Urgent Action – El Salvador
17 October 2002
Dr Guillermo Matta, president of Colegio Medico medical association, Dr Melvin Guardado, president of the Asociacion de Medicos del Sistema Nacional de Salud (Association of Doctors in the National Health Service), Dr Ricardo Alfaro Barahona, secretary–general of the Sindicato de Medicos Trabajadores del Instituto de Seguro Social (SIMETRISS, the Doctors' Union in the Institute of Social Security) and approximately 27 other health professionals have received death threats. We are concerned for their safety.
The anonymous threats were communicated in telephone calls to the individuals' homes, all in the capital, San Salvador. It is thought that they have been threatened as a result of their involvement in trade union protests against government plans to privatize health services.
The threats allegedly come from a self styled "death squad" calling itself "Comando de Exterminio" – "Extermination Command." Death squads and paramilitary groups were responsible for the systematic secret murder, torture and "disappearance" of suspected government opponents during the 1980s and early 1990s. They benefited from total impunity, as nobody was ever brought to justice for these crimes. There have been no reports of active death squads for several years. Any re emergence of such groups is cause for grave concern.
Trade unions, doctors and other health personnel have for some years been involved in opposition to government plans to privatize health services, which they considered to have been started by outsourcing ancillary services. They claim that this will negatively affect the population's health care. In September the health care workers' union, Sindicato de Trabajadores del Instituto de Seguro Social (STISS), Union of Workers in the Institute of Social Security, and the doctors' union Sindicato de Medicos Trabajadores del Instituto de Seguro Social (SIMETRISS), the Doctors' Union in the Institute of Social Security, went on strike in support of their efforts to stop privatization.
Since the strike began on September 16, government attempts to break it have failed, and public support for the strikers is growing. Together doctors and workers have shut down 12 hospitals, and many sectors of the public have denounced the government's privatization plan. Along with the national Salvadoran doctors professional association, influential figures in the church, including the Archbishop of San Salvador have called on the government to negotiate. The government has threatened doctors and health care staff that they will be dismissed if they do not return to work.
The strike is entering its fourth week. The doctors, nurses and health employees from the public network of hospital will join the strike as well. President Flores refuse to meet with the union leaders but has backed down in his plans for privatization. Union leaders have said that they will not end the strike until there is guarantee that the hospitals and clinics will not be privatized. El Salvador already has a three tier health system. One is private for the very wealthy which has North American standards. The second, is the public or "charity hospitals" for the very poor where people just go to die; the third and the most efficient is the social insurance institute very similar to the Canadian Medicare plan. This system is financed by the companies, the workers and the government. All unionized labour, teachers, public employees and workers in large companies are part of this. The government has been trying to privatize this system.
The Flores government might well be enthusiastic promotors of the privatization of the health sector, but they are not alone in this. The Inter–American Development Bank (IDB) and the World Bank (WB) have both encouraged the Government to privatize medical services and are working alongside it in the gradual transfer of health care and other social services, previously covered by the Government, to the private sector. This affects not only those groups that can afford to pay, but rather the entire population, except perhaps the lowest 20%. Low– and middle–income groups must now pay increased rates for services such as education, electricity, and water, as well as health care.
In March 1998, the IDB approved Operation # 1092/OC–ES, the Support for the Modernization of the Ministry of Health and Social Assistance Project. This was a loan that led to the presentation of a health sector reform proposal known as the ANSAL study. While many of the ideas it contained were valid and remain widely accepted, other aspects introduced market mechanisms into health care and would effectively transfer direct service provision to the private sector.
