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Health effects of child labour
THE LANCET
HEALTH AND HUMAN RIGHTS
Police brutality in the USA A small proportion of police bner Louima, a Haitian immiblows, punches, or kicks during officers are responsible for most of grant, was brutally assaulted by arrests. In such cases it can be the abuse, yet these repeat offenders officers of the New York City Police difficult for a physician to assess are rarely disciplined or prosecuted. Department (NYPD) in the early whether the injuries are excessive Police organisations and unions hours of Aug 9, 1997. He was relative to the circumstances of the are powerful lobbying groups and arrested for allegedly arrest. When brutality have prevented independent civilian striking a police occurs at a police review boards in most jurisdictions. officer during a station, the assaults In the spotlight of the Louima mêlée outside a night are more likely to affair, New York’s Mayor, Rudolph club; the charges inflict the severe Giuliani, and Police Chief, Howard were unfounded and physical and mental Safir, have promised to reappraise later dropped. What pain that constitute the recommendations of Amnesty took place after his torture. Chicago’s International’s June 1996 report1 on arrest shocked the Area 2 Headquarters city and the nation. was infamous for its police brutality and excessive force Louima, who was methods of interrogain the NYPD, which they rudely dishandcuffed, stated tion, which included paraged when it was first published. that during the drive Abner Louima in hospital beatings, mock executo Brooklyn’s 70th tions, near-asphyxiaRobert H Kirschner Precinct, the arresting officers tion with plastic bags, thermal burns, International Forensic Program, Physicians stopped their vehicle and beat him. and electric-shock torture. Los for Human Rights, DePaul University Shortly after his arrival at the station, Angeles has settled many lawsuits College of Law, 25 East Jackson Blvd, he was taken to the bathroom and arising out of more than 50 deaths Chicago, IL 60604, USA sodomised with a toilet plunger or related to lethal police choke holds, 1 Amnesty International USA. United States similar implement that perforated his and many other cities are paying out of America: police brutality and excessive rectum and lacerated his bladder; it large sums to settle instances of force in the NYPD. AI Index: AMR was then shoved into his mouth, and police misconduct. 51/36/96, June, 1996. broke several of his teeth. Still handcuffed, he was put in a holding cell Health effects of child labour for 1·5 h until an ambulance arrived at 0625 h. Although it was clear that sample sizes or have design flaws. hildren have a right to freedom Louima needed to be admitted to These limitations are often exacerfrom exploitation and an educahospital, the precinct commander bated by the settings in which investition, as elaborated in the 1989 UN refused to provide the required gations are conducted, for example, Convention on the Rights of the police escort until about 0800 h, areas where medical care is sporadic Child. But there are about 250 despite repeated requests from the or non-existent and conditions favour million child labourers worldwide emergency paramedics. the spread of diseases.2 Moreover, who work long hours, usually in Louima was taken to Coney Island hazardous conditions.1 Such work access to child labourers can be diffiHospital where he underwent cult because most work illegally and has an adverse impact on the health emergency surgery to repair his torn few have any type of labour contract. and development of these children. internal organs. There have been Without long-term exposure data Child labourers work in a range allegations that some supervisory on child labourers, it is possible to of occupations that can endanger personnel at the hospital concealed develop disease models that examine their health—eg, in stone quarries, the cause of Louima’s injuries to prethe impact of latency on the early tanning leather, and electroplating vent the information from becoming development of disease. A child who metals. Most children who work in public, despite the ethical obligation begins work at a young age has more these environments are not given of health workers to report torture or years to develop a protective clothing other degrading treatment that occurs disease than an adult or equipment; the in custody. That evening, Magalie with a similar expoclothing provided Laurent, a hospital nurse, acting in sure. In India, silicohas generally been the best tradition of her profession, sis and tuberculosis designed for adults called the NYPD Internal Affairs are common in and is, therefore, Bureau to report the assault. Her call industries with a useless. Many child was ignored. large proportion of labourers work in The next day the Louima family child labourers. industries with wellfiled a complaint, but the investigation Among stone cutters defined exposures only began on Aug 11, giving those and slate workers, such as silica, linked involved enough time to destroy evithe rate of silicosis to silicosis, and prosdence of the assault. Four police offiis 35% and 55%, titution, linked to cers have subsequently been indicted respectively,3 and in HIV-1 infection. for the attack. Laurent has faced hosAlthough several potteries, about tility from her colleagues; she was even studies on the health 15% of workers are attacked by another nurse. of child labourers affected, although in Police brutality is a daily occurhave been carried some places the rate rence across the USA, most of it out, they tend to is as high as 34%.4 inflicted in the form of a few extra include only small Indian child labourer The overall rate of Archive Photos
A
David L Parker
C
Vol 350 • November 8, 1997
1395
THE LANCET
David L Parker
HEALTH AND HUMAN RIGHTS
Brick workers in India
tuberculosis in pottery-related industries is about ten times higher than that for the general population. The mean duration of exposure before a
family and healthier children6 than a child labourer who has not been educated.
