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  An ambulance enters the Aleman-Nicaraguense Hospital, which cares for people infected with Covid-19, as relatives of patients wait in line in Managua, Nicaragua, on June 1, 2020. © 2020 INTI OCON / AFP via Getty Images.

(Washington, DC)– Nicaraguan authorities have fired at least 10 health workers in apparent retaliation for voicing concern about the Daniel Ortega government’s management of the Covid-19 health crisis, Human Rights Watch said today. The Ortega regime should immediately allow the health workers to return to their jobs, compensate them for their lost wages, and adopt effective measures to respond to the pandemic.

On May 18, 2020, more than 700 health workers from the public and private sectors signed a letter urging the government to acknowledge that the virus was spreading in Nicaragua and to put in place preventive measures recommended by the World Health Organization to limit its further spread. They noted that Nicaragua’s weak public health system was at “great risk of a collapse that could endanger the lives and health of Nicaraguans broadly,” contradicting the official narrative that the virus has had limited impact. On June 6 and 9, Nicaraguan Health Ministry officials dismissed several workers in the public health system who had signed the letter, without following standard legal procedures for dismissals.

“Ortega is seeking to intimidate and punish health workers for trying to protect the health of all Nicaraguans and exercising their basic right to freedom of expression,” said José Miguel Vivanco, Americas director at Human Rights Watch. “The government went from denying the pandemic to deliberately trying to conceal the real effects of its shameful failure to respond to the virus. Arbitrarily removing health workers amid a health crisis further threatens a public health disaster.”

In June, Human Rights Watch interviewed by phone five of the fired doctors and one who resigned. They included an internist, a general surgeon, an otolaryngologist, an anesthesiologist, and a doctor specializing in infectious diseases. All worked for the public health system and had signed the May 18 letter urging the government to act quickly to stop the spread of the virus.

The Ortega administration has responded to the pandemic with denial, inaction, and secrecy, Human Rights Watch said. Contrary to global and local health experts’ advice, the government initially encouraged large-scale public events and has not closed schools or ordered lockdowns or social distancing. On April 30, Ortega said he was against public campaigns that urged people to stay at home, and called those who encouraged such measures “radicals” and “extremists” who “only want to see the country destroyed.”

Four doctors told Human Rights Watch that the Health Ministry keeps tight control of Covid-19-related information, particularly of tests and their results. Covid-19 samples from public and private hospitals are all sent to the national health laboratory (Centro Nacional de Diagnóstico y Referencia), the only institution in Nicaragua that performs the tests. As the May 18 letter from health professionals noted, the lack of public information, including on the number of tests conducted and Covid-19 cases, means “the real magnitude of the pandemic” is unknown.

Media reports and doctors’ statements suggest that Covid-19 cases are most likely drastically underreported. While the government reported 1,823 cases of people infected with Covid-19 and 64 deaths through June 16, the nongovernmental organization Covid-19 Citizen Observatory (Observatorio Ciudadano Covid-19) registered, through June 10, almost 5,000 suspected cases and more than 1,300 suspected deaths.

After downplaying the threat posed by the disease, Ortega now appears to be trying to conceal its spread. Hurried burials have been increasing in Managua, media reported, carried out by Health Ministry officials and closely monitored by police. Health authorities deny that Covid-19 caused these deaths. Instead, they tell families the cause of death was “atypical pneumonia” or some other respiratory disease. In several cases, families have not been allowed to attend the burials.

Human Rights Watch reviewed the dismissal letters sent to the five doctors. The letters, issued on June 9, have identical text and do not indicate the grounds or justification for dismissal. All five doctors said they had worked for the public health system for more than five years, and none had been sanctioned for issues or concerns with their performance.

Nicaraguan administrative law provides that workers will be retained “on the basis of merit, ability, specialization and professionalism, with the objective of becoming a career public servant.” The Health Career Law provides a specific procedure for firing those working in the public health system, which requires opening a formal disciplinary investigation and allowing the worker to present a defense. All of the doctors interviewed said the Health Ministry did not follow legal procedures in dismissing them.

On June 9, the Nicaraguan Center for Human Rights (CENIDH) issued a statement of concern over the “dismissal of several health professionals in the midst of the serious situation that Nicaragua is facing due to the Covid-19 pandemic.”

