Proceedings of Ü
Prague 17-19 June
access for all
rights & services
by Neil Davies - SAD (CZ)
PRESENTATION of SMES-EUROPA
by Luigi Leonori
President of SMES-EUROPA
SHARING OF TESTIMONIES
Testimony from daily life of any
current and former users of services
Presented by Pavel Penkava:
Ostrov nad Ohří State Penitentiary, 13th June 2004
Dear Sir or Madam
name is Václav.
am currently serving a stint in jail.
am an homeless invalid with rich criminal record. Sounds
silly, doesn´t it ?
am not wholly aware of the issues to be discussed at your conference, but I
plead that you have it on your mind that we are, too, and perhaps just due to
it, mere humans.
beg you to stay always on the side of those who need help of any form.
Václav, a convict.
At name of all
participants, Luigi Leonori asked to Pavel Penkava presenting to
Václav many thanks for participation in the conference and insurance
that SMES will implementing and improuving the promotion of "human
dignity and right's respect" with especially attention in prisons too.
discussing with Lucie Ripova,
Penkava and Neil Davies.
18 th JUNE
Representing of SAD
Ms. Hana Halová
- Counsilor on Health and Social Affairs of Prague Municipality
Luigi Leonori -
Presentation of "D&H-5Project" and the 8° European Conference.
THEME: Human dignity and the
right to health care
Chapter I of the Charter of fundamental rights of the European Union is entitled
« Dignity » and Article 1 borrows from the German Grundgesetz the principle of
inviolability of human dignity.
following introductory remarks will be divided into two parts : first
a short evocation of the philosophical sources of the concept of human
dignity and second, a review of the modalities of access to the
effective enjoyment of such right, namely in the field of health care.
Philosophical Sources of Human Dignity
The very concept of human dignity goes back to the earliest Antiquity,
Christian and pagan. The human being is invested in the Creation and
above all other living beings with a dignity which makes him according
to a Cartesian expression “master and possessor of Nature”. One is
nowadays conscious to what excesses has been brought the exploitation
of natural resources. Such criticism which is akin to ecological
preoccupation is stressing the aristocratic ideal which seems inherent
to human dignity.
The exploitation of nature and its consequence, the destruction of the
environment is a violence made to nature — in Latin and in latin
languages the word is feminine and it suggests that, as women have
been and still are, nature is the victim of the violence and the greed
of men. The word “rape” is perfectly fit to describe the exploitation
of nature, which was assumed by rich peoples for the benefit of the
rich at the expense of the poor, Indian communities, slaves,
workpeople devoid of any right. It would be too simple to oppose North
to South. All inhabitants of the Northern countries do not share in
the exploitation of natural resources and there exists in the South
social strata which are helping in the looting.
The most actual philosophical expression of human dignity has been
framed in the last years of the eighteenth century by a German
thinker, Kant. Human beings may not be treated as an object or a
means, but as an end. The Kantian golden rule is : “behave against
the other as you wish to be treated yourself”. Kant adds : “humanity
is itself a dignity”. The notion of humanity is universal : dignity
belongs to every human being, whatever his or her race, religion,
nationality. The international provisions which forbid
discriminations are only referring to such criteria. Poverty,
destitution, ignorance are no sources of discrimination because one
does not want to be conscious that such discriminations are engendered
by the social fabric.
The aristocratic origin of the concept of dignity is corroborated by a
semantic usage which is more alive than the egalitarian approach. The
word points to a function or an attribute which distinguishes and
separates their holder from all other human beings : such as the royal
dignity, the episcopal dignity, etc. In the dictionaries of theology,
either of protestant denominations or of the Catholic church, the word
“Dignities” makes no reference to the dignity of all men and women,
but to the attributes invested on dignified persons. According to
Cicero, “dignitas” is a virtue of the male, corresponding to “venustas”
(Venus) in the fair sex.
Juridical consequences of the concept of human dignity and their
application to the field of health care
Some international instruments — but not the European Charter — set
health among the fundamental human rights.
Art. 25,1 of the Universal Declaration of Human Rights (1948) :
Everyone has the right to a standard of living adequate for the health
and well-being of himself and of his family, including food, clothing,
housing and medical care and necessary social services …
Art. 12,1 of he International Covenant on economic, social and
cultural rights (1966) :
The State Parties to the present
Covenant recognize the right of everyone to the enjoyment of the
highest attainable standard of physical and mental health.
See also Article 11 of the European Social Charter (1961).
In the European Charter, the enjoyment of health is dealt with in two
Article 3, Right to the integrity of the person
Everyone has the right to respect for his or her physical and
In the fields of medicine and biology, the following must be
respected in particular :
the free and informed consent of the person concerned, according to
the procedures laid
down by law,
the prohibition of eugenic practices, in particular those aiming at
the selection of persons,
the prohibition of making the human body and its parts as such a
source of financial gain,
the prohibition of the reproductive cloning of human beings.
provisions protect everyone against state’s immixtion within the
bodily integrity. It does not guarantee any effective access to
health care, which is contemplated by another Article.
Article 35 Health care
Everyone has the right of access to preventive health care and the
right to benefit from medical treatments under the conditions
established by national laws and practices. A high level of human
heath protection shall be ensured in the definition and implementation
of all Union policies and activities.
The first sentence contains a notable restriction : ”under the
conditions established by national laws and practices”. The Charter
hand over the protection of health to the legal order of each state.
No trace whatever of a fundamental right enjoying a higher level of
protection. The second sentence is a pious vow.
As other economic, social and cultural rights the right to health care
is handicapped by the necessity of requiring positive prestations of
the collectivity. Traditional human rights, those which are fairly
well guaranteed by the European Convention protect the subject against
States’ aggression or immixtion. Such is also the nature of Article 3
of the European Charter. It is much more difficult to realize rights
implying a positive performance of the collectivity.
No progress can be contemplated but for a strong action of the organs
of the civil society. Public authorities have to be required to
implement a health policy favourable to the needs of the most
destitute. Health care expenses have become a burden of the
The actual choices remain elitist : sophisticated medicine instead of
a preventive one, favour to health care of already privileged people.
In democratic states, each citizen is, through the electoral process,
able to influence the state : the access to health care for the most
destitute should be an objective of political parties and NGOs should
act in that direction.
I shall terminate by the quotation of a German poet : Friedrich
Schiller, who had retained Kant’s doctrine, embodying it in a manner
adapted to the subject-matter of this conference :
Würde des Menschen
Nicht mehr davon, ich bitte euch. Zu essen gebt ihm, zu wohnen,
Habt ihr die Blösse bedeckt, gibt sich die Würde von selbst.
Don’talk any more, please. Give him food,
Cover their nudity, dignity will follow by
Prof emeritus of the
Université catholique de Louvain
on Heath /Mentale
1st seminar in
Neil Davies, S.A.D. (CZ)
SMES-EU D&H-5P Workshop 1
– November 2003
V Praze – listopadu 2003
The presentation includes comments and observations made during
the Czech Republic Workshop of November 2003.
Attendees included only 11 Czech Representatives of NGOs and
After initial meetings with the Ministry of Labour and Social
Affairs and Ministry of Health, there was no response to the
invitation to send a representative to the Seminar.
The right to medical services;
to those rights for socially excluded people.
Time Scale /
The Czech JIM was published after the Workshop was hosted.
The Czech NAPSinc is currently being prepared.
Czech Context /
Generally there is a lack of knowledge about rights amongst:
of those services.
If people are not aware of their rights they cannot access them.
There is also a lack of legislation about the system of mental
health care management.
No specific mental health law exists within Czech Legislation
resulting in problems with financing and quality.
However, there is a Health Act but the problem is in it’s
The quality of service, in theory, is discussed more, but is not
based on the law as standards are being developed.
