“Gypsy Rooms” and Other Discriminatory Treatment Against Romani Women in Hungarian Hospitals
15 December 2004
Throughout 2003, the European Roma Rights Center (ERRC) conducted field research aimed at documenting practices of discrimination against Romani women within the health care sector in Hungary. The research focused on Szabolcs-Szatmár Bereg, Hajdú-Bihar and Borsod-Abaúj-Zemplén counties. Based on the interviews with 131 women, the ERRC documented the following2:
- Forty-four cases of so called "Gypsy rooms", i.e. segregated maternity wards,
- thirty cases raising concerns about negligent treatment of Romani women by medical professionals,
- twenty-two cases of verbal abuse,
- sixteen cases in which Romani women were provided with health care services by medical professionals whose level of qualification was apparently lower than required by the condition of the patient, (i.e. nurses were involved in providing health care services expected from doctors),
- thirty-one cases involving the practice of "paid doctors" – informal supplementary fees required by doctors in order to expedite care, or for the provision of service above the minimum standard.
Segregated Maternity Wards
The ERRC documented forty-four cases in which Romani women were reportedly placed in separate hospital rooms from non-Romani women. In Miskolc (Borsod-Abaúj-Zemplén County), in the Vasgyári hospital, according to the testimony of one Romani woman, despite the fact that there was a free bed in a room with five other non-Romani women, the Romani woman was placed in an empty room all by herself. She stated that this was humiliating and that she felt offended. Another Romani woman from the same hospital said that the separate "Gypsy room" was not cleaned during her stay in the hospital and that the Romani women in the room had to clean it themselves. The women stated that the phenomenon of separate rooms (the so-called "Gypsy rooms") had not existed during Communism when all women were treated equally.
In Ózd (Borsod-Abaúj-Zemplén County), a Romani woman stated that she was put in a separate room within the maternity ward of the local hospital. Even when the nurses distributed sweets and pastries to the patients, they did not bring any to the Romani women in the "Gypsy room". The nurses reportedly ate the pastries themselves.
Szilvia S., 26, from Nagyecsed (Szabolcs-Szatmár-Bereg County), reported that room No 8 in the Mátészalka hospital was a "Gypsy room". M., a young Romani woman from the same town told the ERRC that, on both occasions when she went to the hospital to give birth, she was put in room No. 8. When she asked the nurse if she could change rooms, she was told that there were no other beds available. The nurse also said that women in room No. 8 were not allowed to bring stereos or television sets whereas this was allowed for non-Roma in other rooms.
When asked about the existence of separate rooms for Roma, István Keresztényi in the hospital of Nyíregyháza (Szabolcs-Szatmár-Bereg County) stated that "There is no such thing, but still, it may have occurred and if so, room No. 10 in the maternity ward could be one." When asked about the possibility of a Romani woman changing rooms, the doctor stated that if she asked for a transfer it would be granted. Moreover, the doctor stated that "The placement of a woman in room No. 10 is based on her lifestyle, not on ethnic criteria." Doctor Csaba Sándor in the Miskolc hospital stated that at times discrimination is in the best interest of Romani women "because they are spared abusive attitudes". He told the ERRC that in one instance the husband of a non-Romani woman visited her in the maternity ward and, when he recognised one of her roommates to be a Romani woman, he started abusing her verbally. According to this doctor, the patients' social status can also justify separation. Poorer women have, at times, asked to change rooms because they did not feel comfortable in the same room as richer women.
A number of domestic laws in Hungary prohibit discrimination on racial/ethnic grounds in access to health care. Article 76 of the Civil Code3 says that discrimination on grounds of "gender, race, ancestry, national origin, or religion; violation of the freedom of conscience; any unlawful restriction of personal freedom; injury to body and health; contempt for or insult to the honor, integrity, or human dignity of private persons shall be deemed as violations of inherent rights". The Hungarian Health Care Act4 includes a non-discrimination clause which reads as follows: "All patients shall be entitled – within the framework prescribed by law – to receive (…) non-discriminative health services." The Anti-Discrimination Act5 says that all health care providers have to act and proceed according to the requirements of equal treatment6. Article 25(1) reads as follows: "The requirements of equal treatment shall be secured in the health care system especially in providing services such as (…) b) healing-prevention services c) in the use of places provided for patients."
Concerns Related to the Conduct of Medical Professionals
The ERRC documented thirty cases giving rise to serious concerns about the judgement and professionalism of the doctors concerned.
One case involved B.L., a 22-year-old Romani woman from Hajdúhadház (Hajdú-Bihar County) who, while in labour, started bleeding heavily. The obstetrician, instead of using sterile gloves, reportedly wrapped the sheet the Romani woman was lying on around her hand and proceeded to examine the labouring Romani woman's womb.
