Δευτέρα, 21 Ιανουαρίου 2013

18ΑΝΩ -Κ.ΜΑΤΣΑ: μια γιατρός που τιμά τον όρκο της/ αναδημοσίευση ενός συγκλονιστικού άρθρου..


 
18 ΑΝΩ: Όχι «ομερτά», κ. Υπουργέ. Θεραπεία

 Καταγγελίες και δημοσιεύματα «έγκριτων» ΜΜΕ...
 
Της Μαρινίκης Αλεβιζοπούλου

Σοβαρές κατηγορίες εναντίον της Μονάδας Απεξάρτησης 18ΑΝΩ ήρθαν προ ημερών στη δημοσιότητα. Όμως τα γεγονότα είναι διαφορετικά από όσα υποστήριξαν τα ΜΜΕ. Και τα πραγματικά αυτά γεγονότα δεν δείχνουν παραπτώματα στη λειτουργία της επιστημονικά έγκυρης Μονάδας Απεξάρτησης αλλά μια συντονισμένη επίθεση, με αρωγό τα φίλια ΜΜΕ, εναντίον όσων αντιστέκονται στην πολιτική του υπουργείου Υγείας να καταργήσει τα «κλειστά» προγράμματα κοινωνικής επανένταξης και να τα αντικαταστήσει με την χορήγηση υποκαταστάτων.

Για «κλοπιμαία» που βρέθηκαν στη Μονάδα Απεξάρτησης 18 ΑΝΩ έκαναν λόγο τηλεοπτικές εκπομπές και δημοσιεύματα του Τύπου, προ ημερών, καλώντας το κοινό να μπει σε υποψίες για την εντιμότητα ενός από τους πιο καταξιωμένους και ευυπόληπτους φορείς στον χώρο της δημόσιας υγείας.

Το δημοσίευμα του Βήματος, λόγου χάρη, στις 7 Απριλίου, είχε τίτλο «Εισαγγελική έρευνα για κλοπιμαία στο 18 ΑΝΩ – Αφορά σάκους που προέρχονταν από το πλιάτσικο της 12ης Φεβρουαρίου». Από το άρθρο της αρμόδιας συντάκτριας για το υπουργείο Υγείας, Έλενας Φυντανίδου, μάθαμε ότι το θέμα είχε ανακύψει μόλις πριν κάποιες ώρες, ύστερα από σχετική αναφορά του δημοσιογράφου Ιορδάνη Χασαπόπουλου, στην πρωινή ενημερωτική εκπομπή «MEGA Σαββατοκύριακο».

Σύμφωνα με αυτό και άλλα παρόμοια δημοσιεύματα, η υπόθεση είχε ως εξής: Νοσηλεύτρια του δημόσιου, «στεγνού» (άνευ υποκαταστάτων) και «κλειστού» (εθελοντική επικέντρωση στη θεραπεία, χωρίς περισπασμούς από εξωτερικούς παράγοντες) προγράμματος απεξάρτησης, είχε καταγγείλει εγγράφως στον διοικητή του Ψυχιατρικού Νοσοκομείου Αττικής, όπου υπάγεται το 18 ΑΝΩ, τον εντοπισμό «κλοπιμαίων στην μονάδα απεξάρτησης που προέρχονταν από το πλιάτσικο στα λεηλατημένα καταστήματα της Αθήνας».

Σύμφωνα, μάλιστα, με τις ίδιες καταγγελίες, «η υπεύθυνη του προγράμματος (σ.σ.: άνευ ονόματος) εφέρετο να έχει καλέσει, στη συνέχεια, γιατρούς και νοσηλευτικό προσωπικό να δώσουν όρκο τιμής ότι δεν θα αποκαλυφθεί το περιστατικό». «Ομερτά», όπως καταλόγισαν στη συνέχεια άλλα δημοσιογραφικά site – μολονότι κανένας από τους αποκαλυπτικούς αυτούς δημοσιογράφους δεν το έκρινε σκόπιμο να μπει στον κόπο να ζητήσει εξηγήσεις από οποιονδήποτε υπεύθυνο του προγράμματος.

Για την «ομερτά» ο ίδιος ο υπουργός Υγείας Ανδρέας Λοβέρδος μας ενημέρωσε μέσω ανακοίνωσης την ίδια κιόλας μέρα –για την ακρίβεια λίγες ώρες μετά την εκπομπή του Σαββάτου– ότι διατάχθηκε ΕΔΕ «με το ερώτημα της παύσης κάθε υπευθύνου», ενώ επιβεβαίωσε την προαναγγελθείσα από την δημοσιογράφο εισαγγελική έρευνα «για το ποιοι φιλοξενούνται εκεί μέσα και ποιοι είναι αυτοί, γιατί είναι τέσσερα συγκεκριμένα άτομα, ποιοι κάνουν το πλιάτσικο, ποιοι χτυπάνε, τρομοκρατικές ομάδες, τελοσπάντων…».

Οι εξηγήσεις που δεν ζητήθηκαν

Η άνευ ονόματος αναφερόμενη στα δημοσιεύματα επιστημονική υπεύθυνη του 18 ΑΝΩ, είναι στην πραγματικότητα η διευθύντριά του και είναι κάτι παραπάνω από γνωστή – και σίγουρα στην πλειοψηφία των δημοσιογράφων, τουλάχιστον αυτών που συνδέουν την έννοια της δημοσιογραφίας με το ρεπορτάζ. Λέγεται Κατερίνα Μάτσα και είναι πρωτοπόρος στον τομέα της απεξάρτησης και της κοινωνικής επανένταξης Και ο υπουργός την ξέρει. Τον προειδοποιούσε παντοιοτρόπως, πολύ πριν την σημερινή κατάσταση, ότι η κρίση οδηγεί σε αύξηση της εξάρτησης και ότι οφείλουμε να στηρίξουμε ως κοινωνία πιο πολύ από ποτέ «τους ευαίσθητους δέκτες αυτής της συστημικής κρίσης, που οδηγεί στον κατακερματισμό του κοινωνικού ιστού, αρχίζοντας από τα πιο αδύναμα στοιχεία».

Σε πείσμα της αναμφίβολα ορθόδοξης δημοσιογραφικής πρακτικής των άλλων ΜΜΕ που βρίσκει τα στοιχεία με… μαγικό τρόπο, το UNFOLLOW απευθύνθηκε στην ίδια την επιστημονική υπεύθυνη και τη ρώτησε τι συνέβη.

«Κάποια παιδιά πήγαν στην πορεία της 12ης Φεβρουαρίου» μας απάντησε η Κ. Μάτσα «και επιστρέφοντας στον ξενώνα στον οποίο διαμένουν, βρήκαν πεταμένα στο δρόμο κάποια πράγματα –ρούχα και παπούτσια– και τα πήραν. Την επομένη το πρωί, τα ίδια τα παιδιά θεώρησαν ότι αυτή η πράξη τους σηματοδοτούσε πισωγύρισμα στον παλιό τρόπο ζωής, “ολίσθηση” στην πορεία της κοινωνικής επανένταξης, όπως λέγεται επιστημονικά, και έτσι αποφάσισαν μόνοι τους να μιλήσουν στους θεραπευτές τους. Από αυτούς ενημερώθηκε όλη η θεραπευτική ομάδα η οποία και το αντιμετώπισε όπως όφειλε: ως θεραπευτικό ζήτημα. Επομένως υπήρχε εξ’ ορισμού το ιατρικό απόρρητο και όχι οι “όρκοι σιωπής” ή “ομερτά”, όπως είπαν και έγραψαν. Είναι θεραπευτική αρχή το να μην ποινικοποιούμε τη θεραπεία, η οποία ούτως ή άλλως έχει τους κανόνες της και τις αρχές της».

Και τι συνέβη, ρωτήσαμε, με τα παιδιά που ενεπλάκησαν στο περιστατικό; «Έφυγαν» απάντησε «από τους ξενώνες και επέστρεψαν στο στάδιο της εμψύχωσης». Το θέμα, ωστόσο, όπως δηλώνει και η ίδια αλλά επιβεβαιώνουν και οι υπόλοιποι θεραπευτές συζητήθηκε σε όλες τις δομές και αναπτύχθηκε πολύ σοβαρός προβληματισμός για αυτό το πισωγύρισμα. «Και τα παιδιά που συμμετείχαν και εκείνα που φοβήθηκαν και δεν κατέβηκαν στη διαδήλωση, κατάλαβαν πολύ καλά το πώς, ενώ δίνεις τη μάχη της κοινωνικής επανένταξης, μπορεί κάποια στιγμή να ολισθήσεις στην παραβατικότητα. Κάποια μάλιστα από τα παιδιά που έκαναν το πισωγύρισμα, μέσα σε αυτούς τους μήνες που μεσολάβησαν, προχώρησαν τόσο στη θεραπεία τους, ώστε σήμερα να επιστρέφουν στον ξενώνα».

