Rio de Janeiro Olympic Games: mixed blessing in badly-run country

At a time when the Olympic Games in Brazil are in the offing, the country appears to be not ready since its economy and political situation are disastrous. All over the country, the public health system does not work owing to a shortfall in the relevant budget sector allocations. The removal of President Dilma Roussef and the constitution of a new government can be a solution but every measure must be taken quickly since the pressure on the population is stronger than ever.

Things are getting uglier here every day. I advise everyone with plans to visit Brazil for the Olympics in Rio to stay home. You’ll be putting your life at risk here. This is without even speaking about the state of public hospitals and all the Brazilian political mess. Only God can change the situation in our Brazil”, says Rivaldo, a former Brazilian footballer, on his Instagram account.

Unquestionably, he is right. Each day in Brazil is more dramatic than the one before, and the news is uniformly grim. There is a political crisis, an economic crisis and, shouldn’t that be enough, a public health crisis as well.

Every day the world’s major newspapers write a flood of words about the political crisis affecting the country, but the economy is in a turmoil too. Between 2011 and 2014 Brazil’s economy grew on average by 2.2% a year. Abruptly, last year, the GDP collapsed by 3.8%, and is expected to shrink 3.6% again in 2016. Several data may explain the situation. Dating back to 2003, last year was the first one registering a drop in household consumption. At the same time, public spending has surged and the budget deficit increased to 10.4% of GDP in 2015, with an overall budget deficit rising to 613 billion Real and the closely monitored primary budget balance jumping to 111.249 billion Real. In this economic earthquake, the government has loosened the fiscal policy and the Central bank has reduced its benchmark interest rate in 2011-2012 pushing up the inflation above the bank’s self-imposed upper limit of 6.5%, and way above its 4.5% target.

Furthermore, the labour market has jammed. In fact, real wages have been dropping since March 2015 and the unemployment rate in the main metropolitan areas increased to 8.2% in February 2016 (and is expected to raise even more by the end of the year). Moreover, in a desperate attempt to improve public finance, the government has cut spending on unemployment insurance and increased taxes.

Though an upfront investment policy could improve the situation, Brazil has unfortunately no money to boost investments at the moment. From bad to worse, Petrobras, the state controlled oil giant and Brazil’s biggest investor, is in the midst of a corruption scandal that has paralyzed spending: relevantly, it has been estimated that the forgone investment likely reduced GDP growth last year by one percentage point.

If the overall economy works badly, the medical industry does not perform better. In fact, the industrial production of equipment and materials for medical and dentistry application, as well as optical supplies, decreased by 14.9% in December 2015 as compared to the previous year, and the number of workers employed in the sector decreased by 2.2% from January to December 2015.

Moreover, the overall public health system is on verge of collapse. In this regard, the end of 2015 was quite shocking as the public health system of the Rio’s state government broke down after the authorities confirmed a budget shortfall. The situation was dramatic with hospitals lacking even saline or other basic medical stuff. As a response, patients were sent to emergency care units instead of hospitals and the state government published daily bulletins to confirm which hospitals were working.

Last year, on the 23th of December, the governor of Rio de Janeiro State declared a state of emergency. Few days later, 389 million reals (US$ 96 millions) were granted by the federal government. Actually, this was a drop in the ocean owing to the tune of 1.4 billion real (US$347 million) arrears in payments to suppliers and subcontractors, according to the authorities.

But things can unexpectedly get even worse. Since the end of January, Brazil has been facing a Zika virus large-scale epidemic. As such, the already overloaded local health facilities now have to deal with a new influx of patients: some 1,500 cases of infection by the mosquito-transmitted virus have been recorded in the region since the beginning of the year.

And all of this just occurs now that the Olympic Games are about to officially begin.

Many reasons can be listed to explain what is going on in the Brazilian health sector. Relevantly, concepts such as misused resources, poor management and corruption are emblematic of the issue.

The government explains the crisis blaming the fall in the oil price and the impact on the state’s budget of the Petrobras chaos.

Adding to these, other prominent reasons do emerge, with the corruption of public authorities likely ranking first. As reported by a local newspaper, at the beginning of March 1000 tons of out of date medicines purchased by the state health ministry are doomed to burning at a cost of almost 3 million reals. According to Deputy Pedro Fernandes, the chairman of the Budget Committee audit and control, this would represent an absurd waste of still usable medicines and supplies. Inherently, in spite of the opening of a public audience and a parliamentary inquiry, the ghost of corruption is in the air since some industries could take advantage of drug burning.

Public money is also regularly misappropriated. The most recent example was in February, when a court case revealed a network producing false medical bills with proceeds going to local politicians in São Gonçalo, the state’s second biggest city after Rio.

What’s more, evidence has emerged that the Rio government has denied money for hospitals in order to save up for the Olympic Games.

If the health sector is suffering from corruption and poor management, the legislation does not work better. Relevantly, amendment 86/2015 altered the financing model proposed by amendment 29/2000 and made congressional amendments binding when computing health expenses. At first glance, amendment 86/2015 looks like it would increase health sector financing, but in nominal terms the amounts earmarked for the ministry of health in 2016 may actually mean a smaller share than in 2015.

