The boy with the bullet wounds: Neglect and brutality in Uruguay’s care homes

When Sebastián Silva* thinks about the night of 26 January last year, he smells burnt skin and sees blood gushing from the wounds on his right arm as he lays on a wet floor, surrounded by broken furniture, in a care home for teenagers in Montevideo.

Having turned 19 this year, and moved 340 kilometres away from the Uruguayan capital, Sebastián is talking for the first time about how a police raid on his former state-run care home – a place where he should have been safe – led him to receive 31 painful scars across his arm and back, and left him with physical and mental trauma that he says will never go away. Two of his fellow child inmates, both girls, were also assaulted in the course of the raid.

No prosecutor, police officer, doctor, or official from the Uruguayan Institute for Children and Adolescents (INAU) has ever asked the children what happened that night, when officers from Montevideo’s second precinct stormed the Himalaya centre, a care home for adolescents struggling with addiction and mental health issues.

Neither the police, INAU nor any of the people who were supposed to be involved in caring for Sebastián have faced any criminal consequences for that night. In April this year, prosecutor Pablo Rivas said he found “insufficient evidence” to charge them and asked a court to close the case. An internal investigation by INAU found “negligent actions” by staff members at the Himalaya centre. But it has not ended its contract with the Ave Fénix Foundation, the private foundation owned by an influential Uruguayan family, that runs the care home, and is currently paying Ave Fénix for three times as many minors as it houses.

openDemocracy spent almost six months reviewing internal documents from the Ave Fénix Foundation and INAU, and interviewed a dozen sources and eye-witnesses to understand what exactly happened at the Himalaya centre that night, as well as how it treats other teenagers in its care. We have found that in the past year and a half since Sebastián was brutally injured, the centre has also faced accusations of a staff member sexually assaulting two girls and four adolescents being sexually exploited during unauthorised trips out of the centre.

The experiences of Sebastián and the other teens living in Himalaya are part of a broader pattern of alleged abuse against vulnerable children in state care: those who have suffered abuse or neglect; those from very poor families; those in need of temporary care or awaiting foster care or adoption; and those with behavioural or psychological issues without adult support. The Himalaya centre is not alone in its alleged failures. The 8,000 or so children, adolescents and youths under INAU care, 3,300 of whom live in its care homes, often face experiences like those detailed in this article.

Uruguay is known for its high human development and strong child protection laws. But behind this facade, systemic issues persist – and particularly affect children and teenagers. Poverty among children has worsened since the 1990s, with 20.1% of kids under six living in poverty, compared to 10% of the general population.

These high rates of poverty and food insecurity for families with young children “indicate that the protection system has not been a strength of the country”, Gustavo Salles of child protection non-profit Gurises Unidos (United Boys) told openDemocracy.

Poverty also contributes to the 9% rise in violence against children and teenagers last year, according to Adriana Briozzo of El Abrojo (The Thistle), a non-profit working to improve society. INAU handles an average of 22 cases relating to violence against under-18s every day – more than half of which involve girls. An INAU board member , Natalia Argenzio, told openDemocracy that the state agency’s care homes has “581 places for violence cases” and 562 children on a waiting list, adding that the actual number of children in need is likely much higher.

Our investigation has revealed that even those children who receive a place in an INAU home often face neglect, unyielding bureaucracy, and mistreatment by authority figures. Some are exposed to extreme risks such as physical violence – as in Sebastián’s case – or sexual abuse and exploitation, as has happened to other teenagers living in the Himalaya centre. This can worsen their existing trauma and contributes to the high levels of suicide and self-harm among children in state care in Uruguay.

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Argenzio, who sits on the INAU board as a representative of Uruguay’s opposition parties, said that suicide attempts by minors in state care have increased by 45% in the past three years. At least 750 children and adolescents ran away from care homes about 5,500 times in the first six months of 2024, she said, adding that sexual exploitation is commonplace for state-protected adolescents. Of the 346 children and adolescents identified as victims of sexual exploitation in 2023, 36% were under INAU’s care. The crimes occurred during unapproved outings.

“The situation is heartbreaking,” Argenzio said, “Uruguay needs to transform its child and adolescent protection system."

