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

(New York) – The latest revisions to China’s Criminal Law impose up to seven years in prison for “spreading rumors” about disasters, Human Rights Watch said today. The revised law, which took effect November 1, 2015, does not clarify what constitutes a “rumor,” heightening concerns that the provision will be used to curtail freedom of speech, particularly on the Internet.

“The revised Criminal Law adds a potent weapon to the Chinese government’s arsenal of punishments against netizens, including those who simply share information that departs from the official version of events,” said Sophie Richardson, China director at Human Rights Watch. “The authorities are once again criminalizing free speech on the Internet, which has been the Chinese people’s only relatively free avenue for expressing themselves.”

The National People’s Congress Standing Committee approved the addition of a provision to article 291(1) of the Criminal Law (Criminal Law Amendment Act (9)), which states that whoever “fabricates or deliberately spreads on media, including on the Internet, false information regarding dangerous situations, the spread of diseases, disasters and police information, and who seriously disturb social order” would face prison sentences – with a maximum of seven years for those whose rumors result in “serious consequences.” The vagueness of the provision means that individuals doing nothing more than asking questions or reposting information online about reported local disasters could be subject to prosecution.

In the past, the Chinese government has detained netizens who questioned official casualty figures or who had published alternative information about disasters ranging from SARS in 2003 to the Tianjin chemical blast in 2015, under the guise of preventing “rumors.”

The revision was made in the context of a wider effort to rein in online freedom since President Xi Jinping came to power in 2013:

  • In August 2013, the authorities waged a campaign against “online rumors” that included warning Internet users against breaching “seven bottom lines” in their Internet postings, taking into custody the well-known online commentator Charles Xue, and closing popular “public accounts” on the social media platform “WeChat” that report and comment on current affairs;
  • In September 2013, the Supreme People’s Court and the Supreme People’s Procuratorate (the state prosecution) issued a judicial interpretation making the crimes of defamation, creating disturbances, illegal business operations, and extortion applicable to expressions in cyberspace. The first netizen who was criminally prosecuted after this took effect was well-known blogger Qin Huohuo, who was sentenced to three years in prison in April 2014 for allegedly defaming the government and celebrities by questioning whether they were corrupt or engaged in other dishonest behavior;
  • In July and August 2014, authorities suspended popular foreign instant messaging services, including KakaoTalk, claiming the service was being used for “distributing terrorism-related information”;
  • In 2015, government agencies such as the State Internet Information Office issued multiple new directives, including tightening restrictions over the use of usernames and avatars, and requiring writers of online literature in particular to register with their real names;
  • In 2015, the government has also shut down or restricted access to Virtual Private Networks (VPNs), which many users depend on to access content blocked to users inside the country and also help shield user privacy;
  • In March 2015, authorities also deployed a new cyber weapon, the “Great Cannon,” to disrupt the services of GreatFire.org, an organization that works to document China’s censorship and facilitate access to information;
  • In July 2015, the government published a draft cybersecurity law that will requires domestic and foreign Internet companies to increase censorship on the government’s behalf, register users’ real names, localize data, and aid government surveillance; and
  • In August 2015, the government announced that it would station police in major Internet companies to more effectively prevent “spreading rumors” online.
     

Activists in China are regularly prosecuted for speech-related “crimes,” Human Rights Watch said. The best known of these crimes is “inciting subversion,” which carries a maximum of 15 years in prison. But authorities have also used other crimes such as “inciting ethnic hatred,” as in the case of human rights lawyer Pu Zhiqiang, who has been detained since May 2014 for a number of social media posts questioning the government’s policies towards Uighurs and Tibetans.

While providing the public with accurate information during disasters is important, the best way to counter inaccurate information would be to ensure that official information is reliable and transparent, Human Rights Watch said.

Above all, journalists should have unimpeded access to investigate and inform the public about these events, and the wider public should have the freedom to debate and discuss disaster response.

“The casualties of China’s new provision would not be limited to journalists, activists and netizens, but the right of ordinary people and the world to know about crucial developments in China,” Richardson said. “The best way to dispel false rumors would be to allow, not curtail, free expression.”

Posted: January 1, 1970, 12:00 am

Corridor in a care facility for older people. 

© Flickr

The Australian government is taking an important step to investigate potential abuses against older people in care facilities and beyond. This week, Australian Prime Minister Scott Morrison announced a Royal Commission to investigate the industry responsible for providing support and health services to older people. Terms of reference are being drawn up now.

Sadly, the commission appears quite timely. The day after it was announced, a leading television news program exposed serious concerns in care facilities for older people, including lack of informed consent for the use of antipsychotic drugs. Another news story this week carried the claim by a geriatric specialist that 80 percent of people with dementia in nursing facilities in Australia are being given those drugs.

Human Rights Watch has found similar abuses in private nursing facilities in the US, concluding that people in such nursing facilities are often at heightened risk of neglect and abuse. This is frequently due to their physical or mental disabilities, and isolation from friends, family and the community. Often, they are unable or not allowed to leave the facility alone. Human Rights Watch determined that in the US, many people are forced to depend entirely on the institution’s good faith and have no realistic avenues to help or safety when that good faith is violated.

The experiences of older people should help shape the terms of reference for the commission. Older people who are most at risk will not have their perspectives included unless the government actively seeks them out. This investigation is about the daily lives of older people, and the Royal Commission has the chance to do this right by including the voices and perspectives of older people using aged care. 

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

Naloxone, a medicine that can reverse an opioid overdose. Massachusetts, US, August 8, 2017. 

© 2017 Reuters.
The opioid crisis in the U.S. rages on, with no end in sight. More than 72,000 people died of drug overdose in 2017, up from 63,000 the year before. In Florida, experts estimate that 20 Floridians are dying from overdose every day.

Video

Video: Florida Needs Syringe Exchange

Syringe exchange programs have a proven record of reducing HIV and Hepatitis C infection, preventing overdose, and bringing people into treatment without raising rates of drug use or crime. 

Many of these deaths are unnecessary. From a public health perspective, we know what to do — we are just failing to do it.

Naloxone, for example, is not nearly as available in Florida as it should be. Naloxone is a safe, generic medication that when administered promptly can reverse the effect of opioid overdose, literally bringing someone back to life. Used for decades in emergency rooms and ambulances, it has no potential for abuse and can be administered by lay people with minimal training. But naloxone can only be effective if it gets into the hands of the people most likely to be at the scene of an overdose — people who use drugs, and their family and friends. The U.S. Surgeon General recently issued an advisory urging greater access to naloxone, but there are still too many unnecessary barriers.

Syringe exchanges are ideal sites for direct naloxone distribution, as people who use drugs go to exchanges to receive a range of health services in a non-judgmental setting. Syringe exchanges are saving an astounding number of lives every day. The University of Miami’s IDEA Exchange has reversed more than 700 overdoses since it began distributing naloxone in March 2017. 

Yet resistance to syringe exchange programs blocks their expansion. Drug paraphernalia laws, lack of understanding of how exchanges work, stigma surrounding drug use and other factors prevent offering this  proven public health service in many communities.

The IDEA exchange is the only such program in Florida, but Miami isn’t the only place where it is needed. According to the Centers for Disease Control, in 62 Florida counties rates of overdose death are higher than they are in Miami-Dade. In seven counties — including Franklin —people are dying of overdose at rates  three times as high as in Miami-Dade.

In 2017, state Sen. Oscar Braynon and Rep. Shevrin Jones sponsored legislation to permit other counties to establish syringe exchange programs in conjunction with their local departments of health. The bill gained substantial support from law enforcement, but failed to get to a floor vote in the House. Some people think making syringes available to people using drugs enables their habit and threatens to bring more crime to the community. But the facts indicate otherwise.

After decades of research in the U.S. and globally, there is no evidence showing increased drug use in communities with syringe exchanges. Indeed, the opposite is true. Exchanges have a strong record of helping to bring people into treatment. They are also incredibly cost-effective, as clean needles cost pennies while drug-related infections cost millions in emergency room visits, medications and hospital stays. 

This year, Sen. Braynon and Rep. Jones will re-introduce the bill to allow other Florida counties to start a syringe exchange. If it passes, by next year there could be better news to report.

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

Human Rights Watch submits this comment in response to the Notice of Petition for Rulemaking and Request for Comments on the continued exclusion of surgical procedures from the medical benefits package offered to transgender veterans by the Department of Veterans Affairs (VA). Human Rights Watch urges the VA to remove this exclusion as arbitrary and discriminatory. It should be seen as contrary to the statutory obligation of the VA to provide necessary medical care to veterans.

Under federal law, the Secretary of Defense is required to furnish to veterans “medical and hospital care that the Secretary determines to be needed.”[1] In implementing that directive, the Secretary has established the medical benefits package, and the criteria used for inclusion in that package is whether the particular care is “medically needed,” defined as “care that is determined by appropriate health care professionals to be needed to promote, preserve or restore the health of the individual and to be in accord with generally accepted standards of medical practice.”[2] In keeping with that definition, the VA covers and/or provides treatment for gender dysphoria for transgender veterans, including hormone replacement therapies, counseling, and other health services.

However, the VA has for decades excluded coverage for surgical procedures related to gender transition. For some individuals, however, surgical procedures for the treatment of gender dysphoria are necessary and meet the criteria for inclusion in the benefits package. Exclusion of surgery in all cases fails to meet the standards of care set forth by the World Professional Association for Transgender Health (WPATH), standards that are recognized as authoritative by numerous medical bodies including the American Medical Association, the Endocrine Society, and the American Psychological Association.[3]

The medical necessity of surgery for some individuals in care for gender dysphoria has been acknowledged by the Department of Veterans Affairs. In a letter from then Under Secretary for Health in the Department of Veterans Affairs David Shulkin, MD to Senator Elizabeth Warren dated November 10, 2016, Shulkin stated that “surgical procedures are now widely accepted in the medical community as medically necessary treatment for gender dysphoria.”[4] In this letter, Under Secretary Shulkin stated that the VA was considering issuing a Notice of Proposed Rule Making for removal of this exclusion from the benefits package.

Shortly thereafter, however, the Trump administration announced that the exclusion would not be removed, prompting a Petition for Rulemaking filed by transgender veterans including Gio Silva, a veteran who was denied a mastectomy by the VA because he is transgender. Mastectomies and other surgeries of many types are offered to cisgender veterans when determined necessary for mental or physical health.[5] As Human Rights Watch and others have extensively documented, transgender people face high levels of discrimination in health care settings, and continuation of this rule by the VA serves as yet another barrier to access to health care that is unnecessary and unjust.[6]

For these reasons, Human Rights Watch urges the Department of Veterans Affairs to remove the exclusion of surgical procedures for transgender individuals from the benefits package.


