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1 N 19 International Migration Law Migration and the Right to Health: A Review of International Law

2 N 19 International Migration Law Migration and the Right to Health: A Review of International Law Compiled and edited by Paola Pace

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4 TABLE OF CONTENTS Migration and the Right to Health: A Review of International Law FOREWORD...vii ACKNOWLEDGMENTS...ix ABBREVIATIONS...xi INTRODUCTION... 1 I. MIGRATION HEALTH IN THE INTERNATIONAL CONTEXT Health Across Centuries and the Right to Health The Right to Health in the Context of Migration Migration and the Protection Offered by International Law Conclusions II. INTERNATIONAL INSTRUMENTS II.1 GENERAL INTERNATIONAL INSTRUMENTS Universal Declaration of Human Rights (excerpts), International Covenant on Economic, Social and Cultural Rights (excerpts), CESCR General Comment No. 5: persons with disabilities (excerpts), CESCR General Comment No. 14: the right to the highest attainable standard of health (art. 12), International Covenant on Civil and Political Rights (excerpts), HRC General Comment No. 6: the right to life (Article 6), International Convention on the Elimination of all Forms of Racial Discrimination (excerpts), CERD General Recommendation XX on non-discriminatory implementation of rights and freedoms (Article 5), CERD General Recommendation XXX on discrimination against non citizens (excerpts), CERD General Recommendation XXVII on discrimination against Roma (excerpts), Declaration of Alma-Ata, II.2 SPECIFIC INTERNATIONAL INSTRUMENTS II.2.1 NON-NATIONALS CERD General Recommendation XI on non-citizens (Article 1), iii

5 CERD General Recommendation XXX on discrimination against non citizens, HRC General Comment No. 15: the position of aliens under the Covenant, HRC General Comment No. 31: the nature of the general legal obligation imposed on States parties to the Covenant, Declaration on the Human Rights of Individuals Who are Not Nationals of the Country in which They Live (excerpts), WHA61.17 Resolution Health of migrants, II.2.2 STATELESS PERSONS Convention relating to the Status of Stateless Persons, II.2.3 MIGRANT WORKERS International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families (excerpts), II ILO CONVENTIONS AND RECOMMENDATIONS Convention No. 97 concerning Migration for Employment (Revised 1949) (excerpts), Recommendation No. 86 concerning Migration for Employment (Revised 1949) (excerpts), Convention No. 143 concerning Migrations in Abusive Conditions and the Promotion of Equality of Opportunity and Treatment of Migrant Workers (excerpts), Recommendation No. 151 concerning Migrant Workers (excerpts), II.2.4 VICTIMS OF TRAFFICKING IN PERSONS Protocol to Prevent, Suppress and Punish Trafficking in Persons Especially Women and Children, supplementing the United Nations Convention against Transnational Organized Crime (excerpts), OHCHR Recommended Principles and Guidelines on Human Rights and Human Trafficking (excerpts), II.2.5 CIVILIAN PERSONS IN TIME OF ARMED CONFLICTS Geneva Convention (IV) relative to the Protection of Civilian Persons in Time of War, Protocol Additional to the Geneva Conventions of 12 August 1949, and relating to the Protection of Victims of International Armed Conflicts (Protocol I), iv

