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 the founding 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 Australia, Brazil, Central African Republic, China, Croatia, Ghana, India, Indonesia, Iran, Morocco, Nepal, Peru, Russia, Serbia, South Sudan, Tanzania, Uganda, the United States, and Zambia.  

Shantha is a founding member of the International Network of Women with Disabilities, member of the Amnesty International Advisory Group on Disability Rights, expert advisor to the Catalyst for Inclusive Education Initiative and a senior advisor to the Global Campaign for Mental Health. She also served on the UNICEF Advisory Board for the 2013 State of the World’s Children report.

Before joining Human Rights Watch, Shantha participated in the UN negotiations toward the Convention on the Rights of Persons with Disabilities, working as part of a global coalition to advocate for strong protections on non-discrimination, accessibility, education, legal capacity, independent living and international monitoring. She also previously worked with UNICEF Tanzania, carrying out an assessment on children with disabilities in refugee camps in Kibondo.

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. Shantha is married and has two sons.

Posted: January 1, 1970, 12:00 am

(Washington, DC, October 23, 2018) – A leading organization promoting the rights of older people awarded Human Rights Watch its annual Public Service Award on October 22, 2018.

The National Consumer Voice for Quality Long-Term Care presents the award to an individual or organization whose work has expanded coverage and public understanding of long-term care for older people. The award was presented in recognition of Human Rights Watch’s 2018 report “‘They Want Docile’: How Nursing Homes in the United States Overmedicate People with Dementia.” The report estimates that every week in US nursing facilities, more than 179,000 people, most of them older and living with dementia, are given antipsychotic drugs without a diagnosis for which their use is approved. In many cases, nursing facilities use these drugs without obtaining or even seeking informed consent.

“We are honored to receive Consumer Voice’s recognition for this work,” said Bethany Brown, researcher on older people’s rights at Human Rights Watch. “We are proud of our partnership with them and with other dedicated advocates around the country to promote equality and dignity for older people living in nursing facilities.”

Human Rights Watch visited 109 nursing homes in six states and interviewed 300 people living in facilities, their families, staff, government officials, and others, and analyzed publicly available data. Human Rights Watch found that nursing homes routinely give antipsychotic drugs to residents with dementia to control their behavior. Regulations prohibit this misuse of drugs as “chemical restraints.” This abusive practice remains widespread even though the use of antipsychotics on older people with dementia is associated with a nearly doubled risk of death.

Using antipsychotic medications as a “chemical restraint” – for the convenience of staff or to discipline residents – violates US federal regulations and may amount to cruel, inhuman, or degrading treatment under international human rights law. Using the drugs without adequate indication for use or appropriate monitoring is also barred under federal standards.

Human Rights Watch recommended that national government and state agencies should strengthen their enforcement of federal regulations regarding antipsychotic drugs. Residents and their families should be told they have the right to be informed of their treatment alternatives and their right to refuse. The government should ensure that nursing homes employ enough staff to provide adequate care.

“Human Rights Watch research and reporting sparked a greater understanding of some of the risks to older people in nursing homes in the United States,” said Lori Smetanka, executive director of the Consumer Voice. “With this award, we recognize this important contribution to public awareness and encourage government and state agencies to ensure all older people have the right to choose and refuse treatment for themselves.”

Video

Video: Oversedation in Nursing Homes across the United States

Nursing homes across the United States routinely give antipsychotic drugs to residents with dementia to control their behavior, despite regulatory prohibitions on this misuse of drugs as “chemical restraints.” This abusive practice remains widespread even though the use of antipsychotics is associated with a nearly doubled risk of death in older people with dementia. 

Posted: January 1, 1970, 12:00 am

People with disabilities, artists, and activists gather at a rock concert in Pavlovsk Russia, June 2018.

© 2018 Andrea Mazzarino

A new Russian film, “Temporary Difficulties,” features a character named Sasha, born with cerebral palsy. A doctor tells his parents, “You can give him away and no one will judge you for it.” Although the film takes place during the Soviet era, it paints a picture familiar to millions of Russians today – a couple struggling to raise a child with a disability, without social support, and in the face of pessimism in Russia’s medical community.

Sasha’s parents do not give him away. His mother accepts him for who he is, a person with a disability who has a talent for math, loves music, and is courageous. She tries to get him support, like a donated wheelchair and physical therapy. But reflecting the social stigma surrounding them, Sasha’s father tries to turn him into a “real man” who can move like everyone else. At one point in the film, he abandons Sasha in a forest without a wheelchair or crutches, making him crawl back home.

By the film’s end, Sasha is living in contemporary Russia, having magicked away his disability. He walks like others and is successful and married. The film’s message is cruel and warped: the only way to find acceptance is to will away your disability.

In today’s Russia, some 13 million people live with disabilities. And unlike the fictional Sasha, wishing away their disability is neither possible nor necessary to find acceptance. With the help of more accessible infrastructure and efforts by independent groups to support inclusive health care, schools, workplaces, and recreation, many have begun to rightfully live fuller lives.

Recently I went to a rock concert outside St. Petersburg, attended by residents of local orphanages and adult institutions for people with disabilities. Most people there had cerebral palsy, down syndrome, or limited mobility, or were blind or deaf. They were there with friends and supporters from local nongovernmental organizations. Everyone danced together, without self-consciousness or shame.

It is time for the Russian government to support more efforts toward inclusion, and for more film makers and other artists, as well as journalists, to embrace a rights-respecting vision for all people in Russia. That way millions of children with disabilities can look around on city streets or on television screens and see themselves as they are, not as some in the government and the media may still, even in 2018, suggest they should be.

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

Restraints on a bed in a seclusion room for children in Lopača Psychiatric Hospital, in southwest Croatia. 

© 2014 Emina Ćerimović/Human Rights Watch
(Brussels) – Croatia’s government should end the confinement of children and adults in institutions, five disabled people’s and human rights organizations said today in a letter to Prime Minister Andrej Plenković. Despite some initial progress, the process of moving people out of institutions and into community-based living has stalled, the groups said.

Based on government figures for 2017, more than 7,800 adults and children with disabilities live in state-run institutions. More than 2,000 others live in privately run but state-funded institutions. These include smaller institutions called family homes, which house up to 20 people with intellectual or psychosocial disabilities, or mental health conditions. It is unclear how many others live in long-term care in psychiatric hospitals without their consent.

“The Croatian government should follow through on its promises to respect the rights of everyone who has a disability to live independently and make their own choices,” said Emina Ćerimović, senior disability rights researcher at Human Rights Watch. “The government helped make this a reality for hundreds of people and should build on this experience for thousands of others.”

According to official data, between 2011 and 2016, the government provided support for approximately 700 people to move out of state-run institutions and into organized housing in the community.

The groups sending the letter are Inclusion Europe, the European Network on Independent Living, the Centre for Peace Studies Croatia, Human Rights House Zagreb, and Human Rights Watch.

The Croatian government should make a clear plan to phase out institutions, the groups said. The government should also develop services in the community, so that children with disabilities can grow up in families and that people with disabilities can live independently, with adequate support.

“The Croatian government needs to move more quickly to meet its obligations under the international disability rights treaty, which it ratified a decade ago,” said Human Rights House Zagreb’s Ivan Novosel. “This includes removing all legal and societal barriers that prevent people with disabilities from taking an active and full part in society.” 

The government’s figures show that as of April 2018, more than 2,455 adults with disabilities were living in foster care. On May 21, the government published a draft Law on Foster Care that would give priority to placing adults with disabilities in the foster care program, including without their consent. Foster care cannot be considered independent living in community for adults as required by the disability rights treaty, the organizations said.

Both the United Nations Committee on the Rights of People With Disabilities and Croatia’s Ombudswoman for Persons with Disabilities have criticized placing adults in foster care.

“Under the international disability rights treaty, Croatia must respect the right of all people with disabilities to live independently in the community, regardless of their impairment, support needs, or age,” said Ines Bulic Cojocariu, deputy director at the European Network on Independent Living. “The government should develop and adequately fund community-based services. Instead, the government continues to place adults with disabilities in institutions and foster families against their will.”

People with psychosocial disabilities in psychiatric hospitals and those in foster care remain excluded from the government’s deinstitutionalization efforts.

In an April meeting with Human Rights Watch, the Social Policy Ministry promised to adopt a new plan to support community-based living for people with disabilities, including those in state-run institutions, private institutions, and family homes. In a subsequent letter to Human Rights Watch, however, the ministry said that people with disabilities who need long-term and intensive care will remain in institutions.

Many people with intellectual or psychosocial disabilities end up in institutions or foster care because they are denied legal capacity or the right to make basic decisions for themselves. A guardian makes some or all decisions for them. About 18,000 people with intellectual or psychosocial disabilities are under some form of guardianship in Croatia.

In June 2014, the Croatian Parliament adopted a new Family Act, which abolished full guardianship. It required courts to review all previous decisions on deprivation of legal capacity with the aim of restoring partial or full legal capacity to those previously stripped of it by January 2020. Since then, courts have reviewed only 1,179 cases, restoring full legal capacity to just 95 people and partial legal capacity to 273. Restoring partial legal capacity means a court can specify what decisions the person is allowed to make independently and those that a guardian will continue to make, such as for living arrangements and health care. 

“Guardianship and other forms of restricting the right to make decisions are inconsistent with Croatia’s human rights obligations,” said Jyrki Pinomaa, president of Inclusion Europe. “Croatia should be restoring legal capacity to people under guardianship and implementing supported decision-making systems that respect the autonomy, will, and preferences of each person.”

The Convention on the Rights of Persons with Disabilities guarantees the right of everyone with a disability to live independently and to be included in the community, regardless of their disability, wither they have multiple disabilities, or whether they need a high level of support. The freedom for individuals to make decisions and control their lives is essential to living independently, the organizations said. In December 2017, the Council of the European Union called on EU governments to ensure that everyone has the right to live independently within their community and to play an active part in society.

“Croatia should mark the 10th anniversary since ratifying the disability rights treaty by reforming laws and policies to meet its obligation under the treaty, including to ensure the right of all persons with disabilities to live in the community and make their own decisions on where and how they want to live,” said Cvijeta Senta of the Centre for Peace Studies.

Posted: January 1, 1970, 12:00 am

October 10, 2018

 

His Excellency Mr. Andrej Plenković

Prime Minister of the Republic of Croatia

 

Dear Prime Minister Plenković,

 

We, the undersigned organizations of persons with disabilities and nongovernmental human rights organizations, are writing to express our concern at the worrisome situation for thousands of women, men, and children with disabilities who live in institutions across Croatia.

We urge you to ensure that every person with a disability has a right to live in the community and to legal capacity, including by reforming laws that are not in line with the UN Convention on the Rights of Persons with Disabilities (CRPD). This year marks the 10th anniversary since Croatia ratified the CRPD.

We acknowledge the important efforts of the Croatian government to ensure the rights of persons with disabilities since the ratification of the CRPD, in particular the government’s deinstitutionalization plan from 2011 and legal capacity reforms from 2014.

We remain concerned, however, about a number of aspects of the government’s policies regarding the right of people with disabilities to live independently in the community and the right to legal capacity, as guaranteed under the CRPD. In particular, we documented that the process of moving people out of institutions and into the community has stalled and that no progress has been made on restoring legal capacity. We detail these concerns and our recommendations to fully promote the rights of people with disabilities in the attached Annex.

We thank you for your attention and remain available for any further discussion with your excellency or a relevant government official on this important matter.

Sincerely,

Inclusion Europe

European Network on Independent Living

Kuca za ljudska prava (Human Rights House) 

Centar za mirovne studije (Center for Peace Studies)

Human Rights Watch

 

Annex

 

Reduced Efforts to Ensure the Right to Live Independently in the Community

Despite progress from 2011 to 2015, the process of moving people with a disabilities out of institutions and into the community has stalled. According to official data, between 2011 and 2016 the government supported approximately 700 people to move out of state-run institutions and into organized housing in the community. Those who did move are by and large successfully living in their communities, underscoring that deinstitutionalization is both the right thing to do and effective.

Nevertheless, in the first half of 2017, only 15 adults were moved from institutions to independent community living. In the same period, 75 children and 21 adults were reunited with their biological families.

We are concerned about the continued institutionalization and lack of access to community-based support for people with a disabilities. Personal assistance is limited to 1,536 persons with disabilities and is not available to those leaving institutions.

According to 2017 government figures, as of December 2016, more than 7,500 adults and children with disabilities remain in state-run institutions. More than 2,000 others live in privately run, but state-funded institutions, including smaller family homes. 

Exclusion of Certain People from Deinstitutionalization Plans

The Croatian government excludes certain people with disabilities from its deinstitutionalization efforts. The 2011-2016 Plan on Deinstitutionalization and Transformation of Social Welfare Homes (“Master Plan”) excluded people with intellectual or psychosocial disabilities who lived in the 24 privately run but state-funded institutions, as well as those living in so-called family homes and foster care. The 2011-2016 Master Plan also excluded people with psychosocial disabilities placed in long-term care, without their consent, in psychiatric hospitals. In an April 2018 meeting with Human Rights Watch, the Ministry of Social Policy promised to adopt a new plan to support community-based living for people with disabilities, including those in state-run institutions, private institutions, and family homes. In a subsequent letter to Human Rights Watch, however, the ministry said that people with disabilities who need long-term and intensive care will remain in institutions. People with psychosocial disabilities in psychiatric hospitals and those in foster care remain excluded from the government’s efforts.

All rights enumerated in the UN Convention on the Rights of Persons with Disabilities (CRDP), including the right to live independently and be included in the community, are guaranteed to all people with disabilities equally, irrespective of their current living arrangement, type of disability, age, the presence of multiple disabilities, or support requirements. 

