Each month, about one million people cross through checkpoints like Stanytsia Luhanska in east Ukraine. More than half are older people traveling into areas under Ukrainian control to collect social benefit payments. Between January and early April, according to the Organization for Security and Co-operation in Europe (OSCE), at least 19 people died while crossing these checkpoints, mostly older people with heart-related complications. Ukrainian officials have voiced deep suspicion and even hostility toward this population, suggesting they are “anti-Ukrainian.” The government also forces them to register as internally displaced persons and to provide addresses in government-controlled areas – a legal fiction which often involves paying monthly fees to landlords there – and to make the difficult journey through Ukrainian crossing points at least once every 60 days. If they fail to register or cross, the authorities automatically stop paying their pension. Spend an hour in Stanytsia Luhanska and it becomes clear just how arduous these requirements are for older people. Dozens pass by in wheelchairs, while others can walk only with crutches, walkers, or canes. Some people pay up to 200 hryvnia (about US$7.60) to be ferried one half of the journey in hand-pushed carts – no small price for someone on a pension of 2000 hryvnia (US$76).

Posted: January 1, 1970, 12:00 am

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

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

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

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

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

Shantha received degrees from the Fletcher School of Law and Diplomacy at Tufts University and the University of Michigan, and was a Fulbright Scholar to Austria. She speaks German and Kannada. Shantha is married and has two sons.

Posted: January 1, 1970, 12:00 am

A relative pushes John Biel Dup’s wheelchair through the dirt paths of Protection of Civilians Camp 3 in Juba,. The uneven paths make it difficult for people with physical disabilities to move around the camps..

© 2017 Joe Van Eeckhout for Human Rights Watch

People with disabilities around the world face serious obstacles to realizing their rights on an equal basis with others. Human Rights Watch’s World Report 2020 documents abuses such as violence, discrimination, segregation, and unlawful detention of people with disabilities in 32 countries including Australia, Tanzania, Kazakhstan, Mexico, and the United States.

Due to prevalent stigma and lack of adequate mental health services, thousands of people with mental health conditions are shackled – chained or locked up in small confined spaces – in many countries, including Nigeria, Ghana, Indonesia, and Somaliland. Human Rights Watch has documented cases of shackling in homes, traditional and religious-based healing centers, schools, psychiatric hospitals, and state-run rehabilitation centers. Those shackled are often exposed to physical and emotional abuse, neglect, and isolation. Though shackling persists in Indonesia, government agencies have made some progress by signing an agreement to monitor places where people with mental health conditions have been shackled. Governments should ban shackling and develop quality, accessible community-based support and mental health services.

In countries facing conflict and humanitarian crises, such as Cameroon and South Sudan, people with disabilities are at heightened risk as they struggle to flee or are left behind when others flee. In April 2019, the United Nations Security Council unanimously passed its first resolution calling for the protection of people with disabilities in armed conflict by ensuring “access to justice, basic services and unimpeded humanitarian assistance” with the participation of people with disabilities in humanitarian planning and delivery.

People with disabilities still face barriers to quality education due to discrimination, lack of reasonable accommodations, and inaccessible buildings and teaching. In South Africa, children with disabilities face prejudice from education officials and are often placed in special schools, excluding them from an inclusive education in mainstream classrooms. In addition to inaccessible infrastructure, children with disabilities in Iran are subjected to a mandatory medical assessment for school enrollment that includes a discriminatory I.Q. test to determine which type of school – if any – they are permitted to attend. Children with albinism are often excluded from schools, stigmatized by students and teachers, and, in Mozambique, kept at home due to fears of kidnapping and violence. Governments should end segregation of children with disabilities and ensure inclusive education where children with and without disabilities study together.

In numerous countries, including Brazil, Serbia, and India, many children and adults with disabilities are confined or unlawfully detained in closed state and private institutions where they may face violence, neglect, and, in some cases, physical and chemical restraint. But some countries, such as Armenia, are making progress in supporting people with disabilities to live independently in the community.

As we enter 2020, governments should do more to support people with disabilities and ensure they can enjoy the same rights and safety as others around the world.

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

ABC's editorial director Craig McMurtrie speaks to the media as Australian police raided the headquarters of public broadcaster in Sydney on June 5, 2019. 

© Peter Parks / AFP
(Sydney) – Australia’s sweeping national security laws and police actions against journalists and whistleblowers are having a chilling effect on freedom of expression, Human Rights Watch said today in its World Report 2020.

Refugee rights, indigenous rights, and aged care are, among other issues, raising concerns. Australia has demonstrated some progress in its performance at the United Nations Human Rights Council in Geneva.  

“Australia’s national security laws shouldn’t be used to intimidate the media or those holding the government to account,” said Elaine Pearson, Australia director at Human Rights Watch. “The government seems intent on sending a message to officials not to share information with journalists.”

In the 652-page World Report 2020, its 30th edition, Human Rights Watch reviews human rights practices in nearly 100 countries. In his introductory essay, Executive Director Kenneth Roth says that the Chinese government, which depends on repression to stay in power, is carrying out the most intense attack on the global human rights system in decades. He finds that Beijing’s actions both encourage and gain support from autocratic populists around the globe, while Chinese authorities use their economic clout to deter criticism from other governments. It is urgent to resist this assault, which threatens decades of progress on human rights and our future. 

In 2019, police raided the Sydney headquarters of the Australian Broadcasting Corporation (ABC) and the home of a News Corp journalist over reports about war crimes in Afghanistan and surveillance in Australia respectively. Closed court proceedings continued against a whistleblower, “Witness K,” and his lawyer for secrecy breaches regarding exposures of alleged wrongdoing by the Australian government concerning trade negotiations with Timor-Leste.

About 600 refugees and asylum seekers who have been sent to Papua New Guinea and Nauru under Australia’s offshore processing system remain in legal limbo there after six years. In 2019, the government transferred about 170 refugees to Australia under a medical evacuation (medevac) law that enabled refugees and asylum seekers in ill-health who cannot get appropriate care in Papua New Guinea or Nauru to come to Australia. But in December, the government repealed the law, baselessly claiming it was necessary for border security.

“Repealing the medevac law was a cruel political maneuver that makes it more difficult for refugees and asylum seekers with serious illnesses – victims of offshore processing operations – to get the care they need,” Pearson said.

Indigenous Australians remain significantly overrepresented in the criminal justice system, and people with disabilities are particularly at risk of neglect and abuse. In February, in Perth’s Hakea prison, prisoners beat to death an Aboriginal man with a mental health condition. At least two Aboriginal men with mental health conditions committed suicide in Western Australia prisons in 2019.

A royal commission into abuse and neglect of people with disabilities began hearings. Another royal commission found Australia’s aged care system to be “a shocking tale of neglect,” and recommended immediate action on the rampant practice of chemical restraint: using drugs to control people’s behavior in aged care facilities. A government regulation that went into force in July purported to minimize the use of physical and chemical restraints, but may in fact simply normalize the practice, Human Rights Watch said.

At the UN Human Rights Council, Australia took the lead on a joint statement bringing attention to human rights violations by Saudi Arabia and ensuring the council renewed the mandate of the UN expert on human rights in Eritrea.

Posted: January 1, 1970, 12:00 am

A blind girl reads from a Braille book in a classroom at the Royal Academy for the Blind in Amman.

© 2011 REUTERS/Ali Jarekji

(Amman, December 23, 2019) – Jordan’s government has failed to fund key ministries to carry out the law on the rights of people with disabilities passed two years ago, Human Rights Watch said today. Jordanian lawmakers should ensure that the 2020 budget provides adequate funding for policies and programs to ensure the rights of people with disabilities.

In 2017, Jordan’s parliament passed a law on the rights of people with disabilities, which offers comprehensive protections for people with disabilities in all spheres of society. However, the government has not budgeted funds for several ministries and other programs to carry it out.

“Jordan’s disability rights law is great on paper, but it means nothing for people with disabilities if the government will not put it into practice,” said Michael Page, deputy Middle East and North Africa director at Human Rights Watch. “The government should urgently revise the budget to give key ministries and agencies the resources to ensure disability rights protections.”

