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Frequently Asked Questions
Defining an ‘institution’ is essential, but not straightforward. There is no universally accepted definition of an ‘institution’. In some contexts, ‘residential care’ and ‘institutions’ may be used interchangeably, or a narrow definition of an institution is used, focused for example on only one size or type of provider.
Some agencies use the size of a facility to identify an institution – for example, classifying any residential care for more than 10 children as an ‘institution’. However, a group of experts working on the issue for the European Commission approached the question differently, looking at the nature of the care provided, rather than just the number of children served. The size of the institution matters, but is not the only defining feature.
These experts determined that an institution is any residential setting where an ‘institutional culture’ prevails. Children living in an ‘institutional culture’ are isolated from the broader community and are compelled to live with children to whom they are not related. These children, and their families, do not have control over their lives, or decisions that affect them. Crucially, the requirements of the organisation tend to take precedence over the children’s individual needs.
This definition covers arrangements more commonly known as ‘orphanages’, compound/cluster facilities, ‘reception centres’ for unaccompanied refugee children, residential health facilities and psychiatric wards, and residential ‘special schools’.
 European Commission. (2009). Report of the Ad Hoc Expert Group on the Transition from Institutional to Community-based Care.
 Adapted from International Handbook: Dolan, P.v& Frost, N. (Eds.). (2017) Routledge Handbook of Global Child Welfare. Oxon: Routledge
Over 80 years of research demonstrates that growing up in an institution harms the physical, emotional, and mental health and well-being of children.These effects can last a lifetime.
There is no such thing as a ‘good’ institution. Although many are established with good intentions, even well-run institutions with good material conditions are not able to provide the sensitive and consistent care that children need for healthy emotional development
Research shows that children need families to flourish. Babies in particular fail to develop as they should without one-to-one interaction, and institutionalisation can have a severe negative impact on early brain development. Babies who live in institutions for more than six months often face developmental impairments, including mental and physical delays.
The long-term effects of institutional life for children can include severe developmental delays, disability, irreversible psychological damage, and increased rates of mental health difficulties, involvement in criminal behaviour, and suicide.
Reports from countries across the world demonstrate that children living in institutions are at increased risk of violence, abuse, and neglect by staff, officials, volunteers, and visitors responsible for their care. Documented abuse includes torture, beatings, isolation, restraints, sexual assault, harassment, and humiliation. Children with disabilities in institutions are at even greater risk of abuse.
For more information on the risks that children face in institutions, see Children In Institutions: The Global Picture and Lumos Factsheet: The Risks.
2015 Berens, A. and Nelson, C. "The science of early adversity: is there a role for large institutions in the care of vulnerable children?" Harvard Medical School, Boston Children's Hospital. Lancet 386:388-98
 Bucharest Early Intervention Project. (2009). Caring for Orphaned, Abandoned and Maltreated Children, 2009. https://www.crin.org/docs/PPT%20BEIP%20Group.
 Rutter, M. (1998). Development catch-up, and Deficit, Following Adoption after Severe Global Early Privation. http:// journals.cambridge.org/action/display-Abst...
 United Nations General Assembly. (2006). Report of the independent expert for the United Nations study on violence against children. A/61/299. http://www.unicef.org/violencestudy/reports/SG_vio... p16; and Holm-Hansen, J., Kristofersen, L. B. & Myrvold, T. M. (eds). (2003). Orphans in Russia. NIBR 1, p83.
 United Nations (2006).Violence against Children in Care and Justice Institutions. Chapter 5, p 175. https://www.unicef.org/violencestudy/5.%20World%20... [Accessed 2 May 2018].
 Milovanovic, et al. (2013). The hidden and forgotten: Segregation and neglect of children and adults with disabilities in Serbia. Mental Disability Rights International, Belgrade. http://www.mdri-s.org/wp-content/uploads/2013/10/t... [Accessed 2 May 2018]. See also: Ahern, L. & Rosenthal, E. (2006). Hidden suffering: Romania’s segregation and abuse of infants and children with disabilities. Mental Disability Rights International, Washington D.C. http://www.driadvocacy.org/wp-content/uploads/roma... [Accessed 2 May 2018].
