Pavee Point Traveller and Roma Centre

Submission to Ireland’s COVID-19 Evaluation

Pavee Point Traveller and Roma Centre (‘Pavee Point’) is a national non-governmental organisation committed to the attainment of human rights for Irish Travellers and Roma in Ireland. Established in 1985, the organisation comprises Travellers, Roma and members of the majority population working in partnership to address the needs of Travellers and Roma, who as minority ethnic groups, experience exclusion and marginalisation. The aim of Pavee Point is to contribute to improvement in the quality of life and living circumstances of Irish Travellers and Roma by working for social justice, solidarity and human rights.

INTRODUCTION

The COVID 19 Pandemic had a significant impact in Ireland, with nearly 9,000 people dying of complications related to the illness and over 1,700,000 contracting the acute respiratory illness^[1]. National restriction control policies and behaviour change expectations reformed how we live overnight. Policies and procedures developed included closure of schools and workplaces, handwashing and social distancing practices, masking, isolation measures and movement restrictions. The associated containment policies and procedures had multiple intended and unintended consequences. We know that the pandemic had a disproportionate impact on marginalised and minority communities, including Travellers and Roma, due to the health and social inequalities that these communities face.

CONTEXT: PAVEE POINT’S WORK DURING COVID 19 DURING THE PANDEMIC

In Pavee Point, we quickly recognised that COVID-19 should be an organisational priority for all staff, participants and programmes and galvanised ourselves into action in working to mitigate the impact of the pandemic among the Traveller and Roma communities in Ireland.

We were aware that at European and international levels concerns^[2] were being raised about the potentially disproportionate impact that COVID-19 on minority and marginalised communities, and specifically on Traveller and Roma communities.

During COVID-19 Pavee Point worked collaboratively and in partnership with the HSE, Traveller Health Units (THUs) and Traveller organisations, groups working with Roma and Primary Health Care Projects (PHCPS), the Department of Education and Skills, Department of Housing, Local Government and Heritage, the Department of Rural and Community Development and other government departments to ensure the prioritisation of Travellers and Roma during this time. Using an interagency approach and ensuring a social determinants focus to public health, this work resulted in policy and service provision changes which has had tangible outcomes for Travellers and Roma on the ground.

KEY ACHIEVEMENTS TO SUPPORT AND PROTECT TRAVELLERS AND ROMA DURING THE PANDEMIC

Pavee Point’s work ensured the rights of Travellers and Roma were upheld. Our work national, regional and local levels, included:

Travellers and Roma were named under vulnerable groups and included in the work of the NPHET Vulnerable People Subgroup
Travellers and Roma were identified as priority groups for COVID-19 testing
Fast tracking and targeted testing of Travellers and Roma
Issuance of a national circular from the Department of Housing, Local Government and Heritage to all local authorities to ensure the provision of emergency facilities and Traveller accommodation to self-isolate where necessary
Engagement of public health doctors in implementation of the national circular
A national ban on Traveller evictions during the COVID-19 crisis, including Travellers living on the side of the road or Travellers doubling up on sites in emergency legislation.
Community Response Forums (CRFs) were inclusive of Traveller representation, resulting in the Department of Housing, Local Government and Heritage issuing advice to Local Authority Chief Executives through the City & County Managers Association (CCMA) to ensure Traveller representation on these structures.
Inclusion of an ethnic identifier in the HPSC database (CIDR)
Issuance of PPE to all Traveller Primary Health Care Workers
Development of culturally appropriate COVID-19 health education materials

KEY LEARNING FROM THE COVID 19 CRISIS FOR FUTURE RESPONSES

The importance of Equality Data to Monitor the Impact of crisis on everyone in society, including Travellers and Roma.
A Nationally Consistent, Collaborative, ‘Whole of Government’ Approach which pools resources from across Departments.
Resourcing of Civil Society (inclusive of Traveller organisations) as key partners and recognising the vital role of community sector in mobilising to protect the most marginalised individuals, families and communities.
A just recovery is built on achieving equality and fulfilling human rights, promoting an intercultural and anti-racist society, It is vital that the Community Sector, Traveller organisations and Traveller Primary Health Care Projects and services are resourced and protected.
The need for robust implementation of targeted strategies such as NTRIS II, TRES, and NTHAP, with accurate data and adequate resourcing, as well as the development of a National Roma Health Action Plan.
Further invest in the Traveller health infrastructure and provide better pay and conditions for Traveller community health workers (including retention of medical cards) and invest in establishing a Roma health infrastructure.
Conduct an equality assessment of digitisation/telehealth to ensure that its use does not further exclude/marginalise groups facing health inequalities, such as Travellers and Roma.
Targeted measures are needed to address the wider impacts of crisis, such as mental health, substance use, and violence against women, particularly for Travellers, Roma and other marginalised groups.

