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Argentina: Abusive Covid-19 Measures in Northern Province

Unsanitary Conditions in Formosa; Isolation, Quarantine Centers; Free Speech Restrictions

People held in mandatory quarantine at School N°18, which served as a quarantine center, in the city of Formosa, on January 21, 2021. © 2021 Leo Fernández.

(Washington, DC) – Authorities in Argentina’s northern province of Formosa have employed often abusive and unsanitary measures to prevent the spread of Covid-19, Human Rights Watch and the Johns Hopkins University’s centers for Public Health and Human Rights and for Humanitarian Health said today. Provincial authorities have also limited journalists’ ability to cover the situation in Formosa, allegedly used excessive force against those protesting the Covid-19 measures, and, for months, severely restricted the ability of people from the city of Clorinda to leave their city and get health care.

Over 24,000 people have been held in mandatory isolation and quarantine centers in Formosa since April 2020, many for more than the 14 days recommended by the World Health Organization, and in many cases under circumstances that amount to arbitrary detention. Formosa authorities have held some people who tested positive with others who tested negative or were still waiting for their test results. The centers have at times been overcrowded and unsanitary, making social distancing difficult. Some lacked proper ventilation, and the authorities have at times failed to provide proper medical care to people in the centers.

“Unsanitary and crowded centers like those in Formosa can cause the virus to spread, undermine basic human rights, and erode the trust in public health authorities that is critical for a successful Covid-19 response,” said Dr. Kathleen Page, a physician and faculty member of the Johns Hopkins University School of Medicine and the Johns Hopkins University centers. “Isolating entire cities can cause more problems than benefits for people’s health in the long term.”

Between January and March 2021, Human Rights Watch interviewed 45 people in Formosa by phone, including 30 who were in isolation or quarantine centers, as well as doctors, lawyers, victims of police abuse, journalists, a legislator, and two councilwomen. Most fear reprisals in Formosa and spoke on condition that their names and other identifying information would be withheld. Some said they were government employees and feared they would lose their jobs. This publication is also based on official information provided by the Formosa provincial government and the national Human Rights Secretary’s Office.

Under Formosa province’s Covid-19 rules, people entering the province, regardless of whether they had been exposed to Covid-19, and those who have been in close proximity to someone who tested positive, were sent to quarantine centers, known as “preventive accommodation centers.” Isolation centers, known as “health attention centers,” were created for those who tested positive and have mild symptoms or are asymptomatic. People held in these centers may not leave, are generally under constant police surveillance, and in some cases have been locked into their rooms.

Formosa authorities have often failed to comply with their own protocols. While conditions in isolation and quarantine centers vary, most interviewees described them as unsanitary and overcrowded. In some quarantine centers, people shared rooms and common spaces, including bathrooms. Authorities also mixed people arriving on different dates in the same rooms and did not take into consideration their age, gender, health conditions, and other risk factors. They also placed people who tested positive with others who tested negative or were still waiting for their results. Formosa’s government says that doctors and nurses are permanently stationed at quarantine and isolation centers, but interviewees said they had limited access to timely and proper health care.

These failures, together with conditions at the centers and excessive stays, have most likely contributed to the spread of Covid-19 and violated the right to health of those being held, Human Rights Watch and the Johns Hopkins University centers said.

In January, after a significant uptick in confirmed Covid-19 cases, the government significantly increased the number of people held in quarantine and isolation centers, with many reporting abuse.

Zunilda Gómez, 33, was three months pregnant with her fourth child when, on December 19, police took her family from their home in Clorinda. The authorities locked Gomez and her children, ages 12, 8, and 5, in a hotel room. On January 5, Gómez started bleeding, and called for help. Desperate, she had her daughter climb out the window to seek help, she said.

After an hour, police took Gómez to a hospital, leaving her children locked in the hotel room alone until the next day. Gómez had a miscarriage. Her husband, who had been moved to an isolation center 75 miles away after testing positive, only learned of the miscarriage when a family member called him.

On January 27 and 28, 2021, the National Human Rights Secretary, Horacio Pietragalla, who reports to the Ministry of Justice and Human Rights, visited Formosa to review allegations of abuse.

The Formosa government introduced additional quarantine and isolation protocols after the visit, following also several media reports and lawsuits. The Formosa government additionally closed some of the centers. On February 3, the Formosa authorities introduced new protocols to allow some families with children, people over 60, and people with prior health conditions to quarantine at home.

“The new protocols in Formosa are a positive step, but protocols that look good on paper will not work if they are not adequately implemented,” Page said.

