It was surreal. Within hours of sundry newspaper editors and a TV3 programme director being ordered into the Central Criminal Court charged with failing to preserve her anonymity, the 16-year-old child at the centre of the case was on RTE television, face blacked out, voice slightly distorted but hair and clothes clearly visible, telling the nation: "There is nothing being done about me. I don't know where I am going to sleep tonight".

Meanwhile Eamonn O'Brien, a Labour Party member of the Eastern Regional Health Authority (ERHA), the agency with statutory responsibility not simply to care for such children but to seek them out, thought some good PR would solve the authority's temporary little problem. "We need a good PR response to what is going on in the media . . . We need to speak up to the media and say `Stop knocking us'," he said.

In his musty, cluttered basement office in the north inner city, Father Peter McVerry - the Jesuit who highlighted the case - sat surrounded by his arthritic old dog and half-a-dozen lost-looking youths wandering in and out, casually picking up the phone, plundering the biscuit tin, calling out for a doctor's number, looking for money.

He responded to questions, looked for documents, soothed Ben the dog, without missing a beat. This is his daily reality. But it's been a good week. "Since Monday I've been swamped with health board social workers saying `Thank you very much'. They are so frustrated; they just can't get anything done. I think this case might just change everything . . ."

After 20 years of crusading, he finally has hope. This week, after Padraig O'Morain reported in this paper that the 16-year-old child whose nightmare had just been detailed in Saturday's papers, had been left to wander the streets, homeless, while in the care of the health board, a Minister for Health finally conceded: "The system has failed - and failed very badly . . . We collectively - all of us involved in the provision of these services - we are all responsible for the failure of the system. We've got to acknowledge that. It's gone on for far too long . . ."

It was a historic moment. The Minister made his displeasure and his focus very clear: "I want action on this. I want organisational change."

He failed to mention cultural change, an aspect that the Minister of State, Mary Hanafin, may be dwelling on this weekend.

She was humiliated into a U-turn when information supplied by the Northern Area Health Board - that the girl's siblings were in care and that arrangements made for them were working out very well - turned out to be untrue.

This came as no surprise to another politician, accustomed in the past to regular, top-level contact with the Eastern Health Board: "You got a version - that they were doing their best and what more could they do . . .? You got a very polished version which sounded very plausible - but when you went back into the community to check out the situation with people who were close to the individual, you generally found a completely different picture."

Others recall the board's "fierce opposition" to the "out-of-hours" service for the homeless (i.e. where emergency beds were sought outside business hours) when it was mooted in the early 1990s. "They just didn't think it was necessary. It wasn't about money. I saw no real, compassionate commitment to the young person," says one of those closely involved.

But is it just another part of the national culture? The 16-year-old's horrifying catalogue of repeated rape, torture, imprisonment and mutilation which began when she was 14 at the hands of her father is well documented. Her screams as he chained her mother to a bedroom floor are described in her statement to gardai. No one heard.

She screamed, too, when after the mother had returned from a women's refuge he pushed a spike through her leg and attacked them with a saw, a screwdriver and a razor blade. The rapes and torture continued for at least a year. Still no one heard.

"There were people that knew," she told RTE. "You could hear screaming around the house, but people would never say anything. I often went to school with bruises but nothing was done."

According to the Northern Area Health Board, it had been working with the family since February 1998. But the rapes, mutilations and imprisonment continued throughout that year and into the next, when the mother finally escaped through a kitchen window with her children and walked for half-a-mile before contacting the Garda.

After that, while her father remained in the family home, the child's family was scattered; her mother to one hostel, her brother - her only family companion - to another and the girl herself to another. According to the health board, the girl was put in foster care and later in long-term residential accommodation, but "this arrangement broke down earlier this year".

"But the places they put her into were ordinary services for ordinary homeless children," says Father McVerry, "whereas she had very special needs which mainstream homeless services were not capable of providing . . . It was absolutely predictable that these placements were going to fail."

This severely traumatised child was anticipating the trial of her father, was experiencing flashbacks of her ordeal (a symptom of post-traumatic stress disorder), and was on heroin (though now says she is off it). She still requires treatment for the slash wounds to her face, which had to be reopened under the care of a plastic surgeon.

Since the "breakdown" of the residential arrangement, she has been living in squats or on the streets, presenting herself to the ERHA's "out-of-hours" service at night to seek an emergency bed and - even where a bed became available - being abandoned to the streets the following morning, a ready target for those who prey on homeless and disturbed children.