[1] 38 USC 1710

[2] 38 CFR 17.38 (b)

[3] WPATH, Standards of Care for the Health of Transexual, Transgender and Gender Non-Conforming People, Version 7, https://www.wpath.org/publications/soc and Lambda Legal, “Professional Organization Statements Supporting Transgender People in Health Care,” https://www.lambdalegal.org/publications/fs_professional-org-statements-supporting-trans-health  (accessed September 4, 2018.)

[4] See, appendix 1, Brief of Petitioners, Fulcher v Secretary of Veterans Affairs, USCA Federal Circuit, No. 2017-1460.

[6] Human Rights Watch, “You Don’t Want Second Best: Anti-LGBT Discrimination in Health Care ,” July 2018 https://www.hrw.org/report/2018/07/23/you-dont-want-second-best/anti-lgbt-discrimination-us-health-care

Posted: January 1, 1970, 12:00 am

A general view of atmosphere as THINX lights up the Brooklyn Bridge and UN Secretariat Building to draw attention to period poverty on March 8, 2018 in New York City.

© 2018 Andrew Toth/Getty Images for THINX

Every girl around the world has feared it, or worse, felt it: the snickers of peers who see bloodstains on her clothes, the sneers of classmates as she slips a pad into her pocket. But what of the girls who can’t afford sanitary products, who have to ask teachers or friends for a pad or tampon? Many girls and young women face this burden, which can isolate them and contribute to their missing or even leaving school.

Scotland’s government is leading the way to change this, announcing this week that it will provide free menstrual hygiene products at all schools and universities across the country. This is reportedly a global first. Governments including those in Kenya, some states in India, and the US state of New York have made similar commitments for primary and secondary schools.

But in truth, few governments support girls and young women in overcoming barriers to managing menstruation -- something natural and universal yet intensely stigmatized.

“Period poverty” seems to have taken on new urgency in the United Kingdom after reports surfaced about women and girls having to choose between buying food or period supplies. In February, a survey in Scotland revealed women were using toilet paper, rags, and old clothes in place of sanitary pads, which they couldn’t afford; nearly 1 in 5 respondents said they went without period products due to financial strain. A 2017 survey revealed that 1 in 7 girls in the UK had struggled to afford sanitary products, and 1 in 10 reported being unable to pay for them. 

Distributing sanitary pads or tampons alone won’t eliminate the many and varied reasons girls worldwide miss or drop out of school – which include child marriage, sexual assault and harassment, pregnancy, and discrimination. But it is foolish to ignore periods and their economic, social, and physical toll on girls and young women, especially those struggling with homelessness, unemployment, or poverty

Periods shouldn’t come with sacrifices. The ability to manage menstruation is not a luxury – it’s essential to enjoying the rights to health, water and sanitation, education, work, and non-discrimination. The Scottish government sets an excellent example here. Other governments should follow its lead and commit to respecting the rights of all girls and young women by enabling them to manage periods with dignity—including by ensuring access to period products.

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

 

This submission focuses on the right to education including discrimination in education for children with disabilities and barriers for pregnant girls and adolescent mothers’ to education.  It also looks at protection of environmental activists, the rights of sex workers, and protecting education from attack.

Right to Education (Articles 13 and 14)

When South Africa ratified the International Covenant on Economic, Social and Cultural Rights (ICESCR) in January 2015, it included a declaration that the government “will give progressive effect to the right to education … within the framework of its National Education Policy and available resources.”[1] The declaration indicates a compromise of South Africa’s commitment to key international obligations on the right to education; notably the obligation to guarantee the right to free and compulsory primary education to all children.[2] Indeed, South Africa has yet to develop an action plan on how it will guarantee free and compulsory primary education to all children, pursuant to its obligations under article 14.

Free Education

South Africa does not guarantee the right to free primary or secondary education to all children in law or practice.[3] Research by Human Rights Watch in 2014 and 2015 found that the current fee-based system particularly discriminates against children with disabilities. It results in many children with disabilities paying school fees that many children without disabilities do not, as well as additional costs, such as for uniforms, food, transport, and to secure reasonable accommodations for the child’s disability.[4]

South Africa’s Schools Act mandates that the state fund public schools on an equitable basis.[5] The government in turn requires that the governing bodies of public schools—made up of teachers, parents, and other community representatives—adopt a resolution for a school to charge fees and supplement a school’s funding “by charging school fees and doing other reasonable forms of fund-raising.”[6]

Public schools may be classified as “no-fee” schools, a status granted to public schools by provincial governments, which means that those schools should not charge fees. Today, around 80 percent of schools across the country benefit from a “no-fee” policy, and approximately 60 percent of the current school population accesses “no-fee” schools. The “no-fee” designation is based on the “economic level of the community around the school,” and on a quintile system from poorest to richest, whereby the lowest three quintiles do not pay fees in designated public schools.[7]

Since 2014, Human Rights Watch has found that no special schools, where most children with disabilities are enrolled, are listed in any “no-fee” schools list produced by the government.[8]

Although a high number of students in special schools come from townships and predominantly poor areas of towns, many public special schools in urban areas are located in wealthier suburbs previously inaccessible to the majority of children under apartheid.[9] The income level of surrounding communities and locations means many special schools fail the “needs” or “poverty” test used to assess a school’s access to recurrent public funding or to qualify as a “no-fee” school.[10]

The high cost of education, including school fees and other school-related costs, continues to be a significant barrier keeping children with disabilities out of school. School fees in special schools visited by Human Rights Watch ranged from R350-R750 (US$24-$53) per each of the year’s four terms. In many cases, parents reported not having access to fee waivers. In some cases, parents paid as much as R5,000 ($353) per year in school fees alone. Parents with children who are referred to special schools which are far away from their families also pay for boarding or housing fees and transport for their children to travel long distances to school. Many are not able to pay these costs, which leads to children being excluded from school.[11]

In 2017, senior government officials indicated their intention to review school fees for children with disabilities but did not adopt any policy changes at the beginning of the school year in January 2018.[12] At time of writing, the South African government had not communicated an intention to adopt measures to ensure children with disabilities do not pay for school fees, on an equal basis with children without disabilities.

National Resources for Inclusive Education

Insufficient allocation of resources for inclusive education remains a concern. The majority of the limited budget for students with disabilities continues to be allocated to special schools rather than to inclusive education.[13] Most mainstream schools do not have additional budget lines to provide reasonable accommodation to students with disabilities.

In 2015, the government communicated its intention to publish “Draft National Norms and Standards for Resource Distribution for an Inclusive Education System,” which will have a binding effect on the national and provincial governments once they are adopted.[14] In September 2017, the minister of basic education, Angie Motshekga, announced the proposal of new “National Guidelines for Resourcing an Inclusive Education System,” which will only provide guidance but have no binding effect on governmental institutions.[15] At time of writing, neither of these documents have been finalized.

Discrimination Against Children with Disabilities in Education

In August 2015, Human Rights Watch released our report “Complicit in Exclusion”: South Africa’s Failure to Guarantee Inclusive Education for Children with Disabilities,” documenting barriers to inclusive, quality education for children with disabilities in South Africa. Many of the barriers we documented persist today, although Human Rights Watch acknowledges that the government has progressed in some critical areas, as detailed in this submission.[16]

There is a lack of disaggregated and transparent data concerning current numbers of children with disabilities who remain out of school or on waiting lists for public schools. In 2013, the government estimated that more than 500,000 children with disabilities remained out of school.[17] In 2015 and 2016, the government estimated that close to 600,000 children with disabilities remained out of school.[18]

Human Rights Watch notes that various government departments have agreed to improve data collection on children with disabilities.

In its reply to the Committee on the Rights of Persons with Disabilities, the government stated that “Ensuring the enrolment of children with disabilities, who are currently out of school because of impairment, is a work in progress.”[19]

Although South Africa’s constitution protects the right to a basic education, and protects individuals from discrimination on the grounds of race and disability, the government has not adopted legislation that specifically guarantees and the right to inclusive education for children with disabilities.[20] Despite a national policy to provide inclusive education for all children with disabilities, many children with disabilities do not have equal access to inclusive quality primary or secondary education and face multiple forms of discrimination and barriers.[21] South Africa’s Human Rights Commission has deemed that the education system continues to be exclusionary of children with disabilities.[22]

Many children with disabilities face discrimination when accessing public schools. A lack of governmental oversight of waiting lists and placements leaves school officials with the last word on enrolling learners, delaying children’s entry into schools beyond the age of compulsory education. Many mainstream schools deny children with intellectual or developmental disabilities a place in mainstream schools in their communities. Human Rights Watch found that social workers, district education officials, and health workers most often refer children to special schools based on their disabilities. The referrals system, overcrowding, and special schools operating at maximum capacity means children can wait for up to four years at care centers or at home for placement in a special school.[23] The Department of Basic Education’s statistics for 2017 indicate that 11,461 children with disabilities are on school waiting lists. [24] According to civil society and disability rights organizations, this remains an underestimate.[25]

When children are placed on long waiting lists or turned down by special schools, parents face the burden of having to find alternatives for their children, including special schools further away from their homes or communities. Consequently, they are not always able to register children in the most appropriate school. Traveling to schools to register children can be a very costly activity for many parents who already struggle to pay for basic needs.

Once in school, many children with disabilities do not have access to the same curriculum as children without disabilities nor to the necessary materials, including assistive devices and services in Braille or sign language. Many students in mainstream schools face discriminatory physical and attitudinal barriers they need to overcome in order to receive an education.

The Department of Basic Education has made progress in providing resources for learners who are blind or have low vision. In 2014, the government adopted a policy to ensure education officials adequately assess children with disabilities and provide them with the support they need. The government intends to fully implement this policy by 2019.[26] However, our findings indicate that insufficient resources—due in part to a lack of adequate financing allocated to inclusive education by regional governments, and lack of qualified personnel—mean the policy is being implemented inconsistently, particularly in rural areas and under-resourced townships.[27]

Human Rights Watch recommends the Committee ask the government of South Africa:

•         What measures has the government adopted to ensure children with disabilities have access to free quality inclusive education, on an equal basis with children without disabilities, particularly in rural and remote areas?

•         What binding measures has the government taken to ensure provincial governments respect and fulfil the right to inclusive education of children with disabilities?

•         What steps has the government taken to ensure legislation and policy reflect the government’s obligation to provide free education, and its obligation to provide reasonable accommodation to allow children with disabilities to access education without discrimination?

•         Will the government adopt legislation providing specific protections to children with disabilities and guaranteeing inclusive education?

Human Rights Watch recommends the Committee to:

•         Urge the government to ensure access to free and compulsory primary education and to secondary education to children with disabilities, including by developing a detailed plan of action for the immediate realization of free compulsory primary education, in line with its responsibilities under international human rights law.

