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Bulgaria
Concerns in Europe (Country Entry): January-June 2001
Annual report entries; 2001, 2000, 1999, 1998, 1997
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AI-index: EUR 15/002/2002     11/04/2002

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BULGARIA: Sanadinovo: "This is truly a ghastly place"

Introduction

A room where nine women had been locked up

A room where nine women had been locked up at the time of the Pleven County Prosecutor's visit on 19 November 2001 ©AI

The Sanadinovo Social Home for Mentally Disabled Women (further referred to as Sanadinovo) is located in an abandoned village 50 kilometres north-east of Pleven, the regional centre, and 35 kilometres from Nikopol, the nearest town. Most of over 90 women cared for in Sanadinovo are accommodated in a two-story building constructed in 1927 as the local school. On the south-eastern end of the central yard is a small single-story building for residents with the most severe disabilities who are referred to by the staff as 'bed-ridden'. Beyond this small building is a large field. Behind the main building are several outhouses and a pig-sty. The compound is fenced and guarded. The residents are not permitted to leave the grounds unaccompanied and without official permission.

The institution is grossly understaffed. Both medical and non-medical staff lack appropriate training to work with people who suffer from mental health disorders and/or developmental disabilities (further referred to as mental disabilities). The distance from the nearest urban centre not only makes it difficult for the residents to receive appropriate medical care and for the institution to recruit staff that have appropriate training, but it also prevents residents from participating in community activities.

Many of the women of Sanadinovo were brought up in state institutions as orphans or were abandoned by their parents who relinquished their rights in favour of the state. This is a legacy of a mental health system which provided little community-based support and where the doctors reportedly encouraged such a practice. Others were admitted to Sanadinovo as adults after their legal guardians, and those who supported them, could not, or would not, provide this assistance. Many of the women of Sanadinovo could live independently in the community if provided with some support and community-based care.

Amnesty International's First Visit to Sanadinovo

On 1 October 2001 representatives of Amnesty International, the Bulgarian Helsinki Committee (BHC) and Mental Disability Rights International (MDRI) visited Sanadinovo. Around twenty of the most severely disabled women were found in the two-room, single-storey building, separated from the rest of the facility by a wire fence, which was locked. Most of the women were sitting on the ground in a paved yard. There were no chairs or benches. They were wearing dirty, ill-fitting, tattered clothes and at least one woman was not wearing any underclothes. Several women with amputated limbs, or other physical disabilities, apparently had no recourse to any mechanical or prosthetic devices. One of the physically disabled women was in an old wheelchair but it was unclear if this was for her personal use or if it served others as well. No one exhibited aggressive behaviour during the delegation's visit, although some appeared as if they were experiencing distress and/or discomfort.

The beds of two women who had stayed in the rooms were heavily soiled. The floors of the rooms were wet and there was an overpowering smell of urine and faeces even though all of the barred windows and doors were open. There was faeces on the floor, particularly under the beds, and traces of faeces on the walls. The toilet facilities consisted of two fully exposed squat toilets and a water faucet, adjacent to the room in which women lived. In one of the bedrooms there was a free-standing iron-cast bathtub. Because it was not connected to any plumbing device it was difficult to imagine how it was used. There was no separate space dedicated to day-time activities.

Of particular concern was the method of seclusion practised in Sanadinovo. Women who 'misbehaved' were held in a cage made with brick walls on two sides and iron bars and wire on the remaining two sides. When the delegation visited Sanadinovo six women were being held

Five of the six women who were secluded in the cage
Five of the six women who were secluded in the cage
© BHC

in this 3.5m. x 1.5 m. (10ft x 5ft) space, adjoining the yard of the small building. They appeared calm and non-aggressive, but also looked withdrawn and vacant. The cage was full of urine and faeces and the women were covered in filth. One woman was unclothed on the lower half of her body and many sores were visible on her skin. It was not possible to establish how long anyone could be subjected to this form of seclusion, as no records of this appeared to be maintained. There was no apparent staff supervision of these women, and the delegation saw another resident bringing them water in a plastic bottle to drink through the bars. The director of the home later explained that staff lock patients in the cage when they are violent and destructive: "because we do not have adequate drugs to administer to the patients in such situations".

