Systemic violations of human dignity: Afghanistan and the Netherlands
By Agnes van Wijnen (agnes@kantel.nl)
In a small white plastered house in Samarchel, 10 km from Jalalabad, a town name we are all familiar with since the American war in Afghanistan, one can find the grave of Said Mohamed Ali Shah.
Shah, who lived from 1565-1664, was a very religious man who was known for his healing powers. Especially people with psychiatric disabilities had a big chance to be cured. His treatment consisted of a very rich meal two times a day, and a bath, also twice a day. His critics said that his patients were cured because he treated them as kings and queens, not because of God or his healing powers. The wise man did not defend himself but asked what the worst diet was that they could think of. Water, and bread with pepper, they answered. Forty days in a row the clients of Shah lived on water, bread and pepper. As the story goes, they were still cured.
In July last year, a Dutch psychiatrist and cultural anthropologist, Peter Ventevogel, traveled to Afghanistan to work there for HealthNet International. He kept a diary of his experiences. On one of his journeys through Afghanistan he visited Samarchel and the present-day facility for treatment of people with psychiatric problems, which can be found just opposite the grave of Said Mohamed Ali Shah. The complex, a row of low rooms, was close to tumbling down. Most of the patients were sitting on a mat in the shade of a tree to which they were fastened with ankle chains. They received hardly any treatment.
Ventevogel's diary notes present a way of mistreatment of people with psychiatric or mental disabilities that we are all too familiar with.
Mental Disability Rights International, an advocacy organization dedicated to the recognition and enforcement of the rights of people with mental disabilities, has documented human rights abuses like these in several countries around the world. Pictures of people with disabilities chained in or outside a house or tied to beds have been printed in newspapers or displayed on television. These abuses are most familiar and expected coming from countries in Eastern Europe, Africa or Latin-America.
The Netherlands today: incidents or systemic problems?
About five years ago people in the Netherlands were confronted with a photograph of a young woman naked in a cell like room, tied to a kind of bed. The photo of Jolanda Venema was presented in several newspapers and on prime time television. Her family, desperately trying to change the inhuman circumstances their daughter was kept in by the institution she lived in, had finally presented these photos to the media hoping this would provide the necessary pressure. Eventually they succeeded, members of parliament asked questions and the minister of health was forced to provide extra money to hire more personnel to care for the woman. Abuse was ended, or so it seemed.
Only a few weeks ago I was shocked by observations about the current situation in the mental health care system in the Netherlands. Observations from people working in the Dutch system. Not in one institute in particular, but in several institutions throughout the Netherlands people with mental disabilities are kept isolated for long periods in a row, without treatment and with minimal care. Several institutions are reported to tie down some of the people who live there.
The abuse is said to be structural; in other words, these situations are not necessarily exceptional incidents at all but supposedly caused by structural shortage of personnel and resources.
I was shocked because of the seriousness of the violations, but maybe even more because it forced me to realize how very ready I and other fellow citizens have been to believe that the case of, for example, Jolanda Venema was really an unusual incident in our supposedly civilized country. It now proves to be all but an unusual incident.
Abuses of human dignity, the "anchor norm of human rights"
These abuses, both in Afghanistan and the Netherlands are extremely humiliating and nullifying. They place serious attacks on a person's self-esteem and sense of self-worth. They are extremely disempowering and violate the human dignity of the people who are exposed to such treatment and makes them into objects.
This should not happen! Every human being, every person is to be valued and respected. In their recent study "Human rights and disability" for the Office of the United Nations High Commissioner for Human Rights Gerard Quinn and Theresia Degener make clear that human dignity is one of the four most essential values. The other three being autonomy, equality and solidarity.
"Human dignity is the anchor norm of human rights. Each individual is deemed to be of inestimable value and nobody is insignificant. People are to be valued not just because they are economically or otherwise useful but because of their inherent self-worth."
Keeping people isolated for longer periods in a row, physically restraining people by tying them down to a bed or chair as reported constitute human rights violations. They constitute a form of 'inhuman and degrading treatment' as prohibited by article 7 of the ICCPR, the International Covenant on Civil and Political Rights. Both Afghanistan and the Netherlands have ratified this Covenant; they are legally bound by it.
Investigations necessary and urgent
Extensive and thorough investigation of day to day practice in mental health care institutions is necessary and urgent. These investigations should be followed by a radical reform of the care system towards one where human dignity of the individual is respected as a basic value, and privacy and individual choice are recognized. Where people get the support, care and the treatment they need from adequate staff. Where quality assurance and utilization review are an integral and continuous part of the service delivery system.
A reform also where the right to services delivered in the community is recognized. Realization necessarily includes availability of appropriate services and support systems to ensure people with disabilities can actually live safely in the community. MDRI states that it is ultimately the responsibility of the government to ensure that the rights of people with mental disabilities are protected through adequate support systems both in the community and institutions.
- Source: Trouw, 11, 28th, 2002; Peter Ventevogel, Dagboek / Prozac in het drinkwater
- Quinn and Degener, Human Rights and disability; The current use and future potential of United Nations human rights instruments in the context of disability. United Nations, New York and Geneva, 2002
- See for more recommendations: Human Rights and Opportunities for reform, MDRI, Mental Disability Rights International, Washington, 2000
Agnes van Wijnen is senior consultant for Kantel Konsult, a small headstrong company of disabled people working on empowerment, rights and independent living. See: www.kantel.nl
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