Even after Formosa adopted the additional protocols, some people in the excepted categories were sent to quarantine centers, apparently because their homes did not meet the new protocols’ “environmental and social requirements,” such as having private bathrooms for infected people and adequate ventilation. At the centers, they were, at times, exposed to worse conditions than they probably would have been exposed to at home. Even though overcrowding has been reduced and some centers are closing, Human Rights Watch has received complaints about unsanitary conditions and limited access to health care in some centers after the February protocols were adopted.

On March 19, a federal judge ordered the Formosa authorities to end the mandatory quarantine for people entering the province with a negative polymerase chain reaction (PCR) test. Formosa authorities appealed the decision, but adopted a new protocol on March 22 complying with the court order. Media reports indicate people have started traveling to and from the province.

Between August 2020 and March 2021, Formosa authorities enforced a “sanitary blockade” on the city of Clorinda, suspending public transportation to that city and requiring anyone who intends to leave to present a negative Covid-19 test and obtain police authorization. This seriously undermined the ability of people in Clorinda to access health care.

Authorities in Formosa have also limited journalists’ ability to report about the situation in the province, allegedly used excessive force against people who protested the Covid-19 regulations, and arrested and brought criminal charges against some of them.

Under international law, certain basic human rights cannot be restricted even in times of emergency, such as the right to be free from ill-treatment. Restrictions on many other rights, including rights to liberty, freedom of movement, expression, and association, may be permissible during a public health emergency like a pandemic but must have a clear legal basis, be strictly necessary and proportionate to the public health aim, of limited duration, subject to review, and neither arbitrary nor discriminatory in application. Argentine authorities also have an obligation to take effective steps to prevent the spread of Covid-19 and protect people’s right to the highest attainable standard of health.

Mandatory quarantine that increases people’s risk of exposure to the coronavirus does not serve the purpose of protecting the population from Covid-19 and may amount to arbitrary detention under international human rights law as being an unnecessary limitation on liberty, Human Rights Watch said.

“Covid-19 measures should help protect people, not put them in greater danger,” said José Miguel Vivanco, Americas director at Human Rights Watch. “The national government should work with provincial authorities to periodically verify that is respecting human rights as it responds to Covid-19, including by limiting the use of police forces to conduct contact tracing.”

For additional information on Human Rights Watch’s findings, please see below.

Methodology

Human Rights Watch reviewed photos and videos of several centers that supported what 45 interviewees said regarding conditions in quarantine and isolation centers, and reviewed official information, media reports, and Covid-19 protocols issued by Formosa’s government. A Johns Hopkins University researcher interviewed local doctors and reviewed Formosa’s sanitary protocols.

Human Rights Watch met with Human Rights Secretary Horacio Pietragalla on March 15 to discuss the situation in Formosa, and requested information from the Governor’s Office in Formosa, the national Human Rights Secretary’s Office, and the Attorney General’s Office. The Formosa government and the Human Rights Secretary’s Office provided comprehensive written responses; key information from those responses is included in this publication. The Attorney General’s Office did not respond.

Police Role in Contact Tracing

Formosa’s governor, Gildo Insfrán, has often cited increases in the numbers of confirmed Covid-19 cases and deaths to justify restrictive measures. The province reports one of the lowest Covid-19 death rates in Argentina, both in absolute terms and based on its population. As of March 25, 2021, there were 1,769 confirmed cases and 28 deaths.

Health authorities and police in Formosa conduct “active searches” in neighborhoods of people who have tested positive to identify others who have had contact with them or with people suspected of having it, test them, and place them in quarantine or isolation centers, sometimes before receiving their results.

Eleven people interviewed said that police officers, in some cases with health professionals, took them from their homes in the middle of the night to state-managed centers, citing their close contact with a family member who had tested positive. Many said police did not allow them to pack clothing or toiletries they needed. In some cases, people were driven around for hours, as police gathered others who had also allegedly had contact with positive cases, and mixed them in vans or ambulances. Some said they were not provided masks during the journeys.

The authorities then took the people to get tested at “Units for Prompt Attention to Contingency” (Unidades de Pronta Atención de la Contingencia, UPAC). Covid tests in Formosa are only performed in 19 state-managed laboratory facilities. Formosa allows no testing by private laboratories and centralizes all information on results. Many people interviewed said they did not learn their test results before they were transferred to quarantine or isolation centers.

Argentina’s response to Covid-19 has been marred by a violent police response towards people accused of breaking the rules. Police should not be conducting contact tracing unless there are no other human resources with appropriate training and experience available to do it safely and effectively, Human Rights Watch said.

