Department of Family Medicine & Department of Public Health and Preventive Medicine, S,U,N,Y, Upstate Medical University, 750 East Adams St, MIMC Suite 200, Syracuse, NY 13210.
BMC Int Health Hum Rights. 2010 Jun 4;10:11. doi: 10.1186/1472-698X-10-11.
The "right to health," including access to basic healthcare, has been recognized as a universal human right through a number of international agreements. Attempts to protect this ideal, however, have relied on states as the guarantor of rights and have subsequently ignored stateless individuals, or those lacking legal nationality in any nation-state. While a legal nationality alone is not sufficient to guarantee that a right to healthcare is accessible, an absence of any legal nationality is almost certainly an obstacle in most cases. There are millions of so-called stateless individuals around the globe who are, in effect, denied medical citizenship in their countries of residence. A central motivating factor for this essay is the fact that statelessness as a concept is largely absent from the medical literature. The goal for this discussion, therefore, is primarily to illustrate the need for further monitoring of health access issues by the medical community, and for a great deal more research into the effects of statelessness upon access to healthcare. This is important both as a theoretical issue, in light of the recognition by many of healthcare as a universal right, as well as an empirical fact that requires further exploration and amelioration.
Most discussions of the human right to health assume that every human being has legal nationality, but in reality there are at least 11 to 12 million stateless individuals worldwide who are often unable to access basic healthcare. The examples of the Roma in Europe, the hill tribes of Thailand, and many Palestinians in Israel highlight the negative health impacts associated with statelessness.
Stateless individuals often face an inability to access the most basic healthcare, much less the "highest attainable standard of health" outlined by international agreements. Rather than presuming nationality, statelessness must be recognized by the medical community. Additionally, it is imperative that stateless populations be recognized, the health of these populations be tracked, and more research conducted to further elaborate upon the connection between statelessness and access to healthcare services, and hence a universal right to health.
包括获得基本医疗保健在内的“健康权”已被多项国际协议确认为一项普遍人权。然而,为保护这一理想,人们试图依靠国家作为权利的保障者,从而忽视了无国籍人士或任何国家的无法律国籍人士。虽然仅拥有法律国籍并不足以保证获得医疗保健的权利,但在大多数情况下,没有任何法律国籍几乎肯定是一个障碍。全球有数百万人被称为无国籍人士,他们在居住国实际上被剥夺了医疗公民身份。本文的一个核心动机是这样一个事实,即无国籍作为一个概念在医学文献中基本上是缺失的。因此,本次讨论的目标主要是说明医学界需要进一步监测获得医疗保健的机会问题,并需要对无国籍对获得医疗保健的影响进行大量研究。这一点很重要,既是因为许多人承认医疗保健是一项普遍权利,这是一个理论问题,也是因为这是一个需要进一步探索和改善的经验事实。
大多数关于健康权的讨论都假定每个人都有法律国籍,但实际上全球至少有 1100 万至 1200 万无国籍人士,他们往往无法获得基本医疗保健。欧洲的罗姆人、泰国的山地部落和以色列的许多巴勒斯坦人就是无国籍与健康状况不佳之间存在关联的例子。
无国籍人士往往无法获得最基本的医疗保健,更不用说国际协议所概述的“可达到的最高健康标准”。医学界不仅应假定国籍的存在,还应承认无国籍的存在。此外,必须承认无国籍人群,跟踪这些人群的健康状况,并进行更多的研究,以进一步阐述无国籍与获得医疗保健服务之间的联系,以及健康权这一普遍权利。