National Coalition on the Rights of the Child in Lebanon The Fourth and Fifth Alternative Report on the Implementation of the Convention on the Rights of the Child in Lebanon Introduction

Recommendation 48: Amend the article 186 stating that prohibits any type of violence and punishment on children

Recommendation 49: Issue executive decrees on the implementation of the Law on the Protection of Women and Other Family Members from Domestic Violence.

Recommendation 50: Raise awareness about the law on the protection of the family, especially in the field of the children protection from domestic violence.

Recommendation 51: Approve the Lebanese Child Law, which is still a draft at the Supreme Council for Children to promote the protection of children at risk.

Recommendation 52: Allocate budget lines to support UPEL and other NGOs having the necessary expertise

Recommendation 53: Activate the role of social workers at MOSA to receive child protection cases and to follow up on the decisions

Recommendation 54: Enhancing the capacity of SDCs to receive and follow up on child protection cases

Recommendation 55: Ensure the establishment of the hotline according to the international standards.

Third: Sexual Exploitation and Abuse, including Physical and Psychological Rehabilitation and Social Reintegration

41. 
    In the penal code (Articles 505 to 520, especially 505), penalties for sexual abuse are higher whenever committed against a child. Law No. 422 of 2002 was the principal law that stipulated a statutory child protection response and relevant judicial decisions pertaining to the child’s best interest. The issuance of Law No. 293 in 2014 regarding “the protection of women and all family members from domestic violence” provided further protection. There is no recent or comprehensive data on the prevalence of child sexual abuse. Despite legislation, it appears that the bulk of sexual abuse cases are not reported, due in part to social stigma and, in part, to the lack of responsive and empathic behaviour in the legal system.²³ It is worth mentioning that as a response to the Syrian Crisis, the capacity for the identification of child protection cases was strengthened.²⁴
    

42. 
    With respect to sexual abuse among Syrian refugee children, the only available study is the rapid assessment conducted by Lebanon Child Protection in the Emergencies Working Group.²⁵ According to UNHCR’s 2015 report, almost one in four reported cases of sexual and gender-based violence (SGBV) involves a child.²⁶ One in four reported SGBV cases is related to incidents of sexual violence with the highest number being incidents of rape.²⁷
    

43. 
    The Lebanon Crisis Response Plan 2015-2016 (Jan. 2015) noted during the inter-agency meeting of November 2015 that: “Recent assessments confirm that domestic violence, sexual harassment and exploitation, as well as forced/early marriage, remain the main protection concerns for women and adolescent girls. Unaccompanied girls, single heads ofhouseholds, mothers/spouses, and women/girls with disabilities are particularly exposed to such risks.”²⁸
    

44. 
    A limited number of cases reach the legal system. The system has a poor capacity to address such cases, beginning with the investigation to the sentencing phases and until protection measures are issued. The limited resources available to the family and related specialized services represent another barrier to access services. It should be noted that prevention measures are not in place.²⁹
    

Recommendation 56: build the capacity of social workers at MOSA to deal with child sexual abuse cases

Recommendation 57: following up the child protection minimum standards in response to such cases

Recommendation 58: allocate necessary resources to family and related specialized services to deal with sexual abuse cases.

Recommendation 59: work on prevention of being subject to sexual abuse

Fourth: The Right not to be subjected to Torture or Other Cruel, Inhuman or Degrading Treatment or Punishment, including Corporal Punishment.

45. 
    Lebanon has signed and ratified the Convention against Torture (UNCAT) on the 5^th of October 2000 and has various international obligations under the Optional Protocol to the Convention against Torture (OPCAT) which was signed and ratified on the 22^nd of December 2008. Unfortunately, Lebanon still lacks a system to oversee the implementation of international treaties³⁰. The June 2013 security incidents in Abra posed a clear setback not only in the rights of detainees but also in children’s rights. Amnesty International reported that a 15 year old child was subjected to torture and other ill-treatment and not allowed to contact his family or a lawyer during detention. The child says he was forced to sign documents he was not allowed to read, and witnessed other detainees being subjected to torture or other ill treatment³¹.
    

Recommendation 60: Setting laws in accordance with the Optional Protocol to the Convention against Torture (OPCAT).

Chapter Six: Family Environment and Alternative Care

Third: Separation from Parents³²

46. 
    The situation of children in Lebanese institutions could not be assessed due to lack of qualitative data. Residential care for children is a flagrant infringement of children’s rights, and this is not only due to the alarming numbers. The fundamental problem associated with the institutionalisation of children in Lebanon is that the practice has developed into an entrenched “system,” where there is constant elicited demand generated by the lack of realisation of other rights.
    
