Bulgaria: Residents of Dragash Voyvoda are dying as a result of gross neglect
The organisation is concerned that most of the deaths were caused by lack of adequate medical treatment. The organisation is also concerned that conditions in this institution, which provides indefinite asylum for over 140 men with mental health disorders or developmental disabilities (further referred to as mental disabilities), amount to cruel, inhuman and degrading treatment and are in violation of the international human rights standards ratified by Bulgaria.
Representatives of Amnesty International, including a consultant psychiatrist, the Bulgarian Helsinki Committee (BHC) and Mental Disability Rights International, visited Dragash Voyvoda on 24 January 2002. A second visit by representatives of Amnesty International and the BHC took place on 1 and 2 April 2002. The delegation concurred that the living conditions in this institution were appalling and inappropriate for accommodation for any human being, particularly for people with special needs. The very physical conditions were such that they undermined rather than improved a person's health. The facilities, comprised of three separately fenced-off sections, each with a number of smaller buildings with dormitories, were in extremely poor state of disrepair and were in places dangerous for the residents. There was no central heating and the dormitories were only warmed by poor-quality stoves fired by coal and wood. As a result, conditions in winter in Dragash Voyvoda, as evident during the January 2002 visit, were excruciating.
According to the Nikopol Municipality Social Care Service, 17 residents of Dragash Voyvoda died in 2001, and three in 2002*. However, research by representatives of Amnesty International and the BHC conducted on 1 and 2 April 2002 established that at least 22 men died in Dragash Voyvoda in 2001. Seventeen men died in the period between 1 January and 15 April 2001 and five men died in the period between 22 October 2001 and the end of the year. It is indicative that no deaths had occurred from 15 April to 22 October 2001 in the course of the summer. Post mortem examinations had been conducted in only three cases and the pathologist who conducted these examinations explained to Amnesty International that a proper diagnosis of the condition of the men while alive required no other means than a stethoscope. She observed that the clinical diagnosis of the cause of death was not consistent with the diagnosis established by the pathological examination, namely severe pneumonia and malnutrition. The same causes appear to be the cause of death in all but three of the 22 cases. Five more deaths have occurred in Dragash Voyvoda in 2002, including one from hypothermia when a resident was lost in the desolate landscape surrounding the institution in January 2002. The two most recent cases which occurred in March 2002 have been subjected to a post mortem examination and although the final reports have not yet been issued, preliminary findings seen by the Amnesty International representative indicate that these deaths were also cased by pneumonia and malnutrition.
There appears to have been no investigations into any of the deaths of Dragash Voyvoda residents. Dr Andreev, the physician who treated the two most recently deceased men, stated to the Amnesty International representative that antibiotics for the residents of Dragash Voyvoda were not provided free of charge by Bulgarian social security, and that such medication needs to be paid for by the residents themselves, as the institution's resources are very limited. He also confirmed that the conditions in the institution were not adequate for residents' treatment but could not explain why prompt and adequate treatment was not administered to these two men in a hospital or another more appropriate environment. In 2001 none of the other 2,500 patients which he treated in the Nikopol municipality died as a result of pneumonia. The director of Dragash Voyvoda stated that she had 31 residents registered as suffering from some form of bronchial condition; 16 of this number were receiving some form of therapy**. In July 2001 nine residents were reportedly sent to a special hospital for treatment for tuberculosis.
The bodies of men who died in 2001 and 2002 were buried in unmarked graves. Only the residents, who themselves dug the graves and buried the deceased, appeared to know who had been laid there. The director of the institution was unable to provide to the Amnesty International representative a plan of the unmarked graves.
Amnesty International is concerned that the men with mental disabilities, residents of Dragash Voyvoda, are being deprived of their right to be treated with humanity and respect and to be protected from physical and mental abuse. Furthermore, Amnesty International is concerned that the conditions and the gross neglect of residents in Dragash Voyvoda amount to cruel, inhuman and degrading treatment.
Amnesty International also wrote to Lidiya Shuleva, Minister of Labour and Social Policy, whose ministry is responsible for the Home for Adults with Mental Disorders in Dragash Voyvoda, as well as other similar institutions in Bulgaria. The organisation urged Lidiya Shuleva:
- to take immediate steps to ensure that the men of Dragash Voyvoda are treated in a professional and humane way, consistent with international standards;
- to close the institution permanently and move the residents to adequate facilities, or else take immediate action to bring it into line with international standards;
- to ensure that all similar institutions are adequately staffed and equipped, and subjected to a system of comprehensive monitoring by municipal and national authorities, including independent bodies;
- to implement a professional training program for staff.
*Letter from Vanya Vincheva to the Head of the National Social Care Service dated 1 February 2002 which was made available to the BHC.
** Amnesty International has subsequently learned that these residents have been prescribed the medication but are not actually receiving it because of lack of funds