Abstract
This chapter focuses on the right to health in the Kingdom of Saudi Arabia and looks specifically at the position of vulnerable groups when it comes to the realisation of the right to health. The groups considered are women and migrant workers. The chapter looks at the underlying determinants of the right to health in relation to these groups, specifically the determinants that arise from the concept or practice of gender inequality. In the context of the Kingdom, these inequalities arise from traditional, cultural, and social practices that may affect the health of women and migrant workers. The chapter begins by examining the overall human rights protection in the Kingdom and discusses a variety of disadvantages faced by these groups, which are generally caused by cultural and social practices. It then explains how these disadvantages can have a negative impact in a variety of aspects of these groups’ lives and focuses specifically on the right to health. The chapter shows that it is impossible for the ‘right to the highest attainable standard of health’ to be achieved for these groups unless there are fundamental changes in social and cultural practices that are deeply embedded in the traditions and laws of the Kingdom.
Lara Walker is Lecturer in Law at the University of Sussex.
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Notes
- 1.
CIA World Factbook, available at https://www.cia.gov/library/publications/the-world-factbook/geos/sa.html, accessed 25 January 2013.
- 2.
See Human Rights Watch World Report 2013, p. 603.
- 3.
CIA World Factbook. See also Human Rights Watch 2010.
- 4.
Human Rights Watch World Report 2011 states that ‘8.3 million migrant workers legally reside in Saudi Arabia; an unknown number of other migrant workers are undocumented’ (p. 578).
- 5.
CIA World Factbook.
- 6.
- 7.
Ibid. See also Freedom House 2012a.
- 8.
Ibid. See also Freedom House 2012b.
- 9.
This is common in terms of activists, who have tried to peacefully express their human rights, beliefs and been detained for this. ‘In November, 16 men, including nine prominent reformists, who had tried to set up a human rights association, were given sentences ranging from 5 to 30 years in prison by the Specialised Criminal Court, which was set up to deal with terrorism-related cases, following a grossly unfair trial… Several of them had already been detained for three-and-a-half years without charge and interrogated without the presence of their lawyers.’ (Amnesty International Report 2012).
- 10.
- 11.
Human Rights Watch World Report 2013, p. 20.
- 12.
Idem, p. 603.
- 13.
Idem, p. 603.
- 14.
Idem, pp. 603–605.
- 15.
It has been reported that in July, a hospital delayed amputating a woman’s hand because there was no legal guardian present, after she had been involved in a bad car accident that had killed her husband. (Human Rights Watch World Report 2013, p. 603).
- 16.
See Sect. 6.5.1 below.
- 17.
See, Amnesty International Report 2012.
- 18.
Human Rights Watch 2012.
- 19.
The Convention has applied in the Kingdom since September 2000. See, http://treaties.un.org/Pages/ViewDetails.aspx?src=TREATY&mtdsg_no=IV-8&chapter=4&lang=en, accessed 7 August 2013.
- 20.
Article 5(a) CEDAW. See also UN Human Rights Committee (2000), General Comment 28 on Equality between Men and Women (General Comment 28), particularly para 5.
- 21.
‘More determinants of health are being taken into consideration such as…gender differences.’ (UN Human Rights Committee (2000), General Comment no 14, para 10. See also para 18 and P Hunt, ‘Reducing Maternal Mortality’, p. 6, available at http://www.unfpa.org/webdav/site/global/shared/documents/publications/reducing_mm.pdf, accessed 6 August 2013).
- 22.
Examples are Ethiopia, Kenya and Indonesia. See Human Rights Watch World Report 2013, p. 120, 133 and 327.
- 23.
- 24.
Human Rights Watch World Report 2013, p. 605.
- 25.
Idem.
- 26.
US Department of State 2011, part d. Freedom of Movement, Internally Displaced Persons, Protection of Refugees, and Stateless Persons.
- 27.
Minority Rights Group International 2012.
- 28.
See US Department of State 2012, n 23.
- 29.
- 30.
See General Comment 14 on the right to health (General Comment 14), para 12: availability, accessibility, acceptability and quality.
- 31.
Information on ratifications available at http://treaties.un.org/Pages/Treaties.aspx?id=4&subid=A&lang=en, accessed 28 February 2013.
- 32.
Article 12(1) CEDAW.
- 33.
Article 24(1) CRC.
- 34.
A full list of reservations by State is available at http://www.un.org/womenwatch/daw/cedaw/reservations-country.htm accessed 2 August 2013.
- 35.
See the discussion above on Article 5 CEDAW.
- 36.
See, Van Eijk 2010, p. 157.
- 37.
- 38.
- 39.
- 40.
Shah 2006, p. 887.
- 41.
Sura 4:32 and see Shah 2006, pp. 887–890.
- 42.
Shah 2006, pp. 887–890.
- 43.
- 44.
Van Eijk 2010, p. 157.
- 45.
For a list of state parties see, http://treaties.un.org/Pages/ViewDetails.aspx?src=UNTSONLINE&tabid=2&mtdsg_no=IV-4&chapter=4&lang=en#Participants, accessed 17 September 2013.