Το ζήτημα λοιπόν δεν προέκυψε από την κλειστή φάση του προγράμματος, όπως γράφτηκε στα ΜΜΕ, αφήνοντας να εννοηθεί ότι δίδεται «ειδική άδεια» από την επιστημονική υπεύθυνη για να συμμετέχουν τα παιδιά στις διαδηλώσεις. Προέκυψε από τους ξενώνες επανένταξης, στους οποίους ελεύθερα μετακινούνται οι διαμένοντες. Επίσης, το θέμα συζητήθηκε και στις τρεις επανεντάξεις του 18 ΑΝΩ (δύο ανδρών, μία γυναικών – χωρητικότητας περίπου 100 ανθρώπων) και από όλους τους θεραπευτές. Μάλλον δεν χρειάζεται πολύ μυαλό για να καταλάβει κανείς ότι αν θέλει κάποιος να κρατήσει κάτι μυστικό, δεν το κοινοποιεί σε… 100 άτομα.

Αυτά είναι τα γεγονότα: Όχι «ομερτά» αλλά ιατρικό απόρρητο, όχι «υπόθαλψη» αλλά θεραπευτική διαδικασία και συζήτηση μεταξύ των θεραπευτών.

Οι ακαριαίες αντιδράσεις των… αρχών

Μήπως, ωστόσο, έχει κάποια βάση ο ισχυρισμός πως το περιστατικό καταδεικνύει ότι το πρόγραμμα δεν λειτούργησε όσο αποτελεσματικά θα έπρεπε;

«Με βάσει τα διεθνή δεδομένα» λέει η Κ. Μάτσα «αναφορικά με τη σχέση τοξικομανίας και παραβατικότητας, όταν ένας τοξικομανής μπαίνει σε στεγνό πρόγραμμα έχει ένα 80% παραβατικότητα. Όταν φεύγει, η παραβατικότητα μηδενίζεται. Στην πορεία του προγράμματος μπορεί να έχεις κάποιες ολισθήσεις. Αυτές όμως, εφόσον παραμένει στο πρόγραμμα, αντιμετωπίζονται θεραπευτικά και όχι νομικά. Αυτό μετέδωσαν και οι παλαιότεροι θεραπευτές στους νεώτερους και όλοι τους έκαναν έξτρα συναντήσεις για το θέμα. Δεν πέρασε έτσι από το πρόγραμμα και ουδέποτε είπαμε ότι δεν θα αποκαλύψουμε πουθενά τι έγινε.

Το γεγονός όμως ότι δύο μήνες μετά, μία νοσηλεύτρια, η οποία ήταν και υπεύθυνη του ξενώνα, καταφεύγει στη νοσηλευτική υπηρεσία, χωρίς να έρθει σε επαφή ούτε με τον επιστημονικά υπεύθυνο της επανένταξης ούτε με εμένα, που είμαι η διευθύντρια του προγράμματος, και έπειτα απευθύνεται στον σύλλογο εργαζομένων του ΨΝΑ, λες και πρόκειται για συνδικαλιστικό ζήτημα και από εκεί στον διοικητή, μάλλον άλλα πράγματα δείχνει». Και γίνεται σαφέστερη: «Αυτό δείχνει αφενός ότι υπάρχει ένα σχέδιο να στιγματιστούν τα παιδιά.

Γιατί τους παίρνει όλους η μπόρα με χαρακτηρισμούς όπως “πλιατσικολόγοι” και “εγκληματίες”. Άντε τώρα να πάει ένα παιδί να ζητήσει δουλειά λέγοντας ότι τελείωσε το 18 ΑΝΩ. Μέχρι τώρα το έλεγαν με περηφάνια. Τώρα θα ντρέπονται. Επίσης σπιλώνει τους θεραπευτές οι οποίοι δίνουν την ψυχή τους. Είχα σκοπό να βγω στην τηλεόραση να δείξω τα εκκαθαριστικά τους. Αρχίζουν από 200 ευρώ το μήνα και το ανώτερο είναι στα 600 ευρώ. Πώς να μιλήσουμε όμως τώρα όταν ο δημόσιος διάλογος δαιμονοποίησε ολόκληρο το πρόγραμμα;».

Όσο για το τι πιστεύει για την έκβαση της υπόθεσης; «Είναι απαράδεκτη και πιστεύω ότι θα καταπέσει. Έχουμε αποδείξει τόσα χρόνια τι είμαστε ως πρόγραμμα. Ο κόσμος ξέρει τι προσφέρει το 18 ΑΝΩ».

Της ίδιας άποψης είναι και η δικηγόρος του προγράμματος, Ζωή Κωνσταντοπούλου, η οποία λέει για την προς διερεύνηση κατηγορία της «κλοπής» και της «υπόθαλψης εγκληματία», με την οποία βαρύνεται το πρόγραμμα: «Πρώτα απ’ όλα να ξεκαθαρίσουμε ότι σε καμία περίπτωση δεν πρόκειται για ποινικό αδίκημα. Το να βρεις στα σκουπίδια, στην άκρη του δρόμου, πεταμένα ρούχα και να τα πάρεις, δεν είναι κλοπή. Ο νόμος δεν προβλέπει κάτι τέτοιο. Δεν συμμετείχαν σε κανένα πλιάτσικο, τα βρήκαν στο δρόμο και τα πήραν. Μάλιστα μιλάμε και για αντικείμενα ευτελούς αξίας, ρούχα και παπούτσια. Από κει και πέρα, έχει ένα ενδιαφέρον το πώς διαβιβάστηκε ένα ήσσονος νομικής αξίας θέμα στην Εισαγγελία αλλά και το πόσο άμεσα ένα τμήμα, όπως αυτό του Αγίου Παντελεήμονα, το οποίο έχει ένα σωρό υποθέσεις να χειριστεί, έστειλε μέσα σε ελάχιστο διάστημα αστυνομικούς της Ασφάλειας σε άλλο ξενώνα του προγράμματος, γιατί είχαν, λέει, πληροφορίες ότι θα βρουν τα αντικείμενα. Ο χρόνος λοιπόν κατά τον οποίο ενήργησαν οι Αρχές, ύστερα από την καταγγελία που θυμήθηκε να κάνει η καταγγέλλουσα δύο μήνες μετά το συμβάν, έχουν από μόνα τους ένα ενδιαφέρον».

Όπως προκύπτει, πράγματι, από τη δική μας έρευνα, η καταγγελία της νοσηλεύτριας διαβιβάστηκε από τον ίδιο τον διοικητή του Ψ.Ν.Α. απευθείας στις εισαγγελικές αρχές, χωρίς πρώτα να ερευνήσει ο ίδιος μέσω εσωτερικής προκαταρκτικής έρευνας, ως φυσικός προϊστάμενος της διευθύντριας Κ. Μάτσα, αν πρώτα απ’ όλα η καταγγελία ήταν διερευνητέα.

Εντύπωση προκαλεί ότι ο διοικητής επέλεξε να θέσει σε κίνδυνο τη λειτουργία της ίδιας της υπηρεσίας υγείας, της οποίας προΐσταται, ενεργοποιώντας μια διαδικασία που κατέληξε σε αστυνομικούς να χτυπούν τις πόρτες των ξενώνων, διαταράσσοντας έτσι τις ευαίσθητες ισορροπίες όλων των θεραπευομένων και διακινδυνεύοντας ό,τι έχουν επιτύχει ως τώρα, και προκαλώντας δημοσιότητα δυσανάλογη με τις πραγματικές διαστάσεις του ζητήματος. Προφανώς, η κατ’ εξαίρεση αστραπιαία κινητοποίηση της εισαγγελίας και των διωκτικών αρχών, καθώς και η αναπόφευκτη μεγάλη δημοσιότητα, ήταν κατά την κρίση του διοικητή… μονόδρομος, για μια υπόθεση πεταμένων ρούχων.