Human Rights Watch analyzed the 2018 and 2019 ministerial budget reports published by Jordan’s General Budget Department. For two years, several ministries did not allocate any funding for disability rights initiatives, including the Ministries of Interior; Municipal Affairs; Tourism and Antiquities; Transport; Digital Economy and Entrepreneurship; and Awqaf and Islamic Affairs. Awqaf refers to social assistance programs.  

On December 3, a group of people with disabilities protested outside the prime minister’s office in Jordan’s capital, Amman, to demand greater inclusion and government support for people with disabilities.

While the Education Ministry has an official inclusive education policy, a Human Rights Watch review of its 2018 and 2019 budget reports found no specific funding allocated to inclusive education. International standards guarantee the right to inclusive education, where children with and without disabilities study together in local community schools, with support as necessary. Instead, the ministry allocated 0.4 percent of its total budget to “special education,” or education of children with disabilities in segregated settings.

Funds allocated by ministries for disability-related projects appeared to be insufficient to address disability rights issues. For example, the Public Works and Housing Ministry allocated only 100,000 JD ($141,045), or 0.05 percent of its 2019 budget to improving accessibility of buildings for the entire country. Authorities budgeted the same amount to “purchasing maintenance materials to maintain different roads” in just one governorate, Jerash, with a population of 237,059.

The Vocational Training Corporation allocated just 15,000 JD ($21,157), or 1 percent of its 2019 budget, for increasing participation of women and people with disabilities in training programs.

The Health Ministry guarantees “early diagnosis of disabilities” under its Primary Health Care/Health Services Centers Program. However, it is unclear whether the ministry allocates funding to provide accommodation and accessible formats to ensure that people with disabilities have access to hospitals and other medical centers.

In August, Human Rights Watch sought the views of the Jordanian government by sending letters to 12 ministries regarding current budget allocations to carry out the disability rights law and Jordan’s international human rights obligations. They are the Ministries of Interior; Education; Higher Education and Scientific Research; Health; Justice; Public Works and Housing; Social Development; Tourism and Antiquities; Transport; Vocational Training Corporation; Digital Economy and Entrepreneurship; and Awqaf and Islamic Affairs. At time of publishing, none have yet replied.

While the government has not allocated sufficient funding to ministries, it has committed to supporting the Higher Council for Affairs of Persons with Disabilities, which exists to coordinate implementation of the disability rights law across government ministries. An official with the council told Human Rights Watch that the proposed government budget for 2020 raised the council’s budget to around US$5 million, up from US$2 million in 2019.

In 2008, Jordan ratified the UN Convention on the Rights of Persons with Disabilities, which requires governments to ensure the rights of people with disabilities, including through “legislative, administrative, and other measures for the implementation of the rights recognized in the Convention.”

In its 2018 observations on Jordan, the Committee on the Rights of Persons with Disabilities, which reviews how countries carry out the convention, recommended that the government “adopt a new national strategy for persons with disabilities and a related action plan” and ensure “allocation of the financial, technical, and human resources necessary for its implementation.”

During its review the committee criticized Jordan’s failures to ensure adequate funding to carry out the convention. It noted “the absence of a systematic framework and public budget dedicated to the acquisition of mobility aids and assistive technologies necessary for the unrestricted personal mobility of persons with disabilities.” The committee recommended that Jordan adopt “a dedicated systematic framework and budget” to guarantee disability rights.

Jordan’s government, including each relevant ministry, should review current budgets to ensure funding for policies and programs to provide the protections guaranteed under the disability rights law. They should prioritize resources for making public buildings and services accessible for people with various types of disabilities as well as funding for inclusive education.

“Jordan’s disability rights law provides an explicit list of responsibilities for ministries to ensure non-discrimination and equality in accessing essential services like education, housing, employment, justice, and health,” Page said. “Without the budget necessary to effectively put this law into practice, people with disabilities won’t get the essential services they have the right to get.”

Posted: January 1, 1970, 12:00 am

Blind people hold white canes they received from a local organization working with people with disabilities in Buea, South-West region, December 3, 2019.

© 2019 Private

(Nairobi) – Concrete action is needed to make the humanitarian response to the crisis in the Anglophone regions of Cameroon more inclusive of people with disabilities, Human Rights Watch said today on International Human Rights Day. In September 2019, the United Nations under-secretary-general for humanitarian affairs made a commitment to make the humanitarian response more inclusive, but the commitment needs to be translated into action on the ground.

Violence has intensified since July 2019 in the North-West and South-West regions, escalating in August after a Yaoundé military court handed down life sentences to 10 leaders of the separatist Ambazonia Interim Government following a flawed trial. Human Rights Watch research and media reports indicate that at least 130 civilians have been killed in over 100 incidents since July, and thousands have been forced to flee. Given the ongoing violence and the difficulty of collecting information from remote areas, the number of civilian deaths – including of people with disabilities – is most likely higher.

“As the crisis in the Anglophone regions shows no sign of slowing, people with disabilities are struggling to find safety and face heightened risks of attacks, displacement, and abandonment,” said Shantha Rau Barriga, disability rights director at Human Rights Watch. “Cameroonian authorities and armed separatists should stop their abuses against civilians, while international organizations should fulfil their promises to those most affected by the crisis, including people with disabilities.”

The UN Office for the Coordination of Humanitarian Affairs reported in November that the humanitarian situation deteriorated, with over 656,000 internally displaced people in the Anglophone regions. Humanitarian access to people in need is difficult, with aid workers facing greater risks. In October alone, armed separatists kidnapped 10 aid workers, all of whom have been released. Another aid worker was killed in November.

On September 10, President Paul Biya called for a “national dialogue” to address the Anglophone crisis. The dialogue ended on October 4 with the release of hundreds of people arrested in connection with the unrest in the regions, as well as political opponents. However, violence has continued unabated.

Between September and November, Human Rights Watch interviewed 24 people with disabilities living in the Anglophone regions, their family members, as well as representatives of UN agencies and of national and international humanitarian organizations. Human Rights Watch research indicates that people with disabilities are more likely to be exposed to danger from attacks, including because of barriers to escaping and staying out of harm’s way, and because of the degradation of whatever support systems existed before the crisis.

Since the crisis in the Anglophone regions started three years ago, Human Rights Watch has documented the experiences of people with disabilities who were unable to flee to safety, or were killed, assaulted, and tortured by soldiers or armed separatists. New cases have been documented since August 2019.

In one case, on September 19, Cameroonian security forces searching for armed separatists attacked a locality called “Number One Water” near the town of Muyenge, South-West region, killing four civilian men, including a man with an intellectual disability. A witness to the attack said people fled when the military arrived and started shooting: “I hid in the nearby bush and I went back when things calmed down, the same day. I found four bodies on the ground and helped bury them. Among those killed, there was a man called ‘Jasper,’ who had an intellectual disability, which is the reason why he stayed behind. The military killed him in front of his hut. His body was partly burned, because the military also set his hut on fire.”

Inside one of the homes burned by the military on October 29, 2019 in Muchweni village, North-West region.

© 2019 Private

In another case, a 65-year-old farmer with a physical disability saw soldiers from the Rapid Intervention Battalion (Bataillon d’intervention rapide, BIR) destroy at least seven homes, including his, when they attacked his village, Nchum, North-West region, on October 30. “I hid near a spring when the military came,” he said. “I couldn’t run, because of my disability, and my family left me behind. I saw more than fifteen soldiers, who came with two vehicles. My house was well constructed, with cement blocks, and they burned it to the ground after throwing a grenade against it.” The burning in Nchum occurred one day after the military attacked a nearby village, Muchweni, where the BIR burned homes in retaliation for an ambush to a military convoy by the separatists on October 28.

The humanitarian response in Cameroon is severely underfunded, exacerbating the risks of people with disabilities whose basic needs, including food, shelter, sanitation, health, and education, are not being met. The UN resident coordinator in Cameroon, Allegra Baiocchi, told Human Rights Watch in November: “This acute underfunding of our humanitarian response in Cameroon is leaving millions of people without vital humanitarian assistance and protection, reinforcing the vicious cycle of vulnerability and violence.”