- 46.
http://treaties.un.org/Pages/ViewDetails.aspx?src=TREATY&mtdsg_no=IV-3&chapter=4&lang=en, accessed 27 February 2013. http://treaties.un.org/pages/ViewDetails.aspx?src=TREATY&mtdsg_no=IV-4&chapter=4&lang=en, accessed 28 February 2013.
- 47.
See, http://treaties.un.org/Pages/ViewDetails.aspx?mtdsg_no=IV-13&chapter=4&lang=en, accessed 2 August 2013.
- 48.
http://www.arabhumanrights.org/en/countries/country.aspx?cid=16, accessed 28 February 2013. For information on the Charter see WHO, ‘Arab Charter on Human Rights’, available at www.who.int/hhr/Arab%20Charter.pdf, accessed 17 September 2013.
- 49.
Al-Midani and Cabanettes 2006, p. 148.
- 50.
Rishmawi 2005, pp. 361–376.
- 51.
Al-Midani and Cabanettes 2006, p. 149.
- 52.
Rishmawi 2005, p. 370.
- 53.
The Basic Law of Governance.
- 54.
Idem.
- 55.
Idem.
- 56.
Idem.
- 57.
General Comment 14, para 12(b).
- 58.
- 59.
World Bank 2011 available at http://data.worldbank.org/country/saudi-arabia, accessed 7 April 2013.
- 60.
See Almalki et al. 2011, and http://www.saudiembassy.net/about/country-information/health_and_social_services/the_health_care_network.aspx, accessed 26 March 2013.
- 61.
Almalki et al. 2011.
- 62.
Idem, p. 792.
- 63.
World Health Organisation 2012, p. 58.
- 64.
Idem, p. 60.
- 65.
Under the WHO classifications, Saudi Arabia is in the Eastern Mediterranean Region. For a list of States in this region and further information see http://www.who.int/about/regions/emro/en/index.html, accessed 17 September 2013.
- 66.
World Health Organisation 2012, p. 60.
- 67.
Idem, p. 128.
- 68.
Idem, p. 130.
- 69.
Almalki et al. 2011, p. 789.
- 70.
Sullivan 1995, p. 378.
- 71.
Idem, p. 386.
- 72.
Idem, p. 386.
- 73.
See, Van Eijk 2010, p. 157.
- 74.
This is the body responsible for monitoring the Convention. For more information see http://www.un.org/womenwatch/daw/cedaw/committee.htm, accessed 30 September 2013.
- 75.
UN Committee on the Elimination of Discrimination against Women (1999) General Recommendation 24 on Women and Health, para 14 (General Recommendation 24).
- 76.
Idem.
- 77.
Idem.
- 78.
See, n 30 above.
- 79.
This refers to acceptable as required by the AAAQ. In this context, access to health care will only be acceptable where, all health facilities, goods and services are respectful of medical ethics and culturally appropriate, i.e. respectful of the culture of individuals, minorities, peoples and communities, sensitive to gender and life-cycle requirements, as well as being designed to respect confidentiality and improve the health status of those concerned (General Comment 14, para 12).
- 80.
General Recommendation 24, para 13.
- 81.
UN Committee on the Elimination of Discrimination Against Women, Fortieth Session 2008 CEDAW/C/SAU/CO/2 Concluding Comments of the Committee on Saudi Arabia.
- 82.
Sullivan 1995, p. 378.
- 83.
Article 12(2).
- 84.
General Recommendation 24, paras 26–27.
- 85.
General Comment 14, para 21.
- 86.
See http://www.undp.org/content/undp/en/home/mdgoverview/mdg_goals/mdg5/, accessed 2 August 2013.
- 87.
Millennium Development Goals Report Saudi Arabia 2005, p. 45, available at http://www.un.org/summit2005/MDGBook.pdf, accessed 26 February 2013.
- 88.
World Health Organisation 2012, p. 104.
- 89.
Idem, p. 107. It is unclear how the definition differs. The report simply states that it differs. A skilled health personnel is somebody such as a doctor nurse or midwife, who has specific training in pregnancy and childbirth. It would not include traditional birth attendants. (WHO, Health Statistics and health information systems at, http://www.who.int/healthinfo/statistics/indantenatal/en/index.html, accessed 18 September 2013.
- 90.
World Health Organisation, Statistics 2012, p. 104. WHO recommends that pregnant women get at least four visits from a skilled health personnel. (WHO, Health statistics and health information systems, n 89 above).
- 91.
World Health Organisation 2012, p. 104.
- 92.
Idem, p. 106.
- 93.
Idem, p. 78.
- 94.
Idem, p. 78.
- 95.
Idem, p. 82.
- 96.
Idem, p. 82.
- 97.
P Hunt, ‘Reducing Maternal Mortality’, p. 3, available at http://www.unfpa.org/webdav/site/global/shared/documents/publications/reducing_mm.pdf, accessed 7 August 2013.
- 98.
See Sect. 6.2.
- 99.
World Health Organisation 2012, p. 59.
- 100.
