CHILD sexual abuse is neither a rare phenomenon nor a recent one. It is prevalent worldwide, and its occurrence is understood to be much higher than the reported rates, which vary between 10 to 30 per cent. Both girls and boys are victimised, the former at least twice as often as the latter.

The most vulnerable children are those aged seven to 13, although victims are often even younger. Adolescents are particularly vulnerable to abuse by peers.

Following the scandals in Kasur – first in 2015 and then the recent, horrific murder of seven-year-old Zainab — there has been growing media focus on the sexual exploitation of children, especially associated with pornography and general criminal behaviour.

This kind of abuse tends to happen away from home or school, spaces usually considered safe for children. Except, sadly, they often aren’t.

Abuse in domestic settings is even more common. It is also worse, given that it often continues over extended periods and shatters trusted relationships.

From clinical experience, the perpetrators are usually close male family members — father figures (eg uncles) or brother figures (eg cousins). Girls especially are more likely to be abused by a family member.

A particularly disturbing case is that of a lady, now married with three children, who was abused by three of her four brothers, all much older than herself.

The chances of disclosing this form of molestation are further minimised because of the complexity of family dynamics.

An educated gentleman suffered in silence for decades — he was obliged to socially interact with his uncle’s son, who abused him for seven years in his childhood. Ironically, the victim was condemned by his family when he refused to marry the same uncle’s daughter.

Many children endure years of guilt feeling responsible for acts of sexual abuse they could not prevent.

Abusers may also emerge from among unrelated, but trusted, caretakers, such as domestic staff, drivers, teachers, qari sahibs and neighbours. Some­times, older adolescent boys victimise younger children, or even peers. This is not uncommon in boarding schools or madressahs. Many such perpetrators have been victims of sexual abuse themselves.

Even though perpetrators are usually male, in rare cases they may be women or adolescent girls. Offenders usually have a particular emotional and/or sexual need that is fulfilled through exploiting children. This need outweighs their moral inhibitions and drives them to gain access to vulnerable children and entice or trick them into a ‘secret game’ of intimacy.

Child sexual abuse, by definition, “is the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent, or that violates the laws or social taboos of society”.

It is important to recognise that however benign the act might appear eg, casual (but sexual) touching, it can cause serious harm to a child. Many children endure years of guilt, tragically feeling responsible for acts they were powerless to prevent.

The terms ‘informed consent’ and ‘fully comprehend’ essentially mean that only as an adult (18 years according to Pakistani law) is one able to truly understand and agree to sexual advances.

The wounds of childhood sexual abuse run deep. Most children do not talk about it – either because they are afraid of being blamed, or because they believe it is normal, or because their abuser has threatened them. The process of disclosing and recovering from such trauma can take years.

Details of little Zainab’s ordeal recently triggered the memories of a lady in her 60s. She had been under psychiatric care for a decade before she disclosed her own abuse to her therapist. She had been married at 14 and for years, believed her father-in-law’s caressing was ‘normal’.

Survivors of childhood sexual abuse struggle with strong emotional reactions like anger, betrayal, helplessness, depression, fear, confusion, shame and guilt. Many describe feeling ‘unworthy’ and ‘dirty’ and suffer from poor self-esteem.

Many continue to endure their grief with remarkable resilience. But some face interpersonal challenges; difficulties forming healthy sexual relationships; social dysfunction; and are at a much higher risk of mental disorders including depressive illness, self-harm and substance abuse.

For a parent or guardian, there are warning signs. These include an unusual change in a child’s behaviour, for example, becoming aggressive or withdrawn, having trouble sleeping or concentrating on schoolwork, bedwetting etc.

Sometimes, children may demonstrate inappropriate sexual behaviour or use sexually explicit language. Uncommonly, they might give indirect hints or start avoiding the perpetrator. Also, if a child develops physical health problems such as soreness or infection in their private areas, these should be carefully investigated.

The current media attention has helped to centre the spotlight on child sexual abuse, an issue that has been ignored for too long. But it has also highlighted the need to train the media in sensitive and rational reporting.

There is a great need to generate public awareness: children must be protected against all forms of abuse, and sexual abuse in particular. Educating parents is paramount as the major risk factor for child sexual abuse is a breach in the quality and quantity of their supervision.

That a domestic help can be trusted to look after a home does not mean that he can be trusted with a child, and the ability to recite Arabic is certainly not a guarantee of moral virtue.

Children are already exposed to all kinds of uncensored information — there is no reason not to incorporate sexual health in the curricula. All professionals who work directly with children eg teachers, sports coaches, and security staff in schools should be trained with clear guidelines for child protection.

Awareness must also be raised among professionals such as doctors. Currently, almost no attention is paid to child protection issues in medical training. Needless to say, the role of mental health specialists must be redefined much beyond the biomedical model of practice, if they are to work with victims who have suffered years of emotional trauma.

Child protection laws are essential, of course, but helpful only when fully integrated within a functional social and judicial system.

The writer is a consultant psychiatrist.

Twitter: @AsmaHumayun

Published in Dawn, February 13th, 2018