18 June 2018
The Human Rights Council in a midday meeting held a clustered interactive dialogue with Dainius Puras, Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, and with Alice Cruz, Special Rapporteur on the elimination of discrimination against persons affected by leprosy and their family members.
Mr. Puras said it was unacceptable that confinement continued to be the norm for minor or non-violent criminal offences and for addressing public health issues. Violations of the right to health were both cause and consequence of deprivation of liberty. Deprivation of liberty adversely impacted on the right to mental health and well-being. Incarceration and detention not only were barriers in the realization of the right to health but could also lead to a paradoxical increase in the incidence of infectious diseases, such as tuberculosis.
He spoke of his missions to Armenia and Indonesia.
Armenia and Indonesia spoke as concerned countries.
Ms. Cruz said leprosy was a contemporary disease closely linked with socio-economic, civil and political vulnerability. In 2016 alone, there were 215,000 new cases, of which nine per cent were children. Persons affected by leprosy and their families had historically been deprived of their civic, political, economic and social rights, and continued to be denied their dignity and basic human rights. It was time for States to comply with their international human rights obligations, repeal discriminatory laws, and address structural barriers in access to rights.
In the ensuing discussion, speakers agreed that detention had negative effects on the physical and mental health of detainees. Speakers urged reforms to reduce detention of youth and to transform detention into a process of rehabilitation. Improving detention conditions must become a priority. The report on the right to health could help guide countries away from confinement as a response to infectious diseases. Specific conditions of vulnerable groups such as women, children and persons with disabilities demanded additional efforts from States in detention facilities.
On leprosy, delegations voiced concern that leprosy remained a neglected disease. Prevailing perceptions of the disease had resulted in the stigmatization of those affected by it. Greater cooperation was needed to ensure the rights of that marginalized sector of society. The mandate of the Special Rapporteur on leprosy provided the Council with an opportunity to address the widespread and institutionalized discrimination against persons with leprosy and their families.
Speaking during the discussion were European Union, Togo on behalf of African Group, Israel, Pakistan, France, Maldives, Sovereign Order of Malta, State of Palestine, Brazil, Iraq, Thailand, Egypt, Senegal, United Nations Children’s Fund, Australia, Japan, Djibouti, Morocco, Paraguay, Lithuania, Spain, Iran, Togo, Botswana, Haiti, Tunisia, South Africa, China, Malaysia, Russian Federation, Fiji, Côte d'Ivoire, India, Georgia, Portugal, Ecuador, Bolivia, Ukraine, Belarus, Slovenia, Trinidad and Tobago, Sudan, Nepal, Philippines and Azerbaijan.
The following civil society organizations also spoke: European Region of the International Lesbian and Gay Federation ILGA-EUROPE; International Association of Democratic Lawyers; Ius Primi Viri International Association; International Catholic Child Bureau; Franciscans International (in a joint statement with Geneva for Human Rights; Minority Rights Group International and VIVAT International); Istituto Internazionale Maria Ausiliatrice delle Salesiane di Don Bosco; Action Canada for Population and Development; Defence for Children International; Associazione Comunita Papa Giovanni XXIII; Verein Sudwind Entwicklungspolitik; Center for Reproductive Rights; Minority Rights Group International; Association of World Citizens; Liberation and Mbororo Social and Cultural Development Association MBOSCUDA.
The Council will next hold a clustered interactive dialogue with the International Expert on international solidarity and the Special Rapporteur on the right to education.
The Council has before it the Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health (A/HRC/38/36).
The Council has before it an addendum to the Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health – mission to Indonesia (A/HRC/38/36/Add.1).
The Council has before it an addendum to the Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health – mission to Armenia (A/HRC/38/36/Add.2).