However, in September, the under-secretary-general for humanitarian affairs, Mark Lowcock, announced the release of US$75 million from the Central Emergency Response Fund (CERF) to support underfunded responses, including in Cameroon, which received $5 million. The CERF allocation, Lowcock said, will prioritize assistance to people most at risk, including people with disabilities.

In November, the UN issued the Guidelines on the Inclusion of Persons with Disabilities in Humanitarian Action. These guidelines, developed by the UN Inter-Agency Standing Committee (IASC), aim at assisting aid agencies in making sure people with disabilities are included in all phases of humanitarian action, from planning to coordination and monitoring. They have been circulated in Cameroon among UN agencies and nongovernmental organizations to raise awareness and to be put into practice.

“Slowly but surely, progress is being made and the experiences of people with disabilities affected by the crisis in Cameroon are being recognized and addressed,” Barriga said. “UN agencies and humanitarian organizations operating in the North-West and South-West regions should now deliver on commitments and make sure their response is as inclusive and accessible as possible.”

The Crisis in the Anglophone Regions
The crisis in the North-West and South-West regions began in late 2016, when teachers, lawyers, students, and activists, who had long complained of their regions’ perceived marginalization by the central government, took to the streets to demand more recognition of their political, social, and cultural rights. The brutal response by government forces – who killed peaceful protesters, arrested leaders, banned civil society groups, and blocked the internet – escalated the crisis. Since then, numerous separatist groups have emerged calling for the independence of the Anglophone regions and using force to press their cause. Government forces and armed separatists have both been responsible for serious human rights abuses.

Voices of People with Disabilities from the Anglophone Regions

“Frank”
“Frank,” 27, who has a physical disability, was shot in the leg by government soldiers as he attempted to flee fighting between the Cameroonian military and armed separatists in his village, Mamu, in the South-West region, on July 29, 2019.

He said:

It was about 11 a.m. when the shooting started. I saw one military armored car and two military pickups. The soldiers were shooting towards my direction. I was trying to go back home to gather my family so we could all run to safety. But before I reached the house, I was hit by a bullet fired in the same leg which was already having a problem. I fell. I was bleeding. A friend rescued me and carried me on his shoulders to a nearby house.

“Frank” was later taken to the regional hospital in Buea, where he underwent surgery and was hospitalized for over three weeks.

People with disabilities attend an event marking the International Day of People with disabilities, on December 3, 2019, in Buea, South-West region.

© 2019 Private

“Alain”
On July 28, soldiers of the BIR raided Nkogho village, South-West region, and killed “Alain,” a 60-year-old man with an intellectual disability, in front of his house.

A witness said:

As the military invaded our village, everyone ran away for safety, but ‘Alain’ didn’t. He did not understand what was happening because of his disability. He was shot from behind, and the bullet exited near the heart. The soldiers also burned down his home. We buried him the following day.

Denis
Denis, a 30-year-old man from Lysoka village, in the South-West region, has lymphatic filariasis since 2013. It is a disease caused by a parasitic worm, transmitted by mosquitoes, which can cause tissue swelling and a physical disability.

Denis, a 30-year-old man from Lysoka village, South-West region, with lymphatic filariasis, a parasitic infection leading to severe swelling and permanent disability.

© 2019 Private

On August 12, 2019, he was abandoned in his home after fighting between the military and armed separatists in Lysoka.

He said:

The BIR soldiers and gendarmes clashed with a group of Amba boys [armed separatists]. It caused serious shooting, and I was home alone, sick. Everybody in the village ran away into the bushes, and nobody bothered to know my whereabouts. I stayed home until the gunfire stopped in the evening. I remained in the house alone for three days without food or medication. On August 15, some people started returning. That’s when they discovered that I had not escaped. They apologized to me and said it was too dangerous for them to return for me.… I cannot run when attacks occur. I feel as if I’m a burden to my family, both physically and financially.

Denis is still living in Lysoka despite the continuing violence. His elder brother provides for him. He has not received any humanitarian assistance.

Regina
Regina, a 75-year-old-blind woman, refused to flee her village, Ekona, in the South-West region, when fighting between the military and armed separatists broke out on July 8.

Regina, a 75-year-old-blind woman, in front of her home in Ekona, South-West region.

© 2019 Private

“My family escaped to the bush, but I did not go,” she said. “I survived alone with the little that was left in the house. It was very difficult.”

She had fled fighting in October 2018 and caught typhoid from drinking dirty water in the forest. Since then, she decided that she would stay behind, including during attacks. Due to inaccessible terrain and lack of support, Regina is in danger, as violence continues around her village. She said that she was feeling increasingly vulnerable: “The worst consequence of this crisis is that I no longer appreciate life. I just wish to die so I can end my suffering. I prefer to stay in the house and just die there.”

Chrispu
Chrispu, a 75-year-old man from Ekona, South-West region, is blind and has a mental health condition and a physical disability. His daughter said that, at times, due to the violence, she had to abandon him at home in the deserted village for days, with little access to food and water:

Chrispu, a 75-year-old blind man with a mental health condition and a physical disability in front of his home in Ekona, South-West region.

© 2019 Private

On June 21, a mix of BIR, regular army soldiers, and gendarmes fought the Amba [separatists] in our neighborhood. There was gunfire and everyone ran away for safety. I had to leave my father behind. I couldn’t take the risk to carry him because I could have been killed if I didn’t run fast. I hid in the bush for one week. When I came back, I found my dad in very bad condition. He was very sick.

The crisis has strained family relations, as Chrispu is increasingly perceived as a burden. His younger brother said: “He’s like a heavy weight. We cannot be safe if we take him with us when we have to run away for safety.” Chrispu’s daughter said: “My father’s disability is a big stumbling block. When others are fleeing violence to seek refuge in safer areas, we cannot go. We have to stay to look after him. So, we are all stuck in an unsafe place.”

Cusmas
Cusmas, a 65-year-old blind man from Mautu village, South-West region, who lives with his wife and daughters, said that when attacks occur in his village, his family repeatedly faces the difficult choice of whether to help him at the risk of being killed or flee without him. He is often left behind.

Cusmas holds a wooden stick that helps him move around in Mautu village, South-West region.

© 2019 Private

One of Cusmas’ daughters said:

Whenever there is shooting, what comes first in my mind is my father. This is because we cannot do anything but to lock him alone in the house since we cannot carry him. I am always frightened whenever we are in the bush thinking that, when we come back home, we could find my father dead.

Accessing necessities, such as food and the latrine, is difficult for Cusmas when he is left alone. As a result, he is afraid and anxious.

Being deprived of my basic needs, struggling to find something to eat, feeling alone in dangerous place ... all this has affected my spirit. Although I have a stick to help me moving, it is difficult to get to the toilet alone. I also need help to bathe. But the worst of all my worries is that I always feel that the military will one day burn me in the house alive. Before this crisis, I had challenges in moving and accessing services, but I didn’t have any fear. Now I am constantly afraid, and I tell my children that they should be ready to face the worst at any time.

Posted: January 1, 1970, 12:00 am

(Accra) – Faith-based and traditional healing centers in Ghana continue to hold people with real or perceived mental health conditions – psychosocial disabilities – in chains in inhumane conditions despite a 2017 ban on such treatment, Human Rights Watch said today.

“People with psychosocial disabilities are still chained like animals,” said Shantha Rau Barriga, disability rights director at Human Rights Watch. “If the government wants its ban on chaining to be more than empty words, it needs to ensure that these chains come off and develop local mental health services that respect the rights of people with mental health conditions.”

A man with a real and perceived mental health condition held by a chain around his ankle at a traditional healing center in the Greater Accra Region in Ghana. 

© 2019 Shantha Rau Barriga/Human Rights Watch
From November 4 to 8, 2019, Human Rights Watch interviewed 25 people, including people with psychosocial disabilities, mental health professionals, staff at prayer camps and traditional healing centers, mental health advocates, religious leaders, and two senior government officials.

Of the six prayer camps or traditional healing centers across Ghana’s Greater Accra, Eastern, and Central regions Human Rights Watch visited, dozens of people were chained in two facilities. At both centers, men detained there called out to the Human Rights Watch researcher, begging to be released. In one traditional healing center, Human Rights Watch found 16 men in a dark, stifling room, all of them with short chains, no longer than half a meter, around their ankles. They called out: “We are suffering here. They are abusing our human rights. Please help us. Please help us.”