47. 
    People resort to the institutionalisation of children in order to compensate for a lack of substantive rights that they are unable to provide due to their economic situation. MOSA confirmed that thousands of children continue to reside at home while institutionalised. If we compare the costs versus the benefit, then institutional care should not exist. Institutional care is more expensive per child than other forms of alternative care. It is socio-economic factors that push most children into institutions.
    
48. 
    There are no social safety nets or national family support programmes that could act as gatekeepers to prevent the institutionalisation of children. The prevalent poverty alleviation strategies obviously do not address the needs of the most vulnerable families. The existing programmes increase demand on institutional care. As such, separation of children from their families is unjustified and unnecessary. Even when alternative care is required, non-institutional options are scarce. By placing their children in institutions, parents are essentially breaking the law by relegating the care of their children to institutions, and failing to play their role as duty bearer to their children.
    
49. 
    Although there is no written policy regarding institutionalisation, the practice itself has become the predominant policy. The primary concern is that the government and policy-makers do not yet believe that a full-scale move towards de-institutionalisation is justified, and that there is a need to phase out institutions as a care option.
    
50. 
    MOSA officials emphasise that there are no budgets to revive existing programmes aimed at supporting children within families, but this obstacle could be overcome by the reallocation of funds away from these institutions. The system that has emerged is not governed by the state, although the latter continues to finance it. Institutions are managed by influential politicised civil society organisations including faith-based organisations which tend to overpower policy-makers should the latter attempt to alter the status quo. This is also true in relation to the imposition of any monitoring measures or quality standards. A reduction in the use of institutional care, or the transformation of institutions to community or family-based care options, could be seen as a threat to their funding. This trend is exacerbated by the fact that institutions receive funding on the basis of the numbers of resident children in their care. They are, therefore, keen to maintain high headcounts, especially given that contracts by MOSA for non-residential care are of a lesser financial value.
    

Recommendation 61:Enact a unified civil code that takes care of personal matters between all individuals and takes into account the best interest of the child through the presence of social workers within the establishment of the court system.


Recommendation 62: Until the adoption of a unified civil code, organize the work of the special courts, including the decrees issued by the Council of Ministers and the circulars issued by the Ministry of Justice to take into account the best interest of the child and impose the existence of social worker with an active role at the courts.

Recommendation 63: Enacting a law allowing ‘alternative families’ to be adopted by judges as a solution to the separation of the child from his family.

Recommendation 64: review the custody laws to include nondiscriminationagainst foreign mothers and fathers in regards to custody.

Recommendation 65: A de-institutionalization process should start entailing considerable structural changes within MOSA, including budget, and acceptance from communities. Potential barriers should be taken into consideration.

Chapter Seven: Basic Health and Welfare

First: children with disabilities:

51. 
    Lebanon signed the Convention on the Rights of Persons with Disabilities (CRPD) and its Optional Protocol in June 2007, but as of 2016, no ratification action has been taken. Ratification of this Convention may provide a platform for awareness-raising regarding children with disabilities, and more focus on their rights and freedoms. It is worth mentioning that Law No. 220 (29 May 2000) defines persons with disabilities, drawing on the WHO 1980 classifications and the subsequent amendments. It enhances protection through the introduction of a “card” which allows persons with disabilities to access provisions included in this law, such as medical care, living in specially designed houses, education in all public and private schools, sports activities, work, social services, and fiscal “privileges.” However, it has been reported that the qualifications to hold the card are far too narrow and include only four of the seven types of disabilities identified by the WHO.³³
    
52. 
    Law No. 220 established the National Committee for Disabled Affairs to endorse general policies relating to the affairs of those with special needs, namely the formulation of plans and programmes, the proposal of laws and regulations, participation in external networking and communication. At a general level, this law does not seem to be fully practiced or enforced as additional ministerial decrees are needed for its execution. Furthermore, a considerable amount of inter-ministerial cooperation is needed to implement its provisions. On the other hand, there is no national disability prevention policy, and what is available in that respect is restricted to private initiatives undertaken by local and international NGOs.Law No. 220 does not contain provisions specific to children in accordance with Article 23 of the CRC, and thus recommendations were made for its amendment. Accordingly, the HCC and its partners have drafted a proposed amendment to Law No. 220 which would add provisions specific to children with disabilities in order to guarantee access to their rights. No progress was achieved in that respect. A ministerial decision was issued by MOSA in 2006 which established a specialised sub-committee to HCC on children with disabilities, encompassing representatives from relevant ministries and civil society. The committee drafted a strategy on the rights of children with disabilities, however it was not finalised or presented to the government for endorsement.³⁴
    
