Burundi: Hospital Officials Detain Hundreds of Insolvent Patients
(Bujumbura, September 7, 2006) - Burundian state hospitals routinely
detain patients who are unable to pay their hospital bills, Human Rights
Watch and the Burundian Association for the Protection of Human Rights
and Detained Persons said in a new report released today. The patients can
be detained for weeks or even months in abysmal conditions.
This practice highlights broader problems of the health system in Burundi,
where patients have to pay for their own treatment, the two organizations
said. Both organizations called on the Burundian government to end the
detentions and to make access to health care for all Burundians a central
part of its new Poverty Reduction Strategy Paper.
"Detaining poor patients because they can't pay a bill punishes the poor
and violates international human rights law," said Juliane Kippenberg,
NGO Liaison of the Africa division of Human Rights Watch. "It's an
abuse that the Burundian authorities must end."
The 75-page report, "A High Price To Pay: The Detention of Poor Patients
in Hospitals," documents how Burundian hospitals in 2005 detained
hundreds of indigent patients, sometimes in inhumane conditions. Many of
those detained were women giving birth who unexpectedly needed
caesarian deliveries. In some cases, hospital authorities refused further
medical care to those who could not pay their bills and forced them to
vacate their beds for wealthier incoming patients.
Patients who could not pay their bills were kept under guard and
prohibited from leaving the hospital grounds, often for weeks or months,
but in one case for more than a year. Some detainees sold their farm
animals or land to settle accounts in order to leave hospitals. Others
escaped or were rescued by benefactors who paid their bills. Burundi's
government continues to detain indigent patients and hundreds are
currently in detention in the country's state hospitals.
In Burundi, one of the world's poorest nations, patients commonly have
little money to pay medical expenses. The most vulnerable are supposed to
have part of their medical expenses paid by the government, but the
system of assistance does not work in practice. Moreover, the Burundian
health sector is plagued by massive funding shortfalls and by fraud and
corruption.
"With authorities working on poverty-reduction strategies, it is clearly
past
time for them to address the basic right of all Burundians to health care,"
said Jean-Baptiste Sahokwasama of APRODH.
On May 1, 2006, the government took a positive step of ordering that
maternal and child health care be provided free of charge. Hospitals have
since allowed mothers and small children to leave hospitals without
paying their bills. However, the measure was ill-prepared for and resulted
in an influx of pregnant women and sick children, severely straining
hospital resources. The measure did not provide relief for other indigent
patients who continue to be detained.
"Donors will soon be making major decisions about debt relief and aid to
Burundi," said Sahokwasama. "Funds from debt relief and international
assistance should be urgently directed toward health care so hospitals and
doctors can focus on providing health care to all those in need."
Field research for this report was carried out in six Burundian hospitals
between January and June 2005. The report is based on interviews with
more than 40 detained patients, in addition to health care providers and
government officials.
Testimonies
We arrived in Gitega hospital on June 15, 2004. At that moment I had
nothing because the rebels had come to my house and looted almost
everything. I was operated [on] here, but there was no improvement. Three
months ago, they came to see me and told me to pay . 1,750,000 FBU
[$1,750]. I don't see how I can pay this bill, because I do not even have a
plot of land that I can sell.
- David S., a 32-year-old farmer held at Gitega Hospital following a car
accident.
I had to come to hospital because I needed a caesarean delivery. When I
got the bill, the doctor said to me, "Since you have not paid, we will keep
you here." Life here is difficult. I don't have permission to leave with my
baby. We are often hungry here. I cannot stand this situation any longer.
- Christine K., an 18-year-old woman detained with her baby at Louis
Rwagasore Clinic, Bujumbura.
I had a car accident; it was a U.N. car. I was playing with other kids and
they pushed me onto the street. My leg was destroyed ... I was in seventh
grade in school, but now I am not going to school any more. Now I am
healed; there is just one small injury left. My family cannot pay the bill.
I
have been told that I cannot leave unless the bill is paid. I am detained
here because I cannot go past the exit. The nuns give me food twice a day.
- Félix M., a 12-year-old boy held for over a year at Prince Régent
Charles Hospital, Bujumbura; his father used up funds given to him for the
hospital bill.
I am detained because I cannot gather the money to pay the bill. I cannot
leave or move around. I am watched everywhere because they always
think I want to escape. But it is not good to run away. When they catch
you, you cannot go back for treatment. I would be punished for that.
- Félicité G., 17-year-old mother of a baby suffering from malaria,
detained at Ngozi Hospital.
To read the report, "A High Price To Pay: The Detention of Poor Patients
in Hospitals," please visit: http://hrw.org/reports/2006/burundi0906/
To view the slide show accompanying this report, please visit:
http://hrw.org/photos/2006/burundi0906/
For more of Human Rights Watch's work on Burundi, please visit:
http://hrw.org/doc?t=africa&c=burund
-----------
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