In the end, it seems that Rivaldo was right. The situation is dramatic and could even get worse. The spectre of Rio 2016 Olympic Games is looming and the government is running against time in a race that will see it as the winner at the expense of people’s welfare. According to the Brazilian ministry of health, funding for the health sector will not be sufficient in 2016. This echoes fear that the resources allocated to health will be exhausted by September 2016.

That’s what Brazilians are facing in these days in Rio de Janeiro and all over the country. Can Dilma Roussef removal be the solution? Or is it just smoke in the eyes hiding the whole iceberg?

Someone might be afraid to answer this question.

Pietro Dionisio

Il sistema sanitario europeo: la condizione degli immigrati clandestini

Valori quali il rispetto dei diritti e della dignità umana e del principio di uguaglianza sono alla base dell’Unione Europea. Ma una breve analisi mostra come il sistema sanitario pensato per aiutare gli immigrati clandestini non si integri con questi concetti.

L’immigrazione clandestina è un tema molto caldo in questi giorni. Ogni giorno i confini dell’Unione Europea sono attraversati da una moltitudine di immigrati, spesso clandestini, che richiedono assistenza sanitaria. Ma il sistema sanitario europeo è in grado di far fronte a questa emergenza?

Gli immigrati clandestini sono uno dei gruppi sociali maggiormente esposti ai problemi di salute. Lo status giuridico di “irregolari” e la evidente mancanza di risorse economiche sono le ragioni principali che non consentono loro di godere degli stessi diritti e privilegi di un comune cittadino.

L’accesso ai sistemi di assistenza sanitaria degli Stati in cui si recano è infatti solo parziale. Le prestazioni di cui possono usufruire sono in genere limitate all’assistenza medica in situazioni di manifesto pericolo per la propria vita.

Per effetto delle enormi privazioni a cui sono sottoposti durante le traversate, questi individui sono esposti a molti rischi per la propria salute tra cui emergono malattie epidemiche, l’insorgere di difficoltà legate agli stati di gravidanza, malattie dei bambini e problemi psicologici. Risultano inoltre maggiormente vulnerabili all’HIV e all’AIDS.

All’interno dell’UE, alcuni Paesi hanno creato dei sistemi che cercano di affrontare la questione. A questo proposito, il Governo Italiano ha istituito uno schema in cui ai cittadini stranieri presenti illegalmente in Italia viene assegnato un codice di identificazione, denominato STP (Straniero Temporaneamente Presente), valido per 6 mesi e rinnovabile. Il suo possesso comporta alcuni benefici tra i quali la parziale esenzione del ticket in caso di impossibilità a pagarlo. Oltre a ciò, la firma di una “dichiarazione di indigenza”, valida anch’essa per sei mesi, li esenta dal pagamento di qualsiasi importo e rende loro possibile la fruizione di servizi che includano la gravidanza, l’assistenza sanitaria di base o la cura di condizioni invalidanti.

Aide Médicale État è, invece, il programma messo a punto dallo Stato francese. Anch’esso mira a fornire agli immigrati irregolari servizi sanitari gratuiti.

Come è ormai ben noto, Paesi come l’Italia non sono altro che luoghi di passaggio verso mete più ambite come Svezia e Danimarca.

Purtroppo proprio in questi ultimi paesi le condizioni garantite agli immigrati clandestini sono meno favorevoli. In Svezia, ad esempio, dispongono di una copertura sanitaria molto limitata. Solo dal luglio 2013, gli immigrati sprovvisti di documenti hanno diritto a ricevere dei sussidi per affrontare alcune cure mediche, e soltanto i minori hanno gli stessi diritti dei cittadini svedesi.

In Danimarca la situazione è anche peggiore. Richiedenti asilo e stranieri senza legale residenza, sebbene esista un Servizio Immigrazione Danese che garantisce trattamenti di emergenza ai clandestini adulti, non sono coperti dal sistema sanitario nazionale. Fanno eccezione i minori che, come nel caso svedese, hanno diritto alla copertura sanitaria.

Questa breve analisi mette in luce la mancanza di una strategia politica comune sulla questione, il che causa notevoli difficoltà nella gestione del fenomeno migratorio nonché consistenti violazioni dei diritti degli immigrati. LArticolo 35 della Carta dei diritti fondamentali dell’Unione Europea lascia l’istituzione di norme per l’accesso alle cure sanitarie nelle mani dei legislatori nazionali.

Il suddetto articolo afferma a tal proposito afferma che “ognuno ha il diritto di accedere alla prevenzione sanitaria e il diritto di ottenere cure mediche alle condizioni stabilite dalle legislazioni e prassi nazionali. Un livello elevato di protezione della salute umana deve essere garantito nella definizione e nell’attuazione di tutte le politiche e attività dell’Unione”.

La frammentazione dell’attuale sistema non è coerente con i principi e i valori che sostengono le istituzioni dell’Unione Europea. Espressioni quali “rispetto della dignità umana e dei diritti umani”, “rispetto del principio di uguaglianza”, rappresentano i concetti fondamentali su cui si regge l’Unione Europea. Tali idee, tuttavia, rischiano di perdere la loro integrità quando si scontrano con una mentalità chiusa unita ad interessi politici e finanziari contrastanti.