The Council has before it the Report of the Special Rapporteur on the elimination of discrimination against persons affected by leprosy and their family members (A/HRC/38/42). ADVANCE EDITED VERSION: A/HRC/38/42
Presentation of Reports by the Special Rapporteur on the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health
DAINIUS PURAS, Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, presented his thematic report on the right to health in the context of deprivation of liberty and confinement. Two country visit reports to Indonesia and Armenia were also presented. It was unacceptable that in the twenty-first century, confinement continued to be the norm for minor or non-violent criminal offences and for addressing public health issues. Violations of the right to health were both cause and consequence of deprivation of liberty. Deprivation of liberty adversely impacted on the right to mental health and well-being. There was a need for a paradigm shift in the area of mental health and a necessity for the provision of reasonable accommodation inside of prisons for persons with all forms of disability. Uncountable millions of children were detained and incarcerated. Women’s incarceration was linked to experiences of violence, and sexual, physical and emotional abuse. Incarceration and detention not only were barriers in the realization of the right to health but could also lead to a paradoxical increase in the incidence of infectious diseases, such as tuberculosis. Discussions on the abolition of detention for children had to be continued as well as elimination of institutional care of children under age of five.
Indonesia had made considerable progress in terms of the right to health and was leading the way towards universal health coverage. Many of the challenges were linked to the prevalence of inequalities and discrimination against women, persons living with HIV/AIDS, and persons who used drugs. The situation was aggravated by an extremely restrictive normative framework which criminalized the interruption of pregnancies. Women and girls who underwent abortion faced imprisonment. Lesbian, gay, bisexual, transgender and intersex persons were deterred from obtaining sexual and reproductive healthcare for fear of being stigmatized. As concerned mental health, the “Free shackling” campaign was commended, but much more needed to be done. The situation concerning HIV/AIDS was incompatible with international standards as homosexuality and sex work were criminalized.
Concerning Armenia, significant progress was noted in areas of child and maternal health, the fight against HIV/AIDS, and gender-based policies which had been addressing inequalities in reproductive health. Armenia had inherited a centralized healthcare system that guaranteed free medical care and access to a range of services with geographical imbalances. Recently, there had been a decentralization of services but despite reforms, challenges such as financing, access to primary care in rural areas and the problem of the workforce remained. Also, the mental health system still contained elements of outdated practices, including the hospitalization of people with mental health conditions, overmedication and long-term confinement. In 2016, Armenia was one of the four countries in the world to have eradicated mother-to-child transmission of HIV/AIDS. Still, Armenia had one of the highest incidence rates of tuberculosis in the European region.
Statement by the Special Rapporteur on the Elimination of Discrimination against Persons Affected by Leprosy and Their Family Members
ALICE CRUZ, Special Rapporteur on the elimination of discrimination against persons affected by leprosy and their family members, in her first report to the Human Rights Council, said that contrary to its social representation as a disease of the past, leprosy was a contemporary disease closely linked with socio-economic, civil and political vulnerability. The elimination of leprosy as a global public health problem in 2000 had not meant that leprosy had disappeared, as a large number of new cases continued to be reported in various parts of the world. In 2016 alone, there were 215,000 new cases, of which nine per cent were children. Leprosy’s transmission depended not only on biological factors but also on socio-economic determinants; it was a neglected disease, thus the lack of funds for basic and clinical research explained why the main available drugs for treatment were not as effective as they should be. This, in combination with the persistent stigma and discrimination, explained why so many persons affected by leprosy claimed that even after completing multi-drug therapy and being cured, they did not feel healed – stigmatization and discrimination thus played a critical role in the phenomenological experience of healing.
Persons affected by leprosy and their families had historically been deprived of their civic, political, economic and social rights, and continued to be denied their dignity and basic human rights. Many faced compulsory internment, forced sterilization, institutional silencing and invisibility, and erasure from history. The structural violence and denial of rights imposed upon those affected led some of them to experience the so-called “civil death”. It was worrying that laws that discriminated against persons affected by leprosy still existed in over 20 countries across the world, including in the areas of immigration, marriage, voting, public transportation, and employment. It was time for States to comply with their international human rights obligations, repeal discriminatory laws, and address structural barriers in access to rights as well as ideological, religious and cultural beliefs and practices, and misconceptions that perpetuated such discrimination, stressed the Special Rapporteur.