6 18. Protocol Additional to the Geneva Conventions of 12 August 1949, and relating to the Protection of Victims of Non-International Armed Conflicts (Protocol II), II.2.6 REFUGEES Convention relating to the Status of Refugees (excerpts), II.2.7 INTERNALLY DISPLACED PERSONS (IDPs) Guiding Principles on Internal Displacement (excerpts), II.2.8 DETAINEES Standard Minimum Rules for the Treatment of Prisoners (excerpts), Body of Principles for the Protection of All Persons under Any Form of Detention or Imprisonment (excerpts), Basic Principles for the Treatment of Prisoners (excerpts), United Nations Rules for the Protection of Juveniles Deprived of their Liberty (excerpts), UNHCR Revised Guidelines on Applicable Criteria and Standards relating to the Detention of Asylum Seekers (excerpts), II.2.9 INDIGENOUS PEOPLES Convention No.169 concerning indigenous and tribal peoples in independent countries (excerpts), United Nations Declaration on the Rights of Indigenous Peoples (excerpts), II.2.10 WOMEN Convention on the Elimination of All Forms of Discrimination against Women (excerpts), CEDAW General Recommendation No. 14: female circumcision, CEDAW General Recommendation No. 15: avoidance of discrimination against women in national strategies for the prevention and control of acquired immunodeficiency syndrome (AIDS), CEDAW General Recommendation No. 18: disabled women, CEDAW General Recommendation No. 21: equality in marriage and family relations, CEDAW General Recommendation No. 24: women and health (Article 12), CEDAW General Recommendation No. 26: women migrant workers (excerpts), v

7 II.2.11 CHILDREN Convention on the Rights of the Child (excerpts), CRC General Comment No. 3: HIV/AIDS and the rights of the child, CRC General Comment No. 4: adolescent health and development in the context of the Convention on the Rights of the Child, CRC General Comment No. 6: treatment of unaccompanied and separated children outside their country of origin, Optional Protocol to the Convention on the Rights of the Child on the sale of children, child prostitution and child pornography (excerpts), Optional Protocol to the Convention on the Rights of the Child on the involvement of children in armed conflict (excerpts), World Declaration on the Survival, Protection and Development of Children, World Medical Association, Declaration of Ottawa on the Right of the Child to Health Care, II.2.12 ELDERLY PERSONS United Nations Principles for Older Persons (excerpts), II.2.13 PERSONS WITH DISABILITIES CESCR General Comment No. 5: persons with disabilities, 1994 (see section II.1) CEDAW General Recommendation No. 18: disabled women, 1991 (see section II.2.10 Women) Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care, The Standard Rules on the Equalization of Opportunities for Persons with Disabilities (excerpts), Convention on the Rights of Persons with Disabilities, RATIFICATIONS SELECTED BIBLIOGRAPHY INDEX STORIES vi

8 FOREWORD Migrants are often among the most disadvantaged and marginalized human beings on our planet. While the core motivation for migration is usually the pursuit of a better life, migrants often experience profound, systemic challenges to their physical, mental, and social well-being. They often face separation from their families, unfamiliar social and cultural norms, language barriers, appalling living standards, exploitative working conditions, as well as discriminatory access to health-related services. Migrants are precisely the sort of disadvantaged group that international human rights are designed to protect. International human rights recognize the enjoyment of the highest attainable standard of health as a fundamental human right of every individual, regardless of race, religion, political belief, economic or social condition, and immigration status. The right to the highest attainable standard of health does not exclusively belong to nationals or migrants in a regular situation. Just as a migrant who is charged with a criminal offence should not be denied his or her right to a fair trial, equally sick migrants should not be denied their human right to medical care without discrimination. There are many reasons for not discriminating against a migrant who needs medical care: ethical, humanitarian, public health, economic and human rights. But the right to health is not confined to medical care; it also extends to access to safe water and adequate sanitation, and other underlying determinants of health. The right to the highest attainable standard of health has national and international dimensions. It places duties on States in relation to individuals within their jurisdictions. Second, those in a position to assist have a human rights responsibility of international assistance and cooperation in health. In other words, high-income countries have a human rights responsibility to provide international assistance and cooperation in health to developing countries. Health-related rights, including the right to health, are recognized in numerous international instruments (as well as many national constitutions and statutes). Similarly, there is no single comprehensive international instrument protecting the rights of all those who migrate; their rights are recognized in several instruments and branches of international law. By consolidating and exploring the general and specific instruments that recognize and define the right to health, with a focus on migrants, this timely publication is an invaluable resource for those who seek to have a better understanding of the current state of international law concerning the right to health and its application to migrants. vii

