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I would promove actions to end the Taleban

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I would promove actions to end the Taleban

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The Taliban have also threatened to destabilise Pakistan, where they have controlled areas in the north-west in recent years. Despite a major military offensive against them since 2014, they continue to mount frequent suicide bombings and other attacks across the country. Many observers now believe that future peace in Afghanistan can only come if the government in Kabul negotiates with the Taliban.

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The Taliban were removed from power in Afghanistan by US-led forces in 2001, but the group has seized control of the country once again following a rapid offensive.

The capital, Kabul, was the last major city to fall to the offensive that began months ago but accelerated as the hardline Islamists gained control of territories.

The group entered direct talks with the US back in 2018, and in February 2020 the two sides struck a peace deal that committed the US to withdrawal and the Taliban to preventing attacks on US forces. Other promises included not allowing al-Qaeda or other militants to operate in areas it controlled and proceeding with national peace talks.

But in the year that followed, the Taliban continued to target Afghan security forces and civilians, advancing rapidly across the country.

Rise to power

The Taliban, or "students" in the Pashto language, emerged in the early 1990s in northern Pakistan following the withdrawal of Soviet troops from Afghanistan. It is believed that the predominantly Pashtun movement first appeared in religious seminaries - mostly paid for by money from Saudi Arabia - which preached a hardline form of Sunni Islam.

The promise made by the Taliban - in Pashtun areas straddling Pakistan and Afghanistan - was to restore peace and security and enforce their own austere version of Sharia, or Islamic law, once in power.

From south-western Afghanistan, the Taliban quickly extended their influence. In September 1995 they captured the province of Herat, bordering Iran, and exactly one year later they captured the Afghan capital, Kabul, overthrowing the regime of President Burhanuddin Rabbani - one of the founding fathers of the Afghan mujahideen that resisted the Soviet occupation. By 1998, the Taliban were in control of almost 90% of Afghanistan.

Afghans, weary of the mujahideen's excesses and infighting after the Soviets were driven out, generally welcomed the Taliban when they first appeared on the scene. Their early popularity was largely due to their success in stamping out corruption, curbing lawlessness and making the roads and the areas under their control safe for commerce to flourish.

But the Taliban also introduced or supported punishments in line with their strict interpretation of Sharia law - such as public executions of convicted murderers and adulterers, and amputations for those found guilty of theft. Men were required to grow beards and women had to wear the all-covering burka.

The Taliban also banned television, music and cinema, and disapproved of girls aged 10 and over going to school. They were accused of various human rights and cultural abuses. One notorious example was in 2001, when the Taliban went ahead with the destruction of the famous Bamiyan Buddha statues in central Afghanistan, despite international outrage.

Pakistan has repeatedly denied that it was the architect of the Taliban enterprise, but there is little doubt that many Afghans who initially joined the movement were educated in madrassas (religious schools) in Pakistan.

Pakistan was also one of only three countries, along with Saudi Arabia and the United Arab Emirates (UAE), which recognised the Taliban when they were in power in Afghanistan. It was also the last country to break diplomatic ties with the group.

At one point, the Taliban threatened to destabilise Pakistan from areas they controlled in the north-west. One of the most high-profile and internationally condemned of all Pakistani Taliban attacks took place in October 2012, when schoolgirl Malala Yousafzai was shot on her way home in the town of Mingora.

A major military offensive two years later following the Peshawar school massacre greatly reduced the group's influence in Pakistan though. At least three key figures of the Pakistani Taliban had been killed in US drone strikes in 2013, including the group's leader, Hakimullah Mehsud.

Al-Qaeda 'sanctuary'

The attention of the world was drawn to the Taliban in Afghanistan in the wake of the 11 September 2001 World Trade Center attacks in New York. The Taliban were accused of providing a sanctuary for the prime suspects - Osama Bin Laden and his al-Qaeda movement.

On October 7, 2001, a US-led military coalition launched attacks in Afghanistan, and by the first week of December the Taliban regime had collapsed. The group's then-leader, Mullah Mohammad Omar, and other senior figures, including Bin Laden, evaded capture despite one of the largest manhunts in the world.

Many senior Taliban leaders reportedly took refuge in the Pakistani city of Quetta, from where they guided the Taliban. But the existence of what was dubbed the "Quetta Shura" was denied by Islamabad.

Despite ever higher numbers of foreign troops, the Taliban gradually regained and then extended their influence in Afghanistan, rendering vast tracts of the country insecure, and violence in the country returned to levels not seen since 2001.

There were numerous Taliban attacks on Kabul and, in September 2012, the group carried out a high-profile raid on Nato's Camp Bastion base.

Hopes of a negotiated peace were raised in 2013, when the Taliban announced plans to open an office in Qatar. But mistrust on all sides remained high and the violence went on.

In August 2015, the Taliban admitted they had covered up Mullah Omar's death - reportedly of health problems at a hospital in Pakistan - for more than two years. The following month, the group said it had put aside weeks of infighting and rallied around a new leader in the form of Mullah Mansour, who had been the deputy of Mullah Omar.

At around the same time, the Taliban seized control of a provincial capital for the first time since their defeat in 2001, taking control of the strategically important city of Kunduz.

Mullah Mansour was killed in a US drone strike in May 2016 and replaced by his deputy Mawlawi Hibatullah Akhundzada, who remains in control of the group.

Seizing power

In the year following the US-Taliban peace deal of February 2020 - which was the culmination of a long spell of direct talks - the Taliban appeared to shift their tactics from complex attacks in cities and on military outposts to a wave of targeted assassinations that terrorised Afghan civilians.

The targets - journalists, judges, peace activists, women in positions of power - suggested that the Taliban had not changed their extremist ideology, only their strategy.

Despite grave concerns from Afghan officials over the government's vulnerability to the Taliban without international support, the new US president, Joe Biden, announced in April 2021 that all American forces would leave the country by 11 September - two decades to the day since the felling of the World Trade Center.

Having outlasted a superpower through two decades of war, the Taliban began seizing vast swathes of territory, before once again toppling a government in Kabul in the wake of a foreign power withdrawing.

They swept across Afghanistan in just 10 days, taking their first provincial capital on 6 August . By 15 August, they were at the gates of Kabul.