Ms. Cruz then outlined the conceptual framework and methodology that would guide her work for the next three years, which included intersectionality and affirmative action, vulnerability and intersectorality, and participation and lay expertise. In terms of priorities that would guide the action, the Special Rapporteur highlighted the enforcement of equality, including harmonizing domestic laws and practices with international law, and guaranteeing effective access to rights in order to tackle the structural disadvantages; and the acknowledgement of equality, or eliminating stigmatization through strengthened awareness-raising, with the active participation of the affected persons.
Statements by Concerned Countries
Armenia, speaking as a concerned country, noted Mr. Puras’ constructive engagement with Government authorities and other stakeholders. Despite numerous challenges, Armenia had made significant progress in the healthcare sector. Armenia wished to highlight its Action Plan for the provision of alternative care and social services to persons with mental health problems and its mental health strategy for the period 2014-2019. The Government had demonstrated its political will to pursue comprehensive reform and provide necessary services. The Government was also providing funding to non-governmental organizations working on mental health issues. The right to receive medical care, irrespective of nationality, race, sex or other status was recognized by law. Evidencing progress, the country’s National Centre for AIDS Prevention had been awarded prizes for innovation.
Indonesia, speaking as a concerned country, said the success of Mr. Puras’ visit to Indonesia was proof of the country’s commitment to engage constructively with international human rights mechanisms. However, it was unfortunate that the final draft of the Special Rapporteur’s report was not communicated to the Government before being published on the United Nations Office of the High Commissioner for Human Rights’ website. Indonesia was implementing most recommendations, including improving maternal and infant mortality and modernizing and mainstreaming mental health services. The Constitution guaranteed the protection of all Indonesians and people with HIV/AIDS were assured of access to health services. Regulations did not criminalize abortions carried out in accordance with the applicable laws. The death penalty, in relation to drug crimes, was only applicable as a last resort. Expecting comments on the health situation in Papua, Indonesia said comments must not go beyond the Special Rapporteur’s report.
European Union acknowledged a need to move to a human-rights based model of care grounded in community-based services. People with leprosy had to be treated with dignity and efforts had to be intensified to eliminate stigmatization and promote inclusive policies. Togo, speaking on behalf of the African Group, noted that the African Charter on Human Rights envisaged the responsibility of States to protect the health of their citizens. It was concerning that leprosy was a neglected disease which lacked funds for clinical research and available medicine for treatment. Israel shared the view that leprosy was a neglected disease, making the approach to tackle the intersectionality and discrimination associated with leprosy commendable. Leprosy was rare and non-endemic in Israel but laboratories for initial diagnosis and follow up had been established.
Pakistan noted that safeguarding the right to health of the incarcerated was particularly challenging for resource-constrained developing countries. The mandate of the Special Rapporteur on leprosy provided the Council with an opportunity to address the widespread and institutionalized discrimination against persons with leprosy and their families. France noted that specific conditions of vulnerable groups such as women, children and persons with disabilities demanded additional efforts from States in detention facilities. What specific measures were recommended that included the participation of detainees? Maldives shared the Rapporteur’s view that Sustainable Development Goal 3 on ensuring healthy lives and promoting well-being could not be reach if the global community neglected to address the use of detention and confinement as a public-health policy.
Sovereign Order of Malta spoke of its long experience in leprosy treatment and engagement in fighting the disease in some of the most-at-risk countries in Asia, Africa and South America, and said that MALALEP, a scientific project that studied the genetic mechanisms causing leprosy and developed new therapies, run by the Ordre de Malte France since 2006, was now the main source of financing into eradicating leprosy. State of Palestine recalled that international law guaranteed and protected the rights of detainees and said that Israel’s degrading treatment of Palestinian detainees was inhumane. Acknowledging that accountability was vital for realizing the right to health inside prisons in practice, the State of Palestine asked about measures that could be taken to end impunity and ensure that States fulfilled their obligations under international law. Brazil highlighted the importance of safeguarding the right to health of lesbian, gay, bisexual, transgender and intersex persons inside prisons and detention facilities. Brazil reiterated its commitment to tackle leprosy and promote actions for early diagnosis by ensuring free of charge and decentralized treatment, and by undertaking efforts to eliminate stigma and discrimination.
