In 2001, when the number of orphans (counting both single and double orphans) was 34 million, forecasts put the number at 62 million in 2010. The number today is actually closer to 145 million. Disease, violence, natural disasters, and economic strife have led to these distressing numbers that don’t even include children who have living parents but are forced to live on their own, in orphanages or worse, on the streets.
While there are parentless children in every country, orphans are concentrated in countries plagued by natural disasters, HIV/AIDS, exploitation, famine, and civil conflict. Natural disasters destroy infrastructure, create heightened risk of waterborne diseases, “eliminate sources of food and income … and may result in disability or death of family members.” Before Haiti’s earthquake, there were about 380,000 orphans, while today’s estimates range from tens of thousands to one million.
HIV/AIDS is another major cause of orphanhood. By continent, Asia is home to the greatest number of orphans, while Africa has the most orphans per capita, due to HIV/AIDS. In sub-Saharan Africa, 25% of all orphans have lost parents to AIDS. By 2005, 40% of deaths in Sub-Saharan Africa were in the parental age range of 20-39 years, up from just 10% in 1990.
In Thailand and Tanzania, 30% of orphans lost parents to AIDS, even though the adult prevalence is less than 2% and 5.6%, respectively.
Once orphaned or abandoned, children fare poorly. Some hold jobs; but far from promising welfare, many employers take advantage of orphans’ vulnerability. The International Labour Organization issued a report in 2004 that cited 218 million working children between 5-17 worldwide. At least 126 million of these children are in hazardous and exploitative full-time jobs, and 5.7 million of them are in forced or bonded labor. About 1.2 million of these children are sold into their slavery positions. Many are orphans, as orphanages are too crowded to accommodate the large numbers of children who are sent their way.
In 2002, an Ethiopian study found that 75% of child domestic laborers in Addis Ababa were orphans, and that 80% of the laborers were considered slaves, working more than 11 hours per day, 7 days a week. In 2000, 38% of children working full time in Tanzanian mines, under life-threatening conditions, were orphans. These children “clearly linked the situation of having nobody to take care of them with their involvement in child labour [sic].” As one orphan reported, “After my parents had died there was nobody to take care of me. I stopped going to school for some time, it was only later that my uncle came to collect me and brought me here [to work in the mines], but I was told that I have to work to support myself because he also has a family that he has to take care of.”
Famine/drought and conflict are enormous contributors to crushing child vulnerability, and its likely that these tragedies disproportionately affect orphans. In African and South Asian regions suffering from chronic food shortages, over half of children’s growth is stunted. Famine impairs thinking, the ability to respond to environmental stimuli. Somali famine led to an increase in the number of orphans. Violent religious clashes in Sudan and wars in Bosnia-Herzegovina and Croatia had the same result. Child refugees are among the most vulnerable populations in the world. As of 2006, there were an estimated 9 million. Worse, war doesn’t just “leave many children orphans, it also often turns orphaned children into soldiers.”
Children who are not enslaved or living in the meager shelter most orphanages provide languish on the streets, where they are at daily risk of malnutrition, disease, physical abuse, sexual abuse including prostitution and pornography, drug abuse, HIV infection, recruitment into criminal activity, and often murder. A 2002 Zambia study found the average age of prostitutes to be 15. Almost half of the child prostitutes – who were having sex with an average of 3-4 people per day – were double orphans. In Guatemala, 93% of street children have STDs, and 90% use drugs.
Orphans also die in the name of social cleansing, a eugenic ideology holding that certain populations – usually a specific ethnic, racial or religious group as in the case of the Holocaust or Rwandan genocide – taint society and must be eliminated. Some countries apply the “notion of social cleansing … to street children even when they are not distinguished as members of a particular racial, ethnic or religious group.” In 1994, over 2,000 homeless children were murdered in the streets of Colombia. Street children in Honduras are “often tortured and killed by Honduran police officers.” Brazilian security officers kill 1,000 out of 7 million street children a year. Short of murder, abuse of street children has been reported in India, Kenya, Egypt, Guatemala, Albania and Sudan.