diagnosis of silicosis for an Indian pottery worker may be only 20 years, compared with over 30 years for an iron moulder. Children who work in brick factories and granite quarries are also at increased risk of developing silicosis: the rate among granitecrushing workers is about 75%. Because of high levels of dust exposure, these workers may have a mean latency of less than 10 years before the onset of silicosis. The health effects of child labour extend beyond the conditions in which children are forced to work. Most child labourers are denied an education, and there is a strong correlation between child labour and adult illiteracy.5 Maternal illiteracy is, in turn, associated with low birthweight and severe child malnutrition.6 By contrast, a woman who has just a few years of education is more likely to marry at an older age, seek prenatal care, and have a smaller
David Parker Minnesota Department of Health, PO Box 9441, Minneapolis, MN 55440, USA 1
2
3
4
5
6
Parker DL. Stolen dreams: portraits of working children. Minneapolis: Lerner Publications, 1997. Asthana S. Variations in poverty and health between slum settlements. Soc Sci Med 1995; 40: 177–88. Harvey P, Riggin L. Trading away the future: child labour in India’s export industries. Washington: International Labour Rights Education Fund, 1994. Saiyed HN. Dustiness, silicosis, and tuberculosis in small scale pottery workers. Indian J Med Res 1995; 102: 138–42. Raju T. Child labour, adult literacy and employment rates in India. Indian J Pediatr 1989; 56:193–200. Islam MA. Maternal and socioeconomic factors and risk of severe malnutrition in a child. Eur J Clin Nutrition 1994; 48: 416–24.
Nurses at risk
1396
Committee of the Red Cross (ICRC) was ambushed near the town of Gorahun in Sierra Leone. Two nurses were killed and another injured. In December, 1996, six ICRC delegates, five of whom were nurses, were shot dead in their quarters at the Red Cross hospital in Novye Atagi, Chechnya. In his address at the memorial service in Geneva, the ICRC President, Cornelio Sommaruga, called for a review of the best way to protect
Rex Features
urses have a key role in the front-line delivery of health care; they face similar risks as physicians and can pay a high price for professional or political activities, but often without the world attention and pressure mounted by the medical profession in support of threatened colleagues. Nurses have explicit ethical obligations to refuse to take part in human rights violations and to report abuses that come to their attention. Strategies and action are needed to support nurses in the upholding of these principles. A recent report by Amnesty International1 explores some of the issues that link nurses and human rights and documents cases in which nurses have been attacked. The experience of Mediha Curabaz, a Turkish nurse, illustrates the experience of many nurses. After her arrest, in 1991, she was tortured and raped during her detention at Adana Police Headquarters. She submitted a formal complaint supported by a medical report, but her case was blocked by the Adana Provincial Governor’s office. Her subsequent objection to the appeal court was rejected, although she finally won a civil suit for injury sustained in police custody and was awarded a small sum in compensation. Nurses have also been killed in the course of their duties, despite their protected neutral status. In August, 1993, a convoy of the International
N
Nurses call for democracy
victims from “these conflicts without rules, where even the fundamental principle at the base of the Red Cross movement, respect for medical personnel, respect for the protective emblem, respect for hospitals and humanitarian sanctuaries, is deliberately violated”. In countries where human rights violations are widespread, some nurses have been persecuted for clinical work or legitimate political activity. Reynaldo Soto Hernández,
a Cuban nurse and human rights activist, was arrested in 1994, and sentenced to 3 years in prison for “dangerousness”. During his imprisonment, he was denied reading material and family visits. After a 5-day hunger strike he spent 2 months in a punishment cell. He was finally released on Sept 6, 1997. Vo Van Pham, a 50-year-old nurse currently serving 12 years in a “re-education” camp in Han Tam, Vietnam, has been adopted as a prisoner of conscience by Amnesty International. He was imprisoned in 1991 for comments in favour of multiparty democracy in Vietnam and allegedly planning a democratic political organisation. He still has 6 years of his sentence to serve with 2 years’ probation. Amnesty calls on health professionals to write to the Vietnamese ambassador in your country seeking his release on the grounds that he is a prisoner of conscience who has neither used nor advocated violence. Nursing associations worldwide need to develop measures to extend their cooperation with other health professionals and to provide active support for their members at risk of human rights violations. James Welsh Medical Office, Amnesty International, 1 Easton Street, London WC1X 8DJ, UK 1
Amnesty International. Nurses and human rights. AI Index: ACT 75/02/97, 1997.