Iraq was working arduously to implement the 2030 Sustainable Development Agenda Goals on health, including through vaccination campaigns and health services for children, and noted that it was facing a challenge that was formidable as the health sector had been destroyed during the war against Daesh terrorists. Thailand said that with the increase of numbers of women in detention over the past two decades, Thailand continued to promote the implementation of the United Nations Bangkok Rules on women offenders and prisoners. What were best practices on alternatives to detention for children? Egypt welcomed the focus on healthcare in prisons, which was being provided through curative and preventive teams, as well as by hospitals and clinics. With regards to the report on leprosy, Egypt was focused on empowering individuals affected by leprosy to lead normal lives and encouraged the Special Rapporteur to continue working on eliminating discrimination against those persons.
Senegal recognized that detention could worsen the physical and mental health of detainees, especially women and children. Senegal paid close attention to providing medical care in detention centers. Turning to leprosy, Senegal supported recommendations to improve the living conditions of those suffering from the disease. United Nations Children’s Fund said children in detention faced increased risks of disease that could have long-lasting negative effects on their health. The Fund agreed that all forms of detention severely compromised children’s enjoyment of the right to health. The detention of children must only be undertaken in very exceptional cases. Japan said Ms. Cruz worked tirelessly to combat discrimination against persons affected by leprosy. Japan stressed how important it was for the international community to focus on local and regional engagement in order to realize a diverse and inclusive society. Japan called on Ms. Cruz to conduct official visits to relevant countries.
Djibouti noted the negative effects that detention could have on the physical and mental health of detainees. The Government was committed to ensuring that adequate resources were available to improve detention conditions. On leprosy, Djibouti voiced concern over the stigma faced by persons affected by the disease. Morocco believed that the human rights of all, including detainees, must be upheld. As such, legislation covering penitentiaries had been modified. Morocco said people affected by leprosy faced a great deal of discrimination. The stigma associated with the disease remained anchored in society. Paraguay said the confining of refugees and migrants presented a major challenge across the world. Detention had to be a period of rehabilitation and policy changes were needed to reduce reliance on the practice. The Government was taking a restorative approach to reduce detention, especially among youth.
Lithuania agreed that the deprivation of liberty, used as a preferred tool to promote public safety morals and public health, was detrimental to the enjoyment of the right to physical and mental health. What were the possible synergies of the mandate of the Special Rapporteur on health with the mandate of the Special Rapporteur on violence against women on the gender aspect of incarceration? Spain stated that persons in prison in Spain had all of their rights ensured and were provided with assistance. What best practices existed at the global level to reduce the negative psychological effects of prolonged detention? Iran was pleased that it had succeeded, in close cooperation with the World Health Organization, to keep the prevalence rate of leprosy at the stage of elimination by providing treatment free of charge. The Special Rapporteur was asked to provide insights on positive steps taken by governments to address leprosy in her future reports.
Togo believed that any measure of deprivation of liberty could have an impact on mental and physical health, particularly in the case of children. What recommendations could be made in the area of justice to reconcile the imperative of keeping public order and security and the necessity to guarantee the mental health of detainees? Botswana agreed that particular care had to be afforded to the healthcare of women, children, adolescents and the disabled through the provision of suitable accommodation. Botswana abided by the Nelson Mandela Rules but the economic costs of adequate accommodation in prison facilities often hampered government efforts so the emphasis on international cooperation and assistance was welcomed. Haiti noted that recommendations of the report were important for the identification of obstacles that undermined the enjoyment of the right to health in cases of deprivation of liberty. Haiti adopted a community based approach and despite the overcrowding in prisons had been making efforts to allow for the enjoyment of the rights of detainees.
