zdravniki4azilante

EUROPEAN ENDEMIC RACISM FROM THE VIEWPOINT OF GLOBAL MEDICINE – On the Case of Criminalization of the Erased and Migrants

Dimitar Anakiev, MD

Doctors for Asylees (DfA), Slovenia

Abstract: The manifestations of racism in medical practice and medical relations we find in Slovenia since 1991 up to the present day. The examples we have mentioned in the text tell us, on one hand, that racism is a serious social illness, and, on the other hand, that there is no place for racism in medicine. The abuse of medicine for political purposes is not only specific for Slovenia but can also be found in many countries of the European Union

At the time when I received an invitation to submit a paper for the Conference of the Peace Institute in Ljubljana I was preoccupied with the dilemma whether to join a humanitarian medical mission in Bangladesh. I studied the situation in the country in which, fleeing from violence, 809.000 refugees from Myanmar “got aground”. Very soon I understood that the situation in the Cox’s Bazar district, otherwise a very well known tourist destination, was not only unfamiliar to me but, from the viewpoint of my own culture, also something I cannot even imagine. For example, 92% of the population has no access to potable water; only 0,36% doctors are available per 1000 people; the state pays for only 7,8% of medical services to its population while 43% of the population are malnourished. To this picture, we should further add endemic cholera. I also realized that this shocking situation is a result of socio-historical circumstances, in much the same way as it is the case, in our region, in a large part of Europe, with racism. To Bangladesh its historical development brought cholera while our historical development brought us racism. I dare say that racism in these areas is an endemic phenomenon caused by historical development. I will explain what that means by the example of the erased and migrants.

The real problems with racism start when it gets institutional confirmation which means when it grabs power. In Slovenia the institution of racism started with erasing 25.000 Yugoslavs from the official records as done by the government of Slovenia in 1992, that is, less than a year after gaining independence from Yugoslavia (1). Until the sentence of the European Court of Human Rights (2) all the governments of Slovenia and a great part of politics considered this racist act as a state-forming one while a part of the politics and the “deep state” still think so and so they behave as well. Paradoxically, and of special interest for us, doctors, the one that leads the way in the violation of human rights, till the present day, is the Medical Chamber which consistently places politics over profession, thus daring not only to disregard the Geneva Conventions but to openly violate the domestic legislature. Many doctors were criminalized and drastically sentenced for being loyal to their patients instead of politics (3). The sentences were their “deletion” from the population register by the state organs, not gaining a medical license and annulment of their specializations by the Medical Chamber.

Regardless of its having signed the Universal Declaration of Human Rights and all the accompanying documents and other laws regulating human rights, Slovenia continued with mass violation of human rights immediately after joining the EU. It is the case of denying the right to medical care to the seekers of international protection (asylum). The first Asylum Act in independent Slovenia was brought by Drnovšek’s government in 1999 and this Asylum Act recognizes the right of seekers to the basic medical care (Article 43). Already Janša’s government in 2006 brought new asylum legislature which denied the given elementary human right and allowed only for urgent medical help (Article 46). Ten years later Cerar’s government confirmed Janša’s violation of human rights (Article 86) while Slovenian politics decided that the Cerar’s legislature finally brought Slovenia’s legislature into full accordance with that of the European Union (4). This allegation is not completely groundless. Regarding all the EU members in the region, similar legislatures have Croatia and Hungary but not Bulgaria which recognizes the right to the basic health care (Art. 29 of 2007 Act). Still, the respect of migrants and asylees’ right to health protection is an exception. In Britain these rights are respected unlike in Germany and France. Italy, Spain and Greece improved their legislature after the migrant crisis and enabled health protection. Some European states such as Belgium have numerous additional acts and royal decrees providing for all migrants, not only to asylum seekers, exceptionally good opportunities for medical protection. Practice, yet, shows that in the constitutionally multicultural Belgium, despite positive legislature, developed cultural mediation and care on the part of the whole society – including engagement of the greatest humanitarian organizations such as Red Cross and Caritas that, in Slovenia, do not participate at all in taking care of the medical protection seekers – the overall health care is realized by only 14% of migrants (5). A complicated medical care system and cultural barriers are themselves a great obstacle that does not need any additional legal restrictions at all. Obviously, so far as international protection seekers are concerned, the legal restrictions in Slovenia and other countries aim at deterring seekers and precluding international protection since the decisions about protection are waited upon for many years and in such a long period of time it is not possible to be without basic health care. These restrictions mostly strike the most vulnerable ones.