Ο διοικητής του νοσοκομείου, παρεμπιπτόντως, διορίστηκε στο Ψ.Ν.Α. το καλοκαίρι, με εκείνη την περιβόητη μεταμεσονύχτια απόφαση του υπουργού Υγείας Ανδρέα Λοβέρδου, με την οποία αντικατέστησε όλους τους διοικητές νοσοκομείων. Είναι ο Όθωνας Χαραλαμπάκης, ο οποίος τυγχάνει και πρώην σύμβουλος του υπουργού Υγείας. Είναι διοικητής των νοσοκομείων «Δαφνί» και «Δρομοκαΐτειο». Όταν επικοινωνήσαμε μαζί του, σεβόμενος, όπως μας είπε, το γεγονός ότι η έρευνα βρίσκεται σε εξέλιξη, δεσμεύεται από τον εμπιστευτικό της χαρακτήρα και… δεν μπορεί να μας μιλήσει επ’ αυτής. Τα ερωτήματα γιατί δεν κάλεσε ποτέ την υφισταμένη του διευθύντρια για εξηγήσεις και γιατί δεν επέλεξε να ελέγξει πρώτα εσωτερικά την βαρύτητα των καταγγελιών, προστατεύοντας έτσι το ίδιο του το πρόγραμμα, προτού το παραδώσει βορά στα ΜΜΕ, διαβιβάζοντας μια καταγγελία για την οποία όφειλε να γνωρίζει πόση δημοσιότητα θα πάρει, μένουν αναπάντητα.

Ο υπουργός, οι «εξτρεμιστές» και τα «εύκολα» υποκατάστατα

Ο υπουργός Υγείας Α. Λοβέρδος και η διευθύντρια του 18 ΑΝΩ Κ. Μάτσα έχουν διαμορφωμένη «σχέση»: κατ’ εξοχήν πεδίο αντιπαράθεσής τους αποτελεί η πολιτική του υπουργείου υγείας σχετικά με την απεξάρτηση – καθώς η Κ. Μάτσα, που ευθέως πλήττεται από το ζήτημα που ανέκυψε, είναι μια από τις ηχηρότερες επικριτικές φωνές της πολιτικής του υπουργείου που προωθεί τα προγράμματα υποκαταστάτων και υπονομεύει τα «στεγνά».

«Ένας άνθρωπος που μπήκε στα ναρκωτικά» μας λέει η Κ. Μάτσα «δεν θα σταματήσει αν δεν αλλάξει ριζικά. Αυτό το παθητικό, άβουλο, ανασφαλές πλάσμα που είναι ο άνθρωπος στη χρήση, δεν μπορεί να σταματήσει παρά μόνο όταν μέσω της ψυχοθεραπείας καταφέρει να σηκώσει ανάστημα, να καταλάβει, να υπερασπιστεί τα δικαιώματά του και εντέλει να διεκδικήσει το δικαίωμά του στη ζωή. Οι εφαρμοζόμενες πολιτικές των υποκαταστάτων, όμως, αλλά και του ταυτόχρονου πολέμου στα στεγνά προγράμματα, αποδεικνύουν ότι κάποιοι δεν θέλουν τέτοιους ανθρώπους. Αλήθεια, προτιμούν να τους συντηρούν σε καταστολή με υποκατάστατα;»

Από το περασμένο καλοκαίρι, ο υπουργός από την πλευρά του αναφερόταν υπερηφάνως, από την ίδια εκπομπή του MEGA, στην κατάργηση «της λίστας της ντροπής του ΟΚΑΝΑ», μέσω του νέου προγράμματος χορήγησης μεθαδόνης από τα νοσοκομεία. Ίσως, μάλιστα, να αναφερόταν και στην Κ. Μάτσα όταν δήλωνε: «Τόσα χρόνια δεν προχωρούσαμε γιατί έχουμε στερεότυπα. Γιατί λέγαμε ότι για να χορηγήσουμε ένα υποκατάστατο πρέπει να έχουμε τρεις γιατρούς, δύο ψυχολόγους, δύο νοσοκόμες, τρία δωμάτια, τέσσερα κρεβάτια… Κάτσε ρε φίλε! Πώς θα τα φτιάξεις όλα αυτά;».

Και ο υπουργός Υγείας συνέχιζε: «Θα πας λοιπόν σ’ ένα ταχύρυθμο, εύκολο πρόγραμμα χορήγησης υποκαταστάτων σε πείσμα των εξτρεμιστών του χώρου. Γιατί το θέμα των ναρκωτικών το πληρώνουμε εξαιτίας των εξτρεμιστών του χώρου που επέβαλαν ότι όλα αυτά πρέπει να είναι τέλεια για να δώσεις ένα γραμμάριο». Υπενθυμίζοντάς μας δε τις προεκλογικές δηλώσεις του τότε ηγέτη της «Μεγάλης Δημοκρατικής Παράταξης», βάσει των οποίων «ακόμα και κατ’ οίκον θα το στέλνουμε προκειμένου να εξαλείψουμε τη λίστα της ντροπής», ο υπουργός Υγείας επεκτάθηκε στο παράδειγμα ενός πολυϊατρείου του ΙΚΑ όπου «ουδείς το παίρνει χαμπάρι διότι είναι μια συναλλαγή [sic] ενός ανθρώπου σαν κι εμάς που πάει με το αυτοκίνητο ή τη μηχανή του, παίρνει το υποκατάστατό του και πάει στη δουλειά του». (Η ίδια εκπομπή έχει προσφέρει κι άλλοτε φιλόξενο βήμα στην έκφραση εκτίμησης του Α. Λοβέρδου για τον Γ. Παπανδρέου. Εκεί είχε δηλώσει και το περίφημο «Θα γίνει μακελειό αν πειράξει κανείς τον Παπανδρέου…», θέλοντας να αποτρέψει το ενδεχόμενο πιθανής δίωξης του τέως πρωθυπουργού για την διόγκωση του ελλείμματος της χώρας.)

Η απάντηση της Κ. Μάτσα ήταν άμεση, λίγες ημέρες μετά την συνέντευξη Τύπου που παραχώρησε ο Υπουργός το καλοκαίρι, εξαγγέλλοντας το πρόγραμμα υποκαταστάτων και το κλείσιμο δομών του ΟΚΑΝΑ: «Από κυβερνητικούς κύκλους προωθείται συστηματικά, με τη συνδρομή, μάλιστα, τηλεοπτικών εκπομπών υψηλής τηλεθέασης, η αντίληψη ότι η τοξικομανία αποτελεί “χρόνια ανίατη νόσο”, που η θεραπεία της συνίσταται στη χορήγηση υποκατάστατων των ναρκωτικών, περίπου σαν την ινσουλίνη του διαβητικού! Μ’ αυτό τον τρόπο, ανάγοντας αυθαίρετα στην ιατρική παθολογία τον κοινωνικό βασικά χαρακτήρα του πολύπλοκου και πολυπαραγοντικού φαινομένου της τοξικομανίας, επιχειρείται η απενοχοποίηση της κοινωνίας και η άρνηση των αρμοδίων να αντιμετωπίσουν τους γενεσιουργούς παράγοντες».

Η «σχέση» τους δυναμιτίστηκε έτι περεταίρω με την εξαγγελία του υπουργείου τον Αύγουστο για σημαντική μείωση των δαπανών σε φορείς πρόνοιας και ψυχικής υγείας, καθώς ακολούθησαν μεγάλες κινητοποιήσεις από τους δημόσιους λειτουργούς και ασφαλώς και από την ίδια την επιστημονική υπεύθυνη του 18 ΑΝΩ. Και το ποτήρι μοιάζει να ξεχειλίζει ύστερα από την στοχοποίηση των τοξικοεξαρτημένων και την αύξηση των οροθετικών χρηστών. Σε συνέντευξη Τύπου μάλιστα της Ελληνικής Εταιρίας για το AIDS, στην οποία είχε παραβρεθεί και ο ίδιος ο υπουργός, ο πρόεδρός της Μάριος Λαζανάς είχε –μάλλον αυθαίρετα, σύμφωνα με την πλειονότητα των συναδέλφων του– δηλώσει ότι «υπάρχουν τοξικομανείς που θέλουν να κολλήσουν για να πάρουν το επίδομα της Πρόνοιας». Ο Α. Λοβέρδος με τη σειρά του δήλωσε συντετριμμένος από τα αποτελέσματα των ερευνών του ΚΕΕΛΠΝΟ, εξ ου και έσπευσε να προμηθευτεί 100 χιλιάδες καινούργιες σύριγγες ως μέσο προστασίας.