Requiem for a dream

The Ave Fénix Foundation is the brainchild of its general coordinator, Enrique Tomás Cervini Flores, who told openDemocracy that he became interested in rehabilitation after undergoing treatment for drug addiction in 2007 when he was 17.

Cervini Flores trained as a therapeutic carer and worked at a rehab clinic before deciding to set up the foundation to run an outpatient rehabilitation centre in his hometown of Atlántida, a beach city 44 kilometres east of Montevideo, in 2011. Grateful for their son’s recovery, Cervini Flores’ wealthy parents – who own a network of taxi, security and cleaning companies employing 1,600 people – agreed to fund the foundation and were deeply involved in its running, according to Cervini Flores. Both his mother and father were listed as the foundation’s legal representatives in documents seen by openDemocracy from 2022, although they appear to have been replaced in these roles by the following year.

The Ave Fénix Foundation closed the outpatient centre in 2017 because “it reached a point where it required a lot of money, which started to affect the business”, said Cervini Flores. The foundation was then inactive until 2020, when it signed its first contract with INAU to deliver the ‘Everest programme’ — an agreement to provide outpatient therapy services, as well as “care, education and assistance” for up to 30 children and adolescents in their home or school, according to the INAU contract, which openDemocracy has reviewed.

The Everest programme is supported by Martín Gedanke, a psychologist specialising in drug dependence who also runs his own rehab clinic and leads the medical care at a mental health clinic in Montevideo. Gedanke, an old friend of Cervini Flores’, offers the Ave Fénix Foundation technical advice. Gedanke did not respond to openDemocracy’s request for comment.

Cervini Flores told openDemocracy that despite the “excellent support” offered by the Everest programme, “additional steps” were needed to maximise care. In 2021, the foundation approached INAU with a proposal for a new project: the Himalaya Specialised Mental Health Transitional Centre. The centre’s focus would be adolescents “with disorders related to mental health and other intersectionalities, such as violence, disability, problematic drug use, among others”. Gedanke was listed on the proposal as the technician in charge.

The Himalaya centre was meant to bridge a gap in the country’s social safety net: At least 14% of the 1,745 teens and youths in INAU homes require specialist mental health care, according to official data from July 2024, but Uruguayan law says under-18s cannot stay in a psychiatric clinic for more than 30 days at a time. A lack of accommodation for such at-risk children after their treatment meant the INAU was regularly in breach of this law. The Himalaya centre was supposed to create a safe space for longer-term rehabilitation and care for minors.

In August 2022, INAU signed a one-year pilot contract with the Ave Fénix Foundation to run the Himalaya centre, which would house 20 adolescents for up to six months each and work with five others in their family or social contexts. It was initially agreed that INAU would pay the foundation a monthly sum of $2,600 for each minor supported by Himalaya. Yet although the centre has never had more than a dozen teens under its care at any one time, INAU pays it as though it is operating at full capacity – $65,000 a month at first, rising to $70,000 today with inflation.

INAU promoted the centre as an “innovative” project that would offer the teenagers the help they need to enter or re-enter standard care homes or to leave the care system altogether after six months. Himalaya’s therapeutic approach would be comprehensive and individualised, according to the proposal filed by the foundation to INAU. It would ensure the continuity of occupational projects and the promotion of healthy relationships with relatives and other people close to the teenagers. Everything would take place in a “facility with the necessary characteristics”, including dormitories designed for the “comfort” of adolescents, with “adequate ventilation and lighting” and furniture adapted to their needs. “All areas will have heating or cooling to maintain a suitable temperature year-round,” it promised.

Unlike at Los Robles, the private psychiatric facility where INAU hospitalises all children and young people under its care who suffer from physical and emotional crises, and those who require de-addiction therapy, minors at the Himalaya centre would be able to go on agreed-upon outings and would not be subject to restraints such as straitjackets, isolation or forced medical treatments such as sedatives.

The first teenagers were referred by the state agency to the Himalaya centre in November 2022. Soon after, the Ave Fénix Foundation showed it was unfit to help them.

‘They just shot him’

Sebastián arrived at Himalaya a few days after its opening. He had small, shiny earrings, a chain around his neck, nicotine-stained nails, tattoos, self-inflicted scars on both arms – and a lifetime of INAU files.

