At least they are alive is the most charitable comment as the young Albanians stare silently from their orphanage playpens. But the world they look out on is changing fast, and there is a big question mark over how much longer the impoverished state can support them. If the state cannot look after them what does the future hold? In countries as poor as Albania such children, many with no parents, would almost certainly be dead. Will they end up roaming the streets, like children in many South American cities, or will foreign aid come to their rescue?

Albania has an extensive range of residential institutions for children—orphanages, dystrophic homes (for slow developers), as well as psychiatric hospitals and hospitals for people with learning disabilities. But where a child ends up is a bit of a lottery. Certainly there are some perfectly normal children in the dystrophic and psychiatric hospitals. Their survival is a bizarre living memorial to the late dictator Enver Hoxha, whose regime staffed institutions with cheap state labour on the back of the time honoured communist deal “you pretend to pay us and we'll pretend to work.” The psychiatric hospital in Vlore, a town of 100000 on …