Casting Light on the Care, Recovery and (Re)integration Needs of Commercially Sexually Exploited Children From the voices of children, adult survivors and their service providers in Nepal, the Philippines and Thailand ECPAT International is a global network of civil society organisations working together to end sexual exploitation of children. We aim to ensure that children everywhere enjoy their fundamental rights free and secure from all forms of sexual exploitation. This publication was made possible with the generous financial support of the Swedish International Development Cooperation Agency (Sida). The views expressed herein are solely those of the author and do not necessarily state and/or reflect those of ECPAT International. The support from the donor doesn’t constitute endorsement of the opinions expressed March, 2017 Copyright © ECPAT International 2017 Lead Researcher and Author: Dr. Katherine Hargitt, PSY.D Overall project coordination by: Mariana Yevsyukova and Sheila Varadan Design and Layout by: Margarita de Forteza and Manida Naebklang Illustrated by: Vicky Yang Published by: ECPAT International 328/1 Phayathai Road, Ratchathewi, Bangkok 10400, Thailand Tel: +66 2 215 3388, Fax: +66 2 215 8272 Email: [email protected] Website: www.ecpat.org ISBN: e-book: BN-60-144376 facebook.com/ecpat twitter.com/ECPAT youtube.com/watch?v=mA-6h63lezo Casting Light on the Care, Recovery and (Re)integration Needs of Commercially Sexually Exploited Children From the voices of children, adult survivors and their service providers in Nepal, the Philippines and Thailand Access to Justice and Right to Remedies for Child Victims of Sexual Exploitation Research Project is a multi-country initiative focusing on child survivors’ experiences in accessing judicial remedies and other reparations for sexual exploitation. With its unique focus and prioritization of the voice of the child survivor, the Project empowers children to be active agents in their protection, strengthening access to judicial remedies; identifying the specific recovery and reintegration needs of child victims of sexual exploitation; and improving the opportunity of monetary relief for victims to rebuild their lives. The Research findings and recommendations are presented in thematic papers and reports focusing on Access to Criminal Justice; Access to Recovery and Reintegration; Access to Compensation. TABLE OF CONTENTS LIST OF FIGURES 6 LIST OF TABLES 6 FOREWORD 8 ACKNOWLEDGEMENTS 10 GLOSSARY OF TERMS 12 ACRONYMS 18 EXECUTIVE SUMMARY 19 INTRODUCTION 36 Care, recovery and (re)integration in international legal frameworks 41 Country contexts 45 RESEARCH DESIGN 54 Background 54 Recruitment and training of research assistants/translators 55 Selection of study participants 56 Questions explored and data analysis 57 Ethics and related considerations 58 Research limitations 65 SAMPLE SIZE AND PROFILE OF PARTICIPANTS 70 FRAMING, KEY FINDINGS, AND DISCUSSION 82 1. Foundations of quality care 82 1.1. At the core of all services and programmes 82 1.2. Readiness to work with survivors 86 1.3. A primary ethical responsibility: take care of self! 93 1.4. Expending learning and understanding 102 2. Child protection: Continuum of specialised services and programmes 107 2.1. Prevention 113 2.2. Parents and family involvement and assistance 114 2.3. Hotlines 120 2.4. Outreach 123 2.5. Drop-in centres 127 2.6. Raids and rescue 132 2.7. Basic needs assistance 134 2.7.1. Food and water 135 2.7.2. Personal hygiene and clothing 136 2.7.3. Housing: accommodations and alternative care 138 2.8. Pregnancies, childcare, and parenthood 156 2.9. Health needs and assistance 159 2.9.1. Physical health and medical assistance 165 2.9.2. Mental health and psychological assistance 172 2.9.3 Addiction and rehabilitation 204 2.10. Spirituality and religion 209 2.11. Legal support 214 2.12. Social life, play and recreation 218 2.12.1. Social needs 218 2.12.2. Play and recreational activities 221 2.13. Life skills 224 2.14. Peer-to-peer support and leadership development 231 2.15. Formal and non-formal education 236 2.16. Vocational training and sustainable livelihood 249 2.17. Repatriation 258 2.18. (Re)integration and long-term aftercare 260 2.18.1. (Re)integration 260 2.18.2. Aftercare 266 CONCLUSION 270 RECOMMENDATIONS 282 BIBLIOGRAPHY 302 ANNEXES 325 Annex 1: How was it? 325 Annex 2: Survivors’ advice to fellow survivors 328 Annex 3: “Transition from shelter life to aftercare support” 331 Annex 4: Unstructured discussion questions for CSEC survivors 332 Annex 5: Semi-structured interview questions for service providers 335 Annex 6: ECPAT International children’s consent form 338 Annex 7: Confidential data and log 340 LIST OF FIGURES Figure 1: Discussions with survivors per country 71 Figure 2: Gender of survivors 71 Figure 3: Age of survivors at the time of discussions 72 Figure 4: How many survivors were minors and adults at the time of discussions 72 Figure 5: Number of service providers in each country 78 Figure 6: Number of discussions per country 79 Figure 7: Gender of service providers 79 ECPAT International ‘Access