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Preliminary observations and recommendations by the Special Rapporteur on extreme poverty and human rights: End Mission to the Republic of Moldova 8 – 14 September 2013

Romanian version

13 September 2013

Members of the press, ladies and gentlemen,

I am addressing you today at the conclusion of my official mission to the Republic of Moldova, which I undertook at the invitation of the Government from 8 to 14 September 2013. My objective during this visit has been to evaluate the situation of those living in extreme poverty in the country, and the following statement contains my preliminary findings and recommendations. I would like to emphasize that today’s statement covers above all urgent issues which I hope will be addressed by the State as a matter of priority. I will present my final report to the 25th session of the United Nations Human Rights Council in June 2014. The final report will include my more detailed recommendations to assist the Government in improving the lives of persons living in poverty.

Given the immediacy of some of the issues raised with me by various stakeholders, I feel compelled to address them here today, and not to wait for consideration of the issues in my final country mission report for June 2014. While I recognize that much more could be said on a range of issues, including encouraging Government policies and programmes, this is a deliberate choice. As such, the following comments are – and should be reported as – a work in progress.

Introduction

During my stay in Moldova, I met with various Government representatives of the Ministry of Foreign Affairs and European Integration, the Ministry of Labour, Social Protection and Family, the Ministry of Health, the Ministry of Justice, the Ministry of Education and the National Centre for Human Rights. I also met with representatives of international organizations, donor agencies and a range of civil society organizations. In addition, I visited communities living in poverty and spoken with persons living in poverty in the Chisinau, Calarasi, Balti, Briceni and Drochia regions, as well as in Bender and Tiraspol on the other bank of the Nistru River. I visited several health care facilities and neuro-psychiatric residential institutions (internats) such as the Tuberculosis and the Narco-Psychiatric facilities of the Balti Psychiatric Hospital in Briceni district (Pavlovca village), the Balti neuro-psychiatric residential institution, the Bender neuro-psychiatric residential institution, and the Costujeni Psychiatric Hospital in Chisinau.

I would like to thank the Government of the Republic of Moldova for its excellent cooperation during my visit. I very much appreciate the spirit of openness with which I was able to engage in dialogue with the authorities.

I am also very grateful to the Office of the United Nations Resident Coordinator and in particular to the Human Rights Advisor of the UN High Commissioner for Human Rights in Moldova (OHCHR), for support and assistance with the mission. I would like to offer my sincere gratitude to everyone who took the time to meet with me as their contributions have been invaluable to the success of my visit. I am especially grateful to all those who shared their personal, and sometimes very troubling, experiences of struggling with the plight of poverty and social exclusion.

Ladies and Gentlemen,

Since the declaration of independence in 1991, Moldova has faced a number of political, economic and demographic challenges, which include separatist conflicts, political uncertainty, the effects of the global economic crisis, as well as natural disasters, such as drought, to name only several.

In the last decade, Moldova has achieved important economic growth, with GDP growth reportedly of on average 5.05% annually between 2000 and 2011. The country has achieved a remarkable reduction of poverty from 30.2% in 2006 to 16.6% in 2012.

However, economic growth and development achieved has not been shared by all members of society. It has been unequal not only in geographic but also in social terms. There is a widening gap between urban and rural areas, and some groups of the society remain at the margins of social, political and economic processes, if not entirely excluded from them. While many Moldovan families depend on remittances from family members working abroad, economic growth based on migrants’ remittances, that at their peak in 2008 accounted for 33% of Moldova’s GDP, is not only unsustainable but a non-inclusive development model. Moreover, such an approach hides the enormous sacrifices of those who are forced to leave to seek better opportunities and the dramatic impact on those left behind, particularly children and older persons.

Life expectancy in Moldova is among the lowest in Europe, particularly for men, and in the past decade the gap in life expectancy between rural and urban areas has reportedly more than doubled. The incidence of HIV/AIDS has increased since 2000 and there has been a decline in enrolment rates in general mandatory education. In rural areas, children with disabilities and Romani children have a much lower enrolment rate in pre-school education than the rest of the population putting them in a disadvantaged position from an early age.