“The chaining of people with mental health conditions needs to stop – it needs to stop,” Ghana’s deputy health minister, Tina Mensah, told Human Rights Watch. Similarly, in a meeting with Human Rights Watch, the gender, children and social protection minister, Cynthia Morrison, said, “I give you my commitment right now, and I’m sure we’ll bring an end to it.”

These chains had been around the ankles of a woman with a real or perceived mental health condition through the night at a prayer camp in the Eastern Region of Ghana. She was released just before Human Rights Watch visited, but is still held at the prayer camp in a locked room, with the chain lying next to her mattress. 

© 2019 Shantha Rau Barriga/Human Rights Watch

At another prayer camp, people with real or perceived mental health conditions continue to be confined in cages that they are rarely allowed to leave, based on regular visits since 2011. They are forced to urinate or defecate in small buckets placed outside their cells. Most cages are so narrow that the men cannot even stretch out their arms. In two other facilities, people with mental health conditions are not chained, but the head of each camp explained that they are denied food for up to seven days, based on the belief that “fasting” will enable them to use worship and prayers to heal them.

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

Human Rights has found, based on its research since 2011, that families often take people with real or perceived mental health conditions to faith-based or traditional healers because of widely held beliefs that such disabilities are caused by a curse or evil spirits, and because their communities have limited, if any, mental health services. In some cases, the family member may  have been using drugs such as marijuana; in others, they were outcasts because of so-called deviant behavior.

“We need to talk to the families and make sure that they are ready to receive them because if the family refuses to receive them, where do they go?” Morrison said of the families of people in the spiritual or traditional healing centers.

Human Rights Watch confirmed that people remain unchained in Nyankumasi prayer camp, where officials from the Ghana Mental Health Authority sawed the chains off the 16 residents in 2017. They now refer anyone in a mental health crisis who comes to the camp to the nearby psychiatric hospital. The head of another center, Doctor Jesus Prayer Camp, told Human Rights Watch that they do not chain anyone because they are aware of the national ban.

In one traditional healing center, Human Rights Watch found 16 men in a dark, stifling room, all of them with short chains, no longer than half a meter, around their ankles. They called out: “We are suffering here. They are abusing our human rights. Please help us. Please help us.” 

© Shantha Rau Barriga/Human Rights Watch 2019

Deputy Minister Mensah said: “You can see that there have been improvements since the last time you were here. That means the people are taking up the challenge and improving some of the conditions. But we need to still do more. We have to sensitize the people, educate them on the rights of every individual. They cannot chain people in this way.”

In February 2019, the World Health Organization initiated, with the support of the UK’s development agency, its Quality Rights initiative in Ghana, an e-learning program aimed at training at least 5,000 people on ways to improve the quality of mental health services and ensure respect for human rights, including through obtaining informed consent from the person involved.

Based on interviews with seven mental health professionals and advocates in early November, most of whom had completed the training, Human Rights Watch believes that there has been a marked shift in the attitudes and practices of staff in Accra Psychiatric Hospital and among mental health professionals who administer medication to people in some prayer camps.

A nurse who works at Tetteh Quarshie Regional Hospital said, “Mental health is not just about taking medication. ‘Take your drug. Take your drug.’ Trying to force medication is not right. There is more to it.”

A nurse at Accra Psychiatric Hospital said: “Try to talk to the patient, to find out how you could help the patient – or what the patient thinks could be done to help them to get out of an aggressive mood. It’s possible to do without seclusion.”

A number of efforts led by local nongovernmental organizations, especially groups of people with psychosocial disabilities, are also underway. For example, MindFreedom Ghana has teamed up with the Human Rights Advocacy Center to conduct human rights training for psychiatric nurses and traditional healers. Another organization, Basic Needs Ghana, has been facilitating peer support groups. The Mental Health Society of Ghana is working with Time to Change in the UK to combat stigma and challenge stereotypes by highlighting the experiences of people with mental health conditions who have jobs, families, and are part of their communities, especially through social media.

Despite this progress, the government of Ghana should take further steps to end shackling by setting up the Visiting Committees outlined in the Mental Health Act to monitor prayer camps and traditional healing centers to enforce the ban, and by investing in community mental health services that respect human rights. The government should also ensure that people with psychosocial disabilities get adequate support for housing, independent living, and job training.

The government should follow through on commitments to sensitize the public and to combat the stigma associated with mental health conditions, Human Rights Watch said. Finally, the government needs to set up the levy envisaged under the 2012 Mental Health Act to fund mental health services as a matter of priority.

“It was promising to see that the ban is having its intended effect in some camps,” Barriga said. “But many people with real or perceived mental health conditions are still chained or locked up. Just as the minister said, ‘This needs to stop.’ The government needs to move from rhetoric to reality.”

Posted: January 1, 1970, 12:00 am

Video

Video: Nursing Homes in Australia Routinely Sedate Older People

Monica has dementia and lives with her husband in a facility near Melbourne. Her son realized she was being given a cocktail of drugs when he asked to see her charts. After extensive negotiation, Monica’s doctor and facility staff agreed to wean her off the drugs. Monica went from being hunched and unbalanced to being able to sit, eat, greet people, and dance when her grandson visits and sings.

(Sydney) – Australia’s health and aged care ministers should immediately revise an aged care regulation to prohibit chemical restraint, Human Rights Watch and Aged & Disability Advocacy Australia said today in a letter to the two ministers. Chemical restraint involves giving older people with dementia drugs to control their behavior.

“The Australian government has recently received three major reports on the horrific effects of chemical restraint in aged care,” said Bethany Brown, researcher on older people’s rights at Human Rights Watch. “The ministers for health and aged care should take immediate and decisive action by banning chemical restraint and requiring real support for older people with dementia.”  

In the November 20, 2019 letter to Health Minister Greg Hunt and Aged Care Minister Richard Colbeck, the organizations reiterated their serious concerns about the aged care regulation that permits the use of chemical restraint. Human Rights Watch detailed these concerns its October report “Fading Away.” The ministers have two weeks to revise the regulation before an anticipated Senate vote on whether to disallow the regulation. 

On November 13, Australia’s parliamentary human rights committee reported that the regulation on restraints in aged care could violate Australia’s commitments under international law to prohibit torture and ill-treatment and to guarantee the rights to health and non-discrimination. This statement followed the October 31 Royal Commission of Inquiry into Aged Care Quality and Safety’s three-volume interim report, which called on the government to address chemical restraint as an urgent priority.

“The writing is on the wall with these three highly critical reports,” said Geoff Rowe, chief executive officer of Aged & Disability Advocacy Australia. “The government needs to revise its regulation now to extinguish this practice and protect the human rights of older people in aged care.”

Posted: January 1, 1970, 12:00 am

A relative pushes John Biel Dup’s wheelchair through the dirt paths of Protection of Civilians Camp 3 in Juba,. The uneven paths make it difficult for people with physical disabilities to move around the camps..

© 2017 Joe Van Eeckhout for Human Rights Watch

Can you imagine living in a refugee camp and having to crawl to the latrine because it’s not accessible for you? Sadly, this is the reality for many people with disabilities and older people in countries experiencing conflict or natural disasters around the world.

But today’s launch of the United Nations Guidelines on the Inclusion of Persons with Disabilities in Humanitarian Action marks an important step toward changing that.

These guidelines, developed by the UN Inter-Agency Standing Committee (IASC), will assist humanitarian agencies, governments, and affected communities in making sure people with disabilities are included in all phases of humanitarian action – from planning to coordination to monitoring.

There are at least one billion people worldwide with a disability, many of whom live in conflict zones or in areas affected by natural disasters – both of which are more likely to increase in frequency due, in part, to climate change.

Human Rights Watch has documented the heightened risks faced by people with disabilities and older people in conflict areas such as the Central African Republic, Cameroon, Iraq, Myanmar, South Sudan, and Yemen.