Their lightning advance prompted tens of thousands of people to flee their homes, many arriving in the Afghan capital, others heading for neighbouring countries.

The Taliban's return to rule brings an end to almost 20 years of a US-led coalition's presence in the country.

More on this story

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The Taliban were removed from power in Afghanistan by US-led forces in 2001, but the group has seized control of the country once again following a rapid offensive. The capital, Kabul, was the last major city to fall to the offensive that began months ago but accelerated as the hardline Islamists gained control of territories.

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In Pakistan, the most important aspect of well-being is also the most neglected. In its 70-year history, Pakistan’s successive governments — civil and military — have not made health a priority. It is woeful that discussions around health policy receive little to no space in the agenda of political parties. And while the media tends to report heavily on specific heath-related crises — such as the spread of polio and child deaths in Thar — meaningful debate around the causes of abysmal health services is virtually absent.

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IN Pakistan, the most important aspect of well-being is also the most neglected. In its 70-year history, Pakistan's successive governments - civil and military - have not made health a priority. It is woeful that discussions around health policy receive little to no space in the agenda of political parties. And while the media tends to report heavily on specific heath-related crises - such as the spread of polio and child deaths in Thar - meaningful debate around the causes of abysmal health services is virtually absent.

The result of this apathy is appalling health indicators. The infant mortality rate in Pakistan is 66 per 1,000 births, compared to 38 in India and eight in Sri Lanka. Life expectancy in Pakistan for women is 67 years, as compared to 73 in Bangladesh and 78 in Thailand. The maternal mortality rate in Pakistan is 170 per 100,000 live births, in contrast to 30 in Sri Lanka and 20 in Thailand.

The indifference of Pakistan's government to health is reflected in the fact that Pakistan spends a mere 0.9pc of its GDP on health. Only two countries, the Democratic Republic of Congo and Bangladesh, have a lower ratio of GDP to health spending.

Another indication of the government's neglect is the fact that public expenditure on health accounts for a little over one-third of Pakistan's total health expenditure. Pakistan's citizens rely heavily on private healthcare, which they avail primarily through out-of-pocket payments. This is in stark contrast not only to the developed West, but also to developing countries such as Thailand and Sri Lanka, where public expenditure accounts for most of health spending. The poor quality of government provided health services in Pakistan is the major reason behind the large role played by the private sector in healthcare.

Behind the dismal numbers lie heartbreaking stories of lives ruined and cut short due to the unavailability of affordable and quality healthcare. An unhealthy population with severely diminished capabilities cannot substantially contribute to the economy. Health indicators suggest that it is the lack of accessible healthcare - not terrorism, drones or the energy crisis - that is the greatest adversity facing Pakistan. And although healthcare is certainly linked to problems of corruption and security, there is no reason why healthcare should not be made an immediate priority, rather than placed on the back burner of policy discourse.

The fact that Pakistan is a developing economy with resource limitations is not an excuse when we look to other low-income countries that have made great strides in healthcare in the last few decades. The experiences of these countries provide illuminating lessons that should be applied in Pakistan.

We spend only 0.9pc of our GDP on health. Only two countries have a lower ratio of GDP to health spending.

Thailand and Mexico are examples of two developing countries that have made political commitments towards universal healthcare with very encouraging results. In 2001, the Thai government introduced a '30-baht universal coverage scheme' that covered the entire population with a guarantee that a patient would not have to pay more than 30 baht per visit for medical care.

Thailand also adopted an innovative measure to promote public accountability through the creation of the 'Health Assembly', a regular meeting where citizens voice feedback and complaints on the health system. Mexico established a 'System of Social Protection in Health' in 2003, which includes a public health insurance scheme that has steadily expanded insurance coverage with a package of comprehensive health services to 52 million Mexicans.

While health indicators in India as a whole are lamentable, some states such as Tamil Nadu perform remarkably well. For example, Tamil Nadu's infant mortality rate is 22 per 1,000 births and maternal mortality is 97 per 100,000 births, significantly better than many other states in India (and all provinces in Pakistan).

A distinguishing feature of Tamil Nadu is the extent to which its citizens actively lobby public officials for the provision of health and other public services. This culture of protest, studied closely by researchers such as Vivek Srinavasan, involves regular activism on the part of the public to ensure that government-run health facilities and health programmes are functional and accountable.

At least two lessons may be drawn from the experiences of other countries that excel in the provision of healthcare. Firstly, government-supported universal healthcare is attainable and affordable, even in low-income countries, so long as it is made a political priority. Countries such as Thailand and Mexico have met the healthcare needs of large swathes of their populations by improving public health services and providing public insurance schemes.

Secondly, an informed and activist public can play a crucial role in mobilising public health systems to serve the needs of the population. When healthcare systems are transparent and accountable, citizen advocacy can influence government policy and healthcare governance with positive results.

In Pakistan, implementation of health policies devolved to the provinces in 2010 after the 18th Amendment to the Constitution. In theory, this should create new opportunities for public engagement with provincial and local government officials for the provision of public health services. In reality, however, provinces are yet to realise the fruits of devolution.

In Sindh, for example, public health facilities are in appalling condition, plagued with staff absenteeism and shortage of essential medicines and equipment. What is lacking, but is certainly worth aspiring to, is a 'culture of protest' around access to government healthcare to ensure that medical staff is present for duty and medicines are available in public health facilities. Democratic action is essential to ensure that the administration of public health by provincial governments is effective and equitable.

In their book, An Uncertain Glory: India and Its Contradictions, economists Amartya Sen and Jean Dreze urge that issues of healthcare be brought closer to democratic politics. We in Pakistan must not accept the state of health as inevitable since this mindset only encourages government complacency and indifference. Instead, our public officials and elected representatives must be pushed to make health the central political issue of our time.

The writer is a lawyer practising in Karachi.
malkani.sara@gmail.com Published in Dawn, June 27th, 2016

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IN Pakistan, the most important aspect of well-being is also the most neglected. In its 70-year history, Pakistan's successive governments - civil and military - have not made health a priority. It is woeful that discussions around health policy receive little to no space in the agenda of political parties.

