“Rather on paper”: Observation sites in the Luhansk region
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In the period May 2-19, 2020, the monitoring group of the Charitable Foundation Vostok SOS visited all observation sites in the Luhansk region designated by the Decision of the Regional Commission for Technogenic and Environmental Safety and Emergencies (nr. 13 as of April 15, 2020). The purpose of the monitoring mission was to assess the suitability of these observation sites for the hospitalization of people with suspected novel coronavirus infection.
According to the assessment by the monitoring group, most of the premises, designated as places of observation in the Luhansk region, are in a poor technical condition and do not meet the standards set by the Resolution of the Chief State Medical Officer of Ukraine. (nr. 6 as of April 2, 2020) The participants of the monitoring mission, found the conditions in some of the observation sites unsuitable for the long-term hospitalization of people.
For example, the premises of the therapeutic department of the hospital in Bilolutsk, Novopskovskyi district, were found inadequate. The building of the therapeutic department has for a long time been in need of major repair work. Furniture, equipment and bedding are badly worn out and need to be replaced. Two hospital wards, with six beds each, have been allocated to people undergoing observation. According to a visual assessment, the dining room, toilet, and shower room are hardly complying to sanitary standards. The so-called shower room is a room with a drain hole in the floor. It has two wash basins of which one is equipped with a shower head. In addition to this, cleaning supplies are also stored in the same room.
According to the staff in this hospital, the sewage system of this toilet is designed for 15 residents, it is in very poor condition and ought to be replaced. It is not possible to disinfect the wastewater. Some of the equipment, such as a lamp for the disinfection of the premises, has long been worn out and it’s proper working condition is highly questionable.
There is another major argument against the decision to use the therapeutic department of Bilolutsk hospital as an observation site; The department is located within close proximity to a nursing home. This retirement home is located just 20 meters from the department, and the buildings even share a common yard. Currently, 30 elderly people reside there – all of them are at high risk during the COVID-19 pandemic.
The observation site in the day-patient facilities of Stanychno-Luhansk central regional hospital is in an unsatisfactory condition as well. These premises have not been in use for several years, and are in need of extensive repair. Equipment and furniture are inadequate and deteriorated and must be replaced. Based on these observations, the monitoring group suspects that there might be a problem with maintaining proper temperature conditions in the premises. However, the monitoring group did not have the possibility to verify this. There is a shower and two toilets without seats. On a positive note, this observation site provides quality nutrition, according to statements made by both hospital staff, and the patients.
The premises of the outpatient clinic for primary care in Danylivka, Bilovodsk district, Luhansk region, are in a good condition. The premises of the clinic were overhauled at the end of 2019. Thus, all observation rooms are in good condition, and equipped with furniture and washbasins. However, there is no hot water or shower in the clinic, which is highly unacceptable in case that people are kept in these premises for the mandatory two weeks of isolation. For hygienic reasons, people under observation use metal containers and heat water in electric kettles. It is difficult to maintain adequate sanitary norms under such conditions. Moreover, the staff of the clinic complains about the lack of contactless thermometers and the lack of several bedding items.
The village of Danylivka periodically suffers from electricity cuts due to the debts accumulated by the largest local enterprise the Novoderkul Horse Farm. In addition to this, the power supply is often absent for several days in Danylivka.
This problem appeared during the most recent observation of the clinic in Danylivka. Eight people that stayed in the rural clinic under round-the-clock police guard were left without electricity for three days, and therefore without the opportunity to heat food, boil water for tea or ensure personal hygiene, and were even forced to leave the observation room to use the toilet outside.
The monitoring group of the Charitable Foundation Vostok SOS did not have the possibility to assess the conditions of the observation sites in Popasna and Petropavlivka. Instead of the observation site in the branch of the Stanichno-Luhansk ‘Regional Territorial Medical Association’ in Petropavlivka, the directorate of this location showed the monitoring group a part of the hospital, which it said will be used to accommodate up to three persons under observation. The rooms that were seen were suitable for a two-week quarantine period. But the refusal to show the premises that are officially designated for observation, suggests that they are in an unsatisfactory condition.
At least three out of the eight observation sites exist only on paper. The owners of the private enterprises, namely the hotels ‘Siverskyi Donets’ and ‘Tsentralnyi’ in Sievierodonetsk and the small hotel on Vulytsia Studentska 32, in Rubizhne, are not pleased by the perspective of taking in people for isolation. Representatives of these businesses note that the decision to select their premises as observation sites was a top-down decision, which was taken without consulting the owners of the premises. For example, the administration of the hotel ‘Siversky Donets’ said that representatives of the government authorities and law enforcement agencies came by to check the conditions, but a final decision on the selection of the hotel as an observation site was not communicated to the hotel owners.