We have found that war, natural disasters, and other situations of risk have had a devastating and disproportionate impact on people with disabilities and older people. They have been abandoned, attacked, displaced, and even faced neglect in humanitarian responses. But their plight has been largely invisible, including to humanitarian actors.

People with disabilities who manage to reach sites for internally displaced people or refugees often face difficulties accessing food, sanitation, and medical assistance.

“Félix,” a man with a mobility disability who fled violence in his home village in the South-West region of Cameroon, described his struggles to Human Rights Watch: “The biggest challenge is the toilet. It’s outside and is used by many people, so it is often disgusting. I am afraid I will soon get some disease since I must creep to the toilet with my hands.”

The IASC guidelines are the result of an inclusive consultation process that involved more than 600 participants from both the humanitarian and disability sectors, as well as many organizations of persons with disabilities around the world.

These guidelines are a crucial step in making “No one left behind” a reality and ensuring that Félix and other people with disabilities can live in dignity and access services during humanitarian crises.

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

President Muhammadu Buhari said in October 2019 of the Islamic rehabilitation centers that he would not “tolerate the existence of the torture chambers and physical abuses of inmates in the name of rehabilitation.” But the government has yet to acknowledge that this abuse is rife in government-run facilities too.

President Buhari denounced chaining as torture. But it’s not enough to raid these centers and shut them down. People rescued from these desperate conditions and other Nigerians experiencing psychological distress should have access to proper psychosocial support and mental health services.

Posted: January 1, 1970, 12:00 am

Video

People With Mental Health Conditions Chained and Abused in Nigeria

Thousands of people with mental health conditions across Nigeria are chained and locked up in various facilities where they face terrible abuse.

(Abuja, November 11, 2019) – Thousands of people with mental health conditions across Nigeria are chained and locked up in various facilities where they face terrible abuse, Human Rights Watch said today.

Detention, chaining, and violent treatment are pervasive in many settings, including state hospitals, rehabilitation centers, traditional healing centers, and both Christian and Islamic faith-based facilities.

“People with mental health conditions should be supported and provided with effective services in their communities, not chained and abused,” said Emina Ćerimović, senior disability rights researcher at Human Rights Watch. “People with mental health conditions find themselves in chains in various places in Nigeria, subject to years of unimaginable hardship and abuse.”

President Muhammadu Buhari said in October 2019 of the Islamic rehabilitation centers that he would not “tolerate the existence of the torture chambers and physical abuses of inmates in the name of rehabilitation.” But the government has yet to acknowledge that this abuse is rife in government-run facilities too.

Between August 2018 and September 2019, Human Rights Watch visited 28 facilities ostensibly providing mental health care in 8 states and the Federal Capital Territory, including federal psychiatric hospitals, general state hospitals, state-owned rehabilitation centers, Islamic rehabilitation centers, traditional healing centers, and Christian churches. Human Rights Watch interviewed 124 people, including 49 chaining victims and their families, staff in various facilities, mental health professionals, and government officials. The names of the victims have been changed to protect their safety.

A woman’s leg tied tightly together in a Christian rehabilitation center for in Ibadan City, Oyo State, Nigeria, September 2019. Women and men are chained and tied for perceived or actual mental health condition or intellectual disability. © 2019 Robin Hammond for Human Rights.

Deep-rooted problems in Nigeria’s healthcare and welfare systems leave most Nigerians unable to get adequate mental health care or support in their communities. Stigma and misunderstanding about mental health conditions, including the misperception that they are caused by evil spirits or supernatural forces, often prompt relatives to take their loved ones to religious or traditional healing places.  

Human Rights Watch found that people with actual or perceived mental health conditions, including children, are placed in facilities without their consent, usually by relatives. In some cases, police arrest people with actual or perceived mental health conditions and send them to government-run rehabilitation centers. Once there, many are shackled with iron chains, around one or both ankles, to heavy objects or to other detainees, in some cases for months or years. They cannot leave, are often confined in overcrowded, unhygienic conditions, and are sometimes forced to sleep, eat, and defecate within the same confined place. Many are physically and emotionally abused as well as forced to take treatments.

A nun in charge during a Human Rights Watch visit to a state-owned rehabilitation center in southeastern Nigeria said they chain people to their beds “so they do not run away.” The nun defended chaining a woman who had HIV “to stop her from going around the men.” Human Rights Watch found another woman at the same institution chained naked to her bed.  

A woman who is HIV positive chained to her bed in a state-owned rehabilitation center in Anambra State in southeastern Nigeria, October 2018. © 2018 Anietie Ewang/Human Rights Watch.

The staff, except one older guard, would leave at 6:30 p.m. each day, leaving residents, including children as young as 13, with no one to help them. The facility has no electricity, so people are chained to their beds in total darkness. The nun said that, “The patients are given flashlights to use at night.”

In a traditional healing center close to Abuja, Nigeria’s capital, Human Rights Watch met a woman who was pinned to a tree trunk with an iron ring. She had been restrained like this for three weeks with her upper body naked. She was unable to move and so she was forced to eat, urinate, and defecate where she sat.

A woman in a shed near the house of a traditional healer in Abuja, Nigeria, March 2019. Her right leg is pinned to a tree trunk with an iron ring. © 2019 Human Rights Watch.

Chaining can cause serious injuries and psychological distress. A 35-year-old woman chained for 10 months in an Islamic rehabilitation center in Kano, northern Nigeria, said, “Everything about this (chaining) is difficult. You feel like you want to commit suicide … regardless of how you felt before coming here, you will get worse.”

Adults and children in some Islamic rehabilitation centers reported being whipped, causing deep wounds. People in Christian healing centers and churches described being denied food for up to three days at a time, which staff characterized as “fasting” for “treatment” purposes.  

In many of the traditional and religious rehabilitation centers visited, staff forced people with mental health conditions, including children, to eat or drink herbs, in some cases with staff pinning people down to make them swallow.

A man’s legs chained in a Christian rehabilitation center in Ibadan City, Oyo State, Nigeria, Ibadan City, Oyo State, Nigeria, September 2019. Women and men are chained and tied for perceived or actual mental health condition or intellectual disability. © 2019 Robin Hammond for Human Rights Watch.

In psychiatric hospitals and government-run rehabilitation centers, staff forcibly administered medication, while some staff admitted to administering electroconvulsive therapy (ECT) to patients without their consent.

In some cases, families took their children – including young adults – to religious and traditional rehabilitation centers for actual or perceived drug use or “deviant” behavior, including skipping school, smoking tobacco or marijuana, or stealing from their parents. Some children in the facilities – some as young as 10 – have been abandoned by their families.

Nigeria ratified the Convention on the Rights of Persons with Disabilities (CRPD) in 2007. It has the obligation to ensure equal rights for people with disabilities, including the right to liberty and freedom from torture, ill-treatment, and forced treatment. While the Nigerian Constitution prohibits torture and other inhuman or degrading treatment, the government has not outlawed chaining. In a 2015 report, the United Nations special rapporteur on torture said that chaining “unequivocally amount[s] to torture.”

The Nigerian government should ban chaining and urgently investigate chaining in state-owned rehabilitation centers, psychiatric hospitals, and faith-based and traditional healing centers in all 36 states and the Federal Capital Territory. The government should also prioritize the development of quality, accessible, and affordable community-based mental health services.

“President Buhari denounced chaining as torture,” Ćerimović said. “But it’s not enough to raid these centers and shut them down. People rescued from these desperate conditions and other Nigerians experiencing psychological distress should have access to proper psychosocial support and mental health services.” 

Mental Health in Nigeria

A mental health condition refers to a range of experiences that affect a person’s mood, thinking, and behavior. This includes depression, anxiety, schizophrenia, and bipolar condition. It can affect anyone, regardless of age, gender, race, ethnicity, religion, spirituality, sexual orientation, or any other background. The World Health Organization (WHO) says a mental health condition will affect one in four people globally at some point in their lives.

Nigeria has fewer than 300 psychiatrists for an estimated population of over 200 million. Several mental health professionals told Human Rights Watch that quality mental health services are available only to wealthier citizens who can afford it. The lack of quality mental health care and its prohibitive cost often drives people to consult traditional or faith-based healers.