His records detail an absent father, a mother with cancer, a foster mother whose partner beat him, an uncle he saw die in a shooting, a brother in prison, and a sister with whom he lived for a while and enjoyed playing football. They cover the three years he was moved around care homes across Uruguay; his brief stint in a juvenile detention centre in Montevideo; the time he dropped out of high school; his friendship with a priest in his hometown; and the three months he spent in Los Robles – a breach of the legal 30-day limit for minors – where INAU sent him for help with a drug addiction problem that began when he was 12.

Despite his difficult start to life, Sebastián was in many ways a typical 17-year-old when he arrived at Himalaya. He made TikTok videos rapping and shared photos of himself posing with a Nike Jordan Pro cap carefully tilted over his shaven head on Instagram.

But things took a turn for the worse soon after his arrival.

Despite being billed as an innovative project by the INAU, several former staff members who spoke to openDemocracy on the condition of anonymity said the centre is “filthy”, dark, plagued by “an invasion of rats”, and “falling apart”. The sources, one of whom also provided photographs to support their claims, said pipes leak, the plastering is unfinished, and there is a lack of furniture and appliances.

For several months in the winter, children at the home were forced to huddle in one room for warmth because there was no heating. Basics such as toilet paper or cleaning products frequently ran out, or were provided by employees using their own money. There was no underwear for the teenagers, and the mattresses were so thin that an educator protested during a meeting with the foundation’s directors. Cervini Flores’ mother, María del Carmen, responded with mockery, according to several witnesses, which led the educator to quit her job. These conditions, sources said, persist to this day.

Employees who were at Himalaya when the centre opened told openDemocracy that psychologist Gedanke hired somebody who had undergone treatment at one of his clinics as a care worker, despite them having no prior experience as a carer. Other carers hired to the centre had worked in homes for children or for teenage mothers and their children, but few knew about mental health or addiction. The centre also didn’t provide the activities or care it had promised in the proposal submitted to INAU.

“The first weeks we couldn't go anywhere, and we got stressed out,” Sebastián recalls. Regardless of which clinic or home INAU placed him in, Sebastián said his drug addiction meant he “didn't want to be there. I always wanted to be on the street.”

Sometimes teenagers at Himalaya watched TV, listened to music, played cards, or went on walks with their carers. However, according to openDemocracy’s investigation based on testimonies from the centre’s workers, at other times, they fought with each other and the staff, cut the power cables, defecated on their peers’ clothes, ran away, climbed onto the roof, cut themselves, or attempted suicide.

Argenzio, the opposition board member at INAU, said such conflicts are frequent in care homes, due to the lack of individualised care to address the issues that led to the children and adolescents’ admission to INAU. This absence of care results in physical and emotional crises, which have led to home fires, severe fights among them and with the staff, and unauthorised outings from state-run homes. “Confinement is the protective measure offered to children and adolescents by INAU,” she stated.

On the night of Wednesday 25 January 2023, there were just five adolescents staying at Himalaya, according to INAU reports and the sources affiliated with the centre who spoke to openDemocracy under the condition of anonymity. Two adolescents took their medication and went to bed. Sebastián and two 15-year-old girls, however, snuck out – spending the night in Montevideo’s port area smoking cocaine paste, a low-purity cocaine by-product that is much cheaper than other drugs, including marijuana.

What transpired next is an account pieced together using interviews with Sebastián, anonymous witnesses and Himalaya workers, and reviews of medical reports and INAU files.

When the trio of Sebastián and his friends returned to Himalaya the next afternoon, high on drugs and alcohol, a carer tried to convince them to stay, eat something and take their medication. But Sebastián said he needed to go out to confront a man he had had a disagreement with the previous night. He lifted his shirt to reveal a knife he’d found in a dumpster on the street, which he refused to hand over – prompting the carer to call the centre’s authorities and alert other members of staff.

A staff psychologist, Macarena Casales, attempted to calm the teens down, but her efforts backfired and caused them to become more distressed. One of the girls told her: “You are supposed to be my therapist, and you don't even know my name, so shut up.” The girls threatened to harm themselves, their peers and the psychologist, and to destroy the centre. Sebastián, now in tears, asked to phone his mother and a carer lent him her phone.

“I started to remember everything that had happened to me. And I thought, what am I doing here? And it got even worse,” he said.

