Guest editorial
Human rights, health and our obligations to refugees
Nursing Ethics 2015, Vol. 22(4) 399–400 ª The Author(s) 2015 Reprints and permission: sagepub.co.uk/journalsPermissions.nav 10.1177/0969733015586322 nej.sagepub.com
Trine Myhrvold Oslo and Akershus University College of Applied Sciences, Norway
Legal protection is marginal for a large number of people globally due to war, persecution, torture, terrorism, statelessness and the very state of illegality from which undocumented migrants suffer great hardship. Right now, human rights violations are reflected in the largest number of refugees since the Second World War, according to the United Nations High Commissioner for Refugees. The ongoing humanitarian disaster unfolding along the borders of Europe makes refugees even more vulnerable to traumatic experiences and death during the flight and at the borders. This crisis affects various authorities such as police, immigration authorities and health professionals ‘who are all facing dilemmas which occur in the middle of the ongoing, unresolved conflict of interest between human rights, healthcare, social welfare and the security and sovereignty of the modern state’.1 There is a risk of (further) polarization between the need for safety and well-being for the majority/host population and the need for safety and well-being for individuals and groups with a precarious juridical status in society. An example would be undocumented migrants and asylum seekers who seem to be particularly vulnerable with respect to their state of health, living conditions and lack of access to medical assistance, nursing care and social welfare. Barriers such as the discrepancy between human rights and national laws, limited awareness of human rights among health professionals, limited knowledge of healthcare needs among those with a precarious juridical status, no common understanding of what is defined as sufficient healthcare and payment terms in the established healthcare system are all factors significant to this. The discrepancy between human rights and national laws is particularly visible in countries where different laws make access to healthcare for, for example, undocumented migrants a risk because health professionals are obliged to report ‘undocumentedness’ to police and/or immigration authorities. In Germany, these obligations are due to The Residence Act which claims undocumented migrants must be reported to authorities if they seek public services and even criminalizes assistance of undocumented migrants, including healthcare, with a fine or imprisonment.2 In Denmark, the Danish Immigration Service is responsible for healthcare to those without legal stay if their address is known, but they are also obliged to inform the police of the address.3 However, nearly all countries in the world have ratified the International Covenant on Economic, Social and Cultural Rights (ICESCR), which includes the ‘Right to Health’ in Article 12. Norway did include this covenant in the law on Human Rights, which took precedence over other Norwegian laws in 1999. Also the Immigration Act in Norway (effective as of 1 January 2010) states that humanitarian assistance and medical aid shall not be criminalized, even if there are limitations for undocumented migrants’ access to healthcare also in Norway due to, for example, payment terms, that such access is limited to emergency help, and that rejection of application for mental healthcare in the ordinary system of help in Norway is often explained with reference to the unstable life situation of asylum seekers and undocumented migrants. Thus, a two-tiered health service system may be said to be in place in which the Corresponding author: Trine Myhrvold, Oslo and Akershus University College of Applied Sciences, Faculty of Health Sciences, Department of Nursing, PO Box 4, St. Olavs plass, NO 0130 Oslo, Norway. Email: [email protected]
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Nursing Ethics 22(4)
ordinary healthcare system takes care of those who have legal status, and various non-governmental organizations handle those with uncertain status; this is also the case in the Nordic countries. The ICESCR Article 12 recognizes the ‘right of everyone to the enjoyment of the highest attainable standard of physical and mental health’ and calls for more specific steps to be taken to realize this right. Although the realization of human rights is dependent on each country’s economic situation and overall standard of healthcare and social welfare, how we as health professionals can contribute to sufficiently fulfil the ICESCR without discrimination is an important question within the ethics of care. The preamble of the International Council of Nurses’ Code of Ethics for Nurses (the Code) states an inherent respect for human rights, and that nursing care is ‘unrestricted by considerations of age, colour, creed, culture, disability or illness, gender, sexual orientation, nationality, politics, race or social status’. Thus, the