Klára Pitoňáková, LLB Student International and European Law, University of Groningen (k.a.pitonakova student.rug.nl)

The Roma, Slovakia’s largest ethnic minority, have historically faced discrimination and exclusion, particularly in healthcare. Many Roma reside in segregated settlements, lacking basic infrastructure such as clean water, sewage systems, and reliable electricity.¹ These poor living conditions have led to significant public health issues, including high mortality rates, prevalent infectious diseases, and poor maternal and child health.² The COVID-19 pandemic further exposed these inequalities, with Roma individuals being approximately twice as likely to die from the virus as the majority population.³ These disparities stem from inadequate living conditions, limited healthcare access, and systemic discrimination.⁴ This contribution analyses Slovakia’s compliance with its human rights obligations under the International Covenant on Economic, Social and Cultural Rights (‘ICESCR’), specifically Article 12 as interpreted through the AAAQ framework (availability, accessibility, acceptability, and quality of healthcare services), in relation to Slovakia’s Roma population.

International Obligations

The right to health of the Slovak Roma is protected under Article 12 of the ICESCR, which enshrines the right to ‘the enjoyment of the highest attainable standard of physical and mental health,’⁵ to be implemented without discrimination.⁶ As a party to the ICESCR, Slovakia is obligated to progressively realise this right using the maximum of its available resources.⁷ However, certain core obligations must be fulfilled immediately,⁸ including ensuring access to health facilities, essential food and drugs, and basic shelter, as well as guaranteeing non-discriminatory access to healthcare services.⁹ Other key obligations relate to reproductive healthcare and health education.¹⁰

In its General Comment No. 14, the Committee on Economic, Social and Cultural Rights (‘CESCR’) has further developed the right to health through the ‘AAAQ framework,’ which identifies four key areas for the full implementation of the right.¹¹ Availability refers to functioning healthcare facilities, services, and access to underlying determinants of health such as clean water and adequate sanitation. Accessibility requires that healthcare be accessible to everyone without discrimination. It includes four dimensions: non-discrimination (especially of vulnerable and marginalised groups), physical accessibility, economic accessibility, and information accessibility. Acceptability means that health services must be culturally appropriate, and respect medical ethics. Lastly, quality requires that healthcare services are scientifically and medically appropriate, and of good quality.¹²

Current Situation

Despite Slovakia’s legal commitments, its Roma population still faces significant barriers to healthcare. The AAAQ elements will be analysed below in light of the current situation in Slovakia. Over 40% of the Slovak Roma live in segregated settlements missing essential infrastructure such as clean water, sanitation, and working electricity.¹³ Poor nutrition, food insecurity, and inadequate housing also contribute to various health issues, while insufficient sanitation and overcrowded conditions aid the spread of infectious diseases.¹⁴ In its 2019 Concluding Observations on the Third Periodic Report of Slovakia, the CESCR emphasised that the Roma face disproportionately high levels of poverty compared to the majority population,¹⁵ and are more likely to live in substandard housing without necessary amenities.¹⁶ The Committee specifically recommended that Slovakia improves the access to healthcare for all its citizens, highlighting the physical inaccessibility of healthcare services, limited preventative care, and substandard quality of health services.¹⁷      

Availability

Roma settlements are often located in remote areas with limited availability of healthcare facilities,¹⁸ which impedes access to healthcare services and essential drugs.¹⁹ Preventive care, such as regular checkups and vaccinations, is therefore rare. Additionally, hygiene practices are constrained by insufficient sanitation infrastructure, increasing vulnerability to diseases.²⁰ This demonstrates that Slovakia fails to meet its obligations to ensure healthcare availability for Roma communities.

Accessibility

Healthcare access is hindered by geographic, economic and social barriers. As noted above, the physical segregation of the Roma enclaves makes health services difficult to reach. Financial constraints also limit access to medical services, with many unable to afford medical expenses or transportation costs.²¹ Discrimination in healthcare settings, including neglect and even outright denial of treatment, further discourages Roma individuals from seeking treatment.²² The COVID-19 pandemic exacerbated these issues, with entire Roma settlements being placed under state-enforced quarantine, reinforcing stereotypes and increasing mistrust in public health institutions.²³

Acceptability

Cultural and societal factors significantly contribute to the health inequalities faced by the Roma. Due to negative experiences in healthcare settings, health issues are often deprioritized within the community, and self-treatment or delayed medical attention is common. Anti-Roma sentiments in the broader population further fuel discrimination in healthcare settings, discouraging Roma individuals from seeking care and deepening existing inequalities.²⁴ By failing to provide culturally acceptable healthcare services, Slovakia fails to comply with the acceptability aspect of Article 12.

Quality

Even where Roma individuals do access healthcare, concerns remain about the quality of services provided. Reports suggest that Roma patients often receive substandard care, and women in particular have faced serious violations of their rights, including forced segregation in maternity wards.²⁵ The CESCR expressed concern over the harassment, humiliation, neglect and abuse Roma women endured during childbirth.²⁶ These practices represent a clear violation of the obligation to provide healthcare of good quality.