Evidence of this confused and vulnerable state was available at the Central Criminal Court on Thursday, where - notwithstanding the child's television interview - a Garda sergeant gave evidence that she had tried to overdose twice as a result of continuous media publicity and that she was going around wearing a baseball cap and with her hand over her face because she felt the whole world was looking at her as the victim in the case.

In short, she is a 16-year-old with serious problems, separated from her family who live outside Dublin, left alone to walk the streets, without a haven of any kind.

Phrases chosen by the Northern Area Health Board this week to excuse its inaction only exacerbated matters. "The sentence that really infuriated me," says Father McVerry, "was the one that said she was in nightly emergency housing because it wasn't possible to `arrange appropriate long-term accommodation of her choice'. . . Note that term `of her choice'.

"What they are doing is transferring the blame for not having suitable services on to the child. If a child runs away from services, that to my mind suggests a problem with the services, and that we should look at the services. But the health board is saying there's a problem with the children. One of the great deficiencies of the board is that those who make the decisions do not listen to the social workers on the ground."

"We can't force people into a situation they don't want to be in," said ERHA member Jim Reilly, after pointing out that the girl had been offered a choice, but had refused it.

As a trenchant critic of the "catastrophising that goes on around individual cases", Prof Harry Ferguson would sympathise. He is working on a study based on 319 cases involving child abuse victims and the responses of various health boards to them.

"The critical issue is whether services were got to them, and in a relatively high proportion - some 25 per cent - they were not . . . and the most common reason for this was because the children or the families didn't want them. Something like 15 per cent of the cases I looked at involved cases quite similar to this one, and a really significant theme coming out of the study is that these young people could not be contained because they would not co-operate . . . The frontline workers simply run out of options.

"So here's a rhetorical question: what do you do if a 16-year-old girl continues to refuse help?" asks Ferguson. "Lock her up? Imagine the headlines then: "Health Board locks up 16-year-old rape victim". I'm not saying that the services could not be greatly improved, simply that there is not a pill for every ill. It's not just as simple as blaming the social workers and the system for failing."

But this time no one was blaming the social workers, who in any case found their own voice this week and placed the blame squarely on management. In a letter to newspapers, some 50 of them wrote of "a paralysis in developing resources which can respond creatively to the needs of vulnerable children . . . The expectation is that children will fit within the existing services rather than the services becoming flexible enough to adapt to their needs . . ."

A survey by IMPACT, the public service trade union, suggests that there are 1,150 cases of reported child abuse and neglect in the ERHA area which are not being investigated. Not unrelated to this is the fact that more than 40 social worker posts are vacant in the region.

Robbie Gilligan, senior lecturer in social work at Trinity College, and a founder member of Tabor House (a hostel which Father McVerry describes as a "model" of what can be done) believes the ERHA's problems are merely a symptom of a greater, national malaise. He says: "The people in the health board are working in good faith, but they're stuck in a kind of dance. It's not just the pathology of the ERHA; this is about the way we run things generally in this country.

"Whether it's about traffic in Dublin, or litter or road signs, you see weak governance and a lack of strategy . . . That lack of strategic thinking runs through the whole system. You find people saying `Oh, yes, we have these systems but we don't know how good they are . . .' People are afraid to be explicit about plans or figures because if they don't deliver, they're hammered. So they keep it fuzzy. But if you don't spell it out, the whole thing unravels.

"The health board should be working on a plan to cover what their estimated requirements will be in five or 10 years' time, but they probably could not tell you how many cases they are working on now, on this particular day. Imagine if Marks and Spencer took that line with their knickers sales. They would be out of business."

Meanwhile, those who have carried Mary Hanafin's baton in the past can only look on in frustration. Chris Flood TD, one of the few politicians whose work Father McVerry recalls with approval, wonders frustratedly why the out-of-hours service which he steered through as a minister has never been extended to the satellite towns around Dublin, which are so direly in need of it. Like many others this week, he also questioned the facility with which health board officials escape public scrutiny by simply saying they cannot discuss individual cases.

"In every single individual case like this, a statutory agency says `We can't discuss this individual case because . . .' This is, in my opinion, a cop-out because it really says we don't have to be publicly accountable. This must be addressed."

By Monday, if promises made come to pass, the 16-year-old girl will be offered accommodation at a house staffed with trained workers. Her 18-year-old brother, also homeless, is expected to be offered a place there if he wants it.

"And so the health board will think it can treat this as an isolated case and that it will be back to business as usual," says Father McVerry. "But it will not be business as usual. If they want it that way, then they can expect to open The Irish Times every Monday morning and find an equally distressing case to deal with."