Unit 2 Assessment (Unit 2) New Social Problems in Children

SOCIAL PROBLEMS IN
CHILDREN
Dr Mamta Chhetri 1
STREET CHILDREN
Dr Mamta Chhetri 2
• Street children are casualties of poor
economic growth, war, poverty, loss of
traditional values , domestic violence, physical
and mental abuse
• Every street child has reason for being on
the streets:
- some children are lured by promise of
excitement and freedom
- majority are pushed onto the street by
desperation and realisation that they have no
where else to go
Dr Mamta Chhetri 3
• Street children go through the struggle of
providing themselves with basic things such as
food, shelter, health and clothing
• Providing targeted interventions that meet the
needs of street children requires an
understanding of who they are, what they
need, what they do and how they can be
identified
Dr Mamta Chhetri 4
A street child may be:
a „child of the streets:
- having no home but the streets
- Family may have abandoned him or her or
may have no family members left alive
- Such child has to struggle for survival and
might move from friend to friend, or live in
shelters such as abandoned buildings.
Dr Mamta Chhetri 5
a child „on the street:
- visiting his or her family regularly
- The child might even return every night to
sleep at home, but spends most days and some
nights on the street because of poverty ,
overcrowding, sexual or physical abuse at
home.
Dr Mamta Chhetri 6
a part of a street family:
- Some children live on the sidewalks or city
squares with the rest of their families
- Families displaced due to poverty, natural
disasters, or wars may be forced to live on the
streets
- Often the children in these „street families‟
work on the streets with other members of
their families.
Dr Mamta Chhetri 7
an institutionalized care:
- having come from a situation of homelessness
and at risk of returning to a homeless existence
Dr Mamta Chhetri 8
The typical age and gender of a
street child.
• Typical age of street child varies from place to place
• In developing countries children as young as eight
live completely on their own
• In developed countries, street children are usually
over the age of twelve
• The proportion of girls among street children is
reported to be less than 30% in developing countries
and about 50% in many developed countries
• There are a number of reasons why there are fewer
street girls:
Dr Mamta Chhetri 9
- Fewer girls may be abandoned by their families
- Girls are often socialized (taught by their families
and culture) to be submissive and caring and
therefore they tend to have fewer behavioural
problems as compared to boys
- Since girls have fewer behavioural problems, they
have less conflict with their families and do not
need to leave their home
- Families might get rid of girls by other means,
e.g.„marrying them off‟when they are as young as
13
- The girl would then have another family
Dr Mamta Chhetri 10
- The authorities or individual members of the
community may pick up girls on the street
more quickly
For example: girls may be recruited to do
domestic work in private households or to work
in commercial sex industry.
Dr Mamta Chhetri 11
Importance of identifying street girls
• Girls on the street have more difficulties and

are often overlooked
• Street girls are looked down upon in many
societies and are easily exploited
• They usually have less economic opportunities
than boys and are given less money than boys
for similar activities
Dr Mamta Chhetri 12
• It is important to seek and work to improve the
situation of street girls because by doing so, you
would be:
- Ensuring that young girls and boys have equal
opportunities.
- Boosting their low self-esteem
- They may then participate in income generating
activities and thus break the pattern of vulnerable
situation
- Helping minimize the possibility of early unwanted and
high-risk pregnancies by providing them with
information about sexual and reproductive health.
Dr Mamta Chhetri 13
REASONS FOR CHILDREN ON
THE STREET
• There is one explanation that holds true for
both developed and developing countries -
poverty
• Most street children go onto the street to look
for better way of life.
Dr Mamta Chhetri 14
• To earn money for themselves and support
their families.
- Street children work on the streets to earn money
for themselves
- Some children need to work to support their
families
- Some children may have been denied chance to
go to school or have dropped out of school and
have nothing to do
- They can earn money by begging, car washing,
drug trafficking, juggling,performing music,
scavenging, sex work, shoe shining etc
Dr Mamta Chhetri 15
• To find shelter
- In overcrowded households, children may
decide to leave home to make room for
younger siblings and elderly family members
- Others are on the streets because they do not
have an alternative
- They may have become separated from their
families during civil unrest or their parents/
caretakers may have died from illnesses
Dr Mamta Chhetri 16
• To escape from family problems including
rejection
- Many children feel that living on the streets is
better than coping with problems in their homes
- These problems can include conflicts with
parents, physical or sexual abuse or neglect (e.g.
an abandoned disabled child)
- Some children are forced to leave home by their
families because the family does not approve of a
child‟s behaviour or its consequences, e.g.
pregnancy, homosexuality or substance use
Dr Mamta Chhetri 17
• To escape from work demands in the home:
- In many cultures , children are expected to
participate in routine family tasks
- At times the demands on children may be more
than they can take
- This leads to the child feeling that he or she is
slave or servant
Such children leave home in search of freedom

from adult demands
Dr Mamta Chhetri 18
• To escape from a children‟s institution.
- Street children may feel that children‟s homes
are „like prisons‟
- They cannot adjust to rules after experiencing
the freedom of the streets
- At times the personnel in these institutions
may abuse children
Dr Mamta Chhetri 19
PROBLEMS OF STREET
CHILDREN
• Street children have a greater burden than
other poor children who are supervised by
adults
• Their problems could be grouped into three
classes: social, physical, and psychological
Dr Mamta Chhetri 20
Social problems
• Poverty and illiteracy:
- They lack basic resources to sustain healthy
living
- They usually have no financial means to buy
decent clothing (which may be necessary in cold
places), and no money to buy food, which is
crucial for their development
- Because of the costs of services most street
children cannot afford to go to school
- Even where schools are free,many children cannot
afford to buy uniforms, shoes and books
Dr Mamta Chhetri 21
- Street children live in places where they are
not adequately protected from the environment
- They rarely have access to facilities that they
need for hygiene and sanitation, such as toilets
and clean and safe water supply
- They are therefore more vulnerable to health
problems resulting from poor sanitation.
Dr Mamta Chhetri 22
• Discrimination and lack of accessible
resources:
- When community makes plans, it does not take
into consideration street childrens‟plight
- Street children tend to be excluded from
participating in most of activities and facilities of
other children
- This is one reason why street children often do
not have access to medical, educational ,
recreational and vocational resources
- They face problems such as lack of vaccinations;
poor health , illiteracy and they cannot acquire
skills needed for finding jobs
Dr Mamta Chhetri 23
• Violent Environment:
- The street is an unprotected environment and
street children are exploited frequently
- In some places, street children may even face
the possibility of physical injuries or death
from violence
- Common sources of violence are: the police,
gangs, drug syndicates, those who operate
commercial sex businesses, other street
children, families and sexual partners
Dr Mamta Chhetri 24
• Stigmatization.
- Society usually perceives street children as
difficult children who are out there to cause
trouble
- In general, the public thinks that street children
are uncontrollable and violent, have substance use
problems, have no morals, have lost all the ability
to feel emotions such as love and that they turn
into terrorists
- They tend to be unsympathetic to the street
childrens‟plight
- This negative attitude may be a result of the
society‟s inability to care for its people.
Dr Mamta Chhetri 25
Physical problems.
• Lack of adequate nutrition:
- Even though some street children can usually
get enough to eat, they do not have nutritious
diets
- This leads to malnutrition, anaemia and
vitamin deficiencies
Dr Mamta Chhetri 26
• Injuries:
- Injuries may be caused intentionally (including
injuring self while intoxicated or when
depressed) and unintentionally, e.g. due to use
of tools which have been designed for adults
- The rate of injuries is usually higher for male
than for female street children
Dr Mamta Chhetri 27
• Sexual and reproductive health problems:
- Sexual and reproductive health problems affect
both girls and boys
- Street girls are more vulnerable to physical and
sexual abuse and exploitation
- Common sexual and reproductive health
problems include sexually transmitted diseases(
HIV/AIDS) unwanted pregnancies and unsafe
abortions
- Pregnant street girls do not receive adequate
antenatal care.
Dr Mamta Chhetri 28
• Common diseases:
Street children experience many common diseases
such as :
- Tuberculosis
- skin diseases
- dental problems
- parasitic diseases
can be prevented easily if these children have

enough resources and their basic needs are met
Dr Mamta Chhetri 29
Psychological/mental problems
A Stressful Past:
- Many situations and events that pushed these
children onto the street in the first place (like
natural disasters, man-made disasters ,
exploitation and conflicts) may have a lasting
impact on their wellbeing
Dr Mamta Chhetri 30
For example: family conflict that pushed the
child onto the streets continues to deprive the
child of emotional and material support for years
afterwards
- When the child has his or her own baby,
neither the new parent nor the baby will have
the benefit of the previous generation‟s support
Dr Mamta Chhetri 31
A Transitory Lifestyle:
- Street children in some large cities move frequently
from district to district or between cities
- Sometimes they do this by choice, but at other times
they are forced to move to hide from the police, welfare
authorities, gangs and drug syndicates
These type of lifestyle leads to problems of social

