Appels à l'action
Urgent Action El Salvador

Health crisis in El Salvador



Ask president to launch negotiation with health care workers, investigate violence and threats against striking workers
For a summary, please look at the sample letters at the end. Thanks for your solidarity !

March 28, 2003

Salvadorans protest against privatization of health care.
Health care workers' strike enters its seventh month.


The government of El Salvador has been trying for a long time to privatize the public health care system. It has deprived the system of the proper funding for an effective functioning and has instituted a public campaign to discredit the system and its workers, alleging that the only solution to improve the services is to privatize them.

The privatization of the health care system is part of a project funded by loans from the World Bank and the Inter–American Development Bank, and by other international development organizations. Neither health care workers nor other members of Salvadoran civil society have been consulted. Health care unions denounced an inappropriate priority for profit–seeking concerns in the project, and they have been protesting against it since 1998.

Last year, in view of vocal opposition from the health care workers, including doctors, the government decreed a state of emergency in August 2002, which then it used to further privatization. The privatization process has included private companies owned by the Minister of Health. Yet, it is illegal for Ministers of the Salvadoran government to benefit from such contracts.

The workers started their strike on September 5, 2002 . There have been six huge public demonstrations against this privatization, the first one was in October 2002 and the latest one on March 13, 2003 . These marches have been among the largest ones ever seen in San Salvador , the capital city of El Salvador . There have been large public demonstrations also in the other main cities of El Salvador.

Some of these demonstrations have encountered police brutality that has sent people to hospitals, both among the demonstrators and innocent bystanders, including children that were overcome by tear gas used by the police. In addition to that, union leaders have received anonymous death threats and their families have been intimidated.

The Human Rights Ombudsman, Beatrice Castillo, and the Principal of University of El Salvador, Maria Isabel Rodriguez, have denounced the government's attitude. The Human Rights Ombudsman stated, on 26 September 2002 , that the State of El Salvador is violating the right of Salvadorans to have access to health care.

The Constitution of El Salvador states that health care is a responsibility of the State, and that the State should provide universal health coverage. Furthermore, the right to the highest attainable standard of health is recognized in the International Covenant on Economic, Social, and Cultural Rights, ratified by El Salvador in 1979.

Hundreds of health care workers have lost their jobs and some even have been in jail for exercising their labour rights. Health care workers have the support of many unions and of the majority of public opinion, according to polls.

The government has not responded to proposals to solve the problem. The proposals were sent by the College of Physicians (the professional association of physicians) and by the Catholic Church, represented by Bishop Gregorio Rosa Chavez.

The government expressed, on several occasions, that the strike has only political purposes, linking it to the parliamentary elections of March 16, 2003 . On February 20, President Francisco Flores reiterated his position and said, "that those who are in charge of the strike are, actually, the FMLN (Farabundo Marti National Liberation Front)" and "the only way to end the strike is to wait until March 16". The FMLN is a leftist party and the only one that has consistently opposed the privatization of health services. At the same press conference, President Flores added, "Once the elections have ended, the true purpose of the strike will disappear, then I believe we will have the opportunity to talk sensibly and try to solve it."

Two days after the elections, on March 18, the physicians union sent a letter to President Flores asking him to fulfill his promise to sit again at the negotiations table. The physicians said "for the sake of the health of the population and for social peace, we ask you to re–establish, immediately, a process of dialogue and true negotiation that will end in a definitive solution of the conflict, and to reinstate the discussion on the Comprehensive Proposal for Health, as you promised." President Flores has not answered this letter.

Background information


The people of El Salvador see the actions of their government and the police as clear violations of human rights. They are violating labour rights of the doctors and workers. They are violating the right to freedom of expression of all those who show public dissent to the government policies. Since the strike and protests are a response to the government's desire to privatize health care which would put health care even further away from the reach of the poor, the government is also violating the people's right to health care. The right to freedom of expression is part of the International Covenant on Civil and Political Rights. Labour rights and the right to health care are part of the International Covenant on Economic, Social, and Cultural Rights. Both covenants were ratified by El Salvador in 1979.

