More than 13,500 asylum seekers remain trapped on the Greek islands in deplorable conditions as winter begins on December 21, 2017. Greece, with support from its European Union partners, should urgently transfer thousands of asylum seekers to the Greek mainland and provide them with adequate accommodation and access to fair and efficient asylum procedures.

Author: Human Rights Watch, Human Rights Watch
Posted: January 1, 1970, 12:00 am

Shantha Rau Barriga is director of the disability rights division at Human Rights Watch. She leads research and advocacy on human rights abuses against persons with disabilities worldwide including: the shackling of people with psychosocial disabilities, denial of education for children with disabilities, violence against women and girls with disabilities, institutionalization of children and adults with disabilities, and the neglect of people with disabilities in humanitarian emergencies. She has worked on projects on Central African Republic, China, Croatia, Ghana, India, Indonesia, Morocco, Nepal, Peru, Russia, Serbia, Uganda, the United States, Yemen and Zambia.  

Shantha was a member of the UNICEF Advisory Board for the 2013 State of the World’s Children report and is a founding member of the International Network of Women with Disabilities. 

Before joining Human Rights Watch, Shantha participated in the UN negotiations toward the Convention on the Rights of Persons with Disabilities. Shantha received degrees from the Fletcher School of Law and Diplomacy at Tufts University and the University of Michigan, and was a Fulbright Scholar to Austria. She speaks German and Kannada.

Posted: January 1, 1970, 12:00 am

Public debate on the law on violence in the family, passed in December 2017. 

© 2017 RFE/RL Armenia
(Berlin) – The Armenian government made important steps to improve access to palliative care for people with life-threatening illnesses in 2017 and parliament passed a law on violence in the family, but serious gaps in human rights protection persist, Human Rights Watch said today in its World Report 2018.

The authorities failed to bring to justice officials responsible for excessive use of force against protesters and journalists in Yerevan during July 2016 protests. Domestic violence is a serious problem, with thousands of women reporting incidents annually. Local groups reported at least four women killed by their partners or family members in 2017.

“Despite alarming statistics on domestic violence, the Armenian government hasn’t done enough to protect and support survivors,” said Giorgi Gogia, South Caucasus director at Human Rights Watch. “The recent law on family violence is a step forward, but the government still has a long way to go to ensure that women and children aren’t trapped in abusive and often life-threatening situations.”

In the 643-page World Report, its 28th edition, Human Rights Watch reviews human rights practices in more than 90 countries. In his introductory essay, Executive Director Kenneth Roth writes that political leaders willing to stand up for human rights principles showed that it is possible to limit authoritarian populist agendas. When combined with mobilized publics and effective multilateral actors, these leaders demonstrated that the rise of anti-rights governments is not inevitable.

Human Rights Watch identified other serious human rights concerns in Armenia, including violence and discrimination based on sexual orientation and gender identity. In a positive step, the government overhauled the onerous system for prescribing and accessing opioid pain medications for patents with life-threatening illnesses.

Armenia’s ruling party dominated parliamentary and municipal elections in 2017. International observers concluded that the April parliamentary elections “were well administered,” but the polls were “tainted by credible information about vote-buying, and pressure on civil servants and employees of private companies,” and failed to improve public confidence in the country’s electoral systems.

The government has failed to ensure full accountability for police violence against largely peaceful protesters and journalists during protests in Yerevan in July 2016. Some police officers faced disciplinary action, but no criminal charges were pursued against any officials, despite the gravity of some of the force used. At the same time, authorities prosecuted protest participants and leaders, convicting at least 22 people on charges of using violence during mass disorder and interfering with the work of a journalist.

The authorities also did not effectively investigate the alleged police beating of four men in the court building in Yerevan in June. They were among 32 men facing trial for alleged crimes committed during the July 2016 armed takeover of a Yerevan police station. The men said police beat them in basement holding cells. Some officers alleged to have participated in the beatings remained on duty in the courtroom during the trial.

Thousands of children placed in residential institutions due to disability or poverty faced neglect due to overcrowding. While the authorities have transformed some of the institutions into community support centers, the process has not included all institutions with children with disabilities. Children with disabilities frequently remain in institutions as adults indefinitely, stripped of their legal capacity. Physical barriers and lack of reasonable accommodations at community schools often leave children with disabilities with little or no education.

Posted: January 1, 1970, 12:00 am

The psychological impact of conflict, exacerbated by harsh conditions, uncertainty and inhumane policies, is not as visible as physical injury. But it's just as life-threatening.

(Athens) – More than 13,500 asylum seekers remain trapped on the Greek islands in deplorable conditions as winter begins on December 21, 2017, Human Rights Watch said today. Greece, with support from its European Union partners, should urgently transfer thousands of asylum seekers to the Greek mainland and provide them with adequate accommodation and access to fair and efficient asylum procedures.

The Greek government committed in early December to moving 5,000 asylum seekers from the islands to the mainland as an emergency measure, before the onset of winter. Despite the transfer of almost 3,000 people since early December, the hotspots on Lesbos, Chios, Samos, Leros, and Kos still have almost 11,000 people in facilities with a total capacity of just 5,576. More than 1,000 people have arrived to the Greek islands during the same period.

“While Prime Minister Tsipras’s decision to move 5,000 asylum seekers from the islands to the mainland is beneficial for those moved, it is still a half measure that leaves thousands others out in the cold,” said Eva Cossé, Greece researcher at Human Rights Watch. “It’s an important start but more is needed, including support from other EU governments, to make sure that no one has to spend the winter in a freezing tent.”

Poignant testimonies from the ground provide a gripping look into the dire situation and distress of asylum seekers who are trapped on the Greek islands.

In a campaign that began on December 1, 13 human rights and aid organizations called on Tsipras to end Greece’s policy of containing asylum seekers on the islands. The groups said that Greek authorities should immediately transfer people to improved conditions on the mainland and take concrete measures before the official start of winter so that no asylum seekers are left out in the cold. The groups also said that other EU leaders should take a clear stand to end the containment policy that keeps asylum seekers trapped on the islands under an agreement with Turkey to send people refused asylum back there.

Human Rights Watch and other groups participating in the campaign will continue campaigning throughout the winter, highlighting the deplorable conditions asylum seekers trapped on the islands face. The groups will press the Greek government and EU leaders for a more effective response that protects the rights and reduces the suffering of asylum seekers arriving in Greece.

Ali, a 22-year-old Afghan asylum seeker with a disability, living in Moria camp, on the beach in Lesbos, Greece. He told Human Rights Watch he can’t access showers in the camp and sometimes tries to wash himself in the sea.

© 2017 ZALMAÏ for Human Rights Watch

The Greek government is expected to introduce a bill in parliament in the coming days to accelerate the asylum process with the aim of expediting returns to Turkey, under the EU-Turkey deal. While length of the asylum procedure is one factor contributing to people’s distress on the islands, reducing the length of asylum procedures at the expense of the quality of the process would put asylum seekers at risk of being denied the protection they need, Human Rights Watch said.

Such an approach is the wrong way to alleviate overcrowding or address the systemic issues linked to the containment policy and EU-Turkey deal that have created this inhumane situation on the islands.

Instead, Greece should invest more in creating fair and efficient asylum procedures, allow for all asylum claims to be fairly examined on their individual merits, and the safe return of those who do not have international protection needs, Human Rights Watch said.

“Last winter, five asylum seekers, including a child, died in the miserably cold Moria camp on Lesbos,” Cossé said. “Greek and EU authorities have a responsibility to prevent such tragedies from happening again.”

Posted: January 1, 1970, 12:00 am
Posted: January 1, 1970, 12:00 am

December 20, 2017

 

Sooronbai Jeenbekov

President

Kyrgyzstan 

 

Dear President Sooronbai Jeenbekov,

On behalf of Human Rights Watch, please accept my regards.

As you may know, Human Rights Watch is an international nongovernmental organization working in over 90 countries worldwide. We have conducted research and carried out advocacy in Kyrgyzstan for over 20 years. In 2013, we opened an office in Bishkek. Throughout, we have consistently sought out a constructive dialogue with the authorities of Kyrgyzstan on a range of issues related to human rights and the rule of law, including, for example, freedom of expression, fair trial standards, the prevention of torture, and domestic violence.

I am writing now, in the spirit of this constructive engagement, to share with you, Kyrgyzstan’s new president, our recommendations for steps the Kyrgyz government can take from the beginning of your mandate to improve the human rights situation in Kyrgyzstan. Over the last two decades, we have seen some progress on key issues, but serious concerns remain.

