(This article is from 2004, but still seriously disturbing.) THE screaming starts at 11am sharp each day in the basement of the Raby care home near Prague. That is when a little boy called Vasek Knotek is locked in his cage.
For a brief period each morning Vasek, who is about five, is let out to be fed and washed. But once his cage has been cleaned he is forced back inside.
Vasek shakes the iron frame with all the force he can muster and tears at the wire mesh that confines him. His screams of anger ring through the building. In an adjacent cage his friend Michal puts his hands over his ears to shut out the noise and bursts into tears.
There is nothing in the children's cages to comfort or console them - no teddy bears or toys and certainly no gifts from home. Vasek's parents live less than a mile away, but according to staff they have not visited once since they brought him in as a baby with beautiful blond curls. He has a sister who does not even know he exists, they say.
Nor do the nurses show Vasek any warmth: they refer to him by his surname and cannot say whether he is four, five or six. The human contact in his daily routine consists mainly of a quick wash, nappy changes and perhaps a head shave.
The only distraction for Vasek as he stood forlornly in his cage last week in a room of bare whitewashed walls and fluorescent lights was the sight of a man in his late seventies lying on a bed opposite, shaking, sedated and apparently close to death.
Vasek and Michal are among five mentally handicapped children discovered in cages by an undercover Sunday Times reporter who posed as a prospective social worker and carried a concealed camera during three visits to Raby, a two-hour drive from the sophisticated city of Prague.
Many others - from babies, toddlers and teenagers to frail elderly people - exist in cages across the Czech Republic, which is regarded as one of the most progressive countries among the 10 that joined the European Union last month.
In another home visited by an undercover reporter at Slatinay in east Bohemia, a 14-year-old girl died two years ago when a bar at the top of her cage fell on her head and fractured her skull. Instead of scrapping the cages, the director bought more modern ones. Small children were inside them last week.
They are also used in neighbouring Slovakia and in Hungary, where a recent medical report on a man with spina bifida concluded that he would have learnt to walk had he been given therapy, but was unable to do so now because he had grown up in small cages.
The disclosures prompted condemnation this weekend from medical and legal experts and a demand from a senior British member of the European parliament for urgent reforms.
"I am gravely troubled by this medieval cruelty and I intend to champion the rights of these torture victims at the highest levels in Europe and in Britain," said Baroness Nicholson, who has campaigned successfully to improve conditions for children in Romania. "Now that this has been brought to the world's attention, it has to be stopped immediately."
It was a measure of the Raby home's sensitivity to outside opinion that Michael Balassko, its head of therapy for the past 18 years, warned the undercover reporter that she must not tell anyone what happens there.
She had asked for temporary work at the home, ostensibly to help her to decide whether to pursue a career in care. But after three days she protested at the conditions.
"What you see and hear while you are here is completely confidential," Balassko had said. "You say nothing to anyone." The director of the home even asked her to sign a document that would have legally bound her to remain silent. She declined.
The home is on three floors. The residents with the mildest disabilities - a low IQ, epilepsy and a degree of autism - live at the top. A man with a sign round his neck that says "Director" spends hours pretending to fill out reports.
Yet even here there are cages. The reporter saw a 30- year-old man with learning difficulties being punished - for no reason that she could discern - when a nurse suddenly ordered two other people to put him in a cage.
One seized him by the arms, the other by the legs and he was thrown in. Although usually docile, he kicked and screamed in rage when the door was shut. The others laughed at him and shouted that he would be sent to live in the basement next time.
The basement is somewhere nobody would choose to live. From the ground floor, where residents wander the corridors aimlessly, it is approached by a flight of stairs.
Those who descend are confronted first by the stench of excrement and bleach, then by the paralysing sight of a human menagerie.
There are three children in separate cages in the first room. A tall boy of 15 called Pavel stands up and stretches his hands through the bars in an effort to touch anyone coming towards him. Next to him is another teenage boy, rocking backwards and forwards and occasionally clutching the bars of his cage.
Opposite is Martin, a vulnerable-looking boy of about nine, who moves inquisitively to the front of his cage if someone is near. There are few novelties and hardly any visitors for the 19 residents of the basement.
The older boys make less fuss about the daily 11am lock-up, as if they are conditioned to the routine. It is the younger ones who resist, struggle and protest.
Vasek and Michal, the smaller children, are in the room next door. Their cages consist mainly of mesh rather than bars but the effect is the same. If their cries are deemed too loud, the nurses close a soundproof door and their voices are silenced.
The nurses appear unconcerned. "This job doesn't bother me any more," said one as she changed a nappy. "I've got used to it."
According to the staff, Vasek and the other children have to be in cages because they are hyperactive and would hurt themselves if they were out.