World Health Organisation 2012, p. 61.
- 101.
World Health Organisation 2012, p. 116.
- 102.
World Health Organisation 2012, p. 116.
- 103.
Human Development Report (2007/08) Table 10.
- 104.
World Health Organisation 2012, p. 59.
- 105.
World Health Organisation 2012, p 61.
- 106.
This will be discussed below at 6.5.2.3.
- 107.
World Health Organisation 2012, p. 104.
- 108.
Idem.
- 109.
Idem.
- 110.
General Comment 14, para 12(c).
- 111.
General Recommendation 24, para 12(d).
- 112.
General Comment 24, para 28.
- 113.
CEDAW, Article 5(a).
- 114.
Ministerial Resolution No. 218/17/L of 26 June 1989 of the Ministry of Health Article 24, available at http://www.hsph.harvard.edu/population/abortion/SAUDIARABIA.abo.htm, accessed 17 September 2013.
- 115.
Idem, Article 24.
- 116.
Idem, Article 24.
- 117.
See, http://www.alranz.org/findoutmore/internationalperspective/abortioninthe.html, accessed 17 September 2013 and Ministerial Resolution No. 218/17/L, Article 24(1).
- 118.
Ministerial Resolution No. 218/17/L, Article 24(4).
- 119.
Idem, Article 24(4).
- 120.
Johnston 2013.
- 121.
Johnston 2013.
- 122.
CSDH 2008, p. 30.
- 123.
Human Rights Watch 2012.
- 124.
Human Rights Watch World Report 2013, p. 21.
- 125.
Human Rights Watch 2012, p. 117.
- 126.
According to a Stanford Hospital, obesity-related illnesses cost the US over $150 billion a year. http://stanfordhospital.org/clinicsmedServices/COE/surgicalServices/generalSurgery/bariatricsurgery/obesity/effects.html, accessed 22 March 2013.
- 127.
Ibid and see also Jia and Lubetkin 2005.
- 128.
Almalki et al. 2011, p. 791.
- 129.
CSDH 2008, p. 22.
- 130.
CSDH 2008, p. 22.
- 131.
In this respect, it is noted that those who work for some private companies can access leisure facilities. Companies which have their own compounds often have private leisure facilities that employees and their families are free to use (Human Rights Watch 2012, p. 13).
- 132.
See http://www.telegraph.co.uk/health/expathealth/8701829/Expat-guide-to-Saudi-Arabia-health-care.html, accessed 26 March 2013, and International Labour Organisation (1999) available at http://www.ilo.org/public/english/standards/relm/ilc/ilc87/r3-1b6.htm, accessed 26 March 2013.
- 133.
Almalki et al. 2011, p. 787.
- 134.
Idem.
- 135.
In 2011, statistics showed that only 1 in 10 Saudis worked for the public sector. See http://www.voanews.com/content/saudi-arabia-youth-bulge-private-sector-economy/1709481.html, accessed 5 August 2013.
- 136.
The kafala sponsorship system ‘ties migrant workers’ residency permits to “sponsoring” employers, whose written consent is required for workers to change employers or leave the country. Employers often abuse this power in violation of Saudi law to confiscate passports, withhold wages and force migrants to work against their will or on exploitative terms’ (Human Rights Watch 2013).
- 137.
See Human Rights Watch 2009.
- 138.
‘Although both men and women migrate, migration is not a gender-neutral phenomenon. The position of female migrants is different from that of male migrants in terms of legal migration channels, the sectors into which they migrate, the forms of abuse they suffer and the consequences thereof. (CEDAW, General Recommendation 26 on women migrant workers (General Recommendation 26).
- 139.
- 140.
See, Almalki et al. 2011.
- 141.
Human Rights Watch 2009, p. 5.
- 142.
General Recommendation 26, para 17.
- 143.
See above at Sect. 6.2.
- 144.
See n 136.
- 145.
US Department of State 2011, section D.
- 146.
Human Rights Watch 2009, p. 5.
- 147.
See n 21.
- 148.
CSDH 2008, Foreword.
- 149.
CSDH 2008, Foreword. In this context, the social impact comes from the way Saudi citizens are accustomed to living, economic forces in the migrants country of origin are encouraging immigration for better wages and the political circumstances are shaped by the fact that the Saudi government is not changing the law in order to better regulate the current system.
- 150.
General Recommendation 26, para 17.
- 151.
Idem, para 17.
- 152.
Idem, para 18.
- 153.
Idem, para 18.
- 154.
Committee on the Rights of the Child, Forty-First session, CRC/C/SAU/CO/2 17th March 2006, p. 14.
- 155.
Idem.
- 156.
Human Rights Watch World Report 2013, p. 28.
- 157.
Idem.
- 158.
Idem.
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Walker, L. (2014). The Right to Health and Access to Health Care in Saudi Arabia with a Particular Focus on the Women and Migrants. In: Toebes, B., Ferguson, R., Markovic, M., Nnamuchi, O. (eds) The Right to Health. T.M.C. Asser Press, The Hague. https://doi.org/10.1007/978-94-6265-014-5_6
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