Code can be viewed as a powerful statement of which considerations that might be in need of particular attention. Why we do not let human rights speak on its own without any further specification and how we are to understand these considerations as such are important questions that cannot be addressed in full here. However, human rights are claims on how we organize the society as well as the society’s institutions of which the healthcare system can be regarded as one of great importance. The point here is that with these specifications, we risk a secret approval of what is left outside the Code, which conditions that are not considered to be of equal importance. And though every possible strain cannot be mentioned in the Code, we have to ask whether the specifications included today meet the needs of those who suffer from exclusion due to their precarious juridical status. Although the Code has no legislative power, considerations viewed as particularly important in it might be a first step to realizing the right to health as a human right unrestricted by each individual’s abilities in relation to these considerations. In my opinion, juridical status therefore should be included in what ‘nursing care is unrestricted by’ in the next revision and reaffirmation of the Code, as long as we do not let human rights speak on its own. This is important, both to enable nurses to play a part in decreasing the protection gap for those with a precarious juridical status in society and as a protection to each individual nurse or other health professional on duty to alleviate suffering and restore health for those who suffer from human rights violations throughout the world. Today, in contrast, individuals having a precarious juridical status, as well as health professionals assisting them, face a situation of uncertainty, ambiguity and fear. References 1. Myhrvold T and Eick F. Undocumentedness, human rights and nurses’ obligations: an appeal. International Council of Nurses regarding Code of Ethics for Nurses, The Norwegian Nurses Association, 2010, https://www.nsf.no/Content/428242/Appell%20papirl%C3%B8se%20migranter.pdf 2. Castaneda H. Paternity for sale: anxieties over ‘demographic theft’ and undocumented migrant reproduction in Germany. Med Anthropol Q 2008; 22(4): 340–359. 3. Hansen AR, Krasnik A and Høg E. Access to health care for undocumented immigrants: rights and practice. Ugeskrift Læger 2007; 168(36): 3011–3012.
Downloaded from nej.sagepub.com by guest on June 4, 2016
Human rights, health and our obligations to refugees
Nursing Ethics 2015, Vol. 22(4) 399–400 ª The Author(s) 2015 Reprints and permission: sagepub.co.uk/journalsPermissions.nav 10.1177/0969733015586322 nej.sagepub.com
Trine Myhrvold Oslo and Akershus University College of Applied Sciences, Norway
Legal protection is marginal for a large number of people globally due to war, persecution, torture, terrorism, statelessness and the very state of illegality from which undocumented migrants suffer great hardship. Right now, human rights violations are reflected in the largest number of refugees since the Second World War, according to the United Nations High Commissioner for Refugees. The ongoing humanitarian disaster unfolding along the borders of Europe makes refugees even more vulnerable to traumatic experiences and death during the flight and at the borders. This crisis affects various authorities such as police, immigration authorities and health professionals ‘who are all facing dilemmas which occur in the middle of the ongoing, unresolved conflict of interest between human rights, healthcare, social welfare and the security and sovereignty of the modern state’.1 There is a risk of (further) polarization between the need for safety and well-being for the majority/host population and the need for safety and well-being for individuals and groups with a precarious juridical status in society. An example would be undocumented migrants and asylum seekers who seem to be particularly vulnerable with respect to their state of health, living conditions and lack of access to medical assistance, nursing care and social welfare. Barriers such as the discrepancy between human rights and national laws, limited awareness of human rights among health professionals, limited knowledge of healthcare needs among those with a precarious juridical status, no common understanding of what is defined as sufficient healthcare and payment terms in the established healthcare system are all factors significant to this. The discrepancy between human rights and national laws is particularly visible in countries where different laws make access to healthcare for, for example, undocumented migrants a risk because health professionals are obliged to report ‘undocumentedness’ to police and/or immigration authorities. In Germany, these obligations are due to The Residence Act which claims undocumented migrants must be reported to authorities if they seek public services and even criminalizes assistance of