After the fall of communism in the 1990s, the world saw horrific images of abused children living in deplorable conditions in state-run Romanian orphanages.
Those images and stories led to an international uproar and an outpouring of humanitarian aid to the country.
After the initial furor died down, most people assumed the situation had gotten better.
ABC News, however, had an exclusive look at a report, which was released today by Mental Disability Rights International, that details the horrible abuse of handicapped children in Romanian institutions.
Watch "Nightline" at 11:35 p.m. ET for more on this story.
Over an 18-month period, the organization found 46 disabled children and teenagers ages 7 to 17 inside a hidden ward at a psychiatric hospital for adults. Many of them had cerebral palsy and had been abandoned by parents, some of whom had been told their children were "biological garbage."
When Eric Rosenthal, the organization's executive director, visited an institution in the midsize city of Braila, he captured the misery on camera -- a 17-year-old girl who looked like she was 5 years old and weighed only 22 pounds; children wrapped in full-body restraints with sheets tied to beds and cribs; and children so malnourished that their skin peeled off their bodies.
"What I saw in Braila was the worst I have seen anywhere in the world. It was just an absolute horror," Rosenthal said. "These children, 46 children, were near death."
Progress Left Them Behind
Forty years ago, declining birth rates prompted the government to outlaw abortion and contraception. Birth rates soon doubled, and many Romanian families -- especially the nearly quarter who live in poverty -- could not care for their children.
Great improvements have been made. The number of children living in orphanages and institutions has dropped by more than 60 percent.
"What they've done in 10 years is in many ways impressive. We give them credit for what they've done with most children," Rosenthal said. "But they've written off the children with disabilities."
The sick and disabled often end up in institutions.
"Anytime you leave children lying flat on their backs without any interaction with loving adults, then you're going to have kids who languish, whose joints start to twist in very strange directions," she said. "And it's not that the staff at Braila weren't loving. It's just that there were so few of them and so many kids."
Some of these children had lived in such isolation for so long that it took months before they accepted human contact.
Because of Mental Disability Rights International's reports, ABC went to Romania to investigate what happens to the thousands of children who are abandoned every year.
In a hospital for the severely disabled, we found 20 children and adults, ages 10 to 24, crammed into cribs in a tiny room. They were allegedly there because they are disabled. Karen Green McGowan (www.mcgowanconsultants.com), a nurse who was traveling with ABC, said these children had the potential to live healthy and normal lives.
"What I saw was a group of children who would have walked if they hadn't been kept in cribs," McGowan said.
Crammed Together, but All Alone
It was the same story at a hospital in western Romania where the organization found rooms full of healthy abandoned babies. One nurse with three assistants were taking care of 62 babies.
"The eeriest thing about it was the near total silence," Rosenthal said. "We heard one baby crying, and we asked about that baby and that baby had been placed the night before. But the other children, we asked why weren't they crying? And the staff said, 'We try our best, but we can't come to them when they cry.' So after awhile they stop crying. They learn that there's no one there to take care of them."
Rosenthal doesn't blame the hospital staff, he blames the government.
"One nurse said, 'My heart has turned to stone,'" he said. "They feel so overwhelmed. There's nothing they can do. They're put in impossible situations. So I don't blame the staff. I blame the authorities for denying what's going on, for not taking responsibility."
Thousands of children now living in institutions may never graduate to freedom. When they turn 18, many get transferred to adult institutions. The conditions there, unlike those for children, have not been reformed. Patients are chained to beds. The living conditions are squalid and crowded. The rooms are ice cold, and reek of urine and feces.
"Their terror that they live with is that they'll be in one of those adult facilities for the rest of their life," Rosenthal said.
According to UNICEF estimates, 68,805 disabled children are registered in Romania, but that figure does not include psychiatric patients. Moreover, many babies never receive birth certificates, so they are not counted.
Blank Check Won't Help
Even after being shown some of the horrible images uncovered by ABC News, Ioana Nedelcu, subsecretary of the National Authority for the Protection of Children's Rights, said "those children were protected within a medical service system. … Even though most of them were abandoned by their parents."
For the legions of other children lost in the system, the only hope of escape lies in a foster care system that is slowly groaning its way toward transformation. Romania continues to spend more than 70 percent of the money for child protection on infrastructure, 18 percent on foster care, and 1 percent on training staff.
Rosenthal says that sympathetic Westerners who want to help the situation shouldn't "write a blank check."
"The European Union has a generous amount of money to provide technical assistance," he said. "Don't give them a blank check. Insist that that funding is linked to helping those kids. And not just nice, new, clean facilities, that won't do, families."
For the full report on Braila, visit the Web site of Mental Disability Rights International, which made this report possible.
This story was originally reported by Diane Sawyer.