isolation and loneliness and difficulties in developing
emotional attachments to special individuals.
Dr Mamta Chhetri 32
Mental Health:
- The stresses that street children experience
make them vulnerable to emotional problems
,psychiatric disorders and learning difficulties
- They do not receive adequate care for these
conditions
Dr Mamta Chhetri 33
Substance use:
- Many street children are involved in harmful
use of psychoactive substances
- This can lead too overdose, increase the
chance of accidents, violence ,unwanted
pregnancy and unprotected sex
- continued use of substances can lead to
complications such as brain and liver damage
Dr Mamta Chhetri 34
Street children in Nepal
• The MoWCSW formulated „Directives for
Protection and Management of Street Children,
2015 and it is under implementation
• There is a high level 'Street Children
Protection and Coordination Committee' under
the convenorship of secretary of MOWCSW
and representatives from other relevant
organizations
Dr Mamta Chhetri 35
• In line with the aforesaid directives, MOWCSW
and CCWB in coordination with Kathmandu
metropolis, Metropolis Police office, District
Child Welfare Board, Women and Children
Offices, National Centre for Children at-Risk
(Toll Free no. 104), Child Helpline (Toll Free no.
1098) and some NGOs have been carrying out a
campaign for the management of street children
with a slogan of - 'Children don't need to stay and
they should not stay on the street„
Dr Mamta Chhetri 36
• Rescue, protection, psycho-social counseling
services, socialization, family reintegration,
and rehabilitation activities are undergoing
effectively in Kathmandu valley through
various Drop-in Centers and Socialization
Centers
Dr Mamta Chhetri 37
• Rescue work was started from April, 2015
after having extensive consultations with
concerned authorities, organizations, political
parties and street children themselves
• After the commencement of rescue work, 656
children coming from various districts
comprising of 593 (90.4%) boys and 63 (9.6%)
girls were rescued until July 2017 and their
management process is undergoing
Dr Mamta Chhetri 38
• Out of the total rescued children, 47 percent of
children are aged between 10 and 14, 38.4
percent are aged between 15 and 18, and 15
percent are of age below 10 years
• ethnic groups: 31.5 percent Brahman/Chhetri,
17 percent Dalit and 5.3 percent Madhesi.
Dr Mamta Chhetri 39
• Out of the total rescued children, 478 (72.86%)
children were found literate or school drop-
outs and remaining 27.14 percent had never
enrolled to school
• As results of the campaign, it has been
observed remarkable decline in the number of
street children in the Kathmandu Valley.
• This program is in the process of being
extended to other big cities too
Dr Mamta Chhetri 40
• In Chitwan, 40 street children were rescued
and provided shelter through Nepal Police.
• Point 151 of the budget speech of the FY
2017/018 has spelled out that community
based programs will be carried out to rescue,
care and rehabilitate street children.
NOTE : RECENT BUDGET SPEECH???
Dr Mamta Chhetri 41
Organization working for street
children
• SathSath (meaning” together”) has been
working with children and youth living and
working on the street in Nepal since 1998
• Informally established by a small group of
volunteers who had previously worked
with/for street and street based children
Dr Mamta Chhetri 42
• SathSath was formed around street educators
who had spent many years of their life on the
street
• Initially, the group undertook field-based
activities to provide flexible support to
children on and of the street through these
street educators and founders of SathSath in
1998
Dr Mamta Chhetri 43
• Vision
Society will respect the rights of every child and
youth (and their immediate families)
• Mission
Empower children and youth to defend their
rights and determine their lives
Dr Mamta Chhetri 44
Objectives
• Advocate and create awareness of child rights
(human rights of youth) to society
• Create a platform for the social reintegration
• Prevent children and youth from risk of falling
victim to exploitation and abuse
• Generate and develop capable human
resources to advocate and address the
problems of most disadvantaged children and
youth
Dr Mamta Chhetri 45
Street Children of Nepal(Sath Sath)
• There are more than 5000 children living and
working on the streets of Nepal
• These children are among the most vulnerable in
society, frequently falling victim to some of the
worst forms of child labor and exploitation
• Street children are misunderstood, negatively
viewed and stigmatized by large portion of
society
• This social misunderstanding only serves to
compound the challenges these children face on a
day to day basis
Dr Mamta Chhetri 46
• Street children exist in all of Nepal‟s major cities and
towns.
• As the population grows, and urban poverty spreads,
the number of children living and working on the
streets is increasing
• Though there is no current, reliable estimate into the
number of children living on the streets, it is clear that
numbers are considerably more than they were before
the conflict situation escalated and also after disaster –
much of this is a result of the large number of displaced
people from village areas across Nepal.
• Street children are negatively viewed and stigmatized
by many people, and often labeled with the derogatory
term “Khate.”
Dr Mamta Chhetri 47
PHYSICAL ABUSE
• Most common forms of child maltreatment

• Physical abuse occurs when a parent or
caregiver commits an act that result in physical
injury to child e.g cuts ,bruises , broken bones
• Child physical abuse is a serious problem
Dr Mamta Chhetri 48
• Most children are abused at home or by
someone they know. They often love this
person, or are afraid of them, so they do
not tell anyone.
• Child abuse can happen to child of any race,
religion, or economic status
• Physical abuse. Physical child abuse occurs
when a child is purposely physically injured or
put at risk of harm by another person
Dr Mamta Chhetri 49
Child physical abuse is when a person physically
hurts a child. The abuse is not an accident
Here are some examples of child physical abuse:
• Hitting and beating a child
• Hitting a child with an object, such as a belt or a
stick
• Kicking a child
• Burning a child with hot water, a cigarette, or an
iron
• Holding a child under water
• Tying up a child
• Severely shaking a baby
Dr Mamta Chhetri 50
Physical abuse signs and symptoms
• Unexplained injuries, such as bruises, fractures
or burns
• Injuries that don't match the given explanation
Dr Mamta Chhetri 51
Effects of child physical abuse
• Child physical abuse damages children both
physically and emotionally
• The longer physical abuse of a child continues,
the more serious the consequences
• The initial effects of physical abuse are painful
and emotionally traumatic for the child
Dr Mamta Chhetri 52
• The long-term consequences of physical abuse
impact on the child in their adult life, on their
family and on the community.
• In the most extreme cases, physical abuse
results in the death of the child.
Dr Mamta Chhetri 53
• Studies of physically abused children and
their families indicate that:
- significant number of physical and
psychological problems are associated with
child physical abuse
- Abused children compared with non-abused
children may have more difficulty with
academic performance, self-control, self-image
and social relationships
Dr Mamta Chhetri 54
Initial effects of child physical abuse
• Immediate pain, suffering and medical
problems in some cases death caused by
physical injury.
• Emotional problems such as anger, hostility,
fear, anxiety, humiliation, lowered self-esteem
and inability to express feelings.
Dr Mamta Chhetri 55
• Behavioural problems such as aggression by
the child towards others or self-destructive
behaviour, hyperactivity, truancy, inability to
form friendships with peers and poor social
skills
• Poorer cognitive and language skills than non-
abused children.
Dr Mamta Chhetri 56
Long term consequences of child
physical abuse
• Long term physical disabilities, for example,
brain damage or eye damage.
• Disordered interpersonal relationships, for
example, difficulty trusting others within adult
relationships or violent relationships.
• A predisposition to emotional disturbance.
• Feelings of low self esteem.
• Depression.
• An increased potential for child abuse as a parent.
• Drug or alcohol abuse.
Dr Mamta Chhetri 57
The social cost of child physical
abuse
• The social and economic costs to our community
of child physical abuse are enormous
• They include the financial costs of social welfare
payments and services as well as the social cost to
our community of problems such as mental
illness, homelessness, crime and unemployment,
which may occur in the adolescent or adult lives
of physically abused children.
Dr Mamta Chhetri 58
• Failure to appreciate the costs may be an
important reason why society lacks the will to
aggressively deal with the problem
• Early identification and effective intervention
can ameliorate some initial effects and long
term effects of child physical abuse and
promote the recovery of victims.
Dr Mamta Chhetri 59
• Child maltreatment has enormous immediate and
long-term repercussions
• Beyond death, physical injury and disability,
violence can lead to stress that impairs brain
development and damages the nervous and
immune systems
• This in turn is associated with delayed cognitive
development, poor school performance and
dropout, mental health problems, suicide
attempts, increased health-risk behaviours, re
victimization and the perpetrator of violence
Dr Mamta Chhetri 60
• Maltreatment can be prevented through
interventions:
- That support parents and caregivers
- Promote non-violent norms and values
- Provide education and life skills training
- Strengthen families‟ income and economic
security
- Create and sustain safe environments for children
- Implement and enforce laws against child
maltreatment
Dr Mamta Chhetri 61
Child Sexual abuse
• Child sexual abuse is a form of child abuse that
includes sexual activity with a minor
• A child cannot consent to any form of sexual
activity
• When a perpetrator engages with child (sexual
activity), they are committing a crime that can
have lasting effects on the victim for years
• Child sexual abuse does not need to include
physical contact between a perpetrator and a child
Dr Mamta Chhetri 62
Some forms of child sexual abuse include:
• Exhibitionism, or exposing oneself to a minor
• Intercourse
• Masturbation in the presence of a minor or forcing the
minor to masturbate
• Obscene phone calls, text messages, or digital
interaction
• Producing, owning, or sharing pornographic images or
movies of children
• Sex of any kind with a minor, including vaginal, oral,
or anal
• Sex trafficking
• Any other sexual conduct that is harmful to a child's
mental, emotional, or physical welfare
Dr Mamta Chhetri 63
Warning signs
Physical signs:
• Bleeding, bruises, or swelling in genital area
• Bloody, torn, or stained underclothes
• Difficulty walking or sitting
• Frequent urinary infections
• Pain, itching, or burning in genital area
Dr Mamta Chhetri 64
Behavioral signs:
• Changes in hygiene, such as refusing to bathe or
bathing excessively
• Develops phobias
• Exhibits signs of depression
• Has trouble in school, such as absences or drops in
grades
• Nightmares or bed-wetting
• Overly protective and concerned for siblings, or
assumes a caretaker role
• Runs away from home or school
• Self-harm
• Shrinks away or seems threatened by physical contact
Dr Mamta Chhetri 65
Dr Mamta Chhetri 66
Dr Mamta Chhetri 67
Dr Mamta Chhetri 68
Dr Mamta Chhetri 69
What increases the risk of child
maltreatment?
Having parents or caregivers who
• Suffered from abuse or neglect as children