International human rights law guarantees the right to free expression, including for people who work in the public sector. While restrictions are permitted, including some that may apply specifically to public servants, those restrictions cannot be applied arbitrarily, and must be necessary and proportionate to the circumstances. In particular, governments are not permitted to retaliate against people for the legitimate exercise of that right in the public interest, in the way that the Nicaraguan government has done in this case.

This is not the first time the Ortega administration has targeted health workers. During its 2018 crackdown on dissent, the Ortega administration fired at least 400 doctors, nurses, and other health workers from several public hospitals in apparent retaliation for providing care to victims of violence.

The government’s targeting of the health workers further compounds the fragility of Nicaragua’s public health infrastructure, which leaves the country ill-equipped to confront the further spread of Covid-19. The WHO reported in 2018 that the country had 6,320 doctors – that is, 9.7 per 10,000 people, well below the estimated regional average for the Americas of 23.3 per 10,000.

Health workers in Nicaragua are also at high risk of becoming sick with Covid-19. The Citizen Observatory reports that more than 500 health workers, including doctors and nurses, have reported symptoms consistent with Covid-19 and that at least 60 health workers with Covid-19 symptoms had died by June 10. Doctors attribute the deaths, in part, to a lack of adequate protective equipment.

“By arbitrarily dismissing doctors and other health workers during a pandemic, the Ortega regime appears to be more interested in silencing health professional’s criticism than in protecting the lives and health of Nicaraguans,” Vivanco said. 

For additional details about the cases, please see below.

Summary of Cases Documented by Human Rights Watch

The following doctors interviewed by Human Rights Watch between June 4 and 9, had signed the May 18 letter questioning the Ortega government’s response to the pandemic:

Martha Bendaña, an internist at Manolo Morales Hospital for 17 years, said she was not given any reason for her June 9 firing. The human resources director for the hospital simply handed her a dismissal letter. Bendaña said she had signed two letters expressing concern over the government’s response to the health crisis.

Adolfo Díaz Ruiz, a general surgeon at Lenin Fonseca Hospital for 25 years, resigned on June 9 after receiving information that coworkers at various hospitals were being fired. He said he resigned to protest the arbitrary nature of the terminations. “The government has not developed any policy that acknowledges the seriousness of the pandemic,” Díaz Ruiz said. He said that health workers have been negatively affected by the lack of protective equipment: “In the hospital where I work, at least 20 percent of the health workers have been infected at some point.”

Linda Barba Rodríguez, wife of Adolfo Díaz Ruíz and a radiologist for 16 years at the same hospital, was fired hours after her husband resigned. She did not receive any explanation as to why.

Leonor Eugenia Morín, an otolaryngologist at Francisco Morazán Health Center for eight years, who was fired on June 9, said the human resources director told her only that it was on “orders from above.” “We are a poor country and we don’t have the resources to face the Covid-19 crisis,” Morin said. “The number of infected people has gone up, and the hospitals are packed with Covid-19 patients, even if the government fails to acknowledge it. Our health system is not prepared.”

Maria Nela Escoto, an anesthesiologist at Lenin Fonseca Hospital for 24 years, received no explanation as to why she was fired on June 9, only that the orders came from “above.” To accommodate a chronic health condition, which also places her at a higher risk of getting the virus, Escoto had an agreement with the hospital to be exempted from 32-hour shifts, she said. She was in the midst of undergoing exams to prove her condition to the Health Ministry when she was fired.

Carlos Quant, a doctor who specialized in infectious diseases at Manolo Morales Hospital for 25 years, was fired on June 4. He said that he is a member of the Scientific Multidisciplinary Committee (Comité Científico Multidisciplinario), an independent organization created to respond to the pandemic and provide the public with health information that the government is failing to supply. Quant’s letter of dismissal said he was fired because he did not show up for work between May 22 and 29. 

Quant, who refused to sign the letter, said he had gone to work on those days. He believes the Health Ministry fired him as reprisal for criticizing the government’s response to the pandemic. “Expressing criticism in Nicaragua can be dangerous,” he said. “It is unacceptable [for the government] to have an independent voice; I’m considered a political enemy for contradicting the government’s narrative.”

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