Professionals prepare the standards, but users are excluded from
this process of preparation and evaluation.
People must be insured to receive health care and often the
homeless or socially excluded are not insured.
JIM Actions / Iniciativa JIMu
to interconnect health and social care mainly at community level
by creating so-called integrated community care;
to complete and introduce standards which will ensure guaranteed
minimum care from a qualitative and quantitative point of view;
to support medical rehabilitation within the system of
comprehensive rehabilitation for people with disabilities
to establish a framework for issues related to short-term
rehabilitation centres for disorderly alcoholics and drug addicts
and for detoxification consulting rooms, including their
to ensure long-term financial viability of the health care system
and, at the same time, take measures to ensure full access for
members of disadvantaged groups.
NGO Experiences /
Zkušenosti neziskových organizací
Acute cases are treated but after the life-threatening situation
has been prevented, the person is then sent out from the hospital.
experience is that clients are not treated with respect by medical
is not about the Government giving money but giving to fulfil
needs. It is about empowering the people.”
SMES-EU D&H-5P Workshop 1
– November 2003
V Praze – listopadu 2003
Prezentace obsahuje komentáře
z Workshopu, který v listopadu 2003 proběhl v
bylo pouze 11 zástupců
neziskových a akade-mických organizací
vstupních setkáních s Ministerstvem práce a sociálních věcí a Ministersvem zdravotnictví nereagovalo ani jedno z
ministerstev na pozvání na Seminář
a Zdraví Právo na zdravotní péči
Přístup k těmto
JIM publikován po skončení
NAPSinc je v současné
Czech Context /
Obecným problémem je nedostatek povědomí o právech mezi:
Lidé nemohou využívat
Chybí legislativní podpora správy systému péče pro mentálně postižené
Nedostatek legislativy pro duševní
zdraví má za důsledek
problémy s financování a s kvalitou služeb
existuje zákon o zdravotnictví, jsou problémy s jeho implementací
Diskuse o kvalitě
je na teoretické úrovni – není založená
na právní normě spolu s vytvářením standardů pro kvalitu.
kvality je zajištěna
odborníky - uživatelé
jsou z tohoto procesu vyloučeni.
avšak lidé na ulici, nebo lidé vyloučení
Actions / Iniciativa JIMu
propojovat zdravotní a sociální péči především na komunitní úrovni, a to vytvořením
tzv. integrované komunitní péče,
a zavést standardy, které by zajistily nepodkročitelné minimum péče z hlediska kvantitativního a kvalitativního,
rehabilitace v systému ucelené rehabilitace osob se zdravotním
problematiku protialkoholních a protitoxikomanických záchytných
stanic a AT ordinací, včetně jejich financování,
systému zdravotní péče
nedojde k omezení přístupu
NGO Experiences /
Zkušenosti neziskových organizací
ale jakmile pomine přímé
pacient/klient je z nemocnice propuštěn
“Ze zkušenosti víme,
zdravotnický personál se k našim klientům nechová s respektem.”
“Není to o tom,
vláda dává peníze, ale o tom,
vláda dává, aby uspokojila potřeby. Je to o zplnomocnění
Decent life ressources
Radu, Casa Ioana (RO)
3. HOUSING: Housing
- identity - privacy
by Douhomir Minev,
Marginalisation & work
by Andrzej Czarnocki,
POLISH CONTEXT : SOMETHING TO BE RECKONED WITH IN A
38 million inhabitants
30% of people in direct risk of poverty
30-80 thousand homeless people
7-10 million people directly and indirectly affected by
3% with serious psychic problems – another 17% diagnosable
with psychic problems
20% unemployment rate reaching is some areas 40% and more -
40% unemployment rate among young people - 14% employment rate among the
2. THE DOUBLE NATURE OF THE TASK OF
CONNECTING PEOPLE TO WORK:
Overcoming internal barriers
3. THE IDEA OF HELP - WHAT IS REAL HELP
4. PROPER DIVISION OF ROLES BETWEEN SOCIAL
CREATING CONDITIONS STILL A
VALID MODEL EU
5. METHOD OF HELP – THE EARLIER THE BETTER
The need to engage with
young people and families of children to counter the wrong conditioning
that is bound to take
heavier and heavier toll on a person as the years go by.
& universal education
Rita Erle, Street Children Project (LV)
No dignity without exercising the citizen’s rights
workshop should be able to articulate, as regards reflection as well as
exchanging experiences, the social field to the health fields in order to avoid
– in as much as possible – a mere juxtaposition, where there is no relation. We
would like to avoid the workshops to just focusing on poverty or on mental
health of the tramps or homeless people. We would like them rather to explore
the complex relationships that exist among all these social and health elements.
1. No Health without
accessibility & obstacles
to quality health and mental health
Neil DAVIS - Preben BRANDT
* To increase the knowledge of the participants about :
"EU common objective and application - legislations -
health systems & resources – appropriate practices”,
with reference to the NAPs /inc. and to JIM.
* To analyse the efficient practices and the legislation
(concretely and daily applied !..) about health & social
system in order to propose innovative and adequate
instruments for the promotion of equal access to :
RIGHTS - HEALTH - Social and Care SERVICES, for
Strategies against social exclusion – the role of health
and mental health services and their co-operation with other
As was emphasised in the Polish Joint Inclusion Memorandum,
indices of health status of the population of our country
(such as life expectancy and mortality data, especially infant
mortality) are improving despite the fact that the number of
public health care facilities and employment in health care
are falling. It was also emphasised that relatively low
indicators of infant mortality and mortality of children below
5 are not dependent on the class of locality (large
agglomerations, smaller towns, rural areas). This situation
was brought about not only by social, cultural and economic
development but it is also an outcome of national health and
If the goals of “social inclusion” project are to be achieved,
well-established and consistent health, social, cultural and
economic policy should be developed. Such a policy should take
into account not only infant mortality and average life
expectancy, but also long lasting or so called chronic
diseases and among them – mental disorders*. I would like to
present some possibilities of participation in shaping such a
policy by health care professions and self-help organisations,
co-operating with local self-governments, research and
educational institutions and other interested partners.
Their unique input in European social inclusion project and in
the development of an inclusion policy is connected with their
expertise and experience concerning the wide range of
strategies against social exclusion.
I would like to
present some of these strategies, requiring local, national
and international co-operation.
*According to the recent publications by the National
Institute of Hygiene, during the last years the number of
persons with mental health disorders treated in out-patient
mental health facilities and in psychiatric hospitals,
clinics, wards (in-patients facilities) is constantly
increasing in Poland.
By the year 2000 the overall number of patients of mental
health services (including persons with alcohol and substance
abuse related problems) amounted about 1 000 000. The number
of out- patients reached 2455 per 100 000 people
(including 738 new patients).
Author: Elzbieta Bobiatynska
Institution: Partnership for Health Information Centre
Address: ul. Schroegera 82, 01-828 Warszawa, Poland
IS THE COORDINATION BETWEEN SOCIAL AND HEALTH SERVICES
THE WORK OF TWO UNITS DEALING WITH HOMELESS PEOPLE
IN THE STREET.
The coordinated work and results of the Unidad Móvil de
Emergencias Sociales (U.M.E.S) – Social Emergency Mobile Unit
– and the Equipo de Atención Psiquiátrica a Enfermos Mentales
sin Hogar – Madrid Homeless People Mental Health Unit – are
The Unidad Móvil de Emergencias Sociales is a service provided
by Madrid Council and run by the Gabinete de Trabajo Social
Grupo 5 S.L. It was created in 1990 and its main objective is
to assist homeless people in their own environment: the
The unit consists of:
A mobile team, made up of a social worker, an outreach worker
and a driver, which operates seven days a week,
from 10am till
An outreach team, consisting of a social worker and an
outreach worker, which operates from Monday to
from 9am till 4pm.