• Misuse drugs or alcohol
• Are involved in other forms of violence, such
as intimate partner violence
Dr Mamta Chhetri 70
Living in societies
Living in communities that Living in societies
that:
• Have high unemployment
• Lack support services for families
• Have high tolerance for violence
• Don‟t have adequate legislation to address child
maltreatment
• Have cultural norms that promote or glorify
violence
Dr Mamta Chhetri 71
Note :Research shows that children with
disabilities are four times more likely to suffer
from abuse or neglect
Dr Mamta Chhetri 72
These are strategies that can prevent
child maltreatment
• Parent and caregiver support to teach parents
about child development and healthy positive
strategies for raising children
• Promote norms and values that support pro-
social, non-violent behaviour
• Education and life skills training to improve
children‟s knowledge of abusive situations and
teach them skills to protect themselves
Dr Mamta Chhetri 73
• Income and economic strengthening interventions
to increase investments in children
• Creating and sustaining safe environments for
children
• Response and support services to help children
that have been exposed to violence
• Implementation and enforcement of laws, such as
laws banning violent punishment of children by
parents, teachers or other caregivers
Dr Mamta Chhetri 74
The health sector has a crucial role
in addressing child maltreatment
• Raise awareness about the long-term negative
health effects and social burden of child
maltreatment both in the health sector and
other sectors
• Collect and communicate data about
prevalence, risk factors, and health
consequences of child maltreatment
Dr Mamta Chhetri 75
• Develop and test evidence based interventions
to prevent child maltreatment like home visits
with nurses, or parenting programmes held in
provider's offices or health facilities
• Provide support and services to victims of
child maltreatment, including mental health
and psychosocial services
• Collaborate with other sectors to address child
maltreatment especially social welfare,
protection, education and criminal justice
sectors
Dr Mamta Chhetri 76
Abondoned children
• Child abandonment occurs any time a child is
left without proper parental care for an
extensive period of time
• In cases of baby abandonment, some parents
leave a baby in a place where he might be
found by authorities, or in some situations, as a
means of discarding the baby.
Dr Mamta Chhetri 77
• Child abandonment occurs:
- when a parent, guardian, or person in charge of
a child either leave a child without any regard
for the child's physical health, safety or
welfare
or
- in some instances, fails to provide necessary
care for a child living under their roof.
Dr Mamta Chhetri 78
• While abandoning child typically involves
physical abandonment :
- such as leaving a child at a stranger's doorstep
when no one is home
- it may also include extreme cases of
emotional abandonment such as when a
"work-a-holic" parent offers little or no
physical contact or emotional support over
long periods of time.
Dr Mamta Chhetri 79
• Unfortunately, abandoned children (also called
"foundlings") who do not get their needs met
often grow up with:
- low self-esteem
- emotional dependency
- helplessness
• A person charged with deserting a child may
face penalties and other consequences
Dr Mamta Chhetri 80
What Constitutes Child Abandonment?
• The term "child abandonment" is broadly
categorized and used to describe a variety of
behaviors
• Specific examples of abandonment vary, but
common actions that may lead to charges include:
- Leaving a child with another person without
provision for the child's support and without
meaningful communication with the child for a
period of three months
- Making only minimal efforts to support and
communicate with a child
Dr Mamta Chhetri 81
- Failing for a period of at least six months to
maintain regular visitation with a child
- Failing to participate in a suitable plan or
program designed to reunite the parent or
guardian with a child
- Leaving an infant on a doorstep, in trash cans
and dumpsters, and on the side of the road
Dr Mamta Chhetri 82
- Being absent from the home for a period of
time that created a substantial risk of serious
harm to a child left in the home
- Failing to respond to notice of child protective
proceedings
- Being unwilling to provide care, support, or
supervision for the child.
Dr Mamta Chhetri 83
Psychological Effects of
Abandonment on Children
Neglect
• Abandonment is considered a form of neglect by
the U.S. Department of Health and Human
Services and results in similar negative outcomes
• An abandoned child‟s safety may be endangered,
particularly at the time of abandonment
• Children are also put at risk of suffering physical
effects, such as malnutrition, lack of adequate
health care or substandard hygiene.
Dr Mamta Chhetri 84
Low Self-Esteem
• Long-term effects of abandonment influence
how a person feels about herself and her sense
of self-worth
• As a teenager or adult, coping mechanisms
may be inadequate when managing painful
situations
• person with a history of abandonment may
have difficulty relating with a spouse or
partner
Dr Mamta Chhetri 85
Anxiety
• Children aware they were abandoned may later
show signs of anxiety while relating to caregivers
or important people in their lives
• Doris Landry, an author and educational expert in
the field of international adoption, works with
children who were abandoned as infants in China
• Although they were adopted into loving families,
the children still dealt with severe anxiety as
manifested by difficulty separating from parents,
sleep issues and controlling behavior.
Dr Mamta Chhetri 86
Attachment
• An abandoned child may have difficulty forming
lasting bonds with others, particularly new
caregivers
• A child being cared for after abandonment may
not attach with a new family and remain
indifferent toward family members
• He may have a lack of trust in others, fearing the
departure of someone else important to him
• By not allowing himself to bond with others, he
rationalizes that he will not feel hurt again if he is
rejected
Dr Mamta Chhetri 87
CHILD LABOUR
• The term “child labor” is often defined as

work that deprives children of their childhood,
their potential and their dignity, and that is
harmful to physical and mental development
Dr Mamta Chhetri 88
It refers to work that:
• Is mentally, physically, socially or morally
dangerous and harmful to children
• Interferes with their schooling by depriving
them of the opportunity to attend
school, obliging them to leave school
prematurely.
Dr Mamta Chhetri 89
The worst forms of child labour
• Whilst child labour takes many different

forms, a priority is to eliminate without delay
the worst forms of child labour as defined by
Article 3 of ILO Convention No. 182 :
Dr Mamta Chhetri 90
– All forms of slavery or practices similar to slavery,
such as the sale and trafficking of children, debt
bondage and forced or compulsory labour,
including forced or compulsory recruitment of
children for use in armed conflict
– The use, procuring or offering of a child for
prostitution, for the production of pornography or
for pornographic performances
Dr Mamta Chhetri 91
– The use, procuring or offering of a child for illicit
activities, in particular for the production and
trafficking of drugs as defined in the relevant
international treaties
– Work which, by its nature or the circumstances in
which it is carried out, is likely to harm the
health, safety or morals of children.
Dr Mamta Chhetri 92
Hazardous child labour
• Hazardous child labour or hazardous work is

the work which, by its nature or the
circumstances in which it is carried out, is
likely to harm the health, safety or morals of
children.
Dr Mamta Chhetri 93
• Guidance for governments on some hazardous
work activities which should be prohibited is
given by Article 3 of ILO Recommendation
No. 190
• work which exposes children to physical,
psychological or sexual abuse
• work underground, under water, at dangerous
heights or in confined spaces
Dr Mamta Chhetri 94
• work with dangerous machinery, equipment and
tools, or which involves the manual handling or
transport of heavy loads
• work in an unhealthy environment which may, for
example, expose children to hazardous
substances, agents or processes, or to
temperatures, noise levels, or vibrations damaging
to their health
• work under particularly difficult conditions such
as work for long hours or during the night or work
where the child is unreasonably confined to the
premises of the employer.
Dr Mamta Chhetri 95
• The UN General Assembly has urged the
international community to step up efforts to
eradicate forced labour and child labour, and
declared 2021 as the Year for the Elimination
of Child Labour.
Dr Mamta Chhetri 96
Facts and figures(ILO estimates for
2016)
• Worldwide 218 million children between 5 and 17
years are in employment.
Among them, 152 million are victims of child
labour; almost half of them, 73 million, work in
hazardous child labour.
• In absolute terms, almost half of child labour
(72.1 million) is to be found in Africa; 62.1
million in the Asia and the Pacific; 10.7 million in
the Americas; 1.2 million in the Arab States and
5.5 million in Europe and Central Asia.
Dr Mamta Chhetri 97
• In terms of prevalence, 1 in 5 children in Africa
(19.6%) are in child labour, whilst prevalence in
other regions is between 3% and 7%: 2.9% in the
Arab States (1 in 35 children); 4.1% in Europe
and Central Asia (1 in 25); 5.3% in the Americas
(1 in 19) and 7.4% in Asia and the Pacific region
(1 in 14).
• Almost half of all 152 million children victims of

child labour are aged 5-11 years.
42 million (28%) are 12-14 years old; and 37
million (24%) are 15-17 years old.
Dr Mamta Chhetri 98
• Hazardous child labour is most prevalent
among the 15-17 years old,(19 million) is done
by children less than 12 years old.
• Among 152 million children in child labour,
88 million are boys and 64 million are girls.
Dr Mamta Chhetri 99
• Fifty eight percent of all children in child labour
and 62% of all children in hazardous work are
boys
• Boys appear to face a greater risk of child labour
than girls, but this may also be a reflection of an
under-reporting of girls‟ work, particularly in
domestic child labour.
• Child labour is concentrated primarily in
agriculture (71%), which includes fishing,
forestry, livestock herding and aquaculture, and
comprises both subsistence and commercial
farming; 17% in Services; and 12% in the
Industrial sector, including mining.
Dr Mamta Chhetri 100

WHO (HAZARDOUS CHILD LABOR )
• Children can be found in almost any economic

sector
• At a global level, most of them are in agriculture
(70%), Some hazards in agriculture are :
- exposure to pesticides
- the use of dangerous machinery or tools (like
knives), carrying heavy loads, the presence of
snakes
• Children working in agriculture are the ones
suffering most injuries

• For children working as domestic labourers,
the hazards are sometimes not that obvious ,it
can be the psychological hazards:
- Isolation
- Abuse
- Exploitation
• Domestic labour is often called “hidden”

• Children are often “achievers”, they want to
perform well, go that extra mile, and are
inexperienced and untrained in dealing with
hazards
• Tools are not made for them, and thus pose more
hazards
• There are no personal protection devices for
children
• Girls are at special risk and often begin to work at
a younger age and have a double work burden (at
home and in the fields)
• They frequently work longer hours.

