SWEDEN: Children's rights in the UN Special Procedures' reports

Summary: This report extracts mentions of children's rights issues in the reports of the UN Special Procedures. This does not include reports of child specific Special Procedures, such as the Special Rapporteur on the sale of children, child prostitution and child pornography, which are available as separate reports.

Please note that the language may have been edited in places for the purpose of clarity.

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UN Special Rapporteur on Health
Paul Hunt
(A/HRC/4/28/Add.2 )
Country visit: 10 to 18 January 2006
Report published: 28 February 2007

Infant Morality: Moreover, there have been significant improvements in many health outcomes in Sweden. Between 1970 and 2002, infant mortality fell from 11 to 3 deaths per 1,000 live births. Deaths on account of traffic accidents, work-related deaths and injuries, and the number of daily smokers have also fallen significantly in recent years. Recently, cardiovascular diseases have also become less prevalent. (Paragraph 9)

Sexually Transmitted Diseases: However, there is no room for complacency. There are some worrying health trends in Sweden. Rates of mental health problems, for example, have increased significantly in recent years, as has obesity. Since the 1990s, reported cases of chlamydia have significantly increased, and there have been increasing rates of infection of other sexually transmitted infections - particularly among youth - including gonorrhoea and syphilis. Cases of HIV are also increasing.3 Examined through the prism of the right to health, some health policies are a cause for genuine concern. (Paragraph 11)

Relevant International Obligations: Sweden has ratified a range of international human right treaties recognising the right to health and other health-related rights, including the International Covenant on Economic, Social and Cultural Rights (ICESCR), the International Covenant on Civil and Political Rights (ICCPR), the International Convention on the Elimination of all Forms of Racial Discrimination, the Convention on the Elimination of All Forms Discrimination Against Women, and the Convention on the Rights of the Child. It has also ratified regional human rights treaties such as the Convention on Human Rights and Fundamental Freedoms (European Convention on Human Rights), the revised European Social Charter and the European Convention on Social and Medical Assistance. (Paragraph 15)

Throughout his mandate, the Special Rapporteur has taken the position that a rich State’s human rights responsibility to provide international assistance and cooperation is underpinned by a legal obligation. The Committee on Economic, Social and Cultural Rights, and others, adopt the same position. It is accepted that the parameters and content of this legal obligation are not yet clearly defined, but the same can be said for a number of human rights. In brief, the legal obligation can be traced from the Charter of the United Nations, through to the Universal Declaration of Human Rights,66 and binding human rights treaties, such as the International Covenant on Economic, Social and Cultural Rights and the Convention on the Rights of the Child. It is also reflected in compelling world conference outcomes, such as the United Nations Millennium Declaration. This human rights responsibility of international assistance and cooperation extends to health. (Paragraph 110)

Domestic Obligations: A number of domestic laws set out health-care related responsibilities of various authorities. Of central relevance is the Health and Medical Services Act, which establishes that the goals of health and medical services are to assure the entire population good health on equal terms, and that care should be prioritised according to need. The Act stipulates that county councils have responsibility for providing health care, health promotion and disease prevention. The Act also establishes that municipalities have health-related responsibilities for particular groups, for example they have responsibilities for providing habilitation, rehabilitation and assistive devices for persons with disabilities, care for the elderly, childcare, and support for persons in sheltered accommodation. The Special Rapporteur was concerned about reports of unsatisfactory coordination between the counties and municipalities with respect to health care and related support services. He urges central, county and municipal authorities to take steps to improve coordination, with a view to the better protection of the right to health and implementation of the goals of the Health and Medical Services Act. (Paragraph 20)

Dental Care: A high-cost protection scheme means that patients pay a maximum of SKr 900 over a 12-month period for outpatient care. However, costs have adversely affected the financial accessibility of health care for some population groups. Under the Dental Care Act (1999), for example, patients bear some of the costs for many dental procedures. The cost of dental care has risen significantly since 1999. Although there are exemptions for children and youth up to 19 years of age and for persons over 65 years of age, and despite the maximum payment of SKr 900 over a one-year period, the Special Rapporteur was informed that fees have adversely affected the take-up of dental services, especially for people living in poverty. (Paragraph 36)

