are boarded out with local families are often subject to
both physical violence and sexual abuse.
                   
Institutions  

In many countries, disabled children are placed in institutions at birth or as toddlers and remain there until death.  It is important
to note that while institutions continue to be considered the norm for disabled children in many countries, in fact, until two
hundred years ago, few institutions existed. Prior to the establishment of institutions, it was expected that disabled children would
remain with their families, living in the community throughout their lifespan.   In recent years, a growing number of Disability
Rights advocates as well as human rights advocates and experts in law, pediatrics, public health and rehabilitation have called for
the closing of institutions for disabled children and a return to community-based living.  Certainly all available data show that
children in institutions do far worse socially, educationally, medically and psychologically than children raised in supportive
community settings.  While institutionalization itself can have serious physical and psychological effects on children, violence
against disabled children in institutions is of grave concern – and particularly widespread.  Globally, the following issues appear
with frequency:

Victims of violence:  Disabled infants, children and adolescents in institutions around the world are routinely subjected to
physical violence and sexual, verbal and emotional abuse by staff, visitors and fellow patients.

Profound neglect - (neglect to the point where it is life threatening):  Disabled children are often kept in environments that
can only be described as inhumane.  Institutions for disabled children are often at the bottom of government priority lists and lack
adequate funding, consistent support or oversight from government or civil society.  Institutions are often overcrowded,
unsanitary and suffer from lack of both staff and resources which leads directly to avoidable suffering and death.  Among abuses
reported within the past several years that should be noted in any discussion of violence against disabled children are:

Dangerous facilities that foster violence:  In many institutions, infants, children and adolescents with disability are kept in
overcrowded wards. These children have little or no physical contact with caretakers, lying for hours or days unchanged on urine
soaked mattresses and suffering from undernourishment and malnutrition.  They receive little or no stimulation in the form of
individualized adult attention, toys or attempts at toilet training, self-care or education.   Children who are considered demanding
or troublesome may be inappropriately restrained - chained to their beds, straight jacketed, have plastic soda bottles taped over
their hands, beaten or medicated so they do not disturb the staff.   Accounts of disabled children being placed in cages, cells or
pits come from institutions around the world.

Such conditions are not only inhumane in themselves but are also an invitation to further violence: reports of physical violence and
sexual, verbal and emotional abuse by staff, visitors and other patients in these facilities come from institutions on every
continent.   A Human Rights Watch Report found the death rate among institutionalized disabled children in several countries in
Eastern Europe was almost twice that for children in the general population and for disabled children who are kept at home; in
Chinese orphanages, where a significant proportion of all admitted children are disabled, the mortality rates in some institutions
over the life of the children in their care, exceeds 75%.

Under-staffing of institutions: One consequence of the lack of adequate funding, severe understaffing, with staff/ patient ratios
in some facilities for disabled children reaching more than one hundred children for each adult staff member.  As noted above,
children are not only left unattended for long periods of time during the day, but overnight entire wards are often unattended or
padlocked with only a skeletal night shift to oversee facilities with hundreds of children.  There is often no oversight, and physical
and sexual abuse in such instances is rife.   

Staffing of institutions for disabled children presents an additional problem. Because such work is demanding, low paying and
lacks social status, administrators must often settle for staff that is unskilled and increasingly overworked. Among the regularly
reported issues that arise with such staff are the following:

Lack of understanding of child capabilities: Staff who lacks training and background on disability can be quick to lash out at
disabled children either because of frustration with the job or lack of understanding about the limitations of the children in their
charge.  Training of staff around issues of violence or abuse is rare or non-existent, meaning that the problems are not addressed.

Targeting of children:  The low pay, low social status, long hours and hard working conditions in many institutions means that
workers are hard to find and administrators are quick to hire anyone. Background checks on personnel often are not done.  This
allows some individuals, intent on harming or sexually exploiting children, to regularly seek work in such institutions. As is the
case of caregivers and workers in day schools and special education programs cited earlier, individuals with criminal histories of
child abuse and sexual exploitation are attracted to jobs that allow them easy access to children.  Severe understaffing, lack of
oversight and reluctance to prosecute abuse against disabled children; make institutions particularly susceptible to these staffing
problems.  Reports also indicate that because of lack of a registry or oversight of such predators when an abusive employee is
discovered it is not uncommon for that individual to be fired from one institution and soon turn up working at another institution
for disabled children nearby.