According to representatives of the mentioned private enterprises, notwithstanding the suitable conditions within their buildings, these places do not meet other formal criteria to be equipped as observation sites. Namely, they are located in the center of larger cities, in densely built-up areas, and the parts of the premises that could be used to accommodate people on quarantine do not have separate exits and cooking facilities. For example, the hotel ‘Siverskyi Donets’ is located in a residential area in the center of Sievierodonetsk at a distance of 30 meters from other residential buildings including the Sievierodonetsk City Council. The hotel in Rubizhne is still hosting workers from an infrastructural project. Representatives of all three above mentioned private businesses do not possess the information or have knowledge of the medical care that will be organized for people undergoing observation.
The observation site in hotel “Tsentralnyi” in Sievierodonetsk does also not meet established standards. It is located on the fifth floor of the hotel, which in turn is also located in a residential area in the city center. Moreover, based on data from an appendix to the Decision of the Regional Commission for Technogenic and Environmental Safety and Emergencies (nr. 13 as of April 15, 2020), the number of observation places that have been assigned to the hotel, vastly exceeds the number of existing places on the fifth floor of the building. According to the plans of the Commission, up to 87 persons can be accommodated in hotel “Tsentralnyi”, whereas the administration of the hotel says that they can take no more than 15 persons. On the other floors of the building, there are offices of private businesses which are also operating even during quarantine; whereas the ground floor of the building houses one of the city’s most visited supermarkets. Municipal and government institutions including the Luhansk region state administration are located at a distance of a few dozen meters from this supposed observation site.
Another problem is the provision of meals to those under isolation. Resolution nr. 262 of the Cabinet of Ministers states that the heads of the regional state administrations are responsible for the organization of food, which is paid for by the individuals placed in the observation sites. However, at the moment no appropriate procedure has been outlined. As a result, the locations that take in people under observation, organize meals at their discretion from their own budget, or with financial support of the local community. Moreover, the Resolution does not account for cases in which persons placed on observation do not have the means to pay for their food.
The Resolution of the Chief State Medical Officer of Ukraine nr. 6 as of April 2, 2020 states that observation sites can be established in premises where compliance with the following requirements can be ensured:
- The presence of a sanitary room in each room with a shower cabin, a toilet, and a washbasin. This condition is not met in any of the five observation sites that are actually operating in the Luhansk region. This fact contradicts the requirement that persons on observation cannot leave their room, and in case of an actual infection with COVID-19, can lead to an outbreak of the virus through the contagion of everyone else placed on observation at the same time.
- A connection to the central drinking water system.
- The possibility to disinfect wastewater at local sewage treatment plants or to do so before wastewater is disposed of to the centralized sewage system. This condition is not met in any of the visited observation sites.
- The suitability of room and furniture materials for cleaning and disinfection.
- The availability of a place for the disinfection of vehicles.
- The presence of a paved area with protection against precipitation to place containers for the collection of solid waste.
No more than four persons can be accommodated in the observation rooms, but in the list of observation sites approved by the head of the regional state administration, the location in Popasna is proposing the accommodation of 50 persons in 10 rooms. This does not meet the standards set out by the Resolution. Density standards are also exceeded in the Bilolutsk observation site.
The Resolution also prescribes the presence of an isolation area on the premises of each observation site, which can accommodate people who have been in contact with a person on observation confirmed to have the coronavirus infection. None of the visited sites, except for the hospital in Petropavlivka, do not have properly equipped isolation areas.
According to the Resolution of the Chief State Medical Officer, staff that works on an observation site cannot leave the premises of the site for the whole period during which persons are placed on observation there. Based on the data the monitoring group received, none of the visited observation sites abided by this rule. Staff of the medical institutions selected as observation sites, visit the observation places on a daily basis to carry out the medical procedures and provide meals for those under observation. All staff members that were interviewed, continue to live at home. The monitoring group was not informed about any facilities for the long-term housing of medical staff of the observation sites.
None of the visited observation sites were equipped to accommodate people with limited mobility and people with disabilities.
Conclusions and recommendations
The state administrations and local self-governments in the Luhansk region have only in a formal manner approached the organization of observation sites. The majority of the current observation sites fail not only to comply with standards set by the Ministry of Healthcare of Ukraine, but in some cases may be deemed not to meet the minimal requirements for a decent living environment, as defined in national and international human rights laws.
The long-term detention of people in such poor conditions will not only impair the loyalty of the local population to the Ukrainian authorities, it may also be used to feed anti-Ukrainian attitudes.
The national and local self-government authorities should as soon as possible revise the current list of observation sites and appoint new sites that are more suitable for the purpose of placing people suspected of a Covid-19 infection under observation. Alternatively, they could allocate money to ensure that the current observation sites fulfill the minimum hygiene, sanitary and living standards.
The central government should revise its approach to the organization of meals for persons under observation. A large percentage of people are persons from vulnerable and unprotected groups of society that do not have the possibility to provide food for themselves. The requirement that people in isolation should pay for their own food might lay the ground for lawsuits against the state of Ukraine, claiming a violation of the standards of Article 3 of the European Convention on Human Rights.
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