• Amnesty International’s latest report notes precariousness of certain vital rights
• Calls for relief and recovery measures’ consonance with human rights   

BY Sumudu Chamara   Despite various efforts by the Sri Lankan Government, the adverse impacts of the prevailing economic crisis seem to be worsening, and crisis-hit Sri Lankans feel that the country is nearing a “total breakdown”. Vital sectors such as health, food production and provision, and social security are in dire straits, in addition to rising inflation. Given the seriousness of the situation, it is crucial that Sri Lanka’s economic rebuilding efforts are supported by not just the Government, but also by external parties.   These were some of the observations made in the latest report titled “We are near total breakdown” issued by the international human rights organisation, Amnesty International, with regard to protecting the rights to health, food, and social security in the prevailing economic situation in Sri Lanka. The report, which reflected on the situation in Sri Lanka from April to September 2022, outlined some key steps that policymakers and donors must consider in order to ensure that relief and recovery measures are consistent with human rights.    Persisting economic crisis   With a focus on the rights to adequate food and health and a more limited discussion on social security provisions, the report highlighted the human rights impacts of the current economic crisis. In addition to data that was already available, the impacts of the economic crisis and related social and economic issues were analysed based on the information obtained through interviews with 29 persons including 15 men and 14 women, healthcare workers, civil society groups, international organisations, and experts. Amnesty International noted that these interviews were conducted with daily wage earners (referring to the 29 persons) who had precarious jobs, and people from the Malaiyaha Tamil community, including those working in tea plantation estates.    The report pointed out that the people’s right to health has been undermined in a context where severe shortages in the healthcare sector have emerged. As a country that imports close to 80% of its medicines and medical equipment, the report said, when its foreign exchange reserves began to run low, the Government was unable to purchase the required drugs and equipment. “In the early months of the crisis, comprehensive assessments of the extent of the shortages in the health sector were not available, with limited information made available at the facility level or in specific sectors (e.g. cancer care). However, recently, more comprehensive data is available on this issue. For example, in July 2022, according to the United Nations (UN) Office for the Co-ordination of Humanitarian Affairs, ‘there are 250 regular laboratory items and 600 complimentary items out of stock at the national level and that the system faces stock-outs of essential medicines and supplies, both in the public and private sectors’. In an appeal released in August 2022, the UN Population Fund said that there were ‘seven vital and 188 essential drugs out of stock. Another 163 drugs will go out of stock in the next two to three months’.” Based on interviews, Amnesty International said: “In June 2022, a paediatric surgeon said that she had seen shortages in intravenous potassium chloride (used to treat many common illnesses), intravenous antibiotics, and insulin, as well as shortages in equipment (intravenous lines, cannulae, syringes) in paediatric sizes. ‘We even had a shortage of gauze’, she said. ‘We didn’t have catheters and endotracheal tubes in smaller sizes, so we were asked to re-use them’. Another doctor working in an Intensive Care Unit explained how they had shortages in some drugs prescribed for people with chronic kidney conditions. They previously issued prescriptions for one month but had started to do it for one week at a time. ‘This increases the costs for the patient because they need to come to us more often to have the prescription filled’, she said. She also said that most hospitals had shortages in blood thinners, anti-venom, and anti-rabies medication.    “Another doctor working on patients with chronic kidney diseases said that they had shortages in dialysis fluid. ‘We used to offer most patients dialysis twice a week, and now we only offer once a week,’ she said. ‘We have moved from optimal management to minimal management’. In other instances, people were asked to purchase medicines or equipment from private pharmacies, because Government hospitals did not have stocks. ‘But not everyone could afford it. Those who couldn’t just went home and came back worse,’ a doctor said.” Access to food was also identified by the report as a threatened aspect of the people’s lives and added that food insecurity-related issues have been exacerbated by the economic crisis. The report pointed out that although people living in urban areas had resorted to using their gardens or backyards to try and grow food, this coping mechanism, however, was not available to the many people living in poverty in the urban areas, especially people living in tenement blocks.  “The same is true also for the Malaiyaha Tamil community, who often live in line-rooms (linearly attached houses) and do not own, or are unable to access, land for personal cultivation. In the circumstances, it would not be possible for them to follow Government advice to grow part of their own food. In interviews with Amnesty International, many Malaiyaha Tamil men and women explained how this lack of land affected their access to food and also deepened poverty because it took away a potential source of income. Thirty-six-year-old Malaiyaha Tamil woman, Priya (name changed) said ‘the denial of land rights has caused a greater degree of vulnerability during the current crisis’. Access to land for cultivation was a key demand in these interviews.” With regard to social protection programmes, Amnesty International said that an adequate and robust social protection system is essential for enabling individuals and communities to withstand both regular life cycle risks like the loss of income due to sickness or old age, but also face shocks such as the ongoing economic crisis in Sri Lanka. In the context of skyrocketing inflation and severe shortages in food, it said that medical goods and equipment and fuel among other commodities and access to adequate levels of social protection are key to protecting human rights and in particular the economic, social, and cultural rights of the people living in Sri Lanka.  It added that in times of crisis, concrete social protection measures that are compliant with the right to social security can be crucial to ensuring that all persons, particularly those who are marginalised and at risk of poverty, are able to access an adequate standard of living. The report noted that although Sri Lanka has several social security programmes, there are limitations and flaws in these programmes.   