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1. Introduction

Child abuse is probably the most prominent social challenge for which governments, international and local child protection organizations, the World Health Organization and each adult are called upon to work together to find a solution. From the past to the present, efforts are being made by the world's most vulnerable individuals to be as less as possible exposed to situations that endanger their safety or even their lives. Unfortunately, the phenomenon has existed since ancient times, it still exists, and it is a phenomenon of global scope, but also of global sensitivity.

2. Past

Αncient times

Child abuse has been documented since ancient times in various forms. Infanticide is one of these forms, which in turn is divided over the years, mainly based on the reason behind the act. A form of infanticide that is often found in ancient times, is the sacrifice of children in the name of a certain god; this was in an aim to satisfy the gods with the hope of stopping a very intense weather phenomenon or helping in a war or having good luck and other similar ‘demands’.

Historical evidence has been found for several tribes for whom evidence of infanticide is mentioned either in documents or from archaeological excavations. Beginning with the Bible, Abraham had a son at the age of 100 with his wife and half-sister, Sarah. God, in order to test his faith, commanded him to sacrifice his son in His name. Abraham was ready to carry out the command, until the last moment when the ‘Angel of the Lord’ took his hand and commanded him to slaughter a ram in the place of the child (1,2).

The Incas, from ~1430 AD, until the 16th century, made human sacrifices exclusively with young children (3). The healthiest and strongest children were selected as they believed that they would satisfy the gods the most. These rituals were so ingrained in the culture of the Inca people that it was considered an honor to sacrifice a child of the family. The Inca Empire perished with the landing of the Europeans and the conquest of the New World by the Spaniards. However, despite the violence that characterized this project on the part of the conquerors, an immense effort was made to eliminate the brutal ritual of the sacrifice of the children by the remaining Incas to their gods (4).

In Canaan, an ancient region geographically now located in Lebanon, Syria, Jordan, Israel and Palestine, there are numerous references to child sacrifices to the almighty god, Moloch. The idols of Moloch were large bronze statues with open arms and a large hole in the abdomen, in which they lit a fire and placed the babies in his arms. This was also known as the ‘passage of children through the fire’. Couples who would sacrifice their first child believed that they would obtain a good financial life with health and prosperity for the rest of the family (5).

In ancient Greece, in Greek mythology, there are also reports of the sacrifices of children in the name of some of the gods of Olympus. The case of Iphigenia in Euripides's tragedy ‘Iphigenia in Aulis’ is typical. According to Euripides, Iphigenia, daughter of Agamemnon, King of Mycenae and Argos and General of the campaign against Troy and Clytemnestra, had to be sacrificed to the goddess Artemis for the common good. In those days, the Achaeans were preparing to attack Troy in order to capture it and take back beautiful Helen. However, there was apnea in the area, which did not allow the Achaean fleet to sail. Thus, according to Mantis Calchas, the sacrifice of Iphigenia to the goddess Artemis, would stop apnea and would allow the Achaean fleet to conquer Troy. The sacrifice was not made, as according to the legend, Artemis took pity on Iphigenia and snatched her from the altar, placing a deer in her place. Clytemnestra never forgave her husband Agamemnon for sacrificing his own daughter for the sake of the campaign and killed him, using this as an excuse (6).

The Aztecs were another tribe that sacrificed children in the name of their gods. They believed that the more children they sacrificed, the better life their tribe would have. According to the discoveries of archaeologists, at ~1400 AD, a time when the Aztecs were expanding, there was a significant upsurge in the phenomenon of child sacrifice. In 2017, a cylindrical pit lined with volcanic stones was discovered in present-day Mexico, which was made exclusively for sacrifices in the name of the Aztec gods (7).

In Babylon, the first reference to a child sacrifice was in 230 BC. The Babylonians worshiped the god, Marduk, and later the god, Anu. They celebrated in their honor once a year, lighting large fires and throwing babies or young children into them to remain one of the largest military and economic powers in the world (8).

Modern history: Recent past

In modern history, in several countries and cultures, it was considered a shame for a woman to be an unmarried mother. This is how the mentality prevailed, that the mother who wanted to ‘clean up’ her name and reputation, had to kill her unwanted baby (9,10).