THE IMPORTANCE OF EQUALITY DATA

From the beginning of the pandemic, we were conscious of the urgent need for disaggregated data to monitor the impact of the crisis on Travellers, Roma and other minority ethnic groups. In early 2020, we urged the State to collect and collate ethnic data to monitor and document the impact of COVID-19 on Travellers, Roma and other minority ethnic groups. While it was agreed that the collection of ethnic data was important by NPHET, it wasn’t fully implemented.

Pavee Point consistently raised the issue of the lack of ethnically disaggregated data during the pandemic, which has resulted in the underreporting of positive cases and deaths amongst Travellers, Roma and other minority ethnic groups. In the absence of this crucial data, we are unable to measure the true extent of the pandemic on the communities, including deaths. While it was agreed that the collection of ethnic data was important by NPHET, it wasn’t fully implemented. In the interim, we knew that in the absence of ethnic equality monitoring (inclusive of an ethnic identifier) across all health data collection systems, particularly at the point of referral, identifying cases within the community would be extremely challenging. In response to this, we developed a national Traveller and Roma COVID-19 monitoring template which was shared with all Traveller Health Units, local Traveller organisations, Traveller Primary Health Care Projects and groups working with Roma. We also worked with Safety Net to support the inclusion of an ethnic identifier in their COVID-19 data collection system to capture Traveller and Roma cases.

Through the National Traveller Health Network (NTHN), we advised local Traveller organisations and Traveller Primary Health Care Projects to complete the template and forward it to us and their THU Co-ordinator on a weekly basis. We collated this data and reported it during National Traveller and Roma COVID-19 Response teleconferences where it was shared with the HSE Public Health Lead for Social Inclusion/ Vulnerable Groups and cascaded to the NPHET Vulnerable People Subgroup and locally to public health offices. This data was instrumental in informing the responses by CHOs to Traveller cases in the local area. It also supported the HSE and Traveller organisations to:

establish a baseline of COVID-19 as related to Travellers and Roma nationally
identify clusters/outbreaks
identify close contacts
monitor the outcomes of cases

The introduction of a standardised ethnic identifier (consistent with national census and inclusive of Roma) is required across all routine data administrative systems, including all health and domestic and sexual violence services, to monitor equality of access, participation and outcomes for Travellers, Roma and other minority ethnic groups. It is essential that the application of an ethnic identifier take place within a human rights framework. This data can be used to put in place necessary measures and resources for Travellers, Roma and other minority ethnic groups. This data is required in order to future proof responses.

THE NEED FOR A NATIONALLY CONSISTENT, COLLABORATIVE APPROACH

Ireland can be very good at responding to crises. Throughout the COVID-19 pandemic a whole-of government approach was evident as was the pooling of resources across departments. We hoped that this would become a legacy of COVID-19 and the approach and inter-agency working continued at both national and local levels in addressing Traveller and Roma marginalisation and protecting their human rights into the future. However, this has not fully materialised.

COVID-19 did expose a fragmented approach across some regions/health areas. This was particularly evident in the varied application of COVID-19 testing criteria which led to confusion among Travellers, increased anxiety and fears, and created tensions among families on some sites. Pavee Point lobbied for a consistent national approach and a standardised operating procedure to be applied in all Traveller cases throughout the country where possible to avoid misunderstandings and bring greater clarity to the approach.

THE IMPORTANCE OF A PARTNERSHIP APPROACH WITH TRAVELLER ORGANISATIONS

The existence of a robust Traveller infrastructure at national and local levels was evident throughout the COVID-19 pandemic. Traveller organisations have a long track record of working together collaboratively and information was fed up and down from national to local organisations and vice. Traveller organisations have the trust of the community and were well placed to share information and explain regulations when necessary. This infrastructure was harnessed positively by the State and through working in partnership with Traveller organisations the worst of the impact of COVID-19 on the Traveller community was mitigated.

The COVID 19 response showed that the State can work in a collaborative manner with the community sector. The experience and expertise of community organisations was respected and harnessed. The diversity of organisations and their respective roles were recognised and informed the state responses to COVID-19. Resources were provided where required and the community sector mobilised to protect vulnerable individuals, families and communities. This learning must be harnessed as a model for continued collaboration between the State and the community sector.

A JUST RECOVERY/FACING FUTURE CHALLENGES

Inequality, racism, marginalisation and disadvantage were the source of Traveller and Roma vulnerability to the crisis of the pandemic and the impact of COVID-19 on their communities. Their vulnerabilities were recognised and named by a range of UN and European human rights institutions^[3].

For a just recovery and ensuring that Travellers and Roma do not face these challenges again in a future crisis, it is imperative if this vulnerability is removed for the future. A just recovery is built on achieving equality and fulfilling human rights, promoting an intercultural and anti-racist society. Travellers and Roma suffered disproportionately during Austerity and cannot bear further cuts. As we potentially face public budget constraints/recession, it is vital that the Community Sector, Traveller organisations and Traveller Primary Health Care Projects and services are protected.