During your campaign you noted that your goal as president will be “to create a state where human rights are respected, on democratic principles.” You reiterated this message in your online campaign platform, saying you would “provide life, health, and human rights to all Kyrgyzstanis in fulfilling the [platform’s] provisions.” We encourage you to stand by these campaign pledges, and to do so by addressing the following human rights concerns as a matter of priority, in accordance with the international human rights norms that Kyrgyzstan has voluntarily ratified.

Address Election Shortcomings

The October 15 presidential elections, of which you were the victor, were notably “competitive.” Nonetheless, the Organization for Security and Cooperation in Europe’s Office for Democratic Institutions and Human Rights (OSCE/ODIHR) election monitoring mission raised some serious concerns in its preliminary report, including about “widespread abuse of public resources and pressure on voters, as well as of vote-buying,” and “numerous and significant procedural problems…during the vote count and the initial stages of tabulation.”

Kyrgyzstan should commit to working with OSCE/ODIHR to address these shortcomings, and follow up on its recommendation to review legal provisions on campaigning and campaign financing, citizen observation, and complaints, which “are not comprehensive and lack clarity, and, at times, depart from international standards.”

Stop the Crackdown on Critical Media

Human Rights Watch has observed a notable decline in the protection of freedom of speech and media in Kyrgyzstan since the beginning of the year. Starting in March 2017, Kyrgyzstan’s prosecutor general has brought at least half a dozen defamation lawsuits against critical media outlets, journalists, and others, including human rights defender Cholpon Djakupova, claiming their words or publications discredited the president’s honor and dignity and spread false information.

As you may know, laws that provide for offenses and penalties for those who criticize public figures on the basis that it is considered insulting are not compatible with freedom of expression standards under international law. Yet courts have granted many millions of soms in damages in rushed trials, and rulings have been upheld on appeal. 

There have been other worrying developments as well. Authorities in May brought criminal charges of inciting ethnic hatred against freelance journalist Ulugbek Babakulov after he wrote about the increase of nationalist and anti-Uzbek sentiments in social media. He later fled Kyrgyzstan, fearing for his safety. At least two media outlets have either been blocked online or shut down this year on questionable grounds.

You campaigned on a platform saying that “the President should act as the guarantor of freedom of speech, media, and internet, in combination with effectively protecting citizens’ rights and freedoms.” As president, you now have the opportunity to guarantee free expression and free media in Kyrgyzstan, and ensure that citizens have access to a diversity of opinion, and that critical media outlets and journalists do not risk retaliation for their views.

Provide accountability for June 2010-related abuses

Although over seven years have passed since the June 2010 events in southern Kyrgyzstan, authorities in Kyrgyzstan have failed to adequately address abuses in the south, in particular against ethnic Uzbeks, who endured the majority of casualties and destroyed homes, and who were disproportionately subjected to arbitrary detention, ill-treatment and torture, and extortion schemes without redress in the aftermath of the violence. Impunity for courtroom violence, instances of which continued to occur in 2017, persists. To date, people continue languish in prison on sentences related to the violence that were delivered following trials marred by torture-tainted confessions, attacks on the defendants and their lawyers in the courtroom, and serious violations of due process.

Your government should not ignore such past abuses, but directly confront them. We urge you to commission an independent review of June-2010 related convictions where defendants alleged torture or other glaring violations of fair trial standards. 

Free Azimjon Askarov

We call on you as a matter of utmost urgency to release the wrongfully imprisoned human rights defender Azimjon Askarov, who was accused of participating in the murder of a police officer and imprisoned immediately following the events of June 2010.

It has been a year and a half since the UN Human Rights Committee – an impartial, independent human rights body whose findings are binding on Kyrgyzstan – called on the government to immediately release Azimjon Askarov and quash his conviction, finding that he had been arbitrarily detained, tortured in custody, and denied a fair trial. As a party to the United Nations Convention on Civil and Political Rights and its optional protocol, Kyrgyzstan has committed to upholding the decisions of the Human Rights Committee, following review of individual complaints.

It is a grave injustice to keep Askarov imprisoned. After seven and a half years in prison, Askarov is now an elderly and ailing man. We urgently ask you to right this egregious wrong, and grant Askarov his freedom.

Reaffirm the importance of civil society

We call on you as a matter of priority to reaffirm the importance of the work of human rights defenders and other civil society actors contributing to Kyrgyzstan’s democratic development. We encourage you to reengage in meaningful dialogue and productive partnership with civil society actors, including human rights groups, to carry out promised reforms.

We also call on you to lift restrictions on foreign human rights workers’ access to Kyrgyzstan. Over the last two years, several foreign human rights workers, including Human Rights Watch’s Bishkek office director and Kyrgyzstan researcher Mihra Rittmann and Russian rights organization Memorial’s Vitaliy Ponomarev, have been banned from Kyrgyzstan. These developments have contributed to an increasingly hostile environment for human rights activism in Kyrgyzstan.

End torture

Although Kyrgyz authorities acknowledge the problem of torture in Kyrgyzstan and the government supported the establishment of a national torture prevention mechanism in 2012, impunity for torture remains the norm. Criminal cases into allegations of ill-treatment or torture are rare, and investigations and trials are delayed or ineffective. Kyrgyzstan’s Coalition Against Torture, a group of 16 nongovernmental organizations working on torture prevention, told Human Rights Watch that, on average, the prosecutors’ office declines to investigate torture allegations in over 90 percent of cases.

We urge you to commit to ending impunity for torture and eradicating the practice of torture by making the genuine reform of law enforcement agencies a priority for your government.

Robustly implement Kyrgyzstan’s new domestic violence law

In May, a strengthened domestic violence law came into force in Kyrgyzstan, following women’s and human rights groups’ long-term efforts to respond to widespread domestic violence and advocate for adequate protection, support, and access to justice for survivors. Human Rights Watch was amongst the groups that welcomed the adoption of this law – which increases protections for women and girls who suffer domestic abuse, and aims to improve police and judicial response to domestic violence and ensure practical support to victims, including shelter, psychosocial services, and legal aid.

We ask you to allocate sufficient resources to make the law effective and meaningful for women and girls who suffer domestic abuse. In particular, we urge you to dispatch greater support for: the provision of adequate medical and psychological services and legal aid; capacity-building of judicial personnel and police to respond to, investigate, and prosecute cases; a hotline for abuse victims, and training of emergency response personnel to staff it.

Allow peaceful assembly

People in Kyrgyzstan have for many years enjoyed the right to peaceful assembly, staging regular peaceful protests across Kyrgyzstan. However, following several court rulings in 2017 imposing blanket bans on public assemblies in various locations in Bishkek, with courts citing overbroad concerns about ensuring public order and national security, this right appears under some threat.

In February, a Bishkek court imposed a 3-week ban on public assemblies in the Leninskii district, citing the need to ensure public order and prevent terrorist threats. The Pervomayskii District Ccourt in July banned public assemblies at central locations in Bishkek, including Ala-Too Square, from July 27 to October 20, citing concerns about public security before the elections. On November 8, the court again banned public gatherings in several locations in central Bishkek until December 1, citing the president-elect’s upcoming inauguration on November 24.

While the right to peaceful assembly is not absolute, the former United Nations Special Rapporteur on the Right to Peaceful Assembly and Association has determined that “certain restrictions, such as blanket bans on assemblies, are intrinsically disproportionate and discriminatory and should be limited unless they are strictly necessary and proportionate.” We ask you to ensure that people in Kyrgyzstan continue to enjoy their fundamental right to express dissenting views through peaceful protest in a manner consistent with international standards.

Cease counterterrorism-related human rights abuses

In the last year, the Kyrgyz government has stepped up counterterrorism measures following deadly attacks abroad that investigators linked to armed extremists of Central Asian origin, arresting dozens of people for storage of vaguely defined “extremist” materials, an offense which carries a mandatory prison sentence of three to five years. As of August, 191 people had been imprisoned for terrorism or extremism-related offenses. Many were ethnic Uzbeks who alleged they had been arrested based on false testimony or evidence planted by the police, and that they were tortured and otherwise abused in police custody.

As part of your campaign platform, you expressly stated that you would “respect the fundamental principles of human rights” in protecting Kyrgyzstan from external and internal threats to national security. We call on you to give meaning to those words by overseeing the work of Kyrgyzstan’s national security agency and the police to ensure that their counterterrorism efforts comply with international human rights standards, and due process is afforded anyone suspected of these egregious crimes.

