New Publication: Report on the Health Care for Asylum-seeking Children in the Netherlands (in Dutch)

By Veronika Flegar, University of Groningen, v.l.b.flegar(at)rug.nl

The report titled “Quickscan Gezondheidszorg asielzoekerskinderen in Nederland” was commissioned and published by the UNICEF-led Working Group on Children in Asylum Seeker Centres (Werkgroep Kind in azc). The central question of this research is how the access to and quality of health care and youth care for asylum-seeking children is organized and functions in the Netherlands. The report is based on desk research and qualitative semi-structured interviews with persons involved in the provision of health care to asylum-seeking children at the policy and practical level. The report highlights central aspects of the legal framework, the responsibilities of different organizations and the financing of health care, relevant supervision and monitoring mechanisms as well as the implementation of health policies and the collaboration of health care providers and other organizations concerned with asylum-seeking children in the Netherlands. The research points to the crucial importance of timely information provision, clear standards and a systematic process of transferal and relocation as well as to the role of schools in the prevention of health issues, to the necessity of preventive health care for the mental health of asylum-seeking children and to the importance of a constructive relationship between the parents of asylum-seeking children and health care providers. It ends with recommendations for improving the current situation and questions for future research on this issue.

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Insights from the OHCHR Expert Meeting on Non-Refoulement in International Human Rights Law

By Veronika Flegar, University of Groningen, v.l.b.flegar(at)rug.nl

On 2 June 2016, the Office of the High Commissioner for Human Rights (OHCHR) organized an expert meeting titled “Non-refoulement in International Human Rights Law” in Geneva. During the meeting, representatives from academia, the International Organization for Migration (IOM), the United Nations High Commissioner for Refugees (UNHCR), OHCHR, the EU Fundamental Rights Agency (FRA), the United Nations Children’s Fund (UNICEF), human rights treaty bodies and courts as well as members of non-governmental organizations voiced their ideas on this matter. The meeting aimed to clarify the scope and future of the principle of non-refoulement as well as to highlight possible legal and policy avenues and challenges. One of our GHLG members, Veronika Flegar was invited to speak about her research on extreme poverty, vulnerability and non-refoulement.

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Event: Empowerment of Refugee Women and Girls

Interactive event about the Empowerment of Refugee Women and Girls on 24 May 2016 at 3.30pm in Groningen. Interesting speakers, such as a former refugee and a women’s rights expert will debate issues of medical health for pregnant women, violence, hygiene and other struggles that refugee women and girls encounter. Free entrance. Limited spots, so sign up soon!

Upcoming GHLG event: Doorwerking sociaal-economische mensenrechten

Op 28 april 2016 zal Gerrit-Jan Pulles, advocaat bij Van der Woude de Graaf een lezing houden over de doorwerking van sociaal-economische mensenrechten in de nationale rechtspraktijk.

Wanneer? 28 april 2016 om 16 uur

Waar? Zaal A8 in het Academiegebouw (Broerstraat 5) van de Rijksuniversiteit Groningen

The event will be held in Dutch.

Klik hier voor meer informatie

Human Rights in a Downward Spiral?

By Veronika Flegar, University of Groningen, v.l.b.flegar@rug.nl

With the high number of asylum seekers arriving in Europe, states increasingly struggle to simultaneously accommodate the interests of their citizens and abide by their human rights obligations. Particularly in light of the increasing fear of terrorism in Europe tensions may arise between security concerns and human rights. I suggest that anyone interested in human rights should think about these developments as the current number of people requesting asylum in Europe is not only a test case for the integration capacity of Germany or for the functioning of the European Union, but also for the perseverance and strength of human rights. The goal of this post is not to provide a legal analysis of the issue but rather to raise awareness for the role of human rights in this context.