Foster Care for Adults

We are also concerned about the practice of placing adults in foster care. Foster care cannot be considered “independent living in [the] community” for adults as required by the CRPD. The practice of placing adults with disabilities in foster care has been criticized by the UN Committee on the Rights of Persons with Disabilities and the Croatian Ombudswoman for Persons with Disabilities.

According to official data, as of April 2018, more than 2,455 adults with disabilities live in foster care.  

People with disabilities have the right to live independently in the community; essential to the realization of this right is control over one’s life and the ability to make individual choices with support as necessary. Any forced placement in a living situation, even with a well-meaning foster family in the community, is not consistent with Croatia’s obligations under the CRPD.

The Right to Legal Capacity

About 18,000 people with intellectual or psychosocial disabilities are placed under guardianship in Croatia and denied their legal capacity or the right to make decisions about basic rights, such as the right to marry and form a family, to sign an employment contract, or to hold property. A significant majority live under full guardianship, under which guardians make all decisions for them. For people under guardianship, the decision on where and with whom they shall live is not made by them but by their legal guardians. This also limits their right to leave institutions.

In June 2014, the Croatian Parliament adopted a new Family Act, which abolished full guardianship. It required courts to review all previous decisions on deprivation of legal capacity with the aim of restoring partial or full legal capacity to those denied it. According to official data, courts have reviewed 1,179 cases, restoring full legal capacity to just 95 people and partial legal capacity to 273.

In its General Comment on CRPD article 12 (legal capacity), the CRPD Committee has articulated that any restrictions on legal capacity are not in compliance with the treaty, including the right to live in the community: “In order to comply with the Convention and respect the human rights of persons with disabilities, deinstitutionalization must be achieved and legal capacity must be restored to all persons with disabilities, who must be able to choose where and with whom to live. In December 2017, the Council of the European Union called on EU governments to ensure that everyone has the right to live independently within their community and to play an active part in society.

We urge you to take steps to reform the laws and policies to meet Croatia’s obligations under the CRPD, including to ensure the right of all persons with disabilities to live in the community and make their own decisions on where and how they want to live. In line with the CRPD, we urge you to create a time-bound plan to phase out the use of institutions as a form of living arrangement for anyone with a disability. Essential to this plan is the creation and implementation of a system of support in decision-making that respects the autonomy, will, and preferences of the person with a disability; improvement and expansion of community-based independent living and support; and specific measures to prevent further institutionalization.

Posted: January 1, 1970, 12:00 am

(London, October 10, 2018) – Hundreds of people with real or perceived mental health conditions remain chained or confined in prayer camps in Ghana, despite some progress, one year after the government pledged to enforce a ban on shackling, Human Rights Watch said today on World Mental Health Day. The government of Ghana should take immediate steps to end shackling establishing a monitoring system to ensure enforcement of the ban, and further developing community mental health services. As part of the Inaugural Global Summit on Mental Health, hosted by the United Kingdom on October 9-10, 2018, Ghana should reaffirm its commitment to a rights-based approach to mental health and meaningful consultation with people with psychosocial disabilities (mental health conditions).

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

Video: People with Disabilities Shackled Despite Law in Ghana

Hundreds of people with real or perceived mental health conditions remain chained or confined in prayer camps in Ghana, despite some progress, one year after the government pledged to enforce a ban on shackling.

(London) – Hundreds of people with real or perceived mental health conditions remain chained or confined in prayer camps in Ghana, despite some progress, one year after the government pledged to enforce a ban on shackling, Human Rights Watch said today on World Mental Health Day.  

The government of Ghana should take immediate steps to end shackling establishing a monitoring system to ensure enforcement of the ban, and further developing community mental health services. As part of the Inaugural Global Summit on Mental Health, hosted by the United Kingdom on October 9-10, 2018, Ghana should reaffirm its commitment to a rights-based approach to mental health and meaningful consultation with people with psychosocial disabilities (mental health conditions).

“Hundreds of people with psychosocial disabilities are still shackled like cattle,” said Shantha Rau Barriga, disability rights director at Human Rights Watch. “It’s not only important for the chains to come off, the government needs to sensitize communities and invest in local mental health services. If not, people with psychosocial disabilities may again be subjected to the cruel and abhorrent practice of shackling and the government’s ban will be an empty threat.”

The head of Ghana’s Mental Health Authority, Dr. Akwasi Osei, announced on World Mental Health Day in 2017 that the government would enforce the 2012 Mental Health Act provision that people with psychosocial disabilities “shall not be subjected to torture, cruelty, forced labour and any other inhuman treatment,” including shackling. He said it was “illegal to put anyone in chains.”

However, on a recent visit to Mount Horeb Prayer Camp in Mamfi, jointly with the Mental Health Authority, Human Rights Watch found dozens of people with psychosocial disabilities still chained and detained in overcrowded and congested conditions.

During that visit, Human Rights Watch found more than 140 people with real or perceived mental health conditions detained in unsanitary and dark rooms, with little ventilation or opportunities to go outside. The stench of urine was overwhelming. One room housed 60 men, some of whom have been there for more than five years. As of October 10, 42 men remain confined in that room. The gate locked. 113 people with real or perceived mental health conditions are now in the camp.

A 63-year-old man who has been there since 2012 said, “When I go outside, I feel good. But we don’t get to go outside.”

Families bring people with real or perceived mental health conditions to prayer camps such as this one because of widely-held beliefs that such disabilities are caused by a curse or evil spirits.

Osei expressed his concerns about the ongoing chaining and congestion at Mount Horeb: “You and I can be in their shoes. And the question is, if I am in their shoes… would I be happy to be treated that way? The answer is ‘no.’” He went on to say that, “People [with] mental health conditions are human beings like us, and we should completely respect their human rights.” Under pressure from the Mental Health Authority, the camp leadership has pledged to eliminate the practice of chaining.

In June 2017, in an effort to enforce the law, the Mental Health Authority freed 16 people, including two girls, at Nyankumasi Prayer Camp in central Ghana. Those freed, some of whom have mental health conditions, were taken to nearby Ankaful Psychiatric Hospital. Since then the camp has remained chain-free.

On a visit to the camp in September, Human Rights Watch spoke with Felix, an educated 46-year-old man who was among those freed in the camp. He was chained to a tree for five years, and continues to live there, free of chains, in a room of his own. He said, “When I was under the tree, it [was] very difficult there, very much difficult, and... we couldn’t do anything about it.” When asked what it felt like when the chains were removed, he simply said, “We were very much happy.”

Serious gaps remain in ending the practice of shackling across the country, in part because the monitoring system established by the 2012 Mental Health Act has yet to be set up. It has been stalled by the lack of political will at the highest levels, government officials and partners from nongovernmental groups told Human Rights Watch. The former United Nations expert on torture, Juan Mendez, urged the establishment of, and adequate funding for, such an oversight system following his 2013 and 2015 visits to Ghana.

There are no clear figures on how many prayer camps exist in Ghana, the number that chain people with psychosocial disabilities, or the number of people in chains. Without a monitoring system, the camps operate with virtually no government oversight.

The government of Ghana should immediately set up the monitoring system, described in the law as Visiting Committees, Human Rights Watch said. The government should provide adequate resources to conduct investigations to ensure that people with psychosocial disabilities are not subjected to inhuman or degrading treatment or other abuses.

In parallel, the government should develop community-based mental health services based on the human rights principles of informed consent, dignity, and freedom from torture that enable people with psychosocial disabilities to live in the community. The government should also create public awareness campaigns to change the discriminatory attitudes toward people with psychosocial disabilities.

“There is too much stigma and misunderstanding around mental health, leading to abuses against people with psychosocial disabilities, and no government body is watching,” Barriga said. “Oversight is more important than ever to make sure that people who have been freed from chains have their rights and dignity restored.”

Posted: January 1, 1970, 12:00 am

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In Pictures

Video

Indonesia: Shackling Reduced, But Persists

The Indonesian government has taken important steps to end the practice of shackling people with mental health conditions, Human Rights Watch said today. But many people remain locked up in institutions instead of being able to live in the community. 

 

© 2018 Andrea Star Reese for Human Rights Watch

© 2018 Andrea Star Reese for Human Rights Watch

 

© 2018 Andrea Star Reese for Human Rights Watch

© 2018 Andrea Star Reese for Human Rights Watch

Posted: January 1, 1970, 12:00 am

The Indonesian government has taken important steps to end the practice of shackling people with mental health conditions. But many people remain locked up in institutions instead of being able to live in the community. The number of people with psychosocial disabilities (mental health conditions) who are shackled or locked up in confined spaces dropped from nearly 18,800, the last reported figure, to about 12,800 in July 2018, according to Indonesian government data. The change resulted in part from community outreach to over 16.2 million households

Posted: January 1, 1970, 12:00 am

Sodikin

There used to be a hut next to a family’s home in Cianjur, West Java. In it, a man named Sodikin lived locked up and unable to stand. He ate, slept, and went to the bathroom in the hut, which had one window no bigger than the palms of his hands. His light at night came from a solitary lightbulb his family hung in the hut.

Everything changed when Indonesia decided to support people with mental health conditions – and their families. Now Sodikin goes to work each day and earns money to support his family – the same people who left him shackled for eight years. He has made friends; he has learned skills.

His family burned the hut to the ground. A garden grows there now.

In Indonesia, misunderstanding about mental health is rife, and Sodikin’s family had no idea how to support him when he developed a mental health condition. He would get angry, smash things, and yell. First, they took him to a faith healer, and then they took him to a mental health hospital a day-and-a-half walk from their home.

“The thing with this family is that they did try,” said Kriti Sharma, senior disability rights researcher at Human Rights Watch.

The family was given medicine for Sodikin, and it helped for a while, but then when it came time for a refill of his prescription, no one provided it. The local healthcare center told his father to go back to the hospital. But after he walked the day-and-a-half to get there, the hospital turned him away, saying he had to get the refill locally.

“They didn’t know what to do, so they gave up,” Sharma said. That’s when they began shackling Sodikin.

Video

Indonesia: Shackling Reduced, But Persists

The Indonesian government has taken important steps to end the practice of shackling people with mental health conditions. But many people remain locked up in institutions instead of being able to live in the community. 

Sharma first saw Sodikin while visiting Indonesia in 2014.

“Dusk was falling as we walked down this dirt path and I saw the parents and said, ‘We hear your son is here, can we speak to him?’”

The father pointed to the hut, which stood next to the family bathroom.

“I thought, ‘It’s not possible someone is living in there,’” said Sharma. “I peered in this tiny hole and he was just sitting there, all skin and bones, with his head hanging down.”

When Sharma returned two years later to finish her report “Living in Hell: Abuses against People with Psychosocial Disabilities in Indonesia,” Sodikin was still there. Sandi, his brother-in-law, was the only family member who was looking after him.

“I left feeling so hopeless,” Sharma said. “I was sure he would die in that shed.”

Since then, the Indonesian government has been working to end shackling by providing community-based mental health services. Community health centers known as puskesmas work directly with families going house to house to collect data, raise awareness, and provide support. The local healthcare centers are now stocked with medication and take it to the families when they can’t travel. More than 16.2 million homes now have access to community-based support.

Despite this progress, as of July 2018, 12,832 people with psychosocial disabilities – mental health conditions – remain shackled or locked up in confined spaces. This is down from 13,528 in December 2017. People with psychosocial disabilities also continue to be arbitrarily detained in faith healing centers, social care institutions, and mental hospitals.

Faith healing centers have little oversight, and people with psychosocial disabilities are often shackled, abused, and forced to take alternative “treatments” such as concoctions of “magical” herbs, vigorous massages by traditional healers, and Quranic recitation in the person’s ear.

But for Sodikin, transformation began when a nongovernmental organization rescued him. Sandi had to carry Sodikin out of his hut because his muscles had atrophied so much he couldn’t walk.

He was taken to a shelter run by the nongovernmental organization, where he was finally given the help he needed.

He stayed at the shelter for six months and slowly began to recognize people, including Sandi, who had joined the family several years after the shackling began and whom Sodikin had never really known.

“Now the breadwinner in this family is [Sodikin],” Sandi said. “The most valuable moment would be when I see him giving my kid some pocket money. I was quite surprised he could be that kind to my kid.”

Sodikin now works at a clothing factory stitching buttons onto boys’ school uniforms. The past eight years have been a blur for Sodikin, being shackled was so traumatizing that he has blocked out years he spent in the hut. But sometimes he has moments when he remembers being in chains.

“He does sometimes ask his parents ‘How could you do this to me?’ when he remembers,” Sharma said. “They have asked his forgiveness multiple times.”

Asep

Families in Indonesia often feel desperate when someone in their family starts displaying signs of a mental health condition. There is a lot of stigma in Indonesia surrounding mental health, and when Asep started declining his neighbors complained about his behavior.

“The family didn’t want to see him shackled, it was sad to see it,” Asep’s sister Ernawati told Sharma.

“The first time he was in shackles, everybody was crying, we had no option.”

Asep was found shackled at the waist in an abandoned house opposite his family’s home. The chain was so heavy it took rescuers 15 minutes to saw through it.

“He was found by a community worker who was going door-to-door as part of the new program,” said Sharma. “She was told there was a man shackled in the building, otherwise looking at it you would never know someone lived there.”

When he was freed from his shackles, Asep spent a month in a mental hospital, and after his release the local community health center made regular follow-up visits to his home. These visits enabled the family was able to keep him out of chains.

“They even did a briefing in the village to explain why shackling people with mental health conditions is never okay,” Sharma said.

Asep has changed a lot since he was first found by the outreach worker.