End Discrimination of LGBT people

For several years now, a blatantly discriminatory anti-LGBT ‘propaganda’ bill has been under review in parliament. The bill – which threatens freedom of speech, association, and assembly in Kyrgyzstan – appears aimed at silencing anyone seeking to openly share information about same-sex relations, including with proposed criminal sanctions. Although the bill has not advanced in parliament since May 2016, it has not been definitively withdrawn either.

Pending in parliament, the bill has a chilling effect on Kyrgyzstan’s already-marginalized LGBT rights groups and activists. Many LGBT people in Kyrgyzstan experience blatant discrimination, violence in their families, and even police abuse, all within in a climate of impunity. We urge you to take steps to end homophobia and discrimination against Kyrgyzstan’s LGBT community.

Ratify the United Nations Convention on the Rights of Persons with Disabilities

We join other civil society groups and activists and call on you to ratify the Convention on the Rights of Persons with Disabilities. Kyrgyzstan signed the convention in 2011, yet has still not ratified the treaty. We urge your government to delay no longer and ratify the treaty as testament to the importance you give to upholding the rights of all people in Kyrgyzstan.

We thank you for your attention to these important matters. We look forward to continuing our constructive engagement with the Kyrgyz government. We would be happy to discuss the points raised on an occasion at your convenience.

Sincerely,

Hugh Williamson

Executive Director

Europe and Central Asia Division

Human Rights Watch

Posted: January 1, 1970, 12:00 am

(Brussels, December 7, 2017) – The European Union is taking important steps to ensure that EU-funded humanitarian assistance reaches people with disabilities, the European Disability Forum, Human Rights Watch, and the Norwegian Refugee Council said today. People with disabilities in humanitarian crises face massive problems in getting even basic services such as food, water, sanitation, shelter, education, and safety protection.

At the 4th European Parliament of Persons with Disabilities on December 6, 2017, Christos Stylianides, the European commissioner for humanitarian aid and crisis management, announced a number of measures that would considerably improve access to humanitarian aid worldwide for people with disabilities.

“Aid actors sometimes consult organizations of persons with disabilities, but may not consider that we can also help directly in humanitarian operations. After all, we know what it means to live with a disability and what we need. This must change. Nothing about us without us.

Yannis Vardakastanis

European Disability Forum President

People with disabilities are among the most at-risk groups in humanitarian situations. Yet, they are also among the most overlooked, in part due to insufficient knowledge about including people with disabilities and a lack of clear standards on how to carry out inclusive humanitarian action.

“Aid actors sometimes consult organizations of persons with disabilities, but may not consider that we can also help directly in humanitarian operations,” said Yannis Vardakastanis, president of the European Disability Forum. “After all, we know what it means to live with a disability and what we need. This must change. Nothing about us without us.”

Fifteen percent of the world’s population – or one in seven people – has a disability. This figure is likely to be even higher in emergency situations because of conflict or disaster-related injuries and lack of health care and other services.

In South Sudan, Greece, and the Central African Republic, Human Rights Watch has documented that people with disabilities face neglect, abandonment, and barriers to basic services in refugee and displacement camps. One man with a physical disability in a camp for internally displaced persons in Central African Republic said he needed to crawl into the latrines: “I have to walk with my hands and I don’t have gloves. I must wrap my hands in tissue if I can find it. Most of the time I can’t find it. Honestly it makes me pity myself.”

Research conducted by the European Disability Forum among refugees in Greece also found a lack of access to services, including medical care, and insufficient access to assistive technology. EDF’s national member, the National Council of Persons with Disabilities, is now directly involved in providing support to refugees with disabilities and their families, in cooperation with UNHCR, the UN Refugee Agency.

Stylianides announced that starting in 2018, requests for proposals from the European Commission’s humanitarian agency (ECHO), which funds the operations of humanitarian organizations on the ground, will highlight that applicants must include people with disabilities in their actions. In addition, ECHO will develop standards for addressing the needs of people with disabilities in all EU-funded projects.

Stylianides also promised to consult people with disabilities and their representative organizations in designing and carrying out these initiatives, in line with the principle of “Nothing about us without us.”

“This is a real turning point in global efforts to ‘leave no one behind,’” said Shantha Rau Barriga, disability rights director at Human Rights Watch. “If the EU makes these changes, it could improve the lives of millions of people with disabilities who need aid in emergency situations around the world.”

The EU has a clear responsibility to include people with disabilities in the humanitarian operations it funds, the groups said. The United Nations Convention on the Rights of Persons with Disabilities, ratified by the European Union, requires the EU to ensure the protection and safety of people with disabilities in situations of risk and humanitarian emergencies without discrimination. In addition, the EU has endorsed the Charter on Inclusion of Persons with Disabilities in Humanitarian Action, making a commitment to eliminate discrimination against people with disabilities in aid programming and policy, and to ensure that people with disabilities have access to aid and services.

To bring the voices of refugees with disabilities to policymakers in the EU, the European Disability Forum, Human Rights Watch, and the Disability Intergroup of the European Parliament organized a roundtable panel in the European Parliament in March. At the event, Nujeen Mustafa, a young refugee with a disability from Syria, addressed Commissioner Stylianides: “It’s kind of a sad fact that in the 21st century, toilets and basic services are considered a luxury for some people. All of us, and especially people with disabilities, deserve much better.”

While governments, donors, and aid agencies are overwhelmed with many competing priorities during emergencies, the needs and concerns of people with disabilities can and should be addressed right from the planning stage, the European Disability Forum, Human Rights Watch, and the Norwegian Refugee Council said. This should include making sure that aid workers, peacekeepers, and local and national authorities are sensitive to the rights and needs for protection of people with disabilities and strengthening the workers’ capacity and skills to identify and include people with disabilities in systems both for preparedness and response to emergency situations.

“As one of the world’s largest humanitarian donors, the European Union has tremendous potential to press its implementing partners to include people with disabilities in their activities and become a leader on the inclusion of people with disabilities in the humanitarian space,” said Edouard Rodier, Europe director of the Norwegian Refugee Council. “We call on all donor agencies to follow ECHO’s example and make sure that the needs of people with disabilities in crisis situations are no longer overlooked.”

Posted: January 1, 1970, 12:00 am

A group of courageous moms of children with disabilities in Johannesburg has seized the run-up to International Day of Persons with Disabilities on December 3 to launch a petition that calls upon South Africa’s Department of Basic Education to remove school fees for children with disabilities. Their goal is that their children can, “enjoy the right to an inclusive fee-free basic education.”

Two children sit on chairs in the New Covenant day care center, a center set-up and led by parents in Orange Farm township, Johannesburg, to cater to children with disabilities who are not admitted in the township’s mainstream schools

© 2015 Diane McCarthy/Human Rights Watch

In South Africa, the overwhelming majority of children enjoy their constitutional right to free education. But children with disabilities still face discriminatory barriers to free education.

Children with disabilities should be guaranteed equality in the entire process of their education, including by having meaningful choices and opportunities to be accommodated in free, non-fee paying, mainstream school.

To date, too many children with disabilities have to pay school fees because they are needlessly referred to public special schools. But even children with disabilities who attend mainstream schools are sometimes forced to pay for that access.

Many, if not most, parents of children with disabilities cannot afford fees for their children to access school, or even pay for transport to get to schools that are often far away.

Our 2015 research found that special schools are not part of the government’s “no fee schools” list. Schools on the no fee list accommodate children from low-income backgrounds – the bulk of South Africa’s students. It is not clear why public special schools, which similarly cater to children with disabilities from predominantly low-income backgrounds, are not on the list.

The Department for Basic Education’s most senior official recently stated in parliament: “It is time for special schools to be declared no fee schools and the Department needs to make it a priority.”

This is welcome news. The government now needs to put words into action, and scrap school fees and additional costs for all children with disabilities, so that in practice they can access education on an equal basis with children without disabilities. It should also fulfil its policy of inclusive education by making sure that children with disabilities can access mainstream schools that are accessible, free, and fully inclusive.

Children with disabilities cannot wait any longer for inclusive education.

Author: Human Rights Watch
Posted: January 1, 1970, 12:00 am

Simplice – Central African Republic

The frustration burned in Simplice Lenguy’s eyes as he spoke about the situation faced by people with disabilities since conflict erupted in the Central African Republic.

Simplice Lenguy, in M’Poko camp for internally displaced persons in 2015. Simplice is fighting for the rights of people with disabilities affected by the conflict in the Central African Republic. 