Those who do end up in orphanages do not fare much better; observers refer to the conditions in orphanages around the world as tantamount to infanticide. In China, for example, baby girls languish in state-run orphanages, many eventually starving to death. They do not cry, “because they have learned that no one will respond and care for them.” Babies in Chinese orphanages die at a far higher rate than any other country. Many are deliberately killed, reported in one study as “an apparently systematic program of child elimination in which senior medical staff played a central role.”
In other countries, children are in slightly better care, but still end up “seriously backward in terms of motor skills, such as holding their head up or grasping a toy, as well as emotionally deprived, even frightened or traumatized … [either] desperate for human contact [or] clearly distraught by it.” They “lie in cribs soiled and vanquished [as infants]. As toddlers, they stand among railings, rocking side to side, cruising unsteadily along the railings of their large pens in soundless rooms. The smell of unchanged clothes saturated with stool and urine pervade the room.” Eventually, urine soaked rags instead of diapers lead to bleeding sores. Children “spend aimless hours in [dirt yards] of their fenced institution, or roaming the peeling corridors of a dormitory that reeks of sewage and mold.”
The healthcare available to children in orphanage systems has been described as “what would be considered malpractice in the United States.” Like “animals,” children at many orphanages “are covered with flies.” The poor sanitation, hygiene and pollution exposes institutionalized orphans to the highly contagious hepatitis B virus, along with scabies, pneumonia, jaundice, rickets, and salmonella. Millions are at risk of developing ailments like “asthma, central nervous system pathologies, developmental delays, failure to thrive, anemia, rickets, fetal alcohol syndrome, malnutrition, parasites, exposure to syphilis, and tuberculosis, infectious diseases,  motor problems,” or cataracts.
These conditions are “essentially the state of millions of children all over the world living in orphanages.” Fifty years of research into these institutions show the same thing over and over: “institutions systematically abuse children. Children die at high rates in poor institutions, and even the best institutions destroy children’s life prospects by damaging their intellectual and emotional potential.” Children lose one month of growth and development for every three months spent in these institutions.
No matter what their situation, children, many of them orphans, are dying all over the world, most “for the lack of the means of subsistence” and disease. The major killers of children under 5 are undernutrition, pneumonia, diarrhea, and malaria. A 1989 report stated that an orphan had only a 50% chance of surviving beyond one year.
The UN estimates that 7.5 million children under 5 die every year in the developing world, but doesn’t report specifically on how many are orphans. Orphans have higher mortality risks than non-orphans, but there are few studies on orphan mortality. A reasonably conservative estimate of the number of orphans under 5 that die annually might be 4 million, given
that 7.5 million children under 5 are dying annually, there are 145 million orphans today and orphans are at greater risk of death than non-orphans. Whatever the number, these statistics on mortality don’t include the millions of parentless children who are “merely” suffering from famine, exploitation, civil conflict or disease, or those who will die before turning 18.
 UNAIDS (Joint United Nations Programme on HIV/AIDS) A Joint Report on Orphan Estimates and Program Strategies (2002).
 Olsen, supra at 516.
 Liu, supra at 211.
 USAID, Highly Vulnerable Children: Causes, Consequences and Actions, 7 (2007).
 Haiti’s Children and the Adoption Question, New York Times (2007).
 Olsen, supra at 504.
 Kate O’Keeffe, The Intercountry Adoption Act of 2000: The United States’ Ratification of the Hague Convention on the Protection of Children, and its Meager Effect on International Adoption, 40 Vand. J. Transnat’l L. 1611, 1633-1634 (2007).
 UNAIDS, 2006 Report on the Global AIDS Epidemic Executive Summary 23 (2006), available at www.unaids.org/en/HIV_data/2006GlobalReport/default.asp.
 Making the Right Choices in the Asia-Pacific Region: Protecting Children and Young People from HIV and Its Impacts at 183; Wardle, supra at 331; http://www.avert.org/africa-hiv-aids-statistics.ht
 Most of those positions were held by boys. Wardle, supra at 327.
 USAID, supra at 7 .
 Wardle, supra at 327.