At the same time it should be said that Slovenia with 2,52 doctors per 1000 inhabitants thus overcomes the USA and Japan in the relative number of doctors; hence, somewhat over 1300 asylum seekers annually as were registered in 2016 and 2017 in Slovenia represent no burden for a developed health care system. Only one municipality in Slovenia, Ilirska Bistrica, relatively underdeveloped, with 15.000 inhabitants and one medical center with a dozen of doctors, starting from 1998, had no problem in treating 5.000 refugees from Bosnia and Herzegovina. What problem can then represent 1,300 seekers in the whole state? If we look back further, we can see that in 2015 there were only 277 asylum seekers while in 2013 there were 272. At the time when Janša’s government brought its restrictive law, the problem of asylum practically did not exist. Evidently the legal restriction of human rights has as its main task to keep alive racism as the ruling ideology; it is the matter of political action that Janša obviously found interlocutors for in the EU while Dr. Drnovšek in 1999 needed not such actions and ideology in order to rule.

The restrictive legislature regarding asylum seekers is not only criminalization of asylees and migrants but it is also criminalization of the doctor who gives help to an asylum seeker. All the doctors who had worked with migrants and asylees could feel this criminalization on their own skin. To give help to someone against the law is neither a small nor simple matter. Who should the doctor be loyal to: to the law or to the patient? Should the doctor cooperate with the government that violates human rights en masse? Should he rebel or fall silent? A standard recessive pseudo-professional opinion that can be heard at every step in Slovenia is that “the doctor should not get involved in politics.” This opinion is promoted by doctors-careerists given political positions who are in fact advocating for the primacy of politics in medicine for the sake of their own benefits. The truth is entirely different: the doctor is an advocate of the patient’s rights and is obliged to warn about their violations. These are the dilemmas of essential importance for medical profession; the notion of Dual Loyalty that is more and more often frequent in the modern society is contrary to the basic dictum of the profession: namely, that the doctor is loyal solely and only to the patient. This dictum is regulated, since ancient times, by the professional codes such as Hippocratic Oath or, in modern times, the International Code of Medical Ethics of the World Medical Association. The above-given example of the Medical Chamber of Slovenia has shown us the way primitive communities, that take racism as the basis of their activities, punish the doctors who regard the loyalty to the patient as more important than that to politics. However, the example of the Medical Chamber of Slovenia is not unique in the world regarding the violations of the basic rules of medical profession. Under the apartheid rule in the South African Republic the medical profession completely adapted itself to the rule of racism. I repeat: under the apartheid rule in the South African Republican the medical profession completely adapted itself to the rule of racism! This means that the doctors adopted the rule of racism in their professional work! That is why in the year of 2000, in Durban, in the Republic of South Africa, there was a world conference held on the issue of “dual loyalty” in medicine in which the participants included over 56 experts – doctors from all over the world – with the intention to explain and stop further spread of this, in terms of medical profession, unacceptable (and inconceivable) practice (6). Apparently, we in Slovenia will also have to organize a conference like the Durban one due to very similar practice in our country.

At the time when our racists fortified their bunkers, medical organizations in the developed world published their attitudes towards human rights of asylees, refugees and migrants and in this way, they, relying on the power of their authority, dictated to politics the civilization norms that it was not allowed to violate. One of the most comprehensive such documents is the statement of the Australian Medical Association about the rights of asylum seekers and refugees (7).

In our region the medical organization of relevance have remained silent and persistently subjected to politics – not only these that stood out earlier due to mass violation of human rights such as the Medical Chamber of Slovenia but also the organizations that are apparently entirely professional such as the National Institute of Public Health (NIPH). During our humanitarian work (DfA) we have incessantly warned of a series of health problems that asylum seekers are facing in Slovenia (starting from chronic malnutrition to barrack accommodation and dislocation). And yet, the NIPH, though these problems fall into its field of action, in none of these cases reacted; it seemed as if the public health of asylum seekers did not concern them at all. They showed up and intervened when there were no medical indications for this: they vaccinated a Kurd child from Syria against morbilli, seven days after the child was, due to morbilli, discharged from a hospital in Greece and came to Slovenia afebrile and with developed immunity like all those who got over the disease; that is why additional immunization was, to put it mildly, completely nonsensical. The very action went on like this: the media were informed that in the Asylum Home there was a child from Syria sick from morbilli. When the atmosphere of fear was created, they came in a large number and saved the nation from danger: by unnecessary vaccination. They vaccinated each and everyone who happened to be there including some wretched Cubans, security service, social workers... That is how they left a strong media impression about their being saviors of their nation from dangerous migrants who come to us every day and threaten us with various diseases. We have explained this case of unnecessary vaccination and posted it on our Internet blog but, of course, not anyone from the NIPH was held responsible for this fake medical (media) action though, logically, someone will have to (8).