"These kids need medical care, not therapy, and that basically means feeding them, washing them, keeping them clean," said Balassko.
However, British experts who were told of the Raby regime said there was no benefit in keeping the children in cages. Richard Newton, a leading neurologist and board member of a European association of experts on mental disability, responded with outrage.
"Putting a child who has no mental handicap in a cage will make him aggressive, depressed, angry, difficult to control," he said. "A mentally handicapped child will react in exactly the same way."
Indeed, the reporter found the children playing calmly on the floor after breakfast on her third visit while the cages were prepared for their return.
It is not as if the children are consigned to an ageing asylum for lack of money to pay for decent facilities. Four years ago the 90 or so residents were moved into a purpose-built state-funded complex, complete with a swimming pool and art room. But their cages came with them.
As well as the mentally handicapped children, there is a group of five toddlers with cerebral palsy, one of whom - David - spends most of his time behind bars at Raby.
The children in cages are sometimes fed through the open doors and those who are able to move around are allowed out to play in the basement during cleaning.
"Sometimes we take them out for a breath of fresh air but only one at a time because otherwise they're too much to handle," said a male nurse. "If they misbehave, we give them an injection."
What the children are injected with and how often was not clear. But according to groups lobbying for better conditions, the use of sedatives in institutions housing mentally handicapped and mentally ill residents is commonplace.
Raby is symptomatic of a deeper problem in the Czech Republic and elsewhere in central Europe. Many families feel ashamed of mentally handicapped children. Most are therefore kept out of sight, often in cages welded around beds and measuring just 8ft long, 3ft wide and 4ft high.< BR>
More than 70,000 children and adults live in Czech "social care" and psychiatric institutions. The labour and social affairs ministry says no records are kept of the number of cages but one lobby group says they account for 10% of capacity in some homes.
This group, the Centre for the Development of Social and Health Care, claims that more than 400 residents of one home in Jihlava, south of Prague, have been kept in cages for varying lengths of time in the past year.
The lobbyists have been encouraged by the Czech Republic's entry into the EU to demand the same standards of care that apply in western Europe. They say there is no place for cages in a relatively prosperous country that was led until recently by Vaclav Havel, the former dissident writer who knew only too well what it was like to be locked up during the communist era.
A social affairs ministry survey concluded last year that care homes were breaking international laws on human rights and that rules governing the use of cages could not be enforced. The study recommended that the homes be replaced by a system modelled on Britain's, in which former residents of institutions have been helped to lead semi-independent lives in the community.
"Unfortunately the recommendations on retraining and alternatives were shelved," said Milena Janova, the former civil servant responsible for the report. "Instead of getting rid of them, the government is ploughing millions into repairing and restoring the buildings."
For now there seems little prospect of change for mentally handicapped residents and psychiatric patients alike. A teenage boy at a psychiatric institution in southern Bohemia is said to have spent his life in a cage; patients suffering from senile dementia are kept in cages in central Bohemia; and a psychotherapist who had a nervous breakdown and was sent for a rest at a home in Sternberk, near the city of Olomouc, found himself injected with sedatives and locked in a cage.
"Over a two-week period they spoke to me only twice," said Dusan Dvorak, 42. "It was like One Flew Over the Cuckoo's Nest."
Institutions in the Czech Republic's poorer neighbour, Slovakia, are said to be struggling to cope with more than 30,000 patients and cages are commonly used. A recent picture taken in one home by a human rights activist shows a despairing young woman left almost naked in her cage.
The use of cages was banned in Slovakia before it joined the EU but health workers say privately that the law is not enforced. It does not in any case apply to psychiatric institutions and there are scant funds for alternative treatment.
In Hungary a similar ban is expected to come into force this month but does not apply to the physically handicapped residents of care homes.
Vladimir Hruby, a spokesman for the labour and social affairs ministry in Prague, said it had no intention of outlawing cages.
However, the Czech Republic is facing challenges from the Human Rights Watch lobby group, which says the country is in breach of a United Nations convention on the rights of the child, which takes precedence over domestic law. Nicholson's aides are assessing whether the use of cages contravenes European human rights law that prohibits "degrading" treatment.
The officials in charge of Czech care homes continue to defend the cages. Miroslav Kubin, director of the home where the 14-year-old child had died, said controls had been tightened after the "tragic accident" and added: "But we will continue to use them (cages) unless they are outlawed."
At the Raby home where Vasek shrieks his defiance, Jan Slezak, the director, claimed that worse could follow if the cages were banned: "These cages should be thought of as big cots that stop patients falling out. If we got rid of the cages then we'd have to strap the patients to their beds or put them to sleep with sedatives."