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I would make it possible to end violence against Pakistani children

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I would make it possible to end violence against Pakistani children

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Violence against children occurs in different forms (physical, sexual, neglect, emotional and psychological) and at multiple levels (individual, household, institutional, and societal). A WHO Consultation on Child Abuse Prevention recognized violence against children as a growing public-health and development problem and defined child abuse as “Child abuse and maltreatment constitutes all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child's health, survival, development or dignity in the context of a relationship of responsibility, trust or power.”

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Abstract

World Health Organization has identified violence against children as a growing public-health issue with a global magnitude. This paper explored violence against children as a challenge in the developing world using Pakistan as a case study. A systematic review of existing research and literature on violence against children was followed by assessing the magnitude of this challenge and its impact on policy. Most research done in Pakistan is observational, descriptive, and anecdotal with data collected through survey methods and interviews with small sample sizes. The findings suggest that the confluence of macro risk factors, such as poverty, poor legal protections, illiteracy, large family size, and unemployment, create an enabling environment for violence against children. Lack of empirical data makes it difficult to assess the magnitude of this issue. The health problems reported and the extent of human potential destroyed are unknown. Conclusion calls for focused research to examine the prevalence, potential interventions, and policies in Pakistan.

Key words: Child abuse, Human development, Public health, Violence, Pakistan

INTRODUCTION

The World Report on Violence and Health, released by the World Health Organization (WHO) ( 1), presented the issue of violence against children as a public-health problem that has a global magnitude. In the same year (2002), the member nations of the United Nations (UN) pledged to meet eight Millennium Development Goals by 2015 ( 2). Six of these goals are directly related to children, and all are closely linked to the commitment made at the Special Session on Children of the UN General Assembly in 2002 that all governments would work to promote and protect the rights of every child ( 3).

WHO defines violence as "The intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation"( 1). This definition captures the range of potential and actual violence perpetuated on people, including children, the most vulnerable group. For example, an estimated 57,000 deaths have been attributed to homicide among children aged less than 15 years in 2000 ( 3). The global estimates of child homicide suggest that infants and very young children, aged 0-4 year(s), are at the highest risk, while children in lower-income countries are at a higher risk compared to those in high-income countries. The highest rates of homicide for children aged less than five years are in the African Region (AFRO) at 17.9 per 100,000 for boys and 12.7 per 100,000 for girls ( 3).

Violence against children occurs in different forms (physical, sexual, neglect, emotional and psychological) and at multiple levels (individual, household, institutional, and societal). A WHO Consultation on Child Abuse Prevention recognized violence against children as a growing public-health and development problem and defined child abuse as "Child abuse and maltreatment constitutes all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child's health, survival, development or dignity in the context of a relationship of responsibility, trust or power" ( 3). Establishing the precise magnitude of child abuse for any given country is very difficult. Even in wealthy countries, recognizing and measuring the incidence of fatal violence such as infanticide is problematic due to underreporting and misclassification of deaths. The situation in developing countries is even more challenging due to a mix of poor health-information systems, faulty legal and police structures, and sociocultural stigma ( 3). Data on non-fatal abuse is even harder to collect because of different legal and cultural definitions of abuse and neglect across countries. Such cases are more underreported even in countries where mandatory reporting mechanisms exist.

Violence against children occurs throughout the world, including South Asia, which has 23% of the world's population and is one of the world's poorest regions ( 4). In countries, like India, Bangladesh, Bhutan, Nepal, and Pakistan, child labour, child sexual abuse and prostitution, child trafficking and homelessness are commonly reported issues. The largest number of working children in the world-between 40 and 115 million child workers aged 5-14 years-are found in India ( 5). Data from a 1995 Bangladesh survey of children aged 10-15 years in 150 villages revealed that 21% were in the labour force ( 6).

Pakistan is a developing country in South Asia with a population of 153 million and a per-capita gross national income of US$ 420 ( 4). Of the total population, 43% are children aged less than 15 years ( 7), and according to the World Bank ( 4), poverty remains a serious concern in Pakistan, with 33% of the population living under the poverty-line, with a literacy rate of 44%. Pakistan ranks 138 on the Human Development Index ( 8). Pakistan is struggling to make its general and specific environment conducive for meaningful and sustainable advancement in terms of all aspects of human development. Importantly, Pakistan ratified the UN Convention on the Rights of the Child in 1990.

The paper examines the situation of violence against children in Pakistan. Its overall goal is to assess the current state of knowledge on violence against children in the country. The specific objectives are to conduct a systematic review of the literature on violence against children, to understand the nature and context of this problem, to estimate the magnitude of violence against children in Pakistan as a public-health problem, and to define critical gaps in existing knowledge for public-health research and policy.

MATERIALS AND METHODS

A comprehensive review of literature on violence against children in Pakistan was undertaken. In addition to published articles that contained qualitative and quantitative data from original research or review, organizational reports and unpublished items were also reviewed. PubMed was searched for literature published in English from 1966 to 2003. Combinations of key words, such as 'violence against children', 'abuse', 'child maltreatment', 'pediatric violence', 'neglect', 'child labor', 'child sexual abuse', 'child trauma', 'Pakistan', and 'South Asia', were used. Further searches were conducted using the author's name and 'related articles' links for key publications. A separate search was conducted in www.pakmedinet.com (electronic database) to identify literature from local health journals within Pakistan. A Web-based www.google.com search was also done to retrieve government publications and institutional reports released by international, non-governmental, academic organizations, and research centres. Organizations, such as United Nations Children's Fund (UNICEF), Human Rights Commission of Pakistan, WHO, and International Labour Organization (ILO), were searched using the same key words as above.

Abstracts of each paper of potential interest were reviewed by both the authors for inclusion in the study, and full copies of these publications were obtained. Literature was included in the review if it was based on a population living within the geographical boundaries of Pakistan, in English, relating to any type of violence against children or included information on children aged less than 18 years. Articles were excluded if participant populations were outside Pakistan, represented violence against adults aged over 18 years only, or if they were news reports. Each paper was reviewed to extract qualitative and quantitative data on violence against children. These were tabulated and summarized to assess the magnitude and characteristics of violence against children in the country. A quantitative analysis was done to see if rates of prevalence and summary distributions could be established. Qualitative analysis explored the type, design, and location of each study and evaluated recurring themes and relations for causes of violence.

