17 September 2015
At the invitation of the Government I conducted an official visit in the Republic of Moldova from 10 to 17 September 2015. This was my first-ever country visit under the new mandate established by the Human Rights Council last year. The following statement represents only my preliminary findings based on my various conversations and consultations with the government, organisations of persons with disabilities and broader civil society, and many other stakeholders.
I would like to start by acknowledging the Republic of Moldova’s commitments to advance the realization of the rights of persons with disabilities. Overall, I consider that there are many interesting efforts related to this group, despite limited resources.
Nevertheless, I have observed that the one main issue that permeates the whole society and influences the way that persons with disabilities are perceived therein is the strong prevalence of the medical model of disability. This approach focuses on defining a person’s defect and separating those that are ‘healthy’ or ‘normal’ from those that are ‘unfit’ – resulting in exclusion and segregation, objectifying attitudes and forced interventions.
This outdated model is reflected for instance in the way that administrative data is collected on persons with disabilities. Doctors are given the power to decide on merely medical grounds who is a person with a disability and who is not, and on the ‘degree’ of a person’s disability. This practice categorizes people on arbitrary grounds and affects their entire course of life, as it is used for defining capability (or a lack thereof) to study and work, placement in institutions, and issuance of a disability certificate to access assistance and services. Instead of enabling persons with disabilities to exercise rights such as work, this approach actually certifies many of them as unable to work, an approach completely inconsistent with the international human rights framework. I would strongly urge the Republic of Moldova to abolish this pervasive stigmatization which gravely undermines the rights and dignity of persons with disabilities, and implement the social and rights-based model to disability as anchored in the Convention on the Rights of Persons with Disabilities.
During my visit, I also observed the lack of accessibility of the physical environment in the cities and facilities I visited, and the low involvement of persons with disabilities in public decision-making processes or efforts undertaken by broader civil society. I could further observe that among persons with disabilities, those who are deaf or have intellectual or psycho-social disabilities, women and girls with disabilities and Roma with disabilities seemed to be at biggest risk of being left behind. I would like to recall that based on a rights-oriented concept on disability, persons with disabilities are seen as a heterogeneous group in which each person should be granted the full and effective inclusion in the community.
Interesting initiatives are being implemented to make the system more compliant with the human rights-based approach to disability. Law No. 60 on social inclusion of persons with disabilities was adopted in 2012, just two years after the country ratified of the Convention on the Rights of Persons with Disabilities. I acknowledge the establishment in 2014 of the institutional ombudsman of psychiatric hospitals. Nevertheless, there is a need to move swiftly towards establishing a structure of national level implementation and monitoring in compliance with article 33 of the Convention, with a view to enhancing coordination among different levels of governance and adequate accountability and independent monitoring of undertaken activities.
Turning towards specific thematic issues, I welcome the recent adoption by Parliament of Law 36 which would remove discriminatory provisions establishing the right to vote for persons under guardianship and recognizing the right of persons under guardianship to have legal standing to challenge in court decisions on their placement under guardianship. I am very concerned that this important law has not yet been promulgated. I urge its rapid promulgation in the form in which the Parliament adopted it in May 2015, as it includes key provisions to ensure meaningful participation of persons with disabilities in many aspects of life.
I would also like to commend the Government for its progressive work to ensure inclusive education for children with disabilities. Through my conversations with various stakeholders I got the sense that the right elements are in place to make the system sustainable, namely, a focus on quality education; the development of individual learning plans and solutions on the basis of multi-disciplinary assessments of learning needs; the investment in support staff who has the role of promoting inclusion; and a clear funding structure with coordination and accountability between central and local levels of administration. Focus should now be on ensuring access to quality inclusive education for all children with disabilities, including those that may face particular barriers to access such as children who are deaf, children with intellectual and psycho-social disabilities, girls and Roma children with disabilities. It would also be crucial to enhance efforts on early intervention, pre-school education and opportunities of inclusion of children between 0 and 3 years to ensure that life for these children starts off on the right track.
I welcome the efforts undertaken to review the outdated system on guardianship and introduce systems of support for the exercise of legal capacity, through the draft law on amending the Civil Code. I acknowledge the efforts undertaken to align the national legal framework with article 12 of the Convention on the Rights of Persons with Disabilities, and appreciate the request by the Ministry of Justice for me to provide comments on the draft law. I will do so with pleasure, and look forward to being engaged in this important and exciting process to recognize the full legal capacity of all persons with disabilities.
In the interim, while finalizing the amendments of the Civil Code, there are various ways in which the Republic of Moldova can progress with a view to moving away from the degrading limitations established by the system of guardianship. Following discussions with the Government, I would strongly urge the adoption of a series of measures of immediate effect, such as halting the process of legal incapacitation; putting an end to practices requesting incapacitation for certain administrative procedures such as receiving a disability certificate or receiving a pension; and establishing expedited ways of restoring legal capacity for those deprived of it.
While acknowledging the efforts of the Government to implement a comprehensive social protection system for persons with disabilities, the outdated and exclusionary approach to social protection currently in place represents a significant challenge for the inclusion and participation of persons with disabilities in the Moldovan society. Rather than promoting the participation and independence of persons with disabilities, the system underscores the idea that disability is a medical problem and that persons with disabilities are not able to study, work or live independently, reinforcing stigma, segregation and institutionalization. In this regard, despite interesting initiatives in relation to personal assistants and protected housing arrangements, there is a need to transform the existing social protection system towards one that promotes active citizenship and community participation of persons with disabilities. Furthermore, I urge the Government to guarantee that, regardless administrative considerations related to the process of decentralization, benefits and services are provided in a manner that is consistent with the Convention on the Rights of Persons with Disabilities. The alleged provision of public services through decentralization shall not transform into reduction of social services due to the lack of funding and local accountability mechanisms; the decentralization reform needs to be reviewed in view of the rights-based approach.
Additionally, during my visit many interlocutors expressed concern about the possible impact in the Moldovan social protection system of the current financial situation. Indeed, a delegation of the International Monetary Fund and the World Bank is expected to arrive to Chisinau in the next weeks to discuss solutions to the crisis. In this context, I would like to stress the potential of social protection to alleviate and overcome the potential negative effects of the crisis, in particular in the case of persons with disabilities. It is essential that the Government ensures the enjoyment of the right of persons with disabilities to social protection in these times of economic constraint. I would like to remind the Government that although economic, social and cultural rights are progressive rights, any regress in fulfilling those rights amounts to violation. Human rights are not a negotiable commodity abolishable in times of crisis.
During my mission I have put special attention to the segregation of persons with disabilities in institutions, including psycho-neurological residential institutions (internats), psychiatric hospitals and asylums, where persons with disabilities are placed far away from society. Persons in these institutions are deprived of their liberty for long periods of time – sometimes for their whole lives – based on the existence of an actual or perceived impairment. Inside these institutions, persons with disabilities are frequently subjected to mistreatment, neglect, restraint, forced medication and seclusion, as well as many forms of abuse and violence, including of gender-based nature.
I am particularly concerned about the fact that the domestic legislation allows for the forced detention and non-consensual administration of psychiatric treatment on grounds of mental or intellectual impairments. In Chisinau Psychiatric Hospital, I have met persons involuntarily committed and kept under medication for long periods of time against their will or without their free and informed consent. Moreover, I have obtained information about the administration of chemical and physical restraints, and the use of solitary confinement as a form of control or medical treatment. I was appalled by the severity and inhumanity of the living conditions and the various alleged human rights violations committed against its residents.
I urge the state to take immediate actions to revise the legal provisions that allow detention on mental health grounds or in mental health facilities, and any coercive interventions or treatments in the mental health setting without the free and informed consent by the person concerned. While such institutions still operate as the authorities move towards closing them, I cannot emphasise enough the need of constant and reinforced independent monitoring to prevent further abuses from occurring. The Government should ensure that funds are available for independent monitoring, and that monitoring and investigating bodies have full access to all facilities and materials.
The situation of residents living in the so called “psycho-neurological residential institutions (internats)” is also worrisome. While positive measures have taken place with regard to the deinstitutionalization of children, with the number of children in institutions drastically decreased since 2007, the ones still remaining in institutions are, to a large extent, children with disabilities. The outrageous conditions witnessed during my visit to the Orhei institution for boys and young men with disabilities urge me to call on the government for the immediate closing of this institution. Children are kept in inhumane conditions, tied to their chairs for long periods of time, neglected, and treated in inhumane ways. They have almost no contact with people or activities in the community, they lack access to education and their daily routine is extremely limited. I also cannot keep silent of how appalled I was at the allegations of physical, mental and sexual abuse perpetrated in this institution, and to some extent openly acknowledged by the staffs themselves, remained un-investigated and perpetrators not brought to justice so far. While I did not manage to personally visit the Hincesti institution due to lack of time, various allegations have been brought to my attention about similar human rights concerns related to the girls and young women institutionalized therein.
Regarding the Balti institution for adult persons with disabilities, I received testimonies from several sources about how the system of institutionalisation leads to unspeakable indignities, violence, including sexual abuse and severe forms of human rights abuse, at the hands of the caregivers, health professionals, other staff and other residents. In spite of the fact that the nature the Balti institution is falling outside the mental health legislation and which is not even accredited by the respective national health authority, persons with disabilities in this institution are exposed to psychiatric treatment without their consent. Furthermore, harmful practices against women with disabilities, including sexual violence, forced contraception, forced abortions and deprivation of reproductive rights, have been perpetuated with impunity. First and foremost, all allegations of violence against women should be investigated and properly prosecuted as a matter of the highest urgency.
I welcome the closing of the hospice care units of the Balti Psychiatric Hospital in Pavlovca village, Briceni district, as recommended by the Special Rapporteur on Extreme Poverty in her report to the country in 2013. I was meant to visit the facility as part of my visit but was informed on 11 September by the Ministry of Health that it had been shut down one day prior to my arrival to the country. This is step in the right direction, and I expect it to be a permanent measure. I would also like to have information on where these persons and the hospital staff have been transferred. However, given the grave situation and allegations in all the visited institutions, I urge the Government to start an immediate and comprehensive process of closing these institutions, and replacing all residential institutions with adequate community-based supports in order to respect the rights and dignity of persons currently living on those institutions. The country must revise and come up with a concrete way of accelerating the already started process of deinstitutionalisation of children, while at the same time adopting clear short term action plans for phasing out institutions for children and adults with disabilities and replacing them with community based services.
I also travelled to the Transnistrian Region of the Republic of Moldova, where I met with the de facto authorities. I would like to acknowledge the efforts undertaken to implement some of the recommendations issued by United Nations Senior Expert Thomas Hammarberg in 2013, which are linked to my mandate. I also visited the residential institution of children with disabilities and the newly created rehabilitation centre for children and youth, and observed first-hand the situation in the psychiatric hospital of Vyhvantintsi. In this context I would like to reiterate the need for decisive actions to promote living in the community for all persons with disabilities. Furthermore, children with disabilities should enjoy access to the general school system and efforts to that end should encompass all children, regardless of their impairment. I will look forward to further engagement on these matters.
In conclusion, I would like to highlight the main message that came across in all meetings held during my visit: participation and inclusion of persons with disabilities builds an ever stronger society that upholds the rules of democracy, equality of opportunity and human rights. It is in this spirit that I would like once again to thank the Government of the Republic of Moldova for its outstanding cooperation with my mandate. My full report and recommendations based on my visit will be presented to the Government and to the Human Rights Council at its 31st session in March 2016. In the meantime I look forward to continuing my constructive dialogue with the Government and to identifying areas of practical engagement. I would also like to thank the United Nations Office of the Resident Coordinator, OHCHR and other UN agencies for their work to facilitate my visit in all respects. I am very grateful and humbled by all the stories shared to be by persons with disabilities, their parents and representative organizations, who took time to meet with me and convey their challenges and hopes for the future.