•         Call upon the government to adopt stronger legal protections for children with disabilities to complement the South African Schools Act. This includes a clear duty to provide reasonable accommodation in public ordinary schools, accompanied by specific provisions that prevent the rejection of students with disabilities from schools in their neighborhood.

Insufficient Protections for Pregnant Students and Adolescent Mothers

South Africa has a high rate of teenage pregnancies: in 2016, around 16 percent of 15 to 19 year old girls and women had begun childbearing.[28] According to the government’s estimates, in 2015, over 85,000 students fell pregnant, representing 3.3 percent of the student population.[29] According to the government, only a third of students stay in school during a pregnancy and return following childbirth.[30]

South Africa has had a policy on the prevention and management of student pregnancies since 2007, which states that school children who are pregnant shall not be unfairly discriminated against and cannot be expelled.[31] However, research by South African NGOs indicates that this policy has not been fully respected by schools, and schools have often discriminated against female students.[32] Research conducted by South African organisations shows that some school officials continue to exclude pregnant girls from school or ask them to shift to other schools, contradicting their obligations to respect student’s right to compulsory education.[33]

In 2018, the government initiated a consultation to develop a new policy on management and prevention of student pregnancies.[34] Human Rights Watch recommends that the government removes any conditional measures –currently applied through the government’s 2007 policy—that impact on girls’ education or deter them from going back to school. For example, students should not have to wait a conditional period until they can return to school.[35]

The new policy should ensure that pregnant students can stay in school while they are medically able to, and that they return to school as soon as they are ready. Schools should also provide basic accommodations for adolescent parents, including: time to breastfeed during breaks, and time off in case a student’s child is ill or to comply with other medical or bureaucratic requirements.[36]

Through its policy, the government should communicate a clear obligation on all education establishments to respect girls’ right to stay in school. Schools should not be able to block a student’s return to school.

Human Rights Watch recommends the Committee ask the government of South Africa:

•         What steps will the government take to fully guarantee, in law and policy, pregnant students and adolescent parents’ right to education?

•         What measures will the government adopt to fully support pregnant students and adolescent parents’ return and retention in school?

•         How will the government ensure provincial governments’ and schools’ compliance with its forthcoming policy on pregnancy management and prevention in schools?

Human Rights Watch recommends the Committee to:

•         Encourage the government to adopt a human rights compliant policy that guarantees pregnant girls’ and adolescent parents’ right to education and includes basic accommodations to ensure parents are supported to stay in school. The government should regularly monitor this policy to ensure schools adhere to its provisions.

Protection of environmental activists (Article 12)

Community activists are on the frontlines advocating for the protection of their communities from the environmental impacts of mining. South Africa is one of the world’s biggest coal producers,[37] and a leading producer of a wide range of metals.[38]  The serious environmental, health, and social impacts of mining, coupled with a lack of transparency, accountability, and consultation, has increased public opposition to mining projects. The response to this opposition has at times resulted in harassment and violence against opponents of mines exercising their rights to a health and a healthy environment.

From March to July 2018, Human Rights Watch interviewed more than 40 community members and environmental activists from Limpopo, KwaZulu-Natal, North West, and Eastern Cape provinces. We also spoke with municipal officials, police, and prosecutors in these provinces.

Several activists and community members said they had received death threats related to their opposition of mining and their concerns over its environmental impacts. Some of the activists who experienced threats said they were also physically attacked or their property was damaged. Another issue we documented in several communities relates to limitations of protests about the right to a healthy environment. Several community members told us that the police, and in some instances a private security company, used teargas and rubber bullets to disperse peaceful protesters. Several of the people we interviewed were injured and one person was killed during these interactions. Activists also said that they are often arrested during protests and charged with “public violence.” Even if most of these cases did not result in a criminal conviction, the risk of being jailed or injured every time they participate in a protest deters some communities from protesting or mobilizing against environmental harm that impacts their communities.

Human Rights Watch recommends the Committee ask the government of South Africa:

•         How does the government respond to violence and harassment against environmental activists in mining-affected communities and ensure timely and impartial investigations?

•         How does the government ensure that activists in mining-affected communities can exercise their rights to health and healthy environment and freely voice their concerns during protests?

Human Rights Watch asks the Committee to:

•         Call upon the government to protect community members and environmental activists from harassment and violence, investigate threats or acts of harassment or violence, prosecute those responsible, and provide an adequate remedy for victims.

•         Call upon the government to ensure that community members and activists are free to safely engage in action to secure or promote respect for their rights to health and a healthy environment, such as through participating in protests.

Protection of Sex workers (Article 1, 7 and 12)

South Africa criminalizes the sale and purchase of sex, as well as related activities such as keeping a brothel or living on the earnings of sex work. However, in part because criminalization may be interpreted as at odds with South Africa’s constitution, decriminalization has been under active discussion for nearly a decade.[39]

In May 2017, the South African Law Reform Commission explored the need for reform of South Africa’s laws related to adult sex work.[40] The Commission recommended maintaining the criminalization of both the sale and purchase of sex, albeit with some modifications, or, as a second choice, that the sale of sex should be decriminalized but purchase and third-party involvement remain illegal (partial decriminalization, also known as the “Nordic” model).

Human Rights Watch is concerned about violations of the ICESCR against sex workers in South Africa under criminalization and recommends that the government instead decriminalize sex work. Criminalization of sex work has a direct impact on the right to health, and the right to self-determination and state’s obligations to “recognize the right to work, which includes the right of everyone to the opportunity to gain his living by work which he freely chooses or accepts, and … take appropriate steps to safeguard this right.”[41] Criminalization also interferes with the right to form unions protected by the convention, including at work, and the right to bodily autonomy.

In May and June 2018, Human Rights Watch interviewed 46 female sex workers in 10 interview sites in Limpopo, Mpumalanga, and Gauteng provinces. Almost all interviewees were unmarried mothers and supporting their children (as well as other dependents) was the main reason they chose and remained in sex work. Interviewees shared their experiences of police harassment and frequent, arbitrary detentions, which appeared to almost always be the result of police profiling, that kept them from their families and their work. Police have used their powers of arrest and detention to coerce sex workers into paying bribes or providing free sex. Many of the sex workers we interviewed were victims of violence, and other crimes such as theft and discrimination, at the hands of clients, men posing as clients, police, and community members. About a third of our interviewees said they had been raped in the past three years. Women told us how it is humiliating, useless or even dangerous to report crimes committed against them to the police who do not take them seriously, who see them as criminals, and who are sometimes the perpetrators of such violence.[42]

On a positive note, the sex workers we interviewed told us they had free, fairly straightforward, and non-discriminatory access to healthcare, including reproductive healthcare and HIV/AIDS treatment. Many remarked on their experiences of improved, friendlier services over the past six years. A driving force behind these improvements has been the South African Department of Health and the South African National AIDS Council (SANAC, which coordinates several government bodies) openly calling for services for sex workers and for decriminalization.[43] A whole-of-government approach towards sex work that recognizes the rights and needs of this vulnerable group would make more sense and help end police practices that obstruct SANAC’s goals of ending the pandemic, for example detaining sex workers without access to antiretroviral drugs.

Human Rights Watch recommends the Committee ask the government of South Africa:

  • How does the government plan to respond to the South African Law Reform Commission’s report on sexual offenses, released in May 2017, which recommended continued full criminalization of consensual adult sex work?

Human Rights Watch asks the Committee to:

  • Call upon the government of South Africa to impose an immediate moratorium on arrests of sex workers, including for loitering, indecent exposure, and other misdemeanors, at least until the future legal status of sex work is settled.
  • Call upon the government of South Africa to, in consultation with sex workers, introduce a new law to parliament removing criminal and administrative sanctions against voluntary, consensual adult sex work and related offenses, such as solicitation, living on the earnings of prostitution, and brothel-keeping.

Protection of Education during Armed Conflict (Articles 13, 14)

South Africa was among the first group of countries to join the Safe Schools Declaration when it was opened for endorsements on May 29, 2015. The Declaration outlines various common-sense actions that countries can take to reduce the negative consequences of armed conflict on education, including using the Guidelines on Protecting Schools and Universities from Military Use with respect to protecting schools from military use.[44]

In July 2018, the United Nations Security Council unanimously adopted resolution 2427 (2018) on children and armed conflict, which encourages UN member states to take concrete measures to deter such use of schools by armed forces and armed groups.

As of June 2018, South Africa was contributing 1,177 troops and 20 staff officers to UN peacekeeping operations around the world. Such troops are required to comply with the United Nations Department of Peacekeeping Operations’ UN Infantry Battalion Manual (2012), which includes the provision that “schools shall not be used by the military in their operations.”[45] South Africa’s peacekeepers are deployed in the Democratic Republic of Congo and Sudan — two countries where the military use of schools has been documented as a problem.

The Peace and Security Council of the African Union has recognized the importance of the Safe Schools Declaration in protecting education during armed conflict and encouraged states to support it, including urging “Member States to endorse and implement” the Declaration in June 2017.

Human Rights Watch recommends to the Committee that it ask the government of South Africa:

  • What steps has South Africa taken in line with UN Security Council Resolutions 2143 (2014), 2225 (2015), and 2427 (2018) to deter the use of schools for military purposes?
  • Are protections for schools from military use included in any policies, rules, or pre-deployment trainings for South Africa’s armed forces?
  • What further steps has South Africa taken to implement the commitments in the Safe Schools Declaration?

Human Rights Watch recommends the Committee:

  • Congratulate South Africa for having led the way in being one of the first states globally to endorse the Safe Schools Declaration.
  • Call upon the government of South Africa to take concrete measures to deter the military use of schools, including by bringing the Guidelines for Protecting Schools and Universities from Military Use during Armed Conflict into domestic military policy and operational frameworks.
  • Encourage the government of South Africa to champion the protection of students, teachers, and schools during armed conflict, and the Safe Schools Declaration, during its upcoming membership of the United Nations Security Council in 2019-2020.
 

[1] United Nations Treaty Database, “South Africa,” undated, https://treaties.un.org/doc/Publication/UNTS/No%20Volume/14531/A-14531-S... (accessed August 10, 2018).

[2] Joint statement by Section 27 et al., “South Africa Government’s Declaration on Education Clause Mars the Welcome Ratification of the International Covenant on Economic, Social and Cultural Rights,” Johannesburg, January 21,2015.

[3] Department of Basic Education, “School fees and exemption,” undated, https://www.education.gov.za/Informationfor/ParentsandGuardians/SchoolFees.aspx.