Tunisia said that the Constitution guaranteed the rights of each prisoner to health services and medical examination, and added that it was working with UNICEF and the European Union on improving the social reintegration of children deprived of liberty. South Africa said that the Nelson Mandela Rules were premised on the fact that there was something to be learned from South Africa in changing an abhorrent apartheid system. The new mandate on leprosy would provide a great opportunity to address the widespread, institutionalized and structural discrimination against people affected by leprosy; the Special Rapporteur should include the provision of multi-drug therapy beyond the 2020 period in her further analysis. China recognized that the right to health was a basic human right, and said that China attached great importance to health programmes for its people, whose health indicators equalled those of mid- and upper-middle income country. The lack of knowledge in the past had led to discrimination of persons affected by leprosy, thus China always supported the resolutions that the Human Rights Council had adopted on this issue.
Malaysia recognized that the report on the right to health included elements which could guide countries away from confinement as a response to infectious disease towards community-based, evidence-informed and human rights-based approaches. On leprosy, Malaysia encouraged the Special Rapporteur to develop a framework encompassing priority areas to eliminate leprosy-related discrimination. Russia stressed the need to eradicate the practice of placing children in institutions, which was one of the central pillars of child care services, and asked the Special Rapporteur what he meant by “alternative community-based childcare services” for mothers deprived of liberty. What were the main forms of discrimination against persons affected by leprosy? Fiji was fortunate today to have achieved the eradication of leprosy, but was committed to stomping out historical stigma against persons affected by leprosy which continued to linger.
Remarks by the Special Rapporteurs
DAINIUS PURAS, Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, thanked Indonesia and Armenia for their responses to his presentation and welcomed their critiques. On tuberculosis, Mr. Puras said an open letter to the co-facilitators of the high-level meeting on the matter was made public online. Inequality and human rights violations were driving the tuberculosis epidemic. His thematic report presented good practices to assist people affected by tuberculosis, including the end of criminalization and incarceration of people with the disease. Turning to the Mandela Rules, he said States were taking revisions seriously. Detention conditions must be improved while at the same time States must reduce their reliance on detention. His next thematic report would focus on the right to health of migrants, refugees and asylum seekers, with a particular emphasis on children. States must move towards the abolition of child detention.
ALICE CRUZ, Special Rapporteur on the elimination of discrimination against persons affected by leprosy and their family members, pointed out that leprosy had always been a global issue, even in the nineteenth century when such persons had been subjected to segregation. For that reason, there had been leprosy colonies across the world, and their children had been also affected by stigma. There was a potential for leprosy to become a global issue but now as a positive example of inclusive policies. There was a cure for leprosy which had been effective. However, the problem was not curing but complete healing. Namely, the cure did not restore fully the physical condition of a person. The macro dimension of leprosy was reflected in the lack of funds for clinical research and medicine but also in the lack of policies addressing stigma and discrimination. Even when healed, persons with leprosy could not return to work or their former living conditions. Countries had moved forward when it had come to the public health point of view but not from a human rights perspective. Segregation occurred due to stigma, not for health reasons. International cooperation and cooperation within the United Nations system was essential. The concept of intersectionality was instrumental in understanding stigma that was attached with leprosy. The World Health Organization had a global leprosy programme aimed at fighting discrimination, but the response had to come from the local communities as well. There were many good practices which could be identified, but they needed additional visibility.