Women continue to have limited economic opportunities when compared with men, despite their important achievements in education in recent years. Gender-based violence and women representation in decision-making positions remain critical challenges in Moldova.

Corruption continues to be severe, acting as a powerfully destructive force on Moldova’s development and the effective exercise of human rights. In 2012, Moldova ranked 94 out of 176 countries globally according to the Corruption perception index. Corruption has a particularly devastating impact on persons living in poverty.
Thus, not surprisingly, Moldova continues to rank at problematic levels on the global Human Development Index, with few improvements during the last decades in terms of its rank. Moldova was placed 111th and moved to the 113th place in 2012 out of 187 countries.

These data translate into severe hardship for those living in extreme poverty, including older persons, persons with disabilities, single-person or child-headed households, significant sectors of the Romani community, or those recently returned from work abroad or have been returned after being trafficked, and others, particularly in rural areas. Many such Moldovans struggle to provide themselves and their children with nutritional food, and are often unable to meet the basic costs related to school attendance and health care. Women from stigmatized groups face particular exposure to such threats of poverty or exclusion. This is happening at a time when the costs of essential goods and services, including food, water and sanitation, clothing, education, fuel and electricity, have been steadily on the rise.

I have taken note of the resource constraints of the State and have thought carefully about them in the course of my efforts to understand extreme poverty and human rights challenges in Moldova. As a result, I am fully convinced that still much more can be done even with existing resources to improve the lives and push back the social exclusion of those living in extreme poverty in this country.

I have noted that Moldova is committed to building a robust legal system and in recent years has adopted important legislation including, to name only several key developments, the 2012 Law on Ensuring Equality, the 2008 Law on Preventing and Combating Family Violence, the 2006 Law on Ensuring Equal Opportunities for Men and Women and the 2012 Law on the Social Inclusion of Persons with Disabilities.

In terms of international human rights law, Moldova is Party to seven out of nine core international human rights treaties. Moldova’s 2010 ratification of the Convention on the Rights of Persons with Disabilities has provided a very important reform context in a number of areas related to my mandate. Moldova has actively engaged with human rights monitoring bodies by successfully participating the Universal Periodic Review process; engaging with review by the United Nations Treaty Bodies; and extending a standing invitation to all Special Procedures to the UN Human Rights Council.

I take particular note of Moldova’s incorporation of international review recommendations into its National Human Rights Action Plan, as well as of Government action plans on Roma Inclusion, and to incorporate the 2011 recommendations to Moldova of the UN Committee on Economic, Social and Cultural Rights into a Government action plan.

However, legislation does not always translate into reality for many people in Moldova. There are severe implementation gaps in almost all social policies, ranging from domestic violence to trafficking. Laws and plans of action systematically lack strong implementation and accountability mechanisms. There is a general lack of monitoring and evaluation of the policies in place, limited impact assessment and a general lack of disaggregated data in a number of key areas. Without indicators, benchmarks and the regular collection of quality disaggregated data, it is not possible to properly evaluate the impact of several measures taken by the State.

Ladies and Gentlemen,

During my visit I have identified several segments of Moldovan society which are particularly vulnerable to poverty and social exclusion, including women, children and youth, persons with disabilities, older persons, and Roma. While my report will address in more detail the specific human rights issues and deprivations affecting different groups, I would like to take this opportunity to voice particular concerns about the situation of the following groups:

Women and girls
Although the rights of women in the Republic of Moldova are provided with extensive guarantees of protection under the country’s Constitution and legal framework, many face significant challenges, including: unequal access to employment and decent work, unequal remuneration, lack of representation at the political and decision-making levels, exposure to domestic violence and trafficking. In addition, women with disabilities, Romani women, lesbian, bisexual and transgender women, single mothers, older women, and women living in rural areas face additional exclusion and discrimination that prevent them from lifting themselves out of poverty.

Despite the legal framework, poverty pushes women to seek employment abroad, which creates further vulnerabilities when they find themselves without protection as migrant workers, or being trafficked or exploited, or subjected to other forms of abuse. It is also known that abuse often takes place in their own homes. Domestic violence continues to be seen as a private matter, including by women themselves and more importantly, by law enforcement officials, leading to severe exposure to abuse.