“The day he was released, he hung his head and did not make eye contact,” said Sharma. “His sister thought he was embarrassed to be found like that.”

The derelict house where he was shackled is no longer there. Now ponds have been created on the site. These days, Asep farms fish in the ponds. On an island in the middle of the ponds stands a chicken coop, and he also feeds the birds calmly and gently.

“He’s a man of few words,” Sharma said, “but when you ask him what it is like to be free he says, ‘In chains I felt rigid all the time, I am happy now I am free.’”

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

Video

Indonesia: Shackling Reduced, But Persists

The Indonesian government has taken important steps to end the practice of shackling people with mental health conditions. But many people remain locked up in institutions instead of being able to live in the community. 

(Jakarta) – The Indonesian government has taken important steps to end the practice of shackling people with mental health conditions, Human Rights Watch said today. But many people remain locked up in institutions instead of being able to live in the community.

The number of people with psychosocial disabilities (mental health conditions) who are shackled or locked up in confined spaces dropped from nearly 18,800, the last reported figure, to about 12,800 in July 2018, according to Indonesian government data. The change resulted in part from community outreach to over 16.2 million households.

End Shackling in Indonesia

End Shackling in Indonesia

Help end shackling once and for all by calling on the Indonesian government to monitor and end the practice of shackling inside institutions. Help #BreakTheChains today!

“The Indonesian government has made a serious effort to tackle the practice of shackling and the lack of community-based mental health services,” said Kriti Sharma, senior disability rights researcher at Human Rights Watch. “But with little oversight, thousands of people with disabilities remain in chains or locked up in institutions across Indonesia.”

Human Rights Watch found in its 2016 report, “Living in Hell: Abuses against People with Psychosocial Disabilities in Indonesia,” that thousands of people with psychosocial disabilities were shackled and many were forcibly detained in overcrowded and unsanitary institutions. The practice persisted despite a 1977 government ban on shackling because of stigma and the lack of community-based support or mental health services.

Since then, Human Rights Watch has visited Indonesia five times to monitor government progress in addressing the problem. Human Rights Watch conducted 19 interviews with people with psychosocial disabilities and 48 interviews with family members, caregivers and institution staff, health professionals, disability rights advocates, and government officials across Jakarta, Bekasi, Bogor, Cianjur, Brebes, and Tegal.

Over the past two and a half years, the government has taken promising steps to address shackling. In April 2016, Health Minister Nila Moeloek made a commitment to make mental health medication available in community health centers across the country.

By January 2017, the Health Ministry rolled out Program Indonesia Sehat dengan Pendekatan Keluarga (Healthy Indonesia Program with Family Approach), a community outreach program in which health workers use a “family-based approach,” going house to house to collect data, raise awareness, and provide services relating to 12 measures of family health, including mental health.

As of September 2018, the program had reached 16.2 million – roughly 25 percent – of Indonesian households. The data collected indicates, however, that only 16 percent of people with psychosocial disabilities surveyed have access to mental health services.

A 52-year-old woman with a psychosocial disability was one of many rescued by community health workers in Cijeruk, Bogor. “We locked her in her room for five years,” her sister said. “She would sleep on the floor; she couldn’t walk because her muscles had stopped working. We gave her a bucket to urinate and defecate in. It was very smelly. It made me very sad.”

The family felt they had no alternative but to lock her up. But after a visit and help from outreach workers, her sister said, the family released her from her room in February 2017 and she is now receiving services in the community.

“Integrating mental health into primary health care is crucial but it’s not enough,” Sharma said. “To eliminate shackling, the government needs to educate the public about mental health and provide people with psychosocial disabilities with services that extend beyond medication, including access to education, housing, and employment.”

A man with a real or perceived psychosocial disability lying with his ankle chained to a platform bed in the Syamsul Ma'arif faith healing center in Brebes, Central Java. 

 

© 2018 Andrea Star Reese
Human Rights Watch found that people with psychosocial disabilities continue to be arbitrarily detained in faith healing centers, social care institutions, and mental hospitals. In the absence of regular monitoring, little has changed in faith healing centers, where people are shackled, abused, and forced to take alternative “treatments” such as herbal concoctions, vigorous massages by traditional healers, and forced listening to Quranic recitations. In private institutions, people with psychosocial disabilities routinely face abuse including physical and sexual violence, involuntary treatment, restraints, and forced seclusion.

At Yayasan Galuh Rehabilitation Center in Bekasi, a woman in her mid-thirties with a psychosocial disability, said: “I used to be chained at home. My family tricked me into coming here. They told me my mother had passed away and they were taking me to her funeral. Instead they brought me here. I was locked in an isolation room for four weeks because I got into a fight.”

The Ombudsman, National Human Rights Commission, and National Commission on Violence against Women should immediately order inspections and regular monitoring of all government and private institutions and take appropriate action against abusive facilities, Human Rights Watch said. The Social Affairs Ministry also has a responsibility to regulate private institutions and ensure that it is not inadvertently enabling abusive practices.

“Despite the progress, the government has a long way to go to end abuse in institutions,” Sharma said. “The Social Affairs Ministry needs to adopt a deinstitutionalization policy that moves away from warehousing people in institutions and supports independent living in the community.”

Government Progress Against Shackling

In 2017, the Indonesian ministers of home affairs, health, and social affairs, the chief of the National Police, and the Indonesian Health Insurance Organization signed a memorandum of understanding to work together to comprehensively carry out the 1977 ban on shackling. Both the Social Affairs and Health Ministries have campaigns to end shackling by 2018 and 2019 respectively.

Community health workers distributing medication to local residents as part of the government outreach efforts on mental health in Banjarwangi village in Ciawi, Bogor. 

© 2018 Andrea Star Reese for Human Rights Watch
They carried out awareness-raising activities and provided training for provincial-level staff across the country. Human Rights Watch found that many community health centers have also created their own initiatives to eliminate shackling at a local level. Puskesmas Banjarsari in Ciawi, in one example, has started a text message hotline called “care about shackling” to encourage people to report shackling cases.

Human Rights Watch returned to many communities where it had documented shackling to find that people had been released and were living in the community. When Human Rights Watch first visited Sodikin, a 34-year-old man with a psychosocial disability, in 2014, he was locked up in a tiny shed outside the family home in Cianjur, West Java. The family initially tried to get him medical care but the local health center didn’t have mental health medication and the hospital was too far. Sodikin spent more than eight years shackled in the shed, given his meals through a small hole in the shed, before being released with the help of a local nongovernmental organization in May 2016.

Sodikin’s brother-in-law said: “Sodikin had become very thin. When he was released, his legs were stiff and he couldn’t even stand up or walk so I had to carry him.” Sodikin spent six months recovering in a nongovernmental organization-run shelter before he could come home. Sodikin now works at a clothing factory stitching buttons onto boys’ school uniforms. “We were so happy to have him living in the family home again,” his brother-in-law said. “We never thought he’d recover. His father used to see him as a burden, and now he’s the main bread winner supporting the family.”

Sodikin, a 34-year-old man with a psychosocial disability, at his workplace. Sodikin, who was shackled for more than eight years in a tiny shed outside the family home in Cianjur, West Java, now works in a clothing factory stitching buttons onto boys’ school uniforms. 

© 2018 Andrea Star Reese for Human Rights Watch

According to the Indonesian Mental Health Directorate, the number of people being shackled or locked up in confined spaces across 32 provinces (excluding Papua and West Papua) decreased from 13,528 in December 2017 to 12,832 in July 2018. However, documenting shackling is difficult as it often occurs in remote areas, and families are reluctant to speak due to the shame and stigma around mental health conditions. In addition, people who are rescued sometimes end up in shackles again because of the dearth of community support services.

Human Rights Watch found that one of the risks with government efforts to eradicate shackling is that some people who are released end up in mental hospitals where they could be arbitrarily detained or treated without their consent.

A mental health nurse at Bogor Mental Hospital said: “When we intervene in a shackling case, patients don’t always want to come to the hospital or are in no state to communicate so the family member is the decision-maker.” However, informed consent of the affected individual is a bedrock principle of medical ethics and international human rights law, and not allowing people with psychosocial disabilities to make their own medical decisions violates their rights.

Following his March 2017 visit, the UN’s expert on health, Dainius Puras, urged the Indonesian government to “scale-up” its campaign against shackling but to ensure that it is not “replaced by other forms of restraints and confinement which violate human rights.”

In partnership with the Indonesian Psychiatric Association and nongovernmental groups, the World Health Organization (WHO) is training psychiatrists, doctors, nurses, social workers, government officials, and disability rights advocates in Indonesia in its Quality Rights initiative, which aims to provide alternatives to coercive practices such as involuntary treatment, seclusion, and restraints in mental hospitals and social care institutions.

In May 2018, it began training on the internet for 61 people from 19 different provinces, and in November it will provide in-person training for 80 people. While the WHO training is an important effort in eliminating coercion in hospitals and institutions, the government should amend the 2014 Mental Health Act to ensure that people with psychosocial disabilities cannot be arbitrarily detained against their will, in line with its obligations under the international Convention on the Rights of Persons with Disabilities.

Government Efforts on Mental Health

The government has shown its commitment to making mental health a priority by including it as one of the 12 indicators in its national community health program, the Program Indonesia Sehat dengan Pendekatan Keluarga (Healthy Indonesia Program with Family Approach). The program is an ambitious government initiative that seeks to ensure that even the most rural, isolated, and reluctant communities get access to health services. The program’s home visits are critically important because they eliminate the need for family members to take time off from work and spend money to travel to health centers.

Posters used by community health workers to raise awareness on the 12 measures – mental health, access to clean water, hypertension, tuberculosis, smoking, family planning, access to government health insurance, maternal mortality, child nutrition, immunization, breast feeding, and sanitation – that together contribute to family health in Indonesia's national community outreach program. 

 

© 2018 Andrea Star Reese for Human Rights Watch
For the program’s nationwide rollout, the Health Ministry trained 25,000 master trainers to train five staff members in every community health center across Indonesia. Relying on community workers such as midwives or social workers to deliver basic mental health services has meant that the shortage of trained mental health professionals is no longer a barrier. The trained staff in turn educate additional health center staff about the program and mental health. By the end of 2018, 6,205 community health centers will be operating the program. The government’s target is to ensure full coverage of over 65 million households in Indonesia through all 9,909 community health centers by the end of 2019.

The program’s innovative “family-based approach” looks at 12 measures that together reveal family health – access to clean water, hypertension, tuberculosis, smoking, family planning, access to government health insurance, maternal health, child nutrition, immunization, breast feeding, sanitation, and mental health. If a family fairs poorly on even one indicator, then it is identified as needing assistance. This system effectively gives mental health the same importance as all other indicators, and ensures that community health workers provide immediate and ongoing mental health services to meet their target of 100 percent coverage.

Since the program involves home visits, it becomes easier for community health workers to detect cases of shackling and facilitate the release of shackled people. Dr. Tina Yustiniarsih, a community health center doctor, said that she intervened to rescue Asep, a 34-year-old man shackled for three years in Banjarwangi village in Ciawi:

We found Asep chained in a dilapidated abandoned house. The chain around his waist was so heavy, it took us 15 minutes to cut through it with a saw. I counseled the family, told them that someone with a mental health condition is the same as we are, they have human rights. We also briefed the entire village to make sure everyone knew that people with a mental health condition should not be shackled.

Asep’s sister said, “I felt sad seeing him in shackles. I agreed immediately to him being released, I wanted him to get better. If the health team hadn’t come, we would never have released him.” She didn’t know about the benefits available with the national health insurance card and available services at the hospital.

Asep said: “I felt cramped and rigid in shackles. I don’t remember exactly what happened but I was happy when I was freed.”

During house visits, the community health worker collects data, educates the family about mental health, provides counseling, and helps them get a national health insurance card for free or subsidized health services. In addition, the person with a psychosocial disability and their family can visit the community health center for one-on-one counseling with a doctor or nurse, they can get medication, and they can participate in occupational therapy or other activities. In some cases, the health center facilitates formation of peer support groups through the messaging application WhatsApp, links people to training on how to start a small business, and helps them get funding to start the business.

Siti, a 39-year-old woman with a psychosocial disability, at work in her hair salon in Ciawi, Bogor. The community health center and social affairs department helped Siti with funding to start her business: “I am happy they gave me capital funding of Rp. 2,800,000 [US$190] to start my hair salon. This way I can earn some income.” 

© 2018 Andrea Star Reese for Human Rights Watch
Siti, a 39-year-old woman with a psychosocial disability living in Ciawi, Bogor said that, “[The staff] are quite helpful. I am happy they gave me capital funding of Rp. 2,800,000 [US$190] to start my hair salon. This way I can earn some income.”

Siti’s sister said that their lives have changed after getting the program’s support:

Before, we had to travel all the way to the mental hospital to get medication. Sometimes we didn’t have time to go or the transport was too expensive. Since we got help from the community health center, Siti’s condition is much better. In addition to medication, the center provided counseling, connected us to support groups, and is facilitating support for her business. My dream for Siti is that she is completely independent.

While the program has significant potential to provide easy access to voluntary community-based mental health services, it is still in a nascent stage. Even in the districts where the program has been rolled out, many health centers are still collecting initial data on the 12 indicators and have not moved on to provide services. The success of the program is contingent on effective training, implementation, and regular follow-up, Human Rights Watch said.

Local community health centers have developed creative initiatives to support people with psychosocial disabilities. Puskesmas Cilandak in South Jakarta has created E-Mental, an Android-based application that allows community health workers to provide early intervention for people with psychosocial disabilities and support them in the community. Community health workers visit families to complete a simple 29-question survey to determine whether someone may benefit from psychosocial support and whether they need immediate assistance.

