COUNCIL OF EUROPE

To the GREVIO Group

Submission on the implementation of the Council of Europe Convention on preventing and combating violence against women and domestic violence in Serbia

Joint submission by Women’s rights organization FemPlatz and Mental Disability Rights Initiative MDRI-S

Pancevo& Belgrade

January 2019

Women’s rights organization FemPlatz and Mental Disability Rights Initiative MDRI-S would like to thank the GREVIO Committee for the opportunity to send a written submission addressing the implementation of the Council of Europe Convention on preventing and combating violence against women and domestic violence in Serbia, focusing on women with disabilities.

Women’s rights organizationFemPlatz is a non-profit, non-partisan and non-governmental organization dedicated to protection from discrimination and full realization of human rights of women and girls, especially those exposed to inter-sectional and multiple forms of discrimination. FemPlatz contributes to creation of enabling environment for gender equality, inclusive growth, and social inclusion of women and girls by conducting independent research and policy impact analysis for improving legislation and practices and building capacities of stakeholders relevant for gender equality. Programs are planned and implemented by respecting principles of equality, independence and respect to personal autonomy, social inclusion and participation, and empowerment of women. FemPlatz is based in Pancevo, Serbia, email: [email protected].

Mental Disabilities Rights Initiative of Serbia (MDRI-S), an affiliate of Disability Rights International, is a non-profit and non-governmental organization registered in Serbia since 2008. As a recognized advocacy organization in Serbia, MDRI-S promotes citizen participation, awareness and oversight of the rights of persons with disabilities, and leads the process of development of disability rights advocacy and self-advocacy movement in Serbia. MDRI-S covers the issues of the most marginalized and stigmatized people and its special focus is on children and adults who are at risk of or who are already residing in social and mental health institutions. MDRI-S priority areas are equal recognition of persons with mental disabilities before the law, protection from violence, abuse, ill-treatment and torture, deinstitutionalization, and community living. As a member of the National Preventive Mechanism for Torture (NPM) set up under the OPCAT in 2012, MDRI-S systematically monitors the position of persons deprived of liberty in residential social institutions. MDRI-S is based in Belgrade, email: [email protected].

Violence against women with mental disabilities in residential and psychiatric institutions

There are 18,250 people living in some form of collective accommodation[1] in Serbia and over 11,000 of them report to have some type of disability.[2] Half of them are girls and women. According to the 2016 data of the Republic Institute for Social Welfare, 48% of clients in residential institutions for adults with disabilities were women,[3] while there were about 44% of girls and women in institutions for children and youth.[4]

The patriarchal and stereotyped roles of men and women in Serbia negatively affect already difficult position of women with disabilities.[5] They are discriminated in all areas of public and private life. They are invisible in public life, encounter obstacles to education, health and social protection; they are poorer and more often unemployed than men with disabilities, they are victims of psychological, physical, sexual, economic, and institutional violence, and there are stereotypes and prejudices related to their gender roles, especially regarding marital and family relationships and parenting.[6] Women with intellectual, cognitive or psychosocial disabilities are in additionally vulnerable situation and at higher risk of violence, especially if they are in closed institutions. Their statements about the experiences of violence are questioned, they are not believed, and are often assumed to be unaware of the violence they suffer, or that they cannot recognize it.

Life in a residential institution is characterized by lack of privacy, inability to make decisions about one's own life, social exclusion, and violation of fundamental human rights and dignity of a person, but it also represents a high risk of violence, abuse, and neglect. Although precise data are not available, most women with intellectual and psychosocial disabilities in institutions are deprived of their legal capacity and put under guardianship, which means that they cannot decide on their own place of residence, their own treatment, medical interventions, pregnancy, parenting, partnership. Denial of the right to informed decision-making on important life issues degrades these women and additionally puts them at risk of various coercive interventions. Women with disabilities in residential and psychiatric institutions are exposed to different forms and manifestations of gender-based violence and they are at increased risk of abuse, sexual assaults, rape by other clients and/or staff because of their specific vulnerability.