Σε ερώτηση του UNFOLLOW κατά τη διάρκεια εκείνης της συνέντευξης Τύπου τότε γιατί μειώνουν τις δαπάνες σε φορείς απεξάρτησης, η απάντηση συνοπτικά ήταν ότι ανοίγουν μονάδες χορήγησης υποκαταστάτων μέσα στα νοσοκομεία. Σε σχετικό ρεπορτάζ του UNFOLLOW#1 (Δεκέμβριος 2011), η Κ. Μάτσα είχε αναφέρει, μεταξύ άλλων: «Με τα προγράμματα αυτά, ανάγεται αυθαίρετα στην ιατρική παθολογία ο κοινωνικός χαρακτήρας της τοξικομανίας […] ενώ ταυτόχρονα το μήνυμα που περνάμε στην κοινωνία είναι ότι αυτά τα παιδιά είναι άρρωστα, ότι δεν θα γίνουν ποτέ καλά, οπότε ας φροντίσουμε να μη μας ενοχλούν και άρα πολύ. Δημιουργούμε εξιλαστήρια θύματα και αρνούμαστε να εξετάσουμε τις αιτίες».

Η υγεία της κρίσης

Ο υπεύθυνος του Κέντρου Πρόληψης Αχαρνών και πρόεδρος του Σωματείου Εργαζομένων Κέντρων Πρόληψης, Παναγιώτης Τριανταφύλλου, επιχειρεί να αποτυπώσει την πολιτική του υπουργείου Υγείας σε αριθμούς: «Οι μειώσεις που εξαγγέλθηκαν τον περασμένο Αύγουστο από το υπουργείο Υγείας σε όλες τις δαπάνες για την πρόληψη, την απεξάρτηση και την επανένταξη των χρηστών, βάσει των στοιχείων που συλλέξαμε από τις επαφές μας με τους αντίστοιχους συλλόγους εργαζομένων ήταν: – 44% για τα Νομικά Πρόσωπα Δημοσίου Δικαίου πρόνοιας, – 52% στις μονάδες ψυχικής υγείας, – 50% στα κέντρα πρόληψης, – 33% στον ΟΚΑΝΑ, – 20% στο ΚΕΘΕΑ. Δεν είμαστε εναντίον των παράλληλων προγραμμάτων υποκαταστάτων, αρκεί να μην επιλέγονται σε βάρος των στεγνών προγραμμάτων κοινωνικής επανένταξης.

Και σε αυτό το σημείο θα πρέπει να αναφέρουμε ότι καταργήθηκαν προγράμματα υψηλών προδιαγραφών του ΟΚΑΝΑ, στα οποία χορηγούνταν υποκατάστατα με την ανάλογη, ωστόσο, ψυχοκοινωνική υποστήριξη. Ο τρόπος, λοιπόν, με τον οποίο επενδύουν σε προγράμματα υποκαταστάτων, θυμίζει τον τρόπο με τον οποίο επενδύουν στην εκκαθάριση του κέντρου. Επενδύουμε στην καταστολή με την ευρεία έννοια. Κι εδώ έχουν μια ιδιαίτερη σημασία οι συμβολισμοί. Η λέξη “εξάρτηση” δεν χρησιμοποιείται τυχαία. Ο τοξικοεξαρτημένος, εξαρτάται από κάτι. Ο απεξαρτημένος είναι ανεξάρτητος. Έχει ελεύθερη βούληση. Το “υποκατάστατο” δεν θεραπεύει. Υποκαθιστά».

Ο Π. Τριανταφύλλου εμβαθύνει και στον ορισμό της τοξικοεξάρτησης που «κυριαρχεί», όπως λέει «στη συμβατική καθεστηκυία επιστημονική ιδεολογία, επενδυμένη με το κύρος της ψυχιατρικής». «Βάσει αυτού» εξηγεί «όπως ορίζεται στο εγχειρίδιο των διαγνωστικών κριτηρίων ψυχιατρικών διαταραχών DSM IV της Αμερικάνικης Ψυχιατρικής Εταιρείας, η τοξικοεξάρτηση είναι “αυτοπροκαλούμενη νόσος του εγκεφάλου, χρόνια και υποτροπιάζουσα”. Με τον όρο “νόσος”, δικαιολογούνται τα φάρμακα, τα υποκατάστατα δηλαδή.

Με τον όρο “αυτοπροκαλούμενη” υπονοείται ότι το ίδιο το άτομο φέρει την ευθύνη και άρα όχι η Πολιτεία. Από κοινωνικό φαινόμενο μετατρέπεται σε ατομικό και άρα απλώς πρέπει να φύγει από τη μέση για να μην ενοχλεί την υπόλοιπη κοινωνία. Με τον όρο δε “χρόνια”, δικαιολογείται η διαιώνιση του προβλήματος και όχι η λύση μέσω της κοινωνικής επανένταξης. Σε αυτή τη φιλοσοφία, την αμερικανική, κινείται και ο νέος νόμος περί ναρκωτικών και έχει ένα ενδιαφέρον το γιατί επελέγη η φιλοσοφία του αμερικανικού εγχειριδίου και όχι του διεθνούς, το οποίο ορίζει την εξάρτηση ως κοινωνικό φαινόμενο».

Υπάρχει, ωστόσο, ένα έστω και αδήλωτο αντεπιχείρημα της απέναντι πλευράς, το οποίο συνοψίζεται στην αναγκαιότητα της «λιτότητας» εν μέσω οικονομικής κρίσης. Ρωτάμε, συνεπώς: Είναι αλήθεια φθηνότερο το πρόγραμμα υποκαταστάτων σε σχέση με την απεξάρτηση και την κοινωνική επανένταξη; Ο υπεύθυνος του Κέντρου Mosaic του ΚΕΘΕΑ Δημήτρης Γιαννάτος απαντά: «Ακούγεται αρκετά προσφάτως ότι η μεθαδόνη κοστίζει μόλις 250 ευρώ τον χρόνο για το κάθε άτομο, ενώ τα έξοδα για τις μονάδες κοινωνικής επανένταξης είναι συγκριτικά πολύ υψηλότερα. Το ΚΕΘΕΑ πραγματοποίησε μία έρευνα την οποία έδωσε στη δημοσιότητα πριν λίγους μήνες, αναφορικά με το κόστος της εξάρτησης και τα οφέλη της θεραπείας. Από αυτήν προέκυπτε ότι η παραμονή και μόνο στη θεραπευτική κοινότητα, ανεξάρτητα από την τελική της έκβαση, έχει σημαντικά οφέλη για την κοινωνία.

Αλλά και καθαρά οικονομικά αν μιλήσουμε, η εξοικονόμηση προκύπτει από τη μείωση του κόστους των υπηρεσιών υγείας, δίωξης, απονομής της ποινικής δικαιοσύνης, σωφρονισμού καθώς και των άλλων εξόδων που προκύπτουν από τη ζωή στη χρήση και τις σχετιζόμενες με την εξάρτηση δραστηριότητες. Οι περικοπές της κρατικής επιχορήγησης στους οργανισμούς απεξάρτησης αυξάνουν μακροπρόθεσμα μεν, σημαντικά δε το δημοσιονομικό κόστος, δεδομένου ότι οι δαπάνες μεταφέρονται σε άλλους τομείς, όπως η δημόσια υγεία, το σύστημα ποινικής δικαιοσύνης κ.λπ.».