Vol 350 • November 8, 1997
HEALTH AND HUMAN RIGHTS
Police brutality in the USA A small proportion of police bner Louima, a Haitian immiblows, punches, or kicks during officers are responsible for most of grant, was brutally assaulted by arrests. In such cases it can be the abuse, yet these repeat offenders officers of the New York City Police difficult for a physician to assess are rarely disciplined or prosecuted. Department (NYPD) in the early whether the injuries are excessive Police organisations and unions hours of Aug 9, 1997. He was relative to the circumstances of the are powerful lobbying groups and arrested for allegedly arrest. When brutality have prevented independent civilian striking a police occurs at a police review boards in most jurisdictions. officer during a station, the assaults In the spotlight of the Louima mêlée outside a night are more likely to affair, New York’s Mayor, Rudolph club; the charges inflict the severe Giuliani, and Police Chief, Howard were unfounded and physical and mental Safir, have promised to reappraise later dropped. What pain that constitute the recommendations of Amnesty took place after his torture. Chicago’s International’s June 1996 report1 on arrest shocked the Area 2 Headquarters city and the nation. was infamous for its police brutality and excessive force Louima, who was methods of interrogain the NYPD, which they rudely dishandcuffed, stated tion, which included paraged when it was first published. that during the drive Abner Louima in hospital beatings, mock executo Brooklyn’s 70th tions, near-asphyxiaRobert H Kirschner Precinct, the arresting officers tion with plastic bags, thermal burns, International Forensic Program, Physicians stopped their vehicle and beat him. and electric-shock torture. Los for Human Rights, DePaul University Shortly after his arrival at the station, Angeles has settled many lawsuits College of Law, 25 East Jackson Blvd, he was taken to the bathroom and arising out of more than 50 deaths Chicago, IL 60604, USA sodomised with a toilet plunger or related to lethal police choke holds, 1 Amnesty International USA. United States similar implement that perforated his and many other cities are paying out of America: police brutality and excessive rectum and lacerated his bladder; it large sums to settle instances of force in the NYPD. AI Index: AMR was then shoved into his mouth, and police misconduct. 51/36/96, June, 1996. broke several of his teeth. Still handcuffed, he was put in a holding cell Health effects of child labour for 1·5 h until an ambulance arrived at 0625 h. Although it was clear that sample sizes or have design flaws. hildren have a right to freedom Louima needed to be admitted to These limitations are often exacerfrom exploitation and an educahospital, the precinct commander bated by the settings in which investition, as elaborated in the 1989 UN refused to provide the required gations are conducted, for example, Convention on the Rights of the police escort until about 0800 h, areas where medical care is sporadic Child. But there are about 250 despite repeated requests from the or non-existent and conditions favour million child labourers worldwide emergency paramedics. the spread of diseases.2 Moreover, who work long hours, usually in Louima was taken to Coney Island hazardous conditions.1 Such work access to child labourers can be diffiHospital where he underwent cult because most work illegally and has an adverse impact on the health emergency surgery to repair his torn few have any type of labour contract. and development of these children. internal organs. There have been Without long-term exposure data Child labourers work in a range allegations that some supervisory on child labourers, it is possible to of occupations that can endanger personnel at the hospital concealed develop disease models that examine their health—eg, in stone quarries, the cause of Louima’s injuries to prethe impact of latency on the early tanning leather, and electroplating vent the information from becoming development of disease. A child who metals. Most children who work in public, despite the ethical obligation begins work at a young age has more these environments are not given of health workers to report torture or years to develop a protective clothing other degrading treatment that occurs disease than an adult or equipment; the in custody. That evening, Magalie with a similar expoclothing provided Laurent, a hospital nurse, acting in sure. In India, silicohas generally been the best tradition of her profession, sis and tuberculosis designed for adults called the NYPD Internal Affairs are common in and is, therefore, Bureau to report the assault. Her call industries with a useless. Many child was ignored. large proportion of labourers work in The next day the Louima family child labourers. industries with wellfiled a complaint, but the investigation Among stone cutters defined exposures only began on Aug 11, giving those and slate workers, such as silica, linked involved enough time to destroy evithe rate of silicosis to silicosis, and prosdence of the assault. Four police offiis 35% and 55%, titution, linked to cers have subsequently been indicted respectively,3 and in HIV-1 infection. for the attack. Laurent has faced hosAlthough several potteries, about tility from her colleagues; she was even studies on the health 15% of workers are attacked by another nurse. of child labourers affected, although in Police brutality is a daily occurhave been carried some places the rate rence across the USA, most of it out, they tend to is as high as 34%.4 inflicted in the form of a few extra include only small Indian child labourer The overall rate of Archive Photos
A
David L Parker
C
Vol 350 • November 8, 1997
1395
THE LANCET
David L Parker
HEALTH AND HUMAN RIGHTS
Brick workers in India
tuberculosis in pottery-related industries is about ten times higher than that for the general population. The mean duration of exposure before a
family and healthier children6 than a child labourer who has not been educated.