MDRI-S conducted comprehensive research and documented violence against girls and women with disabilities in residential institutions^[7]which showed that institutionalizedwomen are exposed to various forms of gender-based violence, including physical, psychological, and sexual violence (both horizontal and vertical) ranging from violation of privacy, verbal threats and intimidation, sexual abuse and harassment, coercive measures.Women with mental disabilities are victims of forced abortions, arbitrary separation from a child, and administration of contraceptives without informed consent, while there is no functional complaint or appeal mechanism.Due to their very specific position in residential/psychiatric institutions and isolation from outside world, which includes also lack of access to information, they are denied adequate support in situations of violence, redress, and accessible support services in the local community.

Although these findings were published and presented to relevant decision-makers and other relevant actors during 2016-2017, there has be no improvements in the protection of women in residential and psychiatric institutions from gender-based violence in 2018.

Based on the research conducted in 2017 “Here walls have ears too: testimonials of women with mental disabilities about gender-based violence in residential institutions”,[8]most critical abuses that we want to draw attention to are:

Violation of the right to privacy: right to privacy is violated on a daily basis which can lead to different forms of abuse and violence against women. The lack of privacy manifests in overcrowded rooms, insufficient living space, and lack of control over the choice of room or roommates. Although male and female rooms are separated in most institutions, in some institutions men and women share rooms.People living in residential institution do not own their clothes or private things and there are no places and cabinets for holding private belongings. Most women report that they do not have their own wardrobe, but they take what is clean or available. They do not choose the clothes, but employees give them. Sometimes, clothes that women bought for themselves get lost in the laundry, so they decide not to buy clothes, and over time they stop paying attention to what they wear.

Bathrooms and toilets in institutions are frequently commonly used. Often there are no doors in the toilets, the doors cannot be completely closed or locked, there are no separate shower cabins, and showering is often performed in groups.In most institutions, mostly women work as nurses at women's departments, but this is not always the rule and it often depends on the schedule and availability of staff.

Who is available, works.It is not generally considered that female staff works with women, and male staffwith men […]There are no curtains for changing. Bathing is in groups. Girls today, men tomorrow. And when clients see that it is bathing time, they take off their clothes and stand naked in the room, waiting. They got used to nudity,they have no idea about it, because they constantly see each other and do not have any shame at all. (Employee in the institution)

MDRI-S staff saw in an institution that about 20 women and men sat in the central room, completely naked and waiting for the shower line.

A caregiver helped in showering and dressing, and she worked like on the conveyerbelt. A woman in wheelchair was completely naked, wet, and she sat so uncovered in the hallway and crying. She waited for the caregiver to dry and dress her. She was crying all the time. We had the impression that she was cold and embarrassed. (MDRI-S monitoring team)

It is of utmost importance to provide for the respect of privacy in the institutions in order to prevent possible abuse and violence against women with disabilities.

Forced interventions: Physical restraints and isolation (seclusion) are critical human rights violations in residential institutions.Isolation or seclusion of persons with mental disabilities, for any duration, constitutes cruel, inhuman and degrading treatment, and any form of restraintof people with mental disabilities, even for a short period of time, can amount to torture and abuse.[9]Apart from the fact that such practices should be prohibited, they also increase the risk of additional forms of violence against women. The isolation of women in the rooms from which they cannot exit for various reasons[10]opens a worrying possibility of abuse.Report of the Special Rapporteur on Torture[11] states that every woman deprived of liberty subjected to isolation suffers extremely serious consequences, including the possibility of repeated traumatization if she has been a victim of violence in the past. In addition, when a woman is isolated, she is at higher risk of physical and sexual abuse. If she needs support for moving or if she is not speaking, the risk of violence increases as well as the inability to protect herself.Namely, if physical restraints are usedon a woman who has been sexually abused in the past, especially if her arms and legs are tied, a woman besides all other consequences affecting all victims of confinement may experience this measure as a repeated trauma of sexual abuse, which will further scare and victimize her.[12]The isolation of women who are at risk of violence or who have already survived violence only further victimizes them, discourages reporting violence, and constitutes an act of torture or ill-treatment.[13]It is very important to forbid all forced interventions in the institutions, including isolation and physical restraints.