• Occupational hazards cause not only short-
term health effects example
- mainly injuries
- skin problems etc
but
most effects are long-term and will only become
evident in adulthood(difficult to measure and to
quantify)
Example: Cancer, infertility, chronic back pain
etc are some of the expected long-term outcomes
Child labour in Nepal
• Child labour refers to any work that deprives
children off their childhood and their right to
education, health, safety and moral
development based on the ILO standards on
child labour are defined by the ILO Minimum
Age Convention, 1973 (No. 138) and the
Worst Form of Child Labour Convention,
1999, (No. 182)

• Though child labour is declining at the rate of
100,000 every year, Nepal still accounts for
1.6 million children between (5-17 years) in
child labour
• Of these 621,000 are estimated to be engaged
in hazardous work
• Estimates suggest that 60 per cent of children
in hazardous workplace are girls ( 373,00O)

Facts and figure of child work and
child labor in Nepal
• Of total 7.7 million children between 5 and 17

years of age in Nepal an estimated 3.14 million
(40.4%)children are working (in employment)
the great majority in rural areas
• Two thirds of working children are below the
age of 14

• Of the total number of working children half
fall into the category of child labor which is
likely to interfere with child‟s education or to
be harmful for child health or physical,mental,
social ,spiritual development
• 6,21,000 children are estimated to be engaged
in hazardous work
• More girls(48%)than boys (36%)work and
60% of children in hazardous work are girls

• In kathmandu valley an estimated 11-13000
girls and women are working in „‟night
entertaiment industry” of which many are
forced to engage in sexual activities and are
vulnerable to trafficking
• Nearly one half of all entertainment workers
entered the industry before the age of 18
• 4.5% of primary school aged children are out
of school

• Decline of child labor in 5-14 years age group
and decrease of child labor in some sectors
such as carpet making ,some stone quarries
,beedi making ,portering ,bonded labor
• Furthermore new sectors are emerging and
there Is increase working children in activities
related to adult entertainment and sex
industry(girls mainly),street vending and
highway hawkers home based work,jari
,motorbike and bicycle repair

Causes and consequences of child
labor
Factors related to child labor and its
consequences:
- Poverty
- Inadequate education
- Lack of Legal and employment structure
- Little knowledge and awareness of society at
large and parents in particular
- Social and cultural practices including gender
related discrimination

• Lack of adequate child protection measures
including legal policies
• As long as poverty, illiteracy is prevalent
incidence of child labor will continue in
Nepal

International conventions
The convention on the rights of the child (1989)
• Outlines fundamental rights of children
- Including rights to be protected from economic
exploitation and harmful work
- From all forms of exploitation and abuse
- From physical and mental violence
- Ensuring children will not be separated from their
family against their will

Rights are further refined by two optional
protocols
1.On the sale of children ,child prostitution and
child pornography
2.On the involvement of children in armed
conflict

The ILO minimum age for employment
convention:no 138
- Prohibits economic activity performed by
children below the age of 13 (12 in developing
countries)
- Sets minimum age for admission to
employment at 15(14 in developing countries)

- ILO convention no 138 gives specific
exemption and allows the children between 12-
14 years old (for countries that specify minimum
age of 14) to work in case of light work (<14
hours /week )which does not intervene with
compulsory schooling or harm child health and
development

- Convention allows for regular work (<43
hours/week) and non hazardous work for
children between 15-18 years .

The ILO Worst form of child labour convention
No 182
- Complements ILO convention no 138 and
determines that no child can be engaged in any
form of slavery or practices similar to slavery
such as
 Trafficking of children
 Debt bondage
 Forced labor
 Procuring children for illicit activities for
prostitution,pornography ,forced or compulsory
recruitment for use in armed conflict

National legislation and legal
framework (NEPAL)
The children's act 1992:
- As per the act child is define as person below
the 16 years
- Act ensures to protect the rights and interest of
children and their physical ,mental and
intellectual development
- Prohibits child below 14 years to engage in
any kind of labor work

The child labour (Prohibition and Regulation)
Act 2000:
- The act regulates hours of work children aged
14-16 (not more than 36 hours per week)
- Prohibits employment of children younger
than 16 years of age into hazardous work
- Prohibits engagement of children below 14
years in any kind of employment /labor work

- Act specifies that no child can be engaged in
work against his/her will by way of persuasion or
by subjecting him/her to any influence or fear or
threat or by any other means will be liable to an
punishment of an imprisonment of one year in
maximum or fine of 50,000 rupees

The kamaiya labour prohibition Act 2002:
- Act prohibits bonded (child) labour makes
provision for freeing them and cancelling debt
- As result of this act many bonded (girl
children) in domestic servitude have been
withdrawn and reintegrated into their families

Gaps and challenges
Despite of various Government commitment
still gaps remain:
• Absence of National child labor policy and
concrete implementation strategy including
child friendly budget allocation
• Lack of adequate occupational health and
safety and child protection measures at both
preventive and curative level

• Inadequate human resources and institutional
capacity to coordinate , monitor , initiate
,response and report upon child labour
elimination efforts
• Insufficient awareness on the cause and
consequences of child labor

Conflicting situation
Conflict : Fight, battle, war
- A serious disagreement or argument, typically
a protracted one
OR
- The struggle between opposing forces

• The nature of war has changed dramatically
• Today's conflicts happen where people live
and they take brutal toll on children
• Heavy bombardment and destruction in war
creates a humanitarian crisis where there is
lack of adequate food, clean water and
medicine

• The consequences of war can have major
impact on the health of children for years to
come
• Traumatic events can have profound and
lasting impact on the emotional, cognitive,
behavior
• Depending on the circumstances, the
psychosocial impacts of disasters can range
from mild stress reactions to problems such as
anxiety, depression, substance abuse and post
traumatic stress disorders (PTSD)
• Conflict zone refers to war or political
instability that disrupts essential services such
as housing, transportation, communication,
sanitation, water, and health care which
requires the response of people outside of the
community affected.

• In the First World War, civilians accounted for
5 per cent of casualties
• In the Second World War the figure rose to 48
per cent
• Today, up to 90 per cent of casualties are
civilians an increasing number of these are
women and children

• Some 17 million children have been displaced
by war, more than 2 million children have been
killed due to armed conflict and three times as
many have been seriously injured or
permanently disabled
• Since 1990 More than 1 million children have
been separated from their parents or orphaned.

• The nature of war has changed dramatically
• Its horrors are no longer experienced only by
soldiers fighting on front lines and battlefields
• Wars are being fought not between countries
but within them
• In addition, children are being deliberately
recruited as combatants

• Armed conflict leads to a breakdown in the
family support systems, which is so essential
to child's survival and development
• During crisis government protection and
community support systems also slip away

• As a result, children are being denied the
protection promised to them in the
„Convention on the Rights of the Child‟
• War violates every right of child the right to
life, the right to be with family and
community, the right to health, the right to the
development of the personality and the right to
be nurtured and protected

Burden
• More than 1 in 10 children worldwide are
affected by armed conflict
• From Syria and Iraq in the Middle East to
Myanmar in South-East Asia, millions of
children across the world continue to suffer
grave human rights abuses due to war and
humanitarian crises

• In the annual Children and Armed Conflict
report the United Nations says notable
progress had been achieved over the past 20
years
• But it warns that the “basic rights of children
continue to be regularly violated” including the
denial of education in many troubled places.

