Abstract
BACKGROUND: Street children are a global phenomenon, with an estimated population of around 150 million across the world. These children include those who work on the streets but retain their family contacts, and also those who practically live on the streets and have no or limited family contacts. In Pakistan, many children are forced to work on the streets due to health-related events occurring at home which require children to play a financially productive role from an early stage. An explanatory framework adapted from the poverty-disease cycle has been used to elaborate these findings. METHODS: This study is a qualitative study, and involved 19 in-depth interviews and two key informant interviews, conducted in Rawalpindi, Pakistan, from February to May 2013. The data was audio taped and transcribed. Key themes were identified and built upon. The respondents were contacted through a gatekeeper ex-street child who was a member of the street children community. RESULTS: We asked the children to describe their life stories. These stories led us to the finding that street children are always forced to attain altered social roles because health-related problems, poverty, and large family sizes leave them no choice but to enter the workforce and earn their way. We also gathered information regarding high-risk practices and increased risks of sexual and substance abuse, based on the street children's increased exposure. These children face the issue of social exclusion because diseases and poverty push them into a life full of risks and hazards; a life which also confines their social role in the future. CONCLUSION: The street child community in Pakistan is on the rise. These children are excluded from mainstream society, and the absence of access to education and vocational skills reduces their future opportunities. Keeping in mind the implications of health-related events on these children, robust inter-sectoral interventions are required.