Primary health workers go door-to-door visiting families as part of government community outreach efforts on mental health in Banjarwangi village in Ciawi, Bogor.

© 2018 Andrea Star Reese for Human Rights Watch
The program has reached 1,025 people, providing services in the community for 97 percent of them. Only one case was referred to a hospital. The app allows community health workers to systematically follow up with people and develop community-based support systems and coping mechanisms that do not rely exclusively on medication. Community health workers provide counseling, information on psychosocial support, and link people up to vocational training courses so they can become financially independent.

The Health Minister also created a mobile application to provide mental health information. As of July, the app had been downloaded 20,000 times, with 15,000 active users, according to government data.

People in Institutions

Under Indonesian law it is relatively easy to admit a person with a psychosocial disability to an institution against their will. In 2016, Human Rights Watch visited 16 institutions across the islands of Java and Sumatra and documented 65 cases of people arbitrarily detained in mental hospitals, government and private social care institutions, and faith healing centers. Two and a half years later, there has been little improvement.

Yayasan Bina Lestari Mandiri Brebes, a state-licensed Islamic healing center in Brebes, Central Java, which was described in the 2016 Human Rights Watch report, continues to chain people with psychosocial disabilities. In September 2018, all 50 residents of Bina Lestari were chained. People are chained for nearly 24 hours a day, unable to move more than two to four meters in any direction. They get no medical attention or mental health care, are given poor-quality food and are at risk of physical and sexual violence by other residents or staff.

The local Social Affairs department is aware that people with psychosocial disabilities are shackled at Yayasan Bina Lestari and at times they even send people there. The basis for admission and discharge is left entirely to the faith healer. The National Human Rights Commission conducted a monitoring visit to the institution in December 2017 but its report is yet to be made public.

Men with real or perceived psychosocial disabilities in the Syamsul Ma'arif faith healing center in Brebes, Central Java. 

 

© 2018 Andrea Star Reese
Human Rights Watch also previously reported on the Yayasan Galuh Rehabilitation Center, a privately-run institution on the outskirts of Jakarta in Bekasi. It currently arbitrarily detains about 436 men, women, and children with psychosocial disabilities. People are brought to Galuh by their families or by local police if they are found living on the street. Unless the family comes to take the person out, they can remain there indefinitely.

Residents of Galuh also faced a range of neglect and abuse, involuntary treatment, seclusion, and restraint. They are forced to live in overcrowded and unsanitary conditions. They are held in close quarters without being able to go out or bathe regularly, which contributes to lice and scabies. Female residents are particularly at risk of sexual violence as the toilets have no doors and male staff oversee the female section. During the Human Rights Watch visit, male staff members observed as naked female residents bathed.

Ratih, a woman with a psychosocial disability who has been detained in Galuh for several years, said:

I have been chained here three times. The staff told me I was handcuffed for my own benefit. I got hit by the staff and was handcuffed for one whole week. I couldn’t even go to the toilet, I had to pee there, in my clothes. I had to ask my friend to help me eat but she was too scared…. I want to go home, I don’t belong here.

Recommendations

The Office of the Ombudsman, the National Human Rights Commission and the National Commission on Violence against Women should:

  • Conduct regular, unannounced monitoring visits to government and private social care institutions as well as faith healing centers, with unhindered and confidential interaction with both staff and patients.

The Health Ministry should:

  • Ensure that community-based mental health services work in partnership with organizations of people with psychosocial disabilities, their families, caregivers, and faith healers.

The Social Affairs Ministry should:

  • Conduct regular, unannounced monitoring visits to government and private social care institutions as well as faith healing centers, with unhindered and confidential interaction with both staff and patients. The ministry should publicly report on their findings from these visits;
  • Create and carry out a deinstitutionalization policy and a time-bound action plan, based on the values of equality, independence, and inclusion for people with disabilities. Preventing institutionalization should be an important part of this plan. The ministry should include people with disabilities and their representative organizations in developing the plan; and
  • Engage spiritual leaders to challenge discriminatory beliefs and practices related to psychosocial disabilities to educate them about mental health and the needs of people with psychosocial disabilities.
Posted: January 1, 1970, 12:00 am

The Indonesian government has taken important steps to end the practice of shackling people with mental health conditions, Human Rights Watch said today. But many people remain locked up in institutions instead of being able to live in the community. 

​The number of people with psychosocial disabilities (mental health conditions) who are shackled or locked up in confined spaces dropped from nearly 18,800, the last reported figure, to about 12,800 in July 2018, according to Indonesian government data. The change resulted in part from community outreach to over 16.2 million households

Posted: January 1, 1970, 12:00 am

Human Rights Watch welcomes the opportunity to provide input to the UN Working Group on the issue of discrimination against women in law and practice (the “working group”) as the working group prepares a report on women deprived of liberty. We appreciate the working group taking on this important topic.

This submission draws from Human Rights Watch’s extensive research on the rights of women and girls in a broad range of circumstances involving deprivation of liberty. The submission focuses first on the contexts in which deprivation of liberty of women and girls occurs, and then analyzes the characteristics and consequences of deprivation of liberty for two particularly vulnerable groups of women and girls—women and girls with disabilities and those with lesbian, bisexual and transgender identities.

We appreciate the working group’s commitment to take a comprehensive view of what circumstances can constitute a “deprivation of liberty.” While women and girls face serious human rights abuses in jails, prisons, juvenile detention, and immigration detention—and these abuses are often exacerbated by factors such a sexual orientation or gender identity and disability—there are many other contexts in which women and girls may face deprivation of liberty. These include: trafficking and sexual slavery; child and forced marriage; domestic violence; abusive forms of labor; refugee camps and reception centers for asylum-seekers; orphanages; nursing homes; and even women’s shelters. As you are aware, determining whether a person is being deprived of liberty requires a careful look at how restrictions on personal autonomy intersect with gender and other characteristics such as economic status, language and ability to communicate, ethnicity, disability, sexual orientation or gender identity, immigration status, age, and education level.

Characteristics of different types of deprivation of liberty of women and girls

Jails, prisons, juvenile detention and immigration detention

In addition to extensive research on abusive and unnecessary institutionalization of people with disabilities, detailed below, Human Rights Watch has also documented other circumstances in which women and girls have been unjustly deprived of liberty in violation of their rights.

These include detention of women’s rights activists in Saudi Arabia,[1] Sudan,[2] and China[3] for their political activities. In Iran, women have been jailed for protesting against compulsory dress codes. In Afghanistan,[4] Mauritania,[5] Sudan,[6] as well as in Gulf states and elsewhere we have documented the jailing of women and girls on charges of extra-marital sex, sometimes even when they report being raped. Pregnancy can serve as evidence. The reporting of rape itself can be deemed as an admission that sex took place, and women and girls may find themselves prosecuted if the authorities believe it was consensual and not rape. Consensual sex between adults should never be criminalized. In Afghanistan,[7] even when courts do not find evidence that a woman or girl engaged in sex, they sometimes get long prison sentences for the “crimes” of “attempted” extra-marital sex or “running away.”

Human Rights Watch has documented the consequences of the criminalization of abortion in many countries, including Ecuador,[8] Peru,[9] Kenya,[10] Argentina,[11] Mexico,[12] Nicaragua,[13] and Ireland.[14] Criminal penalties for abortion in many countries[15] around the world lead authorities to question, detain, and in some cases arrest and charge women and girls suspected of having abortions. Journalists and nongovernmental organizations in Brazil,[16] Mexico,[17] Nicaragua,[18] and the Dominican Republic,[19] among others, have documented cases of women and girls being reported to authorities, subjected to preventive detention, or sentenced to time in prison for suspected abortion-related crimes. In extreme cases, such as El Salvador,[20] even women and girls who seek medical attention for miscarriages have been sentenced to lengthy prison terms under laws that treat abortion as a crime.

Research[21] shows that many justice systems fail to give due consideration to mitigating factors in cases where women are accused of murdering their abusers, an issue Human Rights Watch has documented in countries including Kyrgyzstan[22] and Sudan.[23] Human Rights Watch is currently conducting research on the situation of women in prison in Japan, where there have been increasing reports of elderly women intentionally seeking imprisonment because they are so isolated and unserved in the community. In the United States[24] we have documented unduly harsh sentences for children convicted of crimes.

Migrants, refugees, and asylum seekers may be confined in a variety of facilities – including police stations, immigration or migration detention centers, refugee or displacement camps, and reception centers – upon arrival in a country and during reception or processing procedures. We have also documented the excessive use of immigration detention, including of children, by countries including Thailand,[25] the United States,[26] and Australia,[27] and the detention of suspected Islamic State (ISIS)-affiliated women and children in Iraq.[28] Immigration detention of children can also involve children being detained with unrelated[29] adults, a practice occurring in countries including Croatia, Greece, Indonesia, Italy, Malaysia, Malta, Mexico, overseas French territories, Saudi Arabia, Slovakia, and Yemen.

Detained women and girls have a right to humane conditions, and this right is often violated. Women and girls in prison often face particular abuses. Because there are usually fewer female prisoners than male prisoners in any given system, women’s facilities are often fewer, placing many women and girls far from family and friends and cutting them off from emotional support during detention and community ties necessary for successful community reintegration. Facilities for female prisoners may be starved of resources for similar reasons, an issue we documented in France. Female prisoners may face sexual abuse, including both assault and abusive virginity examinations, as Human Rights Watch documented in Afghanistan,[30] Australia,[31] and Egypt.[32] They may also be put at heightened risk of sexual violence due to abusive conditions in detention; Human Rights Watch recently documented women being held in cells with men not related to them while in immigration detention in Greece.[33]

Women and girls also often face violations of their reproductive rights while in detention. These abuses include denial of health care, an abuse we documented in Australia,[34] the US,[35] and elsewhere. They sometimes experience[36] abusive conditions during birth including shackling,[37] and being immediately separated from, or denied the ability to adequately care for, their babies. Women and girls deprived of liberty may experience additional difficulties in managing their menstruation.[38] Women in several immigration detention facilities in the United States[39] described arbitrary and humiliating limitations on access to sanitary pads.

Refugee camps, asylum-seeker reception centers

Some refugee camps and reception centers for asylum seekers prevent people from leaving and should be regarded as places of detention. Even where facilities permit people to exit and re-enter the site, restrictions on freedom of movement and lack of access to transportation or income often leave people virtually confined. Human Rights Watch has documented abusive conditions affecting women and girls in the refugee camps and reception centers for asylum seekers of countries including AustraliaBangladesh,[40] France,[41] Greece,[42] Italy,[43] Lebanon,[44] Sweden, and Tanzania.[45] Women and girls at these facilities have been housed–sometimes for several years--in insecure conditions, denied access to health and mental health care, including pre- and post-natal medical care, denied adequate provision of safe toilets and showers, and confined with unrelated men and boys. Such conditions contravene international standards and put women and girls at increased risk of sexual and gender-based violence.  Women and girls in these facilities told Human Rights Watch that they felt unsafe and that the conditions contributed to physical or mental health problems, including skin conditions, depression, anxiety, insomnia.

Armed conflict settings

In situations of internal armed conflict, women have been detained on suspicion of involvement with opposition forces, or simply having family ties to fighters, without due process protections. In Iraq,[46] authorities detained at least 1,400 foreign women and children who surrendered with Islamic State forces in August 2017, and in some cases prosecuted women for alleged ISIS membership in unfair trials.  In Nigeria,[47] the government has detained thousands of individuals, including women, for suspected involvement with Boko Haram without due process protections. In the context of armed conflict, women and girls are also sometimes detained for the purpose of sexual exploitation, as discussed below.

Trafficking and sexual slavery

Trafficked women and girls often experience a total deprivation of liberty. Human Rights Watch has two forthcoming reports on trafficking: trafficking of women and girls from Nigeria to Europe for exploitation as sex workers, domestic workers and agricultural workers; and trafficking of women and girls from Myanmar’s Kachin and northern Shan States for sale in China as “brides.” Both sets of research illustrate how profoundly victims are deprived of liberty. They are typically escorted closely by traffickers, often drugged during transit, and after arrival (and, sometimes, sale) held in prison-like conditions, under lock and key with no ability to communicate with the outside world. Conflict can exacerbate vulnerability to trafficking among women and girls and provide cover for traffickers.

Sexual slavery occurs both in conjunction with and separate from trafficking. Sexual slavery sometimes occurs in the context of armed conflict as Human Rights Watch documented in countries including the Central African Republic,[48] Iraq,[49] Kenya,[50] and Sierra Leone.[51] In northern Iraq,[52] ISIS forces abducted thousands of Yezidis, subjecting women and girls to organized rape and sexual assault, sexual slavery, and forced marriage by ISIS forces. Women and girls in these contexts have been held for periods of days, months, or even years, and were often subject to repeated rape, sometimes by multiple perpetrators. In many cases, they were also compelled to perform domestic work. Sexual slavery that Human Rights Watch documented was often accompanied by physical abuse that may amount to torture, including being beaten, whipped, tied up for prolonged periods, and threatened with death. In some contexts, we documented abuses associated with sexual slavery that amounted to war crimes or were part of crimes against humanity.