© 2015 Human Rights Watch

In 2015, sitting near some of the tumble-down tents and the frames of old aeroplanes that made up the M’Poko camp in Bangui before it was razed, Simplice explained how he organized the camp’s forgotten residents – those with disabilities –  to try and get some of their needs met.

“People with disabilities have a different life here because their disability is doubled once they fled from their house to the M’Poko camp,” he told Human Rights Watch researchers. “They left behind all the little tricks they had learnt to survive,” he said, adding that people who at home had used tricycles to get around now had to drag themselves around on the rough ground – compounding the problems they faced.

“[A person with disabilities] is crawling like an animal to go where he wants to go. That’s disgraceful,” he said.

Simplice, who can’t walk without a cane or crutches, didn’t initially want to run from the fighting, fearing he would slow his family down.  But his wife persuaded him to come with her and their two children, and he eventually made it to M’Poko.

As many people with disabilities have now left displacement camps and gone back to their communities, Simplice’s fight continues.

“People with disabilities continue to face many difficulties. They should be supported in going home. They have lost their homes and everything that used to allow them to live. Before fleeing to the camp, they had small businesses and were able to feed their families. With the conflict, they have lost all their capital and are left without anything. Funds need to be set up to help develop income-generating activities to enable people with disabilities to start a new life.”

Wa’el – Lebanon

Being uprooted from your home and forced to flee across borders to survive would be difficult for any child. But for 13-year-old Wa’el, who lives with a rare genetic condition, escaping war-torn Syria for Lebanon cost him something very precious – his education.

Brothers Wa’el, 12, and Fouad, 7, study on a desk outside their makeshift home in Jounieh, Lebanon.

© 2016 Bassam Khawaja/Human Rights Watch

Kawthar, Wa’el’s mother, speaks passionately about her children’s education, but tears shine in her eyes as she discusses Wa’el.

“I have a nightmare about his future. I see my son sitting in a corner and not doing anything at all. Nothing at all.”

Wa’el has Hunter Syndrome, a rare genetic condition that can lead to physical and intellectual disabilities.

In Lebanon, many refugee children with disabilities have been denied places in public schools. Schools often do not meet the needs of children with disabilities, and those that accept them often fail to ensure children with disabilities are able to learn alongside their peers.

Kawthar was able to enroll Wa’el along with her other children, but she said staff would not even take the most basic steps to help him learn – such as letting him sit at the front of the class where it was easier to concentrate.

“It’s a small request,” Kawthar said.

Speaking at the start of 2016, Kawthar said Wa’el was also being bullied, and that she was trying to teach him at home, but the school had not given the children any textbooks to work with.

“One time he came home crying because other kids were making fun of him.” Just three months later, she ended up removing all her children from school because the expense was too great and he wasn’t being taught anything.

For now, Wa’el learns multiplication tables from his mother, sitting at a small table outside their home with his younger brother after the housework is done for the day.

Ali – Lesbos, Greece

Ali had not been able to shower for three months when Human Rights Watch researchers met him in September 2017 in the Moria refugee hotspot on Lesbos island, where more than 6,500 asylum seekers live in facilities designed for about 2,300.

Ali, a 22-year-old Afghan asylum seeker with a disability, living in Moria camp, on the beach in Lesbos, Greece. He told Human Rights Watch he can’t access showers in the camp and sometimes tries to wash himself in the sea.

© 2017 ZALMAÏ for Human Rights Watch

The 22-year-old, who uses a wheelchair after being paralyzed in 2016, had been living in Moria, under hellish conditions, for two-and-a-half months. He said he had been washing himself with a bottle of water or in the sea when he could.

“Other people here complain about having to wait in line for food. And for me, I can't even access a toilet. It is bad for everyone – animals can’t live in these conditions”

Ali has ongoing health issues and struggled to get the care he needed in the camp. He told Human Rights Watch that sometimes the Red Cross took him to the hospital, but once there, the doctors often couldn’t do much to help him.

“They say I have serious problems but that they cannot help me. In general, access to a doctor is very difficult. Only people who have serious cases can see them. If you are not dying, or are not seriously sick, they don’t let you see one.”

Throughout the conversation, Ali struggled to adequately sum up how he was feeling. When asked about the smugglers in Turkey who made him give up his wheelchair before boarding the rubber dinghy, he said, “How would it make you feel if someone asked you to take your feet and leave them behind? Wheelchair is my feet.”

I don’t know exactly how I feel,” he said. “But imagine a person whose life changed in one moment. Now, I have to face all of this.”

Angelina – South Sudan

Angelina was shot in the leg as government soldiers launched an attack on the Bor Protection of Civilians camp where she was living in South Sudan. The mother-of-five had to have her leg amputated after the 2014 attack, and since then has struggled to provide for her children, who she looks after by herself.

Angelina Nyanhial lost her leg after it was struck by a bullet during an attack on a Protection of Civilians 3 site in Bor, in 2014. Since, she’s been living in the Juba Protection of Civilians 3, struggling to generate enough income to put her children at school. 

© 2017 Joe Van Eeckhout for Human Rights Watch

“I am thinking too much. Not about my disability but about how I can support my children. It is too much and I think that it is better for me to die because no one is supporting us,” she told Human Rights Watch researchers when they visited the Juba Protection of Civilians camp where she now lives.

People with disabilities living in the camp face greater risks than the other people there because basic things like access to food and sanitation are often beyond them. At greater risk of abuse and sometimes unable to move without assistance, many people who don’t have relatives to help end up leaning on fellow camp residents to help them move about on tricycles or in makeshift wheelchairs.

In South Sudan, the risks are particularly high because both sides of the conflict appeared to be targeting people with disabilities who were left behind when relatives ran from the fighting. People with disabilities often ended up being assaulted or killed after being left behind.

Once they reach the camps, life continues to be tough. Showering is an arduous task where water and sanitation facilities are not accessible to people with disabilities, and food distributions are often too far away from the tents for people with difficulty walking to reach without help.

“The PoC [camp] is very hot,” Angelina said. “There is no water, no soap, the plastic sheet that makes up the shelter is broken and I don’t know how I can support my children.”

Zahra – Lesbos, Greece

People with mental health conditions can often be overlooked when it comes to needing extra support. When Zahra, from Afghanistan, was interviewed after a few weeks living in the Moria refugee hotspot on Lesbos, she regularly circled back to dwelling on her suicidal thoughts.

Zahra from Afghanistan is trapped on Lesbos, Greece. Despite being a survivor of gender-based violence and in need of psychosocial support, she’s been unable to find help in the camp. 

© 2017 ZALMAÏ for Human Rights Watch

She said the only reason she hadn’t acted on them yet was her 9-year-old daughter.

 “Today and all days, I’ve been very bad psychologically,” Zahra said. She described how the doctors in Moria turned her away, not recognizing she needed support and help. “My heart is beating very fast. The doctors said I am fine. But my hands are shaking. I need medication to help with how I feel.”

As a woman travelling alone, Zahra said she felt increasingly vulnerable in the chaotic and volatile camp, and had wondered if killing herself would mean her daughter would get sent to live with Zahra’s brother, who had already made it to Germany.

Despite seeming upset during the interview, Zahra refused water or the offer of a break, wanting to carry on with her story.

“In here [Moria], the physician[s] don’t attend you properly, never mind a therapist. It took exactly two weeks to get to see the doctor. God knows how long would they take to give me an appointment for a therapist.”

The reality is that access to psychosocial support in the overcrowded refugee hotspots on the Greek islands, is scarce.

Before leaving her home in Afghanistan, Zahra had already suffered emotional trauma after her brother-in-law tried to rape her and her family took his side. She showed Human Rights Watch the scars of self-harm along her arms and confessed she had not been thinking of her daughter, Hasti, when she tried to take her own life.

Despite her obvious distress, she wasn’t able to get any help in the EU-sponsored camp, medical or emotional, leaving her to battle her feelings alone.

Author: Human Rights Watch
Posted: January 1, 1970, 12:00 am

Dr. Julio Santaella Castell,

Human Rights Watch is an independent, non-governmental organization dedicated to defending and protecting human rights, working in more than 90 countries. We conduct research on the rights of persons with disabilities around the world, including in Latin America.

We had the opportunity to review the proposed questionnaire for the 2020 census which aims to obtain basic demographic information about the population of Mexico.

Human Rights Watch is concerned that the proposed questionnaire omits questions to identify persons with a disability, which is essential for developing state policies that benefit this sector of the population. The 2010 census questionnaire, however, included a short set of questions recommended by the Washington Group on Disability Statistics.  