9 Of course, the key challenge remains implementation of the law by way of policies, programmes and projects that are respectful of the human rights of all, including migrants. This publication is very warmly welcome as an important step in that direction. Professor Paul Hunt United Nations Special Rapporteur on the right to the highest attainable standard of health ( ) viii

10 ACKNOWLEDGMENTS Migration and the Right to Health: A Review of International Law The author would like to thank Richard Perruchoud, Director of the International Migration Law and Legal Affairs Department of IOM, and Danielle Grondin, former Director of the Migration Health Department of IOM, for making this publication possible. The assistance of Alexandre Devillard with Part I, 3.1 and Part II.2.5 was invaluable, along with indispensible comments from Jillyanne Redpath, Jacqueline Weekers, and Monica Halil. Naomi Uliel, Helen Rachel Armstrong, Jennifer Wyeth, Radiyah Tayob, Joanna Ghosh and Sam Shapiro also provided greatly appreciated support. In addition, the colleagues who collected real life situations should be thanked for their precious contributions. They are: Elizabeth Barnhart and Scott Kinkelaar; Christian Mommers; Rosilyne Borland and Ana Beatriz Fernandez; Islene Araujo; Jaime Calderon, Sandanila Fatharani, Teresa Zakaria, Jihan Labetubun and Muhammad Ali Marikar Sahib; and Sikhulile Ngqase. Additionally, the author is grateful to Mariette Grange, board member of December 18; Christoph Bierwirth from the UNHCR; Carla Edelenbos and Juana Sotomayor Davila from the OHCHR; Lee Swepston, Yun Gao and Ilise Feitshans from the ILO for their essential comments. Finally, warm thanks go to Chidi Okoye for authorizing the use of his vivid painting healing dance for the cover and to Carmelo Torres for his layout. Paola Pace Geneva, 2009 ix

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12 ABBREVIATIONS Migration and the Right to Health: A Review of International Law CEDAW CERD CESCR CMW CRC CRPD CRSSP Convention on the Elimination of All Forms of Discrimination against Women / Committee on the Elimination of Discrimination against Women Committee on Elimination of Racial Discrimination Committee on Economic, Social and Cultural Rights Committee on the Protection of the Rights of All Migrant Workers and Members of their Families Convention on the Rights of the Child / Committee on the Rights of the Child Convention on the Rights of Persons with Disabilities Convention relating to the Status of Stateless Persons C 97 Convention No.97 concerning Migration for Employment (Revised) C 143 Convention No.143 concerning Migrations in Abusive Conditions and the Promotion of Equality of Opportunity and Treatment of Migrant Workers C 169 Geneva Convention IV HRC ICCPR ICERD ICESCR ICRMW Convention No.169 concerning Indigenous and Tribal Peoples in Independent Countries Geneva Convention relative to the Protection of Civilian Persons in Time of War Human Rights Committee International Covenant on Civil and Political Rights International Convention on the Elimination of All Forms of Racial Discrimination International Covenant on Economic, Social and Cultural Rights International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families xi

13 ILO IOM OHCHR OP-CRC-AC OP-CRC-SC Protocol I Protocol II Refugee Convention International Labour Organization International Organization for Migration Office of the High Commissioner for Human Rights Optional Protocol to the Convention on the Rights of the Child on the Involvement of Children in Armed Conflict Optional Protocol to the Convention on the Rights of the Child on the Sale of Children, Child Prostitution and Child Pornography Protocol Additional to the Geneva Conventions relating to the Protection of Victims of International Armed Conflict Protocol Additional to the Geneva Conventions relating to the Protection of Victims of Non-international Armed Conflict Convention relating to the Status of Refugees Trafficking in Protocol to Prevent, Suppress and Punish Trafficking Persons Protocol in Persons, Especially Women and Children, supplementing the United Nations Convention against Transnational Organized Crime UN UNAIDS UNHCR UNICEF WHA WHO United Nations Joint United Nations Programme on HIV/AIDS United Nations High Commissioner for Refugees United Nations Children s Fund World Health Assembly World Health Organization xii

