“They see us differently”: Promoting health for Roma

Roma are Europe’s largest ethnic minority and continue to face discrimination in healthcare. Udani Samarasekera reports.

“I don’t think doctors like Roma. They see us differently. But my diabetes sees me as a person…”. “Whenever I looked for a doctor, she turned me down immediately because I have many children…”. These are some of the voices in a new report by the European Roma Grassroots Organizations (ERGO) Network on the health and long-term care situation for the Roma population in Bulgaria, the Czech Republic, Hungary, Romania, Slovakia and Spain. Differential treatment in the health sector was common for Roma, the report shows, and is often openly expressed. Roma seeking care experienced insults and racial abuse in healthcare settings, while many patients receiving inpatient care were segregated, including in maternity wards.

Other groups have reported similar discrimination in the healthcare sector. “It’s so widespread,” said Jonathan Lee of the European Roma Rights Center (ERRC). We encountered “verbal and physical abuse of Roma in hospitals by medical workers in several countries, notably in Bulgaria, Ukraine, North Macedonia and Romania. This disproportionately affects Roma women and girls, particularly working mothers, who are subject to both abuse and misconduct by health professionals,” Lee explained. Research by the ERRC and other organizations in Bulgaria and Hungary revealed that Roma women reported physical abuse during their stay in the maternity ward in various hospitals. “In both countries, Roma women told us that even if they shared these experiences, they thought no one would believe them,” he said.

In Europe, discrimination against Roma is pervasive and pervasive in all areas of society. “Antiziganism or anti-Roma racism is not only the most widespread form of racism in Europe, but unfortunately also the most accepted,” said a spokeswoman for the ERGO network. This discrimination has led to poor living conditions and poor access to healthcare, education and employment for Roma. It’s a long-standing situation that has been made worse by the COVID-19 pandemic. “In general, the emergency measures during the COVID-19 lockdowns have disproportionately hit and targeted Roma communities. Everything that normally happens to communities in terms of human rights abuses has continued and has been exacerbated by the pandemic,” Lee said. In several countries, Roma have also been treated as a public health threat by the extreme right. In Bulgaria, “the government used planes to spray disinfectant over Roma communities that they had put under local lockdown,” Lee adds. Checkpoints have been set up in segregated Roma communities in several European countries to control the movement of populations, but little or no medicine, personal protective equipment, food or public health information has been sent in, leaving local activists and charity workers to to intervene in. Now grassroots, philanthropic and EU initiatives are underway to improve the health and life chances of Roma. However, many issues remain unresolved, including compensation for historic abuses and discrimination against Roma fleeing the war in Ukraine.

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The Roma are Europe’s largest ethnic minority: 10-12 million live on the continent, 6 million in the EU. According to the European Commission, the generic term Roma encompasses various groups, including Roma, Sinti, Kale, Romanichels, Egyptians, Yeniche and Abdal, as well as Traveler populations. On average, Roma live 10 years less than the non-Roma population in Europe (64 years vs 74 years). Several factors are responsible for the gap. “When we talk about Roma health, we can’t really just talk about health issues. The health of Roma depends heavily on the social determinants of health: employment, education, housing and the level of discrimination they face,” explained Tomas de Jong of the European Public Health Alliance (EPHA). The ERGO network report highlighted that the Roma employment rate in Bulgaria is around 47%, the lowest among the country’s ethnic groups, and access to health care is difficult for many working-age Roma due to unpaid health insurance contributions. “If I get sick, I can’t go to the doctor, I have no money for the doctor, no money for gas to go to the doctor, no money for pills,” a 63-year-old man in Seslav, Bulgaria, told researchers of the ERGO network. In Hungary, around 300,000 people live in segregated settlements, usually with poor housing conditions and poor infrastructure. In the Czech Republic, 80% of Roma live in marginalized areas where poverty is widespread and housing is unsuitable. “Poverty is the greatest enemy of health. This leads to many problems, including totally unsuitable housing with mold and no access to sanitation or running water, all of which have a huge impact on physical and mental health,” said the spokeswoman for the ERGO network The lancet.