Psychological Disabilities: There is a high incidence of psychosocial disabilities among specific population groups, including homeless persons.20 Up to a quarter of refugees and asylum-seekers are affected by post-traumatic stress disorder. Refugees, asylum-seekers and homeless persons all reportedly have difficulty accessing mental health care. Among children and young people, suicide, bulimia and anorexia are increasing. However, there are few mental health programmes focused on children and young persons. Discrimination and stigma have reportedly created a high incidence of psychosocial disabilities among lesbian, gay, bisexual and transgender persons. The Special Rapporteur was informed that psychosocial disabilities are the leading cause of ill-health among women in Sweden: violence and discrimination against women have contributed to this situation. (Paragraph 44)

Recently, the Government has commendably made mental health policies and programmes a higher priority. In 1995, the Government adopted a mental health reform which had the objective of improving the quality of life of users of mental health care. The Public Health Objectives Bill22 sets out several objectives connected to preventing psychosocial disabilities, including creating a healthier working life, and secure and favourable conditions during childhood. The Special Rapporteur welcomes these commitments. (Paragraph 45)

The Special Rapporteur welcomes the focus in the Public Health Objectives Bill on addressing the causes of psychosocial disabilities among the population, and urges the Government to ensure adequate funding for these measures. The Special Rapporteur urges the Government to ensure that it takes measures to address causes of psychosocial disabilities among vulnerable and marginalised groups, including children, adolescents, homeless persons, women, asylum-seekers, and lesbian, gay, bisexual and transgender persons. (Paragraph 48)

He urges the Government to ensure that mental health care, including psychiatric care and other therapies, is made more accessible for marginalised groups. He also suggests that central Government, counties and municipalities should devote more attention to ensuring coordination between services, and the provision of more services and programmes for children and adolescents. (Paragraph 49)

Disease Transmission:These results are in line with the worldwide experience that harm-reduction programmes, including needle exchange programmes and associated health care, promote and protect the health of drug users and reduce transmission of communicable diseases such as hepatitis B and C and HIV, including vertical transmission to newborn children from pregnant intravenous drug users or their partners. These programmes are highly cost-effective. (Paragraph 61)

Asylum-Seeking and Undocumented Children: Asylum-seeking children have access to the same health care on the same basis as children domiciled in Sweden. However, asylum-seeking adults do not have access to the same health care as adults domiciled in Sweden. In the Special Rapporteur’s opinion, such differential treatment constitutes discrimination under international human rights law. (Paragraph 69)

Undocumented children receive health care on the same basis as resident children. Undocumented adults may receive immediate health care, but at their own expense. Undocumented people who seek medical care in a public health-care facility will receive the treatment required. However, they will have to pay the full cost of the treatment and medication. A further problem is that undocumented people fear being reported to authorities by medical staff and thus they often refrain from seeking medical assistance even in the most serious cases. (Paragraph 71)

The Special Rapporteur notes with particular concern the high incidence of severe withdrawal behaviour among asylum-seeking children in Sweden (the so-called “apathetic children”). These children appear to have become severely withdrawn, with some refusing to eat and/or communicate. The most difficult and severe cases present symptoms akin to a psychological condition known as Pervasive Refusal Syndrome: those affected often require tube-feeding to stay alive. (Paragraph 76)

Acknowledging the need to address the problem, in 2004 the Government appointed a National Coordinator for children with severe withdrawal behaviour in the asylum process. The National Coordinator was tasked with providing an overview and analysing the incidence of this problem, which mostly affects children of rejected asylum-seekers. According to the results of the National Coordinator’s survey, Sweden has the largest number of registered cases (424 children). In 2006, the National Coordinator published another report on the situation of children with severe withdrawal behaviour. The Special Rapporteur commends the Government for its commitment to investigating the nature and scale of the problem. (Paragraph 77)