The mobile unit covers the whole of the city of Madrid in a
van, detecting new cases and providing them with information
about the different social resources available to homeless
Follow up work on existing cases is also a large part of the
team’s remit. An individualised work plan is developed for
each client by the outreach team.
The Equipo de Atención Psiquiátrica a Enfermos Mentales sin
Hogar was created in May 2003 and is provided by Madrid Health
Services (SERMAS). The team consists of a psychiatrist, two
nurses and a youth and community worker.
The objectives of the unit are:
To improve the mental health service for homeless people
To evaluate and diagnose
To provide psychiatric treatment and follow up work for those
homeless mental patients who do not or cannot
mental health services
To facilitate the integration of mentally ill patients
into mainstream mental health services
To coordinate with the necessary health and social
To provide professional training for those working in the
To facilitate patients’ social-health integration and
The Homeless People Mental Health Unit provides engagement,
follow up and treatment of homeless mental patients mainly in
the street, following psychosocial, outreach and assertive
community treatment models.
Author: GRUPO 5 ET SALUD MENTAL DE CALLE
Institution: GRUPO 5, SALUD MENTAL DE CALLE
Address: C/. Jardin de San Federico 9,3º, d.
Street Nursing in Copenhagen :
Street nursing is a
relatively new enterprise within the field of outreach work
aimed at the homeless and socially excluded people in Denmark,
e.g. mainly Copenhagen.
The first nurse began
her activities in 1998 in an area of Copenhagen, which is
known to be a well-established drug scene. In 1999 the next
street nursing project followed, called: ‘Nursing on Wheels’.
This clinic offered its services in different places in
Copenhagen and in a few other places; the activities being
part of ‘Projekt Udenfor’ (‘Project Out-side’). According to
both the street nurses themselves and other actors in the
field, these two first nursing projects broke new grounds,
because they displayed that the physical and mental health
conditions among drug addicts and other socially excluded
people were much poorer than perceived on beforehand. The two
projects operated for two and five years, respectively.
Today the Municipal-ity
of Copenhagen offers nursing care for the homeless in three
clinics as part of the Shelters’ services and as outreach work.
The main principals of the work are not very different form
other kinds of outreach work. Thus, street nursing is
pragmatic, and the point of departure is ‘getting to know’ and
‘trying to understand’ the homeless in their ‘own’ environment.
I have carried out five months of ethnographic fieldwork in
Copenhagen among street nurses and the homeless, who receive
their care, and who, by doing that, become ‘users’ (the
concept of user is general in Denmark, and it describes a
citizen who ‘uses’ which-ever (public) service).
The fieldwork was in
preparation for my thesis to become an anthropologist. During
the seminar I will discuss my analysis on how ‘identity’ and
‘agency’ are produced, negotiated and constituted in
interactions between street nurses and users.
Author: Charlotte Siiger
Institution: projekt UDENFOR
Ravnsborggade 2, 3. sal
Fax: 45+33163540 -
Has the Poor Socio-economic Status of the Patient Become the
Most Powerful Factor of Prognosis?
In daily clinical practice for many healthcare professionals
it appears that treating patients with mental disorders who
lack family or society support, a home or even a decent
income, is reduced only to an amount of difficulties and
almost no possibilities.
Starting with the emotional deprivation in
childhood and poor life or/and educational conditions, which
are without questioning trigger or aggravating factors for
many mental (including personality) disorders, then
confronting with the financial, administrative and legal
problems of their hospitalization and with the decreased
number of therapeutic alternatives due to reduced compliance
probability after the hospitalization period, and completing
this vicious loop with their return in the same environment
(no home, or no job, or no family and friends, or very often
all at once, and certainly without support and close
monitoring from any institution, medical or not), all these
things may offset a very important part, if not all of the
mental health professionals efforts.
In order to improve the prognosis and the quality
of life for this category of patients and not only them, RLMH
developed in 2000 in collaboration with “Al. Obregia”
Psychiatric Hospital, the “Pilot Center for Medical and
Psychological Support – STEPS” addressed to adults with mental
health problems and financed by Liaison Committee for
French-Romanian Exchanges, France and Geneva Initiative on
Psychiatry, Netherlands. The variety of activities and
programs coordinated by psychologists, psychiatrists, nurses
and a professional actor offers them a chance to develop and
to maintain a much greater level of self-esteem and dignity,
makes them feel that they have the right to life and something
to offer. Moreover, the group of these project beneficiaries
lately tends to become a loud voice against discrimination.
Unfortunately and despite of the RLMH sustained
efforts (projects, conferences, seminars etc.), in the
Romanian society the absence of the support services for the
mental illness people outside the psychiatric hospitals,
dramatically reduces, both qualitative and quantitative
outcomes of any therapeutic strategy developed for this
Adina-Maria Bitfoi, MD
Romanian League For Mental Health
Clinical Case Management : programs with schizophrenic
patients in Madrid (Spain):
Author: Maria Fe Bravo Ortiz
Preventing exclusion between
mentally ill .
The present study is about the social and clinical situation
of schizophrenic patients included in three " Clinical Case
Management (CCM)” programs in two catchment areas of Madrid
(Spain) It’s part of an effectiveness study of this case
management programs (Project IPSE) in schizophrenic patients
that have been attended in three CMHC in two catchment areas
in Madrid (Spain).
There has been carried out a differential analysis of the
social and clinical characteristics of the patients that there
are included in the programs by respect those that have not
There have been studied 920 patients diagnosed of
schizophrenia according to criteria CIE-10 and that have been
attended from January, 2002 to October, 2003 in three CMHC
(corresponding to a population of 552.000 inhabitants). Of
them 241 were included in programs of CCM with different
components (professional caseload, keyworker assignment,
written individualized plan, team work, domiciliary visits and
control of drop out). The assessment instruments that have
been used are: Positive and Negative Syndrome Scale (PANSS)
(Kay SR, Opler LA, Lindenmayer JP., 1989); World Health
Organization Disability Assessment Schedule (WHO DAS); Global
Assessment of Functioning Scale (DSM-IV); percentage of
psychotic time in the last year, and adherence to treatment;
Camberwell Assessment of Needs and SCHIZOM.
Coauthor: A. Fernandez Liria; M. Muñoz, C. Gonzalez; A.
Santos; M. Alonso
Institution: Ssm Fuencarral
Fax: 0034913732927 - Email:
basic, decent and adequate resources for
Marieta Radu and Serge Zombek
To increase the knowledge of the participants about : "EU
common objective and application - legislations - health
systems & resources – appropriate practices”, with
reference to the NAPs /inc. and to JIM.
To analyse the efficient practices and the legislation
(concretely and daily applied !..) about health & social
system in order to propose innovative and adequate instruments
for the promotion of equal access to : RIGHTS - HEALTH -
SOCIAL SERVICES and ADEQUATE RESOURCES, for excluded
The income & health
A substantial number of people living above a relative income poverty line
may not be able to satisfy at least one of the needs identified as basic,
due to the detrimental influence of such factors
security of work income, need of extra care for elderly or disabled
members of the household, etc.
There is much evidence that children growing up in poverty tend to
do less well educationally, have poorer health.
The Poor Health
There is a widespread understanding that poor health is both a cause and a
consequence of wider socio-economic difficulties. The overall
health status of the population tends to be weaker in lower income groups.
The percentage of people claiming their health to be (very) bad was
significantly higher for those below the risk of poverty line than for
those above it in the Union ... the strong
correlation between poor health and poverty and exclusion.
Particularly vulnerable groups such as the Roma and Travellers have poor
life expectancy and higher rates of infant mortality. This correlation
depends on various factors but in particular on the extent to which
adverse social and environmental factors, which are experienced
disproportionately by people on low incomes, can make it difficult for
individuals to make healthier choices.
