Graphic: DOROTHY KGOSI
Graphic: DOROTHY KGOSI

Nelson Mandela loved children. His birthday parties were always children’s parties. He recalled that in jail for over two decades he never once heard the sound of children.

One of his closest friends and fellow prisoner, Ahmed Kathrada, once described the layers of sound that “drifted around and into the cells: peacock calls, rowdy seagulls, motor vehicle engines and rusted exhaust pipes belching into the sea air, and the crunching of boots on the stones outside. Keys clanging locks open. And closed. Even the crashing of waves against the dock in the evenings. But never the laughter of children”.

One of Mandela’s first acts as president of a democratic SA was to establish an interministerial committee on young people at risk. The committee’s task was to transform the “child and youth care system”. Apartheid, and the migrant labour system on which it was built, severed the social fabric of black family life, and Mandela wanted to signal that building normal family life was one of his highest priorities.

A month later — on June 1, International Children’s Day — he announced that his government had started the work of establishing a number of programmes for children, including free medical care in state hospitals and clinics for those aged under six; nutritional feeding schemes for qualifying primary schools; the emptying of jails of minors and provision of alternative care centres; and free, quality education. Programmes to deal with the problem of street children were under urgent consideration as well.

Mandela launched a national programme of action for children in 1996 to embody the principles of the UN Convention on the Rights of the Child, which SA ratified in 1995, to affirm the call made at the 1990 World Summit for Children to give them the first call on society’s resources. He set the example and pledged a third of his presidential salary to the Children’s Fund. He thought about children as a sociological issue with profound moral dimensions for, as he put it, “there can be no keener revelation of a society’s soul than the way it treats its children”.

After Mandela stepped down as SA president he and his wife, Graca Machel, a strong children’s rights activist in her own right, joined the executive director of Unicef and announced their “commitment to work closely with her and her respected organisation on a cause we hold most dear to our hearts — the rights of children and adolescents of this world to live safe from violence and exploitation, free of poverty and discrimination and to grow healthy and strong”.

I share all of this to illustrate what it means to lead on children’s issues and to underline the point that children have the same moral right to health as adults. However, being legal minors, they do not have the ethical-legal authority to act in their own interests. It is therefore incumbent upon adults to lead on children’s behalf and provide legal and financial protections for their health, economic and social welfare.

I also share the dedication to contrast Mandela’s deep humanity with the cruel manner in which the Donald Trump administration has dealt with children at the US border with Mexico, severing them from their parents, keeping them in cages, punishing them for matters for which they bear no responsibility, and enabling an unprecedented level of maliciousness in a country known for its decency. It is a stain on the soul of the US for which there must be accountability and a reckoning. A bipartisan enquiry into these abuses committed in the American people’s name should be established by the US Congress.

Historically, responses to the needs of children have been inconsistent and based often on cues that have little to do with children’s real interests in this world. Globally, government spending on children is on a downward trend, and the Covid-19 pandemic threatens to undo decades of progress for children’s welfare.

The particular needs of children are rarely considered in disaster planning, and most health-care facilities around the world are ill-equipped to adequately care for paediatric patients. Multilateral humanitarian organisations such as the UN International Children’s Emergency Fund (Unicef) and the World Health Organisation lack the funding to reach all impoverished children in developing countries. In addition, the effects of climate change become more apparent with each passing day, and children are particularly vulnerable to the effects of global warming.

There is ample evidence that early investment in child health has lifelong, intergenerational economic benefits. In an increasingly globalised world it is in our collective interest to provide protection for children of all nations. But these are particularly difficult times. Governments have become conservative by pressing families to take greater care of children’s health, education and welfare, while seeking to reduce the role of the state. Multilateral institutions have also been challenged, with the result that resources have not risen in proportion to the scale of the challenge. The fiscal squeeze brought about by Covid economics will make it worse.

A weakened UN and the rise of militaristic approaches to dealing with conflicts have made it difficult for Unicef to do its work. Particularly painful in recent history is the story of Yemen, where an alliance led by Saudi Arabia has, with its relentless air strikes, crippled the country’s infrastructure and health-care system, leaving children and women particularly at risk.

There are also stories coming out of Syria and other war-torn and civil conflict settings that drive displaced people into refugee camps. Unicef reported that worldwide 31-million children had been forcibly displaced by the end of 2018. The figure includes 13-million child refugees, 1-million asylum-seeking children and an estimated 17-million children displaced within their own countries by violence and conflict. Half the world’s refugees are children.

Philanthropic interventions can never really replace public sector commitments, but it heartening to see how the rise of private funds to support children’s welfare and health security has changed the wider child welfare ecosystem in a positive direction. Billionaire philanthropist George Soros has poured millions into early childhood education and, by supporting Human Rights Watch, child security. The Bill and Melinda Gates Foundation has made more than $10bn in commitments to child health, most of it to help develop and distribute vaccines to the world’s poorest countries.

Through the Global Alliance for Vaccines and Immunisation, which the foundation helped set up, it recently committed $100m for advance procurement of a Covid-19 vaccine to supply lower-income countries. In Africa the Elma Foundation, started by SA musical entrepreneur Clive Calder, is likely the most significant investor in child health and paediatric service delivery.

These are promising developments, but the world’s children are crying out for champions of stature, like the late Nelson Mandela — leaders who can shine a light on children’s plight for all the world to see.

James is a senior research scholar at Columbia University. This is an extract from his keynote address to the 12th annual Pediatric Global Health (Virtual) Conference at the University of Pennsylvania.

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