Child and forced marriage and domestic violence

Human Rights Watch has conducted extensive research on child marriage in countries including Afghanistan,[53] Bangladesh,[54] Malawi,[55] Nepal,[56] South Sudan,[57] Tanzania,[58] Yemen,[59] and Zimbabwe.[60] We consistently find that many young brides experience life in their in-laws’ home as a form of imprisonment. They are often subjected to rape, other forms of physical violence, and forced domestic or farm labor and often have little ability to escape. Their marital home may be far from their birth family, they may be denied freedom of movement, and even when they are able to seek help from their blood relatives, they may be refused help because they are seen as harming the honor of the family if they try to end a marriage. The payment of a dowry or bride price may also create financial incentives for their family to insist that the marriage continue, such as we documented in Malawi,[61] Papua New Guinea,[62] and South Sudan.[63]

Women also face forced marriage including to their rapists. There are a number of countries[64] with laws still on the books that allow for exoneration of those accused or convicted of kidnapping, assaulting or raping a woman or girl if they marry their victim. We reported that the Palestinian Authority[65] repealed this law, which applied to the West Bank, in 2018, yet families may continue to practice forced marriages of their female relatives particularly in cases where they have become pregnant from extra-marital sex or rape, because of stigma, the difficulty of registering children born outside of wedlock and the criminalization of abortion.

Human Rights Watch has also documented domestic violence in which women and girls have reported being confined to their homes, or suffered extreme restrictions to their freedom of movement. For instance, at least three women were reported to be prevented from returning to Spain where they have legal residency by their families in the Sahrawi refugee camps in Algeria. Physical, emotional and financial abuse can also leave women and girls trapped by their abusers--see for example our work on Morocco.[66] These abuses can be facilitated by laws requiring obedience to parents or husbands, lack of legal protections for domestic violence victims, and the failure of authorities to assist victims. In Saudi Arabia,[67] women and girls can be arrested and prosecuted for “parental disobedience” or other disobedience charges under the male guardianship system, including if they leave their family home without permission.

Abusive employment conditions

Some employment conditions are so abusive as to constitute deprivation of liberty. Several notorious incidents in which factory workers—primarily women—were killed, including the Rana Plaza disaster in Bangladesh[68] and the Ali Enterprises disaster in Pakistan,[69] happened under circumstances in which worker’s freedom of movement was curtailed in ways that led to their deaths.

Domestic workers, who sometimes include girls as young as 8 or 9-years-old, are vulnerable to being placed in positions where they face abuse and cannot leave. They often live in the same home as their employer, sometimes far from their families, and may lack a means to communicate with their family or to find their way or pay for transportation to get home in the event that they experience abuse. These vulnerabilities are heightened for child domestic workers. We have documented abuses against child domestic workers in countries including Indonesia,[70] Guinea,[71] and Morocco.[72]

When women and girls travel to another country for work, they may face extreme restrictions on their freedom of movement that can amount to deprivation of liberty. The Middle East’s Gulf region has an estimated 2.4 million migrant domestic workers, most from Asia and Africa. They fall under the abusive kafala (visa-sponsorship) system, not allowed to leave or change employers without their initial employer’s consent. If they do, they can be arrested and punished for “absconding” with fines, detention and deportation.

Isolating and harsh working conditions leave domestic workers vulnerable to sexual abuse. Human Rights Watch has extensively documented abuses against migrant domestic workers in many countries including Bahrain,[73] Kuwait,[74] Lebanon,[75] Malaysia,[76] Oman,[77] Saudi Arabia,[78] Singapore,[79] and United Arab Emirates.[80] Workers in many of these countries described abuses such as employers confiscating their passports, forcing them to work seven days a week, and forcibly confining them to their homes or residential compounds, making escape difficult. Some women said their employers restricted their communication for weeks or months, preventing them from seeking help from the outside world.

Many also described how they lived with little to no privacy–some sleeping on the floor of storage rooms or living rooms, or without locks or keys to their bedroom doors. The women who described sexual harassment and assault said that male family members groped them, exposed themselves, chased them around the house, and entered their rooms late at night. Several described rape and attempted rape.

Orphanages and other facilities for children

When children are held in institutional settings, they are at heightened risk of abuse, and girls may be particularly vulnerable in these settings. In addition to facilities for children with disabilities, detailed below, Human Rights Watch has documented abuses against children in institutional settings in countries including Armenia,[81] Greece,[82] Japan,[83] Russia,[84] and Senegal.[85]

Women’s shelters

Women’s shelters should be a refuge from abuse. But in some contexts, shelters themselves can become a form of deprivation of liberty, particularly when they are used by police as a place to hold women and girls who are facing criminal charges, or when women and girls are prevented from leaving for their own protection. In Afghanistan,[86] Human Rights Watch has documented efforts by the government to take over NGO-run shelters and to impose rules that would deprive women and girls of liberty and increase the risk of them again facing violence. In Saudi Arabia,[87] women who fled to shelters to escape abuse may be required to obtain permission from a male relative before they can leave state facilities. Women who have completed prison terms are always required to obtain this permission before leaving state custody. In Jordan,[88] women and girls seeking safety in shelters from family violence are placed in preventive detention and cannot leave unless their families pledge not to harm them or if they marry someone.

Recommendations to the Working Group

  • In the report, take a comprehensive view of what constitutes deprivation of liberty, including the settings described in this submission.
  • Begin discussions of a specific context in which women or girls are deprived of liberty with an analysis of whether there are women or girls who have been placed in this setting unjustly, or whether there are measures unexplored that might have rendered the deprivation of liberty unnecessary.
  • Advocate for decriminalization of consensual sex between adults and for laws that take into account adolescents’ evolving capacity and maturity to make decisions about engaging in sexual conduct for themselves, age differentials between those engaging in sexual activity, and the removal of inappropriate penalties.
  • Advocate that facilities that do not have deprivation of liberty as their core function—e.g. refugee camps and facilities, orphanages, shelters, etcetera—should limit the liberty of women and girls as little as possible and should do so only for legitimate reasons related to the safety of people residing in these facilities.
  • Advocate for gender-specific standards for all institutions depriving women and girls of liberty that recognize ways in which their needs may differ from that of men and boys, for example in regard to the types of services needed, including: health care, including sexual and reproductive health care such as pre and post-natal and obstetric care, abortion, and post-rape care; mental health care including trauma counselling; legal services; support for parenting; safe facilities such as toilets, showers, and changing rooms; menstrual hygiene supplies; substance abuse treatment; vocational training and job placement services; and pastoral care. Standards should also ensure that women and girls are not housed or confined with unrelated men and boys.
  • Advocate for women and girls to be allowed to leave police stations, detention centers, prisons, and shelter without a requirement that families or a male guardian receive them. 
  • Advocate for measures to assist women and girls deprived of liberty in non-institutional settings--for example at the hands of traffickers, through child and forced marriage, in domestic violence situations, and due to abusive conditions as a domestic worker. This should take the form of measures such as: legislation on domestic violence and trafficking to provide authorities with the power and duty to investigate and assist victims; legislation facilitating access to civil protection (restraining) orders against abusers; shelters and other accommodation assistance; setting and enforcing a minimum age of marriage of 18 without exceptions; criminalizing forced marriage; abolishing visa-sponsorship systems that tie migrant workers visas to their employers; institutional mechanisms to protect domestic workers from abusive conditions, such as monitoring and labor inspections; and online, media, and targeted community-based outreach, hotlines, and other measures.

Detention of Lesbian and Bisexual Women and Transgender People on the Basis of Sexual Orientation or Gender Identity

In many countries, women are at risk of detention by the authorities because of their real or perceived sexual orientation or gender identity. Even simple signs of affection between women can be interpreted as “lesbianism,” resulting in arrest and prosecution.

Arrests for Alleged Sexual Conduct

Laws in at least 34 countries explicitly criminalize same-sex conduct between women, while vague provisions in other countries’ laws may also result in arrests of women for same-sex relations. While many laws imposed under British colonialism around the world only punish sex between men, at least 10 jurisdictions around the world added laws to their books between 1986 and 2011 that criminalize sex between women.[89] Human Rights Watch has documented a number of arrests in the last five years of women and girls accused of consensual same-sex sexual conduct.

In Malaysia, Terengganu state Sharia (Islamic law) enforcement officials arrested two women in a car in April 2018 for allegedly having sex. Without legal representation, the two women pled guilty in a Sharia court in August and were sentenced to six strokes with a cane.[90] They were publicly caned in a courtroom in front of 100 people on September 3.

In Tanzania, four women were arrested in Geita in December 2017 after a video circulated on social media in which two of the women were kissing. Charges of “gross indecency between persons” remain pending in the Mwanza High Court.[91] In addition, several female activists were arrested and charged with “promotion of homosexuality” in October 2017 after participating in a workshop on strategic litigation and the right to health.[92]

In Morocco, two teenage girls aged 16 and 17 were arrested in November 2016 for allegedly kissing on the roof of a building in Marrakech. They were charged with committing a “lewd or unnatural act” with a person of the same sex, which carries a prison sentence of up to three years.[93] They were held in an adult prison for three days before being released on bail and were acquitted in December.

In Ghana, sex between women is not expressly criminalized. Nevertheless, in June 2016, police raided a football camp in Kumasi and arrested three participants based on rumors that they were lesbians. Although they were released the same day, the arrest had lasting consequences: the coach expelled the three women from the team, and when they returned home, their parents disowned them for “bringing shame” to their respective families. Another woman in Kumasi reported being detained with her partner at Suame Police Station in December 2014, after her partner’s mother reported them to the police. They were released three days later after paying a bribe.[94]

In Senegal, in November 2013, four women and one teenage girl were arrested for allegedly kissing at a birthday party in a Dakar restaurant and charged with “homosexual acts,” which carries a sentence of up to five years in prison. They were tried nine days later and acquitted for lack of evidence.[95]

Transgender women and men are often presumed to be homosexual and arrested under anti-homosexuality laws. Human Rights Watch has documented such arrests in Malawi,[96] Uganda,[97] and Sri Lanka,[98] among others.

Arrests for Gender Expression

Laws in at least six countries criminalize forms of gender expression, including “posing as” a different sex.

In Malaysia, arrests of transgender people take place frequently under state Sharia laws, which are enforced by state Islamic Religious Departments and are only applicable to Muslims, who make up approximately 60 percent of Malaysia’s population. While the language of such laws varies across Malaysia’s 13 states and 3 federal territories, most Sharia enactments contain provisions that prohibit “a man posing as a woman,” and three states similarly criminalize “a woman posing as a man.” As far as Human Rights Watch has been able to ascertain, despite the existence of some laws targeting transgender men (“women posing as men,” in the eyes of the Malaysian authorities), all arrests to date under these laws have targeted transgender women. Officers of the federal Royal Malaysia Police have also at times arrested transgender women under an overly vague provision of the secular federal criminal code that prohibits “public indecency” and applies to people of all religious backgrounds. Trans women in Malaysia reported to Human Rights Watch a number of cases in which police physically or sexually assaulted them in the course of arrest or while in detention.

Oman promulgated a new penal code in January 2018 that, for the first time, criminalizes any man who “appears dressed in women’s clothing.” Shortly thereafter, the first arrest of a transgender person took place under this law, and media reports suggest other transgender women may also have been arrested.

In the United Arab Emirates, in August 2017, police arrested a Singaporean transgender woman and a gay man in a shopping mall and charged them with "disguising” as women. Article 359 of the UAE’s federal penal code punishes “any male disguised in a female apparel and enters in this disguise a place reserved for women or where entry is forbidden, at that time, for other than women” with up to one year in prison and a fine; however, the two Singaporeans were not in a place reserved for women. They spent three weeks in prison before being deported to Singapore.[99]

In Kuwait, transgender activists have reported to Human Rights Watch that police regularly arrest and harass of transgender people under a law against “imitating the opposite sex in any way.”

Transgender Women in Immigration Detention

Human Rights Watch has also documented abuses of women in immigration detention in the United States. At any given time, dozens of transgender women, including asylum seekers who have come to the United States seeking protection from abuse in their home countries, are locked up in prison-like immigration detention centers across the country. Many have been subjected to sexual assault and ill-treatment in detention, including indefinite solitary confinement.[100]

Recommendations to the Working Group

The Working Group should urge governments to:

  • Decriminalize consensual same-sex relations.
  • Consider, while laws still criminalize same-sex relations, issuing moratoriums to end arrests and prosecutions under such laws.
  • Revoke all laws that criminalize gender expression, including laws that prohibit “posing as the opposite sex.”
  • Ensure that laws intended to protect women-only spaces are not implemented in a way that results in arrests and prosecutions of transgender women;
  • Ensure that transgender people in detention facilities are housed according to their expressed gender identity.
  • Identify alternatives to detention for asylum seekers, particularly those who may be vulnerable in detention settings for various reasons, including their sexual orientation or gender identity.
  • Monitor all detention settings to identify cases of abuse, either by guards or fellow detainees, against detainees based on their real or perceived sexual orientation or gender identity.
  • Establish complaint procedures that are safe and accessible for lesbian, bisexual and transgender detainees.

Deprivation of liberty and legal capacity of women and girls with disabilities, including older women

Human Rights Watch has done extensive research on the deprivation of liberty and deprivation of legal capacity of persons with disabilities, particularly women and girls with disabilities, in different contexts in a number of countries, including Australia,[101] Brazil,[102] Croatia,[103] India,[104] Indonesia,[105] and Serbia.[106]

Article 14 of the Convention on the Rights of Persons with Disabilities (CRPD)[107] prohibits unlawful or arbitrary detention and provides that the existence of a disability cannot be used as justification for the deprivation of liberty. In her 2012 report on violence against women with disabilities, the UN special rapporteur on violence against women, Rashida Manjoo, denounced forced institutionalization as a form of violence.[108]

While men and boys with disabilities also face abuses, existing gender inequalities and discrimination mean that women and girls may be particularly marginalized and vulnerable to unique forms of neglect or abuse. For example, because some families fear that girls with psychosocial or intellectual disabilities may become easy targets for sexual violence if at home, staff at a night shelter in Kolkata, India said families often prefer to leave their daughters in the custody of an institution where they feel they are safer.

