October, 28 2009, 10:33am EDT
India: Provide Access to Pain Treatment
Government Inaction, Restrictive Regulations Condemn Hundreds of Thousands to Unbearable Suffering
NEW DELHI
Hundreds of thousands of patients in India unnecessarily experience excruciating pain, Human Rights Watch said in a report today. Restrictive drug regulations, lack of training for health care workers, and poorly integrated care result in needless suffering for patients because they cannot get inexpensive and effective pain medications.
The 102-page report, "Unbearable Pain: India's Obligation to Ensure Palliative Care," found that many major cancer hospitals in India do not provide patients with morphine, despite the fact that more than 70 percent of their patients are incurable and likely to require pain treatment and palliative care. Health centers offering services to people living with HIV similarly do not have morphine or doctors trained to prescribe it.
"India's health care system abandons so many patients to severe pain," said Diederik Lohman, senior health and human rights researcher at Human Rights Watch. "They are left to suffer; many told us that their pain was so bad they would prefer to die."
Severe pain is a common symptom among cancer patients, particularly during the last stages of the disease. It is estimated that more than 1 million advanced cancer patients in India experience severe pain in any given year. In addition, many other patients, including those with HIV, TB, or other infections or illness, may face acute or chronic severe pain.
The report identified three key obstacles to improving the availability of pain treatment and palliative care:
- Restrictive drug regulations. Many Indian states have excessively strict narcotics regulations that make it very difficult for hospitals and pharmacies to get morphine. In 1998, the central government recommended that states adopt modified regulations, but more than half of India's states have not done so.
- The failure to train doctors. Most medical students and young doctors receive no training on pain treatment and palliative care because the government does not include such instruction in relevant curricula. As a result, most doctors in India simply do not know how to assess or treat severe pain.
- Poor integration of palliative care into health services. National cancer and AIDS control programs do not contain meaningful palliative care components, thus depriving such care of public funds and relegating it to second-tier status.
"India is one of the world's largest legal producers of opium, the raw material for morphine," Lohman said. "But almost all of it is exported while hundreds of thousands - if not millions - of Indians suffer needlessly."
The report focuses specifically on the availability of pain treatment for cancer patients. It says that, based on official morphine consumption reports, fewer than 4 percent of patients with advanced cancer have access to appropriate pain treatment. The report also says that increased government funding for cancer has not emphasized palliative care.
"The Indian government deserves credit for investing in regional cancer centers and increasing funds for cancer control," Lohman said. "But without specific efforts to ensure that all cancer hospitals can treat pain and offer palliative care, these funds will do little to relieve the suffering for patients with advanced, incurable cancer."
The report is the first by an international human rights organization to examine access to pain relief medicines from a rights perspective. Human Rights Watch believes that governments have an obligation to ensure that essential medicines, including morphine, are available to patients and that health care workers receive adequate training in their use. The report says that the failure by the Indian government to fulfill this obligation violates the right to health.
Human Rights Watch further argues that the government's failure to ensure that cancer hospitals offer pain treatment may violate the prohibition against torture and cruel, inhuman and degrading treatment because of the widespread nature and severity of the suffering it causes. Human Rights Watch says that much of this suffering could be prevented with relatively basic and inexpensive steps.
Selected Quotes from Patients
"It felt as if someone was pricking me with needles. I just kept crying [throughout the night]. With that pain you think death is the only solution."
- Priya, Hyderabad, a woman with breast cancer
"My leg would burn like a chili on your tongue. The pain was so severe I felt like dying. I was very scared. I felt that it would be better to die than to have to bear this pain. [I thought], just remove the leg, then it will be alright. Just get rid of the leg so I'll be free of pain."
- Dilawar Joshi, Hyderabad, a Nepali man with a bone tumor
"I would sleep maybe an hour and a half per night. I could take any number of sleeping pills [without effect]. With morphine, I can relax. This place [the palliative care unit] is heaven-sent..."
- Shruti Sharma, Hyderabad, a breast cancer patient
"I had pain in my back and both legs. My legs twisted into an abnormal position. My legs would turn inside and my toes up. It was a pricking pain that was excruciating. I could not sleep as the pain was particularly bad at night."
- Pillai, Trivandrum, a patient with spinal TB and HIV
"I developed severe pain all over the abdomen and in the area of my genitals. It was a continuous, throbbing pain that radiated to the back. It made me very irritable and frustrated. I went back to the doctor three or four times to say that I had pain and wasn't getting any relief. I would get new medicines but they would still provide no relief."
- Kamala Kanwar, Jaipur, patient with cervical cancer
Human Rights Watch is one of the world's leading independent organizations dedicated to defending and protecting human rights. By focusing international attention where human rights are violated, we give voice to the oppressed and hold oppressors accountable for their crimes. Our rigorous, objective investigations and strategic, targeted advocacy build intense pressure for action and raise the cost of human rights abuse. For 30 years, Human Rights Watch has worked tenaciously to lay the legal and moral groundwork for deep-rooted change and has fought to bring greater justice and security to people around the world.