Arbitrary detention

Mandatory quarantine is a form of deprivation of liberty that should only be imposed if it is necessary and strictly proportionate to the public health threat.

As of February 16, Formosa had held more than 24,000 people in the province’s 188 quarantine and isolation centers, according to official information. Human Rights Watch documented 30 cases in which people were held in these centers between January and March under conditions that run counter to international human rights standards, WHO recommendations, and in many cases Formosa’s own protocols, amounting to arbitrary detention.

Quarantine has often extended longer than the 14 days that the WHO recommends and is established in local protocols, people held in centers told Human Rights Watch. Some said they had been required to stay for 30 days. While extensions beyond the 14 days recommended by the WHO may sometimes be necessary, in some cases people with negative Covid-19 results may have been exposed at centers during these extensions.

Under Formosa’s testing protocols, test results are to be released to people tested through a password-protected private website run by the Formosa government, “MyPortal” (MiPortal), or provided by health authorities responsible for quarantine and isolation centers. But interviews and screenshots of some users’ MyPortal sites show that results are not always posted after several days. In some cases, people said they were not verbally told their results. In the worst cases, people finished their isolation or quarantine without ever getting their test results, which infringes on their rights to health and access to information.

Human Rights Watch interviewed six people who showed negative PCR results before entering the province but who, after a few days in quarantine centers, tested positive. Although it is not clear where they contracted the virus, in some cases the number of days between the negative and the positive tests suggests it happened inside the centers.

  • Juana Ramírez (pseudonym), 33, presented documentation, on December 27, for herself and her 12- and 2-year-old sons, showing that they had tested negative for Covid-19 in preparing to move from Buenos Aires to Clorinda. The next day, when the family entered Formosa province, authorities tested them again, and again the results were negative. They told Ramírez that, before leaving a quarantine center, the family would have to test negative for Covid-19 twice more.

    Authorities sent Ramírez and her sons to a center housed in an elementary school in the capital city of Formosa, where they shared the bathroom with other people. After a test on January 10, people who did not identify themselves or provide copies of official test results told Ramírez that her 12-year-old son had tested positive. Authorities transferred the family, on January 11, to the isolation center in Cincuentenario Stadium. They were quarantined for another 14 days – and had to test negative for Covid-19 twice more – before being released.

Formosa authorities have repeatedly held people who tested positive for Covid-19 along with people who had tested negative or were waiting for their results. Several people interviewed said the authorities took entire families, including children and adults, who had received negative test results, to isolation centers.

  • On January 6, the police told Lucas Garibaldi (pseudonym) and his family – his wife, and her son, daughter, and grandson – that some family members had tested positive and others negative. Officers nonetheless took all of them, including those who had tested positive, to a quarantine center meant for people who had tested negative before entering the province.

People at the centers said they were confused about how often they would be tested. One Formosa protocol requires PCR tests for close-contact cases on arrival and on days 5 and 10 of quarantine. A separate protocol requires a negative result on tests conducted by state-managed centers between days 3 and 5 and again on day 13 of quarantine. People held in some quarantine centers said that the authorities informed them they had to quarantine for 14 days and test negative at least twice, sometimes three times. Some people said they were tested as many as 11 times, suggesting possible exposure to people who tested positive within the quarantine center.

Unsanitary, Dangerous Conditions

Formosa’s quarantine and isolation protocols require “informed consent” – an agreement to stay – from anyone placed at an isolation and quarantine center. However, several people interviewed said that unidentified authorities at the centers told them to sign a consent form in a rush, without allowing them to read the whole document. After signing, some requested – and were denied – a copy.

Human Rights Watch reviewed a form titled “Informed and Prior Consent” from the center for positive cases established in the Cincuentenario Stadium, in which the government purported to “waive” responsibility for anything that happened to those held there. However, because the quarantine was mandatory and people could not leave, it amounted to a form of detention; the government is obligated to care for people it is detaining and cannot waive those obligations.

Some people interviewed said that centers they were held in during January and March were overcrowded and had unsanitary conditions. Several people said that in January at least 260 people shared six bathrooms in the Cincuentenario Stadium.

In January, the Cincuentenario Stadium center was especially crowded, housing over 300 people at a time, people interviewed said, with no separation between families – or accommodation for older people and those with disabilities, due to accessibility barriers such as steps.