Studies consistently demonstrate that most children in institutions are not actually ‘orphans’, on average 80% actually have at least one living parent, and almost all have a relative that could look after them.
Poverty is the main reason why children are separated from their families. Many families struggle to provide food, housing, medicine and access to education for their children, and feel that they have no other choice but to send their child to an institution.
Children with disabilities are often placed in institutions because their parents don’t have access to, or cannot afford, health services or inclusive education. Stigma and discrimination drives many children into institutions, with children from minority populations, such as Roma communities, disproportionately overrepresented.
Many unaccompanied migrant and refugee children end up being placed in institutions at different stages of their journey. And in times of natural disaster, orphanages spring up to be willing recipients of international aid, when the provision of very basic support would keep families together.
There is also evidence that some institutions actively ‘recruit’ children away from families, often using false promises of education or food. This form of ‘orphanage trafficking’ is the active recruitment of children from vulnerable families into residential institutions for the purpose of exploitation.
 Csáky, C. (2009). Keeping Children Out of Harmful Institutions. London, UK: Save the Children. https://www.crin.org/en/docs/Keeping_Children_Out_of_Harmful_Institutions_Final_20.11.09.pdf[accessed 2 May 2018].; Carter, R. (2005), Family matters: a study of institutional childcare in Central and Eastern Europe and the former Soviet Union. London: EveryChild. http://www.bettercarenetwork.org/sites/default/files/Family%20Matters%20-%20A%20Study%20of%20Institutional%20Childcare%20in%20Central%20and%20Eastern%20Europe%20and%20the%20former%20Soviet%20Union.pdf [accessed 2 May 2018].
 Csáky, C. (2009). Op. cit
 EveryChild and Better Care Network (2012). Enabling reform. Why supporting children with disabilities must be at the heart of successful child care reform. New York: Better Care Network. http://bettercarenetwork.org/sites/default/files/Enabling%20Reform%20-%20Why%20Supporting%20Children%20with%20Disabilities%20Must%20Be%20at%20the%20Heart%20of%20Successful%20Child%20Care%20Reform_0.pdf [accessed 19 May 2017]. UNICEF. (2010). At Home Or in a Home: Formal Care and Adoption of Children in Eastern Europe and Central Asia.;
 Chaitkin, S. et al. (2017) Towards the right care for children - Orientations for reforming alternative care systems Africa, Asia, Latin America. Luxembourg: Publications Office of the European Union.
 Chaitkin, S. et al. (2017) Towards the right care for children - Orientations for reforming alternative care systems Africa, Asia, Latin America. Luxembourg: Publications Office of the European Union.; Lumos (2017) Funding Haitian Orphanages at the Cost of Children's Rights.; European Roma Rights Centre (2011) Life Sentence: Romani Children in Institutional Care, available at: http://www.errc.org/cikk.php?cikk=3902[accessed 10 May 2018].
Doore, K.E.V. (2016). Paper orphans: Exploring child trafficking for the purposes of orphanages. The International Journal of Children’s Rights. Volume 24, Issue 2
An estimated 5.4 million children around the world live in large residential institutions, including so-called ‘orphanages’.
However, it is important to note that the figure of 5.4 million is an estimate, as no global definition of an ‘institution’ has been adopted, let alone applied at a country level, when gathering statistics. Inadequate counting systems at a national level lead to significant variability and inaccuracy when trying to reach a global estimate.
In some countries, a large proportion of institutions are unregistered or unrecorded, so that the official, administrative data is likely to significantly underestimate how many children are actually living in institutions. See Lumos’ factsheet for more information on the global picture of institutionalisation.
1. Desmond. C., et al. (2020) Prevalence and number of children living in institutional care: global, regional, and country estimates.Lancet Child Adolescent Health. VOLUME 4, ISSUE 5, P370-377.https://doi.org/10.1016/S2352-4642(20)30022-5[Accessed 24 June 2020]
The majority of children that currently live in institutions will be able to return to their birth families, who can care for them with the right support. Other children may go to wider kinship families (aunts, uncles, and grandparents), or to ‘family-based’ alternatives such as foster or adoptive families. For a small number of children, ‘family-like’ services, such as small group homes, are the most appropriate form of care to meet their needs.