At the time of the visit, this institution accommodated 97 residents and was staffed by only four nurses and five orderlies who work in shifts. At night, one nurse and an orderly are on duty.
Some of the delegation considered that the conditions which they found in Sanadinovo were far worse than any they had documented anywhere in the region, and the whole delegation concurred that they amounted to cruel, inhuman and degrading treatment. Following its mission to Sanadinovo, Amnesty International urged the Bulgarian authorities to take immediate steps to remedy the situation. (1)

Reactions to Amnesty International's findings

Several articles in the Bulgarian media reported on Amnesty International's concerns about Sanadinovo. Two days after the publication of Amnesty International's press release, Trud (Labour), Bulgaria's largest circulation daily newspaper, published its own report on an unannounced visit to Sanadinovo.(2)

In its second article published on 15 October, the Trud reporter described the following incident: "From inside the yard [of the small building for the most seriously disabled women] a fearful male voice could be heard: 'Ana, come back here, get away from there!' The young woman looked frightened and said: 'Beats me, hits me here,' pointing to her chest and head. The angry man responded by shouting: 'Ana, fuck your mother! Get inside!'" A social worker from the institution reportedly stated to the journalists: "These women do not think. They do not have feelings. The only human thing about them is their bodies."

In response to Amnesty International appeals, on 19 October 2001 the Ministry of Labour and Social Policy, which is responsible for institutions like Sanadinovo, publicly presented the findings of its own fact-finding visit to Sanadinovo. This visit was conducted by the Head of the National Social Assistance Service and a psychiatrist from the Centre for Mental Health in Pleven. The Ministry's response was brief and did not address all of the issues highlighted by the organization.

Describing the positive aspects of the situation in Sanadinovo, the Ministry stated that the medical treatment prescribed for the residents was being carried out in accordance with the rules of 'hospital practice'. It also noted that the institution had a farm which is looked after, among others, by residents who are able to do this type of work.

The Ministry said it would address two important issues: staffing and required repairs. It observed that Sanadinovo is understaffed and proposed to change the internal regulations which would allow for the upgrading of staff and an increase of salaries for "those who work in faraway and unattractive work places". Furthermore, the Ministry noted that it would initiate immediately required repairs in the facility "as the institution had not been refurbished since 1955 and was in need of major works" and would allocate 30,000 leva (around $15,000) to the institution for "the purchase of medication, disinfectants, the most urgently required equipment (new mattresses, spring-beds) as well as for some urgent repairs".

Amnesty International's concerns also provoked a response from the European Parliament. On 30 October 2001, in Sofia, the joint committee of the European Parliament and the Bulgarian National Assembly held their regular six-monthly meeting and included in their agenda the situation of people in Bulgaria with mental disabilities. In its Declaration and Recommendations, the committee, inter alia, called on the Bulgarian Government "to further implement measures for the rehabilitation and integration into social life of mentally disabled persons" . (3)

The Bulgarian Prime Minister's Response

Responding to what it described as an alarming situation in Sanadinovo, Prime Minister Simeon Saxe-Coburg-Gotha's office informed Amnesty International and BHC, in a letter dated 19 November 2001, that an urgent investigation had been initiated. The letter noted that the Ministry of Health had reported to the Prime Minister that the Ministry was undertaking all necessary actions to improve the medical service in Sanadinovo. It mentioned the additional resources allocated to the institution by Hristina Hristova, the deputy minister of Labour and Social Policy. It explained that an appeal was issued to the local authorities in the region to find suitable and independent buildings for the residents of Sanadinovo so that they could be accommodated in rooms for two to three people. Finally, the letter from the Prime Minister's Office noted that in the future the government would seek a better financing scheme for such institutions so that they would not be dependent on the municipal budgets and thus subject to difficulties which the municipality may be experiencing.

The Pleven County Prosecutor and the BHC Visit to Sanadinovo

On 23 November, the BHC returned to Sanadinovo for a third visit (the first was on 17 September 2001), this time in the company of the local prosecutors. Their reports showed that, aside from the cage in the yard having been removed, little had changed.