Côte d’Ivoire was pleased that the Special Rapporteur had focused on violations of the right to health, including in the form of forced internment in psychiatric or other medical establishments, which indeed represented de facto deprivation of liberty. Côte d’Ivoire noted with much interest the vision of the new Special Rapporteur on leprosy, and encouraged her to work in close cooperation with States, the United Nations system, civil society organizations and people affected by leprosy. India concurred with the Special Rapporteur that it would be difficult to achieve the Sustainable Development Goal 3 on ensuring healthy lives without addressing the indiscriminate use of detention and confinement. India had launched a widespread leprosy case detection campaign a few years back and was confident that it would be able to eradicate leprosy by 2020. Georgia said it had introduced a primary health care model in the penitentiary system, while the comprehensive reforms initiated by the authorities were aimed at maintaining a balance between the effective enforcement of sentences and the protection of human rights and dignity.
Portugal stressed that it was high time to move from punitive legal frameworks and public policies which made incarceration likelier, to public health and human rights-based models of care, and asked the Special Rapporteur to elaborate on how such models were adequate for drug users and in the context of particular vulnerabilities of migrants, especially children. Ecuador said it sought to provide adequate support, including on health, to support the best possible social integration of detainees, while inside the detention centres, there had been a focus on mental health and substance abuse since a few years back. What could be future developments in the area of health provision for other vulnerable groups such as migrants and refugees? Bolivia was very concerned about the right to health in the context of the penitentiary system and said that those responsible for social rehabilitation and reintegration were constantly undertaking awareness raising and thematic workshops within the detention facilities, including on mental and substance abuse issues. Bolivia was also focused on persons with disabilities and on gender.
Ukraine said violations of the right to health were cause and consequence of confinement, adding that Ukrainian political prisoners faced tragic situations in occupied Crimea. Millions of Ukrainians remained trapped under Russian occupation in Crimea and the situation in the occupied regions of Luhansk and Donetsk had returned to the “dark ages”. Belarus said the mandate on the right to health was crucial to achieving the Sustainable Development Goals and promoting international cooperation. The country’s health services were based on dynamic and innovative approaches and had resulted in improved health indicators. Slovenia supported efforts to achieve the full realization of all human rights and fundamental freedoms, without discrimination on the grounds of leprosy. The continued transmission of leprosy was a fact. Slovenia expressed its full support for World Health Organization efforts to address the human and social aspects of the fight against the disease.
Trinidad and Tobago said efforts were underway to improve the delivery of already free public health services. The country recognized the need to work towards the maintenance of a humane environment for persons in detention. Turning to leprosy, the Government recognized the need for continued awareness of early and regular treatment. Sudan said its health strategy was in line with the Sustainable Development Goals. Health insurance coverage was expanding and training was being provided to health professionals in accordance with integrated strategies. Sudan asked what practical steps could be taken to address rebel activities that impeded access to health. Nepal said its Constitution guaranteed the right to free basic health services and the Government was committed to continually improve health standards. Nepal was mounting its final efforts to eliminate leprosy. Still, without international cooperation and partnerships, such a goal could not be attained.
Philippines stressed that forced and unjustified incarceration created an environment that was detrimental to the enjoyment of the right to health. The detention of children must only be used as a last resort and States must work together to end the practice. Philippines asked how such a goal could be achieved. Azerbaijan said that the conflict sustained by Armenia was having detrimental effects on the health services in Armenia. Conflict was hampering economic development in the country and destabilizing the region. There was low-level investment in health in Armenia, with large sums being directed towards maintaining the occupation of Azerbaijani territories.
European Region of the International Lesbian and Gay Federation ILGA-EUROPE said that trans communities were disproportionately impacted by violence sanctioned by the State, while trans and gender diverse children were taken away from supportive homes by State, religious or traditional authorities based on their identity, and denied their rights as children to a family life. International Association of Democratic Lawyers said that deprivation of liberty took many forms, and noted the case of Mr. Assange, who was spending his sixth year in the Ecuadorian Embassy in the United Kingdom. His protracted confinement was having a severe impact on his physical and mental health.
