Travel the Grand Trunk Road between Lahore and Islamabad, and you come to the city of Gujrat. Awash in the smog and sewage produced by its million-odd inhabitants, it is an unlovely place best known for the manufacture of electrical fans. It is also the location of a shrine to a 17th-century Sufi Saint by the name of Shua Dulah. For at least 100 years, but perhaps for centuries, it has been, though is no longer, a depository for children with microcephaly.

The word “microcephaly” comes from the Greek, “small head”. But in Pakistan, such children are known as chuas or “rat people”. The name is uncharitable but apt, for their sloping foreheads and narrow faces do, indeed, have a rodent quality. When I visited the shrine earlier this year, I found only one chua, a 30-year-old woman called Nazia. Mentally disabled – I would judge her intelligence to be about that of a one- or two-year-old child – her nominal function is to guard the shoes that worshippers leave at its entrance, but that work seems to be mostly done by her companion, a charming hypopituitary dwarf called Nazir.

These days, most chuas are intinerant beggars. Travelling up and down the Grand Trunk Road, following a seasonal calender of religious festivals. Each chua is owned, or perhaps leased, by a minder, often a raffish, gypsy-like figure. The Chua-master looks after, and profits from, his chua rather as a peasant might a donkey; together, they may earn as much as 400 rupees per day, about £4. Most people I asked supposed that there are about 1,000 chuas in the Punjab, but no one really knows.

Where do they come from? There is, inevitably, a local myth to account for origins of the chuas. Infertile women, the story runs, come to the shrine to ask the saint to intercede on their behalf, to give them children. This he does, but only at a price: the first-born child would be a chua. That child has to be given back to the shrine where it would be raised, and live, as an acolyte. Should she fail to do so, all future children will be born chuas as well.

[Source]