Does Health for All Include Health for Street Children, Too?
Danny*, a 14 year old boy, has been living on the streets in Kigali for more than a year. I first saw him on a chilly evening a few weeks ago — he was wearing torn clothes and old shoes, and his body was covered in dust. He was begging for money from people passing on the road. I approached him curious to hear more about his experience on the streets, especially in relation to his access to primary healthcare services.
Danny told me he left his home for the street when conflict between him and his stepmother escalated. At the time, he was in his fifth year of primary school. He has not returned to school since. Danny described total uncertainty about his future and daily exposure to physical and psychological violence, drug abuse contagion, unsafe sleeping places and patterns, hunger, diseases without hope of treatment or cure, and so on. He and other children who sleep in gutters are known as “marines” because their shelters are mostly flooded during the rainy season, leaving them even more vulnerable to illness and other dangers.
Every threat to children is a threat to the Rwanda of tomorrow.
Danny’s situation is sadly not uncommon. Street children number about 150 million worldwide, with more than 30 million in African countries. The number of street children in Kigali alone in 2014 was around 7000. This is especially concerning given the fact that 42.9% of the Rwandan population are children between the ages of zero and 14 years old. Every threat to children is a threat to the Rwanda of tomorrow.
Children living on the streets who have completely left and lost contact with their homes and families for any number of reasons are most susceptible to dangerous health risks. They take shelter under bridges, in destroyed buildings, or other abandoned places that facilitate many forms of abuse that harm their health status. They are exposed to hunger, cold, excessive drug and alcohol use, physical abuse, sexual abuse, and more. In a recent study on the health and social problems of street children, more than half of the children living on the street surveyed had at least one health complaint. In another study, nearly 30% of children living on the street did not seek medical care when in need because of lack of health insurance and money.
The government and some non-governmental organizations such SACCA-Rwanda and FidesCo reach out to street children in various ways, usually with the goal of bringing them into rehabilitation centers that offer housing, education, and some healthcare services while they look for their families for reintegration. However, these centers are severely limited — the majority of street children are not lucky enough to secure a spot.
More innovative measures are needed to bring preventive and curative healthcare services to children living on the streets — they will not be able to reach their potential unless they are given a chance to live healthy lives.
When I spoke with Danny, he told me that he briefly spent time in a rehabilitation center, but was quickly reintegrated with his family. On his return home, problems with his stepmother continued and his family’s poverty forced him to flee again to the streets. Once again, he is living without any guaranteed access to healthcare services.
Danny and many other children living on the streets need the global health community to step up and prove that we mean it when we say that “health is a human right” for all people. More innovative measures are needed to bring preventive and curative primary healthcare services to children living on the streets — they will not be able to reach their potential unless they are given a chance to live healthy lives.
*Danny’s name has been changed to protect his identity.
Julienne Niyikora is a 2016–2017 Global Health Corps fellow at Clinton Health Access Initiative in Rwanda.