Yordanka Antonova, Pleven County Prosecutor, who had been accompanied by Slavcho Slavov, deputy country prosecutor, submitted her report to the Chief Prosecutor of Bulgaria on 7 December 2001. Many of the observations in this report confirm Amnesty International's findings. In fact, the report begins with the following statement: "This place is truly ghastly". The prosecutors observed that Sanadinovo is far from any residential community, difficult to reach, and that the main two-story building "with broken windows and metal doors" had not been renovated for several decades. "The place is difficult, especially in the winter". The distance from urban centres makes it difficult for the residents to have any social contact, apart from the Sanadinovo staff, and for the institution to obtain adequate staff. Thus it had not been possible to recruit a doctor even though the institution was entitled to one. The report noted that the director of Sanadinovo is a physician by training but he "in his words, does not have the right to practice in Sanadinovo or to prescribe medication", although why this is so was not made clear by the prosecutor. If the need for specialist medical treatment arose the director drove the residents to Pleven which is around 50 kilometres away. The report further notes that Sanadinovo, following a visit by human rights monitors, had been visited by Dr. Alina Desimirova, the first psychiatrist to visit the institution "after several years", and that she stated she would ensure that all women would be examined before the end of November. (4) The prosecutor observed that the attending staff were far from sufficient. "A few orderlies who work in shifts cannot cope with the hygiene problems of the unwell (5) (no matter what pressure is applied) and with the maintenance of the residents rooms.... We were gravely affected by the fact that the unwell were bathed directly on the floor of their bedroom... and not in a bathroom. The filth ran directly onto the floor and into an open drainage channel which runs along the length of the room. Having witnessed this, no matter how this place is cleaned one could not claim that any standards of hygiene are observed here. Moreover, for many days now the institution has had no disinfectant." A package of chlorine had been taken by the director on loan from another institution.

On the ground floor of the main building, the prosecutors inspected a seclusion room where they observed a young woman "who was seriously ill". They also visited three empty dormitories, described as "relatively clean", for the more seriously affected residents. According to the prosecutor: "When I asked where were the ill people who are accommodated in these rooms, I was told that they were all on the first floor in the so-called "day-room", watching television. I then asked for the metal door to the left wing of the ground floor to be opened. To say that I and the BHC representatives were surprised by what we then witnessed would hardly suffice. In front of me I saw a corridor with a wet cement floor and a half-naked young woman covered in faeces who was walking barefoot in pools of water. It turned out that this was the so-called "day room" for the most seriously ill women who are not bed-ridden. There were nine women here dressed in military uniforms - trousers and jackets. Some were half-naked, the clothes of others were smeared with faeces. The faeces was spread all over the wooden floor and the white walls had in some places turned brown." The toilet in this wing was completely blocked up. Jordanka Antonova described the scene as profoundly disheartening.

"Another room accommodated, inter alia, a woman with a bloody bandage over her eyes. There was encrusted blood all over her swollen face. Obviously the bandage had not been changed for several days and the staff explained that the ill woman had serious conjunctivitis." The prosecutor also observed that Sanadinovo had only one bathroom with a single shower and a sink with a faucet, and that the toilets on the first floor were broken. The fact that the women bathe only once a week was assessed as unacceptable.

The report noted that for the whole of 2001 the Nikopol municipality, where Sanadinovo is located, had received only 800 leva ($400) for medicine. At the time of the visit the institution had practically no medicine for the residents apart from what they received free of charge from the state social security provisions.

The prosecutor also established that six women died in Sanadinovo in 2000 and four in 2001. Post mortem examinations were not performed in any of these cases. "They were buried in the village cemetery or the bodies were taken to the Pleven Faculty of Medicine for student training."