Staff called the private Mobile Emergency Medical Service (SEMM, by its Spanish acronym), which refuses to enter some INAU centres without police accompaniment due to previous violent incidents at care homes. But the INAU protocol for managing conflict and crises in 24-hour care homes, in place since 2019, doesn’t include any guidelines for police behaviour when entering children’s homes. INAU’s general director, Dinorah Gallo, told openDemocracy that the protocol is being “updated”.

While SEMM and the police were en route, the girls broke some furniture and threw a water canister, flooding the room. But by 11 pm, things were relatively calm. The carers managed to calm all three children down, and had taken them out to the courtyard for a cigarette.

Then, the police arrived.

Casales was outside the centre waiting for the medical assistance when between six and eight police officers arrived, some of whom entered the building. A closed metal gate at one end of the entrance hallway separated the teenagers from the police; but eyewitnesses said some officers insulted and provoked the adolescents, undoing the efforts of the carers to keep the children calm. Sebastián picked up the knife and the girls threatened to attack the officers if they came through the gate.

The lack of specific de-escalation protocols, a carer said, meant the police immediately viewed the incident as a hostage situation even though the carers told openDemocracy that they did not feel they were being held captive.

A veteran officer sat on the floor and attempted to negotiate with Sebastián, urging him to drop the knife and “release” the carers. When one of the girls eventually opened the gate, the officers burst into the house with 12-gauge shotguns drawn. Micaela García, the centre’s director at the time, entered behind the police. She later told openDemocracy that she had asked the police about their weapons and was wrongly told: “They are just stun shotguns.”

One of the girls pushed Sebastián, hoping to make him drop the knife. He stumbled and fell. As he tried to get up, the officers shot him in the back. “It wasn’t a matter of ‘I’ll scare you, I’ll subdue you’. No, they just shot him,” one witness told openDemocracy. “They shot him until he dropped the knife out of pain.”

In total, Sebastián was shot 31 times, on his back and right arm. The Ministry of the Interior refused to answer openDemocracy’s questions on what ammunition was used, though a forensic expert and police officer we consulted said that the wounds appeared to be from rubber bullets, which is also stated in Sebastián’s medical report.

Police also hit him on the head with their weapons and punched his body. He was pulled from this attack by the veteran officer, who took him in a patrol car to the Hospital de Clínicas just before 1am and left him under the watch of another officer from the same precinct as his assailants.

The girls, meanwhile, were grabbed by their hair and hands by two female police officers, who lifted their dresses, groped them and searched their underwear – shoving batons between their buttocks. Crying, they were handcuffed and taken to the street, where they were put against a wall with their clothes in disarray before being taken to the police station and then to the Hospital Español to check for injuries.

Back at the Himalaya centre, one officer washed Sebastián’s blood off his hands and others picked up spent rubber bullets from the floor. The SEMM ambulance arrived and asked to check on the two adolescents in the centre, one of whom had gone to bed before the girls began threatening their peers. The other had locked themselves in a room, along with a staff member who’d only been working at Himalaya for a week, for safety.

Care staff told openDemocracy that they then followed García’s instructions to clean and tidy the place, throwing away the broken furniture and patching bullet holes in the walls. They said the psychologist Casales also told them to “put in order” what they would say at the police station that same night.

Casales declined to reply to specific questions about her work at Himalaya.

The aftermath

When the girls were returned to the Himalaya centre in the early hours of the morning, the centre’s staff still did not know where Sebastián was. García, the former director, told openDemocracy that it took police more than 12 hours to tell her that they had taken him to a hospital. It was not until she finally learned of his whereabouts that she notified INAU of the police raid, according to an ongoing investigation by the state agency.

García denies this, saying: “INAU authorities were informed on the same evening [26 January], at the beginning of the incidents, and the next morning a Zoom meeting was held with them.”

What followed was a blame game between the INAU and García from Himalaya, with each accusing the other of underplaying the seriousness of an incident in which a child in a care-home had been shot 31 times by a police team.

To make things worse, the Hospital de Clínicas’s medical report, which openDemocracy has seen, says the police told doctors that Sebastián was injured as he resisted arrest while on drugs. No one at the hospital assessed whether his injuries were the result of a situation that should be reported or took any photos of the injuries to use as evidence. García resigned from her position at Himalaya in November 2023.