According to the CRPD Committee, the denial of the legal capacity of persons with disabilities and their detention in institutions against their will, either without their consent or with the consent of someone making decisions on their behalf, constitutes an unlawful deprivation of liberty under the CRPD.[109] In many countries, women and girls with disabilities, especially those with psychosocial or intellectual disabilities, are placed in institutions without their informed consent and are denied legal capacity (or the right to make basic decisions for themselves).

Deprivation of liberty in institutions and denial of legal capacity

In India, Human Rights Watch found that due to stigma and the lack of community-based services, women and girls with psychosocial disabilities can be arbitrarily detained in psychiatric hospitals and institutions with no or limited judicial oversight.[110] In these institutions, they experience overcrowding and lack of hygiene, inadequate access to general healthcare, involuntary treatment – including electroconvulsive therapy – as well as physical, verbal, and sexual violence.

In Indonesia, more than 57,000 people with psychosocial disabilities have been subjected to pasung – shackled or locked up in confined space – at least once in their lives.[111] Due to prevalent stigma and the absence of adequate community-based support services or mental health care, women and girls with psychosocial disabilities often end up locked up in overcrowded and unsanitary institutions, without their consent, where they face abuses ranging from physical and sexual violence, and involuntary treatment, to seclusion, restraint and forced contraception.[112]

In Brazil, institution directors told Human Rights Watch that individuals with disabilities had been placed in an institution without asking for their consent, based solely on the consent of the legal guardian.[113] A 50-year-old woman with a physical disability told Human Rights Watch that she felt imprisoned in the institution where she had been for eight years due to the lack of opportunities to leave and live in the community: “This place is very bad, it is like a prison. I don’t want to stay here.”[114]

In Serbia and Croatia, Human Rights Watch documented that women with psychosocial or intellectual disabilities are often deprived of legal capacity and placed in institutions against their will, denying their right to live in the community.[115] In many institutions in both countries, rooms and buildings where women lived were routinely locked, they were not allowed to move freely without permission, institution staff exercised complete and effective control over a woman’s actions and movements, often even denying them the right to make own decisions about reproductive health.

Forced contraception and treatment

Sexual reproductive health care on the basis of informed consent was another concern documented in closed settings in a number of countries.

In Indonesia, Human Rights Watch visited government and private institutions where women and girls who were arbitrarily detained were administered contraception without their consent or knowledge.[116]

In Serbia, medical staff at three institutions told Human Rights Watch about invasive medical interventions conducted on young women with disabilities to prevent or terminate pregnancy and for cancer screening.[117] They acknowledged carrying out these procedures without the free and informed consent of these women but said their guardians had given consent.[118] Under Serbian law, healthcare providers do not need to obtain consent of a person who is stripped of legal capacity and placed under guardianship.[119] The interventions included the insertion of intrauterine devices (for birth control), administration of pap smear tests (Papanicolaou test, a screening procedure for cervical cancer), and termination of pregnancy. According to the staff, some women were put under general anaesthesia for some of the procedures to ensure they would not resist[120]—the use of general anaesthesia for these medical procedures is unusual and unnecessary.

In Bahia, Brazil, Human Rights Watch visited an institution for 87 persons with disabilities, all of whom were under guardianship. All female residents in the institution were given contraceptives without their consent.[121]

Abuses against women with disabilities in prison

Human Rights Watch documented the particular abuses against women with disabilities in prisons in Australia and France.

People with disabilities, including women, particularly indigenous women with disabilities, are overrepresented in prisons across Australia. Only 2 to 3 percent of Australian women are Aboriginal and yet they represent 35 percent of women in prison.[122]

Life behind bars is challenging for all but prisoners with disabilities, particularly women and girls with disabilities, often struggle more than others to adjust to the extraordinary stresses of incarceration and may be at a higher risk of violence and abuse. Moreover, evidence from Australia raises concerns that prison systems there do not provide female prisoners with equal access to intensive mental health care as their male counterparts.[123]

In all 14 Australian prisons visited while conducting research for its February 2018 report, Human Rights Watch found that prisoners with disabilities are viewed as easy targets and as a result are at serious risk of violence and abuse, including bullying and harassment, and verbal, physical, and sexual violence.[124] Some women with disabilities in prison reported experiencing sexual violence from other prisoners and prison officers with little or no accountability.

A lack of training to ensure staff understanding and sensitivity contributes to the frequent punishment of prisoners with disabilities who end up disproportionately represented in punishment units. A nurse manager in an Australian prison told Human Rights Watch, “Women with disabilities are overrepresented in punishment units. Some of the girls with mental health problems get sent ‘down the back’ [punishment units] because they’re seen as a management issue.”[125] Prisoners with a psychosocial or cognitive disability can spend weeks or months locked in solitary confinement in detention, crisis or safety units, for 22 hours or more a day.

Human Rights Watch found that female prisoners with psychosocial disabilities face particularly harsh conditions in French prisons.[126] Women in general, who are a minority in prison, are more restricted in their movements than men and have less access to treatment for mental health conditions than their male counterparts.

Women detained in a French prison with separate quarters for female and male prisoners described to Human Rights Watch how, unlike the men in the same facility, they had to be escorted in all their movements. As noted by the non-governmental organization International Observatory of Prisons (Observatoire International des Prisons, OIP), “the “women’s quarters in facilities that accommodate men and women are generally cut-off and isolated from the rest of the prison […] In facilities where men are incarcerated as well, [women] must be accompanied in all their movements.”[127]

Besides making them feel isolated, this gives women the sense that they are treated more harshly only because they are women. Female prisoners also face discrimination in their access to mental health care: while 26 Regional Medico Psychological Services (SMPR) in French prisons provide mental healthcare during the day and beds for the night, only one of them, in the prison of Fleury-Mérogis, has beds for women. As a result, women detained in other facilities only have the choice of receiving care by way of individual appointments in prison or hospitalization in a psychiatric hospital, and nothing in between.

Human Rights Watch also found that women incarcerated in the prisons it visited in France were at a disadvantage compared to men in terms of detention conditions, particularly access to vocational training and access to health care services. “The way women are treated isn’t equal to the way men are treated,” Yves Bidet, director of the prison for women in Rennes told Human Rights Watch. “There is less choice of vocational trainings. There isn’t much.”[128]

Older Women in Nursing Homes

Human Rights Watch has conducted research on the rights of older people in nursing homes in the US.  Older people now account for one in seven Americans; over 26 million are older women.[129] Many individuals in nursing facilities can be physically frail, have cognitive disabilities, and be isolated from their communities. Often, they are unable or not permitted to leave the facility alone. Many depend entirely on the institution’s good faith and have no realistic avenues to help or safety.[130] This may sometimes render the experience of persons, including women, residing in nursing homes akin to deprivation of liberty. Human Rights Watch documented the deprivation of legal capacity and excessive or premature use of proxies can completely exclude people from decisions that have major implications for their lives.[131] One particular area of concern is the administration of antipsychotic drugs, in nursing home residents sometimes without their informed consent. These drugs have a sedative effect and older residents, including women reported that they make it difficult for them to talk, think, and move.[132] 

Recommendations for the Working Group

Human Rights Watch recommends that the Working Group:

  • Include women with disabilities in the upcoming report on deprivation of liberty, recognizing institutionalization and involuntary hospitalization based on the existence of a disability as a form of discrimination, and institutionalization without consent of the individual or involuntary hospitalization based on the existence of a disability as a form of arbitrary detention.
  • Urge governments to:
    • Ensure that deprivation of liberty outside of the context of criminal detention requires a determination by an independent judicial authority, meeting due process, that is not based on the existence of a disability; but based on behavior that poses imminent actual harm to self or others , on an equal basis with others; and it should be limited to short periods of time as specified by law, and subject to continual full judicial review.
    • Amend or repeal all domestic legislation to ensure that persons with disabilities, including persons with age-related disabilities such as dementia, are guaranteed legal capacity, equal recognition before the law, have access to supported decision-making, freedom from discrimination, and protection from involuntary detention and treatment.
    • Require that medical treatment be provided on the basis of free and informed consent of the person receiving the treatment. Women with disabilities should be provided with the support they might need to exercise their right to free and informed consent to medical treatment. Any exceptions for provision of emergency medical treatment in life threatening or similarly serious situations should apply to all persons on an equal basis.
    • Ensure that reproductive health care services provided to women with disabilities, including medical interventions, are based on the free and informed consent of the person concerned, not their guardian. Provide women with disabilities with the support they might need to exercise their right to free and informed consent to medical intervention.
    • Support community-based mental health and support services for women with disabilities to realize their rights to live independently in their communities and with their rights to private and family life intact, rather than in institutions where many rights are at risk. Similarly support community-based services for older women to enable them to choose to live independently in their communities rather than in an institutional setting such as a nursing home out of necessity. Seek to strengthen community-based models of support instead of creating new or refurbished mental health or residential care institutions.
    • Introduce policies that ensure prisoners with disabilities cannot be held in solitary confinement.
  • Regularly screen prisoners for all types of disabilities upon entry into prison.
  • Adopt humane conditions of confinement and provide reasonable accommodations and respond appropriately to the particular support needs of prisoners with disabilities. Ensure prisoners with a disability, particularly women, have adequate access to support and mental health services.

 


[1] “Saudi Arabia: Free Right-to-Drive Activists,” Human Rights Watch news release, September 11, 2018, https://www.hrw.org/news/2018/09/11/saudi-arabia-free-right-drive-activists.

[2] Human Rights Watch, “Good Girls Don’t Protest”: Repression and Abuse of Women Human Rights Defenders, Activists, and Protesters in Sudan, March 23, 2016, https://www.hrw.org/report/2016/03/23/good-girls-dont-protest/repression...

[3] “China: Drop All Charges Against Feminist Activists,” Human Rights Watch news release, April 14, 2015, https://www.hrw.org/news/2015/04/14/china-drop-all-charges-against-feminist-activists.

[4] “Afghanistan: End ‘Moral Crimes’ Charges, ‘Virginity’ Tests,” Human Rights Watch news release, May 25, 2016, https://www.hrw.org/news/2016/05/25/afghanistan-end-moral-crimes-charges-virginity-tests.

[5] “Mauritania: Rape Survivors at Risk.” September 5, 2018, https://www.hrw.org/news/2018/09/05/mauritania-rape-survivors-risk.

[6] Jehanne Henry, “Dispatches: Sudan’s War on Women and Girls,” Human Rights Watch dispatch, October 12, 2015, https://www.hrw.org/news/2015/10/12/dispatches-sudans-war-women-and-girls.

[7] “Afghanistan: Surge in Women Jailed for ‘Moral Crimes’,” Human Rights Watch news release, May 21, 2013, https://www.hrw.org/news/2013/05/21/afghanistan-surge-women-jailed-moral-crimes.

[8] Human Rights Watch, Rape Victims as Criminals Illegal Abortion after Rape in Ecuador, August 2013, https://www.hrw.org/report/2013/08/23/rape-victims-criminals/illegal-abortion-after-rape-ecuador.

[9] “Peru: At-Risk Women Denied Legal Abortions,” Human Rights Watch news release, July 9, 2008, https://www.hrw.org/news/2008/07/09/peru-risk-women-denied-legal-abortions.

[10] Agnes Odhiambo, “Women Still Dying From Unsafe Abortions Despite the Law,” Daily Nation,

October 2, 2017, https://www.hrw.org/news/2017/10/02/women-still-dying-unsafe-abortions-d....

[11] Human Rights Watch, Illusions of Care Lack of Accountability for Reproductive Rights in Argentina, August 2010, https://www.hrw.org/report/2010/08/10/illusions-care/lack-accountability-reproductive-rights-argentina.

[12] Human Rights Watch, Mexico: The Second Assault Obstructing Access to Legal Abortion after Rape in Mexico, March 2016, https://www.hrw.org/report/2006/03/06/mexico-second-assault/obstructing-access-legal-abortion-after-rape-mexico.

[13] “Nicaragua: Blanket Ban on Abortion Harms Women,” Human Rights Watch news release, August 29, 2007, https://www.hrw.org/news/2007/08/29/nicaragua-blanket-ban-abortion-harms-women.

[14] “Ireland: Abortion Limits Violate Human Rights,” Human Rights Watch news release, January 28, 2010. https://www.hrw.org/news/2010/01/28/ireland-abortion-limits-violate-huma....

[15] “The World’s Abortion Laws 2018,” undated, http://worldabortionlaws.com/ (accessed September 16, 2018).

[16] “Brasil registra um processo por autoaborto todo dia,” Catarinas, May 3, 2018, http://catarinas.info/brasil-registra-um-processo-por-autoaborto-todo-dia/#_ftn1 (accessed September 26, 2018).

[17] “Maternidad o castigo. La criminalización del aborto en Mexico,” undated, http://criminalizacionporaborto.gire.org.mx/#/ (accessed September 26, 2018).

[18] “Nicaragua: Abortion Ban Threatens Health and Lives,” Human Rights Watch news release, July 31, 2017, https://www.hrw.org/news/2017/07/31/nicaragua-abortion-ban-threatens-health-and-lives.

[19] San Jose de Ochoa, “Imponen tres meses de prisión a mujer se habría provocado aborto,” Listin Diario, February 18, 2018, 1https://listindiario.com/la-republica/2018/02/18/503212/imponen-tres-meses-de-prision-a-mujer-se-habria-provocado-aborto (accessed September 26, 2018).

[20] Elisabeth Malkin, “They Were Jailed for Miscarriages. Now, Campaign Aims to End Abortion Ban,” New York Times, April 9, 2018, https://www.nytimes.com/2018/04/09/world/americas/el-salvador-abortion.html (accessed September 26, 2018).

