Roma Communities in Need of Medical Care in Bulgaria Might Be Out of Luck

On Sunday, Bulgarian Health Minister (and probable evil clone of Alan Tudyk) Petar Moskov announced that emergency medical services would no longer respond to calls coming from Roma communities unless local Roma leaders could guarantee their safety. The Minister claims his decision reflects a threat to medical practitioners' safety, as 174 of 225 recent attacks on first responders occurred in predominately Roma areas.

"I am under no obligation to guarantee the right of somebody to beat up doctors," said Moskov during his briefing.

But from the outside this looks like the latest in a local and regional trend of increasingly aggressive anti-Roma discrimination. It may also be an attempt to justify previous failures of medical personnel to respond to Roma calls by using a common European rhetorical trope: blaming the Roma for their own marginalization.

Some online commenters have sided with the Moskov's decision, citing standard paramedic safe-scene protocols (the principle that responders should not rush into an unsafe environment). But by declaring all areas inhabited by a certain ethnic minority unreasonably dangerous, Moskov's decree moves beyond due prudence into what could be considered harmful bigotry.

"Such a public stance on the part of a doctor, who has taken the Hippocratic Oath, is loathsome," said the local human rights watchdog Bulgarian Helsinki Committee in a press release. "[It is] a gross manifestation of misunderstanding of the principle of rule of law and incitement to racial hatred."

The Roma, often known by the pejorative term "gypsies," are the European Union's largest and most diffuse ethnic minority, with 10 to 12 million individuals living in member states. Ever since arriving in the continent some one-and-a-half millennia ago, these dark skinned and linguistically distinct peoples have been on the edges of society, associated with crime and violence. The Nazis eventually used this reputation as a pretense to exterminate 70 percent of their Roma population in the Holocaust, and even in the post-Communist era to sterilize Roma by force in the Czech Republic and Slovakia.

Pew polling data this year found that across Europe the Roma were the most negatively viewed ethnic minority—only Spaniards had more positive than negative perceptions of Roma. This othering tends to correlate to poor living standards, including a lifespan on average ten years shorter than national norms and massively increased rates of diseases like tuberculosis.

With 750,000 Roma constituting 10 percent (and the fastest growing element) of the population, Bulgaria has Europe's largest ratio and second largest absolute population of the ethnic group. (Although  ​the state rejects this number, claiming they only have 325,000 Roma, or 5 percent of the population). Between 40 and 60 percent of them live below the poverty line (versus an 11.6 percent national average in 2013). Living in squalid conditions—50 percent of Roma homes in Bulgaria lack a bathroom—they are in desperate need of state health services.

On paper, Bulgaria's making every effort to help the Roma. They have received over $17 billion in international funding for Roma inclusion and integration programs. But they have a poor record of following through on programs or achieving all their goals. Despite joining the European Union in 2007, Bulgaria did not comply with EU law and fully lift travel restrictions on its Roma until earlier this year.

Part-and-parcel with this miserable track record, the European Roma Rights Center has collected reports of non-response by ambulances to calls from Roma areas since the early 2000s. In a 2006 report entitled " Ambulance Not on the Way," in which the organization lists numerous incidents of selective disengagement by emergency responders, the organization quotes a general practitioner from Novi Pazar, Bulgaria as telling them:

"Roma do not use the regular medical services. They do not come for examinations and prophylactic checkups. They prefer to use the emergency services because it is free of charge. That is why the emergency services does not send ambulances to the Romani neighborhood."

Across Europe, it's very common to lay the blame for Roma ails on supposedly inherent Roma characteristics or behaviors—like poor education or thieving. Earlier this year, while watching the demolition of a Roma ghetto in Hungary, a non-Roma local told reporters that he agreed with the state's removal-without-relocation strategy.

"It's like dogs—if they are in a pack, they will bit you, but not if they are separate," said Ioan Albescu. "When there are a lot of Roma together, they can be aggressive."

"All too often European leaders have pandered to the prejudices fuelling anti-Roma violence by branding Roma as anti-social and unwelcome," John Dalhuisen, the Europe and Central Asia Program Director of Amnesty International, explained to reporters this April. "The European Union has been reluctant to challenge member states on systemic discrimination of Roma that is all too evident."

This discrimination has increased to outright and frightening anti-Roma violence across Central and Eastern Europe in recent years. A study by Harvard University this year highlights this trend in Hungary, but even in the seemingly tolerant Czech Republic crowds marched down the streets in 2013 chanting "gas the gypsies."

That trend holds in Bulgaria. Just this summer, the town of Stara Zagora sent 1,000 riot police against a human chain of Roma protesting the destruction of their 55-home shantytown, illegally constructed on public land. The aggressive demolition, lacking a resettlement plan and contravening European Court of Human Rights rulings on due process, escalated into rock throwing. An ambulance and emergency responders were involved in the incident, meaning such violence is most likely included in Moskov's alarmist report of Roma anti-doctor brutality.

None of this is to say that the Roma cannot be violent independently. Clashes that we might term gang fights in America break out regularly, catching police and medics in the action.

But using these incidents, and common state and police initiated riots, as an excuse to cancel medical services to a marginalized population under the pretext of protecting doctors is absurd. That's telling people that because they've been down and out for centuries and are living out the consequences they have to bare further consequences. It's the health equivalent of destroying Roma homes without providing transitional programs. And it will only create new and exceptional health and order problems down the line, which inevitably some future minister will shrug off again, continuing the circle.