[4] “School fees” are defined as “any form of contribution of a monetary nature made or paid by a person or body in relation to the attendance or participation by a learner in any programme of a public school,” South African Schools Act, Act No. 24 of 2005: Education Laws Amendment Act, 2005, http://www.gov.za/sites/www.gov.za/files/a24-05_0.pdf, ch. 1 and s. 1(b).

[5] South African Schools Act, s. 34.

[6] Department of Basic Education, “School Fees and Exemption – No Fee Schools”, undated, http://www.education.gov.za/Parents/NoFeeSchools/tabid/408/Default.aspx (accessed August 9, 2018).

[7] Department of Education, “National Norms and Standards for School Funding,” General Notice 2363, October 12, 1998, http://www.education.gov.za/LinkClick.aspx?fileticket=ZYYtOiXHTeE%3D&tabid=188&mid=498 (accessed August 5, 2018); Department of Basic Education, “Amended National Norms and Standards for School Funding,” January 16, 2015, http://www.gov.za/sites/www.gov.za/files/38397_gon17.pdf (accessed August 5, 2018).

[9] Human Rights Watch found that this is particularly the case in Gauteng and Western Cape provinces where special schools were traditionally set up to cater for white children with disabilities. Within Gauteng Province, many full-service schools are mainly in the outskirts of the city and the majority are Afrikaans speaking.

[10] Provincial Departments of Education are guided by a “Resource Targeting Table” to define needs-based allocations, “National Norms and Standards for school funding,” pp. 27-28. See Department of Basic Education, “Amended National Norms and Standards for School Funding,” Government Gazette no. 38397, 16 January 2015.

[11] Human Rights Watch, “Complicit in Exclusion: South Africa’s Failure to Guarantee Inclusive Education for Children with Disabilities”, August 2015, https://www.hrw.org/report/2015/08/18/complicit-exclusion/south-africas-failure-guarantee-inclusive-education-children.

[12] Parliamentary Monitoring Group, “Inclusive Education and Special Education: DBE Progress Report; with Deputy Minister, Meeting Summary.”

[13] Department of Basic Education, “Progress Report on Inclusive Education and Special Needs Education, Portfolio Committee on Basic Education Meeting,” 30 May 2017.

[14] Department of Basic Education, “Draft National Norms And Standards For Resource Distribution For An Inclusive Education System,” June 2015, http://www.saou.co.za/wp-content/uploads/2011/04/Draft-norms-2015.pdf (accessed July 22, 2018).

[15] Department of Basic Education, “Statement by Minister of Basic Education, Mrs. Angie Motshekga on the occasion of the post-CEM Media Briefing,” September 15, 2017, https://www.education.gov.za/Newsroom/MediaReleases/tabid/347/ctl/Detail... (accessed July 22, 2018).

[16] Human Rights Watch, “Complicit in Exclusion; Alternate Report Coalition – Child Rights South Africa, Complementary Report to The African Committee of Experts on The Rights and Welfare of the Child, A Response to South Africa’s Second Country Report to The African Committee of Experts On The Rights And Welfare Of The Child On The African Charter On The Rights And Welfare Of The Child; United Nations Committee on the Rights of the Child, “Concluding observations on the second periodic report of South Africa,” CRC/C/ZAF/CO/2, October 27, 2016, http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=CRC%2fC%2fZAF%2fCO%2f2&Lang=en (accessed July 21, 2018).

[17] Government of South Africa, Initial Country Report to the United Nations on the Implementation of the Convention on the Rights of Persons with Disabilities, 2008 – 2012, approved by Cabinet on 17 April 2013, http://tbinternet.ohchr.org/Treaties/CRPD/Shared%20Documents/ZAF/CRPD_C_... (accessed July 17, 2018), paras. 204-206.

[18] Department of Basic Education, “Report on the Implementation of Education White Paper 6 on Inclusive Education: An Overview for the Period 2013-2015,” May 2015, http://pmg-assets.s3-website-eu-west-1.amazonaws.com/160308overview.pdf (accessed August 15, 2018); Human Rights Watch, “Complicit in Exclusion.”

[19] Committee on the Rights of Persons with Disabilities, “List of issues in relation to the initial report of South Africa, Addendum – Replies of South Africa to the list of issues,” CRPD/C/ZAF/Q/1/Add.1, July 2, 2018, para. 152.

[20] Constitution of the Republic of South Africa, Act No.108 of 1996, http://www.gov.za/sites/www.gov.za/files/images/a108-

96.pdf, s.29(1)(a) and 2(a).

[21] In 2001, the government adopted “Education White Paper 6: Special Needs Education,” a national policy to provide inclusive education for all children with disabilities within 20 years, but key aspects of the policy have yet to be implemented. Department of Basic Education, “Education White Paper 6: Special Needs Education, Building an inclusive education and training system,” July 2001, http://www.education.gov.za/LinkClick.aspx?fileticket=gVFccZLi/tI= (accessed August 5, 2018).

[22] South African Human Rights Commission, “National Human Rights Institution Report on the South African Government’s Initial Country Report under the International Convention on the Rights of Persons with Disabilities,” January 2018, https://tbinternet.ohchr.org/_layouts/TreatyBodyExternal/Countries.aspx?CountryCode=ZAF&Lang=EN (accessed August 15, 2018), para. 45

[23] Human Rights Watch, “Complicit in Exclusion;” and “South Africa: Little Progress for Youth With Disabilities,” August 19, 2016, https://www.hrw.org/news/2016/08/19/south-africa-little-progress-youth-d....

[24] Parliamentary Monitoring Group, “Inclusive Education and Special Education: DBE Progress Report; with Deputy Minister, Meeting Summary,” May 30, 2017, https://pmg.org.za/committee-meeting/24505/ (accessed July 19, 2018).

[25] IESA/R2ECWD Response to the presentation, on progress in the implementation of inclusive education, to the portfolio committee on basic education scheduled for 30 May 2017,” May 30, 2017, http://www.included.org.za/news/iesa-r2ecwd-response-dbe-presentation-progress-implementation-inclusive-education-portfolio-committee-basic-education-scheduled-30-may-2017/ (accessed August 15, 2018).

[26] Department of Basic Education, “Policy on Screening, Identification, Assessment and Support (SIAS),” December 2014, http://www.naptosa.org.za/index.php/doc-manager/00-general/367-sias-fina... (accessed August 4, 2018).

[27] Human Rights Watch, "Complicit in Exclusion;” “South Africa: Little Progress for Youth With Disabilities.”

[28] Statistics South Africa, “Media release: South Africa Demographic and Health Survey,” May 15, 2017, http://www.statssa.gov.za/?p=9836 (August 15, 2018).

[29] Department of Basic Education, “Portfolio Committee on Basic Education – Prevention and Management of Learner Pregnancy,” November 14, 2017, powerpoint slide 12. Available in Parliamentary Monitoring Group, “Learner Pregnancies: Basic Education, Social Development, Health Departments briefing,” November 14, 2017, https://pmg.org.za/committee-meeting/25478/ (accessed August 10, 2018).

[30] Ibid.

[31] Republic of South Africa, Department of Basic Education, “Measures for the Prevention and Management of Learner Pregnancy,” 2007, https://www.naptosa.org.za/doc-manager/40-professional/46-general/105-sgb-dbe-pregnancy-2007/file (accessed August 28, 2018), pp. 6 – 7. Despite its existence, schools continue to expel pregnant girls in breach of South Africa’s constitutional laws. Lisa Draga et al, “Basic Education Rights Handbook – Chapter 8 – Pregnancy, http://section27.org.za/wp-content/uploads/2017/02/Chapter-8.pdf (accessed August 28, 2018).

[32] Equal Education Law Centre and Section 27, “Equal Education Law Centre and Section 27 Submission to the Department of Basic Education in Respect of the Draft “National Policy on the Prevention and Management of Learner Pregnancy in Schools,” April 2018, http://section27.org.za/wp-content/uploads/2018/05/EELC-and-S27-Submissions-on-Draft-Pregnancy-Policy-.pdf (accessed August 15, 2018).

[33] Lisa Draga, Chandré Stuurman, and Demichelle Petherbridge, “Basic Education Rights Handbook – Education Rights in South Africa – Chapter 8: Pregnancy,” 2017, http://section27.org.za/wp-content/uploads/2017/02/Chapter-8.pdf.

[34] Department of Basic Education, “DBE Draft National Policy on the Prevention and Management of Learner Pregnancy in Schools,” 2018, https://www.education.gov.za/Portals/0/Documents/Policies/Draft%20Pregnancy%20Policy%202018.pdf?ver=2018-06-26-142235-687 (accessed August 15, 2018).

[35] Republic of South Africa, Department of Basic Education, “Measures for the Prevention and Management of Learner

Pregnancy,” 2007, https://www.naptosa.org.za/doc-manager/40-professional/46-general/105-sgb-dbe-pregnancy-2007/file (accessed August 17, 2018).

[36] Human Rights Watch, Letter to the Department of Basic Education regarding their draft pregnancy policy, August 16, 2018, https://www.hrw.org/news/2018/08/15/letter-south-africas-department-basic-education-regarding-their-draft-pregnancy.

[38] United States Geological Survey, http://minerals.usgs.gov/minerals/pubs/#mcs

[39] Sexual Offences Act, No. 23 of 1957, ss. 2, 10, 12, 12A, 19, 20; Criminal Procedure Act, No. 51 of 1977, s. 268(c); Criminal Law (Sexual Offences and Related Matters) Amendment Act, No. 32 of 2007, s. 11. The debate over decriminalization of sex work in South Africa began in earnest during the build-up to the FIFA 2010 World Cup in South Africa, though many advocates had been pushing for decriminalization long before 2009.

[40] South African Law Reform Commission, “Project 107: Report on Sexual Offences: Prostitution,” June 2015, http://www.justice.gov.za/salrc/reports/r-pr107-SXO-AdultProstitution-20... (accessed July 18, 2018).

[41] Part III, Article 6.1

[42] The Women’s Legal Centre, a non-profit center that offers free legal advice to women in South Africa, analyzed data from cases of verbal, physical and sexual abuse reported to them by sex workers between 2011 and 2015, and found that over 60% of cases were from police as perpetrators. See Women’s Legal Centre, “Police abuse of sex workers: Data from cases reported to the Women’s Legal Centre between 2011 and 2015,” April 2016, http://wlce.co.za/wp-content/uploads/2017/02/Police-abuse-of-sex-workers... (accessed July 18, 2018), p. 14.

[43] See, for example: Nelson Dlamini, “SANAC calls for decriminalisation of sex work,” SANAC News, March 9, 2018, http://sanac.org.za/2018/03/09/sanac-calls-for-decriminalisation-of-sex-... (accessed July 10, 2018); South African Department of Health, “Health Sector HIV Prevention,” 2016, http://www.health.gov.za/index.php/component/phocadownload/category/324-... (accessed July 10, 2018). The Sex Workers’ Programme includes a plan for sex worker community mobilization and engagement, service provision, sensitization of service providers, advocacy, health systems strengthening, and strategic information. Advocacy efforts include a decriminalization campaign (see pp. 7-8).