S.E. Francisco Flores
Presidente de la Republica de El Salvador
Casa Presidencial
Avda. Los Diplomaticos, Calle Mexico
Bo San Jacinto
San Salvador, El Salvador
Fax: + 503 243 9947
Lic. Francisco Bertrand Galindo
Ministro de Justicia y Seguridad Publica
6a Calle Oriente No 42
Antiguo Local Policia Nacional
San Salvador, El Salvador
Fax: + 503 245 2650
His Excellency Dr. Mauricio Rosales–Rivera
Ambassador of El Salvador
209 Kent Street
Ottawa, Ontario K2P 1Z8
Fax: (613) 238–6940 Email: embajada@elsalvador.org
Hon. Bill Graham,
Minister of Foreign Affairs
125 Sussex Drive, Ottawa, ON K1A 0G2
Fax: (613) 996-9607 Email: Graham.b@part.gc.ca
Ms. Susan Gregson, Director Human Rights,
Humanitarian Affairs and International Women's Equality Division (AGH) Department of Foreign Affairs and International Trade
B4 125 Sussex Drive, Ottawa, ON K1A 0G2
Fax: (613) 943-0606 Email: susan.gregson.agh@dfait-maeci.gc.ca
Please send copies to:
Oficina de Tutela Legal del Arzobispado
Comision Archidiocesana de Justicia y Paz
Urbanizacion Isidro Menendez
Calle San Jose y Avda. Las Americas
San Salvador, El Salvador
Fax: + 503 225 2603
Guillermo Antonio Salazar
e-mail: STISS@SALTEL.NET
Dr. Ricardo Alfaro
e-mail: SIMETRISS@TELESAL.NET
Ambassador James Lambert
Canadian Ambassador to El Salvador
Office of the Canadian Embassy
1 Centro Financiero Gigante, Torre A, Lobby 2;
Alameda Roosevelt y 63 Avenida Sur, Colonia Escalón,
San Salvador, El Salvador, C.A.
Fax: 011 503 279 0765 Email: ssal@dfait-maeci.gc.ca
Death threats against medical professionals in struggle against privatization of health services
17 October 2002
Dr Guillermo Matta, president of Colegio Medico medical association, Dr Melvin Guardado, president of the Asociacion de Medicos del Sistema Nacional de Salud (Association of Doctors in the National Health Service), Dr Ricardo Alfaro Barahona, secretary–general of the Sindicato de Medicos Trabajadores del Instituto de Seguro Social (SIMETRISS, the Doctors' Union in the Institute of Social Security) and approximately 27 other health professionals have received death threats. We are concerned for their safety.
The anonymous threats were communicated in telephone calls to the individuals' homes, all in the capital, San Salvador. It is thought that they have been threatened as a result of their involvement in trade union protests against government plans to privatize health services.
The threats allegedly come from a self styled "death squad" calling itself "Comando de Exterminio" – "Extermination Command." Death squads and paramilitary groups were responsible for the systematic secret murder, torture and "disappearance" of suspected government opponents during the 1980s and early 1990s. They benefited from total impunity, as nobody was ever brought to justice for these crimes. There have been no reports of active death squads for several years. Any re emergence of such groups is cause for grave concern.
Background Information
Trade unions, doctors and other health personnel have for some years been involved in opposition to government plans to privatize health services, which they considered to have been started by outsourcing ancillary services. They claim that this will negatively affect the population's health care. In September the health care workers' union, Sindicato de Trabajadores del Instituto de Seguro Social (STISS), Union of Workers in the Institute of Social Security, and the doctors' union Sindicato de Medicos Trabajadores del Instituto de Seguro Social (SIMETRISS), the Doctors' Union in the Institute of Social Security, went on strike in support of their efforts to stop privatization.
Since the strike began on September 16, government attempts to break it have failed, and public support for the strikers is growing. Together doctors and workers have shut down 12 hospitals, and many sectors of the public have denounced the government's privatization plan. Along with the national Salvadoran doctors professional association, influential figures in the church, including the Archbishop of San Salvador have called on the government to negotiate. The government has threatened doctors and health care staff that they will be dismissed if they do not return to work.