 O’Keeffe, supra
at 1635; personal observation in Kenya and Fiji.
 UNICEF, Africa’s Orphaned Generations, 30 (2003).
 J.A. Mwami, A.J. Sanga & J. Nyoni, Investigating the Worst Forms of Child Labour No. 15 (2002).
 Subbarao, Kalanidhi, The Response of the Educational System to the Needs
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of Orphans and Children Affected by HIV/AIDS, 75; The World Bank, Reaching Out to Africa’s Orphans: A Framework for Public Action, 2 (2005).
 Joel Cohen, 7 Billion, New York Times, A19 (2011).
 Kalanidhi, supra.
 Stacie Strong, Children’s Rights in Intercountry Adoption: Towards a New Goal, 13 B.U. Int’l L.J. 163, 170 (1995).
 Liu, supra at 188.
 USAID, supra.
 Wardle, supra at 330.
 Kalanidhi, supra at 7; Wardle, supra at 327; O’Keeffe, supra at 1635.
 UNICEF, supra at 30.
 Wardle, supra at 327.
 See generally T. Markus Funk, Victims’ Rights and Advocacy at the International Criminal Court (2010).
 Wardle, supra at 326.
 Dan Berger, Improving the Safety and Efficiency of Foreign Adoptions: U.S. Domestic Adoption Programs and Adoption Programs in Other Countries Provide Lessons for INS Reform, 5 Cornell J.L. & Pub. Pol’y 33, 37 (1995).
 Liu, supra at 187.
 Wardle, supra at 326.
 Michelle Van Leeuwen, The Politics of Adoptions Across Borders: Whose Interests Are Served? (A Look at the Emerging Market of Infants from China), 8 Pac. Rim L. & Pol’y J. 189, 195 (1999).
 Howard E. Bogard, Who Are the Orphans? Defining Orphan Status and the Need for an International Convention on Intercountry Adoption, 5 Emory Int’l L. Rev. 571 (1991).
 Rebecca Worthington, The Road to Parentless Children is Paved With Good Intentions: How The Hague Convention and Recent Intercountry Adoption Rules Are Affecting Potential Parents and The Best Interests of Children, 19 Duke J. Comp. & Int’l L. 559, 574 (2009).
 Intercountry Adoption Process, 6 (1991).
 Betrayal of Body and Soul: A Tribute to Ben, by Aronson, Jane, in New York Times (‘Nov 28 2007)
 Bogard, supra at 571.
 Donovan Steltzner, Intercountry Adoption: Toward a Regime that Recognizes the Best Interests of Adoptive Parents, 35 Case W. Res. J. Int’l L. 113, 129 (2005).
 Liu, supra at 187-188.
 Jorge Carro, Regulation of Intercountry Adoption: Can the
Abuses Come to an End?, 18 Hastings Int’l & Comp. L. Rev. 121, 137 (2005).
 The Intercountry Adoption Process, supra.
 Steltzner, supra at 128-129.
 The Intercountry Adoption Process, supra.
 Jane Aronson, Betrayal of Body and Soul: A Tribute to Ben, New York Times (2007).
 Haiti’s Children and the Adoption Question, New York Times (2007).
 Melissa Faye Greene, The Orphan Ranger, The New Yorker 41 (2000); but doctors “are often delighted by how quickly adopted children catch up.”
 Henry Shue, Basic Rights: Subsistence, Affluence, and U.S. Foreign Policy (2nd ed. 1996).
 Worthington, supra at 574.
 Danzhen You, Gareth Jones and Tessa Wardlaw, Levels & Trends in Child Mortality: Report 2011 16 (2011), available at www.UN.org (last accessed Dec. 6 2011).
 Mika Ueyama, IFPRI Discussion Paper 00710, Mortality, Mobility, and Schooling Outcomes Among Orphans: Evidence from Malawi 2 (2007), available at www.ifpri.org (last accessed Dec. 6 2011).
 Most children who contract HIV in utero, during delivery or through breast milk die before turning 5, so this must also make up a large percentage of Sub-Saharan under-5 deaths.
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