In Germany, to determine whether a child was capable of living, they examined their endurance by immersing them in ice water. Loud crying was considered a sign of a strong body and therefore, a child was believed to be capable of living and growing up (11).

In Europe in general, a culture of child ownership had been established, which resulted in a number of minors being sold into the established trade and becoming slaves and servants of their guardians. Children born into poor families who were usually unable to take care of themselves and their children, ended up in an institution (the so-called poorhouses) with the rest of the poor family, so they could survive. Survival, however, was not a fact and the weakest members of the family often died. Numerous children also used to work as family members, either on a farm where they were often assigned very heavy work, or in other objects that were often too hard to cope with (12).

Some books that describe the situation that prevailed for children in Europe in the 18th century are representative. ‘Oliver Twist’ by the English author Charles Dickens (13), describes the difficult life of a child who was born in a poor asylum in England and was left an orphan immediately after his mother died, shortly after his birth. He grew up in homes with abusive caregivers and was forced to begin working at the age of nine. He was found as an apprentice to a funeral contractor, where again the whole environment was negligent and abusive and finally, he was forced to leave alone for London, where he was exposed to gangs of thieves, but managed to escape and finally find his family. To a large extent, this book is autobiographical. Another book that describes the spirit of the times characteristically is ‘The Little Match Girl’ by the Dane writer, Hans Christian Andersen (14). According to the story, a little girl was selling matches on a cold night on New Year's Eve; however, a cart passed by and threw her down, causing her to lose one of her shoes and all her matches to fall onto the wet ground and become wet. She did not dare to return home as her father would beat her for not selling any matches; thus, she remained in the cold all night lighting the matches to warm herself and finally died from the cold.

In the USA, for many years, numerous immigrants from Africa and other countries were used as slaves. Automatically the ‘property regime’ applied to the children of these immigrants who, from a very young age, were used as servants and workers or were sexually abused or sold to other owners. In addition to immigrant children, children in several American families were considered from their parents' ‘property’; thus, they were beaten, neglected, or forced to work frequently in very difficult and strenuous conditions (15). A common form of exploitation/child labor was the so-called indenture, where the poor parents had to give their children to special ‘teachers’ who trained them in a specific art and used them at work until the age of 16 for boys and until the age of 21 for girls (16).

At some point, in the history of the Western world, there came a moment when it was widely understood that children could not be killed, exploited or abused without any consequence. Thus, the case of 8-year-old Mary Ellen Wilson in 1874, who lived with her mother and her mother's second husband, played a critical and inaugural role in the internationalization and confrontation of child abuse. Often the little girl was locked out of the house in the cold by her guardians, while at the same time and just as often, they beat her with a leather belt. A neighbor could not stand the screams of the child and reported the incidents to a Church worker and she in turn, to Henry Bergh at the Society for the Prevention of Cruelty to Animals (SPCA). After he took charge, the child was removed from the house and her mother was sentenced to 1 year of forced labor in prison. Mary Ellen remained for a period of time in a hostel which was hosting harassed girls and after that she returned to her mother, on a farm, together with another family. Her mother died shortly afterwards and the girl remained on the farm. This story took on great dimensions, it was written in a book (17), also a film was made and the result was the great awareness and mobilization of the citizens against the abuse of children. Several volunteer organizations were founded to protect abused children, most notably the Society for the Prevention of Cruelty to Children (SPCC) in 1875(18).

In the mid-1940s, the issue of child abuse began to appear in scientific circles as well. John Caffey, a professor of Radiology at Columbia University (New York, USA), was the first to notice certain symptoms in children, which were later to be identified as hallmarks of abuse. He observed multiple fractures in children, which in several cases were combined with intracranial hematomas. From the history of the cases, there were no injuries or falls so severe as to justify these findings and he wondered if these injuries could have been caused by the parents themselves. His theory was reinforced a few years later by some other physicians, doctors and scientists, with the first official publication of the phenomenon written in the ‘Journal of the American Medical Association’ in 1962 entitled ‘The Battered-Child Syndrome’, by Dr C. Henry Kempe (19), chairman of the Department of Pediatrics at the University of Colorado School of Medicine, and his colleagues. Since then, the issue of child abuse has now reached large proportions, with numerous scientists and experts in various fields researching evidence and taking action to suppress or even completely eliminate this phenomenon.

