Access to Emergency Services

Many factors make it difficult for Roma to access emergency medical services, and some

of them appear to be directly related to racial discrimination against them. Roma contend

that emergency-care personnel are often reluctant to administer first aid and that

signif-icant delays in emergency service are more often the rule than the exception. Doctors

say some Roma misuse the emergency medical services and maintain that the health care

system is justified in paying less attention to Romani requests for urgent assistance.

They say that it is not surprising that hospitals sometimes do not dispatch ambulances

when Roma call, or dispatch them with some delay because it is known that Roma abuse

ambulance services.

Yet there is no credible evidence that Roma abuse the emergency

medical services any more than any other group, and it appears that racial bias may affect

health care workers’ responses to Romani requests for emergency services.

7 4 L A C K O F A D E Q U A T E H E A L T H C A R E

Other factors reduce Romani access to emergency care. Many Roma live in set-tlements located in remote areas, far from hospitals and sometimes accessible only by the poorest of roads, making it very difficult for emergency service personnel to reach these areas.

The lack of street lighting and the narrowness of the streets can also impede ambulance access to homes in the settlements. The lack of public and private telephones in and around the settlements makes calling for emergency help impossible.

Racial dis-crimination against the Roma plays a role in the location of these settlements, in their lack of development, and in the quantity and quality of the services they enjoy. There-fore racial discrimination can play a role in reducing Romani access to urgent medical treatment.

A complex combination of factors is often responsible for failure to provide Roma with emergency medical care. In August 2000, for example, a Romani heart patient from Jasov died reportedly because a local doctor refused to attend to him and because a bad road prevented an ambulance from reaching the settlement.

There are reports of ambulance crews refusing to enter Romani settlements in Presov,

and hospitals refus-ing to send ambulances to Jejkov.

In Kolackov, Roma had to pay non-Romani villagers to transport their sick relatives to the hospital after emergency personnel refused to come.

Perhaps it was racial prejudice on the part of health care workers that led to these failures to provide emergency treatment. Or perhaps the health care personnel had legit-imate concerns about their ability to enter and leave the Romani settlements and to pro-vide medical care in a timely manner. Regardless of the causes and motivations, Roma often do not receive the care they need.

Two separate fact-finding missions undertaken two years apart found that Slo-vakia’s government had not improved access to emergency care in certain communities.

In the spring of 1999, a team from the European Commission visited Letanovce. In its report, the team noted: “Medical care is truly lacking. Mothers often give birth in the set-tlement, because there is no transportation to the hospital. . . . According to the inhabi-tants, ambulances do not come to the village and those in need of medical care cannot walk the three and a-half kilometers.”

Two years later, when the author of this report visited Letanovce, the situation was unchanged. Inhabitants complained that the local authorities failed to keep their promises to install a simple telephone line. “People are dying, and we cannot call the ambulance,” one resident reported. “Sometimes we have to run in the night more than three kilometers to the public phone . . . and by the time we get there, it is too late.”

Slovakia’s government is required under constitutional provisions and

interna-tional agreements to provide for the health care needs of its population. In providing

health care services, the government cannot discriminate on the basis of race. Slovakia’s

Romani community is in real need of better emergency medical care. Instances of direct

and indirect discrimination in providing the Roma access to emergency medical

serv-ices appear to be frequent in Romani settlements. The refusal of doctors or ambulance

crews to attend to Romani patients and the failure of doctors and ambulance crews to

pro-vide care in a timely manner due to racial bias constitutes direct discrimination.

Indi-rect discrimination occurs when the remoteness of health care facilities and the lack of

communications facilities and other infrastructure in Romani settlements affect access

to emergency care to a greater extent than these factors affect similarly situated members

of the majority population. The state has the obligation to address both forms of

crimination. It is obligated to sanction medical professionals and staff workers who

dis-play racist attitudes. And it is obligated to ensure that Roma have timely access to

ambulances and health facilities.

7 7

Lack of Adequate Housing

The issue of housing is particularly difficult for Slovakia as it undergoes the transition from communism to a market-based economy. An increasing number of people, both Roma and non-Roma, are at risk of being deprived of housing. This risk arises from gen-eral impoverishment due to decreasing employment opportunities for unskilled workers, changes in social protection policies, and the impact of privatization.

Slovakia’s Constitution incorporates international human rights instruments that recognize the right to adequate housing and the prohibition of discrimination in the enjoyment of that right. Although the Constitution guarantees the legal right to hous-ing, exercising this right is often impossible for Slovakia’s poorest people in general and for its Roma in particular.

In addressing Romani housing conditions and implementation of the right to adequate housing, policymakers and researchers must keep three factors in mind. First, there is a clear difference between the standards of living enjoyed by the relatively few Roma who are highly integrated with the national majority and those Roma who are not.

Intermingled with the rest of the population and hardly recognizable, the “integrated”

Roma share equally with the rest of the population the country’s economic problems and the enjoyment of their personal wealth. While acknowledging the existence of this

cate-The Romani communities of Slovakia suffer some of the most appalling living conditions that exist in Central and Eastern Europe. Many settlements have no running

water or electricity. The water in the wells is often contaminated. Tuberculosis breeds in the

overcrowded houses.

gory of persons, this report does not examine their circumstances in detail. Rather, this report focuses on the poorest segments of the Romani population and on their housing problems. Second, generalizations about “Roma” need to be carefully avoided. Clear dis-tinctions must be drawn between various groups of Roma when assessing their housing needs and their living conditions. Third, housing issues are closely connected to a his-torical context, e.g., the circumstances in which various Romani groups were obliged to settle, and the events of the last decade.

To assess the extent to which state agencies and private persons discriminate

against Slovakia’s Roma or fail to address the inadequate housing available to the Roma,

this section of the report describes the housing conditions for Roma of Slovakia; the

sup-port of the public and politicians for segregated housing for the Roma; direct

discrimi-nation against Roma as individuals and as a class of persons when trying to register as

residents; differential treatment in the provision of basic municipal services, such as

elec-tricity, transportation, garbage collection, and running water; and the process by which

the state supports racial segregation and facilitates the creation of Romani ghettos.