[21] “Women who kill in response to domestic violence: how do criminal justice systems respond?” Linklaters, 2016, https://s16889.pcdn.co/wp-content/uploads/2016/04/Women_who_kill_in_response_to_domestic_violence_Full_report.pdf (accessed September 26, 2018). 

[22] Human Rights Watch, “Call Me When He Tries to Kill You”: State Response to Domestic Violence in Kyrgyzstan, Oct. 28, 2015, https://www.hrw.org/report/2015/10/28/call-me-when-he-tries-kill-you/sta... (accessed Sept. 26, 2018).

[23] Jehanne Henry, “Sudan’s Many Nouras,” Human Rights Watch dispatch, May 15, 2018, https://www.hrw.org/news/2018/05/15/sudans-many-nouras.

[24] “California: New Laws Protect Children, Youth,” Human Rights Watch news release, October 11, 2017, https://www.hrw.org/news/2017/10/11/california-new-laws-protect-children-youth.

[25] Human Rights Watch, Two Years With No Moon Immigration: Detention of Children in Thailand, September 2014, https://www.hrw.org/report/2014/09/01/two-years-no-moon/immigration-detention-children-thailand.

[26] Human Rights Watch, In the Freezer Abusive Conditions for Women and Children in US Immigration Holding Cells, February 2018, https://www.hrw.org/report/2018/02/28/freezer/abusive-conditions-women-and-children-us-immigration-holding-cells.

[27] “Australia: New Video on Cruel ‘Offshore Processing’ Policy,” Human Rights Watch news release, July 17, 2018, https://www.hrw.org/news/2018/07/18/australia-new-video-cruel-offshore-processing-policy. “

[28] Belkis Wille, “ISIS’s Other Victims,” Human Rights Watch commentary, October 9, 2017, https://www.hrw.org/news/2017/10/09/isiss-other-victims.

[29] “The Impact of Immigration Detention on Children,” Human Rights Watch commentary, September 29, 2013, https://www.hrw.org/news/2013/09/29/impact-immigration-detention-children.

[30] Heather Barr, “A Step Toward Ending 'Virginity Exams' in Afghanistan,” Human Rights Watch dispatch, July 10, 2018, https://www.hrw.org/news/2018/07/10/step-toward-ending-virginity-exams-afghanistan.

[31] Human Rights Watch, “I Needed Help, Instead I Was Punished” Abuse and Neglect of Prisoners with Disabilities in Australia, February 2018, https://www.hrw.org/report/2018/02/06/i-needed-help-instead-i-was-punished/abuse-and-neglect-prisoners-disabilities.

[32] “Egypt: Military ‘Virginity Test’ Investigation a Sham,” Human Rights Watch news release, November 9, 2011, https://www.hrw.org/news/2011/11/09/egypt-military-virginity-test-investigation-sham.

[33] “Greece: Asylum-Seeking Women Detained with Men,” Human Rights Watch news release, June 7, 2018, https://www.hrw.org/news/2018/06/07/greece-asylum-seeking-women-detained-men.

[34] Human Rights Watch, “I Needed Help, Instead I Was Punished” Abuse and Neglect of Prisoners with Disabilities in Australia, February 2018, https://www.hrw.org/report/2018/02/06/i-needed-help-instead-i-was-punished/abuse-and-neglect-prisoners-disabilities.

[35] Human Rights Watch, In the Freezer Abusive Conditions for Women and Children in US Immigration Holding Cells, February 2018, https://www.hrw.org/report/2018/02/28/freezer/abusive-conditions-women-and-children-us-immigration-holding-cells.

[36] “II. Life Behind Bars for People with Disabilities,” Human Rights Watch, “I Needed Help, Instead I Was Punished” Abuse and Neglect of Prisoners with Disabilities in Australia.

[37] Meghan Rhoad, “Giving Birth in Shackles,” Human Rights Watch commentary, May 27, 2009, https://www.hrw.org/news/2009/05/27/giving-birth-shackles.

[38] Human Rights Watch, “Going to the Toilet When You Want” Sanitation as a Human Right, April 2017, https://www.hrw.org/report/2017/04/19/going-toilet-when-you-want/sanitation-human-right.

[39] Human Rights Watch, Detained and Dismissed Women’s Struggles to Obtain Health Care in United States Immigration Detention, 2009, https://www.hrw.org/sites/default/files/reports/wrd0309web_1.pdf.

[40] Human Rights Watch, “All of My Body Was Pain:” Sexual Violence against Rohingya Women and Girls in Burma, November 2017, https://www.hrw.org/report/2017/11/16/all-my-body-was-pain/sexual-violence-against-rohingya-women-and-girls-burma.

[41] Michael Garcia Bochenek, “What Is Happening To The Children Of The Calais 'Jungle'?” Human Rights Watch commentary, October 26, 2016, https://www.hrw.org/news/2016/10/26/what-happening-children-calais-jungle.

[42] Hillary Margolis, “Misery for Women and Girls in Greece’s Island Paradise,” Human Rights Watch dispatch, February 14, 2018, https://www.hrw.org/news/2018/02/14/misery-women-and-girls-greeces-island-paradise.

[43] Hillary Margolis, “When Rape Survivors Can’t Ask for Help,” Human Rights Watch commentary, July 5, 2017, https://www.hrw.org/news/2017/07/05/when-rape-survivors-cant-ask-help.

[44] “Lebanon: Women Refugees From Syria Harassed, Exploited,” Human Rights Watch news release, November 26, 2013, https://www.hrw.org/news/2013/11/26/lebanon-women-refugees-syria-harassed-exploited.

[45] “Burundi: Gang Rapes by Ruling Party Youth,” Human Rights Watch news release, July 27, 2016, https://www.hrw.org/news/2016/07/27/burundi-gang-rapes-ruling-party-youth (accessed Sept. 26, 2018).

[46] “Iraq/KRG: 1,400 Women, Children From ISIS Areas Detained,” Human Rights Watch news release, September 20, 2017, https://www.hrw.org/news/2017/09/20/iraq/krg-1400-women-children-isis-areas-detained.

[47] “Nigeria: Flawed Trials of Boko Haram Suspects,” Human Rights Watch news release, September 17, 2018, https://www.hrw.org/news/2018/09/17/nigeria-flawed-trials-boko-haram-suspects.

[48] “Central African Republic: Sexual Violence as Weapon of War,” Human Rights Watch news release, October 5, 2017, https://www.hrw.org/news/2017/10/05/central-african-republic-sexual-violence-weapon-war.

[49] Skye Wheeler, “Why has the World Forgotten Islamic State's Female Sex Slaves?” Human Rights Watch commentary, April 14, 2016, https://www.hrw.org/news/2016/04/14/why-has-world-forgotten-islamic-states-female-sex-slaves.

[50] Human Rights Watch, “I Just Sit and Wait to Die” Reparations for Survivors of Kenya’s 2007-2008 Post-Election Sexual Violence, February 2016, https://www.hrw.org/report/2016/02/15/i-just-sit-and-wait-die/reparations-survivors-kenyas-2007-2008-post-election.

[51] “Sierra Leone: Sexual Violence Widespread in War,” Human Rights Watch news release, January 16, 2003, https://www.hrw.org/news/2003/01/16/sierra-leone-sexual-violence-widespread-war.

[52] “Iraq: ISIS Escapees Describe Systematic Rape,” Human Rights Watch news release, April 14, 2015, https://www.hrw.org/news/2015/04/14/iraq-isis-escapees-describe-systematic-rape.

[53] “Afghanistan: Child Marriage, Domestic Violence Harm Progress,” Human Rights Watch news release, September 4, 2013, https://www.hrw.org/news/2013/09/04/afghanistan-child-marriage-domestic-violence-harm-progress.

[54] Human Rights Watch, Marry Before Your House is Swept Away: Child Marriage in Bangladesh, May 2015, https://www.hrw.org/report/2015/06/09/marry-your-house-swept-away/child-marriage-bangladesh.

[55] Human Rights Watch, "I've Never Experienced Happiness": Child Marriage in Malawi, March 6, 2014. https://www.hrw.org/report/2014/03/06/ive-never-experienced-happiness/ch...

[56] Human Rights Watch, “Our Time to Sing and Play” Child Marriage in Nepal, September 2016, https://www.hrw.org/report/2016/09/08/our-time-sing-and-play/child-marriage-nepal.

[57] Human Rights Watch, "This Old Man Can Feed Us, You Will Marry Him" Child and Forced Marriage in South Sudan, March 2013, https://www.hrw.org/report/2013/03/07/old-man-can-feed-us-you-will-marry-him/child-and-forced-marriage-south-sudan.

[58] Human Rights Watch, No Way Out: Child Marriage and Human Rights Abuses in Tanzania, October 2014, https://www.hrw.org/report/2014/10/29/no-way-out/child-marriage-and-human-rights-abuses-tanzania.

[59] “Yemen: End Child Marriage,” Human Rights Watch news release, April 27, 2014, https://www.hrw.org/news/2014/04/27/yemen-end-child-marriage.

[60] “Zimbabwe: Scourge of Child Marriage,” Human Rights Watch news release, November 25, 2015 https://www.hrw.org/news/2015/11/25/zimbabwe-scourge-child-marriage.

[61] Human Rights Watch, "I've Never Experienced Happiness": Child Marriage in Malawi, March 6, 2014. https://www.hrw.org/report/2014/03/06/ive-never-experienced-happiness/ch...

[62] Human Rights Watch, Bashed Up. Family Violence in Papua New Guinea, November 2015, https://www.hrw.org/report/2015/11/04/bashed/family-violence-papua-new-guinea.

[63] Human Rights Watch, "This Old Man Can Feed Us, You Will Marry Him" Child and Forced Marriage in South Sudan, March 2013, https://www.hrw.org/report/2013/03/07/old-man-can-feed-us-you-will-marry-him/child-and-forced-marriage-south-sudan.

[64] Rothna Begum, “Middle East on a Roll to Repeal 'Marry the Rapist' Laws,” Human Rights Watch commentary, August 24, 2017, https://www.hrw.org/news/2017/08/24/middle-east-roll-repeal-marry-rapist-laws.

[65] “Palestine: ‘Marry-Your-Rapist’ Law Repealed,” Human Rights Watch news release, May 10, 2018, https://www.hrw.org/news/2018/05/10/palestine-marry-your-rapist-law-repealed.

[66] “Morocco: Tepid Response on Domestic Violence,” Human Rights Watch news release, February 15, 2016, https://www.hrw.org/news/2016/02/15/morocco-tepid-response-domestic-violence.

[67] Human Rights Watch, Boxed In: Women and Saudi Arabia’s Male Guardianship System, July 2016, https://www.hrw.org/report/2016/07/16/boxed/women-and-saudi-arabias-male-guardianship-system.

[68] Tejshree Thapa, “Remember Rana Plaza,” Human Rights Watch dispatch, April 24, 2018, https://www.hrw.org/news/2018/04/24/remember-rana-plaza.

[69] Aruna Kashyap, “When Clothing Labels Are a Matter of Life or Death,” Human Rights Watch commentary, May 2, 2018, https://www.hrw.org/news/2018/05/02/when-clothing-labels-are-matter-life-or-death.

[70] Human Rights Watch, Workers in the Shadows. Abuse and Exploitation of Child Domestic Workers in Indonesia, September 2000, https://www.hrw.org/report/2009/02/11/workers-shadows/abuse-and-exploitation-child-domestic-workers-indonesia.

[71] Human Rights Watch, Bottom of the Ladder. Exploitation and Abuse of Girl Domestic Workers in Guinea, June 2007, https://www.hrw.org/report/2007/06/15/bottom-ladder/exploitation-and-abuse-girl-domestic-workers-guinea.

[72] Human Rights Watch, Lonely Servitude. Child Domestic Labor in Morocco, November 2012, https://www.hrw.org/report/2012/11/15/lonely-servitude/child-domestic-labor-morocco.

[73] “Bahrain: Labor Reforms a Major Advance,” Human Rights Watch news release, May 13, 2009, https://www.hrw.org/news/2009/05/13/bahrain-labor-reforms-major-advance.

[74] “Kuwait: For Abused Domestic Workers, Nowhere to Turn,” Human Rights Watch news release, October 6, 2010, https://www.hrw.org/news/2010/10/06/kuwait-abused-domestic-workers-nowhere-turn.

[75] “Lebanon: Judiciary Failing to Protect Domestic Workers,” Human Rights Watch news release, September 16, 2010, https://www.hrw.org/news/2010/09/16/lebanon-judiciary-failing-protect-domestic-workers.

[76] Human Rights Watch, “They Deceived Us at Every Step.” Abuse of Cambodian Domestic Workers Migrating to Malaysia, October 2011, https://www.hrw.org/report/2011/10/31/they-deceived-us-every-step/abuse-cambodian-domestic-workers-migrating-malaysia.

[77] “Tanzania: Migrant Domestic Workers in Oman, UAE Abused,” Human Rights Watch news release, November 14, 2017, https://www.hrw.org/news/2017/11/14/tanzania-migrant-domestic-workers-oman-uae-abused.

[78] “Saudi Arabia: A Step to Aid Migrant Workers,” Human Rights Watch news release, April 10, 2012, https://www.hrw.org/news/2012/04/10/saudi-arabia-step-aid-migrant-workers.

[79] “Singapore: New Contract Shortchanges Domestic Workers,” Human Rights Watch news release, July 21, 2006, https://www.hrw.org/news/2006/07/21/singapore-new-contract-shortchanges-domestic-workers.

[80] “UAE: Proposed Law to Benefit Domestic Workers,” Human Rights Watch news release, May 11, 2012, https://www.hrw.org/news/2012/05/11/uae-proposed-law-benefit-domestic-workers.

