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BUCHAREST, Romania (AP) — Soft toys on the beds and posters on the walls. No more than three children to a room. One of the girls living in the four-bedroom home gushes about getting makeup for her birthday.
In this group home on a leafy street in Bucharest, Romania's orphanage nightmares seem far away.
The horror stories, along with images of hollow-eyed children lying in row upon row of dilapidated cribs, emerged quickly after the 1989 toppling of Communist dictator Nicolae Ceausescu: shocking accounts of thousands of children beaten, starved and humiliated in overcrowded, underfunded state-run orphanages.
"There was no heating, no windows, no bedding, no running water," recalled Rupert Wolfe Murray, a British freelance journalist who accompanied an aid convoy that reached an institution for disabled children soon after Ceausescu's fall. In a single year in the 1980s, 30 children had died of cold, malnutrition and disease, according to records found at the orphanage, said Rupert, who joined the aid effort there after he saw the appalling conditions.
Flash forward to today. The number of children in Romania's orphanages has plummeted from more than 100,000 to about 7,000, with a goal of closing all the old-style facilities by 2023. Legions of children have been reunited with their families, placed in foster homes or relocated to cheerful family-style houses run by well-trained staff like the one in Bucharest's 6th District.
Across the globe, intensive efforts are underway to get children out of orphanages. Bulgaria and the former Soviet republics of Georgia and Moldova have made strides. China says it is now able to provide care for three-quarters of its orphans and abandoned children via foster homes or adoption. Rwanda is set to soon become the first African country to eliminate orphanages.
But it's a goal that remains elusive in many other countries — in India, where privately run, poorly regulated orphanages abound, and in Nepal and Haiti, where unscrupulous orphanage operators sometimes pay parents to relinquish their children and then profit from donations from sympathetic foreigners.
But aid groups working to phase out orphanages believe momentum is on their side.
"We are almost at the brink of achieving a global movement — putting orphanages back into history books," said Dr. Delia Pop, the Romanian director of global advocacy with Britain-based Hope and Homes for Children, which has worked to dismantle orphanages in 30 countries.
There's no precise global tally of children living in orphanages. UNICEF's latest estimate is 2.7 million, but the agency says many countries don't accurately count children in privately run orphanages.
Whatever the type of facility, 80 to 90 percent of the children in them have at least one living parent, according to UNICEF.
"Most often it's poverty driving these families apart," said Shannon Senefeld of Catholic Relief Services. "Parents believe ... their child will be given a better way of life if they live in an orphanage."
Yet research suggests orphanage life often harms a child in lasting ways. Even well-run institutions generally lack the affectionate care that maximizes a child's potential, while many expose children to abuse and exploitation.
"You can never do enough to try and supplement the need for affection from a parent," said Mihaela Ungreanu, a child-welfare official in Bucharest. "It is very hard to meet this challenge."
"This is really about transforming and rethinking social welfare systems," said Aaron Greenberg, a UNICEF child protection official. "If families could get the services they need, it could prevent them from needing alternative care to begin with."
Here's a look at how orphanage reform is faring around the globe:
Once the region with the highest rate of placing children in orphanages, Eastern Europe is now the epicenter of the movement to empty them.
In Moldova, Europe's poorest country, the orphanage population has dropped from 11,000 to 2,000 since 2011 as international charities work with the government to close orphanages, reunite children with parents and establish foster-care services, Hope and Homes for Children says. A similar effort in Georgia has reduced the number of state-run orphanages from 50 to two, now accommodating about 75 children rather than 5,000 in 2005, UNICEF says.
Bulgaria has won praise for focusing its reforms on children with disabilities, finding family-style care for all who had been in state institutions. Overall, the population of Bulgaria's state-run orphanages has dropped from about 7,500 in 2010 to less than 1,200 today, coinciding with a tenfold increase in the number of foster families who now care for more than 2,400 children, UNICEF says.
In sheer numbers, Romania is the region's paramount success story — especially in light of the Ceausescu era abuses.
As in Bulgaria, Romania's reforms have been aided by tens of millions of dollars in European Union funds as the EU assimilated the two former Warsaw Pact nations. Agencies like Hope and Homes for Children have helped place children with foster families or in smaller homes where they can enjoy outings, birthday celebrations and a normal education.
Stefan Darabus, Hope and Homes' regional director, says Romania's next big challenge is to keep vulnerable families together, which benefits the children and costs the state far less than an orphanage placement.
"Once institutionalized children turn into adults, instead of becoming contributors they continue to be dependent on social benefits," he said.
One of the old-style orphanages still operating in Bucharest, called Robin Hood, is due to close next year. Children who can't be reunited with their families or placed in foster care will move into state-supervised family-style homes.
Among them is 20-year-old Cristina. At Robin Hood since 2009, she was smiling one recent morning before starting a new life in one of those homes.
"I'm happy I am moving to a house where there's a garden and dogs," said Cristina, whose intellectual disabilities prevent her from giving informed consent to use her full name.
Elena Ionita, Robin Hood's director, says the youths living there have deep-rooted problems.
"We give them their needs — food, shelter — but in no way can we supplement the one-on-one care that a foster parent could give," she said.
In Russia, child-welfare reforms have been slower.
After a 2014 Human Rights Watch report documented cases of children with disabilities being ill-treated in state-run orphanages, the government put in place policies to help disabled children remain with their families or be placed in family-style settings — but progress has been limited.
