Announcement of Publication Report by the European Roma Rights Centre

05 October 2006

Ambulance Not on the Way:
The Disgrace of Health Care for Roma in Europe

Warsaw/Budapest, 4 October 2006: The European Roma Rights Centre (ERRC) announces the publication of the report "Ambulance Not on the Way: The Disgrace of Health Care for Roma in Europe". The report explores major systemic causes for exclusion of Roma from access to health care, as well as provision of inferior medical services to Roma. 

A number of studies reveal a serious gap in health status between Roma and non-Roma in many European countries. Roma live shorter lives and show markedly higher instances of diseases such as tuberculosis, long thought eradicated but now making a dramatic comeback in Central and Southeastern Europe, as elsewhere. There have also been a number of recent outbreaks of diseases avoidable by routine vaccine, such as measles. One recent measles outbreak in Romania caused the death of fourteen children. 

The World Health Organization (WHO) reports that many Roma are not vaccinated against other serious or deadly diseases, such as polio. Roma are also regularly excluded from emergency care. Where Roma do gain access to emergency care this may in fact be the only meaningful contact they are able to secure with the health care system: Roma often have no access whatsoever to primary or preventative health services. These issues and others implicate the international law ban on racial discrimination. 

For a number of years, the ERRC has documented the interference of racism in the provision of health care services to Romani men and women in a number of European countries -- Bosnia and Herzegovina, the Czech Republic, Croatia, Greece, France, Italy, Kosovo, Romania, Serbia and Montenegro, Slovakia and Slovenia. Research during 2005 in Bulgaria, Hungary and Spain elaborated and reinforced the findings in previous years of persistent and widespread practices that deny Roma the quality of health services available to others. As documented by the ERRC, in many instances, health services are entirely unavailable to Roma. 

Racial discrimination against Roma in health care is manifested in exclusion from health services and in the provision of health services of inferior quality. Roma frequently lack one or more personal documents crucial for gaining access to health care, and in some cases may even lack the citizenship of any state. Many Roma have no health insurance whatsoever. In some cases, access to health care is obstructed by the physical separation of Roma from the mainstream of social and economic life, in segregated communities where public services are restricted or entirely unavailable. In its most egregious forms, racial discrimination in the provision of health care manifests itself as denial of treatment of Roma by health care providers and/or in inappropriate and negligent treatment. Reports of segregation of Roma in medical facilities, verbal abuse and degrading treatment reveal a pattern of substandard level of health care provided to Roma. 

In the case of Romani women, the complexity of influences on health status and access to health care, stemming from the rejection of Roma in their societies at institutional and individual levels, is magnified by gender-related discriminatory barriers and forms of abuse. Lack of access to medical services and inferior medical services have a particular negative impact on Romani women's health, especially where reproductive and maternal health are concerned. In some countries, Romani women experience extreme forms of human rights violations by health professionals, such as coercive sterilisation. 

Racial discrimination outside the health care system also affects the health of Roma in a number of ways. One area in which the impact of racial discrimination on the health of Roma is particularly visible is housing. Patterns of housing discrimination against Roma have forced numerous individuals into inhuman and degrading conditions of segregated slum settlements; exposed Romani individuals to environmental hazards; and made them vulnerable to forced evictions and other violent abuse by state and non-state actors. Higher vulnerability of Romani women from excluded communities to trafficking, domestic violence and early marriage are other factors having a negative impact on the health status of Romani women. 

The exclusion of Europe's largest minority from vast areas of the health care system should in principle constitute among Europe's most significant social inclusion policy concerns. To date, however, the interface between Roma and the health care systems of Europe has received limited policy attention, in particular by comparison with several other key areas. Government policies to facilitate the access by Roma to medical care are for the most part nascent, where they exist at all. 

Where such policies do exist, by failing to acknowledge and confront discrimination against Roma in the health care system, governments postpone the solutions to these problems to the distant future. Policy measures on Roma health tend to be designed and implemented outside the mainstream health policy framework of governments. The effect of implementing separate health policies on Roma while not integrating solutions to Roma health problems in mainstream policies is to diminish the impact of Roma-specific health policies and in some cases to render such policies effectively meaningless. 

Effective health care policies on Roma should involve revision of laws and policies which are shown to have a disparate effect on Roma in the field of social and health services, as well as the development and implementation of specific targeted action to ensure equal access to such services. Furthermore, health policies are contingent on the effectiveness of policies aimed at reducing levels of exclusion of Roma from mainstream and quality education, reducing exclusion from employment, and improving housing standards. 

"Ambulance Not on the Way" includes detailed recommendations to policy- and lawmakers aimed at bringing about fundamental change in these areas. 

Research toward -- and publication of -- "Ambulance Not on the Way: The Disgrace of Health Care for Roma in Europe" has been paid for by a grant from the Open Society Institute's Public Health Program (PHP). The full text of "Ambulance Not on the Way: The Disgrace of Health Care for Roma in Europe" is available in English at:

Hard copies of "Ambulance Not on the Way: The Disgrace of Health Care for Roma in Europe" are available by contacting the offices of the European Roma Rights Centre.


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