We urge the National Institute of Geography and Statistics to re-insert in the basic questionnaire for the 2020 census, the questions recommended by the Washington Group on Disability Statistics, in order to build on the data collected in 2010 and to enable policymakers to design programs and actions aligned with its international obligations.   

Article 31 of the Convention on the Rights of Persons with Disabilities (CRPD), which Mexico was among the first countries to ratify, establishes the obligation to collect appropriate information, including statistical and research data, to enable states parties to formulate and implement policies that give effect to the rights of persons with disabilities. We are aware that the census is not the only tool to collect disaggregated information. Nevertheless, it is an important instrument to gain a broad understanding of how many Mexicans live with a disability and is critical in ensuring implementation of their rights.

The census also serves an important function in evaluating how the government has met the Sustainable Development Goals (2030), which include a number of goals and indicators on disability.

We call on Mexico to maintain its leadership on disability rights, including through its census activities, and appreciate your consideration of this matter.

Posted: January 1, 1970, 12:00 am

Moria hotspot on the island of Lesbos. Poor living conditions in the camp and overcrowded hotspots, with little to no access to basic services, such as sanitation and proper shelter, are key factors that contribute to psychological distress.

© September 2017 Private/Human Rights Watch
“There is no peace, no safety, no dignity in Moria. It’s worse than jail. We are not treated as belonging to society, as human beings,” Roula, a Syrian mother of two small children told me. She was among dozens of people I interviewed in late September about conditions in the so-called Moria hotspot, a refugee reception and identification center on the Greek island of Lesbos. An Afghan woman with diagnosed depression told me, “I can’t handle this [Moria]. Sometimes I think it would have been better to have been killed in Afghanistan.”

All I needed to do was to enter Moria to understand what they were describing. When I visited in September/October, nearly 5,000 asylum seeking women, men and children lived in a facility designed for 2,000. Summer camping tents, designed to accommodate not more than two people were holding families of up to seven. Today, the situation is even worse: more than 6,000 people live in the same facility, exposed to the cold, the damp, and the rain. And because of the crowded conditions, many women don’t have access to a separate, protected section for single women.

Since the EU-Turkey Statement entered into force in March 2016, and a containment policy has blocked asylum seekers from moving to the mainland, the Greek islands of Lesbos, Chios, Samos, Kos, and Leros have become places of indefinite confinement. Thousands of women, men, and children are trapped in devastating conditions, with many denied access to adequate asylum procedures. Some have been there for more than 20 months.

Every day, I would see little children shivering in their underwear as their mothers poured water over their heads, in a desperate attempt to keep them clean and safe from lice and scabies.

It was nauseating to go to the restrooms and showers, where the stench of urine and human excrement was overpowering. Feces were everywhere.

People I interviewed told me access to running water is limited to 30 to 40 minutes, three times a day, and there is no hot water. One day, I watched as the water tap was turned on. Children as young as four were running barefoot over rocks with bottles in their hands struggling with 5,000 other people to secure water.

Accessing the showers and toilets is particularly difficult for the many people in the camp with disabilities. A 22-year-old man in a wheelchair from Afghanistan told me, "Other people here complain about having to wait in line for food. And for me, I can't even access a toilet." He hadn't taken a proper shower in three months.

For women and girls, going to the toilet or shower often entails overwhelming anxiety about security, worsened by verbal harassment they experience from some men in the camp. A group of men hangs out outside the women’s latrine.

Every person we interviewed told us of fights among asylum-seekers each night and of police standing by, doing nothing to stop it or protect other people. A woman with a high-risk pregnancy told me: “We all have difficulties sleeping. Single men get drunk, they start fighting.”

I saw men, women, and children sitting on the pavement, waiting for another day to pass. I asked Abdulrahman, a 26-year-old Syrian who had been a student in Damascus before the war, what he does all day. He y became silent, turning his gaze away. He looked back and said, "Nothing. I do nothing."

Many people have attempted to end their lives due to the extreme distress and emotional pain they experience. In October, Medecins Sans Frotieres (MSF) reported that between June and September an average of six to seven people per week arrived at their clinic on Lesbos for mental health consultations following suicide attempts, incidents of self-harm, or psychotic episodes.

Mohammed, Roula’s husband, told me that the difficult conditions create a hostile environment: “The pressures from all these stuff in here, they [the authorities] are doing it to push you to do something illegal to yourself or others. They make us have a lot of hatred against each other. It’s a ticking bomb waiting to explode.”

Earlier in 2017, Human Rights Watch documented health professionals’ accounts about the deteriorating mental health of asylum seekers and migrants on Lesbos. We went back in September and October to see whether the situation had improved. We found that it has worsened. The European Union and Greece have taken no steps to address the conditions driving this mental health crisis despite numerous reports from non-governmental organizations.

During a hearing in the Greek Parliament in early-October, where a colleague and I testified about the conditions we witnessed, the parliamentary committee on people with disabilities said they would conduct an official visit to Moria to investigate. They should follow-up on their promise.

More immediate action is needed, though, to end the inhumane and harmful conditions for asylum seekers trapped in hotspots on the Aegean islands. Greece has a responsibility to protect the human rights of people arriving on its islands, and ensure that people with disabilities have equal access to services and protection.

Almost every day since I’ve been back from Lesbos, I receive WhatsApp messages from people I interviewed telling me “The situation has gotten worse. Winter is here now.”

The European Union and its member states need to act, too. Pushing Greece to force asylum seekers to remain in conditions that violate their rights and are harmful to their wellbeing, health and dignity to deter more asylum seekers from coming into the EU through Greece, cannot be justified.

The Greek government with the active support of EU member states and the European Commission, should put an end to the containment policy and immediately transfer asylum seekers to the mainland where their needs for basic services and protection should be urgently met.

Otherwise, the risk of the situation exploding into deeper misery is too great.

Author: Human Rights Watch
Posted: January 1, 1970, 12:00 am

An aerial photo showing the site of a mass shooting at the First Baptist Church of Sutherland Springs, Texas, U.S., November 6, 2017. 

© 2017 Reuters

After the horrific event of a mass shooting in the US, it takes time for details of the perpetrator to emerge. But without fail, their violent criminal record, any ties to radical extremism, the legality of weapons they used, and their mental health history are the first things scrutinized by the media, policy makers, and the general public.

However, one of these details is not like the others – mental health histories should not be linked to a propensity to commit a mass shooting. There is no evidence that indicates a person with a mental health condition is any more likely to participate in senseless violence than anyone else. In fact, people with mental health conditions are more than 10 times more likely to be victims of violent crime than the general population.

It is not yet clear whether the perpetrators of the massacres in Las Vegas last month and in Sutherland Springs this week had mental health conditions, and while the Texas shooter spent time in a behavioral facility following assault charges, to blame his long history of violence on a mental health condition would be reductive. And yet President Donald Trump described the cause of Sunday’s tragedy as a “mental health problem,” ignoring the myriad issues that have stronger correlations to gun violence. For example, more than 50 percent of people who commit mass shootings have a history of domestic violence. Yet mental health history is cited much more often.

Instead of thoughtlessly blaming mental health conditions for every act of mass violence, we should look at the facts: the use of a gun by someone with mental health condition is more likely to result in suicide than assault.

Scapegoating people who are already stigmatized based on their mental health won’t end gun violence. While solutions to stopping mass shootings are long overdue, real progress won’t come at the cost of perpetuating false stigma, fear, and unfounded discrimination against people with disabilities.

Author: Human Rights Watch
Posted: January 1, 1970, 12:00 am

Ibtissam, 22, a mother of two hoping to reunite with her husband in Germany, pictured at the Souda Refugee Camp on Chios island, Greece, June 10, 2017. REUTERS/Zohra Bensemra

(Athens) – Prime Minister Alexis Tsipras should end the Greek government’s “containment policy” of confining asylum seekers to the Aegean islands, 19 human rights and humanitarian aid organizations said in an open letter released today.

Thousands of people, including very young children, single or pregnant women, and people with disabilities, are trapped in abysmal conditions as winter sets in. Forcing asylum seekers to remain in conditions that violate their rights and are harmful to their well-being, health, and dignity, cannot be justified by the implementation of the EU-Turkey deal, the organizations said.

Since the implementation of the EU-Turkey Statement in March 2016, the Greek islands of Lesbos, Chios, Samos, Kos, and Leros have become places of indefinite confinement. Thousands of women, men, and children are trapped in deplorable and volatile conditions, with many denied access to adequate asylum procedures. Asylum seekers who arrived on the islands in the first days of the implementation of the EU-Turkey Deal have been stuck there for almost 19 months.