[44] Safe Schools Declaration, https://www.regjeringen.no/globalassets/departementene/ud/vedlegg/
utvikling/safe_schools_declaration.pdf (accessed August 17, 2018); Global Coalition to Protect Education from Attack, Guidelines for Protecting Schools and Universities from Military Use during Armed Conflict, March 18, 2014, http://protectingeducation.org/sites/default/files/documents/
guidelines_en.pdf (accessed August 17, 2018).

[45] United Nations Infantry Battalion Manual, 2012, section 2.13. Moreover, the 2017 Child Protection Policy of the UN Department of Peacekeeping Operations, Department of Field Support, and Department of Political Affairs notes: “United Nations peace operations should refrain from all actions that impede children's access to education, including the use of school premises. This applies particularly to uniformed personnel. Furthermore, … United Nations peace operations personnel shall at no time and for no amount of time use schools for military purposes.” UN Department of Peacekeeping Operations, Department of Field Support and Department of Political Affairs, “Child Protection in UN Peace Operations (Policy),” June 2017.

Posted: January 1, 1970, 12:00 am

The announcement from the task force gives more choices for detecting potential cancer cells.

© iStock

Black women in the United States are more than twice as likely to die from cervical cancer – a preventable disease – as white women. Yesterday, health insurance coverage for a comprehensive cervical cancer screening strategy was expanded. But will it help address this disparity?

The United States Preventive Services Task Force (USPSTF), an independent panel of private-sector medical experts appointed by the government, plays a big role in determining what health insurance covers. Among other responsibilities, the government-funded entity makes recommendations about preventive services.

Since 2012, the recommended standard of care for women ages 30 to 65 has been a Pap test every three years or “co-testing”– a joint test for the human papillomavirus (HPV), which is linked to cervical cancer, and a Pap test – every five years. Yesterday, the task force added high-risk HPV tests, which identify the strains of HPV that are most likely to cause cervical cancer, to its recommendations, meaning that most health plans will have to cover it without co-pay. Women won’t have to pay out of their own pocket.

Providing options to providers and women is overall a good thing. However, it’s not enough to address the US’s cervical cancer problem. Screenings, while necessary, will not prevent a single cervical cancer death unless women have access to further diagnostic follow up and treatment.

Women of color in particular struggle to access the life-saving care they need once they receive an abnormal screening. The Jeanette Acosta Invest in Women’s Health Act of 2018, which is being reviewed by committees in the US House and Senate, aims to address these disparities. Named after a former Hill staffer who lost her battle with cervical cancer last year at age 32, this bill would, among other things, help fund programs that expand access to cervical cancer screening and follow-up for low-income and uninsured women.

This week’s announcement from the task force gives more choices for detecting potential cancer cells. But detection has to be coupled with follow-up care to save lives. Passing the Jeanette Acosta Invest in Women’s Health Act could be a significant next step. 

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

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. 

A year and a half ago in a Texas nursing home, I met an 84-year-old resident with dementia named Felipa Natividad. Her sister, Aurora Suarez, told me that the staff dosed Natividad with Haldol, an antipsychotic drug, to ease the burden of bathing her. “They give my sister medication to sedate her on the days of her shower: Monday, Wednesday, Friday,” Suarez said. “They give her so much she sleeps through the lunch hour and supper.” A review of Natividad’s medical chart confirmed the schedule.

Suarez said she had given her consent to use the drugs because she feared that the staff would not bathe her sister enough if she refused. But when Suarez saw the effect they had, she had second thoughts. She expressed them to the nursing home, but Natividad was taken off the antipsychotics only after she was placed in hospice care. She died a few months after my interview. Her family, seeing her in a reduced state and unable to communicate, wondered whether the drugs had compounded the losses associated with dementia; Suarez thought they contributed to her sister’s decline. “She gets no nourishment,” she told me not long before Natividad died.

The use of antipsychotic drugs as chemical restraints — for staff convenience or to “discipline” a resident — has a long history in nursing homes. In 1975, the Senate released a report, “Drugs in Nursing Homes: Misuse, High Costs, and Kickbacks,” documenting some of the same trends we still see, more than 40 years later. In the past decade, many manufacturers of antipsychotic drugs have faced civil and criminal penalties for misbranding the medications to promote them as appropriate for treating older people with dementia. For more than a decade, the Food and Drug Administration has required manufacturers to place the strongest caution, known as a “black box warning,” on the packaging to advise against the medicines’ use in these patients; such drugs almost double the risk of death for them and have never been approved as safe oreffective for treating symptoms of dementia. Despite the warning, nursing homes still often administer antipsychotic drugs in this manner, sometimes without seeking informed consent first, in violation of federalregulations and human rights norms.

Last year, I visited more than 100 nursing homes across six states as part of Human Rights Watch research on the abuse of antipsychotic drugs in such facilities. Based on government data, we estimate that in an average week, more than 179,000 older people in nursing homes are given antipsychotic drugs without an appropriate diagnosis. The powerful medications were developed to treat schizophrenia, but staff most commonlyadminister them to older people with dementia. Too often, nursing homes use the antipsychotics for their sedative effects rather than to treat a medical problem. It’s true that the prevalence of antipsychotic drugs has declined in recent years, from 1 in 4 nursing home residents without an approved diagnosis in 2012 to 1 in 6 today, but that falsely suggests that a longtime wrong is being righted. Government enforcement of regulations prohibiting the use of the drugs as a chemical restraint or without informed consent remains weak. What’s more, two Trump administration decisions threaten the progress made in curbing the abuse.

These powerful drugs are misused for a variety of reasons, including a misperception by nursing home staff that the medications can help people with dementia; a lack of awareness of their dangers, despite the black box warnings; lack of training in dementia care; and, perhaps most significant, to compensate for understaffing. Nursing homes have been exaggerating levels of nursing and caretaking staff for years, according to an analysis of federal data by Kaiser Health News.

To understand the human toll of the misuse of antipsychotics, in my visits to the nursing homes I interviewed more than 300 people — residents, their families, staff, ombudsmen and doctors, as well as researchers and regulators. In most cases, I did not use their names in my report because they cited a fear of retaliation for speaking openly to me. Human Rights Watch did not identify the individual facilities in its report because the abuse is so pervasive in the industry, and not identifying nursing homes persuaded some staffers to speak with me. Further, the goal was not to expose particular private actors so much as to pressure government officials to enforce minimum health and safety standards for all providers.

Lenora Cline, 88, has lived in a nursing home for years. She has Alzheimer’s disease. Laurel Cline, her daughter, visits her twice a day and assists staff with the care-taking, fearing that otherwise, with the shortage of staff, her mother will not be turned, fed, or changed. She had to persuade the facility to discontinue antipsychotic medications. Before successfully objecting to their use, Ms. Cline said, “Every little thing, they want to put you on psych meds.” Los Angeles, California, August 2017. 

© 2017 Ed Kashi for Human Rights Watch

I found that too often, antipsychotic drugs are administered in harmful, avoidable ways and without the appropriate consent. They are used to control people. Nursing home residents and their family members repeatedly told me they were given these medicines without their knowledge, without awareness of the risks or over their objections. Staff members frankly admitted giving residents these medicines for their own convenience, with some saying they were not aware of an informed-consent policy. Nursing facility staff, pharmacists and medical directors described how doctors commonly prescribed the medications at the request of nursing staff, without even seeing the patients.

[How corporate funding can distort NIH research]

Nursing homes turn to antipsychotic drugs — among other classes of psychotropic medications — because dementia is associated with agitation, irritability, aggression, delusions, wandering, disinhibition and anxiety. While such symptoms are frightening for the people experiencing them and challenging for their caregivers, institutional or otherwise, antipsychotic drugs have not been found to be effective at managing them. In a small number of particularly complex cases, antipsychotic drugs may be appropriate as a last resort. But that is a far cry from how they are used. The American Psychiatric Association concludes that the drugs offer “at best small” potential benefits (such as minimizing the risk of self-harm in people with extreme agitation), while “on the whole, there is consistent evidence that antipsychotics are associated with clinically significant adverse effects, including mortality.”

On paper, federal regulations say that residents have the right to be fully informed of their treatment and to refuse treatment, which should amount to a right to informed consent. But nursing facilities widely ignore the rules, partly because they are rarely held accountable. Reviewing government data from 2014 through mid-2017, Human Rights Watch found that in 97 percent of citations for violations related to antipsychotic drugs, the incidents were determined to have caused “no actual harm” to residents. As a result, in almost no cases did the government impose financial penalties, which correspond to the severity of harm caused by the noncompliance. The prospect of enforcement actions, and the rare sanctions issued, unsurprisingly had little deterrent effect, our analysis found. Nursing homes cited for antipsychotic-drug-related issues did not reduce their rates of drug use any more than facilities not cited.

The way nursing homes obtain or define “informed consent” can also be a factor in the drugs’ misuse. “The use of specific medicines, particularly for somebody with dementia, who lacks the capacity to consent themselves, should require informed consent from their legal representative,” says Jonathan Evans, a former president of the American Medical Directors Association. “But in practice that seldom happens. Not just for that medicine but for any medicine.”

The former administrator of a nursing home in Kansas, who asked to remain anonymous, said: “The facility usually gets informed consent like this: They call you up. They say: ‘X, Y and Z is happening with your mom. This is going to help her.’ Black box warning? It’s best just not to read that. The risks? They gloss over them. They say, ‘That only happens once in a while, and we’ll look for problems.’ We sell it. And, by the way, we already started them on it.”

Despite the limited threat of penalties, many nursing homes have reduced inappropriate use of the drugs in recent years anyway, in response to increased public pressure. By 2012, congressional outrage over the widespread misuse of medications, costing hundreds of millions of Medicare dollars annually, had motivated the Centers for Medicare and Medicaid Services (CMS) to create the National Partnership to Improve Dementia Care in Nursing Homes . While the partnership is only a voluntary initiative offering educational support to train providers, the increased attention has been associated with the reduction in misuse. But it is hard to celebrate the decline when the government elects not to rigorously use the tools it has to protect Americans in nursing homes from irreversible harm.

What’s more, the national reduction may be misleading — and it may not last. First, there’s been a notable uptick in the diagnosis of schizophrenia (a disease that typically develops before age 30) in predominantly elderly nursing home populations. This increase corresponds to the rising pressure on facilities to reduce off-label antipsychotic drug use. There’s no proven link, but the trend does suggest that some homes seek false diagnoses to avoid red flags with the use of these medications. A second concern, recognized by CMS, is that nursing homes are simply replacing this closely watched class of psychotropic medication with other types of sedating drugs with similar health risks.