In another case, L.T., a 26-year-old Romani woman from Kisvárda (Szabolcs-Szatmár Bereg County) was allegedly forced to leave the hospital a few hours after having undergone a caesarean section (C-section), although she felt dizzy and could barely stand because she was still experiencing the effects of the anaesthetic.
The ERRC also documented a case in which L.S., a Romani woman from Vásárosnamény (Szabolcs-Szatmár-Bereg County) was treated in the hospital of Fehérgyarmat (Szabolcs-Szatmár-Bereg County) in connection with an abortion in unsterile surroundings. There were reportedly pools of blood on the floor and the remains of aborted foetuses in bowls.
A., a 26-year-old woman from Miskolc (Borsod-Abaúj Zemplén County) told the ERRC that due to an extra-uterine pregnancy, the doctors had to remove one of her ovaries but did not inform her about it. She had not been aware of this until she had to undergo the removal of her second ovary in connection with another extra-uterine pregnancy.
A woman from Ózd (Borsod-Abaúj-Zemplén County) reported to the ERRC that she delivered her baby with only the help of nurses. The doctor visited her only once the child had been born.
In Ózd, the ERRC interviewed a Romani woman with five children, the youngest of whom was seven months old. She reported that when she was admitted to the maternity ward, she was left on intravenous drips for two days, alone and without any medical personnel around to help her. The doctor reportedly told her that "if the baby comes, then it comes". She told us that the doctor was waiting for money and that was why he did not help her. She was put into a separate room with only Romani women. While she was in labour pains, the midwife went to sleep on a bed next to her only to be replaced in the morning by the midwife doing the dayshift. In the morning they raised the amount of the intravenous drip, which eventually helped her to deliver the baby.
A 20-year-old Romani woman from Ózd told the ERRC that during her delivery, the doctor was reportedly watching television and did not help her at all. A midwife was with her during the delivery and although she called the doctor several times, he did not come. Finally, the midwife reportedly had to drag the doctor from the television. By this time, the woman had already experienced serious ruptures. After the delivery, she was not allowed to eat solid food for nine days due to the stitches and had to stay in the hospital. As a result of this she has problems to date, but is afraid of going back to the same doctor for examination.
The ERRC documented twenty-two cases of verbal abuse directed at Romani women by medical personnel.
H.I. (31), a Romani woman from Dombrád (Szabolcs-Szatmár-Bereg County) told us that a local doctor refused to treat her stating: "I am f*cking fed up with Gypsies" and "what the hell is wrong with you?!" Ms Balogh, the wife of the local Roma Minority Self-Government's representative said, "doctors speak to you like you would speak to a dog".
In Szatmárcseke (Szabolcs-Szatmár-Bereg County), the ERRC learnt that some doctors addressed Romani women in obscene language while they were screaming during delivery. In the same town, H.V. (21), a Romani woman reported that when the ambulance came to pick her up, the ambulance personnel stated: "do you f*ck at this young age – now you will get to know the God of the Gypsies."
In Miskolc (Borsod-Abaúj-Zemplén County), in the Semmelweis hospital, a non-Romani woman was reportedly told by a midwife when six months pregnant: "You stink and you are dirty." The woman believed that she was verbally abused by the midwife because she came to the hospital for her examination with her husband who has darker skin. However, when in hospital for delivery, the same midwife apologised for her previous behaviour.
A 20-year-old Romani mother reported that the nurses in Miskolc hospital (Borsod-Abaúj-Zemplén County) were not attentive and used demeaning language such as "are you giving birth to your children in order to get child allowance?" In the same hospital, a Romani woman with three children reported that during her first pregnancy, she was treated badly by the nurses. The midwife reportedly stated: "My daughter is twenty and she is still a virgin", apparently suggesting that the Romani woman had done something wrong.
A doctor in Ózd (Borsod-Abaúj-Zemplén County) asked a Romani woman with five children: "Why do you give birth to so many children, who will feed them?" and said: "I don't want to see you here again!"
Involvement of Nurses Instead of Doctors
The ERRC documented sixteen cases in which nurses and/or training nurses were involved during delivery instead of practising doctors7. According to the testimonies of Romani women, medical students often experiment on Romani women and are more often used to assist Romani women than non-Romani women.
In Sajószentpéter (Borsod-Abaúj-Zemplén County), the ERRC interviewed one woman who said there was no doctor present during her delivery, only a midwife.
In Kazincbarcika (Borsod-Abaúj-Zemplén County), the ERRC interviewed a 28-year-old Romani woman with two children. She did not have a general practitioner. According to her, health care was a matter of race; doctors and nurses did not pay much attention to her. She stated that she practically had to give birth on her own. The midwife only came around to give her an intravenous drip and some painkiller injections. The midwife reportedly showed up twice in nine hours.
Dr. C.S. in Miskolc told the ERRC that students are not allowed to take care of patients on their own. A delivery doctor has to be present and perform all medical tasks; medical students are not allowed to take part in the medical procedures at all.