3. Present

Although numerous centuries have passed since the ancient times when children were killed and sacrificed in the name of the gods and a number of years since children were considered the property of their parents or other guardians who used them as slaves and workers, child abuse worldwide continues to exist today to a very large extent. Different cultures, religions, social classes and mentalities in various parts of the world, have created the conditions in which children are subjected to several forms of tortures, which often lead to their demise at a young age.

Humanitarian organizations for the protection of children have been established internationally, protocols have been written and goals have been set in the political dimensions of several countries and associations of countries (such as the European Union) to completely eliminate the phenomenon of child abuse (20-22). However, these goals have not yet been achieved and numerous children worldwide continue to suffer.

In 1989, the first small stone was set to create the list of children's rights by the Convention on the Rights of the Child (CRC), which defined what a child is. A child is defined as any human being under the age of 18 years, unless, in accordance with the law applicable to the child, adulthood is attained earlier (23).

As of 2019, the United Nations CRC is the most widely ratified human rights treaty in history (European Parliament). Definitions of child abuse and domestic violence have been presented by a number of scientists. The following are two of the most representative ones so that each term is commonly understood: ‘Child abuse is defined as the physical, sexual, psychological abuse or neglect of a child by a parent or caregiver (24)’; ‘Under Papua New Guinea (PNG) law a child is defined as anyone under 18 years of age, with children aged under 16 not deemed as having the legal capacity to consent to sexual acts’ (25).

Another definition is the following: ‘Family violence: People who have been physically, sexually or emotionally harmed by another member or members of the family, regardless of the age or sex of the victim or perpetrator’ (26). According to some of the organizations for the care of children and women, in several parts of the world, either in places that are considered earthly paradises and are resorts for tourists or in less cosmopolitan areas, abuse is part of the daily life and mentality of the inhabitants. In addition, while the prevailing impression is that the abuse usually derives from individuals outside the family, in the end, the most common form of abuse to women and children derives from someone they know or from members of their close or extended family (27,28).

It is known that child abuse and neglect is even 5-fold more common in families with a low socio-economic background (29); thus, it would be expected that these facts would be more commonly observed in very poor countries. Thus, under the present circumstances, the global economy has been disrupted and violence has spread. However, poverty, as with other individual factors, is not in itself sufficient to create a background of abuse or neglect. Usually its combination with other conditions, such as parental mental health, a history of domestic violence and/or the institutionalization of one of the parents during childhood, ethnicity, age and the possible existence of a disability in a child (30), create conditions conducive to the occurrence of incidents of violence of all forms in children growing up in such an environment.

In a recent review conducted in the UK in 2022(31), which included 90 articles, 17 of which were quasi-experimental studies and seven meta-analyses from 2016 over a 5-year period, it appears that the insecurity that has arisen in recent years with poverty increasing rapidly and an increasing number of citizens falling below the deep poverty line is itself affecting the rates of abuse and neglect. More specifically, it appears that families who suffered a steep decline in fixed income of ≥30% had up to an 18% greater involvement in episodes of abuse; however, this rate decreased when the family was supported with welfare benefits.

In Papua New Guinea, according to the 2011 and 2016 reports of Médecins Sans Frontières (MSF) (27,32,33), more than half of the medical and counseling interventions involved children violence. The rape and sexual abuse of children result in biologically increased chances and a risk of HIV infection, other sexually transmitted diseases, hepatitis B and unwanted pregnancies (34) and from an emotional and psychological point of view, some survivors are at risk of depression, suicidal tendencies and attempts, and post-traumatic stress disorder (35).

According to the MSF report, at the Family Support Centers in Lae and Tari, Papua New Guinea, from January, 2008 to June, 2010, 49% of the medical cases of sexual violence in Lae involved children <18 years of age and 22% <12 years of age, while in Tari, 74% <18 years of age and 56% <12 years of age (33). In Saudi Arabia, which has one of the lowest crime rates worldwide due to strict law enforcement and strict police protection, in a period of 16 months (June, 2010 to February, 2012) 616 cases of child abuse were recorded with the rates of boys to girls being approximately half (51.1% boys and 48.9% girls) (18).

