Segregation in health care facilities

Segregation in hospitals and medical centers is an everyday experience for the Roma of

Eastern Slovakia, and it is the rule rather than the exception. Romani patients often stay

in Romani-only rooms; they sometimes use different showers, bathrooms, and eating

rooms; and occasionally they receive treatment in different facilities. Segregated rooms

can be found in Jarovnice,

Kosice Nemonica SNP,

and in maternity wards in Spisska

Nova Ves,

Stara Lubovna,

Trebisov,

and other places. In the maternity ward in

Kez-marok, the officials allocate room no. 8 to Romani women, and they are not allowed to

use the same showers and the same toilets as the non-Romani women.

“In the

mater-nity in Spisska Nova Ves,” one woman reported, it “is not only about being placed in

dif-ferent rooms, but we, the Romani women from Rudnany, are not allowed to eat with the

other patients in the common space. We are obliged to remain in our room and to eat

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The practice of segregation has allegedly become common in recent years.

“Everyone knows” which are the “Romani rooms” and which are the “white rooms” in the maternity ward in Krompachy, a Romani woman from Richnava says.

“For several years there have been separate rooms for Romani women in Roznava and separate rooms for white women,” said Helena, a 32-year-old mother of two who lives in Rostar.

“Well, as people say, Roma to Roma and white to white,” said 36-year-old Jana from Krompachy while commenting on her experience staying in a segregated, nine-square-meter room with five beds in it.

Some women have reported that the communist government did not permit segregation to the same extent as it exists now. Sixty-one-year-old Ruzena from Vitkovice told an NGO conducting a survey that, in her time, the communists did not allow for such differences.

Other women who reported segregation in recent years said that they had shared rooms with non-Romani women before 1989.

Roma report that the forced segregation has stigmatized, angered, and frustrated them. “We want to be treated like any other mothers,” said a young Romani woman. “We feel humiliated when the whites are separating us like that.”

Most of the women indi-cated that they felt their separation was unfair. “It is not right at all to be so secluded.

But what can we do?” asked Denisa B., a 22-year-old mother of two in Kosice.

Many of the women also expressed the belief that they received lower-quality medical treatment and less attention from medical staff than non-Roma: “[Doctors] did not attend to Romani women as they attended to the white women. . . . Nobody asked us if we had any pain or if we needed something, as they did with the white women. They are not interested in our problems,” said Gizela M., a 28-year-old mother of five in Spis-ska Nova Ves.

“Doctors . . . treat us differently,” said Angela D., a mother of four in Kosice.

“For example, yesterday, when I was in the delivery room, there was only one doctor with me, unlike the white woman next to me. She had everybody around her, nurses, doctors, all of them. . . . Doctors say that, because we give birth every year, we have good practice and do not need the help of nurses and other health personnel.”

Doctors, other health care workers, and supervisory personnel assist in the seg-regation of the Roma in the facilities where these practices now occur. “It is always like this: At the entrance in the hospital they tell us where to go, and there is a Romani room,”

said a Romani woman in Jarovnice. “The doctor would not allow us to stay with non-Roma.”

Health care workers have separated Romani women on the basis of race, even if the Roma have expressed a desire to stay with non-Roma. “I gave birth in Spisska Nova Ves and in Krompachy,” said Maria I., a 34-year-old mother of five who lives in Vitkovce.

“We wanted to be with white women but doctors placed us automatically in rooms where there were already Gypsy women.”

Women patients in Spisska Nova Ves are convinced that the supervisors know of these practices and tacitly, if not explicitly, support them.

“We complained about being treated differently in the maternity, not to the director of the

hospital, who knows and does not take any measures, but to our mayor. However,

noth-ing happened,” one Romani woman said.

Some hospitals have admitted to introducing segregationist practices and justi-fied them by saying that Romani women are antisocial.

Health care personnel offered different explanations to expectant mothers who complained about being separated along ethnic lines. In some cases, they said the Romani women would feel more comfortable together; in other cases, they said non-Romani women do not like being with Romani women. “They say we Gypsy women understand each other better. This is why we are put together,” said Marcela G., a 27-year-old mother of seven in Kosice. “They said the non-Roma don’t understand us. They do not want to be with Gypsies, they want to keep white mothers together.”

A widespread stereotype that all Roma are thieves prompts some non-Romani women to request separation from Romani women. “The white women don’t want to stay with us because they think we will rob them,” said Angela D., a mother of four in Kosice.

In the summer of 2000, the Kesaj Foundation complained to Slovakia’s Ministry of Health about these practices. It notified the ministry by letter that most of the gyne-cological and obstetrical departments in hospitals in Eastern Slovakia separate Romani women from non-Romani women, that the practice violates the state’s obligations under international human rights law, and that the Romani community in Slovakia perceives these efforts as a purposeful attempt by health care personnel to maintain and deepen racial prejudices against Roma. This long-term segregation, the Kesaj Foundation stated in its letter, is evidence of ethnic discrimination.

Under international law, the Slovak government can justify differential treatment upon racial lines if it can show that the policy has an objective and reasonable justifica-tion. Responding to the Kesaj Foundation’s letter, the Ministry of Health said that as a rule segregation does not exist, but if Romani patients are separated from patients from other racial and ethnic groups, it is in accordance with their own wishes. The ministry also argued that some Romani patients are very undisciplined and do not respect hospital reg-ulations, and that Romani mothers leave the hospital right after delivery and return five days later.

The government’s arguments concerning this matter do not appear to justify the impact that the segregation has on the Roma. Research by the Kesaj Foundation and the interviews carried out by the author during two fact-finding visits to Slovakia demonstrate that, almost without exception,

Romani women do not seek and do not want to be placed in separate rooms. They do not need any special additional care that would require separate rooms, because they do not suffer from any contagious diseases and do not have any particular hygiene problems. Nevertheless, they are being treated differently than women from the majority population, so it is difficult to understand how segregation fulfills a legitimate aim under the applicable international and constitutional standards.

Second, it is not reasonable for the health care facilities to place all Roma

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tematically in separate rooms because of the misbehavior of a few. A proportional meas-ure would be to separate only those persons who cause or who have a history of discipline problems. Third, the ministry argued that Romani women leave the maternity ward immediately after the birth and come back five days later to take their children home. Even if this were true for all, or even most Romani women, which cannot be assumed, the moment of a mother’s departure from the hospital is irrelevant in the assignment of rooms and does not justify racial segregation.

It is illegal for doctors to segregate patients on the basis of their race unless

the measure is reasonable and objective and is undertaken for a legitimate purpose.

Slo-vakia’s Ministry of Health has so far failed to demonstrate the existence of such a

pur-pose. Even if the facilities were separate but equal, segregation in Slovak maternity wards

would still run afoul of international antidiscrimination norms, which the Slovak

Con-stitution requires the country to follow.