• In Afghanistan, violence and bloodshed
remain a daily occurrence, with some 5,000
children killed or maimed in 2017 and the first
three quarters of 2018, and children making up
89 per cent of civilian casualties from
explosive remnants of war
• In Iraq, four children were killed in
November(2017) in the north of the
country when the truck they were travelling to
school in came under attack

• In Palestine, over 50 children were killed and
hundreds more injured . Children in Palestine
and Israel have been exposed to fear, trauma
and injuries.
• In Syria, between January and September
2017 the UN verified the killing of 870
children the highest number ever in the first
nine months of any year since the start of the
conflict in 2011

Effects
Gender Based Violence:
• Among the most severe problems which all
children and women face during armed conflicts
is a heightened risk of rape, sexual humiliation,
prostitution and other forms of gender-based
violence.
• While most victims have been girls, young boys
are also raped or forced into prostitution -
although such cases are generally under-reported
• Thousands of children die each year as a direct
result of armed violence, but millions more die
from the indirect consequences of warfare - as
a result of the disruption in food supplies,
destruction of health services, water systems
and sanitation
• In poor countries where children are already
vulnerable to malnutrition and disease, the
onset of armed conflict can increase death
rates by up to 24 times - with the under-five
years at particular risk
• Malaria, acute respiratory infections,
diarrhoeal diseases, vaccine-preventable and
other infectious diseases continue to be the
leading causes of morbidity, disability and
mortality among children

Psychosocial Health:
• Children who are affected by war have an
increased prevalence of posttraumatic stress
disorder (PTSD), depression, anxiety, and
behavioral and psychosomatic complaints

• Pooled estimates from systematic review of
nearly 8000 children who were exposed to war
revealed that the prevalence :
- Of PTSD is 47%
- Depression is 43%
- Anxiety is 27%

• Young children ages 0 to 6 years exhibit
increased anxiety, fear, startling, attention
seeking, temper tantrums, sadness, and crying
as well as difficulty sleeping alone and
frequent awakenings
• More likely to suffer psychosomatic
symptoms, such as stomach aches and
irregular bowel movements, and they
demonstrate alterations in their play, which can
become either more aggressive or more
withdrawn

The Sustainable Development Goals state that
every child has the right to a quality education
but due to the violence in conflicts and post-
conflict conditions, schools are destroyed, and
displaced children often can‟t continue their
education

Challenges
• Despite advances that have been achieved
past decades, basic rights of children are
regularly violated
• The Middle East is one of the worst-affected
regions
• In addition to wars where thousands of
children have been killed, maimed, and/or
recruited, there are rapidly developing
humanitarian crises of serious concern.
• In Iraq, the UN children's
agency UNICEF estimates that more than
500,000 children and their families were
trapped in Mosul with food and medicine
running out and clean water in short supply
• Syria continues to suffer terribly with some
500,000 children living in besieged areas,
completely cut off from humanitarian aid.

• In Yemen, the war has put 1.5 million children:
- At risk of acute malnutrition
- Rights of children to health have been severely
compromised by attacks on hospitals in not
only Yemen but Afghanistan and Syria and
many others

Remedial Measures
• Wars are not going to disappear overnight, but
their effects can be mitigated
• Vital measures include:
- Removing child soldiers from the battlefields
- Banning the manufacture of weapons such as
anti-personnel land mines that target civilians
- Child protection can be used as means of
opening up dialogue
- Rehabilitation needs to be addressed
- Many children have immediate needs for food
or shelter
- They also require psychosocial support to help
them recover from emotional wounds

Urbanization:
• Urbanization is a population shift from rural to
urban areas, "the gradual increase in the
proportion of people living in urban areas",
and the ways in which each society adapts to
the change

• Urbanization is the relative increase of the
urban population as a proportion of the total
population and it is occurring on a scale never
before experienced
• Urbanization will present major challenges for
the nations least prepared to meet the
inevitable strains of urban growth

urban health hazards and associated health
risks:
- Substandard housing
- Crowding
- Air pollution
- Insufficient or contaminated drinking water
- Inadequate sanitation and solid waste disposal
services
- Vector-borne diseases
- Industrial waste
- Increased motor vehicle traffic
- Stress associated with poverty
- Unemployment
Urbanization cont
• Local and national governments and
multilateral organizations are all grappling
with the challenges of urbanization
• Urbanization has led to increased productivity
and economic diversification, but also
deprivation, poverty, and marginalization.

• The cumulative impact of urbanization has
serious effects on urban dwellers, especially
poor children
• Lead emitted from car exhausts or industry
causes reduced fine motor coordination,
hyperactivity, lower IQs in slum children
• Children in slums are more vulnerable to
diseases and deficiencies than their rural and
other urban counterparts.

• Adult supervision of children is rare
• Schools are not always available
• Interaction between children and parents,
recreation, and cultural stimulation are all
lacking
• Child labor is common.

• The promise of jobs and prosperity, among
other factors, pulls people to cities
• Half of the global population already lives in
cities, and by 2050 two-thirds of the world's
people are expected to live in urban areas

Threats
• Intensive urban growth can lead to greater poverty, with
local governments unable to provide services for all
people.
• Automobile exhaust produces elevated lead levels in
urban air.
• Large volumes of uncollected waste create multiple
health hazards.
• Urban development can magnify the risk of
environmental hazards such as flash flooding
• Animal populations are inhibited by toxic substances,
vehicles, and the loss of habitat and food sources.
Cause of urbanization
• Industrial revolution
• Emergence of large manufacturing centers
• Job opportunities
• Availability of easy transportation
• Migration

Effects of urbanization
• Positive
• Negative

Positive /advantages of urbanization
• Reduce transport cost , exchange of ideas
• Cities offer opportunities
• Social and religious taboos disappear
• Accessible to reach services for health care can
prevent child morbidity and mortality
• Employment opportunities

Negative /disadvantages of
urbanization in children
• In developing countries, about a third of urban

inhabitants live in impoverished slums

Slum areas typically suffer from:
• Poor housing with small, overcrowded houses

built very close together using inadequate
materials and with uncertain electricity supply
• Restricted access to water supplies
• Little or no sanitation/latrine facilities and no
solid waste disposal, which leads to a polluted
and degraded local environment

• Inadequate health care facilities which,
coupled with the poor living conditions,
increases sickness and death rates
• Insecure living conditions – slum dwellers may
be forcibly removed by landowners or other
authorities

• These condition will often effect the
vulnerable population i.e children

• Provision of water and sanitation services to
growing urban settlements, peri urban and
slum areas presents critical challenges
• It is especially difficult to provide water and
sanitation services to deprived areas and the
poorest people
• Many people in these areas live without
access to safe drinking water and proper
sanitation

• Poor environment, housing and living conditions
are the main reasons for poor health in urban
areas
• Contamination of water sources can cause
epidemics of waterborne disease
• Close proximity to other people can make the
spread of many types of infectious disease more
likely.
• The polluted air can also cause respiratory disease
and contribute to premature deaths among more
vulnerable sections of the population such as
older people and children
• Population movements also put pressure on
food supplies and on food distribution
• As people migrate to the cities, they tend to
use purchased food instead of their own crops
and this makes them more vulnerable to
changes in food prices
• As the population grows and the demand for
water and land increases, it becomes difficult
to increase food production in a sustainable
way

• Many children will suffer from nutritional
problems because of inadequacy of food
supplies ,costly price , consumption of more
junk food
• The positive effects include economic
development, and education
• Urbanization places stresses on existing social
services and infrastructure
• Crime, prostitution, drug abuse and street
children are all negative effects of urbanization

• There tends to be lack of social support for
children in school and home by their hard
working, usually poor parents
• Inadequate income, overcrowded housing and
poor living conditions create fertile ground for
the development of violence
• Violent crime is more visible in the cities than
in rural areas and it affects people‟s everyday
life and major effects on children
• Crime in the city can create sense of
insecurity in its inhabitants

Solutions
• Combat poverty by promoting economic development
and job creation.
• Involve local community in local government.
• Reduce air pollution by upgrading energy use and
alternative transport systems.
• Create private-public partnerships to provide services
such as waste disposal and housing.
• Plant trees and incorporate the care of city green spaces
as a key element in urban planning.
• Proper legislation and safety net provisiosn to address
vulnerable population (i.e children )

REFUGEE CHILDREN
• Refugees are people who are seeking safe
place after being forced to flee of violence, ill
treatment and war
• Chased by bullets and bombs, children and
families are literally running for their lives
• The word refugee come from the word refuge
"the state of being sheltered from pursuit,
danger or difficulty"

• There are more than 25 million refugees
worldwide
• More than 11 million of them are children.
• Refugee children are among the most
vulnerable in the world
• Every day, they risk loss of some kind,
including the loss of the future that every child
deserves.

• Homes and possessions can be replaced,
children are irreplaceable
• Many refugee children have been injured
escaping their homeland
• Others have been orphaned or lost brothers
and sisters - robbing them of happy childhood.

• Four million refugee children around the world
are currently out of school, leaving them
increasingly vulnerable to discrimination and
potential abuse, as well as exploitation by
traffickers, or the pressure of entering into
early marriage.
• More than half of these out-of-school refugee
children are found in just seven countries:
Chad, Democratic Republic of the Congo,
Ethiopia, Kenya, Lebanon, Pakistan and
Turkey
1 OUT OF 2 ELEMENTARY SCHOOL AGED
CHILD REFUGEE DO NOT ATTEND SCHOOL
(REASON)

• While the word refugee is generally spoken in the
context of Syria or Middle East
• But the world‟s largest refugee settlement is now
in Uganda
• Before this year(2018), Dadaab refugee camp in
Kenya was the largest, home to over 245,000
people.
• In the last year, unimaginable violence in South
Sudan has caused close to one million people to
flee the country, more than 800,000 into Uganda,
with most settling in Bidibidi refugee settlement

• Without education, displaced children face bleak
futures
• Especially in times of crisis, education can offer
child stability, protection and chance to gain
critical knowledge and skills
• Schools can also serve as social spaces that bring
together family and community members, and
create bonds of trust, healing and support.
• Failing to provide education for displaced
children can be hugely damaging, not only for
children but also for their families and societies,
perpetuating cycles of poverty and conflict.

• Conflict makes girls more vulnerable to child
marriage
• The reasons for child marriage vary greatly,
depending on the context, but most of them are
based in situations that become worse during
conflict.
Fear of rape and sexual violence, of unwanted pre-
marital pregnancies, of family shame and dishonor,
of homelessness and hunger or starvation have all
been reported by parents and children as reasons for
early marriage.
• In some instances, child marriage has been used
to facilitate migration out of conflict affected
countries and refugee camps

• Marriage of children under 18 years old is not
new phenomenon in Syria
• child marriage has evolved from cultural
practice to coping mechanism.
• Families arrange marriages for girls, believing
marriage will protect them and also to ease
financial burdens on the family
• According to gender-based violence experts,
trend increased in 2017 and girls are being
married at younger ages

UNICEF (2019 )
• Across the globe, nearly 50 million children
have been uprooted forced to flee brutal
conflict and extreme poverty
Millions of children caught in wars in Syria,

Iraq, Yemen and South Sudan and many other
countries

• Child refugee crisis is worst since World War
II a humanitarian emergency that demands
immediate action.
• Whether these children are migrants, refugees,
or internally displaced, they are all children
first
• They don't choose where they're born
• They urgently need and deserve help now.