Ανακεφαλαιώνοντας, από μια «αποκάλυψη» που δεν αποκαλύπτει τίποτα, μια «ομερτά» που στην πραγματικότητα είναι ιατρικό απόρρητο, μια ταχύτατη αντίδραση αρχών που υπό άλλες συνθήκες θα απαιτούσε απείρως περισσότερο χρόνο και μάλιστα για μια υπόθεση ήσσονος νομικής σημασίας, η οποία προέκυψε από τον ασυνήθιστο ζήλο ενός διοικητή πρώην συμβούλου του υπουργού –και όλα αυτά υπό το φως μιας διαμάχης όπου σεβαστοί εκπρόσωποι της επιστημονικής κοινότητας αντιμάχονται την πολιτική του ίδιου υπουργού– τι είδους συμπέρασμα διαφαίνεται τελικά;

Η τεράστια αγωνία των αρχών και των ΜΜΕ για την «ολίσθηση» ορισμένων μελών ενός προγράμματος απεξάρτησης; Ή η απόπειρα σπίλωσης και δημόσιας διαπόμπευσης επιστημόνων που δεν κάμφθηκαν από τις κρούσεις περί «εξτρεμισμού» και συνέχισαν να διατρανώνουν την αντίθεσή τους σε μια πολιτική που διαθέτει ως μοναδικό επιχείρημα τη λιτότητα – ένα επιχείρημα που κι αυτό είναι λανθασμένο;

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Notebook21 Ιανουαρίου 2013 - 12:42 pm | Μαρινίκη Αλεβιζοπούλου

Kenya: Plans to force 55,000 refugees into camps

Unlawful Transfer Plan to Begin January 21, Could Provoke Conflict
Human Rights Watch Press release

January 21, 2013

The Kenyan authorities should halt their plan to forcibly move 55,000 registered refugees and asylum seekers from cities to overcrowded and underserviced refugee camps, Human Rights Watch said today.

Citing a number of grenade attacks in 2012, the authorities contend the move will improve Kenyan national security and lead to the return of Somali refugees to Somalia.

The plan would violate refugees’ free movement rights and would almost certainly involve the unlawful forced eviction of tens of thousands of refugees from their lodgings in the cities, Human Rights Watch said.
The longstanding humanitarian crisis in Kenya’s refugee camps also means the relocation would affect refugees’ ability to make a living and unlawfully reduce their access to adequate food, clothing, housing, health care and education.

“Kenya is using the recent grenade attacks to stigmatize all refugees as potential terrorists and to force tens of thousands of them into appalling living conditions in already severely overcrowded camps,”
said Gerry Simpson, senior refugee researcher and advocate for Human Rights Watch.

“The plan to forcibly transfer tens of thousands of people from the cities to camps is unlawful and will cause extreme hardship.”

In a December 13 news release, the Kenyan authorities said the transfer of urban refugees to the camps responds to a series of attacks in which unidentified people threw hand-grenades into crowds in various locations, killing and injuring a number of people, including police officers and soldiers.

On January 16, 2013 the Ministry of Provincial Administration and Internal Security wrote to the Ministry of Special Programs saying the first phase of “rounding” up refugees would “target” 18,000 people and would start on January 21.

The letter said they would be taken to Nairobi’s Thika Municipal Stadium, which would act as a “holding ground” pending transfer to the camps.

Organizations and lawyers working with refugees in Nairobi say that since December, police in Nairobi have arrested dozens of Somalis on spurious charges of belonging to terrorist organizations. All of those taken to court have been released for lack of evidence.

In May, Human Rights Watch reported on serious abuses by security officers in northern Kenya against civilians following some of the grenade attacks that killed security officers. In response to the report, the Kenyan military promised to end such violent reprisals and formed a committee to investigate the abuses.

Human Rights Watch is concerned that security forces would again use violence while arresting and forcibly transferring refugees to the camps.

The plan, if implemented, would violateKenya’s international and national legal obligations, Human Rights Watch said.

These obligations require Kenya to show that any free movement restrictions must be the least restrictive measure possible to address Kenya’s national security concerns.

Human Rights Watch’s June 2010 report,  
“Welcome to Kenya,” concluded that Kenya’s requirements that half a million refugees live in closed camps -- which only a few thousand may temporarily leave each year under special circumstances -- violated its legal obligations to guarantee refugees’ freedom of movement.

“Kenya’s plan to move 55,000 refugees into camps is clearly an unnecessary and disproportionate response to the recent attacks,”
Simpson said.
“Kenya should not just brand all refugees a security risk and walk all over the rights of 55,000 people.”

According to the United Nations High Commissioner for Refugees (UNHCR), at the end of 2012, 46,540 registered urban refugees were living in Kenya, including 33,246 Somalis. In addition, 6,832 registered urban asylum seekers from a variety of nationalities, including 447 Somalis, were living in Kenya.

On December 13, Kenya’s Department of Refugee Affairs (DRA) released a press statement to the news media announcing the authorities’ plan to “put in place a structure encampment policy” because of an “unbearable and uncontrollable threat to national security” caused by “grenade attacks in our streets, churches, buses and business places” that have “killed and … injured … many people.”

It said that all asylum seekers and refugees from Somalia in Kenya’s urban areas should move to the Dadaab refugee camps near the Somali border and that all urban asylum seekers and refugees from other countries should move to the Kakuma refugee camp, near the Sudan border.
It said thatregistration of asylum seekers and refugees in urban areas had been stopped, that all registration centers had been closed and thatUNHCR and other agencies serving asylum seekers and refugees should stop providing all direct services to refugees.

At a December 13 news conference, Kenya’s acting commissioner for refugee affairs, Badu Katelo, said that urban refugees’ and asylum seekers’ “documentation has ceased to function in the urban areas and if they will continue staying in the urban areas they will be staying illegally -- and that is a function of another department of government, probably police and immigration.”

Since December, UNHCR and other organizations have asked the Kenyan authorities for a copy of the directive on which the December 13 news media statement is based, but the authorities have refused to issue a copy.

Since the plan was announced, non-governmental organizations and refugee lawyers in Nairobi say the police in Nairobi have arbitrarily arrested hundreds of Somali nationals, most of whom have been released after paying hefty bribes.

Reports from the Somali Embassy in Kenya, airline companies and aid workers on the Kenya-Somali border near the Dadaab camps say that since December over a thousand Somalis have returned to their country every week, either by air or overland.
Some told aid workers in Somalia they left because they feared a crackdown against Somali refugees in Kenya.

Human Rights Watch has also received reports of a significant increase since late December in sexual violence against refugee women and girls in one of the Dadaab camps, “Ifo 2.”
A reliable source told Human Rights Watch that the police have failed to respond adequately to the attacks, which refugees say has led to a general fear of insecurity that has caused hundreds of refugees to leave the camps and cross into Somalia.
Others have relocated to the edge of other camps near Dadaab.

In 2010, Human Rights Watch reported on longstanding Kenyan police failures to investigate sexual violence in the Dadaab camps.

At the December 13 news conference, Commissioner Katelo said that the refugees’ relocation to the camps would “closely be followed by repatriation of Somali refugees back to Somalia.”

On December 21, President Mwai Kibaki said that, “There is no dignity in living in refugee camps” and that Somalia and Kenya would “work together to enable the hundreds of thousands of Somalis who are living in refugee camps to return to their homes.”

Human Rights Watch said the situation in south-central Somalia remains insecure and that any steps by Kenyan authorities to force or otherwise encourage Somalis to return to their country would breach Kenyan and international law, which forbids the forcible return of refugees to persecution, torture, or situations of generalized violence.

The ongoing humanitarian crisis in the Dadaab camps – where at least 450,000 refugees are crammed into space meant for 170,000 -- and the lack of properly developed new camps there or near the Kakuma camps means any transfer of refugees from the cities to the camps would also breach Kenya’s international legal obligations.
They require Kenya not to adopt “retrogressive measures” that would negatively affect refugees’ rights to adequate standard of living -- including food, clothing and housing -- and to health and education.

On December 28, Doctors Without Borders, which runs numerous health care programs in the camps, said that in light of “completely overstretched assistance” in the camps, the “medical and humanitarian situation” of the refugees in Dadaab was already “disastrous,” “dire,” and “precarious” and that the organization was “concerned about the medical consequences a new influx of refugees” on the camp population.

Human Rights Watch also said that arbitrarily forcing tens of thousands of people out of their homes in the cities would amount to forced evictions, unlawful under international law.

Human Rights Watch called on foreign donors to Kenya and on UNHCR to oppose the relocation plan, based on its inevitable violation of refugees’ rights to free movement, basic social and economic rights, and the right not to be forcibly evicted.

“This plan would ride roughshod over a range of refugees’ fundamental rights and enforcing it could well precipitate the very insecurity Kenya says it’s trying to prevent,” 
 Simpson said.
“Foreign donors to Kenya and UNHCR should encourage Kenya to abandon the plan.”

Moldova: OSCE urges leaders to intensify efforts ahead of Transdniestrian settlement talks

*** OSCE Chairperson, in Moldova, urges leaders to intensify efforts ahead of Transdniestrian settlement talks ***

CHISINAU, 21 January 2013 - 

The OSCE Chairperson, Ukrainian Foreign Minister Leonid Kozhara, on an official visit in Chisinau today, urged the Moldovan and Transdniestrian leadership to prepare the ground for progress in the coming months' Transdniestrian settlement talks.