Forms and manifestations of violence against women with disabilities in residential institutions: Research shows that the risk of ill-treatment for people with mental disabilities is increasing the moment they are placed in the institution. The most worrying fact is that violence in institutions is often considered justified, which creates a "culture of institutional violence" that becomes acceptable. Some authors[14] believe that each residential institution creates its specific culture of violence by isolating users, intimidating them, and exercising poor control over employee behavior. This creates an environment in which violence is accepted as normal. Therefore, the causes of violence should be sought within the institution itself, considering the nature and functioning of residential institutions, as well as the attitudes of those employed in them.[15]Apart from the fact that placement of a person in a residential institution against her will constitutes a violent act, women with disabilities in these institutions are additionally exposed or at risk of physical, verbal, psychological, and sexual violence. They can survive violence from other clients in the residential institution (horizontal violence), employees (vertical violence) and persons outside the institution.Women talked about their own experience of punishments for "breaking the rules" which involved standing in the corner, kneeling, denying meals the next day, ban of going out, locking them in the room, all of which are often accompanied by insults, shouting, and physical violence like pulling their hair or slapping.

The punishment for being late was recording a minus in a notebook. Minus, minus ... No breakfast, no lunch, no dinner. Everyone will have breakfast, lunch, and you watch. Because it was forbidden. (K, former client)

He hits, and yells, and threatens. If you do not do it as he says, he will give you injection and you fall asleep. (beneficiary of the institution)

The caregiver pulled my hair, slapped me, and did all sorts of things to me. And I never made a mistake, I never made a problem. (J, former client)

They pull your hair. They do all these things in front of everyone. They hit with their shoes. Everyone keeps silent about this. If you say something, you will also get it. There you cannot complain to anyone. They just kick you out and say, "In the pavilion!" And then the caregiver comes and beats you. (A, former client)

Horizontal violence in institutions is defined as the psychological, physical, and sexual violence that one or more clients carry out to punish, hurt, or control other clients.[16] Given that this type of violence occurs in residential institutions, it often has the characteristics of violent behavior "in the clan" and shows much similarity to the manifestations of peer violence and domestic violence. The biggest problem is that the victim is forced to live with her abuser and cannot leave, and the fact that a joint life in the institution gives the perpetrator the opportunity to find out the most intimate information about the victim, such as her family situation, health condition, disability, which makes it easier for the victim to be intimidated and controlled.[17]

It happened sometimes that clients got into fight. Then I ran away from the situation, because I knew that I would be punished if I reportedit. Such was the practice. Certainly,everyone gets punished – the one participating and the one who wants to prevent violence. (A, former client)

It happened that the clients got into fight, but this was sorted out quickly. Also, some men mistreated girls and women in the institution. Those more aggressive were also attacking the girls. This was solved by going to the management, and then they took him to a psychiatrist, gave him some medication, and sent him to another institution. Sometimes, he was sent to a psychiatric hospital. (F, former client)

Although we do not claim that this is everyday behavior in all residential institutions, the fact that different women who have been living for many years in different institutions have told similar experiences infers that violence is widespread and there are no prevention programs or adequate responses to such behavior. Women who have survived domestic violence are in a particularly difficult situation, because institutional violence additionally victimizes and traumatizes them. Most of the women we interviewed talked about their experiences of violence before they came to the institution, pointing out to partner violence or violence that they survived from other family members. It is very problematic that the official response to the violence they survived (combined with their life in poverty and the fact they have mental disabilities) was to place them in a residential institution that only opened possibilities for new and additional forms and manifestations of violence.