The strike is entering its fourth week. The doctors, nurses and health employees from the public network of hospital will join the strike as well. President Flores refuse to meet with the union leaders but has backed down in his plans for privatization. Union leaders have said that they will not end the strike until there is guarantee that the hospitals and clinics will not be privatized. El Salvador already has a three tier health system. One is private for the very wealthy which has North American standards. The second, is the public or "charity hospitals" for the very poor where people just go to die; the third and the most efficient is the social insurance institute very similar to the Canadian Medicare plan. This system is financed by the companies, the workers and the government. All unionized labour, teachers, public employees and workers in large companies are part of this. The government has been trying to privatize this system.
International Involvement
The Flores government might well be enthusiastic promotors of the privatization of the health sector, but they are not alone in this. The Inter–American Development Bank (IDB) and the World Bank (WB) have both encouraged the Government to privatize medical services and are working alongside it in the gradual transfer of health care and other social services, previously covered by the Government, to the private sector. This affects not only those groups that can afford to pay, but rather the entire population, except perhaps the lowest 20%. Low– and middle–income groups must now pay increased rates for services such as education, electricity, and water, as well as health care.
In March 1998, the IDB approved Operation # 1092/OC–ES, the Support for the Modernization of the Ministry of Health and Social Assistance Project. This was a loan that led to the presentation of a health sector reform proposal known as the ANSAL study. While many of the ideas it contained were valid and remain widely accepted, other aspects introduced market mechanisms into health care and would effectively transfer direct service provision to the private sector.
Actions Requested
- Please contact the El Salvadoran government authorities to:
- Urge the government to take immediate and effective action to protect all who have been threatened;
- Call for an immediate and thorough investigation into these threats and for those responsible to be brought to justice;
- Call for the government to bargain with the strikers in good faith and not resort to intimidation.
- In Canada: please contact the Ministry of Foreign Affairs to:
- Ask that Canada express its concern about these events to the Salvadoran authorities;
- Protest the privatization policies pushed by the Inter–American Development Bank and the World Bank, both of which Canada is a member.
Addresses
S.E. Francisco Flores
Presidente de la Republica de El Salvador
Casa Presidencial
Avda. Los Diplomaticos, Calle Mexico
Bo San Jacinto
San Salvador, El Salvador
Fax: + 503 243 9947
Lic. Francisco Bertrand Galindo
Ministro de Justicia y Seguridad Publica
6a Calle Oriente No 42
Antiguo Local Policia Nacional
San Salvador, El Salvador
Fax: + 503 245 2650
His Excellency Dr. Mauricio Rosales–Rivera
Ambassador of El Salvador
209 Kent Street
Ottawa, Ontario K2P 1Z8
Fax: (613) 238–6940 Email: embajada@elsalvador.org
Hon. Bill Graham,
Minister of Foreign Affairs
125 Sussex Drive, Ottawa, ON K1A 0G2
Fax: (613) 996-9607 Email: Graham.b@part.gc.ca
Ms. Susan Gregson, Director Human Rights,
Humanitarian Affairs and International Women's Equality Division (AGH) Department of Foreign Affairs and International Trade
B4 125 Sussex Drive, Ottawa, ON K1A 0G2
Fax: (613) 943-0606 Email: susan.gregson.agh@dfait-maeci.gc.ca
Please send copies to:
Oficina de Tutela Legal del Arzobispado
Comision Archidiocesana de Justicia y Paz
Urbanizacion Isidro Menendez
Calle San Jose y Avda. Las Americas
San Salvador, El Salvador
Fax: + 503 225 2603
Guillermo Antonio Salazar
e-mail: STISS@SALTEL.NET
Dr. Ricardo Alfaro
e-mail: SIMETRISS@TELESAL.NET
Ambassador James Lambert
Canadian Ambassador to El Salvador
Office of the Canadian Embassy
1 Centro Financiero Gigante, Torre A, Lobby 2;
Alameda Roosevelt y 63 Avenida Sur, Colonia Escalón,
San Salvador, El Salvador, C.A.
Fax: 011 503 279 0765 Email: ssal@dfait-maeci.gc.ca