Nigeria’s 1958 Lunacy Act allows the detaining of people with mental health conditions in mental health institutions, even without providing medical or therapeutic treatment. People spend years in institutions – sometimes decades – because Nigeria lacks adequate services to support them in the community. In all but one of the facilities Human Rights Watch visited, people were not allowed to leave or to challenge their detention.

Unlawful Detention

In 27 of 28 facilities Human Rights Watch visited, all residents had been unlawfully detained. They did not enter the facilities voluntarily and could not leave if they wished to do so.

Victor, a 29-year-old Christian man held in an Islamic rehabilitation center in Kano since June 2018, said:

I heard that I would be here only for two weeks at first when I was brought here, then later that changed to one month, then two months. Now I am going on my third month here. Other people here say they were told the same thing, and they ended up staying here for years.

Akanni, a 22-year-old woman who had a mental health crisis following the death of her mother and who had been detained in a church in Abeokuta for five months at the time of a March 2019 interview, said: “When my father brought me, I didn’t know that he would leave me here. I was not happy, but I don’t have a choice.”

Sometimes families pay healers to detain their relative at home and take them to a center. Shums, a 27-year-old man who said he had depression, was taken as he worked on his farm in early 2019:

Two men approached me and asked if they could talk with me. I complied and started walking with them. They jumped on me, handcuffed me, and put shackles on my feet. Then they brought me here [an Islamic rehabilitation center in Kano].

Two men chained together with an iron shackle, in an Islamic rehabilitation center in Kano State, northern Nigeria, June 2019. They are bound together at all times, including when they sleep, urinate, defecate, and eat. © 2019 Emina Cerimovic/Human Rights Watch.

Chaining

In 27 out of 28 facilities visited, staff chained or shackled adults and children. The youngest child chained was a 10-year-old boy and the oldest person was an 86-year-old man who also had a visual disability. Typically, staff fasten a chain to either both or one ankle of a person and connect it to a heavy or immovable object, such as a bed, tree, or car engine. In some cases, shackles consisted of an iron bracelet around both ankles, making it difficult for the person to move around. Some people are chained for a few days at a time as punishment, or for weeks or months to prevent them from moving or leaving.

Shums, a 27-year-old man with depression, was shackled by his leg to another man’s leg in an Islamic rehabilitation center in northern Nigeria. “We are like this all the time. Even when we have to use the toilet or sleep,” Shums said.  Two other men there were also shackled together. The center’s healer said one man had suicidal thoughts, “So I chained him to another person who is responsible, to prevent him from killing himself.”

In a government-owned rehabilitation center in northern Nigeria, Human Rights Watch saw dozens of men and women chained. Many were chained by one ankle to a piece of iron welded to the concrete floor. Most had lived there for years, some for up to 15 years.

Staff at a psychiatric hospital in northern Nigeria insisted that chaining did not occur on the premises, but a researcher discovered a ward where people had iron shackles around their ankles.

Despite repeated requests, Human Rights Watch was not allowed to meet or speak to people held in federal psychiatric hospitals in Kaduna, Lagos, and Abeokuta. Two psychiatrists, one psychiatric nurse, and one mental health activist said that shackling occurs in federal psychiatric hospitals across Nigeria. A doctor who works in a psychiatric hospital in southern Nigeria said, “We have to use chains in some cases.” A psychiatrist in a hospital in Lagos said that the staff there use handcuffs.

A woman with a mental health condition chained to the floor in a bare room in a state-owned rehabilitation center in Kano State, northern Nigeria, July 2019. Breadcrumbs are around her. © 2019 Emina Cerimovic/Human Rights Watch.

Tightly bound chains cause painful wounds as well as emotional suffering. Zain, who was chained in a traditional healing center in Abeokuta, said, “I was chained for three months until yesterday, with lots of injuries from the chains which are just starting to heal.” Adedamola, a woman in her 40s held in a church in Ibadan, southwestern Nigeria, for two years, said the chains would often injure her ankles.

Unsanitary and Degrading Conditions

People who are chained are forced to live in unsanitary conditions. Many must eat, urinate, defecate, and sleep in the same place, usually within the same place where they are confined.

Staff often provide a bucket or plastic bag to urinate and defecate in, usually in full view of others. Akanni, who was chained in a shed in a Christian church with an unrelated man for up to three days at a time, said, “They left me a bowl to urinate and defecate. I had to do it in front of the man.”

A man with a mental health condition chained to the floor in a state-owned rehabilitation center in Kano State, northern Nigeria, July 2019. © 2019 Emina Cerimovic/Human Rights Watch.

People detained in some Islamic rehabilitation centers Human Rights Watch visited usually had access to toilets during the day, but not at night. Khalil, a young man chained in a center in northern Nigeria after his family accused him of stealing and drug use, said:

If you feel you are in need to use toilet, you wake up someone you are close to and ask them if they have any plastic bag. If you want to urinate, you use the bottle we use for [drinking] water.

Victor, the man chained in Kano, said:

Hygiene is a big issue here. When one person gets sick, it spreads quickly to other people. They refuse to give medicines when necessary because they say we will get hooked on it or they say the police will arrest them for getting it.

Another man said more than 60 people slept in his room: “More than 100 people use 1 toilet, the hygiene is very bad. When we are sick, and we request for drugs, it doesn’t come until we are almost dead.”

A woman in her 30s who was chained to a car engine in a shed together with two men by a traditional healer’s home in Abeokuta, southwestern Nigeria, said: “I go to toilet in this place [where I am shackled] in plastic bags until they take it away at night.”

People also had to urinate and defecate on themselves in two other traditional healing facilities Human Rights Watch visited. A 20-year-old woman said: “They tied me and kept me inside the room at the back for three days. I defecated and urinated on myself while I was in the room.”

The government-run rehabilitation center in southeastern Nigeria had functioning toilets. Yet staff denied those chained there access to the toilets, and instead left them a bucket next to their beds.

In three facilities, staff did not allow people to bathe regularly. A traditional healer in Abuja said: “When people are locked up … they don’t bathe sometimes for months until they feel better…. We just pour water with herbs on them without going very close to them.”

Human Rights Watch also found that people with psychosocial and intellectual disabilities were denied food in some Christian healing centers. Akanni, the 22-year-old woman who had been detained in a church in Abeokuta for five months, said:

When I first arrived here, I was tied with chains for three days straight so I could fast. For the three days I had no food or water. It wasn’t my choice, but the pastor said it was good for me. Sometimes if they say I should fast and I drink water or take food, they (staff in the church) put me on a chain. The chaining is punishment. I have been put on chain so many times I can’t count.

Another 27-year-old woman held in the same church said:

When I came here, I started screaming. They took me to the prayer room, where I was chained and forced to fast for seven days. After the first seven days they released me for a little bit and then again chained me for seven days.

Staff in the church and two other churches in the south confirmed the practice.

Violence

People in Islamic rehabilitation centers said that staff whipped them. Khalil, who was shackled for six months in such a center in northern Nigeria, showed researchers scars on his left arm that he said were from whipping.

An Islamic faith healer in northern Nigeria said:

If you are treating someone who is mentally unwell and he acts in a way that is causing disturbance, you will have to treat him. Some of them might be talking to themselves or suffer from lack of sleep…. For some of them, getting enough sleep will help. For others, we need to whip them – once, twice … up to seven times.

A dozen people in that center showed researchers scars on their arms, chests, and backs that they said were from floggings by staff.

Amina, who had a breakdown after her mother died and was taken to various Islamic healers and a psychiatric hospital, said she was tied with ropes, beaten, and spat on in one rehabilitation center in Kaduna, and then molested by a traditional healer in Abuja who came to her home: “He told me to undress, that it is the part of the healing process, and then he started touching my body,” Amina said. “Explain to me, how is that part of a healing process? How is that Islamic?” Staff in a psychiatric hospital in Abuja also tied Amina to a bed and forcibly injected her with medication. “I peed on myself. I was on my period and they just kept sedating me.”

Akanni said that staff had slapped her.