53. 
    There is no recent data on the number on people with disabilities in Lebanon. The Multiple Indicators Clusters Survey 3 (MICS 3) showed that in 2009, 8 percent of children were reported to have one or more of the disabilities mentioned (such as difficulty walking, moving arms, weakness or stiffness, fits, difficulty learning or ability to speak, and cognitive issues).³⁵In the MICS3 survey, mothers/caretakers were asked to assess their children’s situation in relation to a number of specific conditions and in terms of their perceived mental progress compared with other children. Disability was measured for children aged two to nine years old, while comparisons included a number of situations, such as walking or seeing.³⁶
    
54. 
    Recent estimates indicate the number of Lebanese with disabilities at around 400,000 for a population of 4 million, equivalent to around 10 percent. Around 90,000 (23 percent) have registered with MOSA so far.³⁷ It is evident that comprehensive studies on children with disabilities, whether quantitative or qualitative, are scarce, which calls for further research in that regard.
    

55. 
    MOSA provides services to people with disabilities through the programme for ensuring the rights of the disabled. The programme registers disabled people and provides a disability card. Some 42,128 cards were provided between 2004 and 2014, including 10,399 cards to children below the age of 18 (6,323 males and 4,067 females). Moreover, MOSA sub-contracts social care institutions in order to provide care, education and rehabilitation services to all people with disabilities in all governorates. It is worth noting that an article pertaining to the compliance with the CRC was introduced to the contractual agreement with disability institutions. Children who benefitted from social care services reached 7,579 (37.35 percent females, 62.65 percent males).
    
56. 
    Several NGOs have employed creative methods for raising awareness about the rights of persons living with disabilities in Lebanon, and for building the capacities of young people with disabilities to become productive and active citizens. Other NGOs have developed an advocacy forum that addresses policymakers.³⁸
    
57. 
    Handicap International reported that Palestinian children with disabilities are believed to be particularly vulnerable. In addition to social discrimination, the physical construction of the camps is hostile to persons with disabilities. There are few NGOs working with disabled children in Palestinian camps and there is no vertical referral system. It also reported that Palestinian children with disabilities are often subjected to violence in the camps.³⁹
    
58. 
    Accurate data reflecting numbers, conditions, needs, and challenges of refugees with disabilities is still limited. UNHCR’s Inter-Agency Multi-Sector Needs Assessment (MSNA) – Phase One Report of May 2014 noted: “few available quantitative and qualitative assessments focus on specific needs, particularly of those with disabilities, including children.” A 2014 Handicap International report noted that 20 percent of surveyed Syrian refugees in Lebanon have at least one impairment (44.2 percent physical, 42.5 percent sensory, and 13.3 percent intellectual). Some 6 percent have severe impairments/disabilities. The provision of assistance to refugees with disabilities has so far been through the limited small-scale interventions of a few INGOs and native CBOs, DPOs, NGOs, and GoL entities (FPSC/arcenciel, HI, ICRC, MPDL/LPHU, WRF, SDCs and so on). Assistance remains greatly needed and there are extensive unmet needs for specialised services. ⁴⁰
    

Recommendation 66: Ratify the Convention on the Rights of People with Disabilities (CRPD).

Recommendation 67: Fully implement Law No. 220 and amend it to include children’s rights-related provisions as proposed by the HCC.

Recommendation 68: Formulate a national action plan for children with disabilities.

Recommendation 69: Strengthen and reactivate the National Committee for Disabled Affairs and the intergovernmental disability committee under the Ministry of Social Affairs.

Recommendation 70: Comply with ratified conventions and standards relating to children with disabilities.

Recommendation 71: Conduct a national survey on people with disabilities to estimate their numbers and gauge the types of disabilities, including amongst children.

Recommendation 72: Conduct a thorough situation analysis of children with disabilities.

Recommendation 73: Raise awareness in the public at large about the rights of children with disabilities, and their rights to not be separated from their families.

Recommendation 74: Prevent and prohibit all forms of discrimination against children with disabilities and ensure equal opportunities for their full participation in all spheres of life by implementing Law No. 220 of 2000.

Recommendation 75: Provide children with disabilities with access to adequate social and health services, accessible physical environments, information, and communication.

Recommendation 76: Include children with disabilities in national efforts at de-institutionalisation.

Second: health and health services:

59. 
    The health system in Lebanon witnessed several enhancements in terms of coverage and structure in the last 5 years. However, the right to good quality, accessible, and affordable health services is still held captive between a political interest to keep health as a service offered in return of political allegiance and the expansion of private sector within a weak regulatory role by the state. 
    