‘Deinstitutionalisation’ involves the transformation of services to ensure that children are able to live with their families, or in family-based or family-like care in the community. It typically involves strengthening child protection and care systems and ensuring universal access to education and healthcare.
Fundamentally, it is about inclusion—making sure that the right support services are in place to enable all children are able to live with their families, in their communities.
Providing improved support for children by reforming systems is complex and requires a well-planned approach. Deinstitutionalisation doesn’t mean closing institutions overnight. Children can only leave institutions once the relevant support and alternatives are in place; therefore, a critical component of the process is the creation of new services. Watch an overview of Lumos’ 10 elements of deinstitutionalisation here.
Reform typically involves three components:
- Providing community services that prevent family separation, and give vulnerable children the opportunity to remain with their birth parents, or with other family. Such services might include access to health care, inclusive education, or targeted services to help ‘at-risk’ families who might need additional support in times of need.
- Ensuring that appropriate alternatives are available when it is not possible for children to remain with their families. Following a thorough assessment of a child’s needs, there may be occasions when it is not in the best interests of the child to remain in his or her family. In these instances, it is vital that alternative forms of care, such as kinship care or foster care, are in place that ensure that children continue to benefit from the love and support of a family and remain in their community.
- Dismantling the institutional system. This is a complex and sensitive process that involves moving children from institutions to families or family-based care, and eventually closing down institutions. Throughout this process it is vital to ensure that each child has a placement that best meets his or her needs. For example, children who were separated from their families at a young age may only remember life in an institution. Preparing them to return to their family, or enter a new family, is a highly sensitive process, as is the support and preparation of families for reunion.
Click here to read examples of successful reform in countries that Lumos supports.
In the vast majority of cases, parents do not abandon their children, but give up them up to institutions because they feel they have no other option. The only support they can find is a place for their child in an institution.
In particular, parents of children with disabilities can be led to believe that their children will receive better support in an institution than they would at home. Without inclusive services available in their communities, families are faced with impossible choices where the only opportunity for their child to receive an education, or get medication, is if they are taken away and placed in an institution. The overrepresentation of children with disabilities in institutions can also be a reflection of cultures that ‘hide away’ people with disabilities.
In some situations, parents are coerced or deceived into placing their child in an institution by unscrupulous orphanage directors who have a financial motivation to fill their institutions.
Once a child has entered the institution, parents may be discouraged from visiting or maintaining a relationship with their child. Over time relationships can break down. Families come to believe that their children are better off without them. Children may not even remember their family, or where they come from. This is not a picture of families who do not love their children.
There are three main reasons why institutions still exist:
- A lack of understanding of the problem. Many people think that institutions are a social good, or that better alternatives do not exist, so they continue to invest in and donate to these institutions.
- Changing systems is complex and difficult. It takes a concerted effort and a great deal of expertise to build child protection systems and universal access to education and healthcare.
- Resistance to change. Many people have vested interests in maintaining the status quo, and there is increasing evidence that many orphanages are trafficking children.
Evidence demonstrates that not only is the institutionalisation of children extremely harmful to their health, well-being and future prospects, but it is also, for most children, considerably more expensive than community-based services.
Research demonstrates that “on average, institutional care is twice as expensive as the most costly alternative – community-based residential/small group homes; it is three to five times as expensive as foster care; and around eight times more expensive than providing social services-type support to vulnerable families.”
 Carter, R. (2005). Family Matters - A study of institutional childcare in Central and Eastern Europe and the former Soviet Union. London: EveryChild, p8. http://p-ced.com/reference/Family_Matters_summary.pdf [accessed 5 April 2016].
When an institution is closing, all children go through comprehensive assessments involving a number of specialists. This helps determine what type of placement is in their best interests. If it is not possible for a child to return home to his or her family, then a foster care placement – care provided by a person who has been approved and trained to care for children in their own home – may be an option.
The type of foster home varies because children’s needs are different, but all foster families must have the time, skills and desire to fully commit to raising a child.
