Paediatricians say child abuse cases in Malta are revealing a worrying trend, despite the number of recorded cases having slightly decreased last year.
Writing in the Malta Medical Journal, paediatricians Simon Attard Montalto and Mariella Mangion say child abuse has become an “ever-increasing problem” in Malta, and that eradicating it remains “extremely difficult” – almost as difficult as changing human nature itself.
According to statistics from the non-accidental injury register (NAI), child abuse cases increased steadily in ten years between 1993 and 2003, reaching close to 1,800 cases in 2003.
But an increasing realisation of the problem, and following a period of under-diagnosis of non-accidental injuries, child abuse reports and services for child abuse have increased.
And although child abuse cases have gone down to 1,200 last year, the doctors say the increase “remains real and is the result of many predisposing phenomena”, including family break-up, increase in unwanted pregnancies, parenting pressures, daily ‘stress’ and crime, especially where drugs come in.
There were 6,442 reports of child abuse recorded by the national welfare agency Appogg between 1993 and 2006, affecting boy and girls mainly aged 6-15.
These only represent 30 per cent of all cases – at least over 10,000 cases were reported in the last 13 years by other agencies, relatives, schools and police. Two-thirds of all cases take place in and around the harbour area. But Gozo represents just two per cent of reports.
Preschool children however make up 12 per cent of all cases reported to Appogg.
Attard Montalto and Mangion said children suffered all sorts of injuries, such as pinch marks in the breast area, lacerations, and bruises on the limbs. Other injuries include multiple cigarette burns, immersion burns, broken ribs, and even cerebral and eye haemorrhages. In one of the more horrible examples, the doctors write, some injuries “virtually advertise NAI… the infant presenting with a large, triangular-shaped burn on the buttocks with the name Rowenta embossed within,” with reference to burns suffered by a hot iron.
The doctors said prosecution of abusers was dependent on a thorough examination of all injuries. “This will prove invaluable in a court of law… Ultimately, a conviction is highly dependent on the accuracy and reliability of the medical testimony.”
National statistics show physical abuse comprises one-third of all cases, with a lower incident of neglect and abandonment cases (24%).
Sexual abuse comprises 17 per cent of all cases.
In Malta, girls are five times more likely to be sexually abused than boys although many cases involve young school or preschool children who may delay, or even not report the event at all.
According to Attard Montalto and Mangion, penetration of the genitals is unusual and external physical signs rare. “Victims may present with inappropriate sexualised or precocious behaviour, mannerisms of speech, general emotional liability and regression in schoolwork, whilst physical signs are often absent.”
Children placed in foster care, generally preferably to residential care, have also gradually increased, from just 27 children in 1997, to 185 in 2005.
But the figure remains low compared to those placed in residences, which totalled 425 in 2004, and 282 in 2005.
“The small size of the country makes anonymity of potential foster carers difficult to uphold, accessibility by (often) violent parents is far too easy, and lack of appropriate support and more importantly protection, including police over, further discourages potential foster carers.”

Reporting child abuse
When reporting suspected cases of child abuse to social workers or the police, parental consent is not required.
Where such action is taken, those filing the report are protected against litigation by data protection laws.
But in cases where children are unsafe in the family, these may have to be placed in a refuge of safety. Wherever possible, the family should be encouraged to cooperate and allow for transfer to a place of safety. “Police and social workers storming households in the middle of the night and charging off with the children is, at the very least, terrifying and should be avoided unless absolutely necessary,” Attard Montalto and Mangion write.

The Appogg Supportline 179 is a 24-hour free telephone service run by a team of professionally trained volunteers offered by Agenzija Appogg. It provides immediate, confidential support to callers of any age, who require assistance both in day-to-day and crisis situations.