Women with intellectual and mental disabilities are at higher risk of surviving sexual violence in comparison to women without disabilities and women with physical disabilities. However, research[18] shows that from the moment when a woman is placed in a residential institution, this risk is further increased. This is also explained by the fact that life in a residential institution for women means that they are isolated from the outside world, are vulnerable, and even "consent" to unwanted sex to fulfill their own needs that are denied in the institution. For example, the perpetrators offered cigarettes or a drive, in exchange for sex. Also, the problem is that employees in institutions perceive clients as asexual beings and do not provide them with any protection against abuse or they just use that prejudice to carry out their own violence, because they know that institutionalized women will not be widely believed to report violence.[19]

Some of our interviewees said that men were attacking women in big residential institutions, beaten them and forced into sex. Women mostly keep silent and continue to suffer violence. It has already been stated earlier that in some institutions men and women share rooms and given that women cannot choose who they will be in the room, they may be in the same room as the abuser and to survive continuous violence that goes unreported. Although they mostly do not want to talk about it, one woman told us that a man (and from a further conversation, we realized they were a couple for a while) tried to rape her while she was with a friend in the courtyard of the institution. They managed to escape, and she reported the attack to the staff and the management. The man was punished, but also the girls because they went to that place "although it was forbidden." Two other girls talked about similar experiences.

Women sometimes do not report, and we do not have an idea of ​​what actually happened and whether something happened at all. We had a rape report from one woman, and we talked with her. We later found that she lived alone [before coming to institution] and that various people came to her house, so who knows what is in her head. And when we asked her about rape, she told us something completely different from what rape really is. (Employee in one institution)

During March 2017, a report was published in the Serbian media that a technician at the psychiatric hospital harassed the clients, and one woman was forced to take off her clothes, while he touched her and poured coffee on her. Her husband informed the media about the incident the following day:

He first appeared in the ward at midnight, woke up the patients and presented himself as a doctor from Nis. He started harassing them and lining them up in the hallway, and my wife was forced to strip. He touched her genitals and breasts. My wife complained that it was terrible - says husband Alexander. He says his wife confirmed that there was no sexual intercourse, but that he physically harassed her, slapped her, and forced her to take off her clothes. "My wife told me that there was no sexual intercourse, but that she was made to sit naked in his lap, that he spilled coffee over her body, touched her, and that everything was terrible. She is now in a worse condition than she was 20 days ago when she was admitted to the hospital, although there was some progress several days before the incident."[20]

Therefore, it is important to provide adequate prevention and protection from violence in the residential institution, particularly protection of women with disabilities, since they are exposed to both custodial violence and gender-based violence. 

Administration of contraceptives without informed consent: for women under guardianship, consent for inserting intrauterine device is asked from a guardian (many women are not informed or they are unaware that they’d be subjected to such treatment, which is sometimes done under total anesthesia), while for administration of contraceptives pills the guardian is only informed as the pills are regarded as “part of regular therapy,” while a woman is not informed about it. Most women with disabilities who are sexually and reproductively active are given contraceptive pills or inserted intrauterine devices (IUDs) without their consent or prior information on interventions and effects.

The gynecologist asks woman whether she is in a relationship and whether she needs contraception. (F, former resident of institution)

As soon as you get to the institution, they put IUD in you. And that's it. Those who get pregnant need to have abortion. (S, currently living in the institution)

They put intrauterine device in me. They put it, they did not ask anything. They just asked me when they finished if I was OK, whether I want to vomit. (K, former client)

They [women] are not generally asked. Their guardians are asked about the form of contraception at the recommendation of a gynecologist. Younger girls are given pills and older women are given intrauterine device. He [doctor] found everything, two devices in woman’s uterus. There was little concern about these women. Nothing has been done on this issue, because everyone is kind of shrugging their shoulders. And everyone blames others. (Employee in the institution)

It is crucial to completely separatewoman’s status of legal capacity from the informed consent to medical treatments related to sexual and reproductive rights.

Forced abortions: women under guardianship are not informed or asked about prospective abortion, which is presumed to be the most adequate solution. Women who have their legal capacity are coerced to have abortions by threats of being expelled from the institution and denied means of living. In both cases, it can be said that abortions are forced upon women.

Women who can takecare of themselves recorded their own menstrual period. They also say that the caregivers monitored if the period was regular, and when pregnancy was detected, girls went to a gynecologist to determine the length of pregnancy and schedule an abortion. The girl's consent is not sought.One woman says she was "keeping a record of other women’s menstrual period." Once, she noticed that one girl missed herperiod, so she reported it to the staff. The girl was already four monthspregnant.