IUS PRIMI VIRI International Association drew the attention of the Council to the health challenges faced by refugees, as well as host populations, and cited the case of Syrian refugees in Lebanon, who unable to pay the annual fee of $ 200 for the registration, could no longer move freely, or access work and health care. International Catholic Child Bureau raised concern about detained children who often encountered poor detention conditions, boredom and powerlessness which gave rise to feelings of hopelessness, despair and suicide attempts. All forms of detention severely compromised children’s enjoyment of their right to health and damaged their psychological and emotional development.
Franciscans International in a joint statement with Geneva for Human Rights; Minority Rights Group International and VIVAT International, endorsed the findings of the report, especially on issues related to access and quality of health services, HIV/AIDS and maternal mortality and morbidity in West Papua. Despite efforts of Indonesian authorities, the general situation concerning the right to health of indigenous West Papuan communities demanded international attention. Istituto Internazionale Maria Ausiliatrice delle Salesiane di Don Bosco said that although it was in the supreme interest of the child to remain with the mother, such interests were often ignored in detention facilities. The removal of child from its home had a serious impact on its mental health but children’s views were ignored by tribunals. Action Canada for Population and Development noted that it was instrumental that policing on vague notions of “morality” be condemned and laws had to be based on human rights principles. Depravation of liberty was used in informal settings, including families, especially against women and girls which had been questioning gender stereotypes or norms, and the Council was urged to address such forms of violations.
Defence for Children International said that according to international law, children could only be imprisoned as a measure of last resort and for the minimum duration possible. States were called to fully support the realization of the Global Study on Children Deprived of Liberty which was now in the implementation phase. Associazione Communita Papa Giovanni XXIII noted that too many minors around the world were still confined in detention centres in inhuman conditions, a situation no child deserved. More efforts were needed to promote social policies of inclusion that supported families of people affected by leprosy.
Verein Südwind Entwicklungspolitik said the attitude of governments towards the health of prisoners was an indication of how States valued human dignity. It pointed to poor prison conditions in Iran where health and sanitation services were lacking. Conditions in Tehrani prisons were so bad that prisoners were going on hunger strikes. Centre for Reproductive Rights echoed concerns about the lack of gender-specific health care in prisons. In the United States, incarcerated pregnant women reported mistreatment by correctional guards and staff. The Centre also voiced concern over the impact of criminalization of certain sexual and reproductive health services. Minority Rights Group International welcomed mandate holder visits to Papua and voiced concern over the maternal health of women in Papua. Indigenous women in the region were benefiting significantly less from health services than people in other parts of Indonesia. Association of World Citizens said prisoners of conscious in Iran did not enjoy their right to health. Large numbers of prisoners were dying in jail or shortly after release. In Yemen, rebel militias were failing to uphold the rights of detainees.
Liberation said that the state of the health sector in a country was a central aspect in achieving the Sustainable Development Goals. In India, public health ranked 145th in terms of quality and accessibility of healthcare and the Council was asked to urge the authorities to address this problem. Mbororo Social and Cultural Development Association MBOSCUDA said that the report of the Special Rapporteur on the right to health underlined the importance of community-based approaches in services. Countries like India which lacked health infrastructure had much to learn from the report and the Government was urged to spend more on healthcare services.
DAINIUS PURAS, Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, noted that all delegates agreed with recommendations that the international community had to scale up interventions for community-based services that safeguarded individuals against confinement. When persons with mental health conditions committed some violent acts, the dilemma was “mad or bad”. That meant that such individuals had to be placed either in a mental health institution or prison and it was hard to determine which option was worse. A more humane approach was needed in mental healthcare, taking into account human dignity, and Portugal, Brazil but also the entire Council was thanked for their support to the process which aimed to liberate the mental health field. The Rapporteur had very good cooperation, stemming from the desire to introduce changes in mental healthcare and make it more humane.
ALICE CRUZ, Special Rapporteur on the elimination of discrimination against persons affected by leprosy and their family members, said the possibility of eradicating leprosy was not on the horizon. Identifying best practices was a clear priority for the mandate. The Special Rapporteur called on States to promote the change of the social image of leprosy, including in post-elimination scenarios.
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