The strong public opposition might not be enough to stop the privatization of health care in El Salvador . The governments of developing countries are being pushed by international financial institutions to transfer social services to the private sector; it is part of the conditions attached to loans to third world countries. In the case of health care in El Salvador , the Inter American Development Bank approved a loan to El Salvador in 1998, to support the modernization of the Ministry of Health and Social Assistance (a process started five years earlier with a World Bank loan). The health care sector reform that emerged would transfer direct service provisions to the private sector. Healthcare unions are concerned that the proposal gives priority to profit–seeking concerns and put health needs in a secondary position.

The UN Committee on Economic, Social and Cultural Rights has said, since 1990, that international financial institutions should pay greater attention to the protection of human rights when implementing their policies. The UN Committee on Economic, Social, and Cultural Rights, when reviewing the report presented by El Salvador in 1996, stated concern about "the undesirable consequences that could arise for economic, social, and cultural rights, specially in the short term, from structural adjustment, austerity, and privatization programmes." In its General Comment on the Right to the highest attainable standard of health (2000) the Committee stated that:

"States parties [countries that have ratified the UN human rights Covenants, Canada ratified both Covenants in 1976] have the obligation to ensure that their actions as members of the international organizations take due account of the right to health. Accordingly, State parties which are members of international financial institutions, notably the International Monetary Fund, the World Bank, and regional development banks, should pay greater attention to the protection to the right to health in influencing the lending policies, credit agreements and international measures of these institutions."

Further support for this international responsibility is found in the Maastricht Guidelines for the Implementation of the International Covenant on Economic, Social and Cultural Rights (1997). In its section on "Responsibility for violations", under "Acts by international organizations", stipulates: "The obligations of States to protect economic, social and cultural rights extend also to their participation in international organizations, where they act collectively. It is particularly important for States to use their influence to ensure that violations do not result from the programmes and policies of the organizations of which they are members. It is crucial for the elimination of violations of economic, social and cultural rights, for international organizations, including international financial institutions, to correct their policies and practices so they do not result in deprivation of economic, social and cultural rights."

Suggested Actions


We can show our solidarity with the people of El Salvador, not only by expressing our concerns to the government of El Salvador, also, we must make our government accountable for their participation in the financial institutions that have such a strong influence on the realization of human rights.

Please send messages to:

  1. The government of El Salvador expressing your concern for the violations of human rights that are occurring as a consequence of the privatization policies carried out by the government.

    Please ask them

    • To negotiate a solution to the labour problem in the health care sector, without punishing the workers, who are putting their jobs, and even their lives, on the line to protect the right to health care for the people of El Salvador .
    • To investigate all the cases of threats to union members, to investigate the excessive use of force by the police to demonstrators, journalists, and public in general; and severely punish police and para-military forces found guilty of breaking the law.


    For Canadians:

    Canada has a responsibility, as a member of international financial institutions.


  2. The government of Canada expressing your concerns about the violations of human rights that are occurring in El Salvador as a consequence of the privatization policies carried out by the government.

    Please ask for

    • Monitoring of the situation by the Embassy of Canada and use of diplomatic pressure to ensure respect for all human rights, as detailed above.
    • A revision of the position that Canada takes in international financial institutions in regard to human rights consequences of policies adopted by these institutions.


    Please ask the Minister of Foreign Affairs, as a Governor of the Inter–American Development Bank (IDB), to make certain that Canada uses its influence to ensure that the programmes and policies of the IDB do not result in deprivation of economic, social, and cultural rights. This is especially pertinent in this case given that "States parties have the obligation to ensure that their actions as members of the international organizations take due account of the right to health", as stated by the UN Committee on Economic, Social and Cultural Rights in 2000.
  3. Please send copies of your messages to the workers unions (SIMETRISSS, STISSS, and the Colegio Medico) to express your solidarity. If possible, please send the SJC a copy of your messages.
  4. Please contact the media, local or national, with your position on this issue. It is important to disseminate information on human rights as widely as possible.
Addresses

