May 10, 2006 -- 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, got 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.
To read the full report, "Hidden Suffering: Segregation and Abuse of Children with Disabilities," click here.
In June 2005, 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 as if she were 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," he 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 apparently there because they are disabled. Karen Green McGowan, a nurse who later saw the ABC video, 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. "The reason I know that is when I saw a picture of a child lying on his back, able to bring his rear end off the surface with very wasted calves, I know that's a child who had a lot of motor skills and was never given the opportunity to stand and move."
Children had blankets that they were wrapping themselves up in -- that is how kids who have nothing else to do prevent themselves from self injurious behavior.
The director said he's short-staffed because there's not enough money to pay staff adequately. And so the cycle of neglect continues to extract its toll from these young bodies and minds.
Crammed Together, but All Alone
It was the same story at a hospital in a western Romanian town called Timisoara, where the organization found rooms full of healthy abandoned babies. One nurse and 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."
One tiny baby was rocking violently in his crib to give himself some sort of "sensory input," said McGowan, who also went on the trip.
"If I body rock, it's about sensory feedback because I've got nothing else to do," she said.
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.
Despite a tough new law mandating that all abandoned infants immediately be transferred into foster homes, Nanette Gonzalez, founder and CEO of Romania Outreach to Christ's Kids (ROCK), said the government quietly warehouses children at hospitals across the country.
"They don't call it institutionalization, because they think it's a hospital, not an orphanage," said Gonzalez, who has worked in Romania for 12 years. "This is where they get around that whole law. Sure, these kids are in a hospital, they're being treated, but it's still an institution."
There were 18 children in her ward and she said the number of abandoned kids continues to drop every year. But the problem is still an epidemic -- these children are considered severely disabled even though one child was simply a hemophiliac and another was blind.
"They say there are about 53,000 abandoned children in Romania," Gonzalez said. "Nine-thousand children a year are being abandoned."
The Romanian government said the number is half as much.
Gonzalez brought ABC News to see children who were scattered over three separate areas in a hospital complex in Bucharest. We met a 4-year-old girl with cerebral palsy who weighed about 12 pounds.
"The doctor told us that he thinks she's going to die soon because she's very thin. You can see her bones," McGowan said.
"They feed them mush," Gonzalez said. "Like they'll puree carrots or potatoes."
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.
Neurosurgeon Sebastian Koga is helping to conduct a study on the effects of institutionalization on children called the Bucharest Early Intervention Project (www.idc.ro). He and his colleagues followed some institutionalized children for five years. The study shows that young children lose one month of growth for every three months they live in an institution, which is why most of the Braila children between the ages of 9 to 12 look more like 3- to 5-year-olds. Their intellectual development is seriously impeded as well -- many of them end up with IQ levels close to mental retardation.
"The Bucharest Early Intervention Project has over time collected a huge amount of data that speaks unequivocally in favor of family care," Koga said. "Our study shows that it isn't just behavioral things that can be later modified in life, but that these early experiences change the structure of the brain in a way that can become irreversible with the passage of time."
Rosenthal said 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."
The Romanian Government disputed some of MDRI's findings but said it's creating a special committee to investigate the institutions that shelter children with disabilities. There will be more on this story tonight on "Nightline."
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.