How long the child lives in the family home varies, depending on the needs of the child. The foster carer is responsible for the daily care, but social services supervise the placement and provide ongoing guidance. The child will be assigned an individual social worker who has regular contact and is available to offer help and support to the child and the foster carer.
There are many different types of foster care, including:
- Emergency foster care: families support a child, often at very short notice. These children may need a home urgently, perhaps because their home environment has become unsafe or their family is in crisis.
- Specialist foster care: families with experience and expertise provide a home to children who may need additional support – for example children who may have experienced trafficking or sexual exploitation, or children with disabilities.
- Respite foster care: families provide short breaks for children with disabilities.This provides a different environment for children to experience and the opportunity for their family to have a break.
It is vital that the foster care system has adequate laws, regulations, standards, monitoring and inspection arrangements. Supporting and monitoring foster placements is key, as it can identify whether additional support or training is needed, and provides an opportunity to regularly monitor and review the placement to ensure that it continues to be in the best interest of the child. Foster care systems must have clear criteria and processes in place to recruit and train foster carers, and a formal process of matching children with foster families.
Permanency planning is a crucial part of a system of care for vulnerable children; it can be defined as a framework of emotional, physical and legal conditions that give a child a sense of commitment, security and continuity of care throughout their childhood and into adult life. The primary aim of permanency planning is to ensure that all children and young people are provided with care arrangements that deliver this continuity of care, and provide the opportunity to form secure attachments to a parent/carer through a consistent and permanent relationship. Whether those plans involve a long-term foster care placement, adoption, or return to immediate or wider family, a key task is to develop a support plan for the child, their carers, and the birth family, which aims to sustain the placement until the child is an adult.
Enabling children in institutions to be cared for by their own families where possible is the primary consideration. With the right support, most children are able to return safely to their birth family. All efforts to return children to their families should be exhausted before other options are considered.
In some situations, it is not in a child’s best interest to return, or stay, in their family. It may be that the family is not able to offer a safe and supportive environment – and this may be on a short-term or permanent basis.
For many children, placement with carefully recruited, screened, trained and monitored local foster families is a vital step towards either returning home or being placed in alternative longer-term, family-based care.
In cases where adoption is in the child’s best interests, efforts should be made for the child to be adopted by a local family from his or her community and country and of origin. This supports the child’s sense of identity, enables them to maintain connections with their community and friends, and enables continuation of contact with their birth family, if appropriate.
Exceptionally, if all prior efforts have been explored, or are not in the child’s best interests, then international adoption may be considered as an option. Poverty or political instability should not act as rationale in their own right for international adoption.
Above all, each child should be assessed individually, and continually supported by a competent body. The child’s best interests, not the financial incentive or desires of well-intended international prospective families, should be the primary consideration that drives decision-making. This requires professionals that are well-qualified, with sufficient decision-making capacity, and a suitable range of care options from which to choose.
Lumos’ approach is guided by the responsibilities and entitlements enshrined in the UN Convention on the Rights of the Child.This includes:
- Giving primary consideration to the best interests of the child (Article 3)
- Recognising a child’s right to be known and cared for by their own parents (Article 7); and respecting the rights of parents or, where appropriate, extended family and community, to provide appropriate direction and guidance to the child (Article 5)
- Ensuring that inter-country adoption is only considered if the child cannot be placed in a foster or an adoptive family or cared for in a suitable manner in the child’s country of origin; adheres to safeguards and standards enshrined in international law; and does not result in improper financial gain (Article 21)
- Ensuring that any adoption (national or international) is based on a comprehensive individual assessment of the child, carried out by suitably qualified professionals, and mandated by the appropriate authority (Article 21)
- Ensuring that, a child who is capable of forming his or her own views is supported to express those views freely in all matters affecting the child, and that their views are given due weight (Article 12)
- Respecting the right of the child to preserve his or her identity, including nationality, name and family relations (A8); and paying due regard to continuity in a child’s upbringing and to the child’s ethnic, religious, cultural and linguistic background (Article 20)
- Ensuring that a child shall not be separated from his / her parents against their will, that all interested parties shall be given an opportunity to participate in the proceedings and make their views known, and that, where appropriate, the child maintains personal relations and direct contact with both parents on a regular basis (Article 9);
Lumos also recognises the Hague Convention on the Protection of Children and Co-operation in Respect of Inter-Country Adoption, which seeks to protect children and their families against the risks of illegal, irregular, premature or ill-prepared adoptions abroad. This Convention, which operates through a system of national Central Authorities, reinforces the UN Convention on the Rights of the Child (Article 21) and seeks to ensure that inter-country adoptions are made in the best interests of the child and with respect for his or her fundamental rights. It also seeks to prevent the abduction, the sale of, or traffic in children.