Recommendations    Highlighting the above situation, the Amnesty International report put forward a number of recommendations for the Sri Lankan Government and for several international parties. It was recommended that the Government urgently assess the impacts of the economic crisis on the ability of the people in Sri Lanka to access adequate food, nutrition, and healthcare among other essential services. The report said that this assessment should include groups at risk of adverse impacts such as people living in poverty including in urban areas, people working in the informal sector, people on daily wage incomes, people from the Malaiyaha Tamil community and others with low or precarious incomes, and those who have lost their income due to recent unemployment. Regarding the healthcare situation, it was recommended to continue to collect and co-ordinate information about what drugs and medical equipment are in short supply and where, and to work with partners to ensure that shortages and gaps are appropriately met. The report said that towards this end, where necessary, Sri Lanka should continue to request international finance and other assistance to address shortages and to ensure that health workers and other stakeholders have access to information about the Government’s short, medium and long-term plans to address the shortages in drugs and medical equipment. Working with partners to regularly monitor and collect data on the people’s evolving health status and access to health services, including both mental and physical health, was also among these recommendations. In addition, regarding access to food, it was recommended to launch programmes to address the people’s growing needs around food security. It was noted that nutrition should be based on the existing social security infrastructure in Sri Lanka (such as existing distribution networks). Adding that responding effort aimed at addressing the impacts of the crisis should provide the widest coverage possible and should be strengthened and expanded accordingly, the report recommended that the Government adequately funds and implements programmes that directly or indirectly address malnutrition amongst children, including the Thriposha (three nutrients – a free food supplement given to pregnant females, mothers, and infants) programme and the school meals programme, free from discrimination. Ensuring that children do not miss out on a nutritious diet through school meal programmes as a result of school closures was another key recommendation.  Social protection is another aspect that the report said needs to be improved. To achieve it, it recommended that the Government ensures that the right to an adequate standard of living of people impacted by the crisis is protected, including through bolstering social protection systems and increasing expenditure on social assistance programmes in order to respond to the growing need for support and to ensure that everyone who needs it has access to social assistance. Adding that the Government should revise and increase the amount disbursed as social assistance through existing programmes in order to ensure that people who receive them can access an adequate standard of living, the report recommended that this revision should be done in consultation with the affected groups, reflecting gender analysis and keeping in mind their daily needs and rapidly rising cost of living.  Reforming the existing social assistance programmes in Sri Lanka in a manner that moves away from narrow targeting and offers comprehensive social protection coverage was another recommendation.  To manage the debt and economic reforms-related aspects, the report recommended that the Government conducts human rights impact assessments for the development and implementation of any austerity measures, in line with the guidelines published by the UN Independent Expert on Foreign Debt, and develops mechanisms and processes through which people can effectively participate in and contribute to discussions about budgets and public expenditure, including before decisions to reduce public expenditure on economic and social rights are made in times of economic crisis. Urging the Government to avoid harmful austerity measures, the report said that where such measures are implemented, the Government should ensure that they are, temporary, legitimate, necessary, reasonable, proportionate, and not discriminatory, among other qualities. Moreover, the report recommended that multilateral, bilateral, and private creditors should act in accordance with their human rights-related responsibilities while negotiating Sri Lanka’s debt restructuring, ensuring debt relief, and considering all options for debt relief including debt cancellation, ensuring that key aspects of all agreements related to Sri Lanka’s debt restructuring are transparent and available for public scrutiny, and ensuring that their human rights-related responsibilities and Sri Lanka’s human rights obligations are central to any future commitments around Sri Lanka’s debt. Meanwhile, it was recommended that the International Monetary Fund (IMF) ensures that all agreements and terms and conditions linked to economic, social, and fiscal policy reforms are transparent and available for public scrutiny and that it ensures that human rights impact assessments of financial assistance programmes are prepared before, during, and after their implementation in line with the guidance issued by the Independent Expert on the Effects of Foreign Debt, and that financial assistance programmes are regularly reviewed and evaluated in relation to their economic and fiscal targets and also against the States’ human rights obligations.  Other recommendations for the IMF included ensuring that any economic, social and fiscal policy reforms and targets linked to loan programmes are realistic, sustainable, and can be implemented by the Government without impacting the fulfilment of human rights. Recommendations for multilateral donors and lenders included supporting Sri Lanka in a manner that allows the Government to strengthen human rights protections for the people, refraining from stipulations in economic reform programmes, loan contracts, debt repayments, and other aspects of fiscal policy programming that may undermine the Government’s ability to guarantee economic, social, and cultural rights, and ensuring that the Government has the fiscal space necessary towards this end.  The report further said that other countries should, in line with their obligation to provide international co-operation and assistance, support Sri Lanka with all the financial and technical assistance possible, including regarding tax assessment and collection, and provide support for relief programmes and that this should be done in a manner that allows the Government to strengthen human rights protections for the people in the country and to address any current and future protection related gaps. They were also recommended to ensure that the terms of their support do not undermine the Government’s ability to guarantee economic, social, and cultural rights, protect the fiscal space necessary to fulfil these rights and ensure that agreements and terms and conditions linked to all forms of technical and financial assistance are transparent and available for public scrutiny.