[Aging is not death. Stop conflating the two.]

Meanwhile, in response to an industry request, the Trump administration in July 2017 changed its guidanceon financial penalties, limiting the instances when inspectors can assess the heaviest fines. The guidance also favors one-time sanctions for harmful noncompliance with the law, rather than a per-day sanction that corresponds to the number of days the harm persists. As a result, in many cases facilities face less-significant consequences for harming residents than they used to. And last November , CMS imposed an 18-month moratorium on Obama-era revisions to some regulations — not updated since 1991 — intended in part to protect residents whose psychotropic medications are prescribed on an “as needed” basis. While it is unclear if those new protections will come into force, it is abundantly clear that this administration’s deregulatory scheme, which it calls “Patients Over Paperwork,” reduces oversight and enforcement in an already dangerously underpoliced industry.

Karla Benkula, daughter of a 75-year-old woman in Kansas, said that when the nursing facility began giving her mother an antipsychotic drug, her mother “would just sit there like this. No personality. Just a zombie.” Laurel Cline, the daughter of an 88-year-old woman in a California nursing home, said she thought the facility used antipsychotic medication to silence people whose symptoms disturbed the staff. Cline said it was obvious that her mother had physiological conditions requiring medical attention. “She would be sitting there, slumped over, mucus everywhere. I would go over and say, ‘She’s sick.’ ” But Cline’s mother wasn’t able to advocate for herself, and Cline had to intervene to demand appropriate medical care for a urinary tract infection, pneumonia and a pulmonary embolism, she said.

“Dementia’s already so hard,” said Ashley Plummer, a licensed practical nurse who works in a Kansas nursing home. “But on top of that, throw [on] a few Seroquels [a common antipsychotic drug], and then you’re just drooling. I mean, it’s taking away even your right to be upset about your disease process. It’s taking away your right to mourn what you’re going through.”

In my interviews, it was disturbing how frequently staff justified administering antipsychotic drugs for “behaviors,” a disconcerting term suggesting that residents could, and should, avoid acting in a disruptive way. A social worker in Texas who used to work in a nursing facility said the underlying issue is that “the nursing homes don’t want behaviors. They want docile.”

Many nursing home staff spoke to me about using antipsychotics to control residents as if it were a perfectly acceptable practice. Others told me that they had become aware that antipsychotic drugs were frequently misused only after the facility’s administration or corporate owners decided to cut down on their use. “It used to be like a death prison here,” a nursing director in a Kansas nursing home told me. “Half our residents were on antipsychotics. Only 10 percent of our residents have a mental illness.” Senior staff at the facility led an effort to reduce the antipsychotic drug rate after receiving financial penalties for administering unnecessary medications and after pressure from the chain’s owners. Another nurse in Kansas said: “We were at 55 percent antipsychotic drug rate before. Now we’re down to only people with a diagnosis [for which the FDA has approved the medications] on the drugs. They have a better quality of life because they’re not sedated.”

[I’m documenting my own Alzheimer’s disease while I still can]

Nursing homes, a mostly for-profit industry, control most aspects of their residents’ lives. Presumably, providers would be more inclined to meet minimum health and safety standards if it cost them dearly not to do so. “In this industry, there is a real cost-benefit analysis,” one long-term-care consultant told me. “If the fine will be $100,000, then they’ll hire the three nurse aides who will cost them about the same amount.”

Antipsychotic drugs may be an appropriate treatment for some people with dementia in nursing homes, but determining that requires a doctor and an informed patient (or proxy). And once told of the significant risks, unlikely benefits and possible alternative treatments — such as behavioral therapy, adjusting routine and environment, or alleviating the source of underlying loneliness, pain, boredom or fear — many people would probably reject the drugs. As one long-term-care pharmacist in Kansas said: “I don’t think antipsychotic drugs are presented well to the family in informed-consent conversations. Because if it were, they’d all reject it.”

An 81-year-old man in a Texas nursing home put it this way to me: “Too many times I’m given too many pills. I can’t even talk. I have a thick tongue when they do that. I ask them not to [give me the antipsychotic drugs]. When I say that, they threaten to remove me from the home. They get me so I can’t think. I don’t want anything to make me change the person I am.”

Hannah Flamm, an immigration lawyer at the Door’s Legal Services Center, reported on the misuse of antipsychotic drugs in nursing homes while she was a fellow at Human Rights Watch.

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

A sign which reads “Care instead of Punishment” is held aloft at a protest rally calling for decriminalization of personal drug use, Tbilisi, Georgia, December 10, 2016.

© Yana Korbezelashvili for White Noise Movement

(Tbilisi) – Georgia’s drug laws and their aggressive enforcement is causing severe and unjustifiable harm, Human Rights Watch said in a report released today. Drug prosecutions for consumption and possession often lead to long prison sentences and prohibitive fines against people who have not harmed others, but who acquired small amounts of drugs for personal, recreational use.

The 67-page report, “Harsh Punishment: The Human Toll of Georgia’s Abusive Drug Laws,” describes the impact of overly punitive drug laws and practices on people who use drugs, and on their families. Human Rights Watch documented abusive, mandatory street drug testing, coerced plea bargains, and arbitrary additional punishments, such as stripping people of their driver’s licenses or prohibiting them from working in an array of professions, interfering with their ability to earn a livelihood. Georgia has partially liberalized drug laws, but they remain harsh.

“Every year, Georgian authorities needlessly detain thousands of people, subject them to forced drug tests and funnel them through the criminal justice system, for nothing more than drug consumption or possession for personal use,” said Giorgi Gogia, associate Europe and Central Asia director at Human Rights Watch, and author of the report. “Locking people up for no more than using drugs causes tremendous harm and does nothing to help those who need and want treatment.”

The report is based on more than 85 in-depth interviews with people who have been prosecuted for drug-related crimes, their lawyers and family members, as well as social workers, community organization leaders, government officials, and various advocacy groups and nongovernmental organizations.

In Georgia, first-time illegal drug consumption or possession of a small quantity of drugs for personal use is a misdemeanor. A repeat offense within a year results in criminal liability.

However, Georgian law does not establish a threshold for small quantities of approximately three-quarters of the substances classified as illicit drugs, including those commonly used in Georgia, such as amphetamine, methamphetamine, and desomorphine. Possession of even particles of these substances, including residue in a syringe, automatically qualifies as a large amount, triggering a mandatory minimum five-year prison sentence. Possession of more than one gram is considered a “particularly large amount” and could result in life imprisonment.

In one case, in 2016, police arrested Kote Japaridze, 23, for possession of two grams of the recreational synthetic drug MDMA (“ecstasy”) and charged him with possession of a particularly large quantity of drugs. Facing up to 20 years in prison, Japaridze entered into a plea deal, and a court sentenced him to six years in prison, five of which were suspended. The court also imposed a fine of 25,000 Georgian lari (roughly US$10,800). Japaridze struggles to repay the debt for the fine and has been deprived of his driver’s license and banned from working in certain jobs for five years.

“The drugs I bought were for personal use, and yet I am paying dearly for it,” Japaridze told Human Rights Watch.

Every year, police randomly detain thousands of people for coerced drug testing for which fewer than 30 percent test positive. Police use positive test results as evidence for pressing administrative or criminal sanctions. If the person refuses to undergo testing, police can detain them for up to 12 hours in a forensics lab. Georgian law does not give people held for testing the same rights as detainees, such as the right to make a phone call, leaving them vulnerable to ill-treatment by the police, Human Rights Watch said.

Georgian law imposes long, mandatory minimum sentences for drug-related offenses, with a nearly 100 percent conviction rate for these offenses. As a result, a person charged with a drug-related offense often feels there is no other choice than to agree to a plea deal to avoid a long prison term. These plea deals also lead to prohibitive fines, which can financially devastate the accused and his or her family.

In another case Human Rights Watch documented, a family lost their home to pay drug-related criminal fines.

Drug felony convictions also lead to suspension of driver’s licenses and a ban on work in all government positions and educational and medical institutions for periods ranging from 3 to 20 years after release from prison. Such restrictions effectively strip many people of their livelihoods, Human Rights Watch said.

Some of the harsher features of Georgia’s current drug policies and practices were adopted in 2006, and starting in 2012, Georgia’s leadership partially liberalized them. The government reduced criminal penalties for drug possession and consumption. It also adopted a National Strategy and Action Plan to fight drug addiction, which emphasized the importance of public health and prevention of drug use.

Recent constitutional court rulings further liberalized drug policies. Most recently, on July 30, 2018, the court abolished remaining administrative sanctions for marijuana consumption.

The Georgian government offers, free of charge, opioid substitution with Methadone or Suboxone, and short-term detoxification and rehabilitation. Since 2012, the government has significantly increased financial allocations for these programs.

The Georgian authorities should decriminalize personal use and possession of drugs, Human Rights Watch said. This means removing all criminal sanctions for use and possession of drugs for personal use.

“Many people understandably want the government to address the harmful use of drugs, but the most effective way is to focus on public health responses,” Gogia said. “Criminalization and locking people up for using drugs is not an answer.”

Posted: January 1, 1970, 12:00 am

Ibrohim Hamza Tillozoda

© Payom.net

(Almaty) – Tajik authorities should immediately lift a politically motivated travel ban and allow a critically ill child to receive lifesaving medical treatment abroad, Human Rights Watch and the Norwegian Helsinki Committee said today. The 4-year-old boy, Ibrohim Hamza Tillozoda, has life-threatening stage-three testicular cancer that domestic health care was unable to treat.

Ibrohim Hamza is the son of an opposition member, Ruhullo Tillozoda, and the grandson of the opposition leader, Muhiddin Kabiri, the chair of the Islamic Renaissance Party of Tajikistan (IRPT), both of whom fled Tajikistan in 2015 to evade political persecution and are wanted by Tajik authorities. In late 2015, Tajik authorities confiscated the travel documents and birth certificates of Hamza’s mother, Mizhgona, and other family members, preventing them from traveling outside the country.

“Tajik authorities should immediately allow 4-year-old Hamza and his family to leave so he can receive life-saving medical treatment,” said Marius Fossum, Norwegian Helsinki Committee Regional Representative in Central Asia. “President Emomali Rahmon should ensure that the family can travel.”

For several years, Tajik security services have kept the Tillozoda family under close surveillance and placed harsh restrictions on Hamza’s mother, preventing her from getting her passport back.

