The very concept of child rape is abhorrent and deeply unsettling. That it should happen in a hospital is deeply disturbing. On Saturday 2 October, the leading English language newspaper in Hong Kong, the South China Morning Post, reported that a 13 year old boy had been arrested for assaulting a 5 year old girl (read more). Both children, and yes, the 13 year old boy is still a child, were inpatients in a public hospital, having been admitted for examination as victims of two separate child abuse cases.

Apparently the boy was accused of raping the girl, but as he was under 14 he could only be charged with indecent assault.

Not unexpectedly there were calls for action to prevent such an occurrence from happening again but the proposals were generally of the knee jerk variety. In particular there were calls to keep boys and girls apart.

Does segregation prevent sexual abuse? Certainly not, and this surely is not the answer. One cannot but express sympathy and concern for those who are charged with the care of vulnerable children, and treating such children by segregation and/or isolation can hardly help them in their struggle to regain some elements of normality in their lives.

The problem is that 13 year old boys have the biological potential to be sexually active, but if they have had little exposure to the values of acceptable behaviour the drive to aberrant behaviour may be too powerful to resist. To have two children, both admitted with backgrounds of being suspected victims of child abuse, being involved in this incident may be a clue as to how to reduce the chance of another occurrence in the future.

A rush to segregate children by gender would seem unwise. A policy to limit the number of vulnerable children at any one time in a general paediatric ward may be more feasible and practical.

The policy of segregating wards in hospitals remains a thorny issue. Despite the Labour pledge to abolish such wards when they came to power in 1997, the Telegraph reported last year that one in six UK hospitals still used mixed sex wards.

Now Health Secretary Andrew Lansley has said that he is determined to end the practice and will introduce new NHS sanctions. Hospitals will face fines if they do not meet standards. (http://www.bbc.co.uk/news/health-10982566)

We do not, and never will, live in an ideal world. Given the choice I would far rather be in a mixed sex ward with adequate health care staff than in a single sex ward with insufficient staff.

What is the policy in the NHS with regard to children’s wards? I am not sure but again having enough staff to look after the children is very important. Allowing more privacy for adolescents may be a positive benefit but as many hospitalized children will confirm they yearn for company and integration not seclusion and segregation.

Andrew Burd is professor of plastic, reconstructive and aesthetic surgery at the Chinese University of Hong Kong. His major clinical interests involve paediatric burns care and the role of plastic surgery in the palliation of advanced malignancy. Academic interests include pragmatic ethics related to the practice of medicine including research and publication.