LATEST NEWS
'Collapse of Political Ambition': EU Shelves Nature Restoration Law
"To let this go now means we go into European elections saying the European system is not working, we do not protect nature, we do not take climate seriously," said Ireland's environmental minister. "That would be an absolute shame."
Mar 26, 2024
Environmental ministers in the European Union on Monday warned that the bloc's credibility on heading off the global biodiversity and climate emergencies is in peril following the European Council's decision to remove the historic Nature Restoration Law from its agenda after the proposal lost key support.
"We inspired others, yet now we risk arriving empty handed at COP16 [the 2024 UN Biodiversity Conference]," Virginijus Sinkevičius, E.U. commissioner for environment, oceans, and fisheries, said in a statement. "Backtracking now is... very difficult for me to accept."
The law, first introduced in 2022 and approved by European Parliament last month, faced one final hurdle to passage with the planned Council vote, but recent protests by farmers over the new nature restoration requirements helped push some previous supporters to reverse their positions on Monday.
The Nature Restoration Law, which supporters said they still intend to try to pass before E.U. elections in June, would require member states to adopt measures to restore at least 30% of habitats by 2030, working up to 90% by 2050. Member states would be required to take action to reverse pollinator populations, restore organic soils in agricultural use, increase development of urban green areas, and take other steps to protect biodiversity.
Since the farmer protests began in France and started spreading to other countries including Spain, Belgium, and Italy, policymakers have offered concessions including delayed implementation of another set of biodiversity rules calling for the agriculture industry to keep 4% of farming land free of crop production to regenerate healthy soil. The European Commission also shelved an anti-pesticide law in February in response to the protests.
As countries announced their new opposition to the Nature Restoration Law in recent days, some ministers suggested the demonstrations contributed to their decision.
Anikó Raisz, Hungary's minister of state for environmental affairs, said the law would "overburden the economy" and cited concerns about the "sensitive situation" in the agriculture sector. Italy also said it was concerned about the biodiversity rules' impact on farmers.
The World Wide Fund For Nature (WWF) accused far-right Hungarian President Viktor Orbán, who has dismissed European climate policies, of being behind the "unexpected and clearly politically motivated change in Hungary's position."
Hungary's opposition "was left unchallenged by Sweden, Poland, Finland, the Netherlands, Belgium, Austria, and Italy—who continue to either abstain or oppose," and "has now put the [Nature Restoration Law] in jeopardy again, giving Hungary's President Viktor Orbán the green light to further his own agenda and hold E.U. decision-making hostage," said WWF.
Eamon Ryan, Irish minister for the environment, accused other policymakers in the bloc of "buckling" before the farmer protests, which continued Tuesday, ahead of June elections.
"The biggest risk is the collapse of political ambition and will," Ryan said. "To let this go now means we go into European elections saying the European system is not working, we do not protect nature, we do not take climate seriously. That would be an absolute shame."
BirdLife Europe called on the E.U. the continue its efforts to pass the Nature Restoration Law before the session ends this summer.
"The E.U.'s reputation hangs in the balance in this critical year of E.U. elections," said the group. "Failure to make the law a reality also undermines the E.U.'s credibility and leadership on its international commitments to tackle the biodiversity and climate crises."
"This is definitely not the end of the story," Alain Maron, Belgium's minister for climate change, environment, energy, and participative democracy, told reporters at a press conference Monday. He added that the Belgian presidency of the European Council "will work hard in the next few weeks to find possible ways out of this deadlock, and get the file back on the agenda for adoption in another council."
Keep ReadingShow Less
US Under Fire for Downplaying Security Council Resolution as 'Nonbinding'
One expert accused the U.S. of working to "undermine and sabotage the U.N. Security Council, the 'rules-based order,' and international law."
Mar 26, 2024
Biden administration officials attempted Monday to downplay the significance of a newly passed United Nations Security Council resolution, drawing ire from human rights advocates who said the U.S. is undercutting international law and stonewalling attempts to bring Israel's devastating military assault on Gaza to an end.
The resolution "demands an immediate cease-fire for the month of Ramadan respected by all parties, leading to a lasting sustainable cease-fire." The U.S., which previously vetoed several cease-fire resolutions, opted to abstain on Monday, allowing the measure to pass.
Shortly after the resolution's approval, several administration officials—including State Department spokesman Matthew Miller, White House National Security Council spokesman John Kirby, and U.S. Ambassador to the U.N. Linda Thomas-Greenfield—falsely characterized the measure as "nonbinding."
"It's a nonbinding resolution," Kirby told reporters. "So, there's no impact at all on Israel and Israel's ability to continue to go after Hamas."
Watch Matt Lee ask StateSpox about the passing of the UN ceasefire resolution. Basically the US position is it makes no difference and Miller calls 🇷🇺/🇨🇳 veto cynical.
Lee: Do you expect Israel is going to announce a ceasefire?