Earlier this year, doctors in Tajikistan were unable to successfully treat Hamza, who has been suffering from cancer for several years. His family and medical experts believe that treatment abroad remains the only possible way to save his life. Human Rights Watch and the Norwegian Helsinki Committee have learned that an oncological clinic in Turkey is prepared to provide the treatment.

In response to a social media campaign calling on the Tajik government to allow Hamza to travel abroad for medical treatment, Tajik authorities have claimed that the family is free to leave the country at any time. However, in the three years since the security services confiscated the family’s passports and birth certificates, they have continually intimidated and harassed the remaining family members, confiscating their mobile phones and preventing them from making contact with anyone outside their village.

Security services have repeatedly visited the family and accused them of being the relatives of “terrorists” and “enemies of the people.” The security services recently forced Hamza’s mother to tell journalists that she had lost her passport, even though the security services had confiscated the documents.

OVIR, a part of the Internal Affairs Ministry, which is responsible for issuing new travel documents, has taken no meaningful steps to provide the family with alternate travel documents, even as the child’s medical condition has become critical.

Oncologists in Turkey examined available information about the child’s illness, including photographs showing an orange-sized tumor in the boy’s groin area, and estimated on July 25, 2018, that the boy would be at imminent risk of life threatening complications if he doesn’t get adequate health care within days.

Kabiri and Tillozoda were forced into exile when the authorities began a crackdown on the Islamic Renaissance Party of Tajikistan (IRPT) that led to its forced closure in August 2015. A month later, the authorities later accused its leaders, including Kabiri and Tillozoda, of involvement in alleged coup and designated the group a terrorist organization in October. Since then, authorities have arrested hundreds of party members and other peaceful activists on fabricated charges. In many cases, Tajik authorities have confiscated the travel documents of the relatives of exiled dissidents.

Over the past four years, Tajikistan has been undergoing a severe human rights crisis and crackdown on the peaceful opposition, the groups said. In addition to outlawing the opposition party, the government has persecuted peaceful activists and imprisoned hundreds of opposition members and their lawyers. On July 11, a court in northern Tajikistan sentenced an independent journalist, Khayrullo Mirsaidov, to 12 years in prison on charges that appeared to be retaliation for his exposure of government corruption. Government officials routinely target the family members of critics abroad, subjecting them to harassment, threats and intimidation.

“It is morally reprehensible that Tajik authorities appear to be holding a critically ill child hostage to exert pressure on his father and grandfather,” said Steve Swerdlow, Central Asia researcher at Human Rights Watch. “This case should not be about politics, but about a child’s life.”

Posted: January 1, 1970, 12:00 am

A nurse prepares a vaccine to be given to a child in a hospital in Beijing, China on April 13, 2016. 
 
© 2016 Reuters/Damir Sagolj
China’s social media users are in an uproar over a major drug company’s sale of substandard vaccines – most for babies as young as 3-months-old – and the authorities’ persistent failure to regulate the vaccine market properly.

On Sunday, China’s Premier Li Keqiang vowed to “resolutely crack down on … criminal acts that endanger the safety of people’s lives … and severely criticize dereliction of duty in supervision.” The police have since launched an investigation, but for that or any pledge to be meaningful – unlike commitments made following previous vaccine scandals – Li and other leaders should take the following steps:

First, release from incarceration all the lawyers who assisted victims in previous vaccine scandals. From 2006 to 2009, lawyer Tang Jingling represented a group of parents whose children were left permanently disabled after being given problematic meningococcal vaccines. This would require quashing the five-year sentence Tang is currently serving on baseless charges of  “inciting subversion.” Similarly, lawyer Yu Wensheng has languished in a detention center on spurious “subversion” charges. Yu had represented a man who was detained for seeking redress for his daughter, who became seriously ill after being given spoiled vaccine.

Second, stop harassing, detaining, and prosecuting families of victims of faulty vaccines. In July 2015, after being given vaccines at the local government-run epidemic prevention center in Henan province, Wang Nuoyi was diagnosed with a brain injury and other illnesses. In pursuit of justice, her family wrote letters to the government. The authorities responded by detaining Wang’s father for four months in 2017 as well as at least six other members of his family, and prosecuting Wang’s grandmother for “provoking trouble,” which resulted in a two-year prison sentence.

Third, stop punishing journalists for exposing vaccine scandals. In 2010, prominent investigative journalist Wang Keqin was removed from his post at the China Economic Times after the newspaper published his story about mishandled vaccines that led to the deaths of four children in Shanxi province. Amid the current scandal, while netizens are free to condemn the drug company, news articles and social media posts that showed the Chinese government in a critical light continue to be censored.

If Li is serious about transparency and accountability, his government should stop punishing those who endeavor to achieve exactly that.

Author: Human Rights Watch
Posted: January 1, 1970, 12:00 am
Dr. Brittany Brooks meets with a patient at Open Arms Healthcare Center, a clinic in Jackson, MS, that focuses on alleviating healthcare disparities for underserved populations, with a particular focus on LGBT people. 
© 2018 Nina Robinson / The Verbatim Agency / Getty Images

The Trump administration is considering regulatory changes that would worsen barriers many lesbian, gay, bisexual, and transgender (LGBT) people in the United States face in obtaining health care, Human Rights Watch said in a report released today. The US Department of Health and Human Services (HHS) should reconsider those changes, which would leave LGBT people more vulnerable to discrimination.

The 34-page report, “‘You Don’t Want Second Best’: Anti-LGBT Discrimination in US Health Care,” documents some of the obstacles that LGBT people face when seeking mental and physical healthcare services. Many LGBT people are unable to find services in their area, encounter discrimination or refusals of service in healthcare settings, or delay or forego care because of concerns of mistreatment.

“Discrimination puts LGBT people at heightened risk for a range of health issues, from depression and addiction to cancer and chronic conditions,” said Ryan Thoreson, an LGBT rights researcher at Human Rights Watch. “Instead of treating those disparities as a public health issue, HHS is developing politicized rules that will make them much worse.”

Two upcoming regulatory changes are likely to worsen these barriers, Human Rights Watch said. In January 2018, HHS issued a proposed rule that would broaden existing religious exemptions in healthcare law, giving sweeping discretion to insurers and providers to deny service to patients because of their moral or religious beliefs. In April 2018, the Trump administration announced plans to roll back a regulation that clarifies that federal law prohibits healthcare discrimination based on gender identity. If finalized, these changes would further undermine the limited antidiscrimination protections that currently exist for LGBT people.

Human Rights Watch interviewed 81 people for the report, including providers and individuals who said they had experienced discrimination in healthcare settings.

Existing protections for LGBT people in health care are uneven. In 2016, the Obama administration issued a regulation clarifying that Section 1557 of the Affordable Care Act, which prohibits sex discrimination in health care, also prohibits discrimination against transgender people. Eight states and religious healthcare providers challenged the regulation in court, and the Trump administration has signaled it plans to roll it back.

Protections at the state level are lacking. As of July 2018, 37 states do not expressly ban health insurance discrimination based on sexual orientation or gender identity. New Jersey prohibits discrimination based on gender identity but not sexual orientation. In 10 US states, transition-related health care is expressly excluded from Medicaid coverage, limiting options for low-income transgender people.

LGBT people interviewed for the report described difficulty finding hormone replacement therapy, HIV prevention and treatment options, fertility and reproductive services, and even just welcoming primary care services. Judith N., a transgender woman in East Tennessee, said, “I spent years looking for access to therapy and hormones and I just couldn’t find it.”

Others described discriminatory treatment by providers. Trevor L., a gay man in Memphis, recalled an incident when he took an HIV test at his annual checkup in 2016: “and they sat down and started preaching to me – not biblical things, but saying, you know this is not appropriate, I can help you with counseling, and I was like, oh, thank you, I’ve been out for 20 years and I think I’m okay. It’s almost like they feel they have the right to tell you that it’s wrong.”

In addition to discrimination, many LGBT people are refused services outright because of their sexual orientation or gender identity. In a nationally representative survey conducted by the Center for American Progress in 2017, 8 percent of lesbian, gay, and bisexual respondents and 29 percent of transgender respondents reported that a healthcare provider had refused to see them because of their sexual orientation or gender identity in the past year. Interviewees described being denied counseling and therapy, refused fertility treatments, denied a checkup or other primary care services, and in one instance, told that a pediatrician’s religious beliefs  precluded her from evaluating a same-sex couple’s 6-day-old child.

Both providers and LGBT people noted that concerns about discrimination and mistreatment led LGBT people to delay or forego care. A 2015 survey of almost 28,000 transgender people found that, in the year preceding the survey, 23 percent did not seek care they needed because of concern about mistreatment based on gender identity.

Many interviewees expressed concern that laws permitting providers to refuse service on moral or religious grounds would make care even harder to obtain. Persephone Webb, a transgender activist in Knoxville, Tennessee, said that “[i]t tells people who are prone to being bigoted to be a little braver, and a little braver. And we see through this – we know this is an attack on LGBT people.”

Instead of finalizing the proposed changes, HHS should preserve antidiscrimination protections and withdraw sweeping exemptions that put patients at risk, Human Rights Watch said. Lawmakers at the state and federal level should prohibit discrimination in health care on the basis of sexual orientation and gender identity, and should repeal exemptions that allow providers to refuse to serve patients because of their sexual orientation or gender identity.

“When LGBT people seek medical care, the oath to do no harm too often gives way to judgment and discrimination,” Thoreson said. “Lawmakers need to make clear that patients come first, regardless of their sexual orientation or gender identity.”

Posted: January 1, 1970, 12:00 am

(Beirut) – Iraq’s National Security Service (NSS), an Iraqi intelligence agency reporting to Iraq’s prime minister, has acknowledged for the first time that it is detaining individuals for prolonged periods of time, despite not having a clear mandate to do so, Human Rights Watch said today. NSS is holding more than 400 detainees in a detention facility in east Mosul. As of July 4, 2018, 427 men were there, some of whom had been held for more than seven months.

A blank NSS arrest warrant provided to Human Rights Watch. 

© 2018 Private

One person held there briefly in April described horrendous conditions, and said that detainees had no access to lawyers, family visits, or medical care. He described one prisoner dying in April after being tortured for months. Human Rights Watch was granted access to the facility on July 4. The detention conditions appeared improved but remained overcrowded.

“National Security Service officials in Baghdad told us that the intelligence agency has no authority to hold prisoners, but changed their line once we were able to see the prisoners for ourselves,” said Lama Fakih, deputy Middle East director at Human Rights Watch. “Baghdad needs to publicly clarify which authorities have the right to hold and interrogate detainees.”