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Conscientious Objection or Conscious Oppression?: The Uphill Battle to Access Abortion Services in Uruguay

By Lucia Berro Pizzarossa, University of Groningen

In October 2012, Uruguay passed Law 18,987 that waives criminal penalties for abortion in the first 12 weeks of gestation. Where the pregnancy results from rape, with certain procedural requirements, abortion is permitted in the first 14 weeks of gestation. No time constraints apply if the health of the mother is endangered or the embryo is unviable. Uruguay has also passed Law 18,426 on Sexual and Reproductive Health that recognized the duty of the state to guarantee the effective enjoyment of sexual and reproductive rights. However, access to safe and accessible abortion services remains an uphill battle for Uruguayan women.

On June 23, 2014 anti-abortion advocates attempted to overturn the country’s abortion laws by calling for a referendum. They were supported by only 9 percent of the population, falling significantly short of the 25 percent that was needed for them to succeed. However, the strength of the campaign exposed the influence of the Catholic Church in Uruguay in spite of the fact that it is officially secular. Similar trends have been observed across Latin America. Research conducted by MYSU at the National Observatory on Sexual and Reproductive Health indicates that an alarming number of doctors refuse to perform abortion invoking conscientious objection (CO).  This means that healthcare professionals exempt themselves from providing abortion care on religious and/or moral or philosophical grounds. The MYSU research indicates that the percentages of refusal reach 87% in some areas of the country.

In November 2012 decree n° 375/12 was enacted regulating the procedure of abortion and determining limitations to the CO. Several doctors challenged the decree arguing its that it unduly restricts their right to freedom of thought. On 21 August 2015, in Alonso Justo y otros contra Poder Ejecutivo, the highest administrative court annulled several provisions limiting the exercise of CO. Among others, the court rendered null the requirement that physicians refrain from any form of value judgment regarding the patient’s decision (article 12)—a clause that enables doctors to refuse participation in any steps relating to the termination of pregnancy (not only the abortion procedure).

International human rights standards state that, although the right to freedom of thought, conscience and religion is protected, freedom to manifest one’s religion or beliefs may be subject to limitations to protect the human rights of others. Specifically, human rights and health standards stipulate that health services should be organized to ensure that an effective exercise of the freedom of conscience of healthcare professionals does not prevent women from obtaining access to services to which they are entitled (FIGO; Johnson et al, 2013; Zampas et al, 2012; ICH IACHR, Artavia Murillo v. Costa Rica).

Reproductive healthcare is the only field in medicine where freedom of conscience is accepted as an argument to limit a patient‘s right to a legal medical treatment. It is the only example where the otherwise accepted standard of evidence-based medicine is overruled by faith-based actions. It has been argued that the exercise of CO is a violation of medical ethics because it allows healthcare professionals to abuse their position of trust and authority by imposing their personal beliefs on patients. (Fiala & Arthur, 2014)

The formulation of the CO upheld by the court in its August 21 ruling prevents patients from receiving accurate, scientific and unbiased information about their options, and thus inhibits their ability to access such care (Weitz and Berke Fogel, 2010). This also results in inequities in access, creating disproportionate risks for poor women, young women, ethnic minorities, and other women living in particularly vulnerable conditions, who have fewer alternatives for obtaining the services. It is no wonder that organizations across the world have criticised the ruling as “restrictive and conservative”.

Research shows that the legal option of raising a CO is routinely abused by anti-choice healthcare personnel in denying women their right to health (Cook and Dickens, 2006; Dickens, 2006). In Alegre’s words “[c]onscientious objection can sometimes constitute conscious oppression” (Alegre, 2009). Coppola describes this claim as an illustration of such oppression (Coppola, 2014). It is hoped that the Uruguayan parliament will revise the existing legal framework to eliminate barriers to accessing abortion—including a 5-day waiting period, multiple consultations and the requirement of filing a criminal complaint in rape cases—and strike a fair balance between the right to freedom of conscience and the reproductive rights of Uruguayan women.