14 INTRODUCTION Migration and the Right to Health: A Review of International Law Health will finally be seen not as a blessing to be wished for but as a human right to be fought for. Kofi Annan 1 At least in the case of public health, the best science (that is the knowledge that most effectively meets essential needs related to the health of human populations) springs from and is guided by an activist commitment to work with disadvantaged communities in realizing the economic and social rights. Paul Farmer 2 No one stands so high as to be above the reach of their authority. No one falls so low as to be below the guard of their protection. Sergio Vieira de Mello 3 In view of the increase in global movement and the health implications migration 4 has for both migrating persons and host communities, it has become important to define the legal parameters of migration health. 5 Neglecting inequities in health status and health prevention, care and support for migrating populations versus that of the host population, can be costly for all the actors involved. Currently, there is no comprehensive legal instrument at the international level establishing a legal framework for the governance of migration. However, several international instruments have important implications for the rights of those who migrate, including their right to health. These instruments are spread across different areas, such as human rights law, labour law, refugee law and international humanitarian law. Human rights 1 Kofi Annan served as the seventh Secretary-General of the UN from 1 January 1997 to 1 January Paul Farmer is the Presley Professor of Medical Anthropology in the Department of Social Medicine at Harvard Medical School; Associate Chief of the Division of Social Medicine and Health Inequalities at Brigham and Women s Hospital; and cofounder of Partners In Health. 3 Sergio Vieira de Mello joined the UN in He spent the majority of his career working for the UNHCR in Geneva. He briefly held the position of Special Representative of the Secretary-General in Kosovo and also served as UN Transitional Administrator in East Timor. On 12 September 2002 he was appointed United Nations High Commissioner for Human Rights. In May of 2003, he was asked by the Secretary-General to take a four month leave of absence from his position as High Commissioner to serve in Iraq as Special Representative of the Secretary-General. It was there that he was tragically killed on 19 August 2003, 4 Migration is a process of moving, either across an international border, or within a State. It is a population movement, encompassing any kind of movement of people, whatever its length, composition and causes; it includes migration of refugees, displaced persons, uprooted people, and economic migrants. Glossary on Migration, International Migration Law Series, IOM, Migration health is a state of complete physical, mental and social well-being of those who migrate and host society, and not merely the absence of disease or infirmity. IOM applies the concept of health originally developed by the World Health Organization (WHO) to define migration health. See Migration Health Annual Report 2006, IOM, Geneva,

