Child labour
24. Medical issues
the government does not appear to have used these statutes to prosecute cases of human trafficking. During the year, an unknown number of Eritrean citizens alleged to be traffickers were returned from Uganda. The government did not behave in a
transparent or consistent manner regarding information about prosecutions or punishments of these or other suspected trafficking offenders during the reporting period. Nor was the government transparent regarding any investigations or prosecutions of government officials allegedly complicit in human trafficking. The
government did not provide information regarding training it might have offered to its law enforcement officials on identifying and responding to trafficking crimes.’ [3d] (Eritrea) 23.07 The report by Daniel Rezene Mekonnen and Meron Estefanos stated:
‘The Transitional Penal Code of Eritrea criminalises trafficking in women, infants and young persons which is done for whatsoever purposes (Articles 605-6070). In the case of trafficking for prostitution, the law imposes the punishment of rigorous imprisonment not exceeding five years and a fine not exceeding ten thousand Eritrean Nakfas. Under aggravated circumstances, the penalty can extend up to ten years imprisonment and a fine not exceeding 20,000 Eritrean Nakfa. The crime of trafficking can be aggravated, among other things, where the trafficker has made it into a profession. Other
aggravating circumstances include the use of fraud, violence, intimidation, or coercion, and cases in which the victim has been driven into suicide by shame, distress, or
despair (Article 606). The punishments proscribed by the Penal Code are not sufficiently stringent. Furthermore, Eritrea has a poor record of law enforcement mechanisms.’
[98] (pages 20-21)
See also Human Rights - Introduction; Children; Women.
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‘Despite the fact that the Government has tried to improve the healthcare system in Eritrea, the overall standard is generally poor. In Eritrea, about 90% of the country’s population is entitled to access free medical treatment at public hospitals and clinics.
The doctor to patient ratio in Eritrea is low, about 1:10,000 people and most healthcare providers are mainly located in urban areas. About 80% of the country’s populations are living in the rural areas, which mean that many people will need to travel to urban areas in order to have access to healthcare facilities; this makes it difficult for people living in the rural sections of Eritrea. The lack of access to medical care in the rural areas may result in delayed treatments or leading to needless deaths in patients. Private doctors and clinics are also available in the country and there is even a private hospital in the capital city, however, the private healthcare sector is relatively small as the charges for service are very expensive and only limited group of people in the country can access private medical services due to the majority of the population living below the poverty line.
‘Healthcare facilities in Eritrea include healthcare centres and hospitals. Medical centres provide preliminary medical aid and minor surgical assistance, as well as carrying out diagnostic functions. Except in the case of an emergency, patients are required to make an appointment with the doctor in order to admit into a hospital. Some of the services that patients can find in the hospitals include gynecology, pediatrics and eye care.
‘In general, the infrastructure of the healthcare system in Eritrea is far from meeting the standard of western countries. The modern medical facilities are not always available and they are mostly limited to the urban areas in the country. Chemists and drugstores are available in major towns; however, qualifications of chemists are often unknown.
Basic non-prescription medicines can be found in major cities, though the selection is not large, and the supply of medicines is often irregular.’ [23]
24.03 The World Bank ‘Eritrea Review’, updated in September 2012, stated:
‘The general health status of Eritrea greatly improved after independence. Many health outcome indicators compare favorably with Sub-Saharan African neighbors, and are improving faster, although up-to-date comprehensive data on outcomes has been a challenge. According to the 2011 African Development Indicators report, the infant mortality rate decreased from 58 deaths per 1,000 in 2000 to 39 deaths per 1,000 in 2009, under-five mortality rate dropped from 89 deaths per 1,000 in 2000 to 55 deaths per 1,000 in 2009, child immunization rate was 95% in 2009 and access to safe drinking water has reached over 60%. Based on DHS between 1995 and 2002, total fertility rate decreased from 6.1 to 4.8.
‘Success in some disease control programs, supported by the World Bank and other partners, is particularly impressive. While most other Sub-Saharan African countries suffer from an increasing HIV epidemic, HIV prevalence in Eritrea is estimated to be low and under control at about 0.8% of the adult population in 2009 compared to the Sub-Saharan African average of 5%. In addition, since 1999, the country has been able to reduce overall malaria morbidity by more than 86% and mortality due to malaria by more than 82%.
‘Nevertheless, important challenges remain. Rural households suffer worse health outcomes, and improvements are coming more slowly. Malnutrition is of particular concern among women and children. An estimated 46% of the population were estimated to be undernourished in 2002, and 40% of children were found to be
underweight for their age. Around 37% of women have a low body mass index.
Maternal mortality ratios have drastically reduced but are currently still high (280 per 100,000 in 2008 from 330 per 100,000 in 2005).’ [90b]
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HIV/AIDS – anti-retroviral treatment
24.04 A Eritrean Ministry of Information (Shabait) report, ‘HIV/Aids Keeps on Declining’, dated 1 December 2010, stated that:
‘The spread of HIV/AIDS infection in Eritrea continues to decline, stated Dr Andeberhan Tesfatsion, director of national HIV/AIDS and Tuberculosis control department in the Health Ministry.
‘In an interview he conducted with ERINA [Eritrean News Agency] in connection with World AIDS Day, he pointed out that the infection is declining from year to year thanks to the campaign being undertaken to raise societal awareness.