DIGNITE ET CITOYENNETE, FACE A LA NON DEMANDE D’AIDE :QUELQUES
Une catégorie de personnes peut ne
plus vouloir rien demander : ceux qui vivent à la rue de manière
chronique, sans avenir autre que cette quotidienneté répétitive
émaillée d’offres d’assistances qui s’inscrivent rarement dans un
projet de vie à long terme. Au bout d’un temps souvent long, très
long, le désenchantement et les illusions de l’alcool finissent par
avoir raison de toute demande d’aide. Derrière cet abandon majeur
d’une quelconque accroche de lien social, c’est l’identité elle-même
qui finit par être anéantie. Si, comme nous le pensons, en suivant
Hannah Arendt, il n’est possible de parler de dignité qu’à partir du
moment où elle s’attache à considérer l’homme dans son engagement de
parole au sein de la cité, si donc la dignité sous-tend l’accession
et la non remise en question pour l’homme de sa citoyenneté, alors,
dans ces cas d’exclusion majeure et chronique, le refus d’assistanat
pourrait être entendu de deux manières :
* Dans les plus graves cas, ce refus témoigne de la perte de
toute pulsion de vie autre que celle apportée par la satisfaction
immédiate des pulsions primaires : manger, boire, dormir, boire de
l’alcool, - parler de dignité est alors difficile, voire dangereux,
car la pensée, le souvenir, le projet singulier est alors aboli.
* Dans d’autres cas, heureusement plus fréquents, le refus
peut au contraire s’entendre comme un ultime sursaut de dignité :
au-delà de la honte, en deçà de l’accès à la citoyenneté active. La
personne exclue, par son refus de l’assistanat, peut en effet être
entendue comme celle qui attendrait d’être reconnue dans sa dignité
: par un projet de vie qui la remettrait dans une position de sujet
Ces constats nous amènent à l’interrogation suivante : et si c’était
notre propre dignité, à nous, soignants, intervenants sociaux et
bénévoles, citoyens témoins de cet abandon majeur de toute une
population, qui nous mettaient dans l’obligation de prendre la
parole au nom de ces hommes, femmes et enfants devenus invisibles
parce que silencieux ?
La dignité devient alors un concept important, qui permet
d’interroger nos propres positions au-delà du seul aspect
compassionnel ou humanitaire souvent mis en avant.
Sylvie Quesemand Zucca,
Réseau Souffrance Précarité
un dispositif d’intervention en urgence pour les
personnes en crise socio-médicale
Quand on parle des ressources, on se réfère implicitement aux
besoins. Pour ceux qui travaillent avec les personnes en crise psycho-socio-médicale la première démarche est de se focaliser sur
l’identification des besoins des bénéficiaires. Une autre
démarche, aussi importante, est d’évaluer et de connaître les
services sociaux qui existent dans la communauté et auxquels on
peut faire appel. A l’heure actuelle il existe à Bucarest une
discordance entre les besoins de la population dans la rue et les
services offerts, dans le sens que les nécessités vitales des
personnes socialement exclues ne sont pas couvertes. Dans ces
conditions, les travailleurs sociaux (assistants sociaux,
médecins, psychologues) sont soumis à une suprasollicitation et
souvent le phénomène"burn out" surgit. Le Samusocial de Roumanie
offre un complexe de services socio-médicaux d’urgence pour
assurer la survie, au moins décente, des personnes socialement
exclues. On essaie en même temps d’établir des liaisons avec
d’autres organisations et institutions en vue de créer un réseau
de services qui se soutiennent reciproquement.
Samu social din Romania
Street Work At night.
Solidarios NGO and RAIS Foundation, both SMES-Madrid Group
members, work together on a collaboration proyect.
Our job is a very good example of networks, coordinate and
cross-disciplinary works are the only way to fight social
exclusion and homeless.
The proyect have started in January of 2003 and is a model for
others: professional workers from RAIS Foundation and
volunteers from Solidarios NGO, both working together to do a
better streetwork with homeless people. Only instruments are
coordination and complementarity.
We, Solidarios and RAIS, have the same goal: to make stronger
our streetwork. Both organizations think street work is a
fundamental step into a social rehabilitation process, but we
can forget that encourage personal self-respect is an
important element in that process, too.
& Pepe aniorte
RAIS Fundatión /solidarios NGO
C/ magallanes, 27 Madrid 28015
Medical assisance for elderly homeless
The elderly homeless are a very vulnerable category which
oftenly foll pray to street violence and typical to he
association cronycal degenerativ pathology ( cardiovasculaar,
psychiatric, rheumatologyc)with acute disease, those that
represente the main reason because which they turn to the
medical consulting room.
Thanks to the periodic apointments which IM organizez for
groups of elderly homeless, the medical check-up is easely
realised but the living conditions of the elder prevent our
actions from having the biggest resuls.
Maria Tilita &
Lacramioara Catalina Hetel
The Swedish Organization for Individual
A mobile psychosocial team in Brussels, some experiences
The so-called "Homeless Mentally Ill" are living in a no man's
land, somewhere in between the social sector and the mental
health sector. Because of their psychic problems, they cannot
be reached adequately by social services. At the same time
mental health services donot reach them or feel helpless
because of their complicated social problems. SMES-Belgium
created a mobile psychosocial team in January 2002, at the
demand of both some mental health services as well as social
services in Brussels. This unit is at clients disposal but
through professionals, who have won their trust. It aims at
identifying the needs of the client and answering them, by
creating a stable adequate network around him, where everyone
feels responsible and competent. Some experiences, positive
and negative, will be discussed.
Van Drimmelen-Krabbe, Jenny
Mobile unit of SMES-B
Rue des Rermparts des Moines 78, 1000
the right of all individuals and families to a decent,
affordable and sustainable accommodation.
Douhomir Minev and Xavier Vandromme
Health and Homelessness : The role of FEANTSA
Housing and Homelessness
Housing is an important element in
tackling homelessness, but the housing dimension of homelessness
varies from country to country:
Belgium: housing is a priority in homeless policy
focus on other forms of support
Homelessness is not only a housing
issue – education, independent living, employment, and health
Link between health and housing: Bad
temporary shelter conditions/housing conditions are associated with
a number of health problems – both physical and mental – e.g. little
privacy or security, sharing facilities such as kitchens and
bathrooms, typical problems of poor quality housing such as
overcrowding, dampness, cold
Mental health and homelessness
The health problems of the homeless:
depression, anxiety, borderlines personalities, stress, lack of
confidence (often due to childhood traumas)
Children of homeless families are
prone to behavioural disturbances, poor sleep, etc
Role of FEANTSA – link between homeless issues and EU policy
Our members work with governments and
ministries at national level - FEANTSA works with EU policy-makers
to improve knowledge of homelessness and to improve policies
Working groups – statistics,
employment, housing/right to housing, health
Feed the results into the EU policy framework
EU policy framework: We monitor
closely the EU Social Inclusion Strategy, European Employment
Strategy, Services of General Interest, etc.