Posted originally as Lucia Berro Pizzarossa, “Conscientious Objection or Conscious Oppression?: The Uphill Battle to Access Abortion Services in Uruguay” (OxHRH, 11 September 2015) <http://ohrh.law.ox.ac.uk/conscientious-objection-or-conscious-oppression-the-uphill-battle-to-access-abortion-services-in-uruguay&gt;

Inter-American Human Rights Treaty on the Rights of Older People Defines a Broad Scale of (New) Health Rights: Precedent for a UN Treaty?

Marlies Hesselman, University of Groningen

On 15 June 2015, the member states of the Organization of American States (OAS) approved the Inter-American Convention on Protecting the Human Rights of Older Persons during the General Assembly of the institution. The resolution was not supported by Canada or the USA, but immediately attracted signatures from 5 members of the OAS (Brazil, Uruguay, Chile, Costa Rica and Argentina). The instrument needs two ratifications before it enters into force.

The document can already be taken as a landmark document, however, recognizing for the first time specifically the vulnerability of older persons and their specific rights. According to a press release of the OAS and the new Convention itself, ‘the purpose of the Convention – the first regional instrument of its kind in the world -, is to promote, protect and ensure the recognition and the full enjoyment and exercise, on an equal basis, of all human rights and fundamental freedoms of older persons, in order to contribute to their full inclusion, integration and participation in society. The starting point of the Convention is the recognition that all existing human rights and fundamental freedoms apply to older people, and that they should fully enjoy them on an equal basis with other segments of the population.”

One of the questions that this new regional convention raises is whether it supports and “strengthens the case for a new international UN convention on the rights of older people” as well. We very much like to invite you for a discussion on this question! Is it opportune to recognize a right to healthy and active ageing for the elderly internationally as well, or in a European document? Are these rights currently sufficiently protected? Please share your thoughts in the comment box.

To illustrate the scope of rights to health recognized in the Convention, the convention seems to underscore a range of rights not normally explicitly included in treaties, such as acces to ‘palliative care’, or the concept of ‘active and healthy ageing’. The Convention inter alia includes the following definitions and provisions on the right to health:

Art. 2 (definitions:)

“Palliative care”: Active, comprehensive, and interdisciplinary care and treatment of patients whose illness is not responding to curative treatment or who are suffering avoidable pain, in order to improve their quality of life until the last day of their lives. Central to palliative care is control of pain, of other symptoms, and of the social, psychological, and spiritual problems of the older person. It includes the patient, their environment, and their family. It affirms life and considers death a normal process, neither hastening nor delaying it.
[…]

“Multiple discrimination”: Any distinction, exclusion, or restriction toward an older person, based on two or more discrimination factors.

“Age discrimination in old age”: Any distinction, exclusion, or restriction based on age, the purpose or effect of which is to annul or restrict recognition, enjoyment, or exercise, on an equal basis, of human rights and fundamental freedoms in the political, cultural, economic, social, or any other sphere of public and private life.

“Active and healthy ageing”:  The process of optimizing opportunities for physical, mental, and social well-being, participation in social, economic, cultural, spiritual, and civic affairs, and protection, security, and care in order to extend healthy life expectancy and quality of life for all people as they age, as well as to allow them to remain active contributors to their families, peers, communities, and nations. It applies both to individuals and to population groups.

“Integrated social and health care services”: Institutional benefits and entitlements to address the health care and social needs of older persons with a view to guaranteeing their dignity and well-being and to promoting their independence and autonomy.

[…]

Article 11

Right to give free and informed consent on health matters

Older persons have the inalienable right to express their free and informed consent on health matters. Denial of that right constitutes a form of violation of the human rights of older persons.
[read rest of article and specific obligations here: OAS Human Rights Treaty on Older People -2015]

Article 12

Rights of older persons receiving long-term care

Older persons have the right to a comprehensive system of care that protects and promotes their health, provides social services coverage, food and nutrition security, water, clothing, and housing, and promotes the ability of older persons to stay in their own home and maintain their independence and autonomy, should they so decide.