‘Orphanage trafficking’ is the active recruitment of children from vulnerable families into residential institutions for the purpose of exploitation. Orphanage trafficking is a serious crime and a form of modern slavery.
Evidence from across the worldhighlights that children are being ‘recruited’ from their families into institutions in order tomeet the growing demand forvolunteer placements in institutions. Under the promise of education or food security, families are being coerced or deceived into placing their child in an institution. Once in an institution, despite outward appearances, children seldom receive the care or support promised and are at high risk of harm and abuse.
Over the past decade there has been a growing trend in which young people from wealthy countries volunteer and donate to international causes. In general, such actions are well-intentioned and a considerable amount of ethical volunteering and giving does take place. However, volunteering in institutions has become so popular – and brings so much money into a country – that institutions are sometimes established simply to provide a volunteering ‘experience’. Evidence from a number of countries demonstrates similar disturbing patterns:
An orphanage is established, sometimes unofficially, by people who often have no qualifications to care for vulnerable children. The orphanage is rarely registered with the authorities, who do not know how many children move in and out of the orphanage.
•The orphanage needs children, so they pay ‘child-finders’ to aggressively recruit children. Child-finders prey upon vulnerable families with the promise of education and protection for their children, and persuade or coerce parents to put their child in an orphanage.
•Conditions are usually poor and are often abusive. Because the purpose of the orphanage is to make money, little is spent on the children. They rarely have enough food, are often beaten and neglected. Some are exploited for their labour or for sex. Children may die or disappear without record.
•The orphanage advertises for donors and volunteers. Huge sums of money, much of it in cash, pour into orphanages from well-meaning donors and volunteers. Short-term volunteers rarely witness harm being done to children, who are told to smile and hug the volunteers, otherwise they will be beaten or starved.
Doore, K.E.V. (2016). Paper orphans: Exploring child trafficking for the purposes of orphanages. The International Journal of Children’s Rights. Volume 24, Issue 2 https://www.researchgate.net/publication/305695283_Paper_Orphans_Exploring_Child_Trafficking_for_the_Purpose_of_Orphanages [accessed 10 May 2018]
Joint Standing Committee on Foreign Affairs, Defence and Trade (2017) Hidden in Plain Sight An inquiry into establishing a Modern Slavery Act in Australia. Parliament of the Commonwealth of Australia http://parlinfo.aph.gov.au/parlInfo/download/committees/reportjnt/024102/toc_pdf/HiddeninPlainSight.pdf;fileType=application%2Fpdf [accessed 2 May 2018]
 Doore, K.E.V. (2016). Paper orphans: Exploring child trafficking for the purposes of orphanages. The International Journal of Children’s Rights. Volume 24, Issue 2 ; Lumos (2016) Orphanage Entrepreneurs: The Trafficking of Haiti’s Invisible Children;
 Joint Standing Committee on Foreign Affairs, Defence and Trade (2017) Hidden in Plain Sight An inquiry into establishing a Modern Slavery Act in Australia. Parliament of the Commonwealth of Australia http://parlinfo.aph.gov.au/parlInfo/download/committees/reportjnt/024102/toc_pdf/HiddeninPlainSight.pdf;fileType=application%2Fpdf [accessed 2 May 2018]
Volunteering in orphanages – giving time and money – has become increasingly popular. Although often well-intended, it can be harmful to children in several ways:
- The ‘orphanage industry’.The number of people volunteering in institutions, and the amount of donations given internationally, has become so great that it is creating a demand for more institutions. Every year, thousands of volunteers and hundreds of millions of dollars go to residential institutions.Although in isolation, every donation, every visit and every volunteering placement, may be minor – when combined, they create a multi-million dollar opportunity for traffickers.Whenever such a large amount of money and resource is available, especially in such an unregulated and unseen environment, it can be an attractive and easy way to make money. Evidence from across the world demonstrates that residential institutions are being set up to provide volunteering ‘experiences’, and receive vast amounts of money – little of which ends up supporting children.
