Background
Despite their resilience and agency, street and working children (SWC) face precarious conditions, including violence, exploitation, hazardous and toxic environments, and profound human rights violations.1 The United Nations Committee on the Rights of the Child, via General Comment−21, provides States with long-term national strategies for children in street situations.2 The International Labour Organisation (ILO) provides frameworks for children’s work via Conventions 138 (on minimum wage) and 182 (worst forms of child labour) and the Sustainable Development Goals’ target 8.7, which aims to eradicate forced labour, modern slavery and human trafficking.3 However, prioritising the rights, health, development and well-being of SWC and young people (YP), regionally and globally, remains a global challenge.
According to the Committee on the Rights of the Child, street children encompass two categories (1) children who depend on the streets to live and/or work, whether alone, with peers, or with family; and/or (2) a broader population of children who have formed strong connections with public spaces for whom the streets play a vital role in their everyday lives and identities.2 Working children are typically considered renumerated, although much of their work, such as agriculture and participation in family businesses, is often unpaid. The ILO categorises working children as child labourers when their work is unsuitable for their age or harmful to their health, safety or morals.4 The ILO’s ‘worst forms of child labour’ are defined in Article 3 of ILO Convention No. 182, encompassing all forms of slavery or practices similar to slavery, such as the sale and trafficking of children, debt bondage, serfdom and forced labour, including forced or compulsory recruitment of children for use in armed conflict, child prostitution and child pornography.4
However, there are definitional issues with the groups of children and young people (CYP) presented above; for instance, the term ‘streetism’ describes children as ‘living on the streets’ or ‘being of the streets’; furthermore, there is a significant pushback against stigmatising terms like ‘child labour’ in favour of ‘child work’ by organisation of YP and critical scholars who do research with SWC and YP.5–7 All these CYP face common challenges, often working on the streets, experiencing marginalisation and encountering significant disruptions in their education and access to healthcare, particularly in low-resource settings. A systematic review of street CYP from low and middle-income countries by Woan et al, highlighted the disproportionate morbidity in the areas of infectious illness, psychiatric disease, reproductive health, but also exposure to violence, nutrition and growth problems, and substance use.8 Access to healthcare was a significant concern and vast areas of health had not been investigated, including chronic diseases and cognitive deficits. Another systematic review by Batomen Kuimi et al, about the health status of working CYP identified nutritional concerns, injuries and harmful exposures as significant issues.9 Similarly, Ibrahim et al cited poor growth, malnutrition, higher incidence of infectious and system-specific diseases, behavioural and emotional disorders and decreased coping efficacy in working CYP.10 Several studies have pointed to the gaps in the literature and the significant access issues.
As members of the SWC Working Group, which is an active collaboration between the International Society of Social Pediatrics and Child Health (ISSOP), the International Society for Prevention of Child Abuse and Neglect and the Indian Child Abuse and Neglect and Child Labour Committee of the Indian Pediatric Association, we undertook to explore and map out the issues relating to healthcare access for SWC. Using a child rights lens, our scoping review aimed to identify the enablers and barriers relating to access to healthcare and associated supports for children and their families in street situations, and for working children, as well as to explore the rights violations that occur in accessing optimum healthcare.