INAU’s director of health services, Mónica Silva, told the investigation that the shots could have entailed “an enormous risk to [Sebastián’s] health, as non-lethal ammunition in the thorax can cause death from cardiac arrest, and in the abdomen, it can cause liver or spleen injuries with significant bleeding, and in the face, it can cause loss of vision”.

Yet when INAU reported the incident to the public prosecutor's office on 8 February 2023, prosecutor Pablo Rivas concluded “there is not enough evidence to identify responsible parties or to hold them criminally accountable” and asked the judge to dismiss the case.

“I knew there was a riot by the residents, that the young man admitted he was under drugs and a knife in his hand,” Rivas told openDemocracy. “The INAU did not provide names, site cameras, internal administrative information, nothing. The INAU or the victim’s family never requested an interview with the prosecution team.”

Rivas did not respond to openDemocracy’s questions about whether he had attempted to obtain any of this evidence – or gather any witness testimonies besides those collected by the police on the night of the incident. Both INAU and Rivas confirmed there have been no reports made about or investigations into the police’s mistreatment of the two girls.

The Ministry of the Interior did not respond to openDemocracy’s questions about whether the officers’ conduct was investigated, and we were unable to access police records about the incident. Pablo Abdala, who chaired INAU at the time of the incident and is now vice-minister of interior, did not respond to a series of questions about what responsibility the agency and the police had in the incident.

On 30 August 2023, INAU’s lawyers concluded in an early stage of the internal investigation that “the overall performance of the Himalaya project was inadequate”. The actions taken were “negligent, not only in different aspects of handling this episode but also in assessing and informing INAU’s competent authorities about its consequences”, they added.

INAU’s lawyers said the police should never have been involved, according to the official report. “The situation didn’t entail more risk than a simple reduction and psychiatric medical care,” it said. “Instead, it resulted in a gross assault, damaging to human rights.”

In sum, the situation at the Himalaya centre was not a violent hostage crisis that required a squad of policemen armed with rubber pellets, but rather was a case of terrified adolescents who needed medical attention and the care of well-trained, empathetic staff.

‘Absolutely marginal cases’

Classified INAU reports obtained and reviewed by openDemocracy reveal at least four other incidents of police misconduct against children and adolescents under state protection in 2023 alone.

In the Artigas department in northern Uruguay, a police officer assaulted a 17-year-old boy who had recently undergone heart surgery. The attack “caused such an emotional impact that he now fears to go out in public”, said one INAU document.

openDemocracy has seen firsthand that there is a constant police presence outside the entrances of the short-stay centres in Montevideo, where adolescents are taken by INAU when they first enter the care system. INAU records show that several complaints have been made by carers or other witnesses about these officers beating children with batons.

In a Montevideo home for teenage mothers and their children, a police officer physically and verbally assaulted one of the mothers and staff members who tried to stop him.

In Maldonado, in eastern Uruguay, the police took three children aged 11, 12 and 13 away in handcuffs without adult supervision after they reported an educator for sexual abuse.

Abdala, who presided over INAU until the end of October 2023, told openDemocracy that “these are absolutely marginal cases”. He added: “I would deny any version that there is abuse or repression, quite the contrary.”

Chaos at Himalaya

Cervini Flores of the Ave Fénix Foundation acknowledged reports of previous poor conditions at the Himalaya centre. He said these were due to an INAU “system error” last year, which meant the centre was paid for the number of adolescents it assisted – as its contract seen by openDemocracy says it should be – rather than according to its total capacity.

“For about three or four months we received less money. It’s not the same to be paid for 25 places… as to be paid for five or ten… and maintain the same resources, structure and continue improving the facilities,” he told openDemocracy. “Today, everything is fine.”

openDemocracy is unable to verify this as INAU does not allow press to enter these centres.

Himalaya staff members openDemocracy spoke with said that despite Cervini Flores’ claims, the issues at the centre are ongoing. Rather than being a place of therapy, they said, Himalaya is a place of neglect.

“Adolescents [at the centre] don’t have psychotherapy. There are psychologists, but all they do is guide them,” one person told us. Pages from the centre’s logbook have gone missing several times, with staff beginning to number pages after a psychologist tore a page out at the request of a girl who didn’t want her self-harm recorded.