RESULTS

The systematic review of literature on violence against children in Pakistan identified 15 published papers-three editorials, 10 original research papers, and two review papers-written between 1984 and 2003 (Table ). Unpublished literature covered 11 organizational reports generated during 1998-2003 (Table ). The following main themes predominated the literature on violence against children: child labour ( 9- 18); sexual abuse ( 16, 19, 20- 23); child neglect, as it manifests in the form of lack of education, gender discrimination, and malnutrition, particularly for the girl child ( 19, 20, 22, 24- 26); juvenile law ( 16- 19); and impact of political or street violence on children ( 16, 19, 26, 27). Most published studies were from national medical journals, had an urban bias towards larger cities of Pakistan, and the populations studied were small, except for one study from Karachi city that screened 112,029 children ( 28). The appearance of empirical work in the published literature reflected some research on violence against children in the country, while reviews and situation analysis dominated the unpublished literature.

Table presents the understanding of violence against children as used in the literature in Pakistan. An important common feature to nearly all reviewed literature was their definition of violence against children, based on the United Nation's Convention on the Rights of the Child (CRC). In addition, the selected papers in Table derived their own definition from CRC, which is either issue-specific or is an effort to apply the CRC to a type of violence against children. All definitions in the reviewed papers acknowledge four universal forms of abuse-physical, sexual, mental and neglect-resulting in actual or potential harm to health, survival, development, and dignity of the child, as constituting violence against children. The first two forms (physical and sexual) are elaborately defined and are deemed detectable because of their very obvious nature. However, neglect and psychological violence has been referred to as 'suffering', 'intimidation by position of differential power', 'moral/ethical abuse', and 'harmful traditional practices'. In this context, the reviewed literature identified corporal punishment, impact of street violence on children, malnutrition, poverty, educational neglect, and abandonment, as different forms of neglect.

A summary of all the suggested 'reasons' for child labour mentioned in 11 different studies relating to the issue in Pakistan are presented in Table . Some of these causes can be grouped together although no single category is mutually exclusive. For instance, family circumstances, unemployed parents, large family size, survival, and forced labour could be described as poverty-related causes. These working children seem to come from large, poverty-stricken families, with other factors, such as unemployment, drug addiction, migration, and illiteracy playing an important role. Another rationale proposed in the literature is weak legislation relating to both elementary education and child labour, including bonded labour. No quantitative estimates of the contribution of these causes, or estimates of risk were found in the studies. As a result, the commonality of their appearance has been used for illustrating the potential frequency of this cause.

Quantitative data were available from six studies only on child labour (Table ). These papers suggest that children start work as early as three years of age, while the median age of entering the workforce was reported to be seven years by two studies ( 14, 15). Certain types of work were common across studies, such as domestic employment (household labour), work in mechanic shops, small hotels or restaurants, and work in fruit markets with the youngest children reported to be part of 'beggar' groups. Children work for long ( 6- 15) hours without breaks or leisure time, and sometimes children sleep at their work place in highly inadequate living conditions. Children work for very low wages, sometimes only for food in return, with their contribution to monthly household income ranging from 1% to 29%. The majority of these children are either completely illiterate or poorly educated. 10-60% of children reported physical abuse at the work place, while two studies reported that 66-79% of children felt pushed into work.

Table 5

Source

Children abused (rate per 100,000)

Raped/ sodomy %

Murdered %

Gang raped/sodomized %

Seriously injured %

Other %

We have quantitative data from five organizations on physical and sexual child abuse from 1998 to 2003 (Table ). Three organizations reported national data, and two focused on statistics from Punjab province and Lahore city. However, these organizations made it clear that these data did not represent actual numbers of such incidents in Pakistan because of underreporting. Reasons, such as family honour, concepts of morality, and cultural taboos, were major reasons for underreporting. The three national reports indicated a higher proportion of boys in those reportedly abused, while the two reports from Punjab reported a higher proportion of girls. Using a reference national population (children aged less than 15 years) as of 1998 (latest census available) for the area of study, rates of annual incidence have been generated. These rates assume uniform reporting across the year and have not been adjusted for underreporting to derive 'minimalist' estimates. The reported annual incidence of violence against children ranged from 1.57 to 3.18 per 100,000 for Pakistan. The categories-physical and sexual abuses-used in these reports included abduction, rape, sodomy, torture, or murder against both boys and girls. As can be seen, rape and murder turned out to be most frequent causes, while fewer proportions appeared in the abduction and torture category (Table ). The category of 'seriously injured' is mentioned but not defined in the studies.

DISCUSSION

Violence against children needs to become a public-health priority worldwide. This review showed that there is some, though limited literature (published or unpublished) on violence against children in Pakistan. The literature is mostly focused on the causes and, in some cases, the consequences of child abuse. Most studies and reports have documented child labour, child sexual abuse, and fatal violence, whereas neglect or other non-physical forms of violence have not been captured. The reviewed papers tended to focus on urban settings in the country, while the majority (70%) of the population of Pakistan lives in rural areas. Most work was of observational and descriptive nature with data collected through survey methods and interviews with small sample sizes. The time periods of reporting also vary, and methodological details are often not available in the papers. The duration of reporting differs in all cases from seven months to (over a) one year period. The method of collecting such cases also differed from police reports to special surveillance of newspaper-reported cases. The findings reflect the need for more and better-quality information on violence against children in Pakistan.

All studies in this review present definitions of violence against children that are derived from the United Nations Convention on the Rights of the Child ( 18). This common understanding is very welcome and is important because it allows a universal approach with flexibility to address sociocultural contexts. Although child abuse per se can be defined universally, the diverse types of abuse, their existence in different societies, and more importantly interventions for its prevention and control need to focus on the specific cultural contexts within each country. Pakistan presents a specific set of evolving conservative and traditional social structures, which are reflected in the literature. This review identifies that children in Pakistan experience numerous risk factors in their exposure to the outside world and the quality of care provided by their immediate families. Cultural and traditional norms that foster gender discrimination and under-value the girl child contribute to high rates of overall illiteracy, low nutritional status, and lack of access to health and development opportunities in life ( 29). This represents a hostile macro context, which leads to an increased risk of violence against children (rape, human trafficking, and sexual exploitation). Corporal punishment and the slow process of justice for children who come in contact with the law are another form of neglect at the institutional and societal levels. Dimensions of household neglect, such as improper supervision, abandonment, and educational deprivation, have not been elaborated in the reviewed papers.