They described makeshift “bedrooms,” separated only by cardboard walls, on a large, covered field, a description matched by photos and videos from the facility that Human Rights Watch reviewed. Six to ten people, in many cases from different households, shared an improvised “bedroom.” Beds were next to each other and families often had to share the room with other people.

Inside the centers people from different households, including children, were housed with unrelated adults, raising security concerns. Placement in quarantine centers also raised health concerns as authorities did not organize people by date of arrival, nor according to exposure or test results, which increases the risk of spreading Covid-19 within the facility.

Some of the centers were not cleaned, more than 20 people said. Bathrooms were particularly dirty, they said, and although protocols specify there should be personnel for cleaning common spaces, quarantined and isolated people said they had to clean bathrooms and showers themselves. Several women said they feared their children would get sick from unsanitary conditions.

Sanitation kits with soap, hand sanitizer, a toothbrush, and a face mask were delivered at some centers. However, some said the authorities did not give them sanitation kits or that they had to request the kits several times.

Some facilities appeared to have limited ventilation and access to water. When Laura Quinteros (pseudonym) and her 3-year-old and 18-month-old daughters arrived for quarantining at a school in Formosa city on January 13, the bathrooms were flooded from rains, she said. By the second day, the bathrooms had run out of water. On March 4, a man held in another quarantine center said that in recent days the facility had no water for five to seven hours a day. Food was supplied regularly, people held in several centers said, but it was often too little and of poor quality.

Although Formosa protocols stipulate scheduled outdoor hours for residents in quarantine or isolation facilities, people interviewed said that the authorities often denied the requirement. Some parents said their children had stopped playing or were unable to sleep. At Cincuentenario Stadium and some other centers, after several complaints, quarantined and isolated people have been allowed out during scheduled hours since mid-January.

In some facilities, locks and chains on doors prevent people from leaving. The danger of this practice was evident in January at Cincuentenario Stadium when a protesting group threatened to set their mattresses on fire. “If they had done that, we would be dead, because we were locked in there,” a woman who shared a video of the episode told Human Rights Watch.

Some people could quarantine in hotels, and they often described better conditions. Many said they had to pay to be there. Hotel doors were at times locked from the outside and authorities did not always put in place reliable means of communication to ensure that doors could be promptly unlocked in the event of a medical or other emergency. This put people at unjustified risk.

People said they had limited or no access to health care. Formosa authorities told Human Rights Watch that isolation and quarantine centers have doctors, nurses, psychologists, and administrative personnel, with 24-hour medical assistance in some of the centers, including Cincuentenario Stadium, yet people interviewed reported delays in treatment of Covid-19 symptoms and other health problems – or no treatment at all.

  • The 71-year-old mother of one person interviewed fell in the bathroom of an isolation center and broke her hip. It took authorities approximately six hours to take her to a hospital, the family member said.
  • A blind 82-year-old man with dementia and hypertension – conditions that had been reported to authorities – had his temperature checked daily at a quarantine facility, but a week passed before healthcare workers checked his blood pressure, said his granddaughter, who was with him at the center. He needed daily support to bathe and for changing his adult diapers that his 16-year-old granddaughter could not provide alone.

Under the quarantine and isolation protocols adopted in February, families with children, people over 60, and those with prior diseases are allowed to quarantine at home, if the homes meet official “environmental and social requirements” that enable social distancing. Such requirements include having individual bathrooms and ventilation. However, the state-managed centers themselves often do not meet these requirements. The decision regarding whether a home meets these requirements is made by social workers paid by the government.

Some children, older people, and others in need of support have since been held in quarantine centers apparently because their homes did not meet the “environmental and social requirements.”

The 16-year-old girl and her blind 82-year-old grandfather were isolated in a quarantine center between February 22 and 25, although he had dementia, hypertension, and needed constant support that staff at the center were unable to provide. They were later sent to quarantine at a hospital instead. They both tested negative three times. They were sent home after 10 days. Under the new protocol, they should have been able to quarantine at home because they were under 18 years old and over 60.

Doctors in Formosa told Human Rights Watch that the province’s restrictive regulations and conditions in the centers have discouraged people from seeking medical care or testing for Covid-19. Doctors said they advised patients with mild symptoms of Covid-19 to isolate at home but did not send them to get tested because of the poor conditions in the centers. This loss of confidence by medical professionals and residents is likely to undermine future Covid-19 response in the province.

Since late February, the Formosa government has closed several centers as the number of reported Covid-19 cases in the province has decreased. Although overcrowding in the remaining centers appears to be less of a problem, interviews with people at the centers after late February indicate that some conditions, such as limited access to water and poor quality food, lack of access to medical care, and difficulties maintaining social distancing have not improved.

