Rory Carroll and Sarah Boseley
Friday December 10, 2004
The Guardian

The HIV/Aids pandemic is the worst catastrophe in history and is blighting
childhood across the developing world, especially sub-Saharan Africa, the
United Nations said yesterday.
Advances in children's survival, health and education are being reversed by
a "triple whammy" of Aids, conflict and poverty, according to the UN
children's agency, Unicef.

The disease is driving the destruction of basic services for 1bn children
and violating their right to grow and develop, said Carol Bellamy, the
organisation's executive director.

"We believe Aids is the worst catastrophe ever to hit the world," she told
the Guardian. "It is just ripping up systems, be it health or education. Our
children's childhood is being robbed from them."

But the agency and Ms Bellamy have been strongly criticised by the editor of
one of the world's leading medical journals, the Lancet.

In an editorial published today, Richard Horton said Unicef's
"preoccupation" with children's rights meant that the fundamental right to
survival was, "shamefully", not at the core of its work. "In sum, for almost
a decade, child survival has failed to get the attention it deserves," he
writes.

In Unicef's 150-page annual report, The State of the World's Children 2005,
the agency paints a bleak picture of sub-Saharan Africa slipping further
behind other developing regions such as southern Asia, Latin America and the
Caribbean.

Researchers also found that

· Of the 15m children orphaned by Aids, 80% are African

"Unless action is taken, swiftly and decisively, to stem the tidal wave of
infection and loss, it is estimated that by 2010 over 18m African children
will have lost one or both parents to HIV/Aids," said Ms Bellamy.

She said there were bright spots: an effort to eradicate polio was back on
track, Kenya had introduced free primary schooling and rates of HIV appeared
to be falling in Namibia. "We are not saying everything has fallen apart."

But without identifying them she accused governments of "shutting their
eyes" to HIV and the erosion of gains made since the adoption of the
convention on the rights of the child in 1989.

The report sounded alarm over the growing number of orphans deprived of a
normal family environment and exposed to violence, abuse, exploitation and
stigmatisation.

"The loss of a parent implies more than just the disappearance of a
caregiver. It pervades every aspect of a child's life: their emotional
well-being, physical security, mental development and overall health. In the
most extreme cases, children can find themselves living on the streets,
utterly devoid of family support."

The extended African family network of grandparents, uncles, aunts and
cousins has been credited with shouldering the burden but Unicef warned that
this safety net was severely stretched, especially in Botswana, Lesotho,
Swaziland and Zimbabwe.

Aid workers and government agencies have issued similar warnings that
romanticised notions of heroic relatives selflessly raising broods of
infants can mask an uglier reality.

In the South African village of Kamhlushwa, for example, an uncle offered to
care for the six Ndlovu children, aged four to 11, after both parents died
earlier this year. But neighbours said he was interested only in their
social grants and that it would be better if the eldest child, Thembeni,
were the head of the household.

Around 1.9m children under the age of 14 in sub-Saharan Africa had the HIV
virus, said the report, and around 1,700 children worldwide became infected
every day. But few African countries had followed Brazil's lead in giving
life-extending anti-retroviral drugs to children and adolescents as part of
a national treatment programme.

Social indicators in many parts of Asia, Latin America and the Caribbean
showed improvement but almost half of the world's 2.2bn children lived in
poverty.

In a foreword to the report, the UN secretary general, Kofi Annan, said that
for such children reality was "starkly and brutally different" from the
ideals of the millennium declaration adopted in 2000 as a blueprint for the
21st century.

"Poverty denies children their dignity, endangers their lives and limits
their potential. Conflict and violence rob them of a secure family life,
betray their trust and hope. With the childhood of so many under threat, our
collective future is compromised."

The report is likely to be welcomed by Tony Blair and Gordon Brown as
another spur to their plan to write off African debt, tackle disease and
break down trade barriers during Britain's presidency next year of the G8
industrial nations.

But Ms Bellamy said that after a decade at Unicef she considered the
development glass half full, not half empty.

However, Mr Horton is scathing of Unicef's approach. In his editorial he is
specifically critical of Ms Bellamy, saying it has been her "distinctive
focus" to advocate the rights of children.

"This rights-based approach to the future of children fits well with the
zeitgeist of international development policy," he writes. "But a
preoccupation with rights ignores the fact that children will have no
opportunity for development at all unless they survive.

"The language of rights means little to a child stillborn, an infant dying
in pain from pneumonia or a child desiccated by famine.

"The most fundamental right of all is the right to survive. Child survival
must sit at the core of Unicef's advocacy and country work. Currently, and
shamefully, it does not."

He adds: "Child health needs better leadership, improved coordination of
services and increased funding."