In this issue of Clinical Journal of Sport Medicine, Dr. Bener and his colleagues report on camel racing injuries affecting 275 boys, aged 5 to 15 years, seen at Hamed General Hospital in Qatar during the period 1992 to 2003. Theirs is the first published report on camel racing injuries among children in a Persian Gulf country. There is evidence, however, that the injury picture presented in their report is indicative of a much more serious and widespread health problem affecting child camel jockeys in the Gulf region. Indeed, there is a dark and tragic side to this sport that needs to be conveyed as important background information to “Camel Racing Injuries Among Children.”
CAMEL RACING IN THE GULF COUNTRIES
Camel racing is a deep-rooted traditional sport that finds its origins in the desert culture of the Arabian Peninsula, North Africa, and the Middle East.1 Over the past 2 decades, camel racing has rapidly developed into a hugely popular spectator sport in the Gulf countries. Most racing camels are owned by the ruling sheiks, although a small number of wealthy merchant families, government officials, and Bedouin tribesmen also own camels.2 The races are televised and written up in the sports pages and are said to engender as much enthusiasm as “March Madness” caused by the college basketball finals in the United States.3
Today there are camel race tracks near most of the major Gulf cities. In the United Arab Emirates (UAE), a hub of camel racing activity, it is estimated that at least 16,000 camels race at 17 official racetracks.4 Camel races range from 4 to 10 km, depending on the type and age of the camel, and usually include from 15 to 20 camels and up to 70 or more at the close of the season.1 Average running times for these races range from 6 to 17 minutes, depending on distance covered.2 Mature camels can be 2 metres high at the shoulder, weigh more than 680 kg, and run at speeds of up to 35 to 40 km/h during a race.2 It is not surprising that severe injuries occur in this sport.
As with horse racing, camels with smaller, lighter jockeys are at a distinct advantage. This is not only to achieve greater speed but also to minimize the stress on the camel's spine, particularly the younger racing camels that do not mature until 6 years of age.2 As recently as the early 1970s, race camels were ridden by their owners, usually the nimble youngsters in the family.2 However, during the 1970s, camel owners also began acquiring migrant children as young as 3 or 4 years of age to work as camel jockeys.
Although many child jockeys are escorted into the Gulf countries by their parents or other legal guardians for financial gain,5 thousands of children are trafficked from Bangladesh, Pakistan, and countries in East Africa and sold into slavery to serve as camel jockeys.6 Some of these children have been bought from impoverished families by agents. Others are lured from home with promises to their families that they will be employed as domestic servants within their own countries.7 Destinations for young boys trafficked for the purpose of exploitation as camel jockeys include the UAE, Kuwait, Saudi Arabia, Oman, and Qatar.6,8
It is difficult to determine the precise number of child camel jockeys in the Gulf region given the variable and often clandestine means by which they were trafficked. It is estimated that there were 175 to 250 child camel jockeys in Qatar in 2004 and as many as 1200 to 2700 in the UAE during the same period.6 However, a respected Pakistani nongovernment human rights organization (NGO) estimates that there may be as many as 5000 to 6000 child camel jockeys in the UAE and perhaps roughly 40,000 in all of the Gulf countries combined.9
INJURIES IN CAMEL RACING
It is heart-wrenching to imagine a child as young as 4 or 5 years of age, top-heavy with proportionately large trunk and head and short legs, perched or strapped on top of a camel as the animal races up to 35 to 40 km/h. The children's terrified screams reportedly make the camels run faster.7 By contrast, children 4 and 5 years old in Western culture are still learning to ride a bicycle.
The case series report by Bener et al confirms that camel racing is indeed a dangerous sport for children. Of the 275 boys admitted to the hospital for camel-related injuries, 60% or 165 required hospitalization. Seventeen were permanently disabled as a result of their injuries, and another 3 died. Five of 18 neck injuries resulted in paralysis. One in 4 injuries involved the head, and almost a third of head-injured patients suffered a skull fracture and/or brain injury. The authors could not comment on helmet use as these data were lacking in the hospital records.
The work of Bener et al is extremely important in raising the level of awareness and concern regarding both the frequency and severity of camel racing injuries among children in Qatar. Heretofore, there has been only anecdotal information published on injuries affecting child camel jockeys. For example, in the 2005 US Department of the State Report on Human Trafficking,6 it is noted that some child camel jockeys from Qatar had been thrown from camels and had suffered serious neurologic damage. Unfortunately, denominator data are lacking, and therefore, it is not possible to estimate the rate and severity of injuries affecting child camel jockeys in Qatar. It is possible that some injured children may have been taken to private hospitals in the region that do not require national health or medical insurance registration. Also, as the authors indicate, children who died on site would likely not have been brought to the hospital.
