EUROPEAN ENDEMIC
RACISM FROM THE VIEWPOINT OF GLOBAL MEDICINE – On the Case of
Criminalization of the Erased and Migrants
Dimitar Anakiev,
dr.med
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
- Hipokrat na domobranski način: http://izbris-blog.blogspot.si/2017/11/hipokrat-na-domobranski-nacin.html
-
- 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 Town
Bernd 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.
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