Faith-based and traditional healing centers might have the aim of caring for people who had nowhere else to go for support and help because of a mental health crisis or because they had been abandoned. Many traditional and faith-based healers interviewed seemed to genuinely care about the people in their centers. However, chaining strips people with mental health conditions of their most fundamental rights to dignity and humane treatment. Physical violence and sexual abuse further damages the physical, sexual, emotional, mental, and social well-being of an individual and can amount to torture and other cruel, inhuman, or degrading treatment or punishment.

Forced Treatment

In psychiatric hospitals and government-run rehabilitation centers, staff said that people are given oral and injectable medication without their consent. In two psychiatric hospitals visited, patients were given electroconvulsive therapy without their consent.

In many traditional and religious centers visited, healers forced herbal and other non-medical treatment on people with mental health conditions. One traditional healer in Ibadan said that four people would hold a person down so that he could administer herbs.

Another traditional healer in Ibadan said “We have to force them to take the herbs that will heal them. Sometimes we get strong people, strong boys, to hold them down so we can put the chains on them and give them herbs.”

A Christian pastor in Ibadan described using chains as a threat to make people take herbs. In front of a traditional healer’s home in Abuja, researchers saw several women holding down a 12-year-old girl and making cuts on her back with a blade. They then smeared ground herbs into the cuts. The healer justified it by saying the girl had been stealing from her mother, and they had to let the evil blood come out of her.

Recent Government Action

On June 17 and September 12, 2019, respectively, Human Rights Watch sent letters to the federal government in Abuja requesting to meet with officials of the Federal Ministry of Health and the Federal Ministry of Women’s Affairs and Social Development to discuss the findings but received no response. The two federal ministries have also not responded to an October 24 letter setting out concerns about chaining and abuse.

Since Human Rights Watch began investigating chaining in Nigeria in August 2018, several facilities have been closed. In September 2019, police closed an Islamic rehabilitation center in Kaduna that Human Rights Watch had visited in March. Another Islamic rehabilitation center in Kano was closed preventively in October.

While closing abusive facilities is a positive step, the government should ensure that it provides adequate psychosocial and mental health support in the community to people who have been freed. Otherwise, closing down these centers does nothing to address the desperate moves by families to look towards traditional and faith-based centers for loved ones with mental health conditions because of the lack of rights-respecting alternatives.

Recommendations

The Nigerian government should:

  • Completely ban chaining
  • Urgently investigate all state and private institutions where people with mental health conditions live in all 36 states and Federal Capital Territory with the goal of stopping chaining and ending abuses
  • Ensure that people rescued have access to psychosocial support and social services, including child psychologists and specialist support services for children
  • Train and sensitize government health workers, mental health professionals, and staff in faith-based and traditional healing centers to the rights and needs of people with mental health conditions
  • Conduct a public information campaign to raise awareness about mental health conditions and the rights of people with disabilities, especially among alternative mental health service providers and the broader community, in partnership with people with lived experiences of mental health conditions, faith leaders, and media
  • Progressively develop voluntary and accessible community-based mental health and support services, in consultation with people with lived experiences of mental health conditions and with the support of international donors and partners. This should include development of psychosocial support services and integration of mental health services in the primary healthcare system.
Posted: January 1, 1970, 12:00 am

A man is helped to cast a symbolic vote during an event organized by The Spanish Committee of Representatives of Persons with Disabilities outside the Spanish parliament in Madrid, Friday, June 17, 2016.

© 2016 AP Photo/Francisco Seco

People with disabilities may experience discrimination as they vote in Spain’s general election this weekend, despite a law which guarantees equal voting rights. 

Last year, Spain reformed its existing law on the general electoral system to ensure “the right to vote for all persons with disabilities.” It modified previous legislation which allowed a judge to declare some people with disabilities as “incapable” of voting, or of being elected. The reform had immediate positive effects, allowing 100,000 people, mainly those with intellectual disabilities, to vote for the first time in Spain’s April 2019 elections.

But Plena Inclusión, an organization that represents people with intellectual and developmental disabilities in Spain, has pointed out that a directive issued by the Central Electoral Board after the reform, which allows staff in voting stations to record information on people who, in their opinion, aren’t voting “consciously, freely and voluntarily,” is likely to discriminate against voters with intellectual disabilities.

The directive, after discussing the abolition of prior restrictions on the right of persons with disabilities to vote, provides that in the event an electoral official considers a vote is not freely made, they may make a record of that determination along with the person’s identification number. The directive offers no guidance on how staff should reach their opinion, but clearly is designed to target an unfounded fear that voters with intellectual disabilities, who may be voting for the first time, could fall into this category. The directive doesn’t prevent them from voting, but no other group of voters faces the same risk of needless and arbitrary scrutiny and potential recording of their information.

The Spanish Ombudsman also raised concerns about this, and has recommended that the Central Electoral Board revise its directive and remove the authority of election staff to make “subjective assessments” about people’s supposed fitness to vote.

The Central Electoral Board should heed this call, and suspend this damaging directive that only serves to foster stereotypes and prejudice. People with learning or intellectual disabilities deserve support to fully exercise their right to vote, in line with the spirit of last year’s electoral reform and United Nations disability rights treaty.

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

A blister pack of pills.

© 2019 Daniel Hartley-Allen for Human Rights Watch
(Sydney) – The Australian government should act on the Royal Commission of Inquiry’s report criticizing its failure to protect older people in aged care from chemical restraint and other abuses, Human Rights Watch said today.
 
The Royal Commission recommended urgent government action to address – rather than merely “minimize” – use of chemical restraint, typically administered drugs that control the behavior of older people with dementia.
 
“The Royal Commission report shines a spotlight on the horrific impacts of chemical restraint in aged care, which has become almost normalized in Australia,” said Bethany Brown, researcher on older people’s rights at Human Rights Watch. “The government should act on the Royal Commission’s report by urgently banning chemical restraint so that older people in aged care can live healthy, dignified lives.”
 
Australia’s Royal Commission of Inquiry into Aged Care Quality and Safety released a three-volume interim report, “Neglect,” on October 31, 2019. It documents serious concerns in several areas of aged care, including restrictive practices such as chemical restraint. The report concludes that “the prevalence of restrictive practices in residential aged care is unacceptable” and that “the ongoing and common use of restrictive practices in aged care represents severely substandard and unsafe care.” The Commission said restrictive practices can violate the fundamental rights of older Australians and carry risks of serious physical and psychological harm.

The Royal Commission’s findings on chemical restraint reinforce the October Human Rights Watch report documenting chemical restraint of people with dementia in 35 Australian aged care facilities. Human Rights Watch found that instead of providing support to older people with dementia, facilities use drugs to control their behavior. Many of the drugs used to control people in aged care facilities are antipsychotics that are not approved in Australia for older people with dementia. In addition to the physical, social, and emotional harm for older people restrained with these drugs, the use of these drugs in older people with dementia is also associated with an increased risk of death.
 
The Royal Commission’s report found that the overuse of restrictive practices in aged care comes from a lack of knowledge about restraints, their impacts, and alternatives among care workers, nurses, and doctors. The report also said there is insufficient staff in aged care to provide support to older people, lack of informed consent for medications, and lack of effective rules and regulation of restraints. The Royal Commission highlighted the need “to respond to the significant over-reliance on chemical restraint in aged care” as an urgent priority among the issues the commission identified.
 
The government announced the Royal Commission in September 2018 in response to concerns about abuses in aged care publicized in an ABC investigative TV program, Four Corners. The Royal Commission has conducted hearings across the country. In Sydney in May, it heard oral statements from 45 witnesses and received 693 documents, including 54 witness statements, about residential care and dementia care, including chemical restraint. It will issue its final report and recommendations in November 2020.
 
The Australian government had also responded to reports of restrictive practices in aged care by urgently issuing a new regulation in July, the Quality of Care Amendment (Minimising the Use of Restraints) Principles 2019, which the government contends will protect people from harmful restraints. The Royal Commission’s interim report criticized the regulation, saying that, “The Principles add to, rather than overcome, concerns regarding regulation of physical and chemical restraint, including on issues of consent.”
 
A parliamentary committee is conducting an inquiry into that regulation’s compliance with human rights standards.
 