Mr. Francisco Flores, President of the Republic of El Salvador
Casa Presidencial, San Salvador
Fax 011 503 243 9947 or 011 503.243 3710
CASAPRES@CASAPRES.GOB.SV
Please send copy of your message for the President, to
the Canadian Minister of Foreign Affairs,
the Canadian Embassy in El Salvador , and
the Salvadoran Embassy in Canada

Minister of Foreign Affairs Hon Bill Graham

House of Commons, Parliament Buildings , Ottawa , Ontario , K1A 0A6 (postage free)
Fax: 1 613 996 9607
e–mail: Graham.B@parl.gc.ca
Please add a cover letter for the Canadian Minister of Foreign Affairs and send it with copy to the Canadian Embassy in El Salvador

Office of the Canadian Embassy in El Salvador :
Ambassador: Mr. James Lambert (resident in Guatemala )
First Secretary and Consul: Ms. Diane Harper
1 Centro Financiero Gigante, Alameda Roosevelt y 63 Ave. Sur, Torre A, Lobby 2, Colonia Escalon, San Salvador, Republic of El Salvador
Fax: 011–503 279–0765
E–mail: SSAL@DFAIT–MAECI.GC.CA

The Embassy of the Republic of El Salvador in Canada :
Ambassador: Mr. Mauricio Rosales–Rivera
209 Kent Street , Ottawa , Ontario K2P 1Z8
Fax: 1 613 238–6940
Email: EMBAJADA@ELSALVADOR.ORG

Please send solidarity copies to:

Dr. Isaias Cordero del Cid – Secretary General of SIMETRISSS
e–mail: SIMETRISSS@TELESAL.NET

Mr. Roberto Monge, Secretary General of STISSS
e–mail: STISSS@SALTEL.NET

Colegio Medico de El Salvador:
e–mail: CONCOLMED@TELESAL.NET
Fax 011 503 260 0324

Please send the SJC a copy:
The Social Justice Committee
1857 Maisonneuve West, Montreal , QC H3H 1J9
e-mail: sjc@web.ca or gloria@s-j-c.net

sample letters follow
Mr. Francisco Flores
President of the Republic of El Salvador
Casa Presidencial, San Salvador, El Salvador

Dear Mr President,

I am concerned that privatization of public services in El Salvador , is showing a tendency to oppose the principles of the Salvadoran Constitution. According to the Constitution, the State should work for the common good and the respect of basic human rights.

The attempts to privatize health care and the resulting prolonged crisis of the health care sector is negating a fundamental right of all Salvadorans, the right to have access to health care.

I have been informed that health care workers are on strike to protest against the privatization of the public health care system, and that many thousands of Salvadorans have held several public demonstrations to support them. I also know that leaders of the doctors' union have received anonymous death threats, health care workers' leaders have been dragged out on the street from a hospital and at least one union leader was held at gun point; two months later, his home was raided, terrorizing his family (we are talking about Mr. Roberto Monge). Police has repressed public demonstrations with batons, water cannons, tear gas, and rubber bullets, sending people to the hospital; among those hurt were journalists and, even, infants at a Day Care Centre. This means violation of labour rights, as well as a violation of the right of expression and criminalization of dissent.

As you know, the State has, not only, the obligation to protect and respect human rights but also to fulfil them. Therefore, I respectfully ask you to commit to a prompt solution to this crisis, a solution that will respect all human rights of Salvadorans.

I respectfully ask you

I am confident, Mr. President, that you will do what is best for the Salvadoran people.

Sincerely,


Sr. Francisco Flores
Presidente de la República de El Salvador
Casa Presidencial, San Salvador

Distinguido Sr.:

Me preocupa que la privatización de los servicios públicos en El Salvador está mostrando una tendencia a oponerse a los principios de la Constitución de El Salvador. De acuerdo a la Constitución, el Estado debe trabajar por el bien comón y el respeto a los derechos humanos básicos.