Open method of coordination - much potential/much scope for learning
Our aim is to continue strengthening
the fight against homelessness – the best way is to establish an
integrated strategy (within the framework of the EU Strategy). A
strategy combining all relevant actors in the fields of health,
housing, employment, social support, rehabilitation, etc, which
works on two fronts: prevention and reintegration
Results of FEANTSA strategy
Homelessness is a complex and
wide-ranging issue: unlike a targeted rough sleeping strategy which
has a very clear target of getting people off the streets, FEANTSA
tackles different types of homelessness : rough sleeping, sleeping
in temporary shelters; sleeping in inadequate housing, sleeping in
Nevertheless, the results are visible
Homeless statistics – FEANTSA is a
member of the homeless taskforce coordinated by Eurostat. We offer
our expertise to develop indicators for the EU Social Inclusion
Strategy and EU Housing Ministers to develop homeless
Publications of the European
Observatory on Homelessness
Active Participation of FEANTSA in
the EU Peer Review Programme on the England Rough Sleepers Strategy
(FEANTSA carried out a “shadow” peer review amongst its members
throughout the enlarged
Enlargement of the EU/Enlargement of FEANTSA
FEANTSA has now enlarged to encompass
member organisations from all EU25 except for
Evaluation - We are currently
therefore evaluating the impact of Enlargement on the objectives of
FEANTSA by revising our strategies and our instruments taking into
account the new challenges in the New Member States
The increasing differences in EU25
countries are perceived as a resource for improving policies and
We encourage our members to work
together - transnational CATCH project, NAPs Awareness, etc, etc
But no sector can achieve its aims
without partnership with other sectors – and FEANTSA is open to
projects with organisations working on health issues or with mental
suitable employment for active participation in society.
& Gianfranco Marocchi,
Idee in Rete
Social Co-operation in Italy:
The Contribution to Working Insertion and Job Policies
Gianfranco Marocchi - Idee in Rete - Consorzio Nazionale
While in the eighties the third sector stimulated public welfare state
and anticipated innovative services that would be later assumed from
the public sector, in the nineties it developed a prominent role in
direct production of social welfare services.
There are about 6,500 social co-operatives in Italy, with 200,000
estimated total workers. Their sphere of action consists of managing
social welfare services (e.g.: elderly people house assistance;
household communities and day services for disabled and children; drug
addicts treatment) and of inserting disadvantaged people (disabled,
prisoners, drug addicts, mental patients, diseased minors) in self
supporting market productive activities.
The role gained in services production and the reinforcement of
economic solidity (about 6.5 billion Euros of aggregated income)
determined the entrepreneurial evolution of these organisations.
The two main social co-operatives spheres of action that are
a) the supply of welfare services and b) the insertion of
disadvantaged people in self supporting productive activities. The
second of these fields is described in this abstract.
Working insertion social co-operatives provide job occasions and
professional and personal growth chances to disadvantaged people;
therefore these co-operatives can perform any enterprise activity –
agricultural, industrial, commercial, tertiary activity – but they
have to reserve to disadvantaged people almost 30% of job positions;
social co-operatives predispose individual inserting projects that are
often compiled in collaboration to social services. According to law
381/91, disabled, drug addicts, mental patient, prisoners, diseased
minors are disadvantaged categories.
Insertion results can be, in case of success, both job finding in
profit enterprise and permanent integration in the same social
Many research state that working insertion project, frequently take to
stable jobs; these research also state that anyway insertion projects
bring to a personal and professional growth and also that economic
advantages (lower assistance expenses, tax yield from disadvantaged
people employed thanks to social co-operatives), are higher than costs
(state coverage, possible local support measures).
Local administrators have appreciated this activity and they have
reserved, according to law 381/91, job orders to social co-operatives
to promote working insertion. In this way local administrators perform
a social intervention through ordinary expenses like green areas
maintenance or public buildings cleaning.
1. What Social Co-operatives are
1.2. Birth, Development, and Juridical Acknowledgement of Social
1.3. Social Co-operation today in Italy
1.4. Social Co-operation Peculiarity
2. Social Co-operative Activities
2.1. Social Services Co-operatives in Welfare Renovation
2.2. Working Insertion and Job Policies
2.3. Developing Sectors: not Welfare Personal Services and Services to
3. Social Co-operatives Integration and Relationship with other Third
3.1. Integration among Social Co-operatives
3.2. Integration among Social Co-operatives and other Organisations
4. Social Co-operation and Social Enterprise in Europe
President: Gianfranco Marocchi
Place: Piazza Vittorio Emanuele II°, 31 00185 Roma
Tel.: 06-490821 Fax: 06-491623
the right & access to education,
and SMES Network
SATURDAY 19th JUNE
FIGHTING AGAINST POVERTY and
EXCLUSION for DIGNITY and HEALTH
Using NAPincl as an instrument
for inclusion process
poverty - exclusion - homelessness
...: between utopia and challenge"
by Mr. Huges Feltesse,
repr. Of Unit E2 Politics and programmes for
inclusion of the European Commission
The EU's Social Inclusion Process
The Lisbon European Council
Method of Coordination Aim:
"to make a decisive impact on the eradication of poverty and social
exclusion by 2010"
Method of Coordination - Key Elements
National Action Plans
Commonly agreed indicators
Reporting and Monitoring - Joint Reports on Social
Learning - Community action programme
objectives of Nice
participation in employment and access of all to goods, services,
resources and rights
To prevent social exclusion
To support the most vulnerable
To mobilise and involve all stakeholders
Mobilise all Actors
Participation of excluded
Mainstream into overall policy
- public authorities at all levels
coordination procedures and
- responsive services
dialogue and partnership
- involve social partners, NGOs and social service provider
- engage all citizens
- responsibility of business
- 2nd National Action Plans on poverty and social exclusion
Dec 2003 - Joint Memoranda on
March 2004 -
Joint Report on Social Inclusion
July 2004 -
1st NAPs/inclusion for new MS
2005 - Review of Social
Protection/Inclusion Processes & Lisbon Agenda
July 2005 -
Implementation Reports on 2003 NAPs
2006 – 3 year NAPs for EU-25
still a Major Challenge
15% or 65
million people in EU at risk of poverty
highest risk in Ireland (21%), Greece and Portugal (20%) and Spain
lowest in Sweden (10%), Denmark, Germany, Finland, Netherlands (11%)
High Risk Groups
and larger families
unemployed, especially long-term unemployed
older women living alone
1:5 live in poor household
and 1:10 in jobless household
3% or more
fall in poverty rate in Belgium, Germany, Portugal and UK between
1995 & 2001
Investment in social policies works
risk of poverty before all
social cash transfers 39% and after all transfers 15%
Risk of poverty
and per capita social expenditure
2003 but not sufficient
analysis and multi-dimensional
better reflect diversity of national systems
majority set quantitative & intermediate targets
better links between national, regional and local
increased participation of civil society stakeholder
to overall expenditure priorities
linkages between social, economic & employment policies
more ambitious and quantified targets
multi-dimensional approach: especially re housing, lifelong
learning, culture, e-inclusion and transport
monitoring the impact of policies
raising awareness of wider public and decision-makers
involvement of civil society in implementation & monitoring
6 Key Policy
investment and tailoring of active labour market measures
ensuring adequacy of social protection for all to live life with
improved access to key services (health care, housing, education,
early school leaving and transition from school to work
eliminate child poverty
reduce social exclusion of immigrants and ethnic minorities
States - Poverty An Urgent Challenge
13% at risk
of poverty (Czech Rep 8% - Estonia 18%) [EU15 15%]×
36% unemployed at risk of poverty
18% children and young people (16%) at risk
27% large and 21% one parent families at risk
high deprivation & lack of basic household necessities 2
unemployment rate - 14.3% (EU15 8%)
youth unemployment rate – 31.9% (EU15 15%)
high long-term unemployment – 8% (EU15 3%)
New Member States
Poverty An Urgent Challenge 2
expectancy than EU15 (men -5 % women -3 years)
Poor basic services
Big regional and rural/urban differences
High risk Groups:
- people with physical/ intellectual disabilities
people with poor heath
- people in or leaving institutions
- the mentally ill
- alcohol and drug abusers
States - Key Structural Changes
and agricultural restructuring
rapid growth of knowledge society and ICT
ageing populations and higher dependency rates
changes in household structures
immigration – set to increase
States - Main Challenges
labour market participation
Improving education and lifelong learning
Reforming social protection systems
Access to health, social & transport services
Concentrations of disadvantage
Including Roma and ethnic minorities
Supporting families & protecting rights of children
States– Improving Infrastructure: Mobilising All Actors
and mainstream policies
strengthen national, regional and local links
build capacity of all actors (esp. local authorities and NGOs)
promote partnerships between government agencies and NGOs and social
improve data and analysis
Employment and Social Affairs web site on social inclusion:
CZ Joint Inclusion Memorandum JIM,
A Brief History
EU social inclusion strategy
Dec. 2000 Nice summit
2001-2003 first round of National Action Plans
Dec. 2001 Joint Report on social inclusion
2003-2005 new plans
Aims of the JIM
To prepare accession countries for full participation in the EU
social exclusion strategy
Identifying the principal challenges in relation to tackling
poverty and exclusion
Mobilising all stakeholders active in the fight against poverty
Table of Contents
Economic development and labour market
Promoting gender equality in all actions
Statistical systems and indicators
Support to joint social inclusion policies through the structural
Homelessness and Mental Health
Contents 64 pages incl. Annexes
9 x term homeless or homelessness
3 x term mental (disability or health)
2 x term psychical (disability or health)
!!! the term homeless is used for first time in history in a
official document of the state
National Action Plan (NAP)
line: July 2004
Table of Contents
Main trends and challenges
Strategy, main tasks and key targets
Examples of best practices
NGOs & NAP
Consultations for the MPSV (MOLSA)
3 members organisations of the FEANTSA
Armáda spásy (Salvation Army)
EAPN CR is founded
Naděje, Varšavská 37, 120 00 Praha 2
Telephone: 222 521 110, fax: 222 521 115
2. Presentation of "Piano
Franco Alvaro, Director Dip. V of Municipalité de Rome.