[81] “Armenia: Children Isolated, Needlessly Separated from Families,” Human Rights Watch news release, February 22, 2017, https://www.hrw.org/news/2017/02/22/armenia-children-isolated-needlessly-separated-families.

[82] Human Rights Watch, “Why Are You Keeping Me Here?” Unaccompanied Children Detained in Greece, September 2016, https://www.hrw.org/report/2016/09/08/why-are-you-keeping-me-here/unaccompanied-children-detained-greece.

[83] ‘Japan: Children in Institutions Denied Family Life,” Human Rights Watch news relase, May 1, 2014, https://www.hrw.org/news/2014/05/01/japan-children-institutions-denied-family-life.

[84] Kaitlin Martin, “Children in Russian Orphanage Allege Rape’” Human Rights Watch dispatch, March 5, 2018, https://www.hrw.org/news/2018/03/05/children-russian-orphanage-allege-rape.

[85] “Senegal: New Steps to Protect Talibés, Street Children,” Human Rights Watch news release, July 28, 2016, https://www.hrw.org/news/2016/07/28/senegal-new-steps-protect-talibes-st....

[86] Heather Barr, “No Shelter in Afghanistan,” Human Rights Watch dispatch, March 19, 2018, https://www.hrw.org/news/2018/03/19/no-shelter-afghanistan.  

[87] Human Rights Watch, Boxed In.

[88] Rothna Begum, “How to End 'Honor' Killings in Jordan,” Human Rights Watch commentary, April 3, 2017, https://www.hrw.org/news/2017/04/03/how-end-honor-killings-jordan.

[89] Human Dignity Trust, Breaking the Silence: Criminalisation of Lesbians and Bisexual Women and its Impacts, May 2016, http://www.humandignitytrust.org/uploaded/Library/Other_Material/Breakin... (accessed September 25, 2018).

[90] Human Rights Watch, “Malaysia: Two Women Face Caning for Same-Sex Conduct,” August 21, 2018, https://www.hrw.org/news/2018/08/21/malaysia-two-women-face-caning-same-....

[91] Email communication to Human Rights Watch from Tanzanian attorney, September 25, 2018.

[92] Wendy Isaack, Facing Prosecution for Challenging HIV Policies in Tanzania,” October 20, 2017, https://www.hrw.org/news/2017/10/20/facing-prosecution-challenging-hiv-policies-tanzania.

[93] Human Rights Watch, “Morocco: Drop Homosexuality Charges Against Teenage Girls,” November 25, 2016, https://www.hrw.org/news/2016/11/25/morocco-drop-homosexuality-charges-against-teenage-girls.

[94] Human Rights Watch, “No Choice but to Deny Who I Am: Violence and Discrimination Against LGBT People in Ghana,” January 8, 2018, https://www.hrw.org/report/2018/01/08/no-choice-deny-who-i-am/violence-a....

[95] Robbie Corey-Boulet, “Accused Lesbians in Senegal Freed for Lack of Evidence,” VOA, November 20, 2013, https://www.voanews.com/a/accused-lesbians-in-Senegal-freed-for-lack-of-... (accessed September 26, 2018).

[96] Forthcoming Human Rights Watch report.

[97]Amnesty International and Human Rights Watch, “Uganda: Anti-Homosexuality Act’s Heavy Toll,” May 14, 2014, https://www.hrw.org/news/2014/05/14/uganda-anti-homosexuality-acts-heavy....

[98] Human Rights Watch, ”All Five Fingers are Not the Same”: Discrimination on Grounds of Gender Identity and Sexual Orientation in Sri Lanka,” August 15, 2016, https://www.hrw.org/report/2016/08/15/all-five-fingers-are-not-same/discrimination-grounds-gender-identity-and-sexual.

[99] Human Rights Watch, ”United Arab Emirates: Stop Policing Gender Expression,” September 7, 2017, https://www.hrw.org/news/2017/09/07/uae-stop-policing-gender-expression.

[100] Human Rights Watch, ”Do You See How Much I’m Suffering Here?”; Abuse against Transgender Women in US Immigration Detention,” March 23, 2016, https://www.hrw.org/report/2016/03/23/do-you-see-how-much-im-suffering-h....

[101] Human Rights Watch, “I Needed Help, Instead I Was Punished” Abuse and Neglect of Prisoners with Disabilities in Australia.

[102] Human Rights Watch, “They Stay until They Die” A Lifetime of Isolation and Neglect in Institutions for People with Disabilities in Brazil, May 2018, https://www.hrw.org/report/2018/05/23/they-stay-until-they-die/lifetime-isolation-and-neglect-institutions-people.

[103] “Croatia: Locked Up and Neglected,” Human Rights Watch news release, October 6, 2014, https://www.hrw.org/news/2014/10/06/croatia-locked-and-neglected.

[104] Human Rights Watch, “Treated Worse than Animals” Abuses against Women and Girls with Psychosocial or Intellectual Disabilities in Institutions in India, December 2014, https://www.hrw.org/report/2014/12/03/treated-worse-animals/abuses-against-women-and-girls-psychosocial-or-intellectual.

[105] Human Rights Watch, Living in Hell. Abuses against People with Psychosocial Disabilities in Indonesia, March 2016, https://www.hrw.org/report/2016/03/20/living-hell/abuses-against-people-psychosocial-disabilities-indonesia.

[106] Human Rights Watch, “It is My Dream to Leave This Place” Children with Disabilities in Serbian institutions, June 2016,  https://www.hrw.org/report/2016/06/08/it-my-dream-leave-place/children-disabilities-serbian-institutions.

[107] Convention on the Rights of Persons with Disabilities (CPRD), adopted December 13, 2006, G.A. Res. 61/106, annex I, U.N. GAOR, 61st Sess., (No. 49) at 65, U.N. Doc A/61/49 (2006), entered into force May 3, 2008

[108] UN Commission on Human Rights, Report of the Special Rapporteur on Violence against Women, Rashida Manjoo, Report of the Special Rapporteur on violence against women, its causes and consequences, A/67/227, August 3, 2012, http://www.ohchr.org/Documents/Issues/Women/A.67.227.pdf (accessed December 10, 2013), para. 38.

[109] “The denial of the legal capacity of persons with disabilities and their detention in institutions against their will, either without their consent or with the consent of a substitute decision-maker, is an ongoing problem. This practice constitutes arbitrary deprivation of liberty and violates articles 12 and 14 of the Convention.” UN CPRD Committee, Committee General Comment No. 1, UN Doc CRPD/C/GC/1, May 19, 2014, para. 40..

[110] There is judicial oversight for court-ordered admissions but the woman cannot effectively appeal because she is considered to be of unsound mind. In cases where families admit their relatives, there is no judicial oversight at all unless the duration of stay extends 90 days.

[111] Human Rights Watch, Living in Hell: Abuses against People with Psychosocial Disabilities in Indonesia, March 2016, https://www.hrw.org/report/2016/03/20/living-hell/abuses-against-people-....

[112] Ibid.

[113] Human Rights Watch, “They Stay until They Die”: A Lifetime of Isolation and Neglect in Institutions for People with Disabilities in Brazil, May 2018, https://www.hrw.org/report/2018/05/23/they-stay-until-they-die/lifetime-....

[114] Human Rights Watch interview with Carolina [not her real name], near Brasilia, November 18, 2016.

[115] Human Rights Watch, “It is My Dream to Leave This Place”: Children with Disabilities in Serbian institutions, June 2016, https://www.hrw.org/report/2016/06/08/it-my-dream-leave-place/children-d... Human Rights Watch, Croatia: Locked Up and Neglected, Meager Progress on Moving People With Disabilities Into the Community, October 2014, https://www.hrw.org/news/2014/10/06/croatia-locked-and-neglected.

[116] Human Rights Watch visits to Panti Social Bina Laras Dharma Guna, Bengkulu, November 14, 2014; Phalla Marta Rehabilitation Center, Sukabumi, November 7, 2014.

[117] Human Rights Watch, “It is My Dream to Leave This Place.”

[118] Human Rights Watch interview with medical doctor in Stamnica Home for children and adults with disabilities, October 21, 2015; Human Rights Watch interview with medical doctor in the Institution for children and adults with disabilities in Veternik, October 20, 2015; Human Rights Watch interview with a medical doctor, Sremčica Home for children and adults with disabilities, November 16, 2015. The staff in all three institutions did not provide Human Rights Watch with the exact number of young women who were subjected to these treatments.

[119] Human Rights Watch interview with medical doctor in Stamnica Home for children and adults with disabilities, October 21, 2015; Human Rights Watch interview with medical doctor in the Institution for children and adults with disabilities in Veternik, October 20, 2015, Human Rights Watch interview with a medical doctor, Sremčica Home for children and adults with disabilities, November 16, 2015. The staff in all three institutions did not provide Human Rights Watch with the exact number of young women who were subjected to these treatments.

[120] Ibid.

[121] Human Rights Watch interview with institution staff, Bahia, April 5, 2017.

[122] Elizabeth McEntyre, “How Aboriginal women with disabilities are set on a path into the criminal justice system,” The Conversation, November 13, 2015, https://theconversation.com/how-aboriginal-women-with-disabilities-are-s... [accessed January 15, 2017].

[123] VCOSS, “Request for a Systematic Review of Discrimination Against Women in Victorian Prisons,” http://vcoss.org.au/document/request-for-a-systemic-review-of-discrimina... (accessed April 12, 2017).

[124] Human Rights Watch, “I Needed Help, Instead I Was Punished”: Abuse and Neglect of Prisoners with Disabilities in Australia, February 2018, https://www.hrw.org/report/2018/02/06/i-needed-help-instead-i-was-punish....

[125] Human Rights Watch interview with a nurse (name and details withheld by Human Rights Watch).

[126] Human Rights Watch, Double Punishment: Inadequate Conditions for Prisoners with Psychosocial Disabilities in France, April 2016, https://www.hrw.org/report/2016/04/05/double-punishment/inadequate-condi....

[127] International Observatory of Prisons, March 8 – International Women’s Rights’ Day – Incarcerated women: a minority discriminated against in the prison institution, March 8, 2015, http://www.oip.org/index.php/publications-et-ressources/actualites/1185-....

[128] Human Rights Watch interview with Yves Bidet, director of the prison for women in Rennes, Rennes, April 16, 2015. 

[129] Human Rights Watch, They Want Docile, February 2018, https://www.hrw.org/report/2018/02/05/they-want-docile/how-nursing-homes-united-states-overmedicate-people-dementia. p. 16

[130] Human Rights Watch, They Want Docile, February 2018, https://www.hrw.org/report/2018/02/05/they-want-docile/how-nursing-homes-united-states-overmedicate-people-dementia. p. 2

[131] Human Rights Watch, They Want Docile, February 2018, https://www.hrw.org/report/2018/02/05/they-want-docile/how-nursing-homes-united-states-overmedicate-people-dementia. p. 59

[132] Human Rights Watch, They Want Docile, February 2018, https://www.hrw.org/report/2018/02/05/they-want-docile/how-nursing-homes-united-states-overmedicate-people-dementia. p. 35

Posted: January 1, 1970, 12:00 am

“I want to be a citizen just like any other,” Maria Alejandra Villanueva, a young Peruvian woman with Down Syndrome, told my Human Rights Watch colleagues seven years ago.

Thanks to groundbreaking legal reforms adopted this month in Peru, people with disabilities, like Maria Alejandra, are significantly closer to realizing that dream of becoming full citizens.

Prejudice and stigma are easily recognized as major contributors to discrimination against and exclusion of people with disabilities, especially for people who have intellectual or learning disabilities. And often, the law is also to blame.

In my work as a disability rights advocate I still encounter laws that describe people with disabilities as incapable or worse: "imbeciles," "idiots," or "mentally retarded." The harm from many laws goes even further by preventing many people with certain types of disabilities from making essential, personal decisions – like getting married, voting in an election, renting an apartment or opening a bank account. Many states instead appoint a guardian to make all such decisions for a person with a disability.

Peru has now taken a bold step to end this legal exclusion of people with disabilities. After eight years of debates involving legislators, disabled people’s organizations, the ombudsman, human rights experts and independent groups, President Martin Vizcarra signed into law a comprehensive bill that unequivocally recognizes every individual, regardless of disability or supposed “mental capacity” as equal and holding the same rights as every other person. Under the new law, signed this month, every individual has equal and full legal capacity, or the right to make decisions for themselves.  

Peru’s reforms also include a system of support for people with disabilities in making important decisions, if they would like such assistance. This can be help in understanding legal decisions and their consequences. Importantly, support in decision-making does not mean legal representation, or that someone else gets to make their decisions. The person requesting support defines the scope, duration and purpose that assistance will have.

In exceptional cases, after real, considerable and pertinent efforts have been made, it is not possible to determine the person’s will, a judge can appoint someone close to the individual who will provide support based on the best possible understanding of that person's will and preferences. In that role, the supporter can draw on things like their understanding of an individual’s history and past decisions. There are safeguards in place to prevent abuse, coercion or other inappropriate influence. Significantly, the reform moves away entirely from infantilizing and patronizing perspectives that consider people with disabilities as people who must always be cared for and sheltered. It’s an example of support in decision-making that also aims to allow people the freedom to make mistakes and experience risk.

Peru’s legal capacity reform honors individual autonomy and the dignity of all people with disabilities equally. People like Maria Alejandra, who wanted the same rights as everyone else – to vote, to have a job, to her inheritance – now have those rights. Millions like her are waiting for their countries in Latin America and around the world to follow suit. If Peru can do it, so can Mexico, Colombia, Brazil and others.

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