Los esfuerzos para privatizar los servicios de salud y la resultante crisis prolongada del sector salud, están negando un derecho fundamental de todos los salvadoreños, el derecho a tener acceso a estos servicios .

He sabido que los trabajadores de la salud están en huelga para protestar en contra de la privatización del sistema de salud., y que miles de salvadoreños han llevado a cabo varias marchas para apoyarlos. Tambien me he enterado que líderes del sindicato de médicos han recibido amenazas anónimas de muerte, que líderes de los trabajadores de la salud fueron arrastrados fuera de un hospital y, al menos uno de ellos, con una pistola apuntándole a la cabeza; dos meses más tarde, le allanaron su casa y aterrorizaron a su familia, (nos referimos al Sr. Roberto Monge). La Policía ha reprimido las demostraciones usando bastones, cañones de agua, bombas lacrimógenas, y balines, lo que ha enviado gente al hospital; entre los heridos se cuentan periodistas e, incluso, niños de una guardería infantil. Lo anterior describe violaciones de los derechos laborales, así como violación al derecho de libre expresión y una criminalización del desacuerdo con la posición del gobierno.

Como usted sabe, el Estado tiene, no sólo, la obligación de proteger y respetar los derechos humanos, sino también de realizarlos. Por lo tanto, respetuosamente le pido que se comprometa a una pronta solución de esta crisis, una solución que respete todos los derechos humanos de los salvadoreños.

Sr. Presidente, le ruego se sirva

Confío, Sr. Presidente, que usted hará lo que sea mejor para el pueblo de El Salvador.

Lo saluda respetuosamente,

Minister of Foreign Affairs Hon. Bill Graham
House of Commons, Parliament Buildings , Ottawa , Ontario

Dear Minister Graham,

I am very concerned with the violations of human rights occurring in El Salvador as a consequence of the privatization policies carried out by its government.

There is a crisis of the health care system as a result of the attempts to privatize health care. This privatization is the latest stage of a reform of the health care sector supported by loans from the Inter–American Development Bank and the World Bank.

This privatization process has met with strong opposition from Salvadorans from all sectors. Health care providers have resorted to work stoppage and the general public have supported them with massive public demonstrations. Union leaders have received death threats, the government have fired many workers, and the police have responded to peaceful demonstrations with water cannons, tear gas, and rubber bullets, resulting in serious injures. As you can see, several human rights have been violated: the right to health care, labour rights of health care workers, as well as right to freedom of expression by the public. The State of El Salvador is not complying with its obligations to observe, protect, and fulfill these rights.

There are two levels at which Canada can act to support the realization of human rights. One is bilaterally, using diplomatic pressure at the individual countries where these rights are violated, and the other is at the international financial institutions, when decisions are made regarding policies and practices that could result in obstacles for the fulfilment of human rights.

I respectfully ask that the Canadian government express its concerns about the violations of human rights that are occurring as a consequence of the privatization of health care, and use its influence to ask the government of El Salvador :

I am also asking you, as a Governor of the Inter–American Development Bank (IDB), to follow the Maastricht Guidelines[1], and make certain that Canada uses its influence to ensure that the programmes and policies of the IDB do not result in deprivation of economic, social, and cultural rights. This is especially pertinent in this case because the UN Committee on Economic, Social and Cultural Rights has referred to this obligation specifically in relation to the right to health care, in its General Comment 14, from the year 2000.

I am looking forward to hear what position the government of Canada takes in relation to the government of El Salvador and the Inter–American Development Bank.

Sincerely,


[1] Maastricht Guidelines for the Implementation of the International Covenant on Economic, Social and Cultural Rights (1997). Section on "Responsibility for violations", under "Acts by international organizations", stipulates: "The obligations of States to protect economic, social and cultural rights extend also to their participation in international organizations, where they act collectively. It is particularly important for States to use their influence to ensure that violations do not result from the programmes and policies of the organizations of which they are members. It is crucial for the elimination of violations of economic, social and cultural rights, for international organizations, including international financial institutions, to correct their policies and practices so they do not result in deprivation of economic, social and cultural rights.