diagnosis of silicosis for an Indian pottery worker may be only 20 years, compared with over 30 years for an iron moulder. Children who work in brick factories and granite quarries are also at increased risk of developing silicosis: the rate among granitecrushing workers is about 75%. Because of high levels of dust exposure, these workers may have a mean latency of less than 10 years before the onset of silicosis. The health effects of child labour extend beyond the conditions in which children are forced to work. Most child labourers are denied an education, and there is a strong correlation between child labour and adult illiteracy.5 Maternal illiteracy is, in turn, associated with low birthweight and severe child malnutrition.6 By contrast, a woman who has just a few years of education is more likely to marry at an older age, seek prenatal care, and have a smaller
David Parker Minnesota Department of Health, PO Box 9441, Minneapolis, MN 55440, USA 1
2
3
4
5
6
Parker DL. Stolen dreams: portraits of working children. Minneapolis: Lerner Publications, 1997. Asthana S. Variations in poverty and health between slum settlements. Soc Sci Med 1995; 40: 177–88. Harvey P, Riggin L. Trading away the future: child labour in India’s export industries. Washington: International Labour Rights Education Fund, 1994. Saiyed HN. Dustiness, silicosis, and tuberculosis in small scale pottery workers. Indian J Med Res 1995; 102: 138–42. Raju T. Child labour, adult literacy and employment rates in India. Indian J Pediatr 1989; 56:193–200. Islam MA. Maternal and socioeconomic factors and risk of severe malnutrition in a child. Eur J Clin Nutrition 1994; 48: 416–24.
Nurses at risk
1396
Committee of the Red Cross (ICRC) was ambushed near the town of Gorahun in Sierra Leone. Two nurses were killed and another injured. In December, 1996, six ICRC delegates, five of whom were nurses, were shot dead in their quarters at the Red Cross hospital in Novye Atagi, Chechnya. In his address at the memorial service in Geneva, the ICRC President, Cornelio Sommaruga, called for a review of the best way to protect
Rex Features
urses have a key role in the front-line delivery of health care; they face similar risks as physicians and can pay a high price for professional or political activities, but often without the world attention and pressure mounted by the medical profession in support of threatened colleagues. Nurses have explicit ethical obligations to refuse to take part in human rights violations and to report abuses that come to their attention. Strategies and action are needed to support nurses in the upholding of these principles. A recent report by Amnesty International1 explores some of the issues that link nurses and human rights and documents cases in which nurses have been attacked. The experience of Mediha Curabaz, a Turkish nurse, illustrates the experience of many nurses. After her arrest, in 1991, she was tortured and raped during her detention at Adana Police Headquarters. She submitted a formal complaint supported by a medical report, but her case was blocked by the Adana Provincial Governor’s office. Her subsequent objection to the appeal court was rejected, although she finally won a civil suit for injury sustained in police custody and was awarded a small sum in compensation. Nurses have also been killed in the course of their duties, despite their protected neutral status. In August, 1993, a convoy of the International
N
Nurses call for democracy
victims from “these conflicts without rules, where even the fundamental principle at the base of the Red Cross movement, respect for medical personnel, respect for the protective emblem, respect for hospitals and humanitarian sanctuaries, is deliberately violated”. In countries where human rights violations are widespread, some nurses have been persecuted for clinical work or legitimate political activity. Reynaldo Soto Hernández,
a Cuban nurse and human rights activist, was arrested in 1994, and sentenced to 3 years in prison for “dangerousness”. During his imprisonment, he was denied reading material and family visits. After a 5-day hunger strike he spent 2 months in a punishment cell. He was finally released on Sept 6, 1997. Vo Van Pham, a 50-year-old nurse currently serving 12 years in a “re-education” camp in Han Tam, Vietnam, has been adopted as a prisoner of conscience by Amnesty International. He was imprisoned in 1991 for comments in favour of multiparty democracy in Vietnam and allegedly planning a democratic political organisation. He still has 6 years of his sentence to serve with 2 years’ probation. Amnesty calls on health professionals to write to the Vietnamese ambassador in your country seeking his release on the grounds that he is a prisoner of conscience who has neither used nor advocated violence. Nursing associations worldwide need to develop measures to extend their cooperation with other health professionals and to provide active support for their members at risk of human rights violations. James Welsh Medical Office, Amnesty International, 1 Easton Street, London WC1X 8DJ, UK 1
Amnesty International. Nurses and human rights. AI Index: ACT 75/02/97, 1997.
Vol 350 • November 8, 1997