Conclusion

Slovakia’s failure to protect the right to health of its Roma population demonstrates clear non-compliance with both the core obligations and progressive commitments under Article 12 of the ICESCR. Roma communities still lack access to essential services such as clean water, adequate housing, and basic healthcare. They also face discrimination in the healthcare system, a violation of Slovakia’s core duties.²⁷ Additionally, systemic barriers, such as geographic isolation, poverty, and substandard care, hinder the progressive realization of higher standards of the right to health.²⁸ As highlighted in the CESCR’s 2019 Concluding Observations, Slovakia must take immediate action to address these deficiencies and ensure that all citizens, particularly the Roma, can fully enjoy the right to health.²⁹ This requires both urgent reforms to meet core obligations and long-term efforts to overcome discriminatory practices and improve healthcare availability, accessibility, acceptability, and quality for the Roma population. Only through comprehensive reforms and sustained commitment can Slovakia fulfill its legal obligations and work toward health equity for all citizens.

1.  Andrej Belak, ‘The Health of Segregated Roma: First-Line Views and Practices: A Case Study in Slovakia Using Ethnographic Methods’ (PhD thesis, University of Groningen 2019) 14-15.

2.  Andrej Belak, ‘Úrovne Podmienok Pre Zdravie a Zdravotné Potreby vo Vylúčených Rómskych Osídleniach Na Slovensku [Social Determinants of Health and Health Needs in Excluded Roma Enclaves in Slovakia]’ (Záverečná správa zo vstupného merania hodnotenia a systematického stanovenia potrieb cieľových lokalít Národného projektu Zdravé komunity 2A, Zdravé regióny 2019) 83.

3.  Slavomír Hidas and others, ‘Vplyv pandémie na marginalizované rómske komunity’ (Inštitút finančnej politiky and Útvar hodnoty za peniaze 2022) 5.

4.  Andrej Belak and others, ‘Why Don’t Segregated Roma Do More for Their Health? An Explanatory Framework from an Ethnographic Study in Slovakia’ (2018) 63 International Journal of Public Health 1123, 1126-1127.

5.  International Covenant on Economic, Social and Cultural Rights (adopted 16 December 1966, entered into force 3 January 1976) 999 UNTS 3 (ICESCR) art 12(1).

6.  CESCR ‘General Comment No. 14: The Right to the Highest Attainable Standard of Health (Art. 12)’ (2000) E/C.12/2000/4 (General Comment No. 14) paras 18-19.

7.  ICESCR, art 2(1); CESCR ‘General Comment No. 14: The Right to the Highest Attainable Standard of Health (Art. 12)’ (2000) E/C.12/2000/4 (General Comment No. 14) paras 30-31; John Tobin, ‘Charting the History of the Right to Health’ in John Tobin (ed), The Right to Health in International Law (Oxford University Press 2011) 176.

8.  General Comment No. 14, para 43.

9.  ibid, para 43.

10.  ibid, para 44.

11.  General Comment No. 14, paras 11-12.

12.  ibid para 12.

13.  Belak (n i) 49.

14.  Belak (n ii) 83.

15.  CESCR ‘Concluding observations on the third periodic report of Slovakia’ (2019) UN Doc E/C.12/SVK/CO3, para 26.

16.  ibid paras 30-33.

17.  ibid paras 35-36.

18.  Jurina Rusnáková and Alena Rochovská, ‘Segregácia Obyvateľov Marginalizovaných Rómskych Komunít, Chudoba a Znevýhodnenia Súvisiace s Priestorovým Vylúčením. (Segregation of the Marginalized Roma Communities Population, Poverty and Disadvantage Related to Spatial Exclusion)’ (2014) 2 Geographia Cassoviensis VIII 162, 164.

19.  Belak (n ii) 95.

20.  ibid.

21.  Ibid 83.

22.  Sandra Ort-Mertlová and Danijela Jerotijević, ‘Causes of Health Disadvantages and Consequences of Stigmatization in the Roma Community in Slovakia’ (2025) 11 Social Sciences & Humanities Open 101200, 5-6.

23.  Svetluša Surová, ‘Securitization and Militarized Quarantine of Roma Settlements during the First Wave of COVID-19 Pandemic in Slovakia’ (2022) 26 Citizenship Studies 1032, 1034.

24.  Belak and others (n iv) 1126-1127.

25.  Ort-Mertlová and Jerotijević (n xix) 5-6.

26.  CESCR ‘Concluding observations on the third periodic report of Slovakia’ (2019) UN Doc E/C.12/SVK/CO3, para 44.

27.  General Comment No. 14, paras 36, 43, 52.

28.  ibid para 37.

29.  CESCR ‘Concluding observations on the third periodic report of Slovakia’ (2019) UN Doc E/C.12/SVK/CO3, para 36.