[read rest of article and specific obligations here: OAS Human Rights Treaty on Older People -2015]

The Right to Health itself has also been comprehensively defined in article 19 of the new Convention, reading in full:

Article 19

Right to health

Older persons have the right to physical and mental health without discrimination of any kind.

States Parties shall design and implement comprehensive-care oriented intersectoral public health policies that include health promotion, prevention and care of disease at all stages, and rehabilitation and palliative care for older persons, in order to promote enjoyment of the highest level of physical, mental and social well-being.  To give effect to this right, States Parties undertake to:

a. Ensure preferential care and universal, equitable and timely access to quality, comprehensive, primary care-based social and health care services, and take advantage of traditional, alternative, and complementary medicine, in accordance with domestic laws and with practices and customs.

b. Formulate, implement, strengthen, and assess public policies, plans, and strategies to foster active and healthy ageing.

c. Foster public policies on the sexual and reproductive health of older persons.

d. Encourage, where appropriate, international cooperation in the design of public policies, plans, strategies and legislation, and in the exchange of capacities and resources for implementing health programs for older persons and their process of ageing.

e. Strengthen prevention measures through health authorities and disease prevention, including courses on health education, knowledge of pathologies, and the informed opinion of the older person in the treatment of chronic illnesses and other health problems.

f. Ensure access to affordable and quality health care benefits and services for older persons with non-communicable and communicable diseases, including sexually transmitted diseases.

g. Strengthen implementation of public policies to improve nutrition in older persons.

h. Promote the development of specialized integrated social and health care services for older persons with diseases that generate dependency, including chronic degenerative diseases, dementia, and Alzheimer’s disease.

i. Strengthen the capacities of health, social, and integrated social and health care workers, as well as those of other actors, to provide care to older persons based on the principles set forth in this Convention.

j. Promote and strengthen research and academic training for specialized health professionals in geriatrics, gerontology, and palliative care.

k. Formulate, adapt, and implement, in accordance with domestic law, policies on training in and the use of traditional, alternative, and complementary medicine in connection with comprehensive care for older persons.

l. Promote the necessary measures to ensure that palliative care services are available and accessible for older persons, as well as to support their families.

m. Ensure that medicines recognized as essential by the World Health Organization, including controlled medicines needed for palliative care, are available and accessible for older persons.

n. Ensure access for older persons to the information contained in their personal records, whether physical or digital.

o.Promote and gradually ensure, in accordance with their capabilities, coaching and training for persons who provide care to older persons, including family members, in order to ensure their health and well-being.

Article 24

Right to housing

Older persons have the right to decent and adequate housing and to live in safe, healthy, and accessible environments that can be adapted to their preferences and needs.

States Parties shall adopt appropriate measures to promote the full enjoyment of this right and facilitate access for older persons to integrated social and health care services and to home care services that enable them to reside in their own home, should they wish.

[read rest of article and specific obligations here: OAS Human Rights Treaty on Older People -2015]

Article 25

Right to a healthy environment

Older persons have the right to live in a healthy environment with access to basic public services.

[read rest of article and specific obligations here: OAS Human Rights Treaty on Older People -2015]

Again, we are looking forward to hearing your opinions on this new and unique Convention! How can we strenghtent the opportunities for active and healthy ageing in both developed and developing countries? What can European countries take away from this Convention?
Sources:
https://www.opensocietyfoundations.org/voices/human-rights-treaty-finally-recognizes-right-palliative-care

http://www.rightsofolderpeople.org/inter-american-convention-on-protecting-the-human-rights-of-older-persons/
http://www.theguardian.com/global-development/poverty-matters/2013/jul/31/ageism-human-rights-older-people
http://social.un.org/ageing-working-group/index.shtml

One of the multi-discplinary focus areas at the University of Groningen and the UMCG is ‘healthy ageing’. For more information about the research in this field at the RuG, see here: http://www.rug.nl/research/healthy-ageing/programme-healty-ageing?lang=en