Il tema sanitario, in particolare in relazione ai migranti clandestini, ben rappresenta le criticità della più ampia questione immigrazione. Per questa ragione, ed in quanto proiezione dei diritti umani e del principio di uguaglianza, dovrebbe ricevere priorità assoluta ed univoca risposta.

Pietro Dionisio

Gaza Strip: the Press of War on People’s Health

The last war in the Gaza Strip has left many people in bad conditions. Their health, food, home security and living conditions as a whole got worse in the last year. The situation is unbearable and cannot improve without Israel pressure relief combined with not hypocrite help by the international system

The last Gaza war had a huge impact on Palestinian people. There were 2,251 Palestinian deaths against 73 Israeli and 11,231 Palestinian injuries against 1,600 Israeli. But the shadow of the war does not stop at this. In fact, the economic consequences are enormous. The slow pace of recovery in Gaza has been insufficient to make up for the 2014 recession and conflict. Timid signals of growth in the first quarter of 2015, driven by the reconstruction process, came to a halt in the third quarter. According to the International Monetary Fund, the Gaza economy is not expected to reach its 2013 annual level until the end of 2017.

Additionally, one and half year after the 2014 hostilities, more than 7,000 explosive remnants of war (ERW) are estimated to remain in the Gaza Strip. Only 30 per cent of ERW have been identified and removed. The remaining 70 per cent pose a threat to the population of Gaza, especially children and adults who work on agricultural land littered with ERW.

What’s more, victims are not only caused by war, but by low quality healthcare as well. In fact, nearly 50 per cent of Gaza medical equipment is outdated and the average wait for spare parts is approximately 6 months. In 2014, the MoH Central Drug Store in Gaza reported that an average of 26 per cent of medicines on the essential drug list (124 of 481 items) and 47 per cent of medical disposables (424 of 902 items) were at or near zero stock for MoH facilities. The main reason was an insufficient budget rather than security restrictions imposed by Israel. Furthermore, increasing poverty is the most pervasive barrier to specialized health services access.

Limited opportunity for health professionals in Gaza to attend training courses abroad and access restrictions to get familiar with new medical techniques is also slowing down improvements in developing health care services in Gaza. Political disagreements between the concerned parties remain a challenge in spite of the April 2014 reconciliation between Ismail Hanijeh, the prime minister of Hamas, and a senior PLO delegation dispatched by the Palestinian President Mahmoud Abbas.

Moreover, as stated by the Office for the Coordination of Humanitarian Affairs (OCHA), the Gaza blockade is responsible for a chronic energy crisis in the coastal enclave, impairing service delivery, students’ educational outcomes, the functioning of hospitals and medical equipment and the working of more than 280 water and waste water facilities. Over recent weeks, these circumstances have further worsened and brought increased hardship to Gaza people, with daily electricity supply being only 4-8 hours on (12 hours off) schedule.

Gaza hospitals not only lack electricity but, as reported, the entire health care system is in ruins due to Israeli restrictions on the import of medical equipment from outside Gaza. Israel allows patients to receive medical care abroad only in life-and-death cases, involving a lengthy bureaucratic process. This leaves many Palestinians in Gaza suffering from severe orthopedic problems, visual and hearing impairments or other serious illnesses without access to the required medical care and treatments.

The poor living conditions are made even worse by food insecurity. As such, many Palestinian farmers, fishers and herders face many challenges. Relevantly, since the Separation Barrier and Israeli settlements expand, farmers have increasingly less land and water resources for their crops and animals.

Adding to access constraints, families face disproportionate economic hurdles. For example, many must rely on water brought by tankers, which costs four-times more than the networked water supply. The high costs of livelihood inputs – such as fertilizers and animal feed – reduce farmers’ profits and inflate market prices. These conditions lock communities in poverty, leaving one in five Palestinians food insecure. In particular, 47 per cent of Palestinian households in the Gaza Strip were food insecure in 2014, with a 2 per cent increase in 2015.

Food access decline in Gaza is a result of growing unemployment, high food prices, and extreme volatility of the economy. But, fortunately, something is moving on. On 3 April 2016, Israel just expanded the Palestinian fishing zone off the southern portion of Gaza coast to nine nautical miles from six, allowing fishing in areas that had been off limits for a decade. The expansion of the fishing zone is expected to add 400.000 shekels, nearly $ 106.000, to the 6 million shekels in annual revenue generated by Gaza’s fishing industry.

However, aside from the good news above, there’s nothing to be happy for since the situation as a whole is unbearable for almost all the population and many concerns are renewed every day. The fragile political context, the disastrous humanitarian conditions, as well as the lack of adequate water supplies and electricity services are only few of the many issues on the table.

The resources received from international organizations may have limited impact without Israel pressure relief. Furthermore, the international political fora should stop blathering nice words suitable for the occasion and leave the veil of hypocrisy. This is nothing new, but the only way of guaranteeing a better future to Gaza population.

Pietro Dionisio.