Sources also told openDemocracy that towards the end of last year, a girl at Himalaya told carers that she had been sexually abused by a staff member, who is also an INAU employee. The girl didn’t realise she was a victim and the centre’s management convinced her that she had made the whole thing up due to her mental health issues.

She subsequently wrote two letters – which openDemocracy has read – to staff apologising for the matter. Months later, a second girl at the centre complained of sexual assault by the same member of staff. Again, she did not realise she was a victim. The accused worker was reportedly transferred to another clinic managed by Gedanke without any investigation.

“They didn't want to fire him, because María del Carmen specifically stated she didn't want to pay dismissals,” said a staff member. Neither the Cervini Flores family nor Gedanke responded to openDemocracy’s questions on these allegations.

Other minors at Himalaya have allegedly been sexually exploited during unauthorised absences from the centre. On one occasion last year, Himalaya’s newest arrival, who was 14 years old, asked staff if she could call her mother. Concerned, they asked what was wrong and she admitted she’d been at a trap house – a place for selling illegal drugs – and had been accused of stealing. “She hadn’t done it, but she was scared because they were threatening to kill her,” the source said. “That’s when we found the place.”

It transpired that four girls at Himalaya, all aged 16 or younger, had been frequenting the trap house, and had allegedly been sexually exploited there. One of the four alleged victims was one of the girls arrested the night Sebastián was attacked by the police, another was the second girl to report alleged sexual abuse by a member of Himalaya’s staff.

One worker told openDemocracy that the girls had previously had relatively positive experiences in the care system but struggled with the lack of routine at the Himalaya centre. There are no set schedules or classes; kids wander idly while staff improvise workshops in areas such as make-up, cooking and cleaning.

“They all ended up dropping out of school, then escaping and going out to use drugs,” they said. Sometimes, girls are missing for weeks, they added, then “every so often, they’d return to the home to bathe, eat something, and then run away again”.

García reported the girls’ visit to the trap house and the alleged sexual exploitation that took place there to INAU in September 2023, shortly before she resigned as Himalaya’s director.

“Those who occupy the property [the trap house] and are in charge of the sale of substances have been involved daily with underage youths, offering such substances in exchange for sexual acts, among other things,” her report said.

Two other sources familiar with the case said the alleged sexual exploitation was also reported to the police but never investigated. One of them said: “[Himalaya staff] went to Precinct 2 to file the report, asking them to get the girls out of there, and [officers] said they couldn’t get involved. They were told there were minors there, and they replied they couldn’t do anything.”

The Ministry of Interior didn’t answer openDemocracy’s questions about this.

The future of the Himalaya centre is uncertain. The INAU board is awaiting the outcomes of “several technical and legal reports” relating to a litany of complaints before making any decisions, according to INAU’s general director, Dinorah Gallo. People familiar with the situation confirmed to openDemocracy that the board has not yet decided how to respond to the complaints.

Eight carers resigned between April and May 2024, which sources told openDemocracy was at least in part due to them being upset with the centre’s management. Cervini Flores claimed this is “natural in almost any business”, telling openDemocracy.

“On the field, you see who you want on the team and who you don’t,” said Cervini Flores. He also complained that boys and girls referred by INAU had “profiles” – such as drug addiction or being violent – that didn’t “match those agreed upon in the contract, making it very complicated to assemble a team” of experienced staff.

Sources told openDemocracy that the Cervini Flores family and Gedanke are detached from the centre's realities. “I never met Cervini Flores. I met María del Carmen, who occasionally visited the centre, but she lived in a bubble and had no idea what we were going through,” said one of the workers. “She once arrived with clothes for five-year-olds, when the centre is for adolescents!”

Another employee added that “the Cervini Flores never cared about what was going on here”, while a third said: “They only care about profiting from the children. God forgive them.”

For now, both girls who were arrested with Sebastián are still underage and remain in INAU’s care system. Nineteen-year-old Sebastián, meanwhile, became homeless after leaving Los Robles. He has since found a place to stay, but during his time living on the streets and in shelters, he crossed paths with other boys who had also been placed in Himalaya or another INAU care home or outsourced psychiatric clinics. All were burdened by pain and adrift.

“We were children, and we still are children. Even if you don’t believe it, you know?” he says. “No matter what we’ve done, for me, it shouldn’t have been this way.”

*Some names have been changed for security reasons