In a study and recording of events conducted in Thailand in the years 2015-2016 by the NSO-NHSO-UNICEF, it was found that a large percentage of girls were married prior to the age of 18 or even prior to the age of 15. The reasons are first economic and then social. The majority of the girls' parents have the conception that marriage at an early age will ensure that both the girls and the rest of the family have a good financial and social position in the local and wider community. This results in the sexual life of a girl beginning at a very young age. Marriages are often made with men who are markedly older, thus greatly increasing the chances of these men being carriers of various sexually transmitted diseases (mainly AIDS), which are then transmitted to their wives and when they become pregnant, to their children (36).

In addition, in the same study concerning Thailand, it was shown that the culture of the inhabitants as regards the education of children at home for purposes of discipline or observance of the rules, is implemented with the use of verbal and corporal punishment and violence. The rate of punishment recorded with the use of force was 75.2% in children from 1 to 14 years of age by a member who lives in the same house as the children (36).

On the other side of the world, in the USA, according to the Washington Post, from 1999 to 2016, >26,000 children were killed by gunfire, accounting for 91% of all gun-related deaths among the world's most wealthy nations (37). In addition, hundreds of thousands of missing children are reported worldwide each year, leading to the creation of search organizations. Dedicated telephone lines and online platforms, trained individuals, often volunteers, have been recruited to assist police authorities in searching for information and providing services where needed. The most common ‘alarm network’ created in 1996 is known as AMBER Alert, an acronym for ‘America's Missing: Broadcast Emergency Response’. It is activated in a declaration of disappearance of a child, particularly when there is a suspicion of abduction of the child. This was named after the abduction and murder of 9-year-old Amber Rene Hagerman (November 25, 1986 to January 15, 1996) by a stranger in Texas, USA, who was abused, tortured, raped and eventually murdered; the case of this investigation remains open to date.

In Australia, ~20,000 child disappearances are reported each year, in Canada exactly 45,288 child disappearances were reported in 2015, and in Germany, ~100,000 child disappearances are per year and in the USA, 460,000 child disappearances are reported per year (International Centre for Missing and Exploited Children, https://globalmissingkids.org/awareness/missing-children-statistics/). The German police statistics report that ~16,000 children (<14 years of age) are reported missing each year, from which 97% are soon found. Missing children's statistics, however, are not consistent due to a lack of global definition, but most importantly due to inefficient authority.

Unfortunately, in numerous countries worldwide, no statistics are available for children who have disappeared or, if these do exist, they are not reliable. Over the past 30 years, a number of cases of child abuse, violence, child disappearances, shootings and deaths have been transmitted to the world through the media, which have shocked the public. Infanticide is one of those phenomena that has been encountered since the ancient times but has not been eliminated even today. The act of a parent who kills his child has also received an official definition, with the word ‘filicide’, referring directly to the heinous murder act.

Nowadays, if a parent kills his own child, an examination is performed by experts for association with the existence of a mental illness. An in-depth longitudinal study in the UK that investigated 297 convicted filicide cases and 45 combined filicide and suicide cases between 1997 and 2006; it was found that 37% of perpetrators had a reported mental illness at the time. The diagnoses were mainly mood disorders and personality disorders, and to a lower extent, psychosis (15%) (38).

The case of Mexican Evangelina Tejera in 1989, who was a famous model and had won a beauty contest in Mexico, is typically mentioned (https://astra-mag.com/articles/queen-slave-woman/). She came from an abusive family environment and even though her father was a famous Mexican doctor, she was addicted to parties, alcohol and drugs. While she had two children, 2 and 3 years old, she organized a party by locking the children in a closet so they would not disturb them. After all the guests left and she fell asleep, one of the boys started crying and their mother, under the influence of various substances, took the child out of the closet and shook it hard, and threw it onto the walls and the floor, eventually killing the child. She repeated the same act with her other son and then dismembered the corpses, boiled them and buried them in two pots at the entrance of her house. For weeks no one had noticed the crime until her brother wondered where the children were and she confessed to her act.

Other common cases are mothers who, out of pathological jealousy for their husbands and with vengeful motives towards their husbands, kill their children and either commit suicide or are imprisoned for several years. In Texas, for example, in 2016, Christy Sheats shot and killed her two daughters in front of her husband on his birthday, as according to the sheriff who arrested her and gave an interview, she wanted to make him suffer (https://people.com/crime/christy-sheats-how-beautiful-marriage-turned-fatal-with-daughters-murder/). It was known that the father's relationship with his daughters was excellent, while the couple's marriage was suffering for several years. Thus, Christy Sheats killed their two daughters and stated that her husband should live with this unpleasant memory for the rest of his life.

