Impacts of COVID-19 on children in alternative care
Florence Koenderink has been involved in alternative care, including institutional care in low and middle-income countries for over 13 years. In 2018, she founded Why Family-Based Solutions with the purpose of supporting the move from institutional care toward family-based alternative care through consultancy, awareness raising, research, and publication.
Recently, I was struck by two additional dangers faced by children who are institutionalised in relation to COVID-19 compared to children living in families. And I think it is essential to raise awareness about them.
The first danger is connected to the well-documented inherent effects of institutionalisation on children. Living in a situation where psychosocial needs are not met activates the stress response system > experiencing elevated stress levels chronically creates toxic stress > toxic stress weakens the immune system. So, while overall COVID-19 seems to produce only mild symptoms in healthy children, all institutionalised children are immunosuppressed to a certain extent and are therefore at much greater risk of severe and possibly lethal forms of the illness.
This danger is compounded by the fact that, apart from hygiene practices in institutions often being substandard, there is no such thing as social distancing in institutions. By definition residential childcare institutions have large numbers of people living closely together. While there is an isolation from the community that would seem protective, in practice this tends to be an illusion. Children rarely get the opportunity to interact directly with people from the community, but even if visitors are banned from coming onto the premises, the caregivers and other staff still tend to come and go between the children and the community. If (when) the coronavirus arrives in the institutions, the results would be dramatic. The mortality rate will be very, very high. This would be the most horrendous form of deinstitutionalisation. And worst of all, it is likely to happen.
So where possible, ways have to be found to allow all children who can return to their families for the duration of the epidemic to do so, while providing the families with the support they need. Because spread out in the community, the survival rate will be much better than when they are all clustered together, waiting for the virus to be introduced in their midst.
The second danger comes from a knock-on effect. In many countries, there are ‘orphanages’ set up by unscrupulous managers whose sole intent is to attract foreign donations. Now that COVID-19 is making international travel impossible, and economic blows that accompany it are forcing people to tighten their belts, these for-profit 'orphanages' are likely to see a drop in donations and volunteers. Given that the people running these places have no problem yanking children out of their families, exploiting them and in some cases even keeping them malnourished to get more money, I don't think they will be terribly concerned about taking care of the welfare and safety of the children once the money stops coming in. When 'caring' for children fails as an investment, I predict that it will not be long before the children are dumped, and the managers move on to better opportunities.
We have to be aware of this and put together strategies to protect these children!
You can follow Florence’s other writings and publications online.