She was barely alive, she could die [after the abortion]. She also had problems with the sinuses and she could not breathe. They cut her, because she could not deliver a baby. Terrible. No one asked if she wants it or not. But, she shouldn’t have done that. You cannot do that in the institution. You can have a boyfriend, but you have to be careful. (D, former client)

If a girl gets pregnant, they call her ‘mommy’, say bad things about her, act badly towards her. And then, they do an abortion to her. (D, living in institution)

Again, the status of legal capacity of a woman must be completely separated from the informed consent and decision about abortion.

Forced sterilization: although there is a lack of transparent evidence on cases of sterilization, interviews with several women and staff of residential institutions give grounds to believe that such practices against women are still common in Serbian residential institutions. Forced sterilization is without doubt one of the most severe forms of violation of human rights and medical ethics and it can be described as cruel, inhuman, and degrading treatment that can amount to torture.[21]Women from vulnerable groups are most frequently victims of forced sterilization, while medical and state institutions do not have developed policies about informed consent.

During the data collection, we received information about only one woman with intellectual disability who was sterilized in the past few years, after she gave birth to the fourth child and then placed in a social care institution. In another institution, a woman got pregnant and her mother was appointed as temporary guardian for the event of giving birth. Mother/guardian insisted that the woman (her daughter) be sterilized.

The mother insisted that sterilization be done after givingbirth. We tried to talk her out of this, that it was not a good idea, that nobody would accept such intervention. We struggled to keep her off this intervention. They [women with intellectual disabilities] do not have the same treatment at all as other patients, for sure. (Employeeof the institution)

With the 2017 changes of the Criminal Code in Serbia, criminal acts of forced abortion and forced sterilization have not been criminalized and harmonized with the Convention on preventing and combating violence against women and domestic violence.

Equally critical is partner violence that women with mental disabilities survive in residential institutions and this violence is not recognized adequately by the institutions’ staff. In international theory of domestic violence against women with disabilities, the concept of family has been expanded because disabled women often depend on more people who assist them in performing various daily activities. Besides parents, intimate partners, and other family members, domestic violence is also extended to personal assistants, that is, persons who provide help and support in their day-to-day functioning. These are, for example, personal assistants, drivers, interpreters, doctors and other medical personnel, social workers, therapists, counselors, as well as other employees in residential institutions. Therefore, women with disabilities living in residential institutions and women with severe forms of disability who require care and ongoing personal assistance are at higher risk of being exposed to violence because they depend on a larger number of people and it is difficult for them to leave the perpetrators.

My first boyfriend in the institution beat me because I smoked. He did not like it. I complained to the caregivers, but they did not respond. A friend protected me. After that, my boyfriend was no longer allowed to beat me. (T, former home user)

Women often survive partner violence in institutions, and it seems that employees do not have adequate responses to such situations. One woman told us that she had previously had a relationship with a young man from the institution that beat her, and once he strongly bit her breast. She complained to the caregivers and they threatened that he would go to the "cage" if he still touched her. As he continued with physical violence, "a friend advised her to leave him and find another boyfriend."

If we consider that a residential institution for many people is a long-term placement and that couples in these institutions live together, the question arises as to whether the provisions of the new Law on the prevention of domestic violence will apply to these women as well. Given that the law defines domestic violence as "an act of physical, sexual, psychological or economic violence of the perpetrator towards the person with whom he/she is in present or earlier marital or extra-marital relationship,"[22]there should be a discussion about partner violence in residential institutions until circumstances are changed for complete deinstitutionalization.

Although sector-based protocols for prevention and reaction to violence in social-care institutions defines internal protection mechanism – team for prevention of violence – interviews with survivors and staff, and visits to residential institutions proved that this mechanism is not functional. Names of the members of the team and their phone numbers are not put in visible place in the institution, clients are not informed about the existence of the team, and the number of complaints is negligible. This basically leaves women without any complaint and appeal mechanism and possibilities of redress and receiving adequate support.

Committee on the Rights of Persons with Disabilities already gave recommendations to Serbia to eradicate some of mentioned practices in its 2016 Concluding observations.[23]The submitting organizations ask the GREVIO Group to make similar recommendations in its Report on the Republic of Serbia and give grounds for continuing advocacy for the changes in the legislation and practice in this regard.