With its report, published on November 23, 2022, the organization hopes to improve Roma policy-making and advocacy and the implementation of EU initiatives, including the Roma Strategic Framework for Equality, Inclusion and Participation (2020-30). The objectives of the framework include “improving the health of Roma and enhancing effective equitable access to quality health and social services”. The health target is to reduce the life expectancy gap of Roma by at least half by 2030. However, the ERGO Network notes: “This very limited focus overlooks all other health and care-related aspects that can affect a person’s life and well-being.” Dan Pavel Doghi of the European Commission said the health target is a “major step in the right direction”. He added: “The new framework is a paradigm shift because it emphasizes horizontal goals… The importance of countering antigypsyism and discrimination is horizontal goal number one and the hallmark of the entire new framework”. However, the ERGO network is encouraged by the EU Council Recommendation on Roma Equality, Participation and Inclusion, published in March 2021, and its proposed actions on a wide range of health issues. For example, it calls on member states to “take action to prevent and combat discrimination against Roma by raising awareness of non-discriminatory access to health services and healthcare and by training health practitioners, medical students and health mediators on methods to identify and combat discrimination and its causes, including Antigypsyism and Unconscious Bias” and “Measures to Prevent and Eliminate Segregation in Health Services”.

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A new European Roma Foundation, the largest yet, funded by the Open Society Foundations, is set to launch in October 2023 and hopes to influence government policy on Roma. Goals currently include “strengthening the voice of Roma and strengthening the organizing capacity of Roma voters,” said Zeljko Jovanovic, director of the Office of Open Society Roma Initiatives at the Open Society Foundations The lancet. “For example, in recent years we have mobilized our constituents to different electoral cycles and they pursued their own selection of key priorities in public, in public campaigning, before political candidates and afterwards in the new governments. And we could see, for example, that there were projects that improved access to infrastructure, especially water and sanitation,” he explained.

Governments have also responded to historic abuses against Roma women. From the 1960s to the mid-2000s, in the former Czechoslovakia and later in the Czech Republic and Slovakia, thousands of Romani women were forced or coerced into sterilization or unknowingly sterilized without consent during health visits. In 2009, the Czech government apologized to Roma women for this abusive practice and promised compensation. As of November 24, 2022, 171 out of 474 women who applied had been awarded compensation. But activists stress the lack of government resources to speed up the compensation process, as many women wait months for a response. “There was also no government outreach to help women navigate the compensation process, relying instead on the capacity of local civil society organizations to do so,” reports Lee. Others are more hopeful about progress. de Jong notes that part of the Czech Republic’s Roma inclusion strategy “is devoted to compensation for sterilization, so they are aware of that; they are working on it”. In Slovakia, however, less attention was paid to the situation. Although the Slovak government officially apologized to Roma women for unlawful sterilization in November 2021, it has not announced a compensation plan. “When I looked at Slovakia’s Roma inclusion strategy, there was no mention of sterilization, so they haven’t yet developed a policy to compensate these women for what has been done to them… Of course, what we hope is the will of the government should also take the same steps that the Czech government is currently taking,” de Jong said.

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But compensation does not end discrimination against Roma; Neither is war. Many Roma are stateless and undocumented in the country they live in, or they may have documents from another country if they are nomads and have moved around Europe. de Jong knows of reports of “Roma refugees from Ukraine having difficulty crossing the border because they did not have proper papers, meaning they were not allowed to cross the border even though they wanted to leave the country because of the war.” In addition, some countries were not very interested in receiving Roma refugees. “As soon as they found out that these refugees were of Roma ethnicity, they suddenly decided, ‘No, we don’t want Roma’… There was an antigypsy narrative that Roma were just economic refugees and not necessarily war refugees,” de Jong said .

The ERRC has deployed human rights monitors to Ukraine and to border crossings, railway stations, registration areas and reception centers for refugees in Moldova, Romania, Hungary and Slovakia. They found thousands of cases of biased treatment of Roma by community workers, aid workers, volunteers, police officers and members of the public. “Roma in general face prejudice, segregation and direct discrimination at all stages of fleeing Ukraine and trying to find refuge in other countries in several countries near or bordering Ukraine,” Lee said. “This is the ugly reality of antigypsyism in Europe that will not go away just because there is another war.” Looking ahead, most EU members have submitted new national Roma inclusion strategies to the European Commission, which will provide feedback while other countries continue existing plans. However, whether these initiatives can address the deep discrimination against Roma and the resulting health effects remains to be seen.

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