Litigating Discrimination in Access to Health Care

29 July 2004

Alan Anstead¹

Despite a general increase in life expectancy and decrease in infant mortality across the recently enlarged Europe, evidence shows that social inequalities have increased everywhere and the gap in health between the top and the bottom of the social scale has widened. Also despite the huge amount of money invested in each country's health sector, studies carried out since the beginning of the 1990s have revealed that a significant number of people in economically vulnerable situations find it difficult to access health care and are being left out of the formal channels of health care provision.

The Roma, particularly in Central and Eastern Europe, suffer the worst health conditions. Accord-ing to the World Bank, the proportion of Roma living in poverty exceeds 75% in these countries.² Unemployment is high. Access to preventive and curative healthcare services is low. According to the World Bank, the health status of Roma is considerably worse than that of populations as a whole.³ Discrimination against Roma in access to health care is an area in which ERRC, together with national partner organi-sations, have brought litigation. A number of strate-gic issues concerning access to health care have been dentified, that have a human rights importance to Roma as a group.


Challenging Segregation on Racial Grounds in Health Care Establishments

*Nadka Slavcheva

This is a case involving the segregation of Romani patients in theTina Kirkova hospital in Sofia, Bulgaria.

In 2001, Mrs Nadka Slavcheva, after giving birth to her child, was placed in the corridor of the hospital. She was told that the hospital wing was closed for repairs and that therefore there were no rooms avail-able. However, although all of the Romani patients were placed in the corridor, the non-Roma patients were placed in proper wards. Mrs Slavcheva filed a civil action requesting moral damages. Her claim was rejected and the case is pending on appeal.

*Mrs Rositza Anguelova

Segregation on discriminatory grounds was the sub-ject of a civil action by Mrs Rositza Anguelova and others in 2002. In this case, all of the Romani patients at a hospital in Sofia were placed in specified "Roma wards" rather than regular wards where non-Roma were placed. Hygienic conditions in the Roma wards were worse than normal ones and the rooms were not heated during winter. Acivil claim for damages was rejected by the Sofia District Court and also rejected on appeal before the County Court. The case is now pending before the Bulgarian Supreme Court.


Challenging Discrimination in the Provision of Health Care Benefits

*Csaba Balazs case (husband of victim)

In 2000, a Romani woman in Hungary was refused a nursing allowance by the local authority in Nograd on the grounds that nursing allowances were not regulated by local laws and regulations, even though she was entitled by Hungarian national law to an allowance for staying at home to care for a disabled relative.

An unsuccessful administrative action was filed in 2001, following which a criminal complaint was filed in 2002 claiming abuse of official powers. The case is pending before the Nograd Prosecutor's Office.

*Adriana Boros and Others

This case is on behalf of 10 Romani women from the village of Frata in Romania, who were entitled to re-ceive birth allowances in accordance with Romanian law. This provides that every mother who gives birth is entitled to receive a birth allowance of 1,400,000 Lei (approx. 35 euros) if she files a request with the local Town Hall within 6 months of the birth. In 2003, the Romani women tried to apply and had collected all of the documents required by the law. However, the secretary of the Mayor in Frata refused to register their requests. She told the women to get married or sue the fathers for child allowance, or even take out the name of the father from the birth certificate in order to receive the birth allowance. None of her objections to registering the requests for birth allowances were legal. While the women (who thought the objections were required by law) were trying to follow them, the deadline for applying passed and they lost the right to birth allowance. Since filing a complaint against the Mayor's secretary, police in Frata and the prosecutor have been victimising the women and their families to withdraw their complaint. The Mayor's secretary is reportedly related to a policeman in Frata. The local lawyer in this case filed a criminal complaint against the Mayor's secretary (which was turned down and is being appealed before the Prosecutors Office), and has filed a complaint with the National Council for Combating Discrimination under the Romanian anti-discrimination law (which is still pending a year after filing the complaint).


Contesting the Barriers for Roma Access to Health Care and Treatment, Including the Emergency Services

*Croatian Ambulance case

On 9 February 2001, in a Romani settlement in north-western Croatia, the baby of a Romani couple, Mirko and Verica Oršuš, was stillborn after the local emer-gency medical team refused their calls for help. A neigh-bour had called the emergency services when Ms Oršuš went into labour, but was told that the team would not come, and that Ms Oršuš should be driven to the local medical centre, after which the person on the other end of the line hung up. Mr Oršuš called the same medical centre, and after he told them he did not have a car, the staff told him to put his wife into a wheel-barrow and bring her to the medical centre. Eventually the local police were called and they told the ambulance to go to the settlement. By the time an ambu-lance finally arrived, Ms Oršuš had given birth on the floor of their house and the child was dead. After a successful civil action, the Oršuš family were awarded damages against the Croatian health authorities.

*János Horváth (husband)

This is a sad case from Hungary in which, in 2002, the two hour delay in sending an ambulance in response to a Romani family's call for help led to the death upon arrival at the hospital of a Romani woman. A complaint was filed with the Ombudsman for National Minorities and he requested the Police to start a criminal investigation into the incident. The Police found that neither the doctors, ambulance service nor hospital could be found responsible for the death of the Romani woman. An appeal was filed and this is still pending.

*Miklós Kolompár

Another discrimination case, this time on the alleged grounds of the cost of providing treatment, another barrier that many Roma face when trying to access health care. In 2003 Mr Miklós Kolompár, a prisoner in Hungary, was refused treatment for his kidney disease. Mr Kolompar's condition deteriorated and the kidney eventually had to be removed. A criminal complaint has been filed with the Hungarian Prosecutor in this case.


Combating the Informal and Illegal Payments for Services, Most Prevalent at Public Hospitals

*Stefka Dimitrova

In 2002, Ms Stefka Dimitrova had a sudden miscarriage and needed emergency medical assistance. The doctors at the hospital in Sofia, Bulgaria, refused to provide her with the necessary treatment unless she first gave them a bribe. Ms Dimitrova did not have this money. The hospital refused to admit her as a patient. A civil action is pending before the Bulgarian courts.


Challenging Barriers for Roma Access to Health Insurance

This is an area in which the ERRC will look to support a suitable case to challenge the widespread problems around health insurance systems. The problems are that: 

• Not all of the population is aware of the procedures and the need to have health insurance, especially among the unemployed or those working in informal labour.
• The financial contributions required by patients, although small, are often too high for the poorest people.
• Many Roma lack the new identity cards neces-sary for inclusion in the system (a recent UNDP/ ILO survey showed that only 54% of Roma in Bulgaria had medical insurance).
   

Litigating Against Discrimination in Health Care: Some Comments 

• Countries in the region are required to implement comprehensive anti-discrimination legislation, under the EU Race Equality Directive 2000/43/EC (which includes health in the scope of the Directive), and to ensure that there are effective remedies for victims of discrimination, and special measures (where necessary) to create the conditions of equal enjoyment for Roma of access to health care. With effective national legislation in place it will be easier for lawyers to bring strategic litigation to challenge the widespread practice of discrimination and break-down the indirect (and often direct) barriers to their access to health care.
• Changes in the law need to be accompanied by training of medical and healthcare workers to recognise and combat direct and indirect discrimination on the basis of race or ethnicity.
   

Endnotes:

1. Alan Anstead is ERRC Legal Adviser/Project Manager.
2. World Bank study “Roma in an expanding Europe – breaking the poverty cycle” Ringold, Orenstein andWilkens 2003.
3. Ibid.