The government has not announced changes to the regulation. After the release of the Royal Commission’s interim report, Health Minister Greg Hunt announced a new permissions system for health professionals prescribing risperidone, an antipsychotic drug routinely used as a chemical restraint, when its use extends beyond three months. For broader reforms, he said, “Our approach is to look at the elements outlined in the royal commission and to adopt them.”
 
International human rights law prohibits inhuman and degrading treatment. In 2013, the United Nations Committee on the Rights of Persons with Disabilities criticized Australia for allowing practices that would subject people with disabilities, including older people with dementia, to “unregulated behaviour modification or restrictive practices such as chemical, mechanical and physical restraints and seclusion.” The committee said that Australia should end these practices.
 
The Australian government should prohibit the use of chemical restraints to control the behavior of people with dementia, or for the convenience of staff, in line with its international human rights obligations. The authorities should instead make sure that any medical intervention takes place only with free and informed consent, and that medications are administered only for therapeutic purposes. The government should make it a priority to provide positive support and intervention for people with dementia, including in aged care facilities, and ensure that there are adequate numbers of trained staff to provide this support.
 
“Older people in aged care in Australia don’t always get the support they deserve, and are given drugs instead,” Brown said. “The Australian government should heed the Royal Commission’s call for urgent action by prohibiting chemical restraint and penalizing aged care facilities that violate that prohibition.”
Posted: January 1, 1970, 12:00 am

Asylum seekers rest at a migrant shelter run by the federal government in Ciudad Juarez, Mexico. 

© 2019 Reuters/Jose Luis Gonzalez

(Ciudad Juárez) – Asylum seekers with disabilities waiting in Ciudad Juárez, Mexico for their United States asylum applications to be processed face obstacles to getting basic services, Human Rights Watch said today. Mexico’s government should identify and ensure services for people with disabilities and chronic health conditions.

Human Rights Watch research in Ciudad Juárez – a city across the border from El Paso, Texas – found that the Mexican government does not have a proper system in place there to screen and identify asylum seekers with disabilities and chronic health conditions. The authorities have not ensured physical accessibility in shelters, even new ones. Nor are they consistently providing information about and access to health care for asylum seekers with disabilities or chronic health conditions.   

“People with disabilities face significant challenges when they are forced to stay for many months in Mexico waiting for asylum applications to be processed in the US,” said Carlos Ríos Espinosa, senior disability rights researcher at Human Rights Watch. “If the government doesn’t identify people with disabilities, it won’t be able to adequately ensure their access to basic services including health care, food, and shelter.”

An increasing number of asylum seekers, mostly from Central America, have been marooned in Mexico since January 2019, when the Trump administration introduced a policy it calls the Migrant Protection Protocols, also known as “Remain in Mexico.” This policy forces asylum seekers to wait in Mexico while their US immigration claims are pending. Although US policy states that “individuals from vulnerable populations may be excluded on a case-by-case basis” from being sent back to Mexico, Human Rights Watch has found that US border agents’ identification of people with disabilities and decisions to exclude them from being returned have been inconsistent.

As of October 4, almost 50,000 people were in Mexico awaiting US asylum claim hearings under the program. The US government’s practice of limiting the number of new asylum applications to 15 to 30 per day also means that asylum seekers typically wait 3 to 4 months in Mexican border cities to even begin applying for asylum in the US.

In Ciudad Juárez in August and September, Human Rights Watch interviewed 10 asylum seekers with disabilities or chronic health conditions, their families, and officials from the National Migration Institute and the Chihuahua State Council for Population, state agencies responsible for migrants. Human Rights Watch also visited Ciudad Juarez’s one state-run shelter for migrants and asylum seekers and three private shelters.

None of the four shelters were fully accessible for people with disabilities. The federally-run Leona Vicario National Integration Center, which opened in August with a capacity of 3,000 people, has no bathrooms accessible for people with physical disabilities. When it opened, there were no beds and people slept on mats on the floor, including people with disabilities. There is no accessible transportation to and from the shelter.

Government screening for health conditions and disabilities of asylum seekers who enter shelters is inconsistent. A government official and some asylum seekers said that a doctor conducts a basic medical exam of every person moving into a public shelter. At the Leona Vicario shelter, an official said that 86 percent of asylum seekers entering the shelter are registered as having health problems.

However, the shelter’s screening failed to identify some people with disabilities. One resident said that her one-year-old son had been diagnosed with microcephaly and asthma while in Honduras. When she arrived at the shelter in May, the authorities did not ask questions about her son’s health and did not register him as having a disability.

Four adults with disabilities or chronic health conditions in a private shelter run by a religious organization similarly said that no one had identified their disabilities and health conditions when they arrived.

Human Rights Watch research in December 2018 in Tijuana identified many of the same barriers for asylum seekers with disabilities.

Some asylum seekers end up in private shelters because there is insufficient state-run accommodation for all asylum seekers returned to Mexico. Regardless of where they find shelter, under international law, the Mexican government has an obligation to protect the rights of asylum seekers with disabilities. This includes screening for health conditions and disabilities and taking action to prevent them from developing further disabilities, Human Rights Watch said.

Federal and state officials acknowledged that the screening was not sufficient. The head of the National Migration Institute in Chihuahua said that his agency only detected “visible disabilities” and did not do additional screening. “We still do not have an agreed concept as to what we should understand by disability,” he said.

Four asylum seekers with disabilities interviewed also said that officials did not provide enough information or facilitate their access to health care. Asylum seekers in Mexico are eligible for state health insurance for low-income people, yet Human Rights Watch interviewed asylum seekers who did not have information about the plan.

A 55-year-old man from Cuba who is hard of hearing purchased a hearing aid with his own funds. He spent 200 pesos (US$10), the full amount his family sends to him each month to support himself. Human Rights Watch later learned that he could have received a hearing aid at no charge under the government’s health insurance. No officials had informed him of this benefit.

In another case, a Honduran woman who said she has high blood pressure reported that no officials had given her information about state health insurance. She has not received any treatment or medication for her high blood pressure since arriving in Mexico in May.  

A man from Guatemala said that his son has a prosthetic eye which requires daily cleaning, yet officials did not share information with him about the medical insurance that would allow him to see a doctor. “We were in the dark, not knowing anything about health services,” he said. He secured a doctor’s appointment for his son nine months after arriving in Mexico after a nongovernmental organization informed him about the insurance.

Despite the fact that Mexican law establishes the right for asylum seekers who do not speak Spanish to have an interpreter without cost, the service is not always available. People with disabilities can face a disproportionate impact on their health if they don’t have timely access to an interpreter.

A 39-year-old man partially paralyzed in his right arm and leg from a stroke he experienced before fleeing violence in Cameroon said that during his three months in a private shelter in Ciudad Juárez, he had seen a doctor but had not been able to communicate effectively. “I have not been able to have an appropriate medical consultation because almost no one speaks English, and I cannot explain what happened to me,” he said. “I didn't understand what the doctor was telling me.” Two days after the interview, he was hospitalized for a severe headache and high blood pressure.

Limited food options in shelters worsen some asylum seekers’ disabilities and health conditions. Food provided in three of the shelters visited by Human Rights Watch is primarily fatty meat and beans and is often spicy. An official responsible for providing food at the Leona Vicario shelter said that the shelter does not accommodate medical or other dietary needs.

A 29-year-old man from Uganda who had been in a private shelter for four months said he had an ulcer and back pain after alleged torture by the Ugandan military. “My condition here is very precarious,” he said. “I am very grateful to this shelter, but I am not well here. Every day they feed us the same food, and I need a fat-free diet because of my ulcer.”

Mexico’s Labor Ministry has a program to enable asylum seekers to find employment while their applications are being processed. But the Leona Vicario shelter manager said that this program has yet to ensure equal employment opportunities for people with disabilities.

Under the Convention on the Rights of Persons with Disabilities, ratified by Mexico in 2007, the government, including the National Migration Institute and the Labor Ministry, should identify and register asylum seekers with disabilities and ensure their equal access to shelter, employment, and health services through accessible information and communication.

“Mexico is obligated to protect everyone with disabilities and chronic health conditions, including those seeking asylum,” Ríos Espinosa said. “The government should strengthen procedures to identify and register their conditions and to ensure accessible information and other services.”

Posted: January 1, 1970, 12:00 am