Example 6: Advocating for Access to Pain Relief Through United Nations Mechanisms
Project Type: Advocacy
Human Rights Watch
New York, USA
Website: www.hrw.org Founded over 30 years ago, Human Rights Watch (HRW) is a leading independent organization that protects and defends human rights across the globe. They conduct objective and rigorous investigations and engage in vigorous advocacy efforts.
Health and Human Rights Division
As part of Human Rights Watch’s long commitment to defending human rights, the organization has been reporting on issues related to health and human rights for many years. Human Rights Watch’s work has examined how such rights as freedom of speech, expression, assembly and information; freedom from discrimination and arbitrary detention; property rights; bodily autonomy, protection from violence, cruel, inhuman and degrading treatment and torture; and the right to health care intersect with the realization of the right to health. Investigations and advocacy have particularly focused upon the health of vulnerable populations, including women, children prisons displaced persons, lesbian, gay, bisexual, transgender (LGBT) persons, drug users, ethnic and racial minorities, and migrant workers. www.hrw.org/sites/default/files/related_material/HRW_healthbrochure_low.pdf.
Governments have the positive obligation to protect their people from unnecessary pain related to a health condition. Additionally, governments have a negative obligation not to arbitrarily interfere with the provision of essential health services.
Millions require controlled medications, like morphine, for treatment of moderate to severe pain. However, in over 150 countries across the world, access to palliative care medication is virtually non-existent. These medicines are unavailable or inaccessible in many countries because of overregulation and/or problems with supply and distribution systems for controlled medicines. Governments that report low consumption of morphine to the International Narcotics Control Board relative to the number of its citizens suffering from HIV/AIDS or cancer indicates a substantial gap between those suffering and in need of pain management and the actual accessibility of palliative care medicines
Human Rights Watch advocates for palliative care as a human right, including increased access to medications to manage and relieve pain. Its advocacy efforts include country reports and outreach to UN human rights bodies, including the Commission on Narcotic Drugs and the World Health Assembly. Actions taken include:
- Country reports documenting gaps in policy and practice relating to palliative care in Thailand, Russia, Ukraine, the United States, Canada, Kenya, China, Bangladesh, India, and Kazakhstan, among other countries. Reports available at: http://www.hrw.org/en/news/2009/03/09/un-drug-summit-undo-decade-neglect#pain.
- Submission to the Human Rights Committee and the Committee Against Torture regarding Cameroon’s Fourth Periodic Report (26 August 2009). Report available at: http://www.hrw.org/es/news/2009/08/26/submission-human-rights-committee-regarding-cameroon-s-fourth-periodic-report; www.hrw.org/en/news/2009/08/26/submission-committee-against-torture-regarding-cameroon-s-fourth-periodic-report.
- Both reports advocate for the government of Cameroon to effectuate low-cost reforms to remove barriers and ensure adequate supply of opioid medications to treat tens of thousands of Cameroonians experiencing pain and suffering moderate to severe pain associated with cancer, AIDS, and other health conditions.
- Joint Statement of the International Harm Reduction Association and Human Rights Watch, Interactive Dialogue with the Special Rapporteur on Torture at the Tenth Session of the Human Rights Council (12 March 2009). www.hrw.org/en/news/2009/03/12/joint-statement-international-harm-reduction-association-ihra-and-human-rights-watch.
- The Human Rights Council was urged to reject restrictive drug policies which perpetuate the denial of access to essential medicines, to reject such approaches by the UN Committee on Narcotic Drugs (CND), and to mainstream human rights into international drug policy.
- ‘Please, Don’t Make Us Suffer Anymore…’: Access to Pain Treatment as a Human Right (2009). www.hrw.org/en/news/2009/03/02/un-stop-needless-suffering.
- HRW calls on the UN General Assembly to consider access to pain relief medication. It highlights the causes of poor availability, including “failure to put in place functioning supply and distribution systems; absence of government policies to ensure their availability; insufficient instruction for healthcare workers; excessively strict drug-control regulations; and fear of legal sanctions among healthcare workers.”
- Global State of Pain Treatment: Access to Medicines and Palliative Care (2011). Available at: http://www.hrw.org/sites/default/files/reports/hhr0511W.pdf.
- HRW uses publicly available data on the consumption of pain medicines to illustrate the unmet need for pain treatment. It also presents the results of a survey of healthcare workers in 40 countries regarding the main barriers to better pain treatment and palliative care.
- Report of the Special Rapporteur on torture and other cruel, inhuman, or degrading treatment or punishment, A/HRC/22/53 (February 1, 2013). Available at: http://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf.
- The Special Rapporteur cites to evidence collected by Human Rights Watch of human rights abuses in health care settings, including denial of morphine and other drugs for pain management.
Results and Lessons Learned
HRW’s continued advocacy has brought attention the issues of the international narcotics conventions and access to essential medicines for palliative care. Their reports highlight the issue areas and document human rights violations.