SYNTHETIC FRAMEWORK OF THE
REGULATORY PLAN OF THE CITY OF ROME
The law no 328/2000, indicate the basic goals for a
social service integrated system, the services have new tasks and
resources, and represents a highly integrated public-private
In the Plan there are
six areas of action each with it’s own objectives and measures:
planning between Urbanistic Regulatory Plan and Social Regulatory Plan
projects (plans for target group: child, older, immigrants..)
the stretch budget
In the welfare actions
we have six actions:
system of welfare
inclusion and autonomy
residential (type: elders, minors, homeless…)
of social emergency
This structure assures
both the unity of service for the overall dimension of the citizens of
Rome for all its citizens and for specific local needs (welfare for
Our objective is to
assure all social services at essential levels to all.
Health-Rights and Access, What does the Municipality of Rome do?
FOR THE HOMELESS
We can estimate that
around 2.000 people live on the streets and around 6.000 live in
temporary accommodation and emergency shelters. 1/3 have psychiatric
disturbances, 1/3 have alcoholism problems, and a 1/3 is made up of
Extension of rights
Residency represents a
right/duty of each citizen, in spite of his or her living conditions.
Residency allows one to be a citizen (renew documents, get the
pension, exercise the right to vote).
Since 2002 the homeless
people can obtain Official Domicile at theirs District Via Modesta
Valenti, an official domicile for the homeless instituted in memory
of an elderly woman who died in privation at the Termini Station after
an ambulance didn’t care for her because she was dirty.
In Rome there are 19
official domiciles Modesta Valenti, one for each District.
Dignity to have first aid
In February 2002 the
Social Operation Room was launched with a view to guaranteeing rapid
reaction in social emergencies: it is free of charge and active 24
hours a day, 7 days a week, holidays included.
All citizens of the
municipality of Rome can access the service by applying directly or
after being brought to the attention of the relevant authorities. No
formal requirements have to be met to use it. Applications are to be
filed by telephone, calling a toll-free number. Emergency actions
target all socially disadvantaged people.
The SOS service consists in three
integrated operational levels:
it is located in the premises of the municipality of rome’s 5th
Department. Experts are always ready to take calls, analyse and
interpret them, assess any request, define and activate actions
9mobile units are always operational in the field, and are
permanently connected to the operation room through a satellite
system. The personnel of each mobile units consist of two vocational
trainers and a home carer with a total of 36 staff working in shifts.
Those units react rapidly to any request by carrying out the required
actions on the spot, meanwhile activating the relevant institutional
actors in order to identify the resources available. Thanks to their
constant presence in the field, mobile units can identify situations
of marginalization that would otherwise be undetectable; they contact
invisible users, who would otherwise only become visible when the
situation is unmanageable, thus playing an extremely significant
these social workers or psychologists act constantly as links with
local social and health services.
Those without a fixed abode
are mainly an itinerant population. This shows the importance for a
flexible articulation of the specific services geared towards them,
therefore there is a need to provide the services for these people in
two areas: citizen and municipal.
services for a population in transit
which has not obtained residency or, even if with a residency, does
not live in the defined territory
and secondary shelters,
the people who use these centres, night and
day, are those which do not have significant connections with the area
or they do have connections in the area which do not coincide with
those at the shelter structures. These in fact, in relation to the
type of population which they turn to, have relationships with more
than one town hall.
Possible economical hotel structures.
Services at municipal
level or in
proximity, geared towards a permanent population:
the area importance has shown the necessity, within a social
reintegration programme, that this type of structure interweaves
connections with the neighbourhood to allow a connection between the
area and the people received.
shelter for the resident family nucleus.
Economic hardship - right to housing
One of the most
significant prevention areas regards the housing policy. Resolution
number 163/98 which offers economic support, rent, has an important
prevention function, necessary to avoid the entry into the circuit for
people with no fixed abode to those who have just lost a home and the
consequent chronic process of social exclusion.
a permanent work table dedicated to people with no fixed abode open
to the workers in the sector. The table will also be open to people
who live with hardship.
on to increase the overall places in the first shelter (or called
basic level) at a citizen level.
Continue with the policy of small sized shelter structures spread
throughout the area.
expect a system which allows the permanent stay of guests in the
secondary shelter centres not any more on the basis of a prefixed
time in a contract, but rather on the basis of intervention projects
carried out periodically to check the situation, with also the
participation of all the interested area services.
for the projects. The micro project, as a starting point for the
taking on the person with no fixed abode, which allows, a constant
verification of the team’s work and the programme of the person
Training of the social workers who work in the extreme poverty
Dignity to have medical treatment:
Rome there is a list of doctors on health insurance panel available to
work with homeless
PEOPLE WITH MENTAL HEALTH PROBLEMS
Rome is a capital city
without a mental hospital. In recent years much has been done in the
mental health field, thanks to the joint cooperation between the City
Council and the five Mental Health Departments of the Local Health
Units. The collaboration with the departments has allowed, among other
things, the setting up and running of 24 day centres, 16 social
assistance residences and 19 personalised apartments. Certainly,
regarding the needs and the new urgencies, the work to be done is
still notable, which needs greater coordination of the forces in the
field, so that all can use the services, the treatment, the resources.
The collaboration and support initiatives between the council
authority and the Local Health Units have identified different
There are 24 so called
intermediate structures, located in a capillary way within the whole
citizen area, they mainly receive serious psychotic patient, in the 20
to 45 age group. Each centre is open for eight hours daily, from
Monday to Friday, with the presence of a multi skilled team from the
Local Health Unit responsible for the therapeutic rehabilitation
project and the health related activities, both for the workers within
the social cooperatives, chosen by the Local Health Units, which
manage the recreation and expression activities as well as the
professional training. Within each centre it is foreseen, meetings
between the workers and the patients and specific meetings with the
families and the users to verify the work carried out and to build a
rapport of collaboration, important for the development of the
patient’s therapeutic project.
The residences are low
assistance level structures, directed towards patients who have
reached a sufficient level of autonomy and who have a discrete
possibility to experiment with normal living conditions. The
residences are categorised into two types:
16 social assistance
residences (low assistance level structures and/or self managed). They
are structures which can receive up to a maximum of six patients. They
represent a housing solution outside the protected psychiatric circuit
and which foresee, organised assistance in daily living through the
presence of trained personnel and/or volunteers for the support
activities in daily life.