undocumented migrants, including healthcare, with a fine or imprisonment.2 In Denmark, the Danish Immigration Service is responsible for healthcare to those without legal stay if their address is known, but they are also obliged to inform the police of the address.3 However, nearly all countries in the world have ratified the International Covenant on Economic, Social and Cultural Rights (ICESCR), which includes the ‘Right to Health’ in Article 12. Norway did include this covenant in the law on Human Rights, which took precedence over other Norwegian laws in 1999. Also the Immigration Act in Norway (effective as of 1 January 2010) states that humanitarian assistance and medical aid shall not be criminalized, even if there are limitations for undocumented migrants’ access to healthcare also in Norway due to, for example, payment terms, that such access is limited to emergency help, and that rejection of application for mental healthcare in the ordinary system of help in Norway is often explained with reference to the unstable life situation of asylum seekers and undocumented migrants. Thus, a two-tiered health service system may be said to be in place in which the Corresponding author: Trine Myhrvold, Oslo and Akershus University College of Applied Sciences, Faculty of Health Sciences, Department of Nursing, PO Box 4, St. Olavs plass, NO 0130 Oslo, Norway. Email: [email protected]
Downloaded from nej.sagepub.com by guest on June 4, 2016
400
Nursing Ethics 22(4)
ordinary healthcare system takes care of those who have legal status, and various non-governmental organizations handle those with uncertain status; this is also the case in the Nordic countries. The ICESCR Article 12 recognizes the ‘right of everyone to the enjoyment of the highest attainable standard of physical and mental health’ and calls for more specific steps to be taken to realize this right. Although the realization of human rights is dependent on each country’s economic situation and overall standard of healthcare and social welfare, how we as health professionals can contribute to sufficiently fulfil the ICESCR without discrimination is an important question within the ethics of care. The preamble of the International Council of Nurses’ Code of Ethics for Nurses (the Code) states an inherent respect for human rights, and that nursing care is ‘unrestricted by considerations of age, colour, creed, culture, disability or illness, gender, sexual orientation, nationality, politics, race or social status’. Thus, the Code can be viewed as a powerful statement of which considerations that might be in need of particular attention. Why we do not let human rights speak on its own without any further specification and how we are to understand these considerations as such are important questions that cannot be addressed in full here. However, human rights are claims on how we organize the society as well as the society’s institutions of which the healthcare system can be regarded as one of great importance. The point here is that with these specifications, we risk a secret approval of what is left outside the Code, which conditions that are not considered to be of equal importance. And though every possible strain cannot be mentioned in the Code, we have to ask whether the specifications included today meet the needs of those who suffer from exclusion due to their precarious juridical status. Although the Code has no legislative power, considerations viewed as particularly important in it might be a first step to realizing the right to health as a human right unrestricted by each individual’s abilities in relation to these considerations. In my opinion, juridical status therefore should be included in what ‘nursing care is unrestricted by’ in the next revision and reaffirmation of the Code, as long as we do not let human rights speak on its own. This is important, both to enable nurses to play a part in decreasing the protection gap for those with a precarious juridical status in society and as a protection to each individual nurse or other health professional on duty to alleviate suffering and restore health for those who suffer from human rights violations throughout the world. Today, in contrast, individuals having a precarious juridical status, as well as health professionals assisting them, face a situation of uncertainty, ambiguity and fear. References 1. Myhrvold T and Eick F. Undocumentedness, human rights and nurses’ obligations: an appeal. International Council of Nurses regarding Code of Ethics for Nurses, The Norwegian Nurses Association, 2010, https://www.nsf.no/Content/428242/Appell%20papirl%C3%B8se%20migranter.pdf 2. Castaneda H. Paternity for sale: anxieties over ‘demographic theft’ and undocumented migrant reproduction in Germany. Med Anthropol Q 2008; 22(4): 340–359. 3. Hansen AR, Krasnik A and Høg E. Access to health care for undocumented immigrants: rights and practice. Ugeskrift Læger 2007; 168(36): 3011–3012.
Downloaded from nej.sagepub.com by guest on June 4, 2016