I take note of the fact that in recent years, Moldova has been found in violation of the European Convention on Human Rights by the Strasbourg Court in cases concerning failure of protection of women and girls from domestic violence, inadequate investigation of rape, and coercive sterilization.

I have been informed that women face additional stigmatisation, discrimination and abuse upon their return from work abroad, due to an assumption that they worked as sex workers abroad. This is a vicious cycle for women, especially given the fact that up to 90% of trafficked women report that they have also been victims of domestic violence. These factors and others, such as lack of adequate child care facilities or support to care for disabled family members, which usually falls on women’s shoulders, create conditions for the increasing feminisation of poverty. It has been also reported to me that the challenges faced by women are similar on both banks of the Nistru river.

I commend the State’s commitment to gender equality. However, due to poor implementation rates, lack of monitoring, evaluation, as well as clear accountability mechanisms, the impact and effectiveness of laws such as the Law on Preventing and Combating Family Violence, the Law on Combating Trafficking, the Law on Ensuring Equality, and the Law on Equal Opportunities for Men and Women is thus far questionable. Efforts clearly need to be redoubled in this area.

Children
Children are extremely vulnerable to poverty due to a number of factors, including economic and legal dependence on their parents or guardians, risk of exposure to violence and abuse, lack of awareness of their rights to name just a few. In Moldova, their vulnerability is exacerbated if they also belong to stigmatized or socially excluded categories of population, such as persons with disabilities, the Romani minority, single-parent households, households with parents working abroad, and many others. While two thirds of all Moldovan children live in rural areas, child poverty in rural areas is reportedly almost three times higher than in urban areas. In some cases, children apparently in practice head households.

Among the most outstanding challenges for children living in poverty are school enrolment and attendance, access to health care, nutrition, marginalization and discrimination, trafficking, the negative impact on families of high rates of emigration, and lack of effective support for families, and adequate, human rights-compliant care services.

I have received reports indicating that some children living in social exclusion are unlikely to receive health care, even though they are ensured by the State under the compulsory health insurance scheme. Those who require special and regular medical attention – including children with cystic fibrosis, spina bifida or other curable or manageable diseases giving rise to very serious threats to the life or health of children – do not have access to adequate services or medication, and their parents are required to make out-of-pocket payments to meet their children’s health care needs. Children with mental or physical disability are too often unnecessarily institutionalized, which not only harms their health, but also impedes the effective exercise of a range of fundamental human rights, as well as their development and social integration. For many children, early institutionalization is often a first step to life-long institutionalization or early death. Studies consistently demonstrate that young people raised in institutions are at a much greater risk of unemployment and homelessness or adult institutionalization, sexual exploitation and trafficking, and even suicide, than their peers raised in families.

I have seen evidence of school segregation for Romani children. This is completely unacceptable under international law. I recognize the stated commitment of the Ministry of Education to integrating Romani children. However, I am concerned that in many cases, too much emphasis is placed on problems in the Romani community, with not enough attention to barriers to inclusion in mainstream schooling, arising in schools as well as because of pressure for segregation exercised by non-Romani families. Intensified and concerted efforts to integrate Romani children into mainstream, quality schools and classes are required to resolve this problem as a matter of the highest priority.

Roma
Despite Moldova’s equality and non-discrimination provisions enshrined in the Constitution and the Law on Ensuring Equality, the country’s most vulnerable ethnic minority, Romani people, are still stigmatized, discriminated against and, as a result, marginalised. I visited Romani communities living in destitution and isolation, and I was appalled by their general housing conditions – including an absence of running water, sanitation facilities, heating system for the cold season, and in some cases even electricity. The women I met were eager to take up jobs, but were stuck at home because child care for pre-school children was available only for a few hours per day if at all. In some cases, they were unable to send the older children to primary school due to a lack of shoes or the inability to pay for indirect costs requested by schools. Many of their husbands were working abroad but earn too little to send any remittances home, and are in some cases subjected to exploitative practices abroad. These empirical findings are confirmed by general statistics in the country. I am concerned about the lack of access to information by the Romani community that seems to be hampering the exercise of their rights. It is a State duty to ensure access to information through channels physically and culturally accessible.