19 personalised apartments.
They represent housing solutions for users with a sufficient level of
autonomy. The project is carried out in owned apartments rented to the
same. The increase in personalised housing is foreseen (from one to
four people), that is the housing which allows to progressively leave
the psychiatric structures for a definitive social integration.
These are projects which aid the work integration
of citizens with mental problems both, both through the setting up of
new productive activities managed by the social cooperatives, and the
setting up of schemes to recover and re qualify degraded green areas.
articulated in the by now long term different
experimented forms (short breaks, trips, week end) constitutes a
fundamental opportunity to verify the rehabilitation and therapeutic
interventions undertaken by the services during the year.
Training, awareness and
these are initiatives geared
towards the associations and family members, social health workers,
social cooperatives, and even all citizens to encourage a cultural
change and the change of attitudes regarding mental illness to
increase the experience of social and employment reintegration of
citizens with mental health problems.
the economic contributions
for the realisation of personal projects (work placement, economic
support, residency…) are paid annually to the psychiatric patients.
The National Action Plan
(NAP) for inclusion
Danish Ministry of Social Affairs
Realism and criticisme of NAPincl and JIM
A juridical vision: the right & access in reality, Ieva
LV Centre for Human Rights.Open discussion of participants for recommandations
2. Social worker vision of the reality
Illigal immigrants : job & health
MSF I - B
Frontières – Mission Italie
Prague, 17 – 19
(MI) started its work in 1999. Since that time it has focused its
efforts on provision of health care to undocumented migrants and
assistance at the landings of boat people in the South of Italy.
Despite the fact that Italy has a
well-developed health care system, the statistics concerning the
immigrants’ health are worrying. Among the general population, the
perinatal mortality rate is 0,33% in the north of the country and
0,83% in the south; among immigrants all over Italy it is as high as
10,8%. A recent study revealed that the risk of contracting
tuberculosis is 35 times for a migrant in Italy than for a resident
The Italian law
on immigration (commonly known as the “Bossi-Fini” law) guarantees
health assistance for undocumented migrants by giving them an
anonymous code (STP code). MSF has verified that several local posts
of the National Health System (NHS) have not been implementing the law
or have done so with several malpractices.
Starting in 2003
MSF has opened clinics for undocumented migrants in several parts of
Italy. This clinics are run as part of the NHS and are allowed to give
out STP codes. The objective is to implement the Bossi-Fini law as it
was intended and then hand the clinics back to NHS. Today, there are
such MSF clinics in Sicily and Rome; a new one is due to open in
Sicily is a
major entry point for boat people. They flee war or other precarious
situations and risk their lives on hazardous trips across the
Mediterranean, before arriving on Italian soil.
small island in the south of Sicily, hosts a First Reception Centre
where the migrants are assisted after arrival. In this centre, an MSF
nurse provides first aid. Thus, MSF assists more than 9,000 people per
provides immediate aid to people arriving on Sicily’s southern coast;
a mobile team is on call 24 hours a day to reach the places where
people disembark and provide health care assistance as well as basic
information on Italian immigration law.
In a derelict
railway station in the centre of Rome some 400 asylum seekers are
squatting. They have fled from Sudan, Ethiopia, Eritrea and other
Sub-Saharan countries, and have found no place to stay. The sanitary
and hygiene conditions in Tiburtina railway station are worrying;
there are no facilities like running water, electricity or heating. In
October 2003 MSF started providing health care assistance for the
asylum seekers. The team is also involved in a lobbying and
communication action to push the authority to find a sustainable
solution: reconstruction works in the station area have begun and in
the course of 2004 the entire asylum population will be evicted by the
owner of the premises.
Italy is the only European Union member
state without a comprehensive law on asylum. During 2002 the Italian
government has enacted a new law on immigration and asylum (the “Bossi
– Fini” law) that changed some of the previous procedure.
When an immigrant lands or arrive in
Italy has to been identified by the Italian authorities. At this
moment the immigrant can apply for asylum and start up the procedure.
Then he’s transferred in a First Rescue Centre (Frc) where he waits
for a stay permit as asylum seeker and a contribution of 17.08 Euro
for 45 days. The contribution can be output in three sessions.
Sometimes the asylum seekers wait just for the first part of the
pocket money and then he or she leave the centre.
The asylum seekers have to wait for the
interview at the Central Commission for the Refugee Status. The all
procedure can last 12 or 14 months: during this period the asylum
seekers are not allowed to work according with the Italian law on
immigration and they have not the right to receive any kind of other
When they leave the Frc sometimes they
decide to go to the fields of South of Italy to be employed as
seasonal workers in the harvest of tobacco, tomato and potatoes. The
living conditions monitored by MSF during the summer 2002/2003 are
When the harvest is over they try to
join the capital or the north of the country in order to find better
The Italian Central Commission, in the
last 10 years, has output the 95% of denies. This because the 70% of
asylum seekers don’t receive the communication for the hearing as
they’re scattered in the territory. This is the result of the lack of
places in Second Reception Centres where only the 10% of them have
During the 2002, according to
provisional statistics, 7300 asylum seekers filed claims in Italy, 24%
fewer than in 2001. The majority of applications came from Sri Lanka
(1400), Iraq (1200), Yugoslavia (1100) and Turkey (520).
stories have been collected in Tiburtina railway station by the MSF-Mission
Italy operators on 9th June 2004.
Mohammed, I’m 22 years old and I am a student from Kornoi in Darfur,
Sudan. I am Zaghawa. I left my hometown two months ago because of the
war. Kornoi was bombed during two days; it was like a big earthquake.
There were fires everywhere. All around were dead bodies of people and
animals. My mother and two brothers died in the bombing. I was
bleeding from my head.
I walked to Tine
on the Sudanese side of the border. Local people treated my wounds,
but they were not doctors or nurses. Some people took me in their car
to Lybia because I was wounded. I stayed in Lybia 53 days, working in
the fields for having some pocket money. All people from Darfur in
Lybia collected money for me so I could go to Europe.
We were with 68
people in a small boat, not only Sudanese. Everybody had to crouch
down, we could not sit normally. The boat trip took three days and two
nights. We only had a little water and no food at all. The motor of
the boat broke down, a police boat pulled us for a couple of hours and
then we were picked up by another police boat. That is how we got to
the police station (NOTE: Mohammed refers to the reception centre as
“police station”) on Lampedusa.
We were treated
like prisoners. They took our belts, shoelaces and watches and I never
got my possessions back. They made us stand naked to check us, but it
was not a medical check. They gave us a shirt, underpants and shampoo
in a coffee cup. Because nobody explained anything in Arabic, some
people who were feeling ill thought the shampoo was medicine and drank
it. I too drank the shampoo. Then we could take a shower; the water
was very, very cold.
I arrived in the
police station at 3pm and they only gave us some food at 7pm. We got a
liter of water per four people. We also got some pasta and a piece of
meat, but because we did not know what kind of meat it was nobody
touched it, fearing it might be pork.
We stayed in
Lampedusa for three days. We had to sleep on the floors. Nobody gave
us any information, there was no interpreter and there was no medical
care. They made us stand in line often, for up to an hour, so we could
be counted. Twice they woke us in the middle of the night and lined us
up for a head count.
After three days
they put us on a plane. Again, nobody explained anything. They took us
to a centre in Crotone. We got no breakfast before the trip and only
gave us some food at 4pm. They took our fingerprints in a rough way.
We were given papers (NOTE: in Italian) that we had to sign, again
without any explanation. Nobody asked me any questions, nobody gave me
any information. At eight they gave us train tickets and brought us to
the station; I went to Rome.
