A/HRC/41/47 43. The outbreak of cases in children and adolescents points to recent transmission, as well as to the failure of the health-care system to control the disease. The number of new cases of leprosy among children with visible physical impairments at the time of diagnosis directly reflects late case detection, alongside the incapacity of the health-care system to identify leprosy. However, such evidence should not be taken as a mere indicator of the strength of the epidemic and should also support effective public health strategies capable of ensuring access to the highest attainable standard of health among vulnerable populations and groups. 44. Diagnosis and treatment of leprosy in children require medical expertise, since both demand adjustments to immature cognition, perception and bodies. This poses a significant challenge in the global scenario of decline in medical expertise to diagnose and treat leprosy. 28 Techniques normally used to diagnose leprosy are not fit for children as they require cooperation from the children, and some may even be experienced as violence. 45. Such difficulties and barriers are surely a contributing factor for underdetection and late diagnosis, but they are also a result of the diminished public apprehension of leprosy that followed the global elimination of leprosy as a public health problem (defined as a registered prevalence of less than 1 case for every 10,000 persons) in 2000. 29 This situation has been generally misunderstood as eradication, when in fact such a scenario is unlikely in the future. 46. Treatment dropout rates in children range from 10 to 20 per cent in some programmes, the main cause being the child’s refusal to cooperate in swallowing tablets and the long duration of the treatment, which can be physically challenging and painful. Child-friendly treatment options like flavoured syrups would provide greater quality to the care of children with leprosy and would also help in securing adherence to the treatment. However, no such paediatric formulations are on the horizon, given the overall lack of funds for leprosy.30 Such lack of biomedical technologies that can provide better care is grounded in the mercantilization of health. 47. Children are not only more vulnerable to leprosy, but also to the harmful stereotypes that still frame many of the local explanatory models about the disease and that also support stigmatization at the community level, as well as institutionalized, structural and interpersonal discrimination. However, lack of comprehensive data on how harmful stereotypes and traditional practices impact the well-being of affected children is a major void in leprosy research. There is also scarce knowledge on the impact of discrimination on the grounds of leprosy against children of persons affected by leprosy. IV. How discrimination harms women and children A. Assessing discrimination from below 48. Discrimination on any grounds can be fully understood only if the phenomenological dimension enacted in the daily lives of its victims is properly acknowledged. Such phenomenological dimension allows for uncovering epistemological possibilities that cannot be grasped or generated by representations produced by dominant groups.31 49. In order to assess discrimination from below, the Special Rapporteur strived at giving voice to people living in extreme vulnerable conditions and who are, in consequence, 28 29 30 31 N. Mistry and others, “Childhood leprosy revisited”, Pediatric Oncall Journal, vol. 13, No. 4 (October–December 2016), pp. 83–92. Ibid. Ibid. S. Harding, “Rethinking standpoint epistemology: what is ‘strong objectivity’?”, in The Feminist Standpoint Theory Reader: Intellectual and Political Controversies (New York, Routledge, 2002); and D.J. Haraway, “Situated knowledges: the science question in feminism and the privilege of partial perspective”, Feminist Studies, vol. 14, No. 3 (Autumn 1988), pp. 575–599. 9