To Justice’ Logo Casting Light on the Care, Recovery and (Re)Integrations Needs of Commercially Sexually Exploited Children: 6 From the voices of children, adult survivors and their service providers in Nepal, the Philippines and Thailand LIST OF TABLES Table 1: Terms used to describe survivors as per age groups 70 Table 2: Estimated length of time as beneficiaries at current location 73 Table 3: Estimated age of entry into CSEC 74 Table 4: Dynamics of entry in CSEC 74 Table 5: Estimated duration of exploitation 75 Table 6: Forms of CSEC represented among survivor respondents 76 Table 7: Dynamics of exit among survivor respondents 76 Table 8: Number of survivors with children 77 Table 9: Numbers of survivors who have known parents 77 Table 10: Survivors’ previous experience with research 78 Table 11: Service providers’ years of experience in the field 80 Table 12: Service providers’ professional titles 81 Table 13: Traits and capacities needed of service providers 88 Table 14: Background understanding of CSEC identified as needed to serve survivors 91 Table 15: Knowledge and skills identified as needed to serve survivors 91 Table 16: Suggested self-care activities 100 Table 17: Training topics specific to the commercial sexual exploitation of children 103 Table 18: Training topics related to direct services 104 Table 19: Training topics specific to the care of caregivers 105 Table 20: Training topics related to legal matters 105 Table 21: Other miscellaneous training topics needed 105 Table 22: Reported adverse physical health problems among CSEC survivors 165 Table 23: Medications and other physical health related needs 166 Table 24: Symptoms of psychological distress and other issues reported by respondents 177 Table 25: Other emotional and behavioural challenges reported by respondents 178 Table 26: Reported substance use and other addictions among survivor respondents 205 Table 27: Religious affiliation of survivor respondents 210 Table 28: Recreational activities identified as helpful to CSEC survivors 223 Table 29: Survival (therapy) camp themes for CSEC survivors 229 Table 30: Life skills training topics for CSEC survivors 230 Table 31: Career goals of survivor respondents 240 Table 32: Vocational and income generating activities of interest to survivor respondents 254 Table 33: The right to be properly researched 291 ECPAT International ‘Access To Justice’ Logo Casting Light on the Care, Recovery and (Re)Integrations Needs of Commercially Sexually Exploited Children: 7 From the voices of children, adult survivors and their service providers in Nepal, the Philippines and Thailand FOREWORD Child victims of sexual exploitation can suffer from appalling physical and psychological violence, the scars of which may remain with them forever. This can impact their lives and relationships in so many ways and too often results in stigma, discrimination and the denial of their fundamental rights. Responses to child sexual exploitation are complex and often need to be highly individualised which results in barriers to recovery and challenges the availability of suitable support services, particularly in resource poor countries. As ECPAT International aims to put the voices of children at the heart of all we do, we therefore wanted to gather insights and recommendations from child survivors, professionals and experts who have experience of care, recovery and reintegration services. This child centred study (carried out in 2014 – 2016 in Nepal, Thailand and the Philippines) is part of a tripartite research project examining access to judicial remedies, access to compensation and access to recovery and reintegration. The purpose of the recovery and reintegration component was to better understand the needs of survivors in order to guide more effective recovery and reintegration services and programmes that can appropriately support these children. This particular report provides a unique insight into the experiences and thoughts of child survivors. It uncovers the myriad of short and long term effects of the abuse they have suffered and how it can manifest into feelings of fear, shame, betrayal and a lack of trust in the adults who have failed to protect them. As these children and youth so clearly articulate throughout this report, the first step to recovery is to be shown security, love, kindness, nurturance and support. As such, the experiences they have with professionals and carers are fundamental in contributing to lessening the negative impact of their abuse and overcoming any trauma. Through this study and its very comprehensive report, we have given both survivors and care-givers a voice to tell us about the impact of child sexual exploitation and what will help these children get back their dignity, sense of belonging and allow them the chance to rebuild their lives. Dr. Katherine Hargitt met and talked with these survivors with great understanding and compassion. Through her exceptional interview skills and professionalism, she was able to create a protective environment whereby all respondents felt empowered and safe from judgement or blame.