Table 4 Intermediary determinants of health, human rights, and their impact on SCY’s social and health inequities

Material Circumstances

Article 27 on the right to an adequate standard of living

(49.) Support to Parents, caregivers, and children: states should ensure that all children have a standard of living adequate for their physical, mental, spiritual and moral development.

“The basic needs, they don’t have food because most of the times you will find them eating from the bins. For clothes they have rags and they don’t have shoes. They also sleep outside. They don’t get loved due to separation so some of them are lonely; they don’t mingle with other people freely.” (Police Officer)

• A lack of essential basic needs, such as food, clothing, and shoes leave children and youth vulnerable to malnutrition, and exposed to health compromising conditions and at risk for acquiring infectious and non-infectious diseases.

• SCY are also at risk of psychological consequences associated with street-involvement and a lack of an adequate standard of living.

Material Circumstances

Article 27 on the right to an adequate standard of living (50.) Adequate Housing: states should sure that children and youth connected to the street have a right to live somewhere in security, peace and dignity.

“I live near them. I meet them in the morning while going to town; they can come and sleep in the vibandas (stalls) then go to town in the morning. When we walk at night, we warn them about sleeping there because someone being chased can also hide there.”

(Community Leader 1)

• SCY lacking adequate housing and whom sleep in precarious or makeshift structures are at risk for numerous morbidities due to exposure to the elements and inadequate sanitation.

• A lack of secure housing leaves SCY vulnerable to experiencing physical and sexual violence.

Social-environmental or psychosocial circumstances

Article 6 on the right to life, survival and development (29.) on the right to life: states should ensure street-connected children and youth are free from acts and omissions intended or expected to cause their unnatural or premature deaths.

“Some of them are offenders. They did a mistake and ran away, so you have to sit with the family for several sessions, prepare them and tell them we have found your child any maybe tell us the history. ‘Ah that one is a thief, that one use to steal chicken, that one stole maize, even if he comes back’. Like they are some we took back to Baringo, and we didn’t know fully the felony they had committed. You know they were lynched!...

Yeah the villagers in the community just tied them and lynched them.”

(Children’s Officer)

• SCY experience unnecessary psychosocial stressors associated with infringement on civil and political rights, vigilante justice, and extrajudicial killings.

• SCY disproportionately experience violence, which impacts their physical and mental health and often results in preventable and premature mortality.

Social-environmental or psychosocial circumstances

Article 6 on the right to life, survival and development (32.) ensuring a life with dignity: states have an obligation to respect the dignity of street-connected children and youth, including in relation to procedural and practical funeral arrangements to ensure dignity and respect for children who die on the streets.

“My issue is with the morgue, when a street child dies, they are thrown inside a container and when we go to collect the body it becomes an issue because post-mortem has to be paid for and maybe what we have collected isn’t enough. We want it to be buried in a proper way. So, they will refuse to give us the body and eventually end up throwing it away. When we go to the HOD they tell us to look for its family and maybe they came, and they can’t afford to pay the charges. If they see some are smartly dressed, they say that we have to pay. Maybe the body has stayed for like 40 days and the charges have increased, they will even tell you that they are going to throw away that body. Sometimes we have to protest so that the body is released.”

(Peer Navigator)

• SCY experience social inequities even in death due to income inequality and an inability to pay mortuary fees.

• As a result, their peers experience unfair psychosocial stress to support their burial and a right to a dignified end of life.

Social-environmental or psychosocial circumstances

Article 9 on separation from parents: states should not separate children from their families on the basis of their street-involvement, nor should states separate babies or children born to children themselves in street situations.

“For a mother with a child it also depends why that mother is there and from the experiences of interviewing them, these mothers use their babies to get sympathy from the public so whatever action we take will be a stern one like getting a court order to rescue those children and have the mother face the full face of the law. For the babies I take immediate actions because the environment is basically hostile to them.” (Children’s Officer)

• Separating street-connected babies and children from their parents or families is stressful for both their parent and the child and can have long-term psychological consequences for both.

Social-environmental or psychosocial circumstances

Article 31 on rest play and leisure: street-connected children and youth have a right to utilize informal settings for play, and states should ensure they are not excluded in a discriminatory way from parks, and should adopt measures to assist them in developing their creativity and practising sport.

“Like last month we had a tournament, and some sponsored us and gave us playing kits and food. Our problem is not food alone; it should be something that makes sense and not just bread daily. You can give us food but also something to help us. Like supporting some of us who play football.”

(FGD, Street-connected young men)

• Access to resources and ability to engage in rest, play, and leisure can reduce stressful life circumstances thereby ameliorating SCY’s health and well-being.

Social-environmental or psychosocial circumstances

Article 19 and 39 on freedom from all forms of violence: states have the responsibility to protect street-connected children and youth from all forms of violence, including corporal punishment, familial violence, providing mechanisms for reporting violence, and holding perpetrators of violence accountable.

“Some are orphans, some come from dysfunctional families, maybe families where there is a lot of issues of abuse...Others you find they will tell you that there is a lot of violence at home. So, a child opts to run away and then eventually they end up in the streets.”

(Children’s Officer)

• SCY may experience physical violence prior to street-involvement as well as once on the street due to their vulnerability and socioeconomic position.

• Physical violence is linked to long-term physical and psychological health consequences including post-traumatic stress disorder.

Social-environmental or psychosocial circumstances

Article 34–36 on sexual abuse, sexual exploitation, trafficking and other exploitation: states have the responsibility to protect children and youth from sexual violence, exploitation, and trafficking.

“If it’s a girl on the street, I become so irritated. She is very vulnerable. In Bungoma, there is a high rate of defilement of girls by the community at large, by family, by school children, and other teenagers.”

(Police Officer)

• Experiencing physical and sexual violence is linked to long-term physical and mental health consequences.

• SCY may experience sexual abuse and exploitation prior to street-involvement as well as once on the street due to their vulnerability and socioeconomic position.

Social-environmental or psychosocial circumstances

Article 32 on child labour: states have responsibility to protect children and youth from economic exploitation and child labour.

“Others will move to other towns like if you go to Molo, Maunarok, mostly there is the issue of child labor. So, they will prefer to go to somewhere like Maunarok, where they know there are a lot of farms. And most of these people, they tend to use these children as casual laborers; you know they get something small.... if you go to Njoro, Molo where we have the flower farms, you will find many children, and the majority will tell you that we used to live on the streets.”

(Children’s Officer)

• Child labour exposes SCY to stressful life circumstances including the possibility of violence or threats of violence.

• Child labour may result in exposure to potentially harmful chemical, environmental and ergonomic factors and working conditions that are hazardous to their physical and psychological health.

Behavioural and biological factors

Article 33 on drugs and substance abuse: street connected children and youth should have access to free healthcare services and states should increase the availability of prevention, treatment, and rehabilitation services for substance use.

“The things we use are very strong especially gum. It is stronger than alcohol and people who sniff gum are hard to talk to. They just do what they want. We use a lot of things, not just glue. Not all of them will understand things, you may tell me this and that but after sniffing gum I forget everything.” (FGD, street-connected young men)

• The health damaging effects of alcohol and substance use are well established.

• SCY report that they use substances as coping and survival behaviour in response to the harsh environment on the streets.

• These detrimental substance use practices are associated with their street-involvement and thereby socioeconomic position.