Miller: I do not
Lee: What’s the point of the UN? pic.twitter.com/FibaSKWjuh
— Assal Rad (@AssalRad) March 25, 2024
Josh Ruebner, an adjunct lecturer at Georgetown University and former policy director of the U.S. Campaign for Palestinian Rights, wrote in response that "there is no such thing as a 'nonbinding' Security Council resolution."
"Israel's failure to abide by this resolution must open the door to the immediate imposition of Chapter VII sanctions," Ruebner wrote.
Beatrice Fihn, the director of Lex International and former executive director of the International Campaign to Abolish Nuclear Weapons, condemned what she called the Biden administration's "appalling behavior" in the wake of the resolution's passage. Fihn said the administration's downplaying of the resolution shows how the U.S. works to "openly undermine and sabotage the U.N. Security Council, the 'rules-based order,' and international law."
In a Monday op-ed for Common Dreams, Phyllis Bennis, a senior fellow at the Institute for Policy Studies, warned that administration officials' claim that the resolution was "nonbinding" should be seen as "setting the stage for the U.S. government to violate the U.N. Charter by refusing to be bound by the resolution's terms."
While all U.N. Security Council resolutions are legally binding, they're difficult to enforce and regularly ignored by the Israeli government, which responded with outrage to the latest resolution and canceled an Israeli delegation's planned visit to the U.S.
Israel Katz, Israel's foreign minister,
wrote on social media Monday that "Israel will not cease fire."
The resolution passed amid growing global alarm over the humanitarian crisis that Israel has inflicted on the Gaza Strip, where most of the population of around 2.2 million is displaced and at increasingly dire risk of starvation.
Amnesty International secretary-general Agnes Callamard said Monday that it was "just plain irresponsible" of U.S. officials to "suggest that a resolution meant to save lives and address massive devastation and suffering can be disregarded."
In addition to demanding an immediate cease-fire, the Security Council resolution calls for the unconditional release of all remaining hostages and "emphasizes the urgent need to expand the flow of humanitarian assistance."
Israel has systematically obstructed aid deliveries to Gaza, including
U.S.-funded flour shipments.
Farhan Haq, deputy spokesman for the U.N. secretary-general, stressed during a briefing Monday that "all the resolutions of the Security Council are international law."
"They are as binding as international laws," Haq said.
Keep ReadingShow Less
State of Emergency Declared After Cargo Ship Destroys Baltimore Bridge
Maryland Congressman Jamie Raskin said he was "deeply concerned for the safety and well-being of everyone affected by the collapse of the Francis Scott Key Bridge in Baltimore."
Mar 26, 2024
A state of emergency was declared in Maryland early Tuesday morning after a large cargo ship slammed into the Francis Scott Key Bridge in Baltimore, leading to its total collapse and sending a number of vehicles and people into the Patapsco River.
As the Baltimore Sunreports:
In a Tuesday morning news conference, just a few hours after the incident, Baltimore Fire Department Chief James Wallace said authorities are "still very much in an active search and rescue posture" noting they are searching for "upwards of seven individuals" and that sonar has detected the presence of vehicles in the water. There is no indication that the event was intentional, Wallace said.
"This is a tragedy that you could never imagine … It looked like something out of an action movie," Mayor Brandon Scott said.
In a later press conference, officials said that two members of a construction crew that was on the bridge at the time of the collision had been rescued while six others remained unaccounted for.
The terrifying footage of the bridge's collapse—which CNN correspondent Omar Jimenez commented was "almost unbelievable" to watch—is circulating widely on news channels and social media:
This video is almost unbelievable. The Francis Scott Key Bridge in Baltimore literally collapsed this morning after it was struck by this large ship. pic.twitter.com/rYuy4U2r7H
— Omar Jimenez (@OmarJimenez) March 26, 2024
U.S. Transportation Secretary Pete Buttigieg said Tuesday that he had spoken with Mayor Scott and well as Maryland Governor Wes Moore and was helping to coordinate federal assistance.
"Rescue efforts remain underway and drivers in the Baltimore area should follow local responder guidance on detours and response," said Buttigieg.
Moore said in a statement he had declared a state of emergency and that work was underway to "quickly deploy federal resources" to the area.
"We are thankful for the brave men and women who are carrying out efforts to rescue those involved and pray for everyone's safety," said Moore. "We will remain in close contact with federal, state, and local entities that are carrying out rescue efforts as we continue to assess and respond to this tragedy."
Early reporting indicated that no crew members aboard the container ship, which sails under a Singapore flag, were injured or missing. A local harbor pilot was also said to be on board at the time of the crash.
"Deeply concerned for the safety and well-being of everyone affected by the collapse of the Francis Scott Key Bridge in Baltimore," said Rep. Jamie Raskin (D-Md.) following the accident. "I'm profoundly thankful to first responders on the scene and will track rescue efforts by local, state, and federal authorities."
Keep ReadingShow Less
Most Popular