Almost one in every 100 children in Cambodia is living in a residential care institution, a number far higher than previous estimates, according to a new report in the British Medical Journal.

Around 70 percent of the children in Cambodia’s orphanages are estimated to have at least one living parent, and the government has pledged to return 30 percent of orphanage residents back to their families by 2018. The new study – conducted by Cambodia’s National Institute of Statistics, together with researchers from Columbia University and the consulting firm Moulathan – aimed to produce more accurate data to help the government track its progress towards reaching the reintegration goal.

But the researchers found that around 48,775 children live in residential care, a number far higher than the figure of 11,453 children the government previously presented. Of those children, more than half are between the ages of 13 and 17.

According to James Sutherland of the youth organisation Friends International, reintegrating a child back into family life gets harder the longer the child is institutionalised, a fact that poses particular problems for this older age group.

“It becomes more difficult to reintegrate with your family and also with everyone else,” he said, adding that institutionalised children often have vastly different experiences from their peers.

Bunly Meas, a representative of Unicef Cambodia, noted that new programs targeted at teenagers will be needed to help these young people reintegrate.

“Without programs to help them adjust to their new environment, they can sometimes feel lost,” Meas said in an email. “Some also face discrimination from the community … It is more likely to happen to children in older age groups.”

The new figures show how much work must be done before a significant number of young people return home, Sutherland added. “This shows us the scope and the level of work we have cut out for us over the next few years,” he said, adding that the new numbers are “still only a best guess”.

The study was the first attempt to estimate the number of institutionalised children in Cambodia that went beyond summarising administrative data, the report’s authors wrote, proving it is “feasible to conduct a national estimation of children in residential care institutions in a resource-limited setting”.

Among the children surveyed who had at least one living parent, the majority were living in an institution in the same province as their parent. According to the study’s authors, the high number of institutionalised youth is indicative of a lack of alternatives for parents who struggle to support their dependents.

“Some people have even gone so far as to describe residential care in Cambodia as a de facto social welfare system, albeit one that has been subject to intense criticism,” the authors wrote.

The researchers also found that around one-third of the country’s institutions did not have a memorandum of understanding with the Ministry of Social Affairs, and that around 70 percent of these institutions had not been inspected by the ministry.

“These findings raise substantial concerns for child health, protection and national development priorities,” they wrote.

Officials at the ministry declined to comment for this story.

According to Sutherland, members of the NGO sector are “very aware” that many orphanages are unregulated, a fact that allows them to “pretty much do whatever they want”.

Nevertheless, the study’s results weren’t entirely bleak. Children living in institutionalised care in countries like Russia and Romania have been found malnourished, undereducated, emotionally neglected and permanently stunted.

But that is not the case in Cambodia, where researchers documented “high levels of school attendance and literacy, low levels of reported work and illness, and high levels of reported safety and trust” among children in residential care.

“For some indicators, children in residential care may be doing better than their community counterparts in the lowest wealth quintiles, especially in terms of educational achievement and literacy,” the authors wrote.