Don't forget health when you talk about human rights
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Last week, Human Rights Watch (HRW) released World Report 2015,
their 25th annual global review documenting human rights practices in
more than 90 countries and territories in 2014. The content is based on a
comprehensive investigation by HRW staff, together with in-country
human rights activists. In his opening essay, HRW's Executive Director,
Kenneth Roth, writes, “The world has not seen this much tumult in a
generation…it can seem as if the world is unravelling”. Indeed, this
656-page report is a grim read in a year marked by extensive conflict
and extreme violence. But when one delves deeper, there is a hidden
story that often does not make the headlines. That story is the health
dimension of human rights. Viewed through the lens of health, the report
contains several compelling and disturbing themes.
First,
the countless attacks on health-care facilities and health workers in
conflict and crisis settings. Examples are legion. The targeted killing
of more than 70 polio vaccination workers in Pakistan and Nigeria by
militant groups. Fear of Ebola in south-eastern Guinea when the virus
emerged in early 2014, prompted attacks on treatment centres (the most
notable attack was the brutal murder of six health workers and
journalists). In conflict zones, violations of human rights and
international humanitarian law have been seen with arrests of health
workers providing care to government protesters (in Bahrain and Turkey),
and the indiscriminate bombing of hospitals, killing and injuring
health workers (in Syria and the Gaza Strip). The pressure on nations to
stop these attacks has been mounting. In late December, 2014, the UN
General Assembly passed a resolution calling for concerted and specific
actions by States to protect health workers from violence and to assure
patients access to health care in situations of conflict and insecurity.
Little
attention was paid to the rights violations that occurred during the
early stages of the Ebola response in west Africa, especially from
imposed quarantines. These interventions only reinforced fear and
mistrust at a time when health providers needed to strengthen a
community-based response. According to HRW, access to routine health
services within the quarantine zones was limited, breaching
international human rights law. Furthermore, there have been reports of
increased sexual risk taking because of the collapsed economy, including
areas under quarantine and among young people who were excluded from
school because of the epidemic. There have also been accounts of
increased sexual violence against children in Sierra Leone.
Gender-based
violence and the violation of women's and girls' reproductive rights
were also prominent in 2014. Gender-based violence is widespread and the
report is littered with examples of rights abuses worldwide. These
cases include countries where abortion is illegal and access to
reproductive services is limited, such as in countries in Latin America.
Involuntary sterilisation (in India and Uzbekistan) are common and are
often done without a woman's informed consent and in unsafe medical
facilities.
Mental health care in many countries is dire,
especially for individuals living with other disabilities. In India,
fewer than 20% of people who need mental health care have access to
treatment. Because of stigma and lack of services, families are unable
to cope, which often leads them to abandon or institutionalise relatives
with disabilities. There is also inadequate access to palliative care.
The report highlights the situation in Armenia where needlessly complex
prescription and procurement of opioid drugs means endless suffering for
terminally ill patients due to the absence of pain medicines.
Encouragingly, the 2014 World Health Assembly unanimously adopted a
ground-breaking resolution that urges all countries to integrate
palliative care into their health systems. India, Kenya, and Ukraine are
countries in which progress has been made, but challenges remain,
especially in the scarcity of trained health-care workers in palliative
care.
Other rights violations against health include poor
access to clean air and water. Toxic pollution is a serious threat to
health worldwide, mostly affecting the poor and the powerless, and the
report shows that governments have been slow to respond.
This
latest HRW report is an important call to arms to protect health as a
fundamental human right. It is a pity that HRW did not identify health
as a core element in its analysis, not only as part of a comprehensive
package of human rights protections but also as a necessary component of
resilient human security. Their analysis should prompt all governments
and international health organisations to reflect carefully on their
actions to make health a core responsibility and right of all citizens.