I commend the Republic of Moldova for introducing the position of Roma community mediators in communities throughout the country. While some mediators are now working officially, I understand that the full network of 48 planned mediators is only slated to be in place at the end of 2014. I call on local authorities to ensure that the engagement of the mediators is carried out in full compliance with the principles of transparency, meaningful and effective participation of the relevant communities, access to information and accountability. If the process is undertaken in compliance with these principles, I believe Moldova will be one step closer to full inclusion of the Romani population. I call on the State to ensure adequate resources to implement and monitor all policies aiming at ensuring that Roma people can enjoy their rights on an equal basis with the rest of the population.

I was informed about the Government’s plan to desegregate the school in Otaci and I call on the Government to proceed as quickly as possible. The Government should continue supporting the ongoing integration efforts of children from the Schinoasa community in the school in Tibirica as well as to proceed quickly to integrate other communities with problematic separated schooling arrangements, such as those in Stejareni/Lozova and Parcani/Racula.

Older persons
Similar to children, older persons in Moldova find themselves in a vulnerable situation as their wellbeing is usually at the mercy of their families and the social protection system. Furthermore, the negative impact of emigration places additional burden on older persons as they often find themselves as care-givers for grandchildren or other relatives on an already overstretched minimal pension. I have been informed that pension levels are far below the minimum subsistence level and are manifestly insufficient to pay for bills, buy food and other basic necessities.

Many older persons live in rural areas without adequate water and sanitation, heating, flooring or roofing. With its new National Roadmap on Ageing, the Government should address these challenges faced by older persons through a comprehensive and adequately financed plan of action.

Persons with disabilities
Reports I have received indicate that there is a high level of discrimination and stigma against people with physical, mental and intellectual disabilities. The Convention on the Rights of Persons with Disabilities, of which the Republic of Moldova is a State party, envisions a paradigm shift in the treatment of persons with disabilities.
During my stay I have visited neuro-psychiatric residential institutions and psychiatric hospitals for persons with disabilities in both side of the river, and I am appalled by some of the conditions in which they are living. I am extremely troubled by the fact that the long standing system in place – heritage of the Soviet times – favours the exclusion from society of persons with disabilities, in particular mental or intellectual disabilities, without serious effort to ensure their integration and lacking direct support to caring families or other trusted supporters.

The Committee on the Rights of Persons with Disabilities has been explicit in calling for the prohibition of compulsory institutionalization or confinement based on disability. Community living, with support, is no longer only a favourable policy development; it is now an internationally recognized human right.

Article 14, paragraph 1 (b), of the Convention on the Rights of Persons with Disability states: “the existence of a disability shall in no case justify a deprivation of liberty”. Legislation, policies and practices giving rise to the institutionalization of persons with disabilities on the grounds of their disability without their free and informed consent must be abolished. This must include the repeal of provisions authorizing institutionalization of persons with disabilities for their care and treatment without their free and informed consent, as well as provisions authorizing the preventive detention of persons with disabilities on grounds such as the likelihood of them posing a danger to themselves or others, in all cases in which such grounds of care, treatment and public security are linked in legislation to an apparent or diagnosed mental illness.

I received report that severe abuses such as neglect, mental and physical abuse and sexual violence, continue to be committed against people with psychosocial disabilities and people with intellectual disabilities in residential institutions and psychiatric hospitals in Moldova.

