A/74/136 D. Institutions 61. International law is clear that the removal of children from their family environment should occur only where children cannot be allowed to remain there on the basis of a best interests determination, and any separation should be for the shortest possible duration. However, large numbers of children are separated from their families, and the majority of States are failing in their obligation to provide equal access to preventive, protective and supportive mechanisms to families. In many States, children simply “drop off the radar” of those States once they are in institutions, in particular, private institutions, which are often not State -regulated. 62. Latest estimates informed by study research indicate that, in 2018, the total number of children placed in institutions amounted to between 3.5 and 5.5 million. Since institutions are usually places where children cannot simply leave of their own free will, one could argue that most of those children, including children with disabilities, are in fact deprived of liberty. However, in the study, the estimated number is based only on those children who are deprived of liberty by order of a judicial or administrative authority (de jure). Data gathered indicate that at least 430,000 to 680,000 children living in institutions are deprived of liberty de jure. If children deprived of liberty de facto are also taken into account, the total figure is much higher. 63. The pathways that unnecessarily lead children to be separated from families include socioeconomic conditions, discrimination, family violence and lack of access to essential services (e.g., health, education, rehabilitation, treatment). Some children end up in institutions owing to the incorrect application of the best interests principle. Systems favouring institutions are sometimes characterized by profit motives or commodification of the care of children. Many States lack gatekeeping systems, which are necessary to prevent the placement of a child in care outside of the immediate family and to ensure that any such placement is suitable to meet the child’s needs and preferences. 64. Evidence shows that institutions are often characterized by living arrangements that are inherently harmful to children. The characteristics include but are not limited to: separation and isolation from families and the wider community; forced co-habitation; depersonalization; lack of individual care and love; instability of caregiver relationships; lack of caregiver responsiveness; lack of self -determination; and fixed routines not tailored to the child’s needs and preferences. The most egregious and direct forms of deprivation of liberty include solitary confinement, physical restraints and forced medication. Conditions in institutions are often characterized by violence, sexual abuse and neglect, amounting to inhuman and degrading treatment. Failure to register institutions and inadequate monitoring and complaints mechanisms raise the risk of human rights violations for the children involved. 65. Research for the study and the Independent Expert’s first-hand experience, as a former Special Rapporteur on torture, clearly indicate that children should not be institutionalized to receive care, protection, education, rehabilitation or treatment, as it cannot substitute for the benefits of growing up in a family or in a family -type setting within the community. This need for deinstitutionalization has already been expressed by States, when adopting the Guidelines for the Alternative Care of Children (General Assembly resolution 64/142) in 2009. 19-11838 13/23