The deprivation of the migrants in the EU of the right to health was an issue dealt with by many research studies even before the last migrant wave took place in 2015. The classical work on the subject is a book (dating 2011) by a group of authors led by the sociologist Bernd Rechel from the London School of Hygiene and Tropical Medicine. The book entitled Migration and Health in the European Union was also signed by the government of the Republic of Slovenia in joining this project (9). Explicitly it says in the book that many EU countries abuse medicine for the purpose of dissuading migrants from settling in their countries. Racism is, therefore, concerning all that has been said, a normal political means in the EU. It also says that the EU members were called upon many times, by two Secretaries General of the UN, Kofi Annan and Ban Ki-moon, to pass the laws that would prevent any violation of human rights in the domain of health care but this has not taken place so far. Quite the contrary: we are witnessing increasing and ever more present racism in the European society.

This short survey I would like to conclude with an example from the humanitarian practice of the DfA. Some time ago I wrote a text about our humanitarian work for a monthly. I mentioned, without telling her name but only specialization, a female doctor from a health center in the province that had helped us with her pro bono work in the cases of much needed diagnostics. Soon the editor phoned me and said, „You must not write things like this, do you know what might happen to her? At least her car, when parked in front of the health center, will have her tires cut or the windsheet broken. And she might get fired. And God knows what else may happen...“. I had to hide all the facts including the name of the health center and the doctor's specialization. Moreover, her gender I also hid and I just wrote „doctor“, so that no shadow of a doubt could be cast on her. Therefore, we are living in a society in which help given to a certain man, or a certain kind of man, could be severly punished. This is typical for the rule of racism. It is not fully public as it was in Hitler's state but it is sufficiently powerful to induce a real fear in the majority of people. Probably that is why many of the doctors who are helping us want to remain anonymous; we understand that. On the other hand, people are willing to help. Racism is not a state of human soul; this is politics led in order to grab power and for personal gain. That is why when speaking about endemic racism in Europe we should underline that this phrase means only a certain political continuity – sometimes on the margin and sometimes in the center – that is incessantly rehashed by certain political circles. The manifestations of racism in medical practice and medical relations we find in Slovenia since 1991 up to the present day. The examples we have mentioned in the text tell us, on one hand, that racism is a serious social illness, and, on the other hand, that there is no place for racism in medicine. The abuse of medicine for political purposes is not only specific for Slovenia but can also be found in many countries of the European Union.

SOURCES AND REFERENCES:

Jasminka Dedić, Vlasta Jelušić and Jelka Zorn, The Erased, 2003, Mirovni inštitut, Ljubljana

(2) ECHR: https://www.statelessness.eu/sites/www.statelessness.eu/files/attachments/resources/ECHR_GC_Kuric%20v%20Slovenia_June2012.pdf

Hipokrat na domobranski način: http://izbris-blog.blogspot.si/2017/11/hipokrat-na-domobranski-nacin.html

https://www.rtvslo.si/slovenija/sprejet-nov-zakon-o-mednarodni-zasciti-obstrukcija-sds-a-in-nsi-ja/387366
Nel Vandevannet, Director of the Belgian Mission of Medecins du Monde, Welcome Speech at the National Congress of the Belgian section of the MdM, February 2017, Brugge, Belgium
Dual Loyalty & Human Right in Health Professional Practice, 2002, Physicians for Human Rights and School of Public Health and Primary Health Care, University of Cape TownBernd Rechel, Migration and health in the European Union, 2011, Open Universyty Press, Berkshire, England

AMA Position statement: Helth Care of Asylum Seekers and Refugees, 2011, https://ama.com.au/sites/default/files/documents/Health%20Care%20of%20Asylum%20Seekers%20and%20Refugees%20-%202011.pdf
VACCINATION IN ASYLUM HOME AGAINST MEASLES BY THE NIJZ (National Public Health Institute), WAS NOT REALLY NEEDED: http://zdravniki4azilante.blogspot.si/2017/07/vaccination-in-asylum-home-against.html
Bernd Rechel, Philipa Mladovsky, Walter Deville, Barbara Rijks, Roumyana Petrova – Benedikt, Martin McKee, 2011, Migration and Helth in the European union, Open University Press, Berkshire, England.