The recent increase in arrivals of men, women, and children has increased the pressure on the already overcrowded reception and identification centers known as hotspots. Current arrivals are still comparatively quite low and should be manageable for Greece and the EU more broadly, but they include a significant number of women and children.

The situation is particularly critical on Samos and Lesbos, where a total of more than 8,300 asylum seekers and migrants are living in hotspot facilities meant for just 3,000. The recent announcement that 2,000 asylum seekers will be moved from the two islands to the mainland in the coming weeks as an emergency decongestion measure is a positive development, the groups said. But it is not sufficient to alleviate the current overcrowding of the facilities and does not sustainably address the systemic issues that have created this emergency situation – namely the containment policy.

With the approach of the third winter since large-scale arrivals on the islands began, it is evident that the Greek authorities cannot meet the basic needs and protect the rights of asylum seekers while they remain on the islands. Implementation of the EU-Turkey Statement has been cited by EU and Greek officials as a justification for the containment policy. But forcing asylum seekers to remain in conditions that violate their rights and are harmful to their well-being, health, and dignity, cannot be justified, the organizations said.

The organizations urged Prime Minister Tsipras to protect the human rights of asylum seekers trapped on the islands by ending the containment policy. They should be transferred to the mainland so that they can be provided with adequate accommodation and services to meet their needs and to ensure that their asylum claims are fairly heard.

Quotes from Participating Groups

“Greece should end its cruel policy of trapping asylum seekers on the islands,” said Eva Cossé, Greece researcher at Human Rights Watch. “People should not be forced to suffer another winter in unheated tents and without proper services.”

“The policy of containment is putting the lives of people who are seeking sanctuary in Europe at risk,” said Jana Frey, the International Rescue Committee’s country director. “While we welcome the government’s announcement to move 2,000 people on Lesbos and Samos off the islands in the coming days as an emergency measure, this can only be seen as a first step. Far more must be done to both improve conditions on the islands, and move the most vulnerable to the mainland, in order to ensure that lives are not lost this winter.”

Refugee tents next to the Moria hotspot on Lesbos island, where thousands of people, including very young children, pregnant women, and people with disabilities, are trapped in abysmal conditions as winter sets in. Emina Cerimovic for Human Rights Watch. September 2017.

“The EU-Turkey deal must no longer be used as pretext to strand asylum-seekers in inhuman conditions on the Greek islands’’ said Irem Arf, Amnesty International’s researcher on migration. “It is imperative that the Greek government urgently move people to mainland Greece.”

“The policy of implementing the EU-Turkey Statement has been violating asylum seekers’ rights under international law, and has contributed in disrupting social cohesion in the Greek islands affected,” said Spyros Rizakos, director of Aitima. “It is high time the EU and Greek authorities abandoned this policy.”

“Europe is refusing to offer humane reception conditions and dignity to people in need who arrive on our shores,” said Nicola Bay, head of mission for Oxfam in Greece. “Greek and EU authorities should immediately transfer migrants to the Greek mainland instead of leaving them trapped in abysmal conditions on the Greek islands.”

“Making these Greek islands a huge detention center isn’t in the interests of anyone,” said Gianmaria Pinto, Country Director of the Norwegian Refugee Council. “We all know what it is needed, including the government: to provide vulnerable people trapped on the islands with dignified accommodation and adequate services, without overlooking legal aid.”

Posted: January 1, 1970, 12:00 am

(Mexico City, October 17, 2017) – Mexico’s Congressional Mental Health and Drug Commission is considering a national mental health bill that proposes to improve mental health services for all in Mexico but would seriously jeopardize the rights of people with disabilities, Human Rights Watch said today.

In a letter sent on October 16, 2017, to the Commission on Health and Drugs in the Chamber of Deputies, Human Rights Watch urged the commission to reject the bill in its current form. The commission should revise the bill to reflect a human rights-oriented framework, based on consultations with organizations representing people with disabilities and disability rights experts. The final bill should ensure the right to mental health for all in Mexico on an equal basis, without resort to forced treatment, and be consistent with Mexico’s laudable international commitments to the rights of persons with disabilities.

“The bill before the commission unfortunately reflects a discredited approach to mental health, focusing on forced medical treatment instead of on the consent, autonomy, and rights of those in need of mental health services,” said Carlos Ríos Espinosa, senior researcher and advocate for disability rights at Human Rights Watch. “The bill is inconsistent with Mexico’s human rights obligations, in particular the right to consent to or refuse treatment, which is an integral aspect of the right to health.”

Mexico was an early champion of the United Nations Convention on the Rights of Persons with Disabilities (CRPD), signing the treaty when it was first opened and becoming a full party to the CRPD in 2007. The Mexican government has the opportunity with this new law to incorporate the standards of the CRPD into domestic law and protect the rights of persons with disabilities. It should follow the example of other countries and international organizations, such as the World Health Organization, that are developing new mental health policies that respect the rights of people with disabilities and emphasize people’s right to choose and to govern their own lives. In particular, it should act on the recommendations to it from the CRPD Committee to:

  1. Eliminate security measures that mandate medical and psychiatric inpatient treatment and promote alternatives that comply with articles 14 and 19 of the Convention;
  2. Repeal legislation permitting detention on grounds of disability and ensure that all mental health services are provided based on the free and informed consent of the person concerned.

The current bill would still allow people to be locked up against their will on the basis that they had a diagnosed disability, Human Rights Watch said  But UN experts on health and torture and the UN expert body on disability rights have emphasized that forced treatment and other nonconsensual invasive measures, including involuntary admission to psychiatric hospitals for medical treatment, should be ended.

The bill would provide broad authority for medical and judicial authorities to find that people labeled as having “mental disorders” do not have the capacity to make decisions for themselves. In such circumstances, the bill authorizes involuntary hospitalization and treatment without the person’s consent. Under human rights norms, people with disabilities may not be detained on the basis of their disability, and may only be detained, on an equal basis with others, if they engage in behavior that constitutes grounds for detention for everyone under the law.

Among other worrisome elements, the bill allows the solitary confinement of and use of physical restraints on people with “mental disorders,” which experts agree can constitute torture or cruel, inhuman, or degrading treatment.

“It is commendable that the commission is devoting time and effort to enhance the right to health for all Mexicans, but it’s all the more important for them to get it right,” Rios Espinosa said. “The commission should create a framework for health services that respects the right to informed consent, whether you have a disability or not.” 

Posted: January 1, 1970, 12:00 am

Human Rights Watch is an independent, non-governmental organization dedicated to defending and protecting human rights, working in more than 90 countries. We conduct research on the rights of persons with disabilities around the world, including in Latin America.

Human Rights Watch welcomes your commitments to advance the rights of citizens of Mexico to access mental health care. These efforts can be beneficial for building a stronger legislative framework to provide mental health services for the Mexican population at large, and will hopefully bring Mexico in line with its international obligations on disability rights.

We would like to raise our concerns in relation to the proposed bill on mental health (Iniciativa con Proyecto de Decreto por el que se crea la Ley Nacional de Salud Mental) that is currently in front of the chamber of deputies.

We urge the Mental Health Commission to not approve the bill in its current form but rather propose a revised bill that reflects a human rights-oriented framework, developed in consultation with disabled persons organizations and disability rights experts, to ensure the right to mental health for everyone in Mexico without resorting to coercive treatment.

The paradigm shift towards human rights-based model of disability

As the Special Rapporteur on the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health, Mr. Dainius Pūras, noted in his latest report “[e]veryone, throughout their lifetime, requires an environment that supports their mental health and well-being; in that context, we are all potential users of mental health services.”[1] Mental health policy, including legislation, should address mental health services for everyone and not just for those who are labeled, as the proposed bill does, to have “mental illness” or “mental disorders” (psychosocial disabilities).

The Convention on the Rights of People with Disability (CRPD), to which Mexico became a state party in December 2007, establishes a paradigm shift based on a human rights-based model in opposition to a medical model that considers disabilities, including psychosocial disabilities, “illnesses” or impairments. Instead of focusing on the specific features of the person, the new paradigm underscores the relational character of disability and its evolving nature. It is the impairment (including physical, sensory, or mental), in interaction with the environment and other attitudinal barriers, which constitutes a disability. The bill under consideration includes multiple references to the need to have regard to the CRPD when developing the provision of mental health services in Mexico.

