In this case, a child is born at a state-run hospital or maternity ward and is left there in the hands of the Ministry of Health. The staff of the maternity ward will observe the child, giving him or her various medical and developmental diagnoses based on what it known of the family history and birth.
According to Russian medical practice, all risk factors are listed on any infant's chart under the initial diagnosis, and the high risks of many orphans win them a diagnosis of at least “delayed.” Within a few weeks, all infants, except those who require immediate hospital care, are transferred to state-run baby houses where they reside for roughly four years.
Even in the best case, children who are closest to normal health at birth become retarded to some degree after these four years of collective living, deprived of individual nurture. An alarming number of less resilient infants seem to succumb to a self-fulfilling diagnosis of retarded.25 This puts them at a distinct disadvantage at the age of four, when all institutionalized children are evaluated by the state Psychological-Medical-Pedagogical Commission of the Ministry of Education for distribution to institutions for children five years old and up.26 The evaluation, which becomes an official "diagnosis" entered into an orphan's record, is often based on the visiting commission's one-time session with the child.27
It is impossible to overstate the crucial importance of this test to an orphan's future. It is a crossroads which routes the child either to a life of limitedopportunities, or to a life of doom. Many Russian experts interviewed by Human Rights Watch sharply criticized this process, and could readily identify children who were certainly misdiagnosed. Although Russian law provides for the child to appeal through his legal guardian, it is almost impossible for a four-year-old in the custody of the orphanage director to lodge a complaint.
In the best case—if the toddlers clear this hurdle—they will be channeled into an orphanage in the Education Ministry system. There they will receive nine years of public education, learn a vocation, and get a job and place to live after the age of eighteen.
In general these children will enter the tunneled domain of state institutions, where they will inhabit a stultifying world apart from society at large. Orphans in Moscow told Human Rights Watch that their public school classmates teased them as "dyet-domovskii” kids. 28 Upon returning to their dyetskii dom after a school day, the orphans are once again in their separate world, where they find a dubious haven. Teenaged orphans in Moscow and St. Petersburg interviewed by Human Rights Watch reported several categories of abuse they had suffered or witnessed. They said that children with no parents are treated more harshly than those whose parents are in touch with them. Punishment by the director and staff may involve physical assault, verbal abuse, public humiliation (for example forcing children to strip in front of peers), isolation in unheated rooms in winter, or standing naked in front of an open window in winter. Runaways from the orphanage are often regarded as abnormal and sent to psychiatric hospitals.29
Brutal treatment is not confined to direct confrontations with adults, however, for they encourage older children to beat up, bully, intimidate and coerce the younger ones.30 Orphans interviewed by Human Rights Watch had abundant episodes to recount, including punishment by proxy. Not only are they brutalized by this, they are socially stunted, and poorly prepared for a decent life as adults in the outside world.
When the orphans graduate from their world of the dyetskii dom, they face a "new Russia" in such social upheaval and economic disarray that it is distressful for those who have grown up in it. Gone is the social safety net of the Soviet era which at least guaranteed orphans housing, employment and a place in the army. Now, as a diplomat in Moscow told Human Rights Watch, "Their passport is marked with "dyetskii dom" so that people always know they were from orphanages. They have no one to turn to when they're unleashed at eighteen. Some have never ridden a metro before or been to a store or anything. A lot of them end up on the streets."31
Type 2: Worst prospects for a child abandoned at birth and disabled
A baby born with physical or mental disabilities in Russia faces the worst prospects if he or she is abandoned at birth. Some of them have only physical disabilities, or minor mental retardation and could learn to walk and talk, read and write. Among these are children with mild Down syndrome, cerebral palsy, and correctable conditions such as club foot and cleft palate.
Numerous parents are routinely pressured at the maternity ward to give up such infants.32 After initial observation they are transferred to baby houses where the children classified with severe physical and mental disabilities are segregated into lying-down rooms. Confined to cribs, staring at the ceiling, these babies are fed and changed, but they are deprived of one-to-one attention and sensory stimulation and are not encouraged to walk or talk. However tentative their diagnosis of retardation was at birth, particularly for those who have only physical disabilities, it becomes self-fulfilling by the age of four.33
In the worst case, these babies fail the diagnostic evaluation of the Psychological-Medical-Pedagogical Commission at the age of four and are handed over to the Labor and Social Development Ministry. There they are interned in closed internaty for imbetsily and idioty, where there is little more than a perfunctory classroom to keep some of the children busy for a few hours a week.
The bedridden children from the baby houses are again confined to cots in lying-down rooms, often laid out on bare rubber mattress covers, unclothed fromthe waist down and incontinent, as we witnessed in one internat and heard in credible reports from volunteers working in many state institutions.34
Human Rights Watch saw children who were considered “too active” or “too difficult” being confined to dark or barren rooms with barely a place to sit. The staff tethered them by a limb if they believed they might try to escape, and restrained others in makeshift straitjackets made of dingy cotton sacks pulled over the torso and drawn at the waist and neck.35
Children with Down syndrome and other hereditary conditions are regularly passed over for corrective-heart surgery that is routine in the West, based on a long-held bias against spending medical resources on children judged as "socially useless."36
The orphans who survive to the age of eighteen move on to an adult internat, again removed from public view. Some, however, are housed in huge centers with hundreds of handicapped people across the age spectrum and where older inmates feed and care for younger or more disabled ones.
There are scores of variations on the two types of journeys followed by Russian orphans. For instance, some children are abandoned after living several years at home. As one baby house director told Human Rights Watch, this can occur in the case of severe disability, when a family struggles for a while to raise their child themselves:
If the mother decides to keep the child, after three years, maybe, she loses her job. The state subsdidies are minimal. The man might leave her. While the child weighs under twenty-two pounds, she can carry him. But then the baby grows, more care is needed and she has less money, and her physical and moral strength is getting weaker. We know instances where those cases will be found locked in a dark room in an apartment, because the mother had to goto work to feed her children, because the monthly pension for having a disabled child is really miserable—200,000 rubles (U.S. $30).37
Not all variations are so bleak. Volunteers and child development specialists in Russia told us about an increasing number of children who are being kept an extra year or two in the baby houses in order to improve their chances of passing the commission evaluation and avoid banishment to a psychoneurological internat. In addition, not all the children in baby houses are neglected equally, as certain children have winning personalities or attractive characteristics that encourage the staff to devote more attention to them.38
Finally, all children have their individual constitutions, which miraculously navigate some of them through the harshest circumstances, and help them not only to survive, but thrive.