Children tied to cribs and chairs, often cold, underfed and smeared with their own feces: Romania has tried over the last decade to erase those images of its orphanages seen around the world.
Writing in a report to be released today, just days before the European Union issues its final assessment on whether Romania has met human rights and other membership standards, researchers described an eerie silence in a ward where 65 abandoned children were housed, because "children who do not receive attention when they cry learn to stop crying."
In an adult psychiatric hospital, investigators found some children wrapped head to toe in sheets used as full-body restraints. When the staff agreed to remove the sheet on a 17-year-old girl, the report states, "her skin came off with the sheet, leaving a raw open wound beneath it."
"It was the most horrible thing I've ever seen in 13 years of doing this work," said Eric Rosenthal, executive director of Mental Disability Rights International, a Washington-based group, and the co-author of the report.
Mr. Rosenthal's group is urging the European Union to insist that Romania take immediate action to end the abuse before next year, when the country hopes to join the union.
The strategy has worked before. In September 2005, as Turkey began formal talks to join the European Union, Mental Disability Rights International released a report on the use of electroshock therapy without anesthesia in Turkish psychiatric hospitals. Turkey has since ended the practice at its main psychiatric hospital in Istanbul and is addressing other problems raised in the report.
Simona Pella, an official at Romania's National Authority for the Protection of Children's Rights, said she had not yet seen the report, but disputed its findings.
"We are talking about a report made by a nongovernmental organization, and it's their opinion," Ms. Pella said by telephone from Bucharest. "They are not talking about facts in all of Romania, just about some cases in two counties."
While the number of children in the country's orphanages has dropped to about 30,000 from 170,000 in the early 1990's, many children, particularly those with mental or physical disabilities, have simply been moved into less visible, though equally appalling, institutions, including adult psychiatric hospitals, Mental Disability Rights International found.
"Romania was rushing to show that it had decreased its orphanage population, but it left children with disabilities behind," Mr. Rosenthal said in New York on Monday. He said there was no way to estimate how many children were living in the conditions described in the report.
Romania's orphanages are a legacy of Nicolae Ceausescu's rule. He banned birth control and left under-financed state institutions to care for the wave of abandoned children that followed. After he was assassinated in 1989, as Communist rule ended, the horrors of the system were exposed to the world.
Much has improved since then. Foreign aid organizations rushed in, and European and American advisers worked with Romania's new government to help put abandoned children up for adoption or place them in foster homes. In January 2005, intending to bring the country in line with European Union practices, Romania passed a law that prohibited placing children under 3 in institutions unless they were "severely disabled." The law also blocked foreign adoptions in the hope of cutting down on child trafficking.
But, according to the report, about 9,000 babies are deserted in Romania every year, one of the highest rates in Europe. The country's foster care and adoption programs strain to keep up with the number of children who need their help.
As a result, abandoned children with even mild disabilities and some with none at all are being kept in maternity wards or other hospital-associated institutions until they are old enough to be moved to an orphanage or other institution. In February, investigators for the group found 65 infants, some without any disability, being cared for by three people at a "nutritional recuperation center" in the western city of Timisoara.
The children were confined to their cribs most of the time, the report states. Some of the older ones rocked back and forth, banging their heads or "making the rhythmic sounds from dislocated jaws common in children left lying down for extended periods," the report said.
Karen Green McGowan, a registered nurse who assessed many of the children cited in the report, said the early neglect led to disabilities later on, making it likely that many otherwise normal children would end up institutionalized for life.
"What they're doing there, in my opinion, is manufacturing disability," Ms. Green McGowan said. "By the time they're in their teens, these kids are being moved into institutions."
Ms. Pella, the government official, said that her figures showed that 5,000 children are abandoned each year but that half are eventually reunited with their families. Foster care and adoption programs handle the rest, she said. Only those who require medical care stay in the hospital or are institutionalized, she said.
But the report documents several cases of older children, some kept in permanent restraints, in adult facilities, including the St. Pantelimon adult psychiatric hospital in the eastern city of Braila.
"We found 46 children in Braila, one near death, that looked like they were from Auschwitz, just skin and bones," Mr. Rosenthal said.
They found bed ridden teenagers "so emaciated that they looked like they were 3 or 4 years old," their limbs atrophied and contorted from disuse.
Instead of giving the children attention, the report states, the hospital staff tied them down.
After Mental Disability Rights International and a Romanian organization notified the government of the situation, the children were moved to two smaller institutions for children, the report stated. But the more disabled of them remained isolated, without even a bathroom for toilet training. All of them, up to the age of 17, use diapers.
Anyone else feel thwarted, frustrated, helpless? Well, maybe the thing to do is look around our own backyards and see what needs fixing, and start with that. I started volunteering at the Getty Museum in 1998 because I wanted to do something pleasant after four years of volunteering for AIDS organisations. Maybe vacation time is over and I should think about getting back to something grittier again. Anyone care to join me?