The mental health bill and the medical model of disability

The bill that is now currently the subject of discussion with the Mental Health Commission depends heavily on a coercive framework for mental health treatment of persons with psychosocial disabilities (mental health conditions) as well as persons who are considered to be dependent on drugs. Any approach to mental health should follow a human rights model. The CRPD Committee, the Special Rapporteur on the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health, and the Special Rapporteur on Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, have all emphasized the need to abandon the use of forced treatment and other nonconsensual measures, i.e. involuntary admission to psychiatric hospitals for medical treatment.

An integral part of the right to health, including mental health, is the right to consent to treatment, both as a freedom and an essential safeguard to its enjoyment. This includes the right to refuse treatment.[2] Mexico needs to move away from a paternalistic approach towards mental health and build on alternatives that emphasize peoples’ right to choose and govern their own lives as a core element. In the realm of mental health, an array of services should be made available from which people can choose freely, instead of continuing coercive policies, such as involuntary treatment, forced medication, and others.

Human Rights Watch is concerned that the proposed bill is deeply entrenched in the medical model of disability and the language used is inappropriate and outdated, for example using terms like “mental disorder” (instead of psychosocial disability), and “mentally ill patients” (instead of persons with mental health conditions). Although there is an explicit recognition of the obligations set forth in the CRPD, certain provisions in the bill are in direct opposition to them.

Currently, several countries and international organizations are working together to transform mental health policies that are conducive to ensure access to services that are respectful of human rights. We call on the mental health and drugs commission of the chamber of deputies in Mexico to review new trends that are currently being constructed to this effect, like the one that is currently being promoted by WHO.[3]

Broad exceptions to fundamental rights

The bill provides for measures such as “selective intervention for families at risk” (article 23, I) and “early interventions in schools”. The bill however does not define the exact scope of these measures which leaves open the possibility of misguided measures emerging that are overly intrusive and fail to respect the rights of persons with mental disability or mental health issues. There is no consensus as to what is to be understood by “families at risk”. Such vague terms could lead to the biased application of the law, for instance, a bias towards believing that one parent households are more at risk of mental health problems. Likewise, children who are poor at complying with very rigid rules of discipline, could be labeled in these “early interventions” as having “mental issues”.

Designed as preventive measures to avoid so-called “mental disorders”, these policies, if subject to overly broad discretion, poorly implemented, and absent close monitoring and review including appeal by the families, could lead to the possibility of medicalizing families and school environments, and prompting screenings on persons that might have unorthodox living styles that could be considered signals of “mental disorders”.[4]

Likewise, the bill establishes several exceptions to the fundamental rights of persons with psychosocial disabilities but does not spell out the limits on exceptions to ensure that they are compatible with human rights law, such as the exceptions must be for a legitimate aim, proportionate to achieving that aim and non-discriminatory. Such exceptions apply to areas such as patient confidentiality and the prohibition of involuntary hospitalization. (Article 24, IV and VIII)[5]

The confidentiality principle between patient and psychiatrist means that the patient has the right to keep his or her medical record and interactions with mental health professionals confidential, thus mental health professionals have the duty not to disclose any information. The proposed bill recognizes this principle but foresees exceptions to the obligation, referring in general to applicable legal norms that might lead to the principle being breached in ways that are unjustified. The proposed bill should clarify with greater precision when and what types of exceptions exist and how those can be compatible with human rights protection.

Involuntary hospitalization can happen relatively easily and anyone, such as the police or a member of the community, can ask the health authority to determine that the hospitalization of a person should be permitted because the requestor believes a person might have a “mental disorder” (Article 53) and pose a threat.[6] Article 14 of the CRPD protects the right of persons with disabilities to liberty and they cannot be deprived of liberty on the basis of disability. Involuntary hospitalization amounts to deprivation of liberty because the person is not free to decide whether he or she wants to be admitted to a medical facility and when such involuntary hospitalization is based on a disability, it is arbitrary.

Infringement to the right to informed consent and the right to legal capacity

Article 26 of the bill establishes a general provision allowing the restriction of human rights for persons with disabilities when there is a need to protect the safety and security of the person or other persons, or to protect security, public order, public health, or third parties’ rights. [7]

In principle, the bill recognizes that persons with psychosocial disabilities must consent to any treatment and have a right to refuse and it is presumed they have capacity of discernment. Nevertheless the bill also makes it easy for medical staff or judicial authorities to challenge a person’s capacity (article 31 and 32).[8] The exception is so broad the risk is that involuntary treatment will become the rule. The right to be treated only on the basis of informed consent, which is a core component of the right to health, can be limited in cases of urgency, when it is determined that the person needs to be involuntarily hospitalized, or when health professionals consider there is evidence that treatment is the best alternative to the patient’s needs. These exceptions are so broad that it threatens to deprive the right of all substance (article 24, VIII)[9].

Article 30 of the bill, in conjunction with article 31, provides that family members who are assuming responsibility for the care of persons deemed to have “mental disorders” have the right to be involved in the formulation and implementation of treatment if the person is said to lack capacity.[10] Where this constitutes a situation that a person can be treated without their informed consent, or against their wishes, then this violates the right to health.[11]

The CRPD Committee has held that forced treatment by psychiatric and other health and medical professionals is a violation of the right to equal recognition before the law and an infringement of the right to personal integrity (article 17); freedom from torture and inhuman and degrading treatment (article 15); and freedom from violent exploitation and abuse (article 16). Non-consensual medical treatment denies legal capacity of a person to choose medical treatment and is therefore a violation of article 12 of the CRPD. The Special Rapporteur on the Right to Health has noted that where grounds of “medical necessity” and “dangerousness" of the person are used as justification for non-consensual treatment their application is open to broad interpretation and, consequently, raises questions of arbitrariness.[12]

State parties to the CRPD have an obligation to respect legal capacity of persons with disabilities to make decisions at all times, even in crisis situations. If the person so requests, state parties have an obligation to provide access to supported decision-making regarding psychiatric and other medical treatment. Decisions relating to a person’s physical or mental integrity should only be taken with free and informed consent of the person concerned.[13]

Involuntary hospitalization and violations to the right to liberty

Article 36 of the bill says that no one shall be obliged to submit to a mental health evaluation to determine if he or she has a “mental disorder”[14], however, a family member, the police, a judicial authority, a psychiatrist or a member of the community (article 53) can request a health authority to agree to the involuntary hospitalization of a person, if they consider he or she has a “mental illness”, with the goal of “protecting” the person from harm to self and others, or when they are disturbing “public order”.

Detention of persons with disabilities in institutions against their will, either without their consent or with the consent of a substitute decision-maker, because of their disability, or assumptions that they will cause harm because of their disability, constitutes arbitrary deprivation of liberty and violates articles 12 and 14 of the CRPD.[15] Detention on the basis of medical necessity or for the purpose of treatment for drug users has also been criticized by the Special Rapporteur on Torture on the basis that it opens the way for abuse and it has no scientific basis.[16]

The CRPD Committee has held that there are no exceptions to the right to liberty and security of the person because of actual or perceived disability. Any mental health legislation authorizing involuntary internment or hospitalization on the basis of “danger” for self and others which is based on the alleged dangerousness of the impairment of a person is contrary to the right to liberty as established in article 14.2 of the CRPD.[17]

In October 2014, the CRPD Committee in its Concluding Observations on Mexico, called on the government to:

(a) Eliminate security measures that mandate medical and psychiatric inpatient treatment and promote alternatives that comply with articles 14 and 19 of the Convention;

(b) Repeal legislation permitting detention on grounds of disability and ensure that all mental health services are provided based on the free and informed consent of the person concerned.[18]

The Commission should therefore use this opportunity to act on the Committee’s recommendation and not to reinforce legal provisions and practices that are inconsistent with the CRPD. Persons with disabilities can be detained, on an equal basis with others, when they engage in behavior that would constitute a legitimate cause for detention for everyone else. In these cases, reasonable accommodation should be provided when it is so required.

Mexico’s constitutional framework only permits detention of persons when there is a criminal or administrative infraction, cases of foreigners with irregular migration status, and for extradition purposes.[19] The Mexican Constitution warrants no detention on the basis of disability or perceived disability, so enabling involuntary hospitalization contradicts the Mexican Constitution and constitutes disability-based discrimination according to article 1 of the Constitution.