‘Dr Andeberhan further indicated that the Government is disbursing 8 million to 10 million Nakfa annually for providing medical care to nationals living with HIV/AIDS so as to enable them [to] become productive. He went on to say that concerted action is also being taken to help them organize in the Bidho HIV/AIDS Association so that they may obtain psychological and medical advice, besides securing financial support.
‘Noting that the Ministry has been working diligently through mapping out a 5-year work program for the period 2008 to 2012, Dr Andeberhan said that strenuous efforts are being exerted to raise public awareness to the highest level and reducing the infection to the lowest level possible.’ [46c]
24.05 The Medical Advisor’s Office (BMA) of the Netherlands Ministry of the Interior and Kingdom Relations, Immigration & Naturalisation Service, stated in a response provided through the MedCOI service (European Commission-funded project to share medical information in countries of origin) on 22 March 2012 that the following facilities were available in a private hospital in Asmara:
Outpatient treatment and follow up by an internal specialist
Inpatient/clinical treatment by an internal specialist
Laboratory check up of CD4 count
Laboratory check up of viral load. [81a]
24.06 The same response noted that the following anti-retrovirals were available at that time at the same hospital:
Nucleoside/nucleotide reverse transcriptase inhibitors:
zidovudine
lamivudine
abacavir
emtricitabine
zalcitabine
tenofovir
didanosine
stavudine Combinations:
efavirenz+ emtricitabine+tenofovir (=atripla)
zidovudine+lamivudine (=combivir) Non- nucleoside reverse transcriptase inhibitors;
Efavirenz
Nevirapine Protease inhibitors:
indinavir
saquinavir mesylate
lopinavir/ritonavir (=kaletra). [81a]
24.07 The same response noted that the following were not available at that hospital at that time:
Combinations:
abacavir+ lamivudine (=epzicom)
abacavir+ zidovudine+ lamivudine (=trizivir)
tenofovir+ emtricitabine (=truvada) Non- nucleoside reverse transcriptase inhibitors;
Delavirdine Protease inhibitors:
amprenavir
tipranavir
fosamprenavir Entry fusion inhibitors:
enfuvirtide. [81a]
24.08 A further response, dated 23 April 2012, stated that darunavir and ritonavir were not known to be available in Eritrea at that time. [81b]
24.09 A UNAIDS report, undated, about AIDS in Eritrea, stated that:
‘According to the 2010 UNAIDS Report on the Global Epidemic, there were about 29,160 people living with HIV in Eritrea at the end of 2009. Of these, 60.2 per cent were female and 3,180 were children…According to the 2010 UNAIDS Report on the Global Epidemic, there were 4,955 people on antiretroviral therapy (ART) at the end of 2009.
This represents 25 per cent of all people in need of treatment. The proportion of women on antiretroviral prophylaxis to prevent mother-to-child transmission of HIV was 34 per cent in the same period.’ [60a]
24.10 A more recent report published by UNAIDS, ‘UNAIDS Report on the Global AIDS
Epidemic 2012’, published in 2012, stated that that there was a 25-49% decrease in the number of deaths caused by AIDS-related causes between 2005 and 2011, and that there was an upper estimate of 24,000 people receiving antiretroviral therapy in 2011.
Also, 40-59% of the people eligible to receive antiretroviral therapy were receiving it at the end of 2011. [60b]
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Mental health
24.11 Regarding mental health care in Eritrea, the World Health Organization (WHO) ‘Mental Health Atlas 2011’, published in 2011, stated that:
‘An officially approved mental health policy does not exist. However, mental health is specifically mentioned in the general health policy.
‘A mental health plan does not exist. Dedicated mental health legislation does not exist and legal provisions concerning mental health are not covered in other laws (e.g.
welfare, disability, general health legislation etc.)…Prescription regulations do not authorize primary doctors to prescribe psychotherpeutic medicines. Similarly, the department of health does not authorize primary health care nurses to prescribe and/or to continue prescription of psychotherapeutic medicines. Official policy also does not permit primary health care nurses to independently diagnose and treat mental disorders within the primary care system.
‘The majority of primary health care doctors and nurses have not received official in-service training on mental health within the last five years. Officially approved manuals on the management and treatment of mental disorders are not available in the majority of primary health care clinics. Official referral procedures for referring persons from primary care to secondary/tertiary care exist, as do referral procedures from
tertiary/secondary care to primary care.’ [22]
24.12 The WHO ‘Mental Health Atlas 2011’ [22] also provided information about the
availability of mental health facilities and medical personnel in Eritrea:
Total number of facilities/beds
Rate per 100,000 population
Number of facilities/beds
reserved for children and adolescents
only
Rate per 100,000 population
Mental health outpatient facilities
3 0.06 0 0.0
Day treatment facilities 0 0.0 NA NA
Psychiatric beds in general
hospitals
UN* UN* UN* UN*
Community residential facilities
0 0.0 NA NA
Beds/places in community
residential facilities
NA NA NA NA
Mental hospitals 1 0.02 0 0.0
Beds in mental hospitals 160 3.06 0 0.0
*UN = Information not available
Number of health professionals working in
the mental health sector Rate per 100,000
Training of health professions in
educational institutions Rate per 100,000
Psychiatrists 0.0 NA
Medical doctors, not specialized in
psychiatry
0.02 0.57
Nurses 1.07 4.19
Psychologists 0.04 NA
Social workers 0.02 NA
Occupational therapists
0.0 NA
Other health workers 0.08 NA
See also Overview of availability of medical treatment and drugs.
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