Child abuse in Bermuda is worse than many other developed countries with almost a third of women exposed to abuse as children, according to the Health Care Review report.

But social workers are so "grotesquely overworked'' they can only take part in "crisis intervention'' and court cases have failed because of inconclusive evidence.

Now the Review team is recommending the Child Protection Act is up-dated and that a trained professional examines a child at the emergency department within 24 hours of admission if it has symptoms that suggest physical or sexual abuse.

The team also recommends that social workers at the King Edward VII Hospital should follow through with treatment to victims and their families.

And they say the Health Department should as a priority adopt recommendations made by the Coalition for the Protection of Children.

As part of its examination of health care in Bermuda the Health Care Review team looked at the question of child abuse.

It found that 20 to 30 percent of all women and between three and ten percent of men have been victims of sexual abuse as children.

"The problem of physical and sexual abuse of children in this community is as bad, if not worse, than other similarly developed countries,'' says the Health Care Review report.

"As a healthcare issue, the evidence is overwhelming that these children will be the bigger drain on the healthcare system as adults,'' the report adds.

"They are statistically far more likely to become addicts or alcoholics, more likely to suffer chronic physical or mental health problems and more likely to inflict pain or injury to others,'' adds the report.

It says court cases have sometimes collapsed because professional evidence was not available or the professional was asked to make judgements based on photographs rather than an examination.

The Child Protection Team follows model practice but the report says: "The Team, however, is only as good as the resources it has at its disposal.'' It adds: "After the initial stage the cases are passed onto the Department of Social Services to follow-up.

"Unfortunately the Department and its social workers are so grotesquely overworked already, with caseloads that permit little but crisis intervention, that the kind of follow-up necessary is virtually impossible to achieve.'' The report also recommends adopting the Coalition's policies for monitoring day care and child nurseries and for reducing the number of teenaged mums.

"Bermuda's children attend day care and nursery facilities in record numbers.

"They are especially vulnerable if these facilities are not carefully monitored by well qualified people armed with a set of regulations that require a high standard of care.'' No figures are available for the number of teenaged mothers, but the report says the earlier the pregnancy the more likely it is that the mother has come from a disadvantaged family.

"Very often these disadvantaged young girls have grown up emotionally neglected and lack a personal sense of mastery and self-esteem.

"They see only minimal prospects of a decent job and they have little reason to postpone parenthood.

"These young women feel they have very little else to offer except their bodies in return for badly needed affection and look forward to the prospects for emotional gratification and empowerment that they feel a baby can offer,'' says the report.

Last night Sheelagh Cooper, the executive director of the Institute of Child and Family Health, welcomed the report's recommendations but called for a study of child abuse, commissioned almost three years ago, to be made public.

Mrs. Cooper also suggested making it mandatory for professionals such as teachers to report cases of suspected child abuse.