Solitary confinement and physical restraint

The proposed bill also considers the possibility of applying solitary confinement and physical restraints on persons with “mental disorders”. Article 66 establishes the possibility of applying restraints for 72 hours when there is a need to control situations of “unmanageable violence”, or when the person has lost “sense of reality”, and to prevent harm to self and others.[20] The CRPD Committee has stated in numerous concluding observations that mental health laws that condone the practice of restraining persons with disabilities or using other coercive measures to control them, still reflect the medical model of disability and should be repealed.[21]

Moreover, the special rapporteur on torture has emphatically stated that “it is essential that an absolute ban on all coercive and non-consensual measures, including restraint and solitary confinement of people with psychosocial or intellectual disabilities, should apply in all places of deprivation of liberty, including in psychiatric and social care institutions.”[22] Passing this bill would be to flagrantly ignore the CRPD committee’s recommendations to Mexico issued in 2014, in which the Committee expressed serious concern with respect to human rights violations committed against persons with psychosocial disabilities, “such as physical restraint and placement in isolation”, which might even “amount to acts of torture or cruel, inhuman or degrading treatment”.[23] The bill under consideration is in startling contrast to the CRPD Committee’s explicit recommendations.

Article 55 provides for circumstances in which psychosurgery, irreversible medical treatments, and electroconvulsive therapy can take place. While the provision is subject to further development in guidelines to be issued by the health authority, there is the possibility that at least some of these procedures will be allowed proceed without the informed consent of the person receiving. [24]

We would appreciate your interest to discuss these issues further with Human Rights Watch and other disabled persons organizations who have also expressed their concerns on several aspects of this proposed bill.

 

[2] Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health A/HRC/35/21, paragraph 63.

[3] Realising recovery and the right to mental health and related services - WHO QualityRights training to act, unite and empower for mental health (pilot version). Geneva: World Health Organization; 2017 (WHO/MSD/MHP/17.4). Licence: CC BY-NC-SA 3.0 IGO.

[4] Article  23. Policies of prevention, alongside the promotion of mental health, should be oriented by the needs of the population and cover different environments. These policies, should include, among other actions:

II. Selective interventions with at risk families and confronting family disintegration;

III. In schools, the development of life skills, coexistence skills, education in values, as well as early intervention in schools to promote a healthy environment amongst pupils;

[5] "Article  24. It is recognized as fundamental freedoms and human rights to each people with mental disorders and drug addictions the following:

IV. Right to confidentiality of personal information, information derived from the relation between the psychiatrist and the patient and confidentiality of treatment established in the clinical file. Except in cases provided in the applicable legal norms.

[6] The  mandatory internment refers to the one that is determined by the sanitary or judicial authority. Mandatory internment could be administrative, when it is determined by the sanitary authority, upon the request of the family, police authority, a certified psychiatrist responsible for the patient, or some member of the community, with the goal of protecting the person who apparently has a mental illness or whose behavior is endangering his integrity or that of third parties, or to avoid alteration of public order.

Mandatory internment should be reevaluated every five days with the opinion of another certified psychiatrist, that doesn't belong to the interdisciplinary team responsible for the patient to inform the sanitary authority about the situation of the patient.

Judicial mandatory internment is determined by a judge and it should be based on the recommendation of an expert opinion of a physician about the situation of the patient. The interdisciplinary team must inform the judge every 10 days about the evolution of the patient and if he has obtained a therapeutic goal of the internment.

[7] Article  26. The exercise of fundamental rights and safeguards to which this law makes reference can only be subject to limitations in those cases provided by the Constitution, the Mexican laws or international treaties the project health and security of the person, or to protect security, order, public health or fundamental rights of third persons.

[8] Article 31. Every treatment and internment of patients with mental disorders or drug addictions should be administered with prior informed consent, except were there are exceptions to mandatory and involuntary procedures.

Article 32. In order to be valid informed consent must satisfy the following criteria:

I. Person giving informed consent should have capacity to do so, capacity is presumed except when the contrary is proven.

[9] Article 24: VIIII. Right to informed consent of the person or his representative in relation to treatment or internment. Informed consent will not be needed in cases of involuntary internment, when there is an urgent case, or when it is proven that the treatment is the better way to meet with the patient needs.

[10] Article  30: III. Families have the right to be involved in the framing and implementation of treatment.

[12] Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health A/HRC/35/21, paragraph 64.

[14] The determination of a diagnostic of a mental disorder or drug addiction, shall be established in accordance with internationally accepted medical norms. No one can be forced to medical screenings to determine if they are suffering from a mental disorder or drug addiction, unless the screening is determined when there is mandatory and involuntary treatment.

[15] CRPD Committee, General Comment 1, CRPD/C/GC/1 paragraph 40.

[16] Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan E. Méndez A/HRC/22/53, paragraphs 40, 41 and 42. February 2013. http://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session...

[17] Guidelines on article 14 of the Convention on the Rights of Persons with Disabilities. The right to liberty and security of persons with disabilities. Paragraph 6.

[19] Political Constitution of the United Mexican States (articles 16, 33, and 119)

[20] Article  66. Isolation and physical restraints as means of control can only be applied in exceptional cases, as a therapeutical last resource when there is a situation of unmanageable violence, alongside the lost of judgment and sense of reality, or when there is lack of real conscience of the state the person is in, and, as long as there is the purpose of protecting health or integrity of the ill person and of those who are surrounding him in providing care, in accordance with the criteria of the physician in order to avoid an immediate harm to the patient or third persons. The patient under this measure will be under the care and monitoring of qualified staff at every moment.

Solitary confinement and physical restraints should never be determined to punish the person or for the convenience of the staff. The time of application of solitary confinement and physical restraints can never exceed 72 hours and should be authorized by the interdisciplinary team. The sanitary authority must publish the guidelines for psychiatry contention.

In order to apply contention measures professional personnel and train technical staff are needed. The employment of contention measures should be reduced to a minimum.

Duration and reasons for the application of contention measures should be registered immediately in the patient's clinical file and should be informed in the weekly report in order to be reviewed systematically.

The family member or legal representative of the patient should be informed about the application of these contention measures.

[21] Armenia, concluding observations CRPD/C/ARM/CO/1, paragraph 25; Bosnia and Herzegovina, Concluding Observations CRPD/C/BIH/CO/1, paragraphs 27 and 28; Lithuania, Concluding Observations CRPD/C/LTU/CO/1, paragraphs 29 and 30; New Zealand, Concluding Observations CRPD/C/NZL/CO/1, paragraphs 31 and 32; Republic of Moldova, Concluding Observations CRPD/C/MDA/CO/1, paragraph 30; Ethiopia, Concluding Observations CRPD/C/ETH/CO/1, paragraphs 33 and 34; Serbia, Concluding Observations CRPD/C/SRB/CO/1, paragraphs 27 and 28; Slovakia, Concluding Observations CRPD/C/SVK/CO/1, paragraph 45 and 46; Thailand, Concluding Observations CRPD/C/THA/CO/1,  paragraph 31; Uganda, Concluding Observations CRPD/C/UGA/CO/1, paragraph 28; Kenya, Concluding Observations CRPD/C/UGA/CO/1, paragraphs 29 of 30; Croatia, Concluding Observations CRPD/C/HRV/CO/1 , paragraphs 23 and 24; Czech Republic, Concluding Observations CRPD/C/CZE/CO/1, paragraph 31 and 32; Germany, Concluding Observations CRPD/C/DEU/CO/1, paragraph 33 and 34; Denmark, Concluding Observations CRPD/C/DNK/CO/1, paragraphs 38 and 39; Republic of Korea, Concluding Observations CRPD/C/KOR/CO/1, paragraphs 29 and 30; Mexico, Concluding Observations CRPD/C/MEX/CO/1, paragraphs 31 and 32; Australia, Concluding Observations CRPD/C/AUS/CO/1, paragraphs 35 and 36; El Salvador, Concluding Observations CRPD/C/SLV/CO/1, paragraphs 37 and 38.

[22] Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan E. Méndez A/HRC/22/53, paragraph 63. February 2013. http://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session.

[23] Mexico, Concluding Observations CRPD/C/MEX/CO/1, paragraphs 31 and 32.

[24] Article  55. Sterilization, psychosurgery, other irreversible treatments, electroconvulsive therapy, experimental treatment are considered special treatments. The following should be considered:

I. Chemical techniques or sterilization shall never be applied as part of psychiatric treatment;

III. Psychosurgery or other irreversible treatments or those that modify the integrity of the person, shall not be applied, they can only be applied (sic) if authorized by legislation, with the consent of the patient, and following a specific protocol.

IV. Electroconvulsive therapy shall be applied only with the informed consent of the patient or the consent of his legal representative or guardian, as long as the protocol is followed. Electroconvulsive therapy on minors should be subjected to the evaluation of an ethical and medical committee of the institution. The use of electroconvulsive therapy on children below 12 years old is prohibited.

Posted: January 1, 1970, 12:00 am