15 law is at the core of this protection. Knowledge of relevant norms is a necessary first step towards the application of such laws. The present study concerns the heterogeneous group of individuals involved in the migration process. They include: migrants, 6 be they in a regular or an irregular situation including the victims of smuggling, 7 or intending a long or short term stay; victims of trafficking in persons; 8 asylum seekers; 9 refugees; 10 displaced persons 11 and others in need of international protection and assistance. Collectively, all these categories of individuals are referred to, in this publication, as migrating persons. The objective of this publication is primarily to promote respect by the State for the right to health for those who migrate. Secondly, the publication aims more generally at guiding health and legal practitioners, students, academics, and those migrating themselves through the myriad of norms and principles contained in international instruments impacting on migrating persons right to health. It includes both binding and non-binding instruments, or excerpts thereof. A short definition of the instruments legal 6 At the international level, no universally accepted definition of migrant exists. The term migrant is usually understood to cover all cases where the decision to migrate is taken freely by the individual concerned for reasons of personal convenience and without intervention of an external compelling factor. This term therefore applies to persons, and family members, moving to another country or region to better their material or social conditions and improve the prospects for themselves or their family. Glossary on Migration, loc. cit. n Victims of smuggling are individuals who are victims of the crime of smuggling of migrants. Smuggling is the procurement, in order to obtain, directly or indirectly, a financial or other material benefit, of the illegal entry of a person into a State Party of which the person is not a national or a permanent resident (Art. 3(a), UN Protocol Against the Smuggling of Migrants by Land, Sea and Air, supplementing the UN Convention against Transnational Organized Crime, 2000). Smuggling contrary to trafficking does not require an element of exploitation, coercion, or violation of human rights. Glossary on Migration, loc cit. n Victims of trafficking are individuals who are victims of the crime of trafficking in persons. Trafficking is the recruitment, transportation, transfer, harbouring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation (Art. 3(a), UN Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children, Supplementing the UN Convention Against Organized Crime, 2000). 9 Asylum seekers are persons who have left their country of origin seeking safety from persecution or serious harm, have applied for asylum in another country, and are awaiting a decision on their application. They hope to obtain refugee status or protection on other humanitarian grounds in order to benefit from the legal protection and material assistance which is an automatic part of such protection. If the application is rejected after consideration and after all possible appeals, the applicant s right to asylum is dismissed and the State usually tries to remove or deport them, sometimes after detention. Not every asylum-seeker is a refugee, but every refugee is initially an asylum-seeker. See Glossary on Migration, loc cit. n. 4 and Master Glossary of Terms, UNHCR, June A refugee is a person who meets the eligibility criteria under the applicable refugee definition, as provided for in international or regional refugee instruments, under UNHCR s mandate, and/or in national legislation. 11 Displaced persons broadly refers to persons who have not necessarily been exposed individually to persecution but have been forced to leave their homes and communities as a result of generalized violence, armed-conflict situations, or other man-made disasters. This category includes persons who are externally and internally displaced. 2

16 force and effect precedes the excerpts. There is a brief introduction on migrating persons right to health and its international protection guaranteed by the various norms applying to those who migrate. The instruments are divided into two sections: general and specific. The first section includes relevant human rights instruments whose guarantees are not reserved for nationals or a specific group of people, but apply to all individuals, nationals and non-nationals alike. The second section examines the right to health of specific categories of individuals involved in the migration process. Finally, considering the importance of the application de iure and de facto of the human rights norms which, as aforesaid, are at the core of migrating persons protection, examples of compliance or non-compliance by States with relevant articles of human rights instruments have been added in Part II. Such examples have been extracted from the UN Treaty Bodies concluding observations relating to various country reports. All documents are in the official English version together with citations of their original source. The reader is, however, encouraged to consult the original text for any details or updates on the status of each instrument. Finally, any act of selection is by definition subjective and considering the multitude of legal norms relating to the international movement of people, 12 it is impossible to be comprehensive. The desire of the author, however, is to acquaint the reader with the various international instruments relating to right to health of those who migrate with the aim of encouraging him or her to carry the research forward. 12 International Migration Law draws together the norms governing the legal relationships between States and those between States and individuals vis-à-vis movement of persons. It is an umbrella term for an area of law that has developed over time and indeed, continues to develop. For a comprehensive list of international instruments, see Compendium of international migration law instruments, edited by Richard Perruchoud and Katarίna Tömolövà, Asser Press,