Lack of discrete facilities for children: In many institutions, disabled children are cared for on the same floors or in the same
wards as adults.  In fact, in some institutions, adult patients are pressed into service to help care for disabled infants and children.
This is particularly true in mental health facilities and institutions for those with intellectual impairments.  In overcrowded and
poorly staffed institutions, oversight or guidance of adult patients as they care for disabled children is rare.  The opportunities for
abuse are rife and common, further compounded by the fact that the adult patients, now abusing the disabled children, may
themselves have been victims of similar violence when first institutionalized as children.

Lack of heat and food: Under-funding creates other risks for disabled children.  For example, because it is widely believed that
individuals with intellectual disabilities and mental health impairments cannot feel the cold, to save money, in some institutions in
Eastern Europe, even in the dead of winter, the heat is routinely turned off overnight.

Lack of oversight/ monitoring: Many institutions have historically been set in isolated areas far from urban centers.  While the
tranquil country existence was at one time believed to be beneficial to patients and staff, such locations also assure that there will
be few visits from family, and little oversight by government, public health officials, members of the general public, or the press.
Even institutions in the middle of large urban areas routinely isolate children from the surrounding community through         
tightly restricted visiting policies that deny easy access to family, community leaders and the press.  

Children in such institutions are often further isolated when they are rarely or never allowed to leave the grounds of the
institution.  Indeed, many urban schools are surrounded by high walls or fences to make sure that the children are visually as well
as physically and socially isolated from the urban landscape that surrounds them. The result is that in institutions where violence
is a problem, oversight from the wider community has historically been difficult to         maintain and even today, this presents
major challenges that must be addressed.  Moreover, few institutions have any internal reporting or oversight mechanism that
would allow staff or visitors who witness abuse to report it.  Even fewer institutions have any internal mechanism that would
allow children who are being abused to report the abuse to responsible parties within or outside of the institution to ensure that
their complaints are investigated and acted upon.

In addition, children in institutions may hesitate to identify their abusers for the same reasons that children are afraid to identify
abusers in their household or in the community: They fear physical, sexual or         psychological reprisal; they fear loss of
attention or affection from         individuals on whom they have come to depend; they fear they will not be         believed and
they fear that they will be blamed or otherwise embarrassed         or humiliated.

Guardianship: Mechanisms for children to report abuse by staff do not exist in many countries.  This is further complicated
where institutions hold legal guardianship over disabled children.  In such situations, the right to request outside review or
intervention to end violent situations can be denied by the very institution in which the abuse is occurring, on the grounds that the
institution holds the legal guardianship over the abused individual and is therefore entitled to decide for that individual what
services or interventions are needed.

The Criminal Justice System

While disabled children are often discussed in terms of special education and institutionalization, it is important to note that
disabled children are also disproportionately represented in the criminal justice system.  Furthermore, once in the system, they
often fare far worse than their non-disabled peers. Such findings have been reported since the early work of Gunnar Dywad in
the 1940s, when it was found that a significant number of children in the criminal justice system in Europe and the United States
were intellectually disabled or had mental health impairments.

Disabled children are at risk for a number of reasons.  They are more likely than their non-disabled peers to have no schooling
available or to leave school early due to abuse and lack of appropriate educational opportunities and because of this, are much
more likely to wind up on the streets.  Indeed, as noted earlier, UNICEF estimates that perhaps a third of all street children may
have some type of disability. (12) Once on the streets they are at risk of being talked into taking part in criminal activities often by
non-disabled individuals who see them as pawns. For example:

•        Psychologists suggest that because many disabled children have been socially marginalized growing up, they are more
easily talked into things because they are particularly anxious to please others and to feel included.    
•        Such children are at increased risk of being caught and incarcerated, as they are less adept than their non-disabled peers in
discerning when to run from the police and less capable of talking their way out of situations when stopped and questioned or
picked up as vagrants.
•        Such children are also often less adept then their peers in understanding what they need to do and say once they are in the
criminal justice system, thus lessening their chances to get out of trouble, explain their actions to lawyers or counselors or
making a compelling witness in front of a jury
•        Once incarcerated, either in an adolescent facility or an adult prison, such children are at risk of bullying and violence.  
They are also at greatly increased risk of sexual exploitation.

Additional concern:
•        Human rights organizations report that in some countries where large and growing numbers of street children are
considered a threat to the urban life, there have been systematic killing of these children by the police death squads.   Disabled
street children – less likely than their non-disabled peers to protect themselves or flee from the police, may be at increased risk in
such situations.
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Violence Against Disabled Children