According to Russian officials, the number of children without parents or guardians has declined almost 50 percent in recent years, from about 126,000 in 2011 to 66,000 in 2016. But recent data indicates only a few hundred are placed with foster families each year and there's been no major surge in adoptions.
Historically, Russia's orphanage system has been tightly controlled by the government. Now, for the first time, an orphanage outside state control has been set up to care for children with severe disabilities: St. Sophia's, run by the Russian Orthodox Church in a residential Moscow neighborhood.
In the past, few Russian families adopted children with conditions such as Down syndrome or cerebral palsy, but St. Sophia's has been able to place at least three such children in adoptive homes.
Unlike state-run orphanages, where many children might share one bedroom, they are divided into groups of five or six at St. Sophia's, each living in an airy, apartment-like space with a kitchen, bathroom, living room and bedroom.
"It used to be one room for 25 people — now it looks more like small families," said St. Sophia's director, Svetlana Babintseva.
"What I've seen in other orphanages — the conditions there were horrendous," said Yelizaveta Derzhayeva, who volunteers at St. Sophia's. "The worst thing is the staff — they are burned out and often take it out on the children."
In China, orphanages mostly house children abandoned by their families because of serious medical issues.
Families faced with high medical costs — as well as rules that long restricted couples to one, and now two, children — sometimes feel they have no choice but to abandon such children, particularly if they live in poor rural areas.
Following reports of babies left in fields, garbage dumps and even flushed down toilets, China experimented in 2011 with opening "baby hatches" attached to orphanages to provide desperate parents a safe place to leave children they couldn't care for. But many programs have since been suspended after being inundated with hundreds of children.
Orphanage conditions have improved over the past decade but funding is a challenge because most children require specialized medical treatment.
China is now promoting the care of such children in family settings. By late last year, there were 460,000 orphans and abandoned children in China — about 373,000 cared for through foster care or adoption, and 88,000 in orphanages, according to official statistics.
Still, the number of adoptions in China has steadily fallen, from 44,260 in 2009 to 18,736 last year.
Robin Hill, chief executive of New Hope Foundation, a charity that provides medical treatment for babies with deformities, said the Chinese government is seeking to place children in foster care with families living near orphanages or within the facilities themselves.
"There's been a tremendous amount of money spent and the actual facilities there now are much better than they used to be 10 years ago," he said. "They've been pushing for foster care and paying foster care families."
In India, the government estimates there are 20 million orphans and abandoned children, but only a small fraction have no living parents.
Some orphanages run by religious groups and nonprofits undergo government inspections to ensure standards are met. However, there are hundreds of unregulated privately run institutions, and reports surface periodically that children in some of them suffer maltreatment and sex abuse.
Nepal has been plagued by multiple orphanage-related problems.
In 2015, after an earthquake killed nearly 9,000 people, a UNICEF report decried an upsurge in cases of children "deliberately separated from their families and placed in orphanages so they can be used to attract ... donors."
Since then, the government has been urged to reunite abandoned children with their parents or extended family. But the current number of children in orphanages — about 15,000 — is down only slightly from UNICEF's estimate of 16,000 before the earthquake.
Extreme poverty in Haiti has led to a proliferation of homes for orphaned and abandoned children, with the government struggling to provide oversight.
There are about 35,000 children in 814 homes, according to Haiti's main social services agency. Officials say the vast majority were placed in the belief they would stay temporarily to receive education and care that their families couldn't afford. There have been frequent reports of children being adopted without their families' consent and parents being tricked into placing children in orphanages so they can be available for international adoption.
The government began placing new restrictions on adoption and bolstering oversight of orphanages after the devastating January 2010 earthquake, when the lack of regulation drew international attention. The underfunded social welfare agency has shut down about 150 homes since 2015, but new ones have opened in their place.
In the United States, as in Western Europe and other developed countries, orphanages generally faded away decades ago, replaced by foster-care programs and specialized residential facilities for children with special needs. Formerly prominent orphanages such as Boys Town in Omaha, Nebraska, now serve a variety of troubled youth — often in cooperation with their families.
In Africa, where child-welfare services are sparse and millions of children live in poverty, Rwanda's ambition to eliminate orphanages stands out.
Claudine Uwera Kanyamanza, director of the National Commission for Children, said 3,323 children were in orphanages when the program began in 2012, and all but about 235 have been reunited with relatives or placed with adoptive or foster families.
"It is mainly a question of sensitizing parents and families, and supporting them so they keep the kids in their homes," she said.
The government has deployed social workers to help smooth children's transition to post-orphanage life, but some say the program has been too drastic. They cite cases where families are unable to properly feed the children returned to them, and youths leaving the orphanages who end up living on the street.
One 21-year-old said he left his longtime orphanage in tears in 2015 and now lives in an uncle's mud hut, with scant job prospects.
UNICEF's Greenberg applauds Rwanda's efforts to close orphanages even while acknowledging the challenges.
"Any delay in closing these institutions is fundamentally a violation of children's rights," he said. "I visited a number of the orphanages. They were hell on earth, and no child should experience them."
Wong reported from Beijing and Crary from New York. Associated Press writers Nataliya Vasilyeva in Moscow; Sophiko Megrelidze in Tbilisi, Georgia; Ignatius Ssuuna in Kigali, Rwanda; Binaj Gurubacharya in Katmandu, Nepal; and Ben Fox in Miami contributed to this report.