The Lancet, Editorial – “The past year severely tested the international system’s capacity to respond to crises and mass forced displacements of people, and found it woefully inadequate.” So begins Amnesty International’s annual report for 2015, The state of the world’s human rights, published last week. Set against the backdrop of unprecedented and worldwide migration, recurring themes include access to health services, the effects of conflict on health, women and children’s health, sexual rights, and the denial of health care in prisons. In this comprehensive review of human rights in 160 countries, health is an explicit and constant underlying thread.
Many of the human rights injustices in 2015 were shaped by waves of migration, as refugees faced inadequate provision of health care in countries that struggled with existing poor infrastructures; accounts of ill treatment, torture, and abuse were commonplace in many countries. In 2015, a further 1 million Syrian people fled the country, on top of internal displacement of 7·6 million Syrians (half of them children). In Spain, there were an estimated 750 000 unofficial migrants living without access to health care. Greece continued to be overwhelmed with asylum seekers, putting pressure upon health-care systems that were not adequate to begin with. Amnesty’s report also draws attention to Greece and Croatia’s Roma populations where extremely poor housing conditions are having a devastating effect on health. On a positive note, Canada’s new incoming government in November laid out plans to resettle 25 000 Syrian refugees by early 2016, along with a guarantee of health coverage for all.
Regarding access to health services, already poor rural services and health-care infrastructures were exacerbated by natural disasters in many regions. Nepal’s April, 2015, earthquake led to the near collapse of health-care services. With 8856 confirmed deaths, and 22 309 injured, the complete destruction of at least 602 257 homes, and the displacement of more than 100 000 people, emergency support workers faced often insurmountable challenges, and the country is still rebuilding itself. In Haiti, in addition to a lack of health-care services for tens of thousands of refugees, a cholera epidemic in the first 6 months of 2015 led to a three-fold increase in cases compared with the same period during the previous year. An underfunded humanitarian response to these crises has denied Haitians their basic right to health.
Political conflict has led to continuing devastating violence, often directed against medical workers and hospitals, and the subsequent denial of health as a human right, in countries including Pakistan and Sudan. Repeated bombing of health facilities in the South Kordofan area of Sudan have destroyed some 26 hospitals and clinics since 2011, leaving just two hospitals in 2015 to serve a population of 1·2 million people. In Syria, the armed Islamic State (IS) group’s violence has led to closure of multiple health facilities and widespread denial of access to health care, in addition to 697 medical workers being killed since April, 2011.
As violence against women and girls continues to be problematic in many countries, and unsafe or criminalised abortions are documented in many country profiles, there are few positive developments around women’s health and sexual health. Several countries are addressing problems through health policy reviews, but common denial of basic rights for people identifying as lesbian, gay, bisexual, transgender, or intersex, and for women who have experienced violence, continues to be a widespread issue.
Children’s rights are threatened through the recruitment of children for military purposes in many war-stricken territories. Amnesty cites the Boko Haram armed group in Nigeria, Somalia, and Sudan, who recruited children to carry out much of their destruction, that in 2015 led to more than 8200 deaths. Elsewhere, children are also hard hit and poorly served through limited or non-existent access to health care. In Madagascar, the fifth poorest maritime country in the world, the report cites UNICEF’s 2015 findings that 47% of children younger than 5 years are malnourished and have no access to basic health care.
Amnesty’s report does note positive developments: the adoption of the UN Sustainable Development Goals, and evidence of social and economic progress in some countries. However, as Salil Shetty states in the report foreword, “…protecting and strengthening systems of human rights and civilian protection cannot be seen as optional. It is literally a matter of life and death.” In reviewing the state of the world’s human rights in 2015, it is clear that denial of the fundamental right to health is an urgent and recurring theme that must be addressed by the global community.