The literature review also explored the causes of child labour and its impact on children, their families, and overall human development. There is a strong qualitative association between poverty and related factors (family size, unemployment) with child labour in Pakistan. Studies on child labour indicate that, for these children, living in the cycle of a poor large family with unemployed parents creates the conditions in which they have to work. Illiteracy, lack of educational opportunities, and weak legal structures then further disadvantage these children, making them the lowest paid workers in the country. Working children then experience harsh working conditions, lack of food and rest, and no play which then disproportionately affect their health. Studies documented children reporting complaints of skin and eye infections, problems relating to the digestive system, headaches, dizziness, asthma, body aches, stress, and depression. These health outcomes were not specifically diagnosed in the studies nor were the presence of other health consequences, such as suicide, studied. In addition to putting children in physical danger, work reduces their chances of getting an education. An early-age exposure to 'street survival situations' also makes them at risk for drug abuse, prostitution, and crime.

Studies that provided quantitative data on physical and sexual abuses of children are challenging to interpret. Studies relied on cases of abuse that were either reported in newspapers or also reviewed police records ( 16, 22). Newspapers have been used as sources of health data in Pakistan and for reporting stigmatized events more frequently than the police ( 29). The use of such data in deriving a rate of child abuse is only meant to capture a 'minimalist' estimate of the problem and to stimulate a research agendum for child health in Pakistan. It was not clear whether the trend in available 'estimates' of child abuse, from 1998 to 2003, was because of more events happening or simply because of better reporting. This distribution of reported cases by gender provided an inconsistent pattern across the studies reviewed here. What is clear is that both girls and boys are victims in Pakistan. The usual reason given for not reporting sex-related crimes is that it has a huge social stigma attached to it, not only for the victim but also for the victim's family. Talking about sex in the conservative Pakistani society is taboo; nevertheless, sexual violation and exploitation of children is happening. It is important that this problem is not just acknowledged, but also explored in terms of its magnitude and impact, and national-level data inform policies and strategies for prevention and control.

The concept of post-event care and victim support for child victims barely exists in Pakistan. Non-governmental organizations have initiated limited support services in some urban parts of the country but there are no data to determine either their accessibility or their effectiveness. Moreover, there are no national centres or publicly-subsidized services of this type across the nation. Our review indicates that weak legislation on elementary education, poor labour laws, and corporal punishment are also a determinant of an increasingly complex situation within which violence against children is perpetrated. This goes beyond health, economics, and development to become a political question; a continued lack of political will is, thus, only going to distance the children of Pakistan from realizing their potential.

The confluence of macro risk factors, such as poverty, poor legal protections, and illiteracy, together with family specific factors, such as large size and unemployment, create an enabling environment for violence against children. Focused research is needed to examine the prevalence, manifestations, and potential interventions for violence against children from a public-health perspective. The health problems reported by children and the extent of human potential destroyed are unknown. It is imperative that healthcare providers find alternative ways to identify and address violence as an issue threatening the future of children. It is crucial for policy-makers in Pakistan to recognize that children are particularly vulnerable to violence and that ignoring child rights only further threatens their health and development while they are trapped in a cycle of poverty and helplessness.

REFERENCES

1. Krug EG, Mercy JA, Dahlberg LL, Zwi AB, editors. World report on violence and health. Geneva: World Health Organization; 2002. Violence-a global health problem; pp. 3-19.

3. Krug EG, Mercy JA, Dahlberg LL, Zwi AB, editors. World report on violence and health. Geneva: World Health Organization; 2002. Child abuse and neglect by parents and other caregivers; pp. 59-86.

16. Society for the Protection of the Rights of the Child. The state of Pakistan's children 2002. Karachi: Oxford University Press; 2004. p. 264.

28. Hussain R, Fikree FF, Berendes HW. The role of son preference in reproductive behavior in Pakistan. Bull World Health Organ. 2000;78:379-88. [ PMC free article]

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Violence against Children: A Challenge for Public Health in Pakistan

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World Health Organization has identified violence against children as a growing public-health issue with a global magnitude. This paper explored violence against children as a challenge in the developing world using Pakistan as a case study. A systematic review of existing research and literature on violence against children was followed by assessing the magnitude of this challenge and its impact on policy.

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In Syria’s savage war, it seems incongruous to single out the experiences of one group. Yet many gay men there face a double threat: They’re being persecuted by the Syrian army and by militant groups while their families often reject them, or worse. Of course, the war did not bring homophobia to Syria. Gay men there have long been the target of “honor killings,” as they are considered a disgrace to their families. Others have been imprisoned on the basis of Article 520 of the country’s 1949 penal code, which calls for a three-year sentence for “carnal knowledge against the order of nature.” The war has, however, intensified the surveillance, entrapment and public exposure of gay men.
Over two days in February, Human Rights Watch interviewed 19 gay Syrian men who had taken refuge in Lebanon. (Lesbians are more difficult to find in Syria’s closeted culture.) Their stories offer a glimpse of what gay people face while the nation is consumed by violence, with no end in sight. They described the appalling conditions of Syria’s makeshift prisons, with intense overcrowding — as many as 400 people crammed into a single room — and the frequent use of torture.

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A 26-year-old mobile technician and taxi driver from Aleppo was kept for 23 days in an ice cream factory-turned-detention center, where he was physically and verbally abused. He'd been picked up at a checkpoint by the Syrian Islamic Liberation Front and accused of working for the regime. While detained, he witnessed the execution of two prisoners charged with blasphemy, and he feared that would be his fate. But his father, who is from a "prominent tribe," paid to have him released and helped him flee to Lebanon.

That was before his family knew. When his former captors outed him as gay, his father called him in Beirut and threatened to find and kill him. His brother, who had joined the Islamic Front, threatened to kill him, too. With no one to turn to, he sought the protection of the United Nations refugee agency. He lives every day in fear.