60. 
    In regards to expenditure, there was an increase in the budget of the Ministry of Public Health (MoPH) by 13% between 2010 and 2012, accompanied by an improvement in health indicators namely maternal mortality and vaccination rates. Furthermore, the expenditure on health decreased from 12.3% of GDP to 8.5% in the recent years, the challenge remains in the distribution of money as 83% of the budget of the MoPH in 2012 was spent on coverage and medicine rather than focusing on primary health care (PHC).  
    
61. 
    A big proportion of the public expenditure on health goes to private sector and politically affiliated service providers. In 2012, 82% of total hospitalization expenditure was spent on private sector while 18% only went to public hospitals.  In addition, MoPH spent 4 billion Lebanese liras on offerings to PHC centers and NGOs providing health care services in 2012, where 71% of those are affiliated with political or religious groups and provide the service in the name of their affiliated groups.  
    
62. 
    As for coverage: 53.3% of the Lebanese remain outside any structured health coverage system, the Ministry does form a safety net for those but the coverage criteria are unclear and leave room to favoritism. Several other challenges face the health coverage system namely the delay in reimbursement of NSSF and the variance in coverage rates among different funds.  Coverage is more of a challenge for vulnerable groups, as the delay in implementation of law 220 leaves people with special needs uncovered, and the absence of an elderly retirement system especially that NSSF coverage stops on retirement when the need for care is the highest.
    
63. 
    Regarding equity of the health system, Clear discrepancies exist between regions in terms of number of beds, availability and quality of services, and % of people covered, with higher ratios concentrated in Beirut and Mount Lebanon. The absence of clear indicators for health coverage by the ministry, difference in quality of services between private and public sectors, and the difference in prices and coverage criteria for each fund further challenges the equity of the system.
    
64. 
    MoPH and the various health syndicates have tried to regulate prices and set standards for service providers but their efforts still fall short and there remains a significant need to control quality and prices of service providers, decrease discrepancies among them, and limit the uncontrolled expansion of services.
    
65. 
    As for the pharmaceutical sector, the high percentages of spending on medicine which reached 22% of total health bill in 2013, necessitates further regulation of the sector and the adoption of the generic system. The central lab, primary entity responsible for quality assurance of medicine is still closed, and there is an informal drug market running without regulation through 3000 dispensaries.
    
66. 
    On the other hand, in regards to food safety and quality of services, year 2014 witnessed an impressive enhancement in the MoPH audit role focusing on food safety and quality of services. However, there remains a need to institutionalize the efforts through the adoption of regulatory laws, reactivation of the role of regulatory bodies, and filling the vacancies in health inspector positions
    
67. 
    As for the Syrian crisis repercussions, the system has shown significant resilience in absorbing the impact of the crisis considerably after 2012. However, the influx of over one million refugees is straining existing health services. In addition, with the low funding for the crisis, the refugees are facing difficulties in accessing quality health services especially for chronic diseases and other costly health conditions.⁴¹
    

Recommendation 77:Issue a comprehensive health coverage law that assures vulnerable groups are covered with clear selection criteria and independent and sustainable sources of funding. 

Recommendation 78: Implement a series of reforms to strengthen the NSSF including filling the vacancies, inviting CSOs to management board, and decreasing political intervention.

Recommendation 79: Reinforce the health care system and revisit the health map study to assure equity between the regions.

 Recommendation 80: Enhance MoPH regulatory role through enhancing coordination among various entities affecting health, increasing MoPH jurisdictions and strengthening its audit role by filling vacancies in unit and issuing of supportive laws and decrees.

Recommendation81: Regulate the medicine sector through reopening of the central lab, adopting the generic medicine system, and monitoring the informal dispensaries.⁴²  

Fourth: Standard of Living

68. 
    The Lebanese Government adopted a policy to reduce poverty through approving “the National Program to Support the Poorest Families”, which is based on determining the poverty level of families through assessing the social and economic situation via 62 indexes / information authorized by the family’s representative. During the application phase (2011-2013), 36,575 families (containing 171,903 people) were classified under the minimum poverty line; therefore, they can benefit from the contributions of the program.
    

69. 
    With reference in this regard to the Syrian crisis and its negative repercussions on the standard of living in Lebanon and preceded by the economic and financial crisis and the lack of security stability within the country, all this data and events proceeded to eliminate the so-called middle class in Lebanon, which has played an important role in the economic cycle in Lebanon; therefore, the vast majority in Lebanon suffer from poverty as a result of the economic, social and security situation that prevailed.