HISTORY (NEPAL)
• Tibetans first sought refugee in Nepal in 1959,
when tens of thousands left Tibet following the
flight of the Dalai Lama XIV to India.
• Although many only transited Nepal on their
way to India, several thousand Tibetans
remained and the Government of Nepal
responded generously by providing land to
settle and the right to residence

• Tibetans who arrived in Nepal before 1989 and
their descendants are recognized as refugees
by the Government of Nepal
• It is estimated that Nepal hosts between 12,000
and 20,000 Tibetans

• The second group of refugees consists of
refugees from Bhutan residing in camp settings
in eastern Nepal
• As of 31 December 2014, the total camp
population stood at 23,059 refugees
• Refugees from Bhutan are also recognized by
the Government of Nepal since the onset of the
crisis in the early 1990s

• Lastly, so-called urban refugees and asylum-
seekers also seek protection in Nepal.
• They come from 11 different countries and the
majority of them are from Pakistan, Myanmar
and Afghanistan
• As of 31 December 2014, Nepal hosted 137
asylum-seekers and 431 recognized refugees
awaiting a durable solution

National situation of refugee
children
• In the early 1990s, close to 106,000 Bhutanese
refugees settled in seven U.N. supervised
camps in eastern Nepal after being evicted
from their homes in Bhutan
• According to UNHCR in 2007, 108,000
refugees from Bhutan were living in seven
camps in Nepal

• More than 40,000 children are among the
refugees who grew up in the camps, according
to the Bhutanese Refugee Children‟s Forum.
• In 2017,there are still 9, 222 refugees living
in Beldangi and Pathari Sanischare in Morang,
as per the record of the UNHCR. Of them,
some 1,641 are without refugee ID cards

At the end of 2016
• 90%of refugee children in Nepal were enrolled
in primary education

Programmes /activities and response for
refugee children
In context of Nepal
• The United Nation High Commisioner for
Refugees(UNHCR) and the Nepal Bar Association(NBA)
had started the initiative of recording personal event of
children born to refugee parent in various camps in eastern
Nepal.
• Damak Municipality in Jhapa has started issuing birth
certificate to children born to Bhutanese refugees while
living inside refugee camps in eastern Nepal since 1990.
• Though the government had announced to begin the birth

registration process, it is only now that a considerable
number of refugee parent are visiting municipal office daily
to record the detail of their children.
• Most refugee parents participating in the
ongoing birth registration process hope to see
their children become Nepali citizen one day.
• With a large-scale third-country resettlement

under way since 2007, there are still 9, 222
refugees living in Beldangi and Pathari
Sanischare in Morang, as per the record of the
UNHCR Of them, some 1,641 are without
refugee ID cards
STUDY SHOWED
Refugees in Nepal( Impact on Refugee Lives and
National Security)
• The study shows that 90 percentage of the Tibetan
and Bhutanese refugees are facing various
problems: -
- Identity
- Unemployment
- Health
- Socio-cultural and religious
- Access to further education
- Food, shelter

• Refugees are found involved in various
frivolities:
- Murder
- Rape
- Looting
- Fake citizenship
- Fake passport
- Smuggling
- Protest including self-immolation
• Forty-six percentage of the Tibetan and 47
percentage of the Bhutanese refugees agreed
that Nepal is facing different problems due to
the refugee influx
• The study shows that refugee influx has
depressing impact on the internal security of
Nepal

• Study shows cumulative number of the
refugees from Bhutan from 01 January 2008 to
30 November 2015
As of 30 November 2015, 100,706 refugees are

already resettled in third countries and 17,573
refugees are still in Nepal looking forward to be
resettled

• Bhutanese refugees are kept in two camps.
Among 17,573 refugees, 14,070 are in Beldangi
camp in Jhapa, 3,470 are in Sanischare camp and
thirty-three are out of camp
- Number of male of all age group population is

higher in both the camps except the age group 5-11
in Sanischare camp
- In Sanischare camp, the number of female
population of age group 5-11 is higher than male
population

Difficulties and problems faced by
refugee children
Social problems
• loss of status, language problems
• legal problems, social isolation, family conflict, role changes
• discrimination, racism, and xenophobia, and
• lack of family support
Psychological problems
• stress
• Anxiety, mental disturbances
• parental depression
• specific fears, such as separation and isolation and fear of the
future
5 UNIQUE CHALLENGES FACING REFUGEE
CHILDREN
January 15, 2020
• The world is currently dealing with the largest
refugee population on record, with more than
25 million people uprooted from their homes
and living abroad in host communities
• Of this 25 million, 11 million (according to
UNICEF) are children
• This number has doubled over the last 10 years

1. LIMITED ACCESS TO QUALITY
EDUCATION
• A quality education is one of the essentials to
success in life, but this becomes challenge in
refugee emergencies
• According to UNICEF, refugee children are 5
times more likely to be out of school than
other children, often due to school
safety, language barriers in the classroom , and
financial issues.
BARRIERS TO EDUCATION
1. lack of toilets
2. harvest & market days
3. child marriage
4. conflict and war
5. climate change
6. unpaid teachers
7. being an older student
8. being female
9. violence and bullying in the classroom
10. cost of supplies and uniforms
11. outbreaks and epidemics
2. COMPROMISED MENTAL HEALTH AND
THE THREAT OF “LOST” CHILDHOODS
• The causes of forced migration are traumatizing
• But they hit children especially hard as they are
still developing emotionally and mentally
• “When children grow up in armed conflict, their
deep mental scars are often overlooked,”
(UNICEF Executive Director Henrietta H. Fore
said at a 2018 conference in Berlin)

• “Prolonged exposure to violence, fear and
uncertainty can have catastrophic impact on
children‟s learning, behavior and emotional and
social development for many years.”
All of this adds up to the sense of “lost” childhood

for those who have to grow up too quickly in order
to survive.

• It doesn‟t end with past trauma, either:
- Displacement can further affect the mental
health of children, leaving them to develop
number of unhealthy coping mechanisms in
response to their heightened vulnerability
- Even if conflict ends and they‟re able to return
home, these experiences may remain with
them for the rest of their lives.

3. SEPARATION FROM FAMILIES AND
GREATER VULNERABILITY
• UNICEF‟s latest estimates suggest at least
300,000 unaccompanied and separated
children were registered in 80 countries over
the course of two years
• Many of these children are separated from
their families.

• While refugee children in general are more
vulnerable to violence, exploitation, and abuse,
they‟re even more so if they‟re unaccompanied
( 2017 study published by UNICEF found that
risk could be more than doubled)
• Young girls can be the target of gender-based
violence or trafficking
(UNACCOMPANIED REFUGEE CHILDREN
ARE AT MORE THAN DOUBLE THE RISK FOR
VIOLENCE, EXPLOITATION, AND ABUSE)

4. SHIFTING FAMILY DYNAMICS AND
RESPONSIBILITIES
• Overcrowded housing conditions
• The aftermath of traumatic events
• Radically different financial realities
These circumstances are common with refugee

families living in host communities, which can
lead to dysfunctional shift in family dynamics
once they reach asylum
• Can have family-wide impact, and leave
children in an especially vulnerable position.
• In the Central African Republic, violence has
displaced over 1 million people, creating one
of the largest refugee crisis today

5. ISOLATION IN HOST COMMUNITY
• Many of factors can affect how much “at
home” refugee child feels in their host
community
• Beyond these challenges, xenophobia and
discrimination play big role in isolating those
seeking asylum

• Amid such lonely conditions, it‟s hard to
rebuild life or regain sense of normalcy.
• UNICEF report also points out that children
are often isolated from area surrounding
refugees
This adversely affects how much their own

unique needs are heard and considered when it
comes to setting policies or offering social
services and child protection
Syrian refugee children living in informal settlements
in Lebanon

Child trafficking
• Human trafficking is a crime that exploits
women, children and men for numerous
purposes including forced labour and sex
• Child trafficking is a crime that exploits girls
and boys for numerous purposes including
forced labor and sex

• Child trafficking is form of human
trafficking :
- The recruitment, transfer ,transportation and
harboring of children for the purpose of
exploitation
- Any act or transaction where a child is
transferred by any person or a group of people
for money or any kind of other form of
payment

Forms of trafficking
Child trafficking is considered as modern day
slavery.
• Sex trafficking
• Domestic servitude
• Factory and farm slavery
• Children in army
• Children in bondage labor

• When human trafficking occurs, children are
often trafficked for commercial sexual
exploitation or for labor such as domestic
servitude, agricultural work, factory work,
mining or are forced to fight in conflicts.

Vulnerable groups for trafficking
• marginalized and disadvantaged group
• Those with disability
• Migrant workers and their families
• bonded and forced laborers
• urban slum dwellers
• women and children from illiterate households

CHILD TRAFFICKING contd….
• Child trafficking occurs when children are

taken away from safety and exploited
• Children who are trafficked are often forced
into some form of work, used for sex or simply
sold.