We should note that the above testimony has come from ordinary women who, like the overwhelming majority of Hungarians, have low medical competence and a habit to submit to medical paternalism. What is important in the above statements, however, is the Romani patients' feeling that they have been mistreated and humiliated because they are Roma. While it is difficult in each concrete case to prove the abuse in terms of non-observance of healthcare regulations and medical malpractice, the attitude of medical personnel towards Roma is itself a cause of concern.
Extortion of Money from Romani Patients
The ERRC documented thirty-one cases in which Romani women had allegedly given money to doctors hoping to receive better treatment. According to the Hungarian Health Care Act8, patients and women in particular are entitled to choose their physician, including obstetrician and/or gynecologist9. Those who have medical insurance do not have to pay for maternity consultations and delivery. In practice, however, the delivery is not free of charge. Women are usually expected to offer informal payment to the doctor ranging between 5,000-20,000 HUF (approximately 20-80 Euro). The ERRC has documented cases in which doctors refused to treat Romani women before they were provided with supplementary monetary payments.
In one case, a doctor in Nagyecsed (Szabolcs-Szatmár-Bereg County) demanded to be paid 20,000 HUF (approximately 80 Euro) for a C-section. In the doctor's cabinet there was reportedly a price list for various surgical interventions which is illegal. When the Romani woman gave the doctor only 500 HUF (approximately 2 Euro) (all her money), the doctor reacted disapprovingly. Eventually, however, the woman paid the "standard" amount (20,000 HUF, approximately 80 Euro) for both of her C-sections and 50,000 HUF (approximately 203 Euro) for her last C-section combined with sterilisation.
Four different Romani women – M. from Nagyecsed, R.S., L.S. and P.S. from Vásárosnamény – told the ERRC that although they had given some money to their doctors, the doctors demanded higher amounts.
A woman stated that one doctor in Ózd(Borsod-Abaúj-Zemplén County) would say "If you have money – you will have a baby, if you don't have money – you won't have a baby". Another Romani woman from the same town stated that she was not allowed to see her newborn baby before paying 2,000 HUF (approximately 8 Euro) to the doctor.
The complaints described above indicate possible abuse of the principle of equal treatment in the provision of health care services to Romani women. Romani women are humiliated by being segregated from non-Romani women in maternity wards; in many cases they are subjected to less qualified treatment and sometimes to negligent treatment; finally, they experience constant verbal abuse on racial grounds by both nurses and medical doctors. Apart from the lack of access to equal standards of health care due to discriminatory treatment by medical personnel, Romani women are exposed to the risks of less qualified treatment due to the fact that they cannot afford to offer doctors tips for better health services. Evidence of numerous cases of egregious human rights violations by medical professionals such as coercive sterilisation of Romani women like the ones documetned by the ERRC in Slovakia and the Czech Republic, is not available in Hungary. However, the existence of cases of interference with the Romani women's reproductive rights cannot be precluded. Indeed, an ERRC/NEKI complaint on behalf of a Romani woman who was sterilised without full explanation about sterilisation in a public hospital in the Hungarian town Fehergyarmat, is pending before the UN Committee on the Elimination of Discrimination against Women.10
Filing legal cases against hospitals or medical staff involved in abuse of Romani women, however, in the ERRC's experience has proven difficult. The main reason for that is the Romani women's fear of retaliation by doctors. Romani women appear to be more willing to endure discriminatory treatment than to undertake actions which may threaten their relationship with local doctors and therefore possibly risk their own – and their children's – health.
A new prospect for litigating discrimiantion in health care is opened with the adoption of the Hungarian anti-discrimination act, Article 20 of which allows for non-governmental organisations (NGOs) to litigate in their own capacity if the violation complained of affects a large number of people. This opportunity potentially opens new possibilities for eliminating racial discrimination in the health care system and providing equal opportunities to all patients regardless of their origin and economic or social status.
- Rita Izsák is ERRC legal monitor. The present article summarises the results of ERRC research conducted by the following ERRC staff and interns: Kerieva McCormick, Lydia Gall, Rita Izsák, Orsolya Szendrey and Angela Wu.
- Some Romani women agreed to testify to the ERRC but were reluctant to have their names disclosed.
- 1959/IV. Act.
- 1997/CLIV. Act.
- 2003/CXXV. Act.
- Article 4 (k).
- According to Ordinance 60/2003 of the Hungarian Ministry of Health, Social and Family Affairs on the Necessary Professional Minimum Requirements in Providing Health Services, the presence of medical doctors is required during delivery.
- Act CLIV of 1997 on Health.
- Chapter II, Title 2, Section 8.
- See ERRC/NEKI press release, February 12, 2004, at: http://www.errc.org/cikk.php?cikk=355.