Pakistan’s legal system isn’t built for children. This clinic is trying to change that

It is a pecularity of Pakistan’s criminal justice system that it has treated children as miniature adults, not just in the way their crimes are prosecuted but in how the victims themselves are perceived. “We handle a four-year-old child through the same protocols used for an 18-year-old boy, a 16-year-old girl, or even a 30-year-old man,” said Police Surgeon Dr Sumaiyya Syed. She is part of the government effort to open the country’s pilot Child-Friendly Medicolegal Clinic at the Office of the Police Surgeon as part of the Anti-Rape Crisis Cell. It was inaugurated last week and fulfils a requirement of the Sindh Medico-Legal Act. In the case of bodily harm, a medico-legal certificate or report needs to be prepared as evidence. The child has to be brought to a government facility where one of its doctors will examine the child and document injuries, their severity and probable cause. The ML certificate is the bridge between medicine and the courts. Every year, Sahil, a nonprofit organisation working on child protection since 1996, publishes its Cruel Numbers report, tracking child sexual abuse, abduction, missing children and child marriage across Pakistan. Last year, at least 2,003 child sexual abuse cases were recorded , with 1,549 (77 per cent) in Punjab, 330 (16pc) in Sindh, 91 (4pc) in Khyber Pakhtunkhwa, and 33 (3pc) across other areas. (function(){function e(){window.addEventListener(`message`,function(e){if(e.data[`datawrapper-height`]!==void 0){var t=document.querySelectorAll(`iframe`);for(var n in e.data[`datawrapper-height`])for(var r=0,i;i=t[r];r++)if(i.contentWindow===e.source){var a=e.data[`datawrapper-height`][n]+`px`;i.style.height=a}}})}e()})(); The figures are widely cited, but they barely reflect the full problem. Sahil compiles its data through secondary collection, using reports published in over 80 newspapers. But so much more never makes it to press. Families and communities suppress cases more often than they report them. Dr Syed said she’s pushing to have violence against women and children recognised as a public health crisis. “It would change our protocols, our entire approach. Until we recognise it as a crisis, we will just keep working randomly.” The child-friendly approach It is not easy to open up in a government hospital or police station if you have been sexually assaulted or worse regardless of your age. But at the new clinic some effort has been made to create an environment to put children at ease with toys and snacks. Dolls and figure diagrams help children indicate what happened. Children used to be examined lying down, but the approach now is to adapt to their comfort, even if that means examining them while they sit in a parent’s lap. A system of psychosocial support is integrated, connecting children to shelters when needed, and making sure case workers follow up on their care. A psychologist is stationed at the clinic, though currently only during working hours. There is also a case worker, and children can be referred for psychological support either before or after the medico-legal examination, depending on what they need. The idea is to have clear referral pathways so care doesn’t stop at the examination. “The benefit of the case worker is that, without involving me, they can coordinate with the Sindh Child Protection Authority, Dar-ul-Aman, or other shelter homes,” said Dr Syed. “In the second phase, there is also a plan for a safe room where children who need to stay overnight can remain in a secure environment, ideally with their mother, instead of being sent back immediately or handed over to police,” she said. “At present, we request hospitals to admit the child because we cannot send them back.” The clinic also caters to minors in custody who are brought in by police for examination or age assessment. For girls who have reached puberty, an ethical priority would be to provide emergency contraception. “If a survivor presents within three days, it should be given immediately,” added Dr Syed. Adolescent girls are frequently brought in for age determination in cases shaped by family pressure, early marriage or disputes over legal age. Since consent under 18 is not legally recognised, such cases are often referred through police, courts or FIRs to establish a child’s age and legal status. It has to be determined with medical and forensic assessments, including physical examinations, radiology and dental X-rays. In such situations, children were often questioned in the presence of adults or in ways that may be damaging to their emotional state. And then there are children who are refugees or have been rescued from trafficking or experienced repeated abuse. Here, the initial clinical concern is the risk of HIV and sexually transmitted infections. While tests like VDRL are used for STI screening, HIV prevention is also addressed through post-exposure prophylaxis (PEP)