Interview | Forensic pathologist on child abuse: “Child abuse runs through all social classes”

Interview | Charité forensic pathologist

“Child abuse cuts across all social classes”

dpa/N. poor

Sound: Antenna Brandenburg | 08/03/2022 | Doretta Kirmse | Picture: dpa/N. poor

Nationwide, 152 children died violently in 2020. This is 40 more cases than the year before. The number of unreported cases is significantly higher, says Saskia Etzold, head of the violence protection clinic at Charité Berlin. And help often comes too late.

rbb: Mrs Etzold, in Charité’s anti-violence clinic, children are not treated, but examined, what does this mean concretely?

Saskia Etzold: Children are presented to us with suspicion of abuse and/or neglect. We then carry out a forensic examination and write an expert opinion on whether the suspicion of malpractice is confirmed or not. In almost 20 percent of the cases, we determine in the investigation that the injury was either caused by an accident or, even more frequently, that it 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 cannot comment on individual cases. But in the end it must be said that all cases where a child dies as a result of abuse is one too many. It is believed that for every known case there is at least one other that is in the dark field. We must assume that the number is at least twice as high.

Archive image: Dr.  Saskia Etzold from the anti-violence outpatient clinic.  (Source: dpa/J. Carstensen)
dr Saskia Etzold is a forensic pathologist and head of the violence prevention clinic at Berlin Charité | Picture: dpa/J. Carstensen

In 2019, 112 children died violently nationwide, in 2020 there were already 152 cases. Has the corona pandemic worsened the situation?

We have very well seen in everyday life that the numbers have increased significantly. We mostly saw that when the lockdown was triggered and the children then returned to daycare or school, for example. Of course, we can’t really say what happened inside the lockdown because injuries in children heal very quickly. You will see no more damage within a few days. But overall, the numbers have increased significantly for us. We also know from other areas, for example from the women’s counseling services, which also provided telephone counseling, that overall family violence has increased significantly in these times.

Does child abuse only occur in a specific social environment?

Child abuse runs through all social classes, all cultural backgrounds and all educational backgrounds. What is changing in part, as with domestic violence, is the type of wounds we see. With well-educated parents, we often find that the abuse is not visible in the visible area, not in the face itself, but that the children state that they are beaten on the hairy head, on the back or on the buttocks, so that – if the children are clothed – cannot see that they have received injuries. This is something we are repeatedly told about partner violence.

From your point of view, are there some families that are more vulnerable than others?

Overall, it must be said that there are risk factors for abuse, both what shocking trauma (Brain damage caused by violent shaking of babies and young children, editor’s note.) as well as for other general abuse. We know from studies that the risk increases, for example, if we have a family history of mental illness, if we have drug addiction – that is, drug or alcohol addiction – in the family, if there are major financial problems in the family, or if they have a very bad family history has cramped living quarters. These are all risk factors that increase the whole thing. Single parents are more likely to be abused, and they may not have parents around who will say, ok, I’ll take the child off your hands for a few hours.

In the end, it cannot be said that certain social classes are particularly exposed to abuse, which also makes it difficult to identify abuse, but there are risk factors that are looked at more closely. Meanwhile, there are also many projects that are looking at it very early. For example, the baby guides, who seek talks with parents in the maternity clinic and, if they identify risk factors, try to organize help for the parents through the youth office.

Is it mainly men or women who beat children?

There are studies that show that there are both men and women who practice this violence. There are certain constellations that we encounter more frequently in everyday life. For example, it is often a mother’s new partner who abuses the child. But there are actually constellations in each variant.

In 2014, together with forensic pathologist Michael Toskos, you published the book “Germany abuses its children” by pointing out structural errors in the protection of children and young people. Where exactly is it stuck in the system?

The problem we have in the system is that certain areas that need to collaborate, for example, are separate. A simple example: If the youth office becomes aware that a family needs support, the youth office cannot provide the help itself. This means that the Youth Office, which has to decide how the whole thing should proceed, does not have the opportunity to work with this family themselves on when it becomes difficult, but they have to outsource it to an independent body.

There is such a concentration of cases that the people concerned are hardly able to deal with such cases.

Saskia Etzold, forensic doctor at Charité Berlin

The independent agency depends on getting these orders and makes its money by helping the family within the families. Here they have a certain financial dependence on the child staying with the family. Ungdomsværnet, which decides on the cases, has no direct contact with the family, but receives reports. Now we all know that paper is patient. Reports can never present a situation as impressive as when we are in contact with the people in question.

We have the problem here that the institution that has to decide something does not have the opportunity to control something there. At the same time, the youth office is part of the public service, so funds are always very scarce. That said, the pay is not great, which causes a lot of experienced people to leave that field and go somewhere else where they can make more money. That means they have a lot of young people here. It is common knowledge that a large number of positions are unfilled, and the positions that are filled often have a very high rate of sick leave. There is such a concentration of cases that the people concerned are hardly able to deal with such cases.

In your book you also called for certain areas to be trained better. What has happened in this regard during the last eight years?

A lot has happened since the book was published. As a violence protection outpatient clinic, we offer training courses for people who work with victims of violence, and these are also received on an ongoing basis. In the meantime, almost all youth welfare offices in the city have been trained and independent providers are contacting us. In the meantime, many schools and day care centers have had us educate them. Of course, it is still the case that on certain educational courses, for example in studies in social work, child abuse is either not compulsory at all or marginally compulsory. It is something that is being worked on so that in all these curricula for the various subject groups, this subject is implemented more strongly and more deeply.

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

The interview with Saskika Etzold was conducted by Dorett Kirmse. This is an edited and shortened version of the interview.

Broadcast: Antenne Brandenburg, 3 August 2022, at 15.10

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