"I have put the Transdniestrian settlement process at the top of Ukraine's agenda as OSCE Chair, which is why my first official visit as OSCE Chairperson is to Moldova," 
 said Minister Kozhara.
"I urge leaders in both Chisinau and Tiraspol to make good use of the time between now and next month's 5+2 talks in Lviv so that we can start the year on a positive note with progress in the negotiations."

The Chairperson stressed that Ukraine - which is a co-mediator in the 5+2 process along with the OSCE and the Russian Federation - was uniquely placed to take forward the negotiations.

"Ukraine is very familiar with the complex issues involved in the settlement process, both as a mediator and as a neighbouring country.

I hope that this experience can act as a catalyst for further progress as we chair the 5+2 talks this year on behalf of the OSCE,"
 he said.

"Last month the 57 OSCE participating States gave their full political backing to the settlement process at the OSCE Ministerial Council in Dublin, where they encouraged the advancement of the negotiations on all three baskets of the agreed agenda.

I have reiterated this here in Chisinau and I will be giving the same message when I visit Tiraspol tomorrow.”

The three baskets are socio-economic issues, legal and humanitarian issues and human rights, and a comprehensive settlement, including institutional, political and security issues.

“As a first step, the re-opening of the Gura Bicului bridge to traffic would be a positive signal of the commitment of both sides to the process and immediately improve the lives of the people on both banks of the river,” he added.

The Chairperson met with Moldova’s President Nicolae Timofti, Prime Minister Vlad Filat, Deputy Prime Minister for Reintegration Eugen Carpov, Minister for Foreign Affairs and European Integration Iurie Leanca and Parliament Speaker Marian Lupu.
Tomorrow he will meet Transdniestrian leader Yevgeniy Shevchuk in Tiraspol.

The Chairperson was also briefed by the staff of the OSCE Mission to Moldova on their work on human and minority rights, democratization, media freedom and combating human trafficking.

OSCE Press release

CRC 62nd session: Committee on the Rights of the Child reviews the report of Guinea

Committee on the Rights of the Child
18 January 2013

The Committee on the Rights of the Child today reviewed the second periodic report of Guinea on its implementation of the provisions of the Convention on the Rights of the Child.

Hadja Diaka Diakite, Minister for Social Affairs and Advancement of Women and Children of Guinea, spoke about the achievements in the protection and implementation of the fundamental rights of children in Guinea and noted the harmonization of the domestic legislation with the Convention and the enactment of the Law on the Guinean Child.
The institutional framework had been strengthened and progress was evident in the areas of education, child and maternal mortality, child exploitation and the fight against harmful traditional practices such as female genital mutilation, which still affected 96 per cent of girls and women in Guinea.
The challenges still remained, principally in the form of poverty and illiteracy and that was why the Government was considering the revision of the national child policy, the Law on the Guinean Child and the strengthening of the system of rights-based child protection.

Committee Experts welcomed the enactment of the Law on the Guinean Child, the 2000 Law prohibiting harmful traditional practices and the ratification by Guinea of a number of international human rights instruments.
The Committee was aware of the political and social problems that the country had faced over the past five years and their impact on the budgetary allocations to key sectors such as health and education, and inquired about measures to curb the corruption and expand the tax revenue base, particularly from the resource rich sectors such as mining, agriculture and fisheries.
The Committee expressed its concern about the widespread use of corporal punishment in detention centres, schools and institutions, about the situation of children living or working in the street, the non-respect of the provisions of the Convention governing deprivation of liberty of minors and the social exclusion and social discrimination against 40,000 Guinean children with disabilities.

Pilar Nores, Committee Rapporteur for the Report of Guinea, in concluding remarks said that the basis of the many problems in Guinea was the culture and customary law and that a greater degree of compliance with the positive law was required.
It was hoped that the revised Children’s Code would address crucial issues discussed today, such as the death penalty and the prohibition of corporal punishment, and that the authorities would invest further efforts in the fight against corruption, combating violence against children in all settings, eradicating harmful traditional practices such as female genital mutilation, including children with disabilities in everyday life and in reforming the juvenile justice system.

Also in concluding observations, Ms. Diakite said that the implementation of the concluding observations would be part of the political will of the President to bring change into the lives of the people of Guinea, and urged development partners to increase assistance for the benefit of children.

Jean Zermatten, the Committee Chairperson and Co-Rapporteur for the Report of Guinea, in closing remarks expressed hope that the concluding observations would be disseminated among the Government officials, the Parliament and children, and that Guinea would find today’s dialogue useful for the implementation of its many new initiatives.

The delegation of Guinea consisted of representatives of the Ministry for Social Affairs and the Advancement of Women and Children, the Committee for the Protection of Children’s Rights and the Ministry of Foreign Affairs.

The next public meeting of the Committee will be at 10 a.m. on Monday, 21 January when it will begin the consideration of the initial report of Burkina Faso under the Optional Protocol to the Convention on the Rights of the Child on the sale of children, child prostitution and child pornography (CRC/C/OPSC/BFA/1) and Burkina Faso’s initial report under the Optional Protocol on the involvement of children in armed conflict (CRC/C/OPAC/BFA/1).

Report

The second periodic report of Guinea under the Convention on the Rights of the Child can be read here: (CRC/C/GIN/2).

Presentation of the Report

HADJA DIAKA DIAKITE, 


Minister of Social Affairs, Promotion of Women and Children of Guinea, said that the fundamental rights of children were embedded in the Constitution of Guinea and the legislation protected children and punished the perpetrators of crimes and offences against them.
In 2011, meetings of the justice sector had helped to address the weaknesses and to increase the access of the population to the judiciary.
The President had established a Ministry of Justice, Ministry of State and Ministry of Human Rights. The challenges involved poverty and illiteracy that affected a high proportion of the population.
The fight against the worst forms of child labour, child exploitation and sexual exploitation, and the involvement of children in armed conflict were among the most important commitments undertaken by the Government with regard to child rights.
The Government had harmonized its domestic legislation with the provisions of the Convention and had enacted the Law on the Guinean Child.
This Law defined the child as any human being under the age of 18 and recognized their rights to life, name, nationality and health.
Progress had been made in reducing child mortality rates from 229 per thousand in 1992 to 117 per thousand in 1999; nevertheless it was difficult to expect that the related Millennium Development Goal would be achieved by 2015.
HIV prevalence rates were at about 1.8 per cent and the Government continued to undertake measures to slow down the rate of new infections. 
In 2002 it had created a multisectoral coordination Committee and had mobilized funds for the combat against this disease.

There had been a significant increase in the vaccination practices, while a strategic plan to eradicate some harmful traditional practices such as female genital mutilation had been adopted for the period 2012-2016.
Harmful traditional practices persisted throughout the country and 96 per cent of girls and women were still victims of female genital mutilation in 2012.
The minimum age for marriage for boys and girls had been harmonized and was 18 years.
The primary school enrolment rates in 2010 were 79 per cent, but preschool enrolment rates were extremely low and stood at 9 per cent in 2011.
Special efforts had been undertaken to combat violence against children and community-based child protection measures had been instituted in 2010.
The Government was also focused on birth registration initiatives and hoped to hold a national forum on civic issues which would lead to the adoption of a strategic plan in 2013.
Thanks to those efforts, the birth registration rates had increased from 28 per cent in 2005 to 53 per cent in 2012, while it was expected that in 2014, a total of 70 per cent of all births would be registered.
In recent years Guinea had dealt with political and institutional insecurity and in the period 2006-2010 frequent changes in the country’s leadership had made it difficult to engage in long-term initiatives and had weakened the leadership of the country.
As far as children’s rights were concerned, the past three years had seen progress in the area of education, maternal mortality, the fight against exploitation, and the participation of children, but the challenges remained and that was why the Government had held in June 2012 the first National Forum dedicated to childhood to spur the implementation over the coming three years of a system of rights-based child protection, including the revision of the national child policy and the Law on the Child.

