The situation of extreme poverty in which many Andean communities live makes children the most vulnerable group of the population. Amantaní exists to work for them.
Cusco, Perú, 1996. Tú sí los llamarás (Poema L. Rosales)
|Inhabitants Dto. Cusco 2015||
|Inhabitants Department Cusco||1.205.527|
|Cusco city||437.538 (INEI 2018)|
|Desnutrition chronique < 5 years Región Cusco (ENDES) 2017||12,9%|
Area rural (OMS)
In the region of Cusco, at over 3000 metres above sea level, progress and socio-economic backwardness coexist. This can be seen:
• in the growth and economic modernisation of some towns
• in the underdevelopment and extreme poverty of many rural areas.
The city of Cusco, capital of the Department, has experienced rapid immigration from rural areas and neighbouring Departments. Cusco is the seventh city in Peru, in terms of population; the peripheral zones of the city have received the influx with no preparation or town planning, which has led to a high concentration of slums. The majority of these settlements are in seismic and flooding high-risk areas, making it impossible to provide affordable running water and sanitation.
The environmental problems which the region and city of Cusco face are related to indicators of poverty: water shortages, the absence of a drainage system as well as the lack of sewers or a sewage treatment system; and, above all, the persistence of certain customs and practices among the populace all contribute to environmental deterioration. The problem of atmospheric pollution exceeds the permissible limit recommended by the World Health Organization.
In the Peruvian southern Andes the child and adolescent population is in a serious state of maltreatment, abuse and neglect. According to national statistics, 49% of children and adolescents are maltreated by their parents, and this figure rises considerably in rural areas (National Demographic and Health Survey, 2000). 18.8% of children and adolescents receive physical abuse in schools, and 48% have been maltreated at home. (Save the Children - Peru, 2002). In recent years, reports of sexual abuse of both boys and girls have increased. It is estimated that in eight out of ten reported cases the aggressor is a family member, but reports have also indicated educational workers. According to the same sources, six out of ten child and adolescent pregnancies between the ages of eleven and fourteen are a result of incest or rape (Social exclusion in Peru, UNICEF, 2001).
There are many different reasons to explain these data, but in the context of the Southern Andes one of the most significant is the extreme poverty which leads parents to view their children as mere workers who must contribute to the family income. To these factors must be added insufficient state policies and resources to remedy the precarious situation of children and adolescents.
In the last decade Cusco Department has enlarged its healthcare system and its primary care staff by 29% and 47% respectively. These resources are, however, unevenly distributed: the provinces with greater poverty and mortality rates have fewer healthcare workers than those suffering less hardship. In Peru there are 10.3 doctors per 10,000 inhabitants; in Cusco, there are 5.1 doctors per 10,000 inhabitants; and in Paruro, 0.3 doctors per 10,000 inhabitants. At regional level the health programmes have been oriented to combating the food provision problem, and to reducing the incidence of the most frequent diseases.
Despite this, the socio-economic divides which persist between provinces, districts and communities put Cusco amongst the regions with greatest risk of infant mortality at a national level. Although it is true that the number of children surviving has increased, the quality of life for infants is far from being ideal for their development and growth according to the international parameters which reflect human development (Endes, 2000).
Chronic malnutrition in children under five reaches 35.4%. Death rate in childbirth has decreased significantly; however, the persistence of infant mortality is associated with a widespread failure to use the health services: only 50% of pregnant women use pre-natal healthcare services, thus not gaining access to simple, practical information about nutrition and care during pregnancy. Of these, only a small percentage give birth in healthcare centres. The rest are assisted by family members and community health workers, both qualified and unqualified.
Geographical inaccessibility and subsequent cost of healthcare provision, cultural differences, combined with social disparity and a lack of information and education are other factors which can explain the under-use of the health services by the general population.