IMPLEMENTATION OF POLICY ACTIONS FOR TRAVELLERS AND ROMA

Since the pandemic, we have welcomed the publication of the new National Traveller and Roma Inclusion Strategy (NTRIS) 2024-2028, as well as the first National Traveller and Roma Education Strategy and the National Traveller Health Action Plan.

While these are extremely positive policy developments, to see real change on the ground for Travellers and Roma, robust implementation of these strategies with accurate data and adequate resourcing will be required. Also, the commitment to developing a Roma Health Action Plan in NTRIS II is a welcome step in addressing the stark Roma health inequalities across the country.

FAIR TERMS AND CONDITIONS FOR TRAVELLER AND ROMA WORKERS

The value of our strong Traveller Health Infrastructure and in particular, in responding to the pandemic and ensuring Travellers were protected during the crisis cannot be understated. In the absence of such an infrastructure, we believe COVID-19 would have had a much worse impact on the community. This work should be recognised through the provision of medical cards to all Travellers given their underlying health conditions and inequalities and the imperative to retain experienced Travellers in undertaking this important health work which is part-time and employs people on the minimum wage.

COVID 19 also saw, for the first time, specific funding provided by the HSE for Roma community health workers across all HSE health areas. This was in response to the significant health inequalities facing Roma, exacerbated and made more visible during the pandemic. These provisions need to be strengthened, with the establishment of a nationally consistent Roma health infrastructure.

THE NEED TO CONSIDER DIGITISATION AND TELEHEALTH CHALLENGES

This crisis marked a major shift in our health services particularly as it relates to digitisation of health services or tele/online health (as per Sláintecare) which we believe has the potential to further exacerbate existing health inequalities and limit access to health services for Travellers and Roma. Many older Travellers and Roma in particular, often cannot use mobile phones, do not have mobile phones, do not have access to computers or internet connection, and have either no or low levels of literacy. Further, many Traveller sites/group housing schemes do not have broadband and given overcrowded living conditions there is also limited space for many Travellers and Roma to have a private conversation with GPs and/or other allied health professionals. It is imperative that telehealth cannot be seen as a panacea in addressing existing gaps in health services and that it is subject to an equality impact assessment to ensure that its use is inclusive and accessible for Travellers, Roma and other marginalised groups.

MENTAL HEALTH: We know that Travellers were already at risk for poor mental health with disproportionately higher rates of frequent mental distress and suicideconnected to a legacy of deep-rooted systemic racism and discrimination. Research^[4] shows that the pandemic took a heavy toll on Travellers’ mental health and continues to have an ongoing impact and weighs heavily on many Travellers.

Ring-fenced and sustainable funding should be made available as a matter of priority for Traveller organisations to provide community development and peer-led approaches to address Traveller mental health inequalities and Traveller organisation representation on the Sharing the Vision National Implementation and Monitoring Committee must be ensured.

DRUGS/SUBSTANCE USE: COVID 19 also exacerbated issues of drug use in the Traveller community^[5]. Adequate funding and full implementation of the new National Drugs Strategy is needed, with specific actions to provide mainstream and targeted interventions for Travellers.

VIOLENCE AGAINST WOMEN: A standard procedure should be adopted across all local authorities to fast-track women and children fleeing domestic violence in social housing allocations, considering the high levels of homelessness within the Traveller community, to specifically fast track Traveller women fleeing domestic violence in allocations of Traveller-specific accommodation and other types of social housing. Regulatory barriers, including the Habitual Residence Condition, for Roma women accessing domestic violence services and long-term housing/social protection must also be addressed.

[1] Health Protection Surveillance Centre (2021) COVID-19 Interim Case Definition [online] https://www.hpsc.ie/a-z/respiratory/coronavirus/ novelcoronavirus/casedefinitions/covid-19interimcasedefinitionforireland/ (accessed 14 April 2023).

[2] See Statements from the OSCE and FRA here: https://www.osce.org/odihr/449668; https://fra.europa.eu/en/news/2020/persistent-roma-inequalityincreases-covid-19-risk-human-rights-heads-say

[3] https://www.osce.org/odihr/449668; https://fra.europa.eu/en/news/2020/persistent-roma-inequality-increases-covid-19-risk-human-rights-heads-say; https://www.coe.int/en/web/commissioner/-/governments-must-ensure-equal-protection-and-care-for

[4] https://www.paveepoint.ie/wp-content/uploads/2024/07/Travellers-Mental-Health-Reflections-on-the-Impact-of-COVID19.pdf

[5] https://www.paveepoint.ie/wp-content/uploads/2024/01/Pavee-Point-Submission-to-the-Citizens-Assembly-on-Drug-Use-Final-Submitted-29-06-2023-PDF-2.pdf