On April 17 a senior NSS official in Baghdad denied operating any detention facilities and claimed that the agency only holds small numbers of people for up to 48 hours before transferring them to places of formal detention. But researchers were granted access to the facility, where officials said 427 prisoners were being held at the time. A subsequent written response from the Baghdad office confirmed the NSS is holding prisoners in one facility in Mosul, but then proceeded to speak about detention facilities in the plural form. Given the serious contradiction in statements and facts on the ground, the NSS should clarify the number of prisoners it is detaining and the number and location of facilities it is using to detain them. Iraqi authorities should declare the number of detention facilities across Iraq. Judicial authorities should investigate the allegations presented in this report.

On May 16, Human Rights Watch interviewed Faisal Jeber, 47, an archaeologist, who said that on April 3 a group of three Ministry of Interior Intelligence officers in uniform and two armed men in civilian dress, one of who told Jeber he was “from the Prime Minister’s Office” arrested him at an archaeological site in east Mosul, claiming he had no permission to be there and accusing him of illegal excavations at a public heritage site. They first took him to an intelligence office, before turning him over to NSS officers who called a judge to endorse the arrest, Jeber said. Jeber was not given an opportunity to speak to the judge. NSS then brought him to a two-story house next to the NSS office in al-Shurta neighborhood in Mosul. Jeber said that on the ground floor of the house he saw four rooms being used as cells to hold prisoners and estimated that at least 450 prisoners were held with him based on a daily head count.

Jeber said he was taken before an investigative judge at Mosul’s criminal court on April 4, and then returned to the prison for a second night and released the following day pending trial. Upon arrival at the prison, he said guards confiscated his glasses and watch, and other personal items. When he was released, Jeber said guards did not give him his shoes or socks back, sending him out barefoot, and kept his belt, keychain, and headphones.

While Jeber was only held for 48 hours, he said he spoke with six men and one boy detained in the cell with him who told him NSS held them for between four months to two years, some being transferred to several NSS facilities before arriving at this one. Human Rights Watch researchers visited the facility on July 4, and the head of the NSS in Mosul showed them a brand new prison block that had been built next to the house where Jeber had been held. The new facility had three rooms and held 427 adult male prisoners, according to the NSS official. He said they transferred all prisoners under the age of 18 to another facility. He said some had been at the prison for up to seven months.

Another NSS officer who spoke to researchers on condition of anonymity said that some had been held for over one year, having been transferred from Qayyarah to Bartalla and on to Mosul when the detention site opened there seven months ago. The second officer said they had been holding the prisoners in a house next door, but after “pressure from Baghdad,” a few months ago they built the new prison block and transferred the prisoners there to improve conditions. The three rooms were clean, with air-conditioning, but like other prisons in Iraq extremely overcrowded.

The head of the NSS in Mosul said all the prisoners were wanted for ISIS affiliation, and were interrogated before they were either brought before an investigative judge or handed over to another security entity if that entity had the person on one of their “wanted” databases, including the Ministry of Interior’s intelligence branch, or military intelligence. He said they only arrested people after obtaining a warrant, and that all detainees had access to a judge and a lawyer within 24 hours of their arrest. Human Rights Watch did not interview any of the detainees at the facility.

Two Mosul lawyers who defend ISIS suspects said that in their experience, many prisoners are seeing an investigative judge within 24 hours, but have no government-appointed lawyer present then, nor later when the NSS interrogates them further. While the seven detainees told Jeber they had been brought before an investigative judge, none of them had access to a lawyer and they did not know if a lawyer was present to provide them with a defense during their hearing.

Iraq’s Criminal Code of Procedure allows police and “crime scene officers” to detain and interrogate criminal suspects if they have a warrant. It defines crime scene officers broadly, making it impossible to ascertain which forces are included. The NSS head in Mosul said that the NSS was authorized to arrest, hold, and interrogate prisoners.

However, Hamid al-Zerjawi, deputy National Security Service chief, told Human Rights Watch on April 17, that the NSS has no functional detention facilities in the country, and only one facility in Baghdad that is not yet operational. He conceded that the NSS held small numbers of people for up to 24 hours after their arrest at one of their offices, before bringing them before a judge, who could allow them an extra 24 hours of detention, before they needed to transfer the detainee to a formal detention facility. He said the NSS never held any detainee for over 48 hours.

On July 11, the NSS’s Baghdad office responded to Human Rights Watch inquiries into the facility. The written response acknowledged that the NSS is holding detainees at a single facility in Mosul with the consent of the High Judicial Council in Nineveh, that all detainees are held under judicial arrest warrants, see a judge within 24 hours of arrest, and are transferred to Ministry of Justice prisons upon being sentenced. The response did not provide any numbers of detainees nor details into the length of time they are being held at the facility, but stated that detainees are allowed to retain a lawyer, or have one appointed by the court, but added: “most lawyers in the governorate of Nineveh abstain from arguing terrorism cases.” It said there were no detainees under the age of 18.

The Iraqi authorities should publicly clarify which forces have a legal mandate to arrest, hold, and interrogate suspects, and provide a list of all official detention facilities. They should transfer all detainees to prisons run by authorities with a legal mandate to detain people. Such sites should be built to accommodate detainees, and equipped to meet basic international standards, even if this requires transferring the detainees outside of the Nineveh governorate, where Mosul is located. All detainees should have a medical screening upon arrival and be ensured access to medical care. Judges should only order detention in locations, and under the authority of forces, legally authorised to hold detainees, and order the immediate release of detainees or prisoners being held in inhuman or degrading conditions or otherwise detained unlawfully.

The authorities should also ensure that there is a clear legal basis for detention, that all detainees have access to legal counsel including during interrogation, and that detainees are moved to facilities accessible to government inspection, independent monitors, relatives, and lawyers, with regular and unimpeded access. The authorities should immediately notify families of the detention of their loved ones and which authority is detaining them and promptly take detainees before a judge to rule on the legality of their detention. They should immediately comply with any order by judges to release detainees.

Children alleged to have committed illegal acts should be treated in accordance with international juvenile justice standards. International law allows authorities to detain children pretrial in limited situations, but only if formally charged with committing a crime, not merely as suspects. The authorities should release all children not yet formally charged.

“Authorities should be doing whatever it takes to make sure that families know where their loved ones are,” Fakih said. “The government should crack down on forces with no legal mandate that are holding detainees for months on end without seeing a judge.”

The Former Detainee’s Account
Faisal Jeber, the archeologist, told Human Rights Watch that the detainees he spoke to said they were being held on suspicion of ISIS affiliation and alleged that during interrogations NSS officers had beaten them with plastic or electrical cables, electrocuted them, beaten the soles of their feet, and hung them with their hands bound behind their backs.

Jeber said that at 3 a.m. on his first night at the prison, an argument broke out between two prisoners in his room. He said two guards came in, took the two men out, and in front of the window Jeber saw each guard beat one of the men with plastic cables and pipes for about 20 minutes, cursing and shouting at them before returning them to the room.

He said that first night in detention he was told that a man had died after being tortured: 

My first night it was the time when we all get to use the bathroom. As we were getting ready to leave our room in a line, we heard voices coming out of the room and it was chaos; the guards were saying someone had died. One prisoner with me said that he had been in the cell with the man who died, and said he was in his thirties, had been at the prison for some time, and had been tortured to the point that he had been half paralyzed.

The NSS July 11 response acknowledged deaths at the prison, stating, “There have been very limited cases of death, which were judicially documented,” without providing any further detail. The response also stated,

 

There has been no use of torture inside detention centers, and no signs of torture or ill-treatment have been found, knowing that there is a department within the NSS that is specialized in these cases if they occur.

Jeber described the conditions in the facility, raising concerns about overcrowding, unhygienic conditions, and unreasonable restrictions on using the bathroom. He said that the room he was held in had a single window and small ventilator and was about 4 by 5 meters:

As I walked in I saw that half the prisoners were standing and the other half sitting because there wasn’t enough room for all of us to sit at the same time. My fellow inmates told me that I was the 79th person in the room. All around me on the walls were plastic bags hanging as well as plastic bottles holding a dark yellow liquid. The prisoners told me that was the only way that I could use the bathroom- urinate into the bottle or defecate into the bag- because the NSS guards only allowed prisoners to use the bathroom once every two days.

He said that at night the prisoners slept in shifts in the scabies-infested room because there was not enough room for all of them to lie down, with some standing until 6 a.m., before it was their turn to lie down with their heads between the legs of other prisoners.

Jeber also raised concerns about the absence of medical care for the detainees. He said that the first night of his detention one man in his cell suffered an epileptic seizure but received no medical attention. Other prisoners told him the guards had said that a doctor would only come if someone died and the body needed to be removed.

The NSS head in Mosul told Human Rights Watch that a representative from the Health Ministry visited there regularly to provide medical assistance, something Human Rights Watch was unable to verify.

The conditions the NSS held Jeber and others in, before the transfer to the new facility, are similar to the dire conditions at other prisons in the towns of Qayyarah and Hammam al-Alil, that Human Rights Watch visited in 2017.

Most of the prisoners Jeber spoke to said they had been able to bribe the guards to allow them to communicate with their families indirectly but none had been allowed a family visit. One gave Jeber his uncle’s phone number. Jeber said, “After I was released I called his uncle, who was surprised that he was still alive and said the family had no news of him since he had disappeared during the Mosul battle in early 2017.” The anonymous officer said that they forbade prisoners to have any visits or contact with their families or the outside world. The NSS July 11 response stated that detainees were only allowed to contact their families after the interrogation period ends.

Jaber believed that there were at least 450 prisoners in the home at the time he was held, because on the two days he was held there he said guards at the facility did a headcount and he overheard them counting at least 450 prisoners.

The NSS response

The NSS officer who spoke to researchers on the condition of anonymity said that officers know some prisoners are innocent. He said the NSS held many of them for months because Nineveh only has one counterterrorism judge hearing cases of detainees held by the NSS, leading to long delays. He said in cases where a defendant does not confess to a crime, the judge needs to order a range of investigations to be carried out by various security actors which also takes a long time to complete.

The NSS head in Mosul stated that the detention site has many prisoners they would like to transfer to other authorities, with a judge’s order, but that there is no room available in other prisons. The prohibition against arbitrary detention is enshrined in Iraq’s constitution and civil code. Under international criminal law, widespread or systematic use of arbitrary detention can be considered a crime against humanity if it is applied as part of a state policy.

Iraq’s penal code says that arbitrary detention is a criminal act if, among other conditions, the person who commits the offense issues a false arrest or detention order, threatens the person with death or torture, and holds the person for more than 15 days.

Posted: January 1, 1970, 12:00 am

Rural residents are being poisoned in Brazil from pesticides sprayed near their homes, schools, and workplaces. Many rural communities fear reprisals from wealthy and politically powerful farmers if they denounce such poisonings or advocate more protective laws and regulations.

Posted: January 1, 1970, 12:00 am