VII. The Government ResponseThe government has an immediate duty to end the detention of poor patients for non-payment of their medical bills, and a longer-range responsibility to progressively realize the right to health of its citizens. Senior government officials and hospital staff alike often deny or minimize the problem of hospital detentions. The chef de cabinet in the Ministry of Health told us,
The director of Prince Louis Rwagasore Clinic said,
The director of Roi Khaled Hospital declared that this is not a prison, and said that people who cannot pay their bills are released.117 Several hospital managers questioned the use of the word detention.118 The reality was different, as shown above. In nine of the eleven hospitals we visited, patients were detained, and many of them for far longer than one week. While denying or minimizing the problem, government and hospital officials contradicted themselves by attempting to justify hospital detentions. According to the chef de cabinet in the Ministry of Health:
The chef de cabinet in the Ministry of National Solidarity, as well as several hospital managers, echoed this argument, pointing out that hospitals would have to close if they lacked the funds to operate. Others suggested the alternative was to refuse treatment.120 Government and hospital officials alike presented the issue as deplorable but refused to take responsibility for it. In December 2005, the Ministry of National Solidarityapparently at the initiative of the presidentordered the release of patients and announced it would pay for their bills. The move was widely reported in the press, and one formerly detained patient we spoke to expressed her gratitude to the president for this initiative. The ministers chef de cabinet reportedly told hospitals that they should release their detainees and send the bills to her Ministry. But when asked by the press whether detentions in hospitals would now end, she replied evasively,
To the dismay of hospital officials, the government did not reimburse the bills as promised. By May 2006, the government owed the four major hospitals over U.S.$50,000.122 According to the chef de cabinet, the responsibility for the non-payment lay not with her Ministry, but with the Crédit de Relance Economique, a World Bank-financed fund for reconstruction activities.123 Ad-hoc measures such as the December 2005 charitable release of detainees in hospitals may bring the government good publicity but do nothing to solve the real problem. Shortly after Christmas 2005, hospitals were again filling up with insolvent patients in detention. 115 Human Rights Watch/APRODH interview with Dr. Julien Kamyo, chef de cabinet, Ministry of Health, Bujumbura, February 13, 2006. 116 Human Rights Watch/APRODH interview with director and other managers, Prince Louis Rwagasore Clinic, Bujumbura, February 14, 2006. 117 Human Rights Watch/APRODH interview with director, Roi Khaled Hospital, Bujumbura, February 14, 2006. 118 Human Rights Watch/APRODH interviews with financial and administrative director, Prince Régent Charles Hospital, Bujumbura, February 10, and with administrator, Roi Khaled Hospital, Bujumbura, February 11, 2006. 119 Human Rights Watch/APRODH interview with Dr. Julien Kamyo, chef de cabinet, Ministry of Health, Bujumbura, February 13, 2006. 120 Human Rights Watch/APRODH interviews with Béatrice Ntahe, chef de cabinet, Ministry of National Solidarity, Human Rights and Gender, February 17; financial and administrative director, Ngozi Hospital, Ngozi, February 15; and financial and administrative director, Prince Régent Charles Hospital, Bujumbura, February 10, 2006. 121 150 malades indigents libérés, Le Renouveau (Bujumbura), December 27, 2005. 122 Human Rights Watch interview with representative of the Ministry of National Solidarity, Human Rights and Gender, Bujumbura, May 10, 2006. 123 Human Rights Watch/APRODH interview with Béatrice Ntahe, chef de cabinet, Ministry of National Solidarity and Human Rights, February 17, 2006. |