As has been reiterated by the Special Rapporteur on Torture, there can be no therapeutic justification for the use of prolonged restraint of persons with disabilities in psychiatric institutions; both prolonged seclusion and restraint may constitute torture and ill-treatment, and reinforce severe exclusion leading to extreme poverty.
I am also concerned at the impact of plenary guardianship provisions under the Moldovan Civil Code – similar to laws throughout this region -- in giving rise to or magnifying the situation of persons threatened with poverty. Guardianship or so-called “incapacitation” measures involve placement of a person in the formal legal care of another person or institution. A person – most frequently a person with mental or intellectual disabilities -- placed under guardianship cannot engage in even the most basic socio-legal acts, such as marrying or divorcing, concluding a work contract, claiming social benefits, or consenting to or refusing medication. Persons placed in guardianship have no legal standing at all, not even to appeal the guardianship measure. Many people in guardianship are then also institutionalized. Guardianship and incapacitation measures are incompatible with the Convention on the Rights of Persons with Disabilities (CRPD).

I understand that the Government is in the process of examining guardianship, with a view to its reform in light of the CRPD Convention, and that this action is included in the National Human Rights Plan. I call on the Government to complete this work as soon as possible, and above all to adopt a reform which empowers to the fullest extent persons with disabilities in the exercise of their own will, autonomy and preferences, as established under the CRPD Convention.

I also understand that the State is in the process of amending the Law on Parliamentary Advocates, Moldova’s Ombuds institution, currently a B-Status National Human Rights Institution (NHRI). I commend the fact that the Government appears intent on completing this work during 2013 and that the draft Law appears to include a number of measures which would significantly heighten the transparency of appointments of Ombudspersons. I urge that the opportunity of amendment of this law be used to establish within the Ombuds institution the independent monitoring body envisioned under Article 33(2) of the CRPD Convention.

I welcome the fact that the Government has instituted a pilot Ombudsperson for Psychiatry. The Ombudsperson is currently empowered to ensure human rights oversight in institutions under the Ministry of Health, but not yet in residential institutions under the Ministry of Labour, Social Protection and Family (MLSPF). I understand that, in practice, the Ombudsperson has access to the facilities in Orhei and Balti, but has faced problems in access to the Chisinau psychiatric hospital (Costujeni). The Ombudsperson is not yet budgeted, being supported financially in the pilot phase by the United Nations Country Team in Moldova.

I was favorably impressed with the pilot Ombudsperson for Psychiatry arrangement, as well as with the positive changes and human rights scrutiny provided by the arrangement. I urge the Government to swiftly formalize and fully institutionalize the position of Ombudsperson for Psychiatric, ensuring that the mandate is fully independent and provided with adequate resources from the State budget as soon as possible, meaning from 2014. I also call on the State to extend the mandate to cover residential institutions under the Ministry of Labour, Social Protection and Family, and that access is ensured for all institutions under the mandate of the Ombudsperson for Psychiatry.
I was concerned by sexual and reproductive health arrangements in the institutions I visited, as well as related hygienic arrangements. I do not believe that adequate provision is made to ensure the rights of persons in institutions to sexual and reproductive health, including contraceptives, as well as counselling done in language readily understandable by persons in institutions.

I understand that the Government is currently involved in the design of an adult deinstitutionalization strategy. I urge that work on the strategy be completed in the shortest possible time. I hope that, at the time of my report to the Human Rights Council in June 2014, I am able to commend the Government on the closure of one or more of Moldova’s large psychiatric hospitals, and the integration of persons with mental disabilities into the life of the community, as is their right.

The State has extensive positive obligations to safeguard the human rights of persons with disabilities. The Government must ensure that no patient is subject to any form of ill-treatment.

The right to health
Despite the significant investment in health, some primary health-care facilities do not meet national standards regarding their infrastructure and shortages of basic equipment. Those ranking lowest in terms of quality are located disproportionately in rural areas where there is also a lack of availability of essential medicines. This contrasts dramatically with the situation in Chisinau where, for example, where 50% of all hospitals are located. This geographic inequality also extends to family doctors; national statistics indicate that in some regions family doctors cover larger numbers of people than in others. Specialists are reportedly missing in a number of rural areas.

I urge that efforts be strengthened such that those living in rural areas have access to affordable quality services, by improving infrastructure and overcoming shortages in human resources in primary health care services. I also urge the State to take immediate measures to ensure that the right to free and informed consent in any intervention in the health field is fully respected at all levels.

While the State should strengthen the efforts to improve the coverage of the compulsory health insurance by the most vulnerable sector of society, it must ensure that the financial cost in not a barriers for those living in poverty to have access to quality health care and necessary pharmaceutical beyond emergency care.

As evidence suggests, Moldovans tend to perceive that those living in poverty are the group facing most discrimination in access to health care linked to their inability to pay, unemployment, lack of medical insurance and, even when they have medical insurance, their inability to pay extra. As a result, their rights are not fully respected.
Those living in poverty who suffer from additional grounds of discrimination based on ethnicity (in particular Roma), age, sexual orientation or gender identity, health status, experience additional challenges to access health services needed. The State must ensure that all health care services are culturally appropriate. Regular data should be collected to improve service in line of the impact of discrimination – including that based on income and the inability to pay extra – on the quality of service provision.

I am troubled by reports that suggest that although children are ensured by the State, many parents from vulnerable groups are not aware of this provision, and as a result, do not seek medical attention for their children when needed because they believe they cannot afford it.

The situation in the Pavlovca facility (Briceni district)
During my stay I visited the Tuberculosis and the Narco-Psychiatric facilities of the Balti psychiatric Hospital in Briceni rayon (Pavlovca village). I witnessed there outrageous violations of rights of the 81 patients in the facility in particular those in the tuberculosis facility. I am therefore urging here and now that this facility be closed immediately.

The patients in the Pavlovca facility live in deplorable and degrading conditions, with fundamental rights including the right to liberty and security of person, the prohibition of inhuman and degrading treatment, the right to health, the right to privacy and the right to an adequate standard of living constantly violated. In the tuberculosis wing, persons with open and closed forms of tuberculosis are manifestly housed together in ward facilities at close quarters. In one room, ten beds were occupied by eleven patients. Patients arriving with simple forms of tuberculosis frequently therefore contract far more deadly multi-drug-resistant (MDR) strains of tuberculosis. Seven people have reportedly died in the facility during 2013; at least eleven people reportedly died there last year.

As confirmed by a report undertaken by the Ministry of Health following a mission there in August of this year, patients have not given consent for admission and treatment, the treatment that are receiving is not medically adequately, they are deprived of their liberty as they are not allowed to leave premises, they are not provided with sufficient food. There is also strong evidence that they are also subject to labour exploitation as some of them are forced to work in the impressive farm of 15 hectares of agricultural land that seems to produce industrial volumes of agricultural production. This was described to me as “work therapy”. It is reportedly not remunerated.

I welcome the fact of a documentary mission to these facilities carried out by the Ministry of Health in August. I was provided with a copy of the Ministry’s report, and I understand that there is a decision to close the facility within 3 months’ time. While I welcome this commitment, human rights law requires immediate action in response to demonstrated threats to life and health. I do not believe that it is appropriate for the authorities to delay the closure of the Pavlovca facility for three months. I understand from the Ministry report that there is no obstacle whatsoever to the immediate transfer of patients either to decent tuberculosis treatment hospitals, or to out-patient care in their home communities, depending on their particular treatment needs.

Under international law, the Ministry’s report and its conclusions compel the authorities to act upon its findings without delay. I call on the Government to take immediate actions to ensure that rights of all patients at the Pavlovca facilities are fully protected. First and foremost, the Pavlovca institution -- which is not even accredited by the respective national health authority – should be closed down as a matter of the highest urgency. All patients currently in the Pavlovca institution should be provided with treatment and rehabilitation services in line with national and international standards, in another health care facility or at their own residences according to their medical condition.

Where necessary, persons caring for patients transferred from Pavlovca must receive the necessary support to assist them. In parallel, the authorities should relocate or otherwise provide for the staff of this institution without infringing their labour rights. The Government should fully investigate the situation. If an where the evidence warrants it, persons culpable for human rights harms should be held accountable, including where appropriate under criminal law.

Ladies and gentlemen,

I will finish by reiterating my commitment to continue the dialogue initiated during this visit. I would like to thank once again the Government of the Republic of Moldova for its excellent cooperation during my visit. I look forward to working with the Government in a spirit of collaboration on the implementation of my recommendations.