- Attachment disorders. Children in institutions may often show a great deal of affection to international volunteers, sometimes running and hugging them on arrival. These displays of indiscriminate affection are often interpreted as evidence of the positive impact of volunteering. However, the fact that children relate like this to strangers is a sign that they are not able to develop healthy relationships. The regular turnover of volunteers who offer affection and care for a few days or weeks, means that children only receive pockets of affection, without consistent and stable support. This harms children’s ability to form secure attachments, essential to healthy development.
- Lack of appropriate skills. Volunteers in institutions are rarely required to have specific skills, experience or qualifications to work with vulnerable children. Supporting and caring for children requires specialised skills, knowledge and experience. In your own country, it is likely that there are strict procedures around access to children, particularly those with complex needs. The same principles to protect children in your country should apply internationally.
- Normalising access to vulnerable children. The lack of basic child protection procedures in many institutions creates an environment which can be taken advantage of by those with harmful intentions towards children.
- Risks to children’s safety.Not all volunteers are required to undertake background checks which may highlight previous criminal activities that should prohibit them from working directly with children.This relatively easy access to vulnerable children is seen as an opportunity by some child sex abusers, who pose as orphanage volunteers.Even where background checks have been made, many institutions, and the countries in which they operate, do not have strong child protection systems in place to prevent, recognise and respond to abuse.
- Prioritising the volunteer experience. The desire to sustain the influx of paying volunteers and visitors to institutions means that often, their experiences will be prioritised over the wellbeing of the children. Children in institutions are often forced to spend time with tourists against their will, to perform in cultural ‘shows’ for visitor entertainment, and to beg on the streets.
- Diverting money from reaching sustainable solutions. There is a growing movement of governments, businesses, charities, and individuals shifting away from supporting institutions.Without a corresponding shift in the behaviour of people who want to volunteer or visit institutions, the support will continue to prop up a system that has more sustainable alternatives, which result in far better outcomes for children.
- Support for volunteers. Without experience of working with vulnerable children, volunteers may be placed in situations that they are not trained to cope with, such as children confiding in the volunteer that they have been abused, or witnessing abuse of children. Where volunteers experience inappropriate or illegal practices in an institution, and choose to question these practices, they may also be putting themselves at risk. These experiences can be upsetting and potentially dangerous for the volunteer.
- Risks to personal safety. Well-intentioned volunteers will often wish to reform practice in institutions and improve the wellbeing of children. Evidence from some former volunteers demonstrates this may place volunteers in danger from institution directors who have an incentive to leave the children and facilities in a poor condition in order to garner donations.
Children need families.Institutions operate on the model that children need to be taken out of a situation to be protected, cared for and supported.However, evidence from across the world demonstrates how, with basic support, children can live in their families and communities – with far better outcomes, and often for less money.
There are many ways that your desire to support vulnerable children and develop your skills and interests can be used to support communities – both in your own country and internationally.
We will soon be publishing guidance on how to identify sustainable and ethical alternatives to volunteering in institutions, and examples of responsible volunteering. Please do email firstname.lastname@example.org in the meantime and the team can send you some recommendations.
Many people who become aware of the harm of institutions and ‘orphanage trafficking’ will wish to withdraw support.
However, many institutions are heavily dependent on the support they receive. If support for the institution is withdrawn suddenly, standards of care for the children might rapidly decrease and they may end up on the street. Once children have been separated from their families and are living in institutions, returning them to families or finding more appropriate forms of care takes time.A careful process of ‘divesting’ from supporting institutions is needed.
It is possible to redirect your money, time and resources towards alternatives that create a better future for children and a more sustainable care system. We will soon be publishing guidance on how you can redirect your money, time and resources away from institutions towards alternatives that create a better future for children and a more sustainable care system. Please do email email@example.com in the meantime and we will be able to help.