• Trafficking is any part of the process from
finding and recruiting children, to transporting
and receiving them
• Men, women and children all over the world
are victims of trafficking, but children are
particularly at risk

• The International Labour Organization (ILO)
says trafficking is among “forms of slavery or
practices similar to slavery”
Child trafficking is linked to :
- Demand for cheap labour, especially where the
working conditions are poor

• Children may be forced into many
dangerous and/or illegal situations
including:
- Slavery
- domestic labour
- sexual exploitation or prostitution
- drug couriering
- being turned into child soldiers
• Children who are trafficked are exposed to
many dangers such as working in hazardous
environments
• Many are also denied the chance to reach their
full potential because they don‟t get an
education or have the freedom to make their
own choices.

• In disasters, conflicts and other humanitarian
emergencies, children can become separated
from their families
Left without protection, they are easy prey for

traffickers to exploit either by force or with false
promise

Children are trafficked for:
• sexual exploitation
• forced marriage
• domestic slavery like cleaning, cooking and
childcare
• forced labour in factories or agriculture
• committing crimes, like begging, theft,
working on cannabis farms or moving drugs.

Types of child trafficking
• Traffickers often groom children, families and
communities to gain their trust
• They may also threaten families with violence
or threats
• Traffickers often promise children and
families that they'll have a better future
elsewhere.

• Trafficking is also an economic crime.
- Traffickers may ask families for money for

providing documents or transport and they'll
make profit from money a child "earns" through
exploitation, forced labour or crime
- They'll often be told this money is to pay off a
debt they or their family "owe" to the traffickers

Traffickers may:
• Work alone or in small groups, recruiting a
small number of children, often from areas
they know and live in
• Be medium-sized groups who recruit, move
and exploit children and young people on a
small scale
• Be large criminal networks that operate
internationally with high-level corruption and
large numbers of victims

Signs of child trafficking
• Spend a lot of time doing household chores
• Rarely leave their house or have no time for
playing
• Be orphaned or living apart from their family
• Live in low-standard accommodation
• Be unsure which country, city or town they're
in

• Can't or are reluctant to share personal
information or where they live
• Not be registered with a school
• Have no access to their parents or guardians
• Be seen in inappropriate places like brothels or
factories

• Have money or things you wouldn't expect
them to
• Have injuries from workplace accidents
• Give a prepared story which is very similar to
stories given by other children.

How many children are affected by
child trafficking?
• The ILO estimates that 21 million people are
trapped in forced labour or slavery
Of those one in four are under the age of 18.

• The estimated number of children trafficked
around the world is 5.5 million
• They suffer violence, exploitation and abuse -
ending up in work, forced marriage,
prostitution, begging and armed recruitment.

Where does child trafficking
happen?
• Every country in the world is affected by

human trafficking, whether as victim‟s
original country, somewhere they travelled
through or the destination.

• According to the UN Office of Drugs and
Crime's 2014 global report on trafficking, 62%
of all people trafficked in Africa and the
Middle East are children
• Other regional figures are 36% in South Asia,
East Asia and the Pacific, 31% in the Americas
and 18% in Europe and Central Asia
• Of all people trafficked in 2011, 21% were
girls, 12% boys, 49% women and 18% men

Who's at risk
Any child is at risk of child trafficking.

• Human trafficking happens due to:
- Inequalities between countries, such as
different education or employment opportunities
- Poverty

• The effects of war
• The demand for cheap or free labour or a
workforce who can be easily controlled and
forced into criminal activity
• Low levels of education
• Lack of equal opportunities, discrimination or
marginalisation.

What efforts have been made to end
child trafficking?
• There are several global initiatives working to
tackle the issue
• The ILO has programme called the International
Programme on the Elimination of Child Labour
that works with governments, charities and other
organisations to fight child trafficking
It helps to protect children at risk, enforce anti-

trafficking laws and assist victims in need.
• The UN Global Initiative to Fight Human
Trafficking sees organization's such as the ILO
and UNICEF working together to eradicate child
trafficking.
Mission :
• To address the factors that cause child trafficking
Includes:
- Making potential victims less vulnerable
- Ensuring protection to those who fall prey and
catching and prosecuting the criminals involved.
• Important part of tackling child trafficking is
to make sure there are safe spaces, such as
schools, where children can be protected from
harm
• In times of upheaval and crisis, education is a
lifeline
• Students in school can get safety information,
adult supervision and higher chance of being
identified and documented
Examples of tackling child
trafficking successfully
Nepal
• After the devastating earthquakes in 2015, there was a
huge increase in the number of girls forced into labour
and sexual exploitation in neighbouring countries
• It was reported that gangs could earn $570 for every
child they supplied to traffickers
• UNICEF provided temporary learning centres and
child-friendly spaces
• These helped children were off the streets and made
them safe from traffickers
• There they also learned about how to keep themselves
safe and healthy.
Bangladesh
• Parul was married at 14 but her husband
abandoned her when she got pregnant. She was
tricked by her aunt who offered to find her a
job in Dhaka
• The aunt took her to Kolkata, India, and sold
her to a brothel where she was forced to
become a sex worker
• She was later found by the police and sent to a
woman‟s shelter.
Facts of trafficking :
• There are an estimated 27 million adults and
13 million children around the world who are
victims of human trafficking
• Eighty percent of those sold into sexual
slavery are under 24, and some are as young as
six years old
• Over 50% of human trafficking victims are
children.

• According to a 2009 Washington Times article,
the Taliban buys children as young as seven
years old to act as suicide bombers
• The price for child suicide bombers is between
$7,000-$14,000
• UNICEF estimates that 300,000 children
younger than 18 are currently trafficked to
serve in armed conflicts worldwide
• Over 71% of trafficked children show suicidal
tendencies
Impacts
• Loss of support from family and community

• Loss of proper education
• Obstacles in physical development
• Psychological traumas
• Exploitation of child right

National initiatives

• Nepal is a source, transit, and destination
country for men, women, and children
subjected to forced labor and sex trafficking
• Nepali women and girls are subjected to sex
trafficking in Nepal, India, the Middle East,
Asia, and sub-Saharan Africa
• Many Nepali living in areas affected by an
earthquake that struck Nepal in April 2015 are
vulnerable to trafficking

• The Government of Nepal does not fully meet
the minimum standards for the elimination of
trafficking; however, it is making significant
efforts to do so.
• The government made modest anti-trafficking
law enforcement efforts
• The 2007 HTTCA and the 2008 regulation
prohibit most, but not all, forms of trafficking
in persons.

• The Nepal Police launched an initiative to combat
human trafficking, resulting in the establishment
of a working group with civil society and
international organizations.
• Many police officials attended a course on
trafficking investigations and victim protection
• The women‟s cell continued conducting a course
on psycho-social, victim-centered training during
the reporting period
• police officers received extensive crime scene
training on investigating trafficking and gender-
based violence by an NGO, in partnership with
the government.
• The government maintained modest efforts to
protect victims
• The Ministry of Women, Children, and Social
Welfare (MWCSW) began developing a
mechanism to record victims information
• NGOs reported increased vigilance by
authorities following the April 2015
earthquake, which led to improved
identification of potential trafficking victims

• Immigration officials received anti-trafficking
training, resulting in an increase in
identification and referral of potential labor
trafficking victims to police

Recommendation
• Increase law enforcement efforts against all forms
of trafficking, including sex trafficking of Nepali
females within Nepal
• Institute formal procedures for proactive
identification and referral of trafficking victims to
protection services
• Lift current bans on migration for domestic work
to discourage migration through undocumented
channels
• Ensure victim services are available to victims of
trafficking of all genders
Prevention
• The government demonstrated increased
efforts to prevent human trafficking.
• The government conducted coordination
sessions with local officials from all districts to
clarify responsibilities in the implementation
of the national action plan
• NCCHT allocated approximately 250,400
Nepali rupees (NPR) ($2,504) to each of the
district committees to support awareness
campaigns, meeting expenses, and emergency
victim services
• Following increased reports of parents
permitting children to move from earthquake
affected areas to the capital for educational
opportunities, MWCSW banned the transport
of children younger than 16 years of age
unaccompanied by a legal guardian to another
district without approval from the child
welfare board
• To prevent sex trafficking in the adult
entertainment industry, NCCHT reinstated
monitoring committees

• The government provided anti-trafficking training
for all Nepali peacekeeping forces before
deployment and for its diplomatic personnel
• Design programs to reduce the risk of trafficking
focusing on the marginalizes groups
• Address the root causes of trafficking focusing on
adolescents girls and boys
• Formulate and implement programs to include all
disadvantaged groups as empowerment programs
ALCOHOL AND DRUG ABUSE
ABUSE:
Inappropriate use of any substance, especially those that
alter consciousness
Alcohol abuse:
Use of alcoholic beverages to excess, either on
individual occasions (binge drinking) or as a regular
practice
• For some individuals, children or pregnant women, for
example, almost any amount of alcohol use may be
legally considered 'alcohol abuse
• Heavy alcohol abuse can cause physical damage and
death
• Alcohol is a psychoactive substance with
dependence-producing properties that has been
widely used in many cultures for centuries
• The harmful use of alcohol causes a large
disease, social and economic burden in
societies

• Alcohol affects everyone differently
• But if you drink too much and too often, your
chance of an injury or accident goes up
• Heavy drinking also can cause liver and other
health problems or lead to a more serious
alcohol disorder

• Research has shown that teens who use/abuse
alcohol before the age of 15 are FOUR
TIMES more likely to go on to develop
problems with alcohol than those who put off
their first drink until after the age of 20.
• Around 25% of children experience
alcoholism in their family before they are 18