Questions by Experts

PILAR NORES, 

Committee Expert acting as Rapporteur for the Report of Guinea, said that the presence of the delegation in the Committee today was evidence of the commitment of Guinea to the improvement of the situation of children and hoped that the dialogue would contribute to the identification of barriers and challenges that children faced in the enjoyment of their rights.
The Committee welcomed the enactment of the Law on the Guinean Child and the 2000 Law prohibiting harmful traditional practices, and the ratification by Guinea of a number of international human rights instruments.
Over the past several years, Guinea had created a number of human rights institutions and ministries and the Committee wondered which one had the coordinating responsibility for the implementation of the Convention and the Optional Protocols?
The country still did not have an independent human rights commission to receive complaints, conduct investigations and ensure that the activities undertaken for children were consistent with the Convention.

The Committee was aware of the political and social problems that the country had faced over the past five years and noted the impact on the budgetary allocations to key sectors such as health and education; what efforts were being made to expand the tax base and increase fiscal revenues, particularly from the fishing and mining sectors, and what was being done to ensure an increase in resource allocations to social sectors?
A particular challenge in the country was corruption and the inappropriate use of state resources, which directly affected the resources available for children.
What efforts were being undertaken to increase the knowledge about the
Convention among the population and among the employers?
What policies and measures were in place to ensure that all State services and resources were available to all children without discrimination and especially for the girl child?
The Committee was concerned about the widespread use of corporal punishment, particularly in detention centres, schools and institutions, which was prohibited under the Convention; was the explicit prohibition of corporal punishment in all settings being planned?

JEAN ZERMATTEN, 
Committee Chairperson and Co-Rapporteur for the Report of Guinea, said that the adoption of the Code on Children in 2008 was an important event which attempted to bring together all the provisions for children and ensure that they were in line with the Convention.
Two problems remained however, first the awareness of this code among professionals and secondly the continuing existence of some provisions remaining in other texts which gave rise to grey areas and confusion.
Customary law still existed and was enforced in some key areas of life, such as marriage or inheritance; what was the situation in the interplay of customary and civil laws and what happened in case of conflict?
Guinea had set up a Committee to monitor, protect and defend child rights comprised of six ministries and with a permanent secretariat, but it was still unclear how coordination was undertaken between ministries.
Was there a plan to come up with a comprehensive child policy?
Concerning the right of the child to be heard, the Committee requested further information about the obligation of policy makers to hear children when it came to decisions concerning children.

Another Expert noted a paradox of resource-rich Guinea in minerals, agriculture and fishing and the extremely low gross domestic product per capita and asked the delegation to explain the regulation of private enterprises working in the country in relation to the rights of the child and the existing laws in the country on economic activities, labour and child exploitation.
Transnational companies operating in many regions and in fact controlled key resources and services such as water and they were the ones providing it to the population; were there any agreements in place to this effect and how were they governed?
Were there any requirements for foreign companies to conduct studies on the environmental impact of their operations, how were they enforced and governed and what was their link with respect to the rights of the child?

The delegation was asked about the revision of the Law on the Guinean Child, the intentions to accede to the Third Optional Protocol on Communication Procedures, legal standards governing the interplay between customary and positive law especially with regard to harmful traditional practices and early marriages, and trends in suicide and road accidents and how were they being combated to protect the child’s right to life.
What action was being taken to inform institutions and service providers about the changes in the legislation, particularly in the remote areas?
What measures were being taken to increase human and financial resources available for the juvenile justice sector?

Response by Delegation
A Committee to monitor, protect and defend children rights had been set up in 1995 to ensure that the terms of the Convention were respected;
Guinea was now restructuring this Committee to enable it to deal with new issues that were arising.
Concerning the diversion of funds away from social sectors, the President had set up a state-wide inspection exercise to see how to effectively implement the rights of the child and devote funds to required sectors.
Sectoral meetings were held annually to determine the quota of funds to be collected as tax revenue from various sectors.
Discrimination against girls in matters of marriage was present in practice if not in the law, and the Government had conducted work within the communities to ensure that the provisions of the Code in this regard were enforced.
Such mindsets were difficult to change, but the Government had made all efforts to ensure the change of this societal practice.

Concerning sexual offences, the Committee noted that the problem was harmonizing between the provisions of the Code and in the practice of compensation whereby a victim of sexual offence could be married off to the perpetrator of the crime.
Responding, the delegation said that the Government had become aware of this problem in 2008 and was in favour of harmonizing the Code.
The compensation was still practiced in the communities even though the legal prohibition was very clear.
The child protection system set up in the communities in 2010 dealt also with this issue, and this protection system would be further reinforced in 2013.
Whenever legal provisions were violated, the office of the prosecution would take charge of the case; there were however no statistics on prosecution in cases of early and forced marriage.

The Government was making efforts to revise the Children’s Code and the 5,000 copies of the first edition had been used in training of the judiciary,
law enforcement officers and social workers and the dissemination within the civil society, schools and among children themselves.
The second revision of the Code had also been printed in 5,000 copies with ministerial support and almost all were disseminated.
The body in charge of the coordination of children’s rights was the Coordinating Committee for the Protection of Children’s Rights; members of the Committee came from the ministries in charge of the implementation of major issues from the Convention.
Unfortunately, resources allocated to this Coordinating Committee were not sufficient.

The Children’s Parliament had been set up in 2001 and its 1,000 members were elected directly from the 304 rural communes of Guinea; the next elections would be held later this year.
The Children’s Parliament held annual sessions in which it would prepare action plans with input from and discussions with the regions.
 Each Ministry had a system for children’s participation which respected the school obligation of children.
Children with disabilities, those from remote areas, and poor and vulnerable children were represented in the Children’s Parliament.

The election of a democratic Government several years ago and the efforts to pay off foreign debt had markedly changed the situation, but it was hard to completely reverse consequences of previous events.
Child labour in sectors such as mining, agriculture or fisheries occurred because children were sent to work by families, or they were from families earning their livelihood in those sectors.
Water distribution in the country was done by the national society and the land use management entity in charge of water distribution in rural areas.
Mining companies usually provided assistance to communities where they operated, for example through the provision of water.
All mining companies had a community approach, through which they contributed to the development of the country.
They did not employ children, but in some mining areas there existed artisanal or small scale exploitation of the mines in which children were involved in order to support their families.

A moratorium on the death penalty in Guinea had been in place for over a decade now and no executions had occurred during that period.
The abolition of the death penalty was currently being discussed within the society and it was important to note that children under the age of 18 were not subject to the death penalty.
Statistics on child suicide and accidents in which children died were going to be included in the next periodic report of Guinea.
Formal religious instruction did not exist in public schools in Guinea, and children generally followed the religion practiced by the parents.

Questions by Experts
PILAR NORES, Committee Expert acting as Rapporteur for the Report of Guinea, noted the high number of children in alternative care in Guinea, for various social causes such as migrant children, street children, and children kicked out of home for various reasons, etc.
Most shelters were provided by non-governmental organizations which usually suffered from a lack of resources and capacity.
What was the Government doing to support shelters and children in alterative care?
What were the principal causes of the alarming levels of chronic malnourishment among children and what was being done to address this and child mortality?
There was still a huge gap in the level of services offered in various regions of the country; how were children from disadvantaged areas supported in accessing education, especially compulsory primary education?
How were private faith-based schools regulated to ensure they compiled with the official curriculum requirements?
Turning to the issue of child labour, the Committee noted that changes in the law alone were not sufficient, and that they needed to be coupled with awareness raising and prosecution of those engaged in child labour, especially its worst forms.

JEAN ZERMATTEN, Committee Chairperson and Co-Rapporteur for the Report of Guinea, inquired about the reasons for which juvenile courts did not work and then raised the issue of children in detention and the non-respect of the provisions of the Convention governing the deprivation of liberty of minors.
The number of children living or working in the street was rather high; what policies were in place to take care of those children beyond placing them in institutions?
Some 53 per cent of people in Guinea lived in poverty, which was in the infectious belt of noma, a disease associated with hunger and poverty; how was the Government dealing with this and other poverty-related diseases?

Another Committee Expert noted a youth bulge in the population and the importance of providing the young people with education, and asked the delegation to provide information about school enrolment rates and comment on the link between school attendance, especially for girls, and poor hygiene facilities in schools.
Some reports indicated that only about 20 per cent of children completed primary school and the Expert asked what was being done to increase school completion rates.

Many causes of maternal mortality were preventable, such as poor antenatal care, lack of access to health services, malnutrition, and also female genital mutilation which was known to be a serious contributor to maternal mortality and death and disability in newborns.
What was being done to improve care at birth and to improve outreach services to reduce infant, child, and maternal mortality due to preventable causes?