• 24.3% of Cuscan children under five suffer from chronic malnutrition (the highest rate in the country).*
Peru is a geographical complex of extraordinary variety from an ecological and economic point of view, and its population is of great ethnic and cultural diversity. The Andean mountain range creates three strips which run the length of the country: the coast, the mountains and the rain forest. Due to the lack of transport infrastructure access to certain regions is very difficult.
Exploitation of the country's great mining resources has supplied the country with considerable revenue in recent years, but this has not been reflected in an improvement in the standard of living for the general populace due to other factors such as the lack of manufacturing industry and the fact that the majority of the population work in service industries and agriculture. Average per capita expenditure in 1996 was $121.00. In Cusco the figure was $45.00, far below the national average.
Large numbers of people live in poverty, especially in the interior, although some indicators have shown signs of improvement in recent years. Enormous disparities exist between urban and rural areas where economic, social and cultural entitlements are concerned. Some areas of the southern Andes have more socio-economic characteristics in common with certain African countries than with the coastal cities of Peru.
Amongst the causes of poverty arethe scarcity of fertile land and the lack of modern technology. To combat their problems of subsistence, many families have moved to urban centres where they work in insecure conditions in service industries, the so-called 'unstructured sector'. In the 1940s about 65% of Peruvian inhabitants lived in the Andes; nowadays only 25% of the population is rural, while the population of Lima has increased by twelve-fold. This urbanisation has not been the result of industrialisation but rather of the precarious situation in rural areas. People from the country flooded into land on the outskirts of Lima, building rudimentary structures which now form large slum neighbourhoods that continue to grow. It is estimated that these contain 70% of Lima's metropolitan population.
According to UNICEF, of the 3.8 million people who live in a situation of extreme poverty, 2.1 million are children. Of the total of 10.7 million minors under 18, more than 6.5 million live below the poverty line. The Andean communities are the most affected. The majority of children and adolescents in the rural Andean area do some kind of work, which is also the case in the urban areas. The children are forced to work and have no time or place to play; they are also victims of domestic violence, one of the main reasons why young people leave their homes and end up living on the city streets, especially in Cusco and Lima.
As can be seen by the capacity occupation of children's refuges, families abandoning their children continues to be a frequent occurrence. This is largely due to the marginalisation suffered by women (high mortality rate, prevalence of households headed by women, low educational level, paternal irresponsibility etc.) and in general to the high rate of poverty in the area.
According to UNICEF's 2005 report, 7% of births are not officially registered, which means that a considerable percentage of children do not legally exist, and therefore cannot have their human rights recognised.
The illiteracy rate in Peru fell from 58% in 1940 to 9% in 2004. Primary education is compulsory for all children from 6 to 16; nevertheless, many children who live in rural areas cannot attend school due to the lack of facilities. In the Departments of the interior where the greater part of the population is Quechua, illiteracy has not been reduced.
One of the fundamental problems is the poor performance of the children at school. This can be ascribed above all to the effects of malnutrition, inadequate school materials and equipment, the prevalence of mixed-level schools, the lack of a bilingual educational methodology, the under-qualified teachers and so on. Women also have a disproportionately high rate of illiteracy, especially in rural areas.
Although the Government has made some advances in medical facilities, there continues to be an inadequate level of healthcare. This accounts for the recurrence of infectious and parasitic diseases. Chronic malnutrition is still a public health challenge throughout the country, and is one of the principal problems affecting children, especially in the Andean region.
Amongst the determining factors are the lack of hygiene, the unpredictable supply of food, illiteracy among mothers, the high incidence of diarrhoea and chronic respiratory diseases, as well as parasitosis and insufficient medical attention in some Departments. According to UNICEF the situation has reached critical levels in some areas of the country, with figures comparable to those of Afghanistan, the Yemen or Ethiopia. In some of the communities that receive aid from the organisation, 100% of the children exhibit signs of chronic malnutrition, which makes them more vulnerable to potentially fatal respiratory diseases.
The infant mortality rate has fallen appreciably, even though it is still high in the central mountainous region.