• Approximately 500,000 children between the
ages of nine and 12 are drink dependent
• 11000 underage young people try alcohol for
the first time EVERY DAY
• behavioral problems, poor academic
performance, cross- dependence etc
• When they become adults they are more likely
to get involved in crime and violence

DRUG ABUSE:
Drug abuse has also been defined as self-
administration of drugs for non-medical reasons,
in quantities and frequencies which may impart
inability to function effectively and which may
result in physical, social and/or emotional harm

• Use and abuse of drugs and alcohol by teens is
very common and can have serious
consequences
• In the 15-24 year age range, 50% of deaths
(from accidents, homicides, suicides) involve
alcohol or drug abuse
• Drugs and alcohol also contribute to physical
and sexual aggression such as assault or rape

• Repeated and regular recreational use can lead
to other problems like anxiety and depression
• Some teenagers regularly use drugs or alcohol
to compensate from anxiety, depression, or a
lack of positive social skills
• The combination of teenagers' curiosity, risk
taking behavior, and social pressure make it
very difficult to say no

• With family history of alcohol or drug abuse
and a lack of pro-social skills can move rapidly
from experimentation to patterns of serious
abuse or dependency

Warning signs:
• a drop in school performance,
• a change in groups of friends,
• delinquent behavior, and
• deterioration in family relationships.
• There may also be physical signs such as red
eyes, a persistent cough, and change in eating and
sleeping habits
• Alcohol or drug dependency may include
blackouts, withdrawal symptoms, and further
problems in functioning at home, school, or work

Effects of drugs:
• Become victims of diseases like HIV/AIDS,
depression, hepatitis, etc.
• Loss of physical fitness
• Involvement in criminal activities
• Stoppage of progress
• Become offensive/aggressive
• Financial crisis
• Theft, robbery, murder, etc

Alcohol related crime :
• Alcohol plays a large role in criminal activities
and violence
• Excessive drinking has the ability impair a
person‟s judgement and increase the risk of
aggressive behaviors
• researchers have examined the relationship
between alcohol, drugs and crime
• Data suggests that engaging in prolonged
drinking or binge drinking significantly increases
risk of committing violent offenses.
Types of Crimes Associated With
Alcohol
• Robbery
• Sexual assault
• Intimate partner violence
• Child abuse
• Homicide

Prevention of alcohol abuse
• The prevention of alcohol abuse is a shared
responsibility
• For younger people prevention measures
should be taken by parents at home, teachers at
schools , as well as extended family members,
civic leaders, role models

• During formative years parents have most
influence over young people when it comes to
preventing dangerous alcohol consumption
• Kids often look up to their parents‟ drinking
habits as guideline, for starters, so if they see
their parents frequently having lot of alcohol then
it sets a precedent for them to do so as well
• If parents rarely or even moderately drink, then
having an open dialogue with their kids growing
up about the dangers and responsibilities of
drinking alcohol can go long way toward
preventing future abuse.

• Popular culture could do a much better job of
displaying behavior regarding alcohol abuse,
as younger people often emulate what they see
on television and hear in music
• Reality TV shows on multiple channels
frequently depict alcohol abuse as something
really cool or funny, at least in the eyes of
teenagers

• School systems usually have alcohol and other
substance abuse prevention classes or
presentations several times at different grade
levels. This is a good thing and can be very
helpful
• Give right message to the child
• Establishing guidelines which should be
follow up by enforcing these rules ,Guidelines
should be established for what type of
consequence is warranted

Drug abuse in Nepal
• Drug abuse problem in Nepal has become very
serious
• Particularly, the urban and sub-urban areas of
Nepal are susceptible to sale and abuse of
drugs
• In Nepal, marijuana and its byproducts have
traditionally been used for medical purposes as
well as playing role in cultural and religious
occasions for hundreds of years

• Even today in certain communities people
who use marijuana on regular basis are not
considered addicted
• overuse of marijuana and other pharmaceutical
drugs, particularly heroin, has escalated since
the early 1970s, when the hippies began to
enter into Nepal

• Many studies which is done in Nepal have
found out more than 90 percent of the total
drug addicts in Nepal have started using drugs
prior to the age of 16
• The large numbers of drug addicts have been
found to be between the ages of 16 to 20
• The abuse of drugs has led not only to drug
addiction but also to the incidence of
HIV/AIDS, hepatitis B, and other sexually
transmitted diseases (STDs)
• Heroin addicts and other intravenous drug
users (IDUs) have been found to be more
vulnerable to contracting diseases
• IDUs share needles and hence the transmission

of HIV from one person to another is rapid

People usually take to drug abuse in order to
curb the stress caused due to the following:
• Family Issues
• Pressure at Work
• Growing Competition in Schools and Colleges
• Relationship Problems
• Financial Issues
• Feeling of Emptiness

Factors causing drug abuse
Environmental Factors
• A person‟s environment includes various
factors such as his social status, family,
friends, professional life, etc
• Problems in the family, bad company,
competition at work and lack of proper
guidance and support from parents or teachers
can often lead to drug abuse.

Biological Factors
• Drug abuse can also be a genetic problem
• A child stands a high chance of falling prey to
drug abuse if either of his parents has been
under the influence of the same
• Certain mental disorders can also cause a
person to turn towards drugs.

Age Factor
• Though drug addiction can develop at any age
however those who begin taking drugs at an early
age have a high chance of getting addicted
• This is because those areas in their brain that are
responsible for self-control, judgment and
decision making are still in their development
stage
• This is the reason why teenagers are more prone
to drug abuse.

Prevention of drug abuse in children
Prevention Starts With Parents
• As a parent, have a major impact on child‟s
decision not to use tobacco, alcohol, and drugs.
• Prevention starts when you start talking with,
and listening to, your child.
• Help your child make good choices and good
friends.
• Teach your child different ways to say “No”
• Parents are the strongest influence that
children have
• There is no guarantee that your child won‟t use
drugs, but drug use is much less likely to
happen if you:
- Provide guidance and clear rules about not
using drugs.
- Spend time with your child.
- Do not use tobacco or other drugs

Making Smart Choices
• It‟s a parent‟s job to use love and experience to
correct mistakes and poor choices.
• By using a mix of praise and criticism, can
correct your child‟s behavior without saying
your child is bad
This helps children build self-confidence and

learn how to make healthy and safe choices
In time, making smart choices on their own will
become easier
Encourage positive friendships and interests.
• Check to see that the friends and neighbors
child spends time with are safe and have
values similar to yours.
• Find ways to get your child involved in sports,
hobbies, school clubs, and other activities.
These usually are positive interactions that
help develop character and lead to good peer
relationships.
• Look for activities that you and your child or
the entire family can do together.
• Legislative measures should be strong enough
to respond to the issues of drug abuse among
children
• Establishment of organization which helps
children with issues of drug abuse
• Research for intervention measures

THANK YOU

Unit 2 Assessment (Unit 2) New Social Problems in Children

Caricato da

Informazioni sul documento

Titolo originale

Copyright

Formati disponibili

Condividi questo documento

Condividi o incorpora il documento

Opzioni di condivisione

Hai trovato utile questo documento?

Questo contenuto è inappropriato?

Copyright:

Formati disponibili

Unit 2 Assessment (Unit 2) New Social Problems in Children

Caricato da

Copyright:

Formati disponibili

SOCIAL PROBLEMS IN

• Girls on the street have more difficulties and

Such children leave home in search of freedom

can be prevented easily if these children have

These type of lifestyle leads to problems of social

• Most common forms of child maltreatment

• Suffered from abuse or neglect as children

• The term “child labor” is often defined as

• Whilst child labour takes many different

• Hazardous child labour or hazardous work is

• Almost half of all 152 million children victims of

Dr Mamta Chhetri 100

• Children can be found in almost any economic

Dr Mamta Chhetri 101

Dr Mamta Chhetri 102

Dr Mamta Chhetri 103

Dr Mamta Chhetri 105

Dr Mamta Chhetri 106

• Of total 7.7 million children between 5 and 17

Dr Mamta Chhetri 107

Dr Mamta Chhetri 108

Dr Mamta Chhetri 109

Dr Mamta Chhetri 110

Dr Mamta Chhetri 111

Dr Mamta Chhetri 112

Dr Mamta Chhetri 113

Dr Mamta Chhetri 114

Dr Mamta Chhetri 115

Dr Mamta Chhetri 116

Dr Mamta Chhetri 117

Dr Mamta Chhetri 118

Dr Mamta Chhetri 119

Dr Mamta Chhetri 120

Dr Mamta Chhetri 121

Dr Mamta Chhetri 122

Dr Mamta Chhetri 123

Dr Mamta Chhetri 124

Dr Mamta Chhetri 125

Dr Mamta Chhetri 126

Dr Mamta Chhetri 128

Dr Mamta Chhetri 129

Dr Mamta Chhetri 130

Dr Mamta Chhetri 131

Dr Mamta Chhetri 132

Dr Mamta Chhetri 133

Dr Mamta Chhetri 134

Dr Mamta Chhetri 135

Dr Mamta Chhetri 136

Dr Mamta Chhetri 137

Dr Mamta Chhetri 140

Dr Mamta Chhetri 141

Dr Mamta Chhetri 142

Dr Mamta Chhetri 143

Dr Mamta Chhetri 144

Dr Mamta Chhetri 146

Dr Mamta Chhetri 147

Dr Mamta Chhetri 149

Dr Mamta Chhetri 150

Dr Mamta Chhetri 151

Dr Mamta Chhetri 153

Dr Mamta Chhetri 154

Dr Mamta Chhetri 155

Dr Mamta Chhetri 156