During the mission, the Special Rapporteur had the opportunity to discuss severe withdrawal behaviour with clinical psychologists, sociologists, representatives of NGOs and the National Coordinator. He visited a child suffering from severe withdrawal behaviour, and had the opportunity to discuss his situation with his father, the treating psychiatrist, a nurse and the head of the paediatrics department. (Paragraph 78)

Some experts argue that the anxiety of traumatised children arising from the uncertain outcome of their asylum application may be a cause, and call for granting asylum to these sick children. Other experts, including the National Coordinator, emphasise the high incidence of the syndrome in Sweden in comparison with other countries, and that the behaviour primarily occurs among children of certain ethnic backgrounds, suggesting that psychosocial mechanisms fuel the syndrome. Others have highlighted the existence of similar syndromes in other countries (Finland, Norway and Austria), albeit on a much smaller scale, and the existence of pervasive withdrawal syndrome beyond Sweden. The health professionals with whom the Special Rapporteur met stated categorically that there was no possibility that children with acute symptoms of severe withdrawal behaviour could be faking. (Paragraph 80)

While the Special Rapporteur, for a number of compelling reasons, is unable to make assessments of a clinical nature about these children, he wishes to emphasise the following remarks. (Paragraph 81)

First, while the debates about the condition partly reflect the inadequate medical understanding of the problem, the Special Rapporteur is concerned that these debates may sometimes have been caught up in highly politicised public discussion about asylum and immigration in Sweden. Crucially, the plight of these children must be understood as a health and human rights issue, not as a political or immigration issue. (Paragraph 82)

Third, the Special Rapporteur is aware that human rights have not been absent from discussions about children with severe withdrawal behaviour. Nonetheless, in his view the human rights dimensions of the issue should receive more attention. In addition to the necessity of greater medical research, he wishes to emphasise that all relevant policies and interventions must be guided by human rights. In particular, all parties concerned should ensure that the best interests of the child, and the right of the child to the highest attainable standard of health, “including to necessary medical assistance and health care”, guide policies and interventions, without discrimination. (Paragraph 84)

Fourth, as a way of ensuring that the human rights dimensions of the problem receive more systematic and considered attention than hitherto, the Special Rapporteur recommends that the Ombudsman on children be given the formal and important role of closely monitoring this problem in general, as well as individual cases, from the perspective of the rights of the child. The Ombudsman should make recommendations and report publicly, regularly and officially on her findings. (Paragraph 85)


UN Independent Expert on Development
Arjun Sengupta
(‫‪E/CN.4/2002/WG.18/6/Add.1 )
Country visit: N/A
Report published: 31 December 2002

No mention of children's rights.


UN Special Rapporteur on violence against women
Yakin Ertürk
Country visit:
Report published 6 February 2007

Violence against women and girls: Official crime statistics can indicate trends over time, but they never reveal the actual prevalence of violence against women since they only reflect reported crime. Therefore, it is commendable that the Swedish Government commissioned a comprehensive prevalence survey on violence against women. This National Survey, published in 2001,10 revealed a shockingly high prevalence of violence against women. Almost half of all responding women (46 per cent) had experienced physical and/or sexual violence committed by a man since their fifteenth birthday. One in every eight women (12 per cent) had been subjected to physical or sexual violence, including threatening behaviour, in the last year prior to answering the survey questionnaire. (Paragraph 20)

Women in Sweden continue to face a substantial risk of sexual violence. The National Survey on Violence against Women indicates that more than a third (34 per cent) of all Swedish women have experienced sexual violence at least once since their fifteenth birthday; 7 per cent experienced such violence in the year prior to the survey. The most likely perpetrators are men with whom the victims have an intimate relationship. However, the perpetrators may also be colleagues, friends, neighbours, casual acquaintances or complete strangers. A shocking 5 per cent of all women who took part in the National Survey reported to have been forced into some form of sexual activity by a man with whom they did not have a prior sexual relationship. (Paragraph 29)

In view of the measures already taken and the remaining deficiencies, I would like to make the following recommendations:

(ii) Address the root causes of violence against women by:

Strengthening efforts to address the perpetuation of unequal gender power relations in the private sphere, including through measures at the school and preschool levels, to foster the development of male and female identities that break with notions of inequality and use of force; (Paragraph 74)

Children of victims of domestic violence: The victim’s children very often suffer severe negative consequences too - even before they are born. A study undertaken at the Uppsala Centre for Raped and Battered Women indicated that about 1.3 per cent of all women had been abused during or shortly after pregnancy.14 Such antenatal abuse can cause miscarriages, premature labour or direct injuries to the foetus. Studies have also shown that women who had been subjected to violence during their pregnancy were more likely than non-abused women to give birth to a child with low birth weight.

Children are likely to be aware of and witness violence committed against their mothers. UNICEF estimates that 46,000 children in Sweden are exposed to intimate-partner violence committed against their mother. Exposure to violence within an important and intimate environment is a traumatic experience for children, who feel helpless, unable to control the situation and fear that a loved one might be killed. According to professionals, the child may suffer a post-traumatic stress disorder that can seriously affect the child’s cognitive and emotional development. Children who grow up in a violent environment are more likely to become victims of child abuse themselves and are also more likely to continue the cycle of domestic violence (as perpetrators or victims) when they grew up. (Paragraphs 27 and 28)

Sweden has introduced specific legislation to address the vulnerabilities of non-Swedish women stemming from their non-permanent resident status. Under the Aliens Act, a foreign woman who holds a temporary residence permit that depends on her marriage to a Swedish national or a permanent residence can only receive a permanent residence permit after two years of marriage. This dependency can trap women in violent relationships. For this reason, a special provision has been introduced into the Aliens Act which allows women to receive a residence permit of her own in cases where the relationship with the partner ended before two years had passed because she or her children suffered substantial violence or other violations of freedom and integrity at the hands of her partner. It is sufficient that the victim document the violence through reports from a hospital or a shelter; she does not have to take the often difficult - and sometimes dangerous - step of reporting her former partner to the police in order to legalise her status. Women’s organisations and local officials have informed me that this excellent norm is unfortunately still underused, because foreign women exposed to violence are either not aware of its existence or are afraid to pursue this option. (Paragraph 65)

Sexual crimes committed by boys: Some have argued that the growth of sexual violence only reflects the general rise in violent crime that Sweden has experienced over the last decade. Official crime statistics demonstrate, however, that the increase in reported sexual offences has outpaced that of offences against life and health. Most experts I spoke with indicated that two developments were underlying the rise in reports of rape. Firstly, sexual violence may have become more visible. Government and civil society initiatives to raise awareness about sexual violence and improvements of the legal frameworks seem to have encouraged more women to come forward and report the crime. Secondly, and more worryingly, there also seems to be a genuine increase in the prevalence of sexual violence.20 Moreover, a growing number of sexual offenders are boys or very young men. In 2005 alone, there were 187 cases of sexual crimes in which the suspect identified by the police was younger than 15 years old; 190 males suspected of sexual crimes were aged between 15 and 17 years. (Paragraph 31)

Crimes committed in the name of “honour”: While these types of vulnerabilities are generally not disputed and to some extent are also addressed by special legal provisions (see below), it is hotly debated whether cultural specificities contribute to the vulnerability of women with a foreign background. In this context, the phenomenon of “honour-related violence” has commanded much public attention, especially after the murder of Fadime Şahindal in January 2002.22 The term - widely used by Swedish policy-makers, researchers and practitioners without being clearly defined (which is a problem) - is generally employed to describe cases in which women or girls are subjected to, or threatened with, violence because they are seen as defying their family’s expectations of “honourable” social or sexual behaviour. Some also use the term to refer to cases concerning homosexual or bisexual boys and men suffering violence at the hands of homophobic family members. The Swedish National Police Board calculates that about 400 cases of honour-related violence come to the attention of the authorities every year. (Paragraph 34)

