A/HRC/38/36 children from contact with the criminal justice system is now considered part of a strategy for ending violence against children within criminal justice settings. 28 The global study on children deprived of liberty commissioned by the Secretary-General is to include recommendations for the implementation of that strategy. 29 55. Many of the damaging characteristics of prisons that we know to critically impede the enjoyment of the right to health by detained children, especially in terms of their psychological and emotional development, are also evident in large institutions nominally aimed at securing their welfare, including infant homes and education, health and welfare facilities for children with disabilities. Additionally, penal institutions are used to administratively detain children for political “offences”, national security and immigration control. As such, all forms of detention severely compromise children’s enjoyment of the rights to health, to healthy development and to maximum survival and development, in contravention of the International Covenant on Economic, Social and Cultural Rights (art. 12) and the Convention on the Rights of the Child (arts. 6 and 24). A. Overview 56. There are no global statistics on the total number of children deprived of their liberty. Around one million children were estimated to be in detention in criminal justice systems at the turn of the millennium; in some countries, the majority were awaiting trial. Many were detained for non-criminal behaviour associated with poverty and discrimination, themselves breaches of children’s rights. The independent expert for the United Nations study on violence against children found violence to be widespread in penal institutions. 30 57. The likelihood of being detained as a child is linked to the social determinants of health. 31 Poverty, social exclusion, militarized school systems, gender, ethnicity and disability are all factors associated with the loss of liberty in childhood. Children from economically and socially disadvantaged communities, including those from ethnic minorities and indigenous populations, as well as those in care systems, are disproportionately deprived of liberty. Children with disabilities are more likely to be held in institutions, and to suffer appalling violence, often in the guise of “treatment”.32 Scaled up investment in tackling these underlying determinants of health is not only an obligation for the progressive realization of the right to health, but a promising strategy to prevent incarceration over the long term. 58. The Special Rapporteur has witnessed children with disabilities growing up entirely within the forced confines of large institutions, eventually moving into social welfare institutions for adults. While designed with good intentions, such paternalistic models are not compliant with various provisions protecting children’s rights, including their right to healthy development. This sad legacy of confinement begins at the start of life in infant homes, characterized by emotional neglect that is itself a form of institutional violence. The Special Rapporteur reiterates previous calls to fully eliminate institutional care of children under 5 years of age and replace it with a comprehensive family support system. 33 This single measure, if taken seriously, could prevent millions from being deprived of their liberty. 59. While the Convention on the Rights of the Child does not exclude the detention of children, the strongest of presumptions against it are established (art. 37 (b)). Children may be detained only as a measure of last resort. This standard is not to be used retrospectively to justify existing structures. Instead, it is an obligation to exhaust all other strategies at the macro level and all other interventions at the micro level. 28 29 30 31 32 33 12 See the United Nations Model Strategies and Practical Measures on the Elimination of Violence against Children in the Field of Crime Prevention and Criminal Justice, paras. 30–31. General Assembly resolution 69/157. See A/61/299, paras. 61–62. A/HRC/7/11 and Corr.1. Paulo Sérgio Pinheiro, World Report on Violence against Children (2006), pp. 185 and 188. See, for example, A/70/213.