I cannot go back
to my country because of the war. Also, my family was killed and our
house was destroyed.”
NOTE: We have seen the papers
Mohammed signed, they are expulsion orders. Name and date on the
papers are consistent with his story (Erwin).
“I’m Haysam, 18
years old and I am from a village called Disa, not far from Kutum, in
Darfur, Sudan. I am Zaghawa. I was living with my parents and two
brothers and I was studying.
On 2 November,
2003, my village was attacked. My father and both brothers were killed
in the bombardments. My mother was still alive but I had to run to
save myself. With four people we started running, but one was a
12-year-old boy who was too slow so we had to leave him behind. After
one day and nine hours we reached Tine, where we crossed the wadi into
nothing there. I did not eat while I fled and for four days in Tine I
did not eat either. Seven days I ate nothing. Finally I met some other
Zaghawa who gave me a little bit of food. An old man who was
compassionate took me on a truck to Lybia; he did not ask any money.
The trip took 8 days. It was very cold weather and I suffered a lot.
In Lybia I
stayed with other Sudanese for six months. I had no work and not much
food. I tried to continue studying there but was not allowed in
school. There is much racism in Lybia; I was mistreated. Finally, my
Sudanese brothers got me on a boat.
The trip on the
boat took 39 hours before the police picked us up. There was not
enough space and everybody was crouching down. There were people
suffering from headaches, the flu, seasickness.
The place in
Lampedusa they brought us to looked like a prison, with barbed wire
and soldiers. I arrived at 9am but only got something to eat at 11pm.
They took our stuff – our belts and laces –, made us stand up naked,
and then gave us a T-shirt, underwear and a cup of shampoo. The shower
was very cold, the water was salty like sea water. We didn’t receive a
towel; I had to dry myself with paper tissues.
I felt sick. I
went to an officer and asked to see a doctor. I clearly said “Dottor”
several times and I am sure he understood, but he just waved me away.
In Lampedusa we got two meals a day, not from the officers but from an
organisation. We had to eat on the floor. The people serving the food
were wearing gloves and masks to cover their nose and mouth. I don’t
know if the meals were halal.
We got to
Lampedusa on Wednesday (NOTE: 2 June). On Saturday they brought us to
Crotone. We only got breakfast after the trip: water, pasta, a piece
of bread and meat.
In Crotone they
took our fingerprints and gave us papers to sign. There was a Maroccan
girl, a translator. I asked her many times what the papers were, but
she told me to be silent (NOTE: I saw the papers, they are an
expulsion order). She only asked us where we wanted to go in Italy:
Rome, Milan, Napoli. I said Rome and they stuck a card on my shirts
with the destination. Then they gave me a ticket and brought me to the
de Médecins Sans Frontières Belgique - Laetitia Schul
Frontières en Belgique a entre autre, trois projets qui ont pour
objectif d’assurer un accès aux soins de santé. Notamment grâce à un
soutien gratuit médical, social et psychologique pour notamment des
demandeurs d’asile et des personnes en séjour illégal.
Bien que la
Belgique possède un système de sécurité sociale élaboré, les problèmes
d’exclusion sociale et en particulier d’exclusion des soins de santé
sont toujours présents.
réfugiés comme pour les illégaux, il existe en Belgique une
possibilité théorique d’accès aux soins. Malheureusement, il faut
constater que dans la pratique cet accès est souvent très
problématique. Les obstacles pour obtenir l’accès aux soins sont
nombreux : la complexité, la diversité et la longueur des procédures
administratives, le flou des dispositions légales et la méconnaissance
de celle-ci par les acteurs de terrain, le manque d’informations des
patients sur leurs droits, etc.
soignantes sont confrontées quotidiennement à la souffrance
psychologique des réfugiés et illégaux qui viennent à nos
consultations. Dans ce parcours du combattant en vue d’une vie
meilleure, les personnes sont soumises à de multiples facteurs de
stress extrêmes et chroniques (fuir son pays, quitter sa famille,
l’isolation sociale dans le nouveau pays « d’accueil », la police,
l’avenir incertain, …). Tout cela génère de sérieux troubles
« Je ne
peux pas vivre dans l’ombre encore longtemps. Sans papiers, on ne se
sent pas vivant » m’a dit une patiente.
Le simple fait
de ne pas avoir de papiers fait que la personne n’est pas reconnue par
la société dans laquelle elle vit. Si la personne n’existe pas pour
l’Etat, elle ne peut pas se développer et faire valoir ses droits
fondamentaux. Il est impossible pour une personne sans papiers
d’avoir un accès à un logement, à un travail, à une éducation dans le
Dans un contexte
social et politique qui met à mal la santé mentale, nous appliquons et
défendons une approche globale de la santé. Ainsi, le soutien
psychologique s’intègre dans les stratégies d’accès aux soins. Car
nous pensons qu’il n’y a pas de santé sans santé mentale.
parler de dignité, sans identité et sans droits.
patients, nous voyons beaucoup de personnes sans domicile fixe et sans
Selon nous c’est
une population très vulnérable.
nous pensons que ce sera un challenge pour tout le monde d’intégrer
cet aspect multiculturel.
SMES Statements of
8th SMES Seminar in Prague
GENERAL OBSERVATIONS I
Health is substantially
dependant on socio-economic status. Those at the lower end of
the poverty spectrum are much mort likely to experience chronic
Homelessness is not a
unique and separate category but is the final stage in a process
and social exclusion
Some of the most
socially marginalised and excluded are illegal immigrants, who
often have no legal rights to any state provision.
Legal rights need to be both:
I don’t think this adds anything - you
can’t guarantee a legal right. It is either there or not,
implemented or not.
Services should engage
with the socially excluded person as a whole person, not just as
a “sick” part
The different types of
homelessness must be acknowledged and solutions tailored to the
needs of each group
should be set for the training of professionals.
GENERAL OBSERVATION II
EXCHANGE of information is
needed between services for socially excluded people, for:
To enable rapid dissemination of good practice
problem of social exclusion is multi-national, this exchange
should be multi-national
other services are developed, street level services are needed
to ensure access for rough sleepers, the most vulnerable and
preferably informed by practitioners, is needed to clarify
problems and to influence policy.
different professions involved in working with marginalised
people have individual practices and values. Active efforts
need to be made to ensure that these do not interfere with the
service to the client
issue is the frequent problems in joint working between health
and social services
efforts need to be made to bridge the gaps between different
parts of services within professional sectors, eg between
hospital and community services.
A range of
accommodation solutions must be developed to address the
different needs of different groups of homeless people
solutions need always to be considered as part of a
a way to protect homeless people from risk
one aspect of belonging to a local community
market should be used, where possible, as an inclusive
however, be recognised that the liberal labour market based on
competition will generate socially excluded groups of people
needs to be given to:
- Exploring opportunities
within the existing job market
Creating multiple labour markets
work and school systems need to take the initiative in
identifying & helping children with problems earlier rather
Professionals (doctors, nurses and SWs) should be trained to
work with diverse populations, particularly with minorities
should be seen as a resource which can produce answers, not
just be helped
should participate in the training of professionals
should be encouraged to give, not just to receive
should be inclusive – by acknowledging users’ strengths
The decent society is one in which
the institutions and the
people do not humiliate
the person benefiting from their services... !
Pietà Rondanini, (unfinished) 1552-64
height: 195 cm Castello Sforzesco, Milan.
version, still unfinished at the artist's death.
Was probably begun not much later then 1555.
The unity between
Mother and Son is even more intimate.
It is almost impossible to
tell whether it is the Mother supporting the Son, or the Son supporting the
Mother, overcome by despair.
Both are in need of help, and
both hold themselves up in the act of invocation and lament before the world
Place Albert Leemans 3
1050 Brussels - Belgium
Tel/Fax: +32 2 538 58 87 -