The authorities often resort to witness protection practices normally used in cases involving organised criminal syndicates to provide long-term protection for young women and girls at risk of honour-related violence. Some victims are given housing in undisclosed locations or even receive completely new identities. Yet, a comprehensive long-term strategy is still lacking to address the specific needs of young women and girls who are suddenly deprived of their family support network. Women at risk of honour-related violence often need hands-on guidance and support on how to start a new life. Furthermore, special security arrangements have to be made to ensure that young women and girls can safely maintain the contact with those family members that do not want to harm them. Unfortunately, the authorities do not always seem to be willing to dedicate the necessary resources. Breen Atroshi, the sister of murdered Pela Atroshi, for instance, told me that the authorities are not willing to provide her with security arrangements necessary to meet with her mother - contrary to what was promised when she agreed to testify against her sister’s murderers. (Paragraph 64)

Sexual offences committed against girls: Modules on gender equality and gender sensitivity form an important part of mandatory training for Swedish judges, prosecutors and police officers. These training programmes have helped to change the gender-based perspectives, norms and biases that often have an impact on the investigation, prosecution and adjudication of gender-related crimes. Nevertheless, some problems persist. Women’s groups reported that some justice sector officials still display a gender bias in contested sexual violence cases. I was informed, for example, about a 2004 decision of the Sollentuna District Court concerning a 22-year-old man who had had a sexual relationship of three months’ duration with a 13-year-old girl. The man met the girl through a dating site for young teenagers and lied to her about his own age. The Court held that the man could not have known that the girl was younger than the legal age of consent and found him not guilty of a sexual offence. (Paragraph 52)

Female genital mutilation: Sweden has taken special measures to prosecute and punish violence specifically affecting women with a foreign background. As early as 1982, it passed the Act on the Prohibition of the Circumcision of Women and further strengthened it in 1999. The legislation prohibits, regardless of the consent of the victim or her parents, all operations on the external female genital organs, which are designed to mutilate or produce other permanent changes in them. The crime, which is punishable by a minimum of two years’ imprisonment, has been made exempt from the principle of dual criminality. A person with a connection to Sweden can be prosecuted in Sweden for involvement in acts of female genital mutilation committed in another country, even if that country does not prohibit female genital mutilation.25 In June 1999, the Gothenburg District Court convicted a Swedish national of Somali origin for having authorised and participated in the female genital mutilation of his 14-year-old daughter, even though the acts had taken place in Somalia. The man was sentenced to four years of imprisonment. The decision was upheld on appeal. (Paragraph 54)

Early marriage: In 2004, Sweden introduced changes to enhance the protection of women and girls against forced and early marriages conducted in Sweden and abroad. The legal age of marriage is 18 years and exceptions are only possible with a special permit issued only under very narrow circumstances. Child marriages and forced marriages that have been concluded abroad are not valid in Sweden. There is no legislation specifically criminalising early or forced marriages, but Penal Code provisions on unlawful coercion, illegal threats, sexual crimes and trafficking can be applied. The penal legislation is currently under review. (Paragraph 54)

Shelters for girls and young women victims of violence: Reforms in the institutional protection framework also have to address the situation of women with special needs. In recent years, the shelter movement has created specialised institutions for young women and teenage girls exposed to violence. Other groups with special needs are still underserved. For example, women with severe alcohol or drug problems are usually not given access to existing shelters if they face violence. Unless they agree to enter an addiction rehabilitation programme (and actually find a place), they face a protection gap. Therefore, I was pleased to learn that the Swedish Association of Women’s Shelters (SKR) has established an open house in Göteborg, where these women can find safe shelter without being required to enter a rehabilitation programme. (Paragraph 62)

In view of the measures already taken and the remaining deficiencies, I would like to make the following recommendations:

(iv) Recognising, along with the municipalities, the important role of non-governmental women's shelters and providing them with adequate funding for their core activities. Particular attention should be paid to the protection requirements of women with special needs, including women with substance-abuse problems, physical or mentally disabled women, young women and girls, and elderly women; (Paragraph 74)




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