interview | Forensic pathologist on child abuse: ‘Child abuse runs through all social classes’

interview | Charité forensic doctor

Child abuse permeates all social classes.


Dibba / n. poor

Audio: Brandenburg antenna | 03/08/2022 | Dorita Kermes | picture: Dibba / n. poor

Nationwide, 152 children were violently killed in 2020. That is 40 more cases than the previous year. The number of unreported cases is much higher, says Saskia Etzold, head of the outpatient clinic for protection against violence at Charity Berlin. Help often comes too late.

rbb: Mrs. Itzold, at the anti-violence outpatient clinic in the Charité, children are not treated but examined, what does that mean in concrete terms?

Saskia Itzold: Children are presented to us with suspicion of abuse and/or neglect. We then conduct a forensic medical examination and write an expert opinion on whether or not the suspicion of abuse has been confirmed. In approximately 20 percent of cases, we determined in the investigation that the injury was either caused by an accident or, more often, was not an injury at all, but, for example, hyperpigmentation of the skin or an infectious disease.

Is there a case you particularly remember?

We can always talk badly about cases, so I can’t comment on individual cases. But in the end you have to say that every case where a child dies as a result of abuse is too many. It is believed that for every known case, there is at least one more in the dark field. We have to assume that the number is at least twice higher.

Archive photo: Dr.  Saskia Etzold of the Violence Prevention Outpatient Clinic.  (Source: dpa / J. Carstensen)
Dr. Saskia Itzold is a forensic doctor and head of the outpatient clinic for the prevention of violence at the Berlin Charité. | picture: Dibba / y. Carstensen

In 2019, 112 children were violently killed nationwide, and in 2020 there were already 152 cases. Has the Corona pandemic exacerbated the situation?

We have seen very well in everyday life that the numbers have gone up exponentially. We mostly saw this when the lockdown was released and the kids then went back to nursery school or school, for example. Of course, we can’t really say what happened inside confinement because children’s injuries heal very quickly. You won’t see any more infections in a few days. But overall, the numbers have increased significantly for us. We also know from other areas, for example from women’s counseling centres, who also provided advice over the phone, that general domestic violence has increased significantly during these times.

Does child abuse only occur in a particular social setting?

Child abuse extends to all social classes, all cultural backgrounds, and all educational backgrounds. What changes in part, as with domestic violence, is the type of harm we see. With well-educated parents, we often find that the abuse is not visible in the visible area, not on the face itself, but children report being beaten on the hairy head, on the back, or on the buttocks so that – if the children wear – they do not see that they have been injured. This is something we are told over and over about violence in a partnership.

In your view, are there families at greater risk than others?

In general, one has to say that there are risk factors for abuse, whether trauma trauma (Editor’s note: Brain injury caused by violent shaking of infants and young children.) as well as for other public abuse. We know from studies that the risk is increased, for example, if we have a family history of mental illness, or if we have substance abuse – ie drug or alcohol addiction – in the family, if there are major financial problems in the family, or if they have a history Very bad family room they have cramped living space. These are all risk factors that add to the whole thing. Single parents are more likely to be abused, and they may not have parents around who will say, OK, I’m going to take the baby off your hands for a few hours.

Ultimately, it cannot be said that certain social classes are particularly vulnerable to abuse, which also makes it difficult to recognize abuse, but there are risk factors that are closely examined. In the meantime, there are also many projects that you are looking at very early on. For example, child guides, who seek to have conversations with parents in the maternity clinic, and if they identify risk factors, try to organize help for parents through the Youth Welfare Office.

Do children hit mainly men or women?

There are studies that show that there are men and women who commit this violence. There are some constellations that we frequently encounter in daily life. For example, this is often the new partner of a mother who abuses the child. But there are actually constellations in every variable.

In 2014, together with forensic pathologist Michael Tusks I published Germany Child Abuse by pointing out structural errors in protecting children and young people. Where exactly is stuck in the system?

The problem we have with the system is that certain areas, for example, need to work together separately. Simple example: If the Youth Welfare Office realizes that the family needs support, the Youth Welfare Office will not be able to provide the help itself. This means that the Youth Welfare Office, which has to decide how the whole thing goes, has no way of working with this same family to determine when things get tough, but they have to outsource to an independent agency.

Then you have such a concentration of cases that it is difficult for those affected to treat such cases.

Saskia Itzold, coroner at Charity Berlin

The independent agency relies on obtaining these orders and makes its money by helping the family in families. Here they have a certain financial dependence on the fact that the child stays with the family. The Youth Welfare Office, which decides cases, has no direct contact with the family, but receives reports. Now we all know paper has patience. Reports can never present a situation as impressive as when we are in contact with the people involved.

We have a problem here that the organization that is supposed to decide something doesn’t have a way to verify something there themselves. At the same time, the Youth Welfare Office is part of the public service, so the funds are always very tight. However, the pay is not great, which prompted a lot of experienced people to leave this field and go somewhere else where they can earn more money. This means that they have a lot of young people here. It is known that a large number of positions are vacant and the positions that are filled often have a very high level of sick leave. Then you have such a concentration of cases that it is difficult for those affected to treat such cases.

In your book you also advocate for better training of certain areas. What happened in this regard during the past eight years?

A lot has happened since the book was published. As an outpatient violence prevention clinic, we offer training courses for people who work with victims of violence, and these courses are accepted regularly. In the meantime, almost all youth welfare offices in the city have been trained, and independent providers contact us. Meanwhile, many schools and daycare centers have trained her. Of course it is still the case in some courses, for example when studying social work, that child abuse is either not mandatory at all or marginally mandatory. This is something that is being worked on, as this topic is being applied more deeply in all of these curricula of the various professional groups.

Mrs. Itzold, thank you very much for the interview.

Dorit Kermes interviewed by Saskika Itzold. This is an edited and abridged version of the interview.

Broadcast: Anten Brandenburg on August 3, 2022 at 3:10 pm


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