One of the latest shocking cases, is that of the family from Patras in Greece, in 2022, in which the three daughters of the family died within a period of 3 years. While the case is still under investigation by the police and other competent authorities, the first findings indicate that all three children may have been killed; in fact, two of the 3 children had minor injuries around their mouths and noses. The causes of death of the girls were found to be as follows: 3.5-year-old Malena, liver failure and pulmonary edema; 6-month-old Iris died in her sleep and had a rare congenital disease (sinus agenesis); and 9-year-old Georgina, was diagnosed with cardiac arrest without specifying the reasons for the heart attack. The eldest of the girls, who was the last to die, had been hospitalized from time to time with episodes of convulsions and seizures, which apparently were caused by taking a strong anesthetic given to her by her mother, without medical instructions. From the testimony of the father and other witnesses, it appears that the father had an affair with a woman and had asked his wife to divorce him. Every time he asked her to do so, one of their children died, which led to suspicions that the mother was using this method to avenge her husband who wished to divorce her. Doctors at the hospital, where Georgina was being treated, had alerted a childcare NGO that needed outside intervention. The verdict on the death of the two youngest girls is pending, as well as the court against the accused mother who has remanded in custody.

4. Future

Concerning the future, there is now a great number of child abuse engagement worldwide. The subject has taken on immense proportions, and efforts are being made internationally to eliminate child abuse.

The Global Status Report On Preventing Violence Against Children 2020, co-signed by the World Health Organization, UNICEF, UNESCO, the Office of the Special Representative of the Secretary-General on Violence against Children and End Violence Against Children, states in the 2030 Agenda for Sustainable Development, the need to end child violence is described in several areas, but more specifically in Objective 16.2, a clear and bold call is made for ‘an end to abuse, exploitation, trafficking in human beings and all forms of violence and torture against children’ (39).

The report explains that laws against child abuse have been enacted, as well as laws that limit the exposure of children to substances and weapons; however, these laws are rarely implemented. Suggestions proposed for the future that range in a realistic and achievable context, are for example, the effort to strengthen the good cooperation of organizations with the governments of all countries, the prioritization of data collection by each country, the creation of a national action plan to combat the phenomenon of child violence, to strengthen the legal framework in each country and to ensure adequate funding for the implementation of this work.

5. Conclusions

The efforts made to combat the phenomenon of child abuse have taken on immense proportions, particularly over the past decade with the enactment of laws, rules, and protocols at an international level. However, worldwide, from the beginning of times, due to the vast differences and beliefs among individuals and cultures, the adoption of a common line that will be strictly adhered to by all seems to be an impossible task. Notwithstanding, as long as there are individuals who continue to defend children, the future of eliminating child abuse is prominent.

Acknowledgements

Not applicable.

Funding

Funding: The authors would like to acknowledge funding from the following organizations: i) AdjustEBOVGP-Dx (RIA2018EF-2081): Biochemical Adjustments of native EBOV Glycoprotein in Patient Sample to Unmask target Epitopes for Rapid Diagnostic Testing. A European and Developing Countries Clinical Trials Partnership (EDCTP2) under the Horizon 2020 ‘Research and Innovation Actions’ DESCA; and ii) ‘MilkSafe: A novel pipeline to enrich formula milk using omics technologies’, a research co-financed by the European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship and Innovation, under the call RESEARCH-CREATE-INNOVATE (project code: T2EDK-02222).

Availability of data and materials

Not applicable.

Authors' contributions

All authors (ED, EP, FB, EE, GPC and DV) contributed to the conceptualization, design, writing, drafting, revising, editing and reviewing of the manuscript. All authors have read and approved the final manuscript. Data authentication is not applicable.

Ethics approval and consent to participate

Not applicable.

Patient consent for publication

Not applicable.

Competing interests

GPC is an Editorial Advisor of the journal, but had no personal involvement in the reviewing process, or any influence in terms of adjudicating on the final decision, for this article. The authors declare that they have no competing interests.

References