There is reason to believe that the injury problem reported by Bener et al is indicative of the plight of child camel jockeys in other Gulf countries. The US Department of the State6 reports that such children have been seriously injured, and some have been trampled to death. Recently repatriated Pakistani child camel jockeys have recounted instances of serious injuries sustained by boys who have fallen and been trampled by camels.10-12 For example, Salih, a Sudanese camel jockey, said he watched as a boy fell off a camel, broke his neck, and was buried in a hole when the race was over.12 In addition to the accounts of such injuries, observation of recently repatriated child camel jockeys has revealed frequent instances of poorly treated or otherwise untreated injuries.4,9-12
LIVING AND WORKING CONDITIONS OF CHILD JOCKEYS
In their article, Bener et al note that patients in their study were poorly nourished. They also report that children were deliberately underfed to keep their weight down so the camels could run faster. Similar observations are found in the 2005 US Department of State reports on Trafficking in Persons6 and Human Rights Practices,13 which describe abominable living and working conditions for these children in Qatar, including inadequate medical care and malnutrition. The harsh living and working conditions of child camel jockeys also exist in other Gulf countries, as reported in the recent US Department of the State reports.6,13
These conditions raise serious concern about the growth and health status of child camel jockeys.6,13 The effects of chronic undernutrition in children (ie, deficiency of energy or nutrients in the diet persisting over several years) have been well documented and include stunted growth, reduced muscle mass, and delayed or impaired neuromuscular and motor development.14 Case studies of children and adolescents also indicate the potential influence of adverse living conditions, particularly psychosocial or emotional circumstances, on growth and maturation.15,16
There is also grave concern regarding the reported exposure of young camel jockeys to heat.6 In addition to long hours training in excessive heat, some of these children reportedly live in tin shacks that would be unbearable in the desert heat.4 Due to developmental differences in thermoregulation, exercising children do not adapt as effectively as adults when exposed to high temperature. This may affect their performance and well-being and increase the risk for heat-related illness.14 One can only wonder about the number of injuries or deaths among child camel jockeys that are linked to heat-related illness.
The reported living and working conditions of many child camel jockeys are contrary not only to the optimal growth and health of these children but also, one would think, to successful camel racing performance. In their recent article on pediatric equestrian injuries, for example, McCrory and Turner17 note that “in general, a [child equestrian] rider requires a sense of balance, reasonable physical fitness and alertness to ride.” Wouldn't the same also hold true for child camel jockeys?
SOME PROMISING DEVELOPMENTS
Over the last 16 years, a number of Gulf countries have been harshly criticized by UNICEF, the US government, and human rights groups around the world, most prominently Ansar Burney Welfare Trust International, for the use of child camel jockeys. With continued criticism and sanctions stinging harder in recent years, promising developments have been made, particularly during 2005:
* In December 2004, Qatar announced their intention,18 followed by the passing of a law on May 23, 2005,19 banning the import, recruitment, training, or involvement of children in camel racing.
* On April 4, 2005 the UAE passed a law that set an age limit of 16 and a weight limit of 45 kg for camel jockeys.20 This law was revised on July 5, 2005, to prohibit persons under 18 years of age from participating in camel racing in any form.21
* Qatar and the UAE are both reportedly developing robotic camel jockeys to replace child camel jockeys.4,5
* On May 8th, 2005, the UAE signed a pact with UNICEF and the governments of Pakistan, Bangladesh, and Sudan to begin rehabilitating and repatriating child camel jockeys to those countries.22
* On June 5, 2005, Kuwait's camel racing club was instructed, through a ministerial decree, not to use camel jockeys who are under 18 years of age or weigh less than 45 kg.23 In Saudi Arabia, camel jockeys reportedly now must weigh at least 45 kg.24
Skeptics are quick to remind us that, in the past, similarly signed agreements have done little or nothing to stop the trafficking and abuse of child camel jockeys.8,9,25 They declare that in spite of those agreements, the child camel jockey industry continued to develop. There is also concern that only a small proportion of the estimated numbers of children have been accounted for and repatriated.26 Furthermore, if reports are accurate that at least 16,000 camels race at the 17 official tracks in the UAE,4 that amounts to a lot of needed robots and a huge investment for the camel owners. While the concerns of skeptics may be warranted, the steps that are being taken by Qatar and the UAE, in particular, are laudable steps in the right direction.
We applaud Dr. Bener and his colleagues for their courage and compassion in reporting on “Camel Racing Injuries Among Children.” Their report provides, for the first time, an insight into the frequency and severity of injuries sustained by child camel jockeys in Qatar and, by extension, in other countries where child camel jockeys are being used. Their observations also provide additional insights into the working and living conditions of these children.
Ordinarily one might urge more rigorous future study of injuries affecting child camel jockeys, including evaluation of injury risk factors and countermeasures. However, we would prefer to believe that the population for such research will be unavailable because children will no longer be used as camel jockeys. In closing, concern is for the thousands of boys who have been exploited as camel jockeys during the past 20 to 30 years. Having missed schooling in their formative years, some scarred with physical and emotional trauma, these children face poor prospects, especially those who are not repatriated to their native countries and reunited with their families.
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20. Associated Press. UAE bans underage riders in camel racing. July 5, 2005.
22. Press Centre UNICEF. UAE supports UNICEF in safe return of camel jockeys to home countries. May 8, 2005.
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© 2005 Lippincott Williams & Wilkins, Inc.