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18 I. MIGRATION HEALTH IN THE INTERNATIONAL CONTEXT 5

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20 1. Health Across Centuries and the Right to Health 1.1 The Concept of Health The word health shares its etymology with hale, heal and whole. All come from the Old English hal. 13 From Aristotle to the preamble of the World Health Organization (WHO) Constitution, health has been understood as more than the absence of disease or infirmity, it is a highly-prized personal asset. However, although highlyvalued by the ancient Greek philosophers, health was mainly considered physical in character and granted only to some. The Latin phrase orandum est ut sit mens sana in corpore sano 14 refers to the extension of the concept of health to include mental health and well-being. Before Juvenal wrote in the 1 st Century A.D., Buddha was already referring to health for both body and mind in the 6th Century B.C.. With Christianity, health assumed a strong spiritual connotation and it was perceived as an asset for all rather than merely for a few. 15 In Judaism, human life and health are highly valued. Ritualistic eating proscriptions and personal hygiene practices underscores the notion that spiritual well-being is inextricably linked with the physical well-being of the Jewish people. 16 In Islam, health is placed as second only to faith. 17 The promotion and protection of health not only concerns one s self but also others and the environment. 18 A holistic and comprehensive approach to health must consider both mental and physical health, as well as social health. This approach recognizes the determinants of health as including socio-economic, cultural and environmental conditions as well as biological and genetic endowments. Finally, a holistic approach requires an effective and inclusive health system of good quality. It addresses preventive, curative and palliative 13 For the ancients, to be healthy or to be healed was to become whole, and being whole meant to be hale and healthy. When one is whole all the parts of one s being body, mind, soul are in perfect harmony. This is true for the individual as well as for the collective. When one of the parts becomes diseased so do all the others. In the past, the individual was considered as responsible for his/her health, wholeness and healing. 14 You should pray to have a sound mind in a sound body, Juvenal ( A.D.), Satires, x, B. C. A. Toebes, The Right to Health as a Human Right in International Law, Antwerp/Groningen/ Oxford, INTERSENTIA, 1999, p See F. Rosner, Judaism and Medicine: Jewish Medical Ethics in R. E. Ashcroft, et al. (eds.), Principles of Health Care Ethics, 2nd ed. 2007, p.110 and Global Health and Wellness: A Response to International Health Threats: When the Right to Health and the Right to Religion Conflict: A Human Rights Analysis, in Michigan State Journal of International Law, Volume 12, 2004, p M.H. Al-Khayat, Health as a Human Right in Islam, (The Right Path to Health: Health Education Through Religion; 9), WHO, Regional Office for the Eastern Mediterranean, See also M. A. Baderin, International Human Rights and Islamic Law, Oxford University Press, Ibidem. 7

21 efforts, as health care is a determinant of the health of the population it serves, including vulnerable groups. 19 The WHO Constitution defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. 20 In spite of many attempts to find an alternative narrower definition of health, the WHO definition is the accepted starting point for further elaboration of the right to health in international, regional and national instruments. This definition focuses on the integration rather than contradiction of two concepts: one negative (absence of disease or infirmity) and one positive (promotion of human well-being). These two integrated concepts are necessary and relevant to conditions such as disease and well-being, which are not easily separable. 21 Additionally, the extensive definition of health contained in the Preamble to the WHO Constitution clearly shows the path to follow. In fact, it also takes into consideration mental and physical health, addresses preventive and curative health efforts, and refers to the responsibility of States for the health of those in their territory or subject to their jurisdiction, to non-discrimination, to maternal and child health, and to information and participation of the public. 19 See E. Nolte, M. McKee and J. Pomerleau, The Impact of Health Care on Population Health, Section I, Chapter 5, in J. Pomerleau and M. McKee (eds.), Issues in Public Health, 2005, pp Constitutions of International Organizations are multilateral agreements according to public international law; therefore the WHO Constitution is binding upon States that are party to that Constitution. Consequently, these States have to comply with the right to health as set out in the Preamble to the WHO Constitution. The Preamble of the WHO Constitution states the following: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, political belief, economic or social condition. The health of all peoples is fundamental to the attainment of peace and security and is dependent upon the fullest co-operation of individuals and States. The achievement of any State in the promotion and protection of health is of value to all. Unequal development in different countries in the promotion of health and control of disease, especially communicable disease, is a common danger. Healthy development of the child is of basic importance; the ability to live harmoniously in a changing total environment is essential to such development. The extension to all peoples of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health. Informed opinion and active co-operation on the part of the public are of the utmost importance in the improvement of the health of the people. Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, No. 2, p. 100) and entered into force on 7 April A new draft of the preamble s first sentence includes the dynamic nature of the state of well-being including also the spiritual aspect. 21 See P. Benciolini, Il diritto alla salute, in Pace, diritti dell uomo, diritti dei popoli, 1988, p

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