Even though the material conditions in Sanadinovo appeared to be fairly thoroughly documented the prosecutor concluded "that there were no circumstances that would give us reason to initiate preliminary criminal proceedings against any official of the institution". Instead the prosecutor concluded that Sanadinovo needed "more staff and doctors to give better care, more money, greater medical attention, and social contact for the residents". In a final comment the prosecutor considered that, should it not be possible to move the institution to a more suitable facility, Sanadinovo "should be closed down and the ill women moved to another place where they would receive better care". The Pleven County Hygienic Inspection was instructed to conduct a thorough examination of the facility, particularly with regard to food prepared for the residents. Copies of this report were sent to Pleven County Administrator and the Mayor of Nikopol municipality. Pleven Country Prosecutor Yordanka Antonova returned to Sanadinovo on 31 January 2002 and was reportedly pleased to establish that the ground floor wing which was used for the seclusion of women with the most serious disabilities had been closed down.

On 3 December 2001, Romeo Yakov, the Nikopol municipal prosecutor, indicated that there would be no preliminary investigation into the complaint submitted by the BHC concerning the situation in Sanadinovo. The prosecutor said that "There is no evidence that any abuse had been committed with regard to the patients or the resources allocated by the municipality, received as gifts or from other sources. It is therefore evident that there is no evidence that crimes of a general nature were committed".

Amnesty International's January Visit

On 24 January 2002 representatives of Amnesty International, the BHC and MDRI returned to Sanadinovo. They did not find that any significant improvements in the institution had taken place since their October visit.

A resident cleaning the floor in one of the two dormitories of the small building
A resident cleaning the floor in one of the two dormitories of the small building © AI


The living conditions for the Sanadinovo women remained seriously sub-standard. This was painfully obvious in the small building which accommodates 15 "bed-ridden" residents who have the greatest need for care but apparently receive the least. There were seven beds in each of the two rooms. In the first room there were eight women, two of whom shared a bed. The state of hygiene was execrable. The stench was overpowering and made breathing in the rooms very unpleasant. There was urine and faeces on the floor which was, at the time of the visit, being washed by an orderly and a resident from the main building, who herself appeared distressed. She later explained that she worked long hours in this environment. The cast-iron bathtub had been moved from the first room into the adjoining narrow toilet, where it was placed over the two squat toilets. There were faeces in the bathtub as well as around the toilets. When asked to explain the logic of such an arrangement, the orderly replied that the bathtub had been moved into the room when the residents are bathed. This explanation did not seem plausible considering the weight of the bathtub and logistics involved in moving it from the confined space of the toilet.

Amnesty International representatives saw, during their first visit in October, a cage used to hold women said to need discipline. In January the Amnesty International delegation saw that the cage had been disassembled and was not in use. In the main building, the wing on the ground floor where 15 or 16 women had been held behind a locked metal door at the time of the Pleven prosecutor's visit in November 2001 was empty. These rooms were closed down by the Pleven County Hygiene Inspectorate as unsanitary. The state of dilapidation of these rooms was depressing, even if no one was still being held there.

On the first floor, in a 'day room' which measures approximately 4.5m. X 9m. (15ft x 30ft), Amnesty International's representatives found over 30 women standing idly or sitting on benches and on the floor. Some were agitated by the visit, some very quiet and withdrawn. None appeared to be watching a program on a TV set which provided the only form of entertainment. It appeared that the women in the 'day room' were the most seriously affected residents, apart from those who are bed-ridden and accommodated in the small building. There were no staff present and the door into the corridor was guarded by another resident. The space to which these women were confined for most part of the day was totally inadequate in size and furnishings, and the lack of therapeutic activities and staff supervision was unacceptable.

Other residents moved freely inside the building. As on previous visits, there was no sign of any psychosocial and occupational therapeutic activities. (Apart from the resident who was cleaning the floor in the small building, two other women were observed cleaning the pig sty containing five pigs). Several residents approached the visitors to say: "We are happy with the director." One woman stated: "We are happy with everything. We only need money so that the home can be repaired." This seemed to indicate that the implications of the monitoring visits by non-governmental organizations, particularly that the institution could be closed down by the responsible authorities and the staff made redundant, had been discussed with some of the residents.