Isolation of Clorinda City

Between August 2020 and March 2021, the provincial government imposed a “sanitary blockade” limiting entry to and exit from Clorinda, a city of roughly 53,000 people near the border with Paraguay. Under the regulations, people were only authorized to leave for specific work purposes, to assist people who require medical treatment or special assistance, or for “extreme necessity.” Travel for other reasons, such as obtaining medical care, was not explicitly permitted.

On March 12, a federal court ordered the Formosa government to ease Clorinda’s sanitary blockade within five days. The restrictions have undermined the rights to health and education, the court said. On March 23, the government issued a new protocol allowing people in Clorinda to travel within the province provided they present a negative PCR result to the authorities.

The blockade affected people’s ability to get medical care, doctors in Clorinda said, as the city has few hospitals and clinics equipped to provide advanced diagnostics and medical treatment. Doctors said that, due to the restrictions, people have delayed medical treatments for other illnesses or failed to conduct necessary medical examinations.

Access to Information, Freedom of Expression, and Peaceful Assembly

A free press and timely, accessible government information are essential to accountable democratic governance in ordinary times, all the more so when a society faces a challenge as complex and multifaceted as a pandemic. The Inter-American Commission on Human Rights and its Special Rapporteur for Freedom of Expression have urged governments to “guarantee the exercise of the right to freedom of expression and access to information,” and “proactively provide truthful and reliable information on all aspects of public interest related to the pandemic.”

Journalists reported limitations to enter the province to report on the pandemic – including after public complaints were aired about confinement measures and centers. Although a national decree exempts media workers from many Covid-19 restrictions, including quarantines, Formosa required journalists seeking to enter the province to first obtain authorization from provincial authorities to enter, show they had tested negative, and, until February 19, to undergo a 14-day mandatory quarantine. Inés Beato Vassolo, a journalist for the daily newspaper La Nación, published a video showing police officers keeping her and others from entering the province on February 7.

Media reported that on February 19, Formosa authorities adopted a new protocol allowing journalists to visit the province without quarantining. Later that day, a judge granted a petition for habeas corpus filed by two lawyers ordering provincial authorities to allow journalists to enter Formosa without quarantining. The provincial authorities complied.

The authorities have also arrested people protesting conditions in quarantine facilities. On January 21, police detained two Formosa city council members, Gabriela Neme and Celeste Ruiz, for participating in a peaceful demonstration at a school serving as a quarantine center. Police held Neme for three hours, handcuffed, without allowing her to call a lawyer, she said. They face several charges, which appear to be based on their participation in the peaceful demonstration, according to police documents reviewed by Human Rights Watch. They remain under criminal investigation.

On March 5, protesters in Formosa city took to the streets after the government decided to return to a mandatory lockdown due to 17 new confirmed cases of Covid-19. The Inter-American Commission on Human Rights and the UN Office of the High Commissioner for Human Rights said they received reports of excessive and indiscriminate use of force against protesters.

Media reports and five people interviewed by Human Rights Watch who participated in the protest said that police used excessive force against protesters, including by using expired teargas cartridges and rubber pellets fired at closed range and aimed at the upper part of protesters’ bodies. Photos reviewed by Human Rights Watch show people injured by rubber pellets allegedly shot at close range. At least 93 people were arrested and dozens of protesters were injured. The media reported that 12 police officers were injured.

Response by the National Human Rights Secretary’s Office

On January 27 and 28, 2021, the National Human Rights Secretary, Horacio Pietragalla, who reports to Ministry of Justice and Human Rights, visited Formosa.

The National Human Rights Secretary’s office told Human Rights Watch that they “did not receive complaints” about conditions in the centers they visited, but registered “specific problems” concerning access to medical information and family reunification, as well as cases of police brutality against Indigenous people.

The secretary’s team only visited Formosa’s capital city, and did not travel to Clorinda. Even though Formosa authorities confirmed to Human Rights Watch that they had established 188 isolation and quarantine centers in the province, the National Human Rights Secretary’s Office team only visited four centers and interviewed people held in two. At the Cincuentenario Stadium, the largest center, they interviewed staff but not people being held there.

Pietragalla and his team told Human Rights Watch that his office’s intervention promoting a dialogue between national and provincial health authorities contributed to the new protocol adopted by the Formosa government in February and to closing the Cincuentenario Stadium. These are positive measures, but they need to be adequately implemented, and evidence gathered by Human Rights Watch and the Johns Hopkