Focus on health minority rights group international State of the World’s Minorities and Indigenous Peoples 2013 Events of 2012 State of theWorld’s Minorities and Indigenous Peoples 20131 Events of 2012 Front cover: A Dalit woman who works as a Community Public Health Promoter in Nepal. Jane Beesley/Oxfam GB. Inside front cover: Indigenous patient and doctor at Klinik Kalvary, a community health clinic in Papua, Indonesia. Klinik Kalvary. Inside back cover: Roma child at a community centre in Slovakia. Bjoern Steinz/Panos Acknowledgements Support our work Minority Rights Group International (MRG) Donate at www.minorityrights.org/donate gratefully acknowledges the support of all organizations MRG relies on the generous support of institutions and individuals who gave financial and other assistance and individuals to help us secure the rights of to this publication, including CAFOD, the European minorities and indigenous peoples around the Union and the Finnish Ministry of Foreign Affairs. world. All donations received contribute directly to our projects with minorities and indigenous peoples. © Minority Rights Group International, September 2013. All rights reserved. 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Focus on health State of theWorld’s Minorities and Indigenous Peoples 20131 Events of 2012 Edited by Beth Walker Minority Rights Group International Introduction 6 Foreword Paul Hunt, UN Special Rapporteur on the right to health (2002–2008) Part 1 Thematic essays 10 Addressing health inequalities in the post- 2015 development framework Corinne Lennox 24 Improving indigenous maternal and child health Viviana Crivelli, Juan Hautecoeur, Coll Hutchison, Ana Llamas, Carolyn Stephens 36 Minority women’s vulnerability to HIV/ AIDS in South East Asia Nicole Girard 46 Mental health care for survivors of torture and conflict David Gangsei, Erin Morgan, Paul Orieny, Ann Willhoite, Holly Ziemer 50 Litigating to realize the right to health for indigenous peoples Carla Clarke Part 2 Regional overviews 55 Africa Paige Jennings, Inga Thiemann, Laura A. Young 89 Americas Maurice Bryan 117 Asia and Oceania Jack Dentith, Emily Hong, Irwin Loy, Farah Mihlar, Daniel Openshaw, Jacqui Zalcberg 177 Europe Katalin Halász 197 Middle East and North Africa Said Shehata Part 3 Reference 217 Peoples under Threat 2013, Mark Lattimer 234 Status of ratification of major international and regional instruments relevant to minority and indigenous rights 246 Who are minorities? 246 Selected abbreviations 247 Contributors 249 Acknowledgements Foreword Paul Hunt, UN Special Rapporteur on the right to health (2002–2008) 6 Foreword State of the World’s Minorities 2009 e live in a world of profound health compared to the rest of the population. inequalities, a world in which a More often than not, this ill-health and W person’s health and the quality of poor healthcare is a symptom of poverty and care they receive is determined by their ethnicity, discrimination. the language they speak or their religious and In sub-Saharan Africa, a young Samburu cultural beliefs. woman dies from complications during childbirth In almost every country in the world, because the government does not provide any minorities and indigenous peoples are among medical care in the area where she lives. In the poorest and most vulnerable groups, suffer Rwanda, a Batwa child suffers from debilitating greater ill-health and receive poorer quality of but easily treatable intestine worms because care than other segments of the population. of the dirty water he drinks. In India, health They die younger, suffer from higher rates of disease and struggle more to access health services Below: A Batwa child in Rwanda. Eric Lafforgue. State of the World’s Minorities Foreword 7 and Indigenous Peoples 2013 workers refuse to visit a Dalit village because so on. I argued, for example, that reducing of untouchability practices. The suicide rate maternal mortality is not just an issue of among Yezidis living in Sinjar, Iraq, has development, but also an issue of human escalated because of their desperate situation. rights. But despite longstanding international The early mortality and greater morbidity commitments to reducing maternal mortality, faced by so many minorities and indigenous so far progress has been disappointing for peoples is a matter of pressing social justice many minority and indigenous women, for which governments and other actors must as numerous examples in this volume be held accountable. demonstrate. The right to health – the right to survive – Although the MDGs underscore the critical is the most basic human right; its fulfilment importance of health, government initiatives is both a precondition to, and a by-product often fail to reach those most in need. of, the enjoyment of all other rights. National-level targets allow governments But health is also a right in itself under and the international community to ignore international law and in the constitutions of persistent inequalities. Stretched resources many countries. lead governments and donors to focus on The international right to health – or the easy-to-reach population groups. Too often right of everyone to the highest attainable language barriers or different cultural and standard of physical and mental health – not religious practices are not taken into account only includes access to medical care, but also when designing health interventions. to the underlying determinants of health, New strategies are now needed to ensure such as safe water, adequate sanitation, decent the right to health for minorities and housing, healthy working conditions, a clean indigenous peoples in both the global North environment, health-related information and global South. (including on sexual and reproductive health) I welcome this edition of Minority Rights and freedom from discrimination. The right Group’s annual report, which will build has a pre-occupation with disadvantaged a better understanding among readers groups, participation and accountability. about the health issues facing minority and It demands that health-related services indigenous communities and what can be be evidence-based, respectful of cultural done to address their needs. difference and of good quality. Moreover, It not only provides us with a better it places a responsibility on high-income understanding of the state of health for countries to help other countries deliver minorities and indigenous peoples, it also the right to health to everyone within their raises neglected but important issues that borders. affect indigenous and minority health. These And so ensuring minority and indigenous include the link between land security, peoples can live healthy lives is not just a displacement and health; the social exclusion question of providing vaccines or treating and lack of political power that prevent particular diseases, it requires us to address groups from achieving better care; the the underlying causes of ill-health. need for culturally sensitive care; and the This is why as UN Special Rapporteur on importance of traditional medicine. the right to health I focused on two critical This volume also suggests constructive barriers to access to health and well-being: ways forward. It highlights the importance poverty and discrimination. Through a right- of collecting health data about specific to-health ‘lens’, I looked at a range of issues, ethnic, religious and linguistic groups to including access to medicines, water and ensure no one is left behind. It provides sanitation, mental health, the Millennium compelling evidence of the positive impact Development Goals (MDGs), sexual and of involving minorities and indigenous reproductive health, the work of international peoples in designing health interventions financial institutions, accountability, and and broader political processes. It also 8 Foreword State of the World’s Minorities and Indigenous Peoples 2013 provides examples of targeted measures to tackle discrimination – such as collecting evidence, supporting