When Dr Garvanski, the director of Sanadinovo, met Amnesty International's representatives at the beginning of their visit he told them: "A German foundation has offered to build a new home for these women and everything will be just the way you want it". Later he observed that since the October visit many institutions have taken an interest in Sanadinovo. He explained that the Ministry of Labour and Social Policy had allocated 30,000 leva (US$ 15,000) as an immediate assistance. " So far we only received 13,000 leva which was needed to buy the heating fuel," he said. There were no indications that staffing had been increased or that their terms and conditions of employment had improved as stated in the Ministry's press release of 19 October 2001. At the time of writing of this report, according to Dr Garvanski, the home had still not received the balance of the sum allocated by the Ministry as emergency assistance.

Amnesty International's Concerns and Recommendations

Amnesty International is concerned that there has been no improvement in the living conditions in the small building accommodating the most seriously affected residents of Sanadinovo. The level of care these women receive is reflected in the observed level of hygiene. These conditions and gross neglect of residents who have the greatest needs for care amount to inhuman and degrading treatment and are in violation of international human rights standards including Article 7 of the International Covenant on Civil and Political Rights and Article 3 of the European Convention on Human Rights and Fundamental Freedoms. Moreover it is in violation of Point 6 of the United Nations (UN) Declaration on the Rights of Mentally Retarded Persons which states that "the mentally retarded person has a right to protection from exploitation, abuse and degrading treatment".

The cage in which six women were held in October 2001 is no longer in use. Its two sides made of iron bards and wire have been taken down. The rooms on the ground floor of the main building where 15 or 16 women had been locked up at the time of the November visit of the Pleven County Prosecutor were also no longer in use. However, the situation for over 30 women who were found in the 'day room' on the first floor of the main building, a very confined space for this number of residents, and who were apparently unsupervised by the staff and provided with no therapeutic activity, could also be considered to amount to inhuman and degrading treatment.
Amnesty International is also concerned by the apparent failure of the Pleven county and Nikopol municipal prosecutors to initiate an investigation to establish whether anyone should be held responsible for the living conditions and gross neglect of women in Sanadinovo. These decisions appear to be in stark contradiction with the Pleven Country Prosecutor's own report of the situation in Sanadinovo.

Amnesty International welcomes the first steps which the Bulgarian government has taken to address the organization's concerns with the Sanadinovo Social Home for the Mentally Disabled Women. However, Amnesty International is concerned that the Bulgarian government is apparently failing to take effective steps to improve the conditions in Sanadinovo and provide for its residents adequate treatment, ensuring that no one is subjected to inhuman and degrading treatment as required by international human rights standards. For example, the measures outlined by the Ministry of Labour and Social Policy do not appear adequately to respond to the gravity of the situation. Moreover, these measures, which are hardly adequate, have not been implemented effectively. In this respect Amnesty International would also like to remind the Bulgarian government of their responsibility under Point 2 of the UN Declaration on the Rights of Mentally Retarded Persons which states: "The mentally retarded person has a right to proper medical care and physical therapy and to such education, training, rehabilitation and guidance as will enable him to develop his ability and maximum potential".

Amnesty International reiterates its appeals to the Bulgarian government:
  • to take immediate steps to ensure that the women of Sanadinovo 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;
  • to investigate the situation in Sanadinovo fully and impartially, and bring to justice anyone found responsible for gross neglect in the treatment and care of the women committed to this institution.

(1) See Bulgaria: Disabled women condemned to 'slow death', AI Index: EUR 15/001/2001, of 10 October 2001 and Bulgaria: cruel, inhuman and degrading treatment or women inmates of Sanadinovo, AI Index: EUR 15/002/2001 of 10 October 2001.

(2) "Dvadeset zheni umirat, zaklyucheni v kletka" (Twenty women are dying, locked up in a cage), Trud, 13 October 2001, and "Zheni v kletka viyat i prosyat milost" (The women in the cage wail and beg for mercy), Trud, 15 October 2001

(3) EU - Bulgaria Joint Parliamentary Committee, 13th meeting, Sofia, 29-10 October 2001. PE 308.580.

(4) Dr Alina Desimirova visited Sanadinovo together with Margarita Mihalcheva, the Head of the National Social Assistance Service on the instructions of the Ministry of Labour and Social Policy.

(5) The report refers to the residents as "unwell or ill people".

 

Amnesty International is impartial and independent of any government, political persuasion or religious creed.
© Amnesty Internation

 

 

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