In Syria's savage war, it seems incongruous to single out the experiences of one group. Yet many gay men there face a double threat: They're being persecuted by the Syrian army and by militant groups while their families often reject them, or worse.

Of course, the war did not bring homophobia to Syria. Gay men there have long been the target of "honor killings," as they are considered a disgrace to their families. Others have been imprisoned on the basis of Article 520 of the country's 1949 penal code, which calls for a three-year sentence for "carnal knowledge against the order of nature." The war has, however, intensified the surveillance, entrapment and public exposure of gay men.

Over two days in February, Human Rights Watch interviewed 19 gay Syrian men who had taken refuge in Lebanon. (Lesbians are more difficult to find in Syria's closeted culture.) Their stories offer a glimpse of what gay people face while the nation is consumed by violence, with no end in sight.

They described the appalling conditions of Syria's makeshift prisons, with intense overcrowding - as many as 400 people crammed into a single room - and the frequent use of torture.

Several of the men had been subjected to a particular form of harassment. One couple, identified as gay based on text messages between them, were beaten, referred to pejoratively as "tante" (auntie) and for 10 nights were forced to strip and have sex with each other in front of their Syrian army interrogators, who used chalk to make up their faces. Another man, who used to work in the fashion industry, was abducted by unidentified armed men in an area of Damascus controlled by the Syrian army. He said they similarly referred to him as tante, forced him to strip and raped him.

A 26-year-old told of being blindfolded and handcuffed to a ceiling by unidentified men who said they were affiliated with al-Qaeda and who tried to get him to reveal the names of his gay friends. A 25-year-old tailor was twice detained by Islamists, who also tried to force him to give them a list of his gay friends.

In addition to this abuse, perpetrated by all parties to Syria's conflict, more than half the gay Syrians whom Human Rights Watch interviewed told painful stories of family rejection, ranging from ostracism to violence - and, in five instances, death threats.

A 22-year-old student was stranded in Beirut when his once-supportive family discovered he was gay. He had to abandon his studies and now relies on a small grant from a charitable foundation for basic necessities. "I can't find a job, and I can't go back to university," he said.

A 38-year-old baker, who left home in 2007 when his family found out he was gay, learned recently that his family gave his name to the Islamist armed group Jabhat al-Nusra. "I know my family will always try to find me so they can kill me," he said. He is afraid to seek a job in his trade, saying, "I can't work at a bakery because that's the first place my family will look."

A 30-year-old teacher fled to Lebanon after learning that his brother, who had joined an armed opposition group, had killed his partner and was looking for him.

Lebanon represents hope for the resettlement of the most vulnerable Syrian refugees. The ordeal for gay men, though, doesn't necessarily end at the Lebanese border.

The gay couple we interviewed said they had been in Beirut's southern suburb of Dahiyeh when armed men dressed in black beat them. "Instead of coming to Lebanon to be gay, go fight in your country," they were told before being evicted from their temporary lodgings.

In at least two cases Human Rights Watch documented, gay men were subjected to anal exams by the Lebanese Internal Security Forces - despite calls from the Lebanese doctors' syndicate and the justice minister in 2012 to abolish that practice, which amounts to torture.

Lebanon has taken steps to strengthen a human rights culture in the past few years, including establishing a human rights department in 2008 and a committee to monitor treatment in prisons in 2011. But these bodies wield no effective authority, and have no investigative powers, so abuses continue. And people suspected of homosexuality are still prosecuted under a law similar to the one in Syria.

Humanitarian assistance providers and the Lebanese government, with the support of international donors, must make sure gay Syrian refugees are receiving basic levels of assistance and protection. For gay Syrians, there is no going back, but there are no clear markers on the road ahead.

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A 26-year-old mobile technician and taxi driver from Aleppo was kept for 23 days in an ice cream factory-turned-detention center, where he was physically and verbally abused. He'd been picked up at a checkpoint by the Syrian Islamic Liberation Front and accused of working for the regime.

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I would give voice to refugee women in Pakistan

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I would give voice to refugee women in Pakistan

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Afghan refugees in Pakistan account for about 3 million, making them the largest refugee community in the world. Life for Afghan refugees was not easy in Pakistan. UNHCR found that less than a quarter of them are employed and nearly three-quarters of children do not go to school. Refugee women are the worst as a combined result of their gender and refugee status. Becoming a refugee means losing legal and social status as well as traditional community-based structures that often protect women. Because of this, refugee women are vulnerable to trauma, sexual violence, deepening poverty and increased work burden. According to one estimate, one-third of Afghan refugee women are widowed, but little is done to meet their special needs. Tribal and political leaders also restrict women's mobility in a new "alien" land, which means that few women can go out to find jobs or better opportunities. Women's voices are lacking in policies around the training and planning of refugee camps, although women make up seventy-five percent of the refugee population.

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Afghan refugee women in Pakistan: the invisible causalities of the war in Afghanistan - The F-Word

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Mahwash Bhimjee highlights the difficulties faced by Afghan refugee women in Pakistan, who will lose their refugee status in June of this year

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I would lead to gender equality for Pakistani women, such as the right to education

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I would lead to gender equality for Pakistani women, such as the right to education

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While the state of the education system in Pakistan is terrible and the difference between education providers and people's aspirations, we believe that a window of opportunity is now open to begin reforming the system. There is an urgent need to seize this opportunity, because population dynamics will make education a more serious problem in the next decade if immediate action is not taken. In 2012, UNESCO said Pakistan showed the smallest progress in the region by educating low-income girls. Even when there is a possibility of enrolling in a school, in fact, it can be quite dangerous. In June 2013, militants exploded on a bus carrying university students in Quetta, the capital of Balochistan province in southwestern Pakistan, and the school was closed.

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Malala Yousafzai, the co-recipient of the 2014 Nobel Peace Prize, has been advocating across the world for girls' educational rights, even in the face of extremely difficult circumstances in her home country of Pakistan, where gunmen attempted to assassinate her in 2012.

Of course, women throughout the world face a range of challenges, and none more so than in the developing world. Levels of education, health care and political representation can be dauntingly low, and discrimination and sexual violence are all too frequent.