Unavailability and inaccessibility of mechanisms for protection from violence to women with disabilities: Each institution for children and adults with disabilities is obliged to establish an internal team for protection from violence.[24] This team exists in 11 institutions for adults with disabilities (from 15) and in five (all) institutions for children with disabilities. The specific tasks of the internal team are to receive reports on the knowledge or concern about situations of violence, collect information, take measures for the safety of the clients, and work closely with anyone who, during the examination process, develops a protection plan for a survivor of violence. The obligation of the institution is to clearly and publicly announce the names of the members of the internal team, as well as their telephone numbers. Team members must be available 24 hours a day. However, not one woman we spoke with has ever heard about the internal team for protection from violence.There was no public information about internal team in any of the institutions we visited.

However, it should be noted that ten women we interviewed lived in institutions at the time when the internal team mechanism did not exist, but the testimonies of women who live in institutions now and the insights of our monitoring team nevertheless confirm that the internal team is an unknown and insufficiently visible mechanism. This is supported by the fact that in 2015, 15 institutions for adults with disabilities, in which 4,415 people lived during that year, reported only five cases of violence (horizontal violence). Internal teams recorded violence in only three institutions, and the report of the Republic Institute for Social Protection states that "for the past seven years records are being kept for: physical abuse, sexual, emotional abuse, negligent conduct towards the clients, exploitation of clients, as well as types of abusers."[25]Also, from five institutions for children with disabilities, only one reported five cases of violence to the internal team and all related to horizontal violence. Other institutions did not record any situation of violence[26]. Considering the number of people living in institutions, their testimonies of various forms of violence, but also the prevalence of violence in other areas of public life in Serbia, this extremely low number of reports is a result of under-reporting of violence within the institutions, normalization of violence, and inadequate functioning of internal teams.

The employees we interviewed claim that the internal team cannot function properly in the way it is now being designed. They consider this mechanism to be set up to meet procedural requirements. For example, employees claim that they often refuse to leave their phone numbers in a visible place, as this may mean that they will constantly receive calls that are not connected to situations of violence, primarily because women and men placed in institutions are not fully informed about violence, protection measures or prevention. A visible telephone number would not reduce the incidence of violence without previous continuous work and providing information to clients. Some employees consider that trust is an important issue, i.e., whether users have confidence in the person who is in the team.

The internal team for protection against violence has no real role. It has a more administrative role than an essential one. Perhaps clients do not have confidence in people in the team. How then to report violence? It is generally believed that staff should not give their phone numbers to clients. Clients are not informed about their rights. There is a lack of accountability. If I were to be held accountable for whether I gave information to the clients or not, then it would be a very different story. For example, information on how to deal with living in an institution, how to respond to some things… (Employeeof the institution)

As regards external mechanisms for protection from violence, public and private (NGOs providing support to women in situation of violence), they are neither available nor accessible to women with disabilities in residential institutions.

The main challenges in providing services to women with disabilities we detected are:

·         Architectural accessibility of organizations and institutions (police, centers for social work, safe houses);

·         Financial difficulties in providing specialized services (e.g. sign language interpreters, information packages in Braille or other accessible formats);

·         Financial sustainability of services;

·         Lack of human resources and experts;

·         Lack of understanding of the local self-governments and failure to provide civil society organizations with support and assistance.

Also, service providers believe that it is better for women with disabilities to address specialized services. As reasons, they also state that they cannot perceive the scope of the problem, that they are not sufficiently trained to provide psychological support to women with disabilities, have no experience in working with them. Multiple discrimination is cited as a major challenge in providing services, especially when it comes to Roma women with disabilities.

Due to the inaccessible mechanisms for protection against violence outside the residential institution, as well as the non-functional internal mechanism, women with disabilities in institutions are at greater risk of violence, and violence remains invisible. Women who have spent their whole lives in the institution and have no experience of interaction with the community are in a particularly sensitive and difficult situation, as well as those with severe disabilities and need for intensive and complex support, women with a different way of communication, girls and elderly women, women who did not attend school and are illiterate.