Other Experts asked the delegation whether a child under the age of 18 had the right to freely choose his or her religion; about concrete actions to eliminate barriers and to ensure that the 40,000 children with disabilities in Guinea were included in the mainstream education and that the high degree of social exclusion and socially driven discrimination they suffered was removed; and about measures to identify children involved in armed conflicts.

Taking up the issue of child sexual abuse, an Expert asked about monitoring and prevention mechanisms in schools and institutions, how perpetrators were dealt with if they were teachers or caretakers, and what happened if perpetrators were children.
What measures were taken to ensure the social reintegration of children victims of trafficking?

Response by Delegation
The follow-up and evaluation division of the Ministry of Social Welfare had been developing statistics for the past three years and would soon issue the third Yearbook with the data available on nine indicators on all questions related to children’s issues, such as female genital mutilation, birth registration, children in conflict with the law and issues related to the exploitation of children and violence against children.

Most vulnerable children did not live in institutions.
Guinea was well known for a high degree of social solidarity within the extended family, which meant that not many children were placed in institutions.
Many studies had been done on various health issues and the delegation would review them and provide answers on health statistics as requested by the Committee.
Services provided in the education sector did not make it possible for all the children to complete primary education which started at the age of five.
The number of children in preschool education was rather low, and the Government had emphasized community based care over private care; 130 buildings had been bought by the State and its partners for this purpose.
The communities were not willing to pay for the childcare of pre-school children, which included providing salaries of teachers.
These community centres came under the purview of the Ministry for the Advancement of Women and Children.

Juvenile courts worked and handed down the rulings, but they also faced many difficulties, such as inadequate premises, lack of juvenile public prosecutors, training of magistrates to update them on child protection law and others.
Those and other challenges had been identified during the recent special meeting on the reform of the juvenile justice sector, which came up with recommendations and a course of action.
Some of the recommendations were now being implemented with the support of key partners such as the European Union.
Efforts had been made vis-à-vis children kept in penitentiaries, in which serious offenders and minors were separated.
Most of the decisions handed down by the magistrates had to do with the placement of children, some of whom were placed with faith-based organizations, but in general, detention centres suffered from overcrowding.
 In some cases, a minor could be compelled by a juvenile magistrate to undertake community service as a measure alternative to detention, but it was not defined in the law; alternative sentencing was being considered within the framework of the reform of the justice sector.
The age disaggregated data for children deprived of liberty and kept in the minors’ wing of the prison in Conakry, or for children in pre-trial detention, was not available.

The distance between schools and villages was a significant factor in school drop out rates; to address this issue, the Government and its partners were establishing school canteens throughout the country and currently there were over 2,000 of them, mainly in the rural areas.
Health and hygiene issues were indeed a problem in schools and even in urban areas schools were not what they should be.

Responding to the Committee Co-Rapporteur who reiterated concern for the high degree of violence and bullying in schools, the delegation said that measures included campaigns to empower students and the Government had applied, together with its bordering countries, for European Union funding for a regional programme to address violence.
The Criminal Code and Children’s Code repressed violence in school, together with a number of ministerial decrees.
The law gave children the possibility to lodge a complaint against perpetrators, even if those were their parents. No convictions had been made.
Turning to the health-related questions asked by the Committee, the delegation said that noma was not as prevalent as some other diseases.
Child and maternal mortality persisted due to the decreased capacity of the health system, both in terms of equipment and staff.

There were teacher training centres in all regional capitals which trained primary school teachers for a period of three years, with practical work done before teachers were sent to the classrooms.
In order to encourage teachers to go where they were needed, notably to rural areas, their salaries were complemented with bonuses, which meant that the salaries of those teaching in rural areas were higher than other civil servants.
Guinea had two schools for children with special needs but was at the same time developing an inclusive education programme aiming at not separating children with disabilities from mainstream education.
The inclusive education programme had received the endorsement of major partners of the Government and the new programme would effectively take into account all aspects of inclusive education, such as infrastructure or teacher training; an inclusive education programme was not yet a reality in the country.
The Directorate on Inclusive Education was placed within the Ministry for Social Affairs, and it cooperated closely with the Ministry of Education.

There was a national strategic plan to combat female genital mutilation, together with the joint decrees by several ministries to combat the phenomenon, and the Children’s Code severely punished those perpetrating this crime.
It was important to say that progress in this matter had been compromised by rumours sparked in the communities themselves that any girls who were not excised would become sick and die, which caused an upsurge in the practice in 2011.
Despite all this, the Government was continuing with its efforts and had great political will to combat the scourge.
Awareness raising was complicated among the illiterate population whose members were attached to their religions and traditions.

There were regular campaigns to promote exclusive breastfeeding up to the age of six months which were among the most successful campaigns in the country.
The promotion was undertaken via health centres and antenatal visits.
There was no armed conflict in Guinea, but there was an aggression from abroad in 2001 in which many people including children took up arms to defend their communities against attackers.
 At the time, 300 child soldiers had been identified and 150 had benefitted from various programmes aimed at their reintegration.
There was no pressure on children in connection with religion.

Trafficking in persons was a reality in Guinea and the authorities had signed cross-border agreements with a number of neighbouring countries on cooperation in combating the phenomenon.
Guinea was also working at sub-regional levels to combat trafficking in children.
The anti-trafficking bill had been drafted and was currently being reviewed.
The borders were rather porous and Guinea called for greater support from development partners.
 Courts were taking decisions on the placement of street children, but it was important to say that the capacity of centres was limited.
The Government needed to review its child policy and take into account that children were rather mobile, such as in the case of talibé children, who were moving a lot between Guinea and neighbouring countries.
Guinea was developing mechanisms to monitor international adoptions with countries adopting Guinean children.

The presence of a lawyer was now obligatory in all pre-trial investigations involving juveniles, and the authorities were trying to further raise awareness among the general population about this new measure.
The problem was in the low number of lawyers in the country which was one of the reasons delaying procedures.
The Children’s Code enabled children and their parents to inform juvenile courts about instances of violence against children.

The Committee asked about an ombudsman-like mechanism to monitor and indentify violations in institutions and the delegation said that within the Ministry for Social Affairs and Children there was a mediator for children and children’s delegates, but this provision had not yet been applied.
The use of corporal punishment by marabou holy men in madrasas was socially accepted by children and their parents.
The Government was investing efforts in ensuring that ECOWAS standards were integrated in the curricula of military and police schools, including on human rights and the rights of the child.

Concluding Remarks

PILAR NORES, 

Committee Expert acting as Rapporteur for the Report of Guinea, noted that over the past several years Guinea had made great efforts to meet a series of objectives and introduce a human rights-based approach in the lives of its citizens, especially children.
The basis of the many problems discussed today was the country’s culture and the customary law and the challenge was aligning it with the Children’s Code.
This involved not only writing down the laws but also punishing those violating them so that there was a greater degree of compliance with positive law.
The Committee was anxiously waiting for the revision of the Children’s Code to resolve several issues talked about today, such as the definition of the age of children, the death penalty, the prohibition of corporal punishment and the alignment of the provisions with all other laws of the country.
An independent human rights body set up on the basis of the Paris Principles was essential and the resolution of budget issues and resource allocations to health and education services was pressing. Further efforts must be made to register all births and to avoid violence against children in all settings and by all persons, including harmful traditional practices.
A far more energetic programme involving sanctions for violators was needed in order to change customs.
Efforts must be strengthened to include children with disabilities in everyday life and in reforming the juvenile justice system.
To this end, combating corruption was crucial so that the limited resources could be put to this purpose.

HADJA DIAKA DIAKITE,
Minister for Social Affairs and Advancement of Women and Children of Guinea, thanked the Committee for the professional way in which the work was conducted and said that all their comments and suggestions would be taken into account.
The implementation of the concluding observations would be part of the political will of the President to bring change into the lives of the people of Guinea, particularly children.
Guinea urged development partners to increase assistance for the benefit of children.

JEAN ZERMATTEN,
Committee Chairperson and Co-Rapporteur for the Report of Guinea, thanked the delegation and congratulated them for providing a wealth of information, clarifications and answers to the many questions of the Committee.
Guinea should not only publish the concluding observations, but widely disseminate them among the Government officials, the Parliament and children.
Mr. Zermatten expressed hope that the dialogue today would be useful in the implementation of the many new initiatives of Guinea.


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