One of the most prominent cases of a country struggling with the competing dynamics of development, modernization, religion and tradition is indeed Pakistan, the sixth most populous country on earth. The World Economic Forum ranks the country as the least gender equitable in the Asia and Pacific region. The 2012 annual report from the Human Rights Commission of Pakistan details many challenges women there face, including being "attacked and killed on account of asserting their rights to education, work and generally for choosing to have a say in key decisions in their lives."

In 2012, UNESCO stated that Pakistan showed the least progress in the region educating low-income girls: "The poorest girls in Pakistan are twice as likely to be out of school as the poorest girls in India, almost three times as likely as the poorest girls in Nepal and around six times as likely as the poorest girls in Bangladesh." (For additional comparisons between countries and groups within the same country, see the World Inequality Database on Education.) Even when there is the possibility of enrolling in a school, actually doing so can be downright dangerous. In June 2013, militants blew up a bus carrying female university students in Quetta, the capital of Pakistan's southwestern Balochistan province, and the school has since been shuttered. And Malala - the Pakistani schoolgirl and education advocate who was shot by the Taliban for her views - addressed the U.N. in favor of free, mandatory education around the world, adding that she was focusing on women "because they are suffering the most."

Pakistani women who want to contribute to the economy face other barriers as well. A 2012 World Bank report details the difficulties they face gaining access to capital due to social constraints - needing permission from a male to even qualify for a loan, for example. According to the study, 50% to 70% of microloans given to women in Pakistan may actually be used by their male relatives. For further information on these types of obstacles, see the paper "Gender-Specific Barriers to Female Entrepreneurs in Pakistan: A Study in Urban Areas of Pakistan." And even something as basic as using public transportation presents a challenge, according to the International Labour Organization.

The lack of opportunity for Pakistani women is also a loss for their country. According to a 2012 UNESCO report, literate Pakistani women earned nearly twice as much as those who were illiterate.

A study in Comparative Education, "Can Education Be a Path to Gender Equality in the Labour Market? An Update on Pakistan," finds that "the market rewards women's education and skills at a higher rate than men's." As Esther Duflo, a development economist at MIT and the director of the Abdul Latif Jameel Poverty Action Lab, has noted, there is a close relationship between women's empowerment and a country's economic development.

Pakistan's struggling economy needs all the help it can get. The Asian Development Bank estimates that in 2014, Pakistan's GDP growth rate will be 3.5%, half the 7% needed just to absorb new workforce entrants. The World Bank notes that the country's recovery from the global financial crisis has been the slowest in South Asia. According to the Pew Research Center, 80% of Pakistanis say the economy is in poor shape, while a British Council report found that economic factors were the greatest reason for the pessimism of youth on the direction the country is headed.

There are some organizations working to improve gender equality and provide more opportunities for women. The Citizens Foundation, a non-profit organization, runs schools across the country, encouraging female enrollment with the goal of having its campuses gender balanced. The Kashf Foundation, founded in 1996, became the first microfinance institution in Pakistan to target women from low-income communities. The First Women Bank was founded in 1989 to support businesswomen. Pakistan's Small and Medium Enterprises Development Authority (SMEDA) also provides support for female entrepreneurs.

Below is a selection of academic research that sheds light on many of the challenges facing women in Pakistan.

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"Education System Reform in Pakistan: Why, When, and How?"
Aziz, Mehnaz, et al. Forschungsinstitut zur Zukunft der Arbeit, Institute for the Study of Labor, January 2014 IZA Policy Paper No. 76.

Excerpt: "While the state of the educational system in Pakistan is dire, and the gap between education providers and the aspirations of the people huge , we believe that a window of opportunity is now open for initiating system-level reform. It is urgent to seize this opportunity, because population dynamics will make education a graver problem in the next decade if immediate steps are not taken. It is also important to recognize that reform must tackle all sectors of the education system - primary/secondary, higher education and vocational education - as Pakistan does not have the luxury to delay reform in one sector until the other sectors improve. Of course, reforming the system poses a great challenge, but strong examples of success within Pakistan remind us that it can be done. This may be the time for public, private, and philanthropic institutions and change - makers to pool their resources and initiate lasting system - wide change, which some of them have achieved, at least partially, in their respective domains."

Summary: "Pakistan is a patriarchal society where men are the primary authority figures and women are subordinate. This has serious implications on women's and men's life prospects. The aim [of this study] was to explore current gender roles in urban Pakistan, how these are reproduced and maintained and influence men's and women's life circumstances. Five focus group discussions were conducted, including 28 women representing employed, unemployed, educated and uneducated women from different socio-economic strata. Manifest and latent content analyses were applied. Two major themes emerged during analysis: 'Reiteration of gender roles' and 'Agents of change.' The first theme included perceptions of traditional gender roles and how these preserve women's subordination. The power gradient, with men holding a superior position in relation to women, distinctive features in the culture and the role of the extended family were considered to interact to suppress women. The second theme included agents of change, where the role of education was prominent as well as the role of mass media. It was further emphasised that the younger generation was more positive to modernisation of gender roles than the elder generation. This study reveals serious gender inequalities and human rights violations against women in the Pakistani society.... However, attainment of higher levels of education especially not only for women but also for men was viewed as an agent towards change. Furthermore, mass media was perceived as having a positive role to play in supporting women's empowerment."

Abstract: " Drawing on evidence from qualitative field research, this article explores how Pakistani female development practitioners experience their work situations as they are shaped both by local sociocultural norms and globalized development agendas. In this context, policies at global and national levels demand that more female development practitioners work in remote rural places in Pakistan, thus creating new employment opportunities for some Pakistani women. This article argues that, in this work environment, these women are exposed to different expectations about their gender behaviour and that they therefore develop physical strategies on the one hand and discursive strategies on the other in order to negotiate gender relations in a way that allows them to engage in formal employment. This article adds to under-researched debates on gender and work in Muslim countries as well as to debates in critical development and gender studies."

Abstract: "This paper explores the hypothesis that Islamic religious values and beliefs are antithetical to women's education in two cities in Pakistan: Lahore, generally believed to be a socially liberal city, and Peshawar, often regarded as the bastion of conservative values and norms. Leaders and members of selected religious organisations, and some members of women's rights and development organisations, were interviewed to ascertain their views. While there is universal support for girls' education, views on the purpose, content and mode of delivery differ between men and women and also depend on respondents' position on the liberal/conservative spectrum. Some of the policy implications of the findings are discussed."

Abstract: "Socio-political and economic constraints to women's empowerment exist in most of the world societies. However, the nature and shape of these constraints differ from culture to culture and society to society. This study was undertaken on socio-political and economic constraints in women's empowerment in Pakhtun Society of Chakdara District Dir (L) Khyber Pakhtunkhwa, Pakistan. Women in the region have been discriminated in many ways, i.e., at domestic, economic, religious and political levels. To investigate socio-political and economic constraints, the researcher ethnographically selected village Chakdara and a survey of 4,331 households was conducted. Data was collected from 176 educated respondents by systematic random sampling technique using semi-structured interview schedule. The collected information has been classified, tabulated and presented in bar charts, which has further been discussed qualitatively in detail. The study highlights that there exist various social, political and economic barriers to women's empowerment. However, changes are observable in gender roles towards women's participation in socio-cultural activities and the need is to provide educational opportunities, gender representation in government policies and programs and socialization."

Summary: " This article investigates the premise that it is possible to transpose organizational approaches to equal employment opportunity (EEO) from western countries to Muslim majority countries (MMCs). Drawing on policy interviews and documentary evidence from public sector organizations and international development agencies engaged in the promotion of gender equality in Turkey and Pakistan, we question the effectiveness of diffusion of gender equality policies and practices to and among these two MMCs. Our investigation reveals the primacy of context over essence in developing effective ways to construct EEO policies and practices which can be adopted in MMCs."

Summary: "This paper aims to explore some of the manifold and changing links that official Pakistani state discourses forged between women and work from the 1940s to the late 2000s. The focus of the analysis is on discursive spaces that have been created for women engaged in non-domestic work. Starting from an interpretation of the existing academic literature, this paper argues that Pakistani women's non-domestic work has been conceptualised in three major ways: as a contribution to national development, as a danger to the nation, and as nonexistent. The paper concludes that although some conceptualisations of work have been more powerful than others and, at specific historical junctures, have become part of concrete state policies, alternative conceptualisations have always existed alongside them. Disclosing the state's implication in the discursive construction of working women's identities might contribute to the destabilisation of hegemonic concepts of gendered divisions of labour in Pakistan."

Abstract: "This study explored how married women perceive situations which create family conflicts and lead to different forms of violence in urban Pakistan. In addition, it examines perceptions of consequences of violence, their adverse health effects and how women resist violence within marital life. Five focus group discussions were conducted with 28 women in Karachi. Purposive sampling, aiming for variety in age, employment status, education and socioeconomic status, was employed. The focus group discussions were conducted in Urdu and translated into English. Manifest and latent content analysis were applied.... The current study highlights how female victims of abuse are trapped in a society where violence from a partner and family members is viewed as acceptable, where divorce is unavailable to the majority and where societal support of women is limited. There is an urgent need to raise the subject of violence against women and tackle this human rights problem at all levels of society by targeting the individual, family, community and societal levels concurrently."

Abstract: "Despite the overwhelming media attention to the rise of fundamentalism, Pakistan's vocal women's movement has remained unrevealed and unexamined. Gender violence is integral to the agenda of the women's movement, because of the profound violation of women's human rights to life and security. This article draws on formal in-depth interviews and participant observation with women's activists of two prominent women's nongovernmental organizations in Lahore, Pakistan. Using a transnational feminist framework and feminist social movement theory, it examines the organizations' strategies for change and how the historical, political and social environments of their fields for protest shape these strategies. The struggles and achievements of women's activism against gender violence are analyzed with implications beyond the experiences of these organizations."

Abstract: "Examining the influence of women's suffrage and democracy on gender equality in education in a sample of 80 countries, covering Asia, Africa, the Middle East, South America and Eastern Europe, this study shows that countries with a longer duration of suffrage tend on average to perform better in terms of gender equality in education. The empirical association between democracy and gender equality in education disappears when religion is controlled for. In Asia and Africa, other factors, including income, employment in agriculture and colonialism, also help explain the under-representation of girls in education."

Abstract: " A historical analysis of the women's movement and gender reforms in Pakistan, the study provides an evolutionary perspective on social change and development. Data was collected from PhD dissertations conducted in the years 2008-12 in the Department of Anthropology, Quaid-i-Azam University, Islamabad. The paper provides detail about gender and women's reforms and concludes that they are part of a long historic process and that progress has been slowed by multiple factors, including conservative forces. However, the study finds that there is always the possibility of change and development, as is clear from the country's ongoing gender reforms."

"Gender Discrimination and Social Identity: Experimental Evidence from Urban Pakistan"
Delavande, Adeline; Zafar, Basit. Federal Reserve Bank of New York, Staff Report No. 593, January 2013.

Abstract: "Gender discrimination in South Asia is a well-documented fact. However, gender is only one of an individual's many identities. This paper investigates how gender discrimination depends on the social identities of interacting parties. We use an experimental approach to identify gender discrimination by randomly matching 2,836 male and female students pursuing bachelor's-equivalent degrees in three different types of institutions - Madrassas (religious seminaries), Islamic universities and liberal universities - that represent distinct identities within the Pakistani society. Our main finding is that gender discrimination is not uniform in intensity and nature across the educated Pakistani society and varies as a function of the social identity of both individuals who interact. While we find no evidence of higher-socioeconomic-status men discriminating against women, men of lower socioeconomic status and higher religiosity tend to discriminate against women - but only women of lower socioeconomic status who are closest to them in social distance. Moreover, this discrimination is largely taste-based. Our findings suggest that social policies aimed at empowering women need to account for the intersectionality of gender with social identity."
Keywords: women and work, gender equity, South Asia

Last updated: October 10, 2014

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Women, girls and Malala: Research on gender and education in Pakistan, and beyond - Journalist's Resource

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Malala Yousafzai, the co-recipient of the 2014 Nobel Peace Prize, has been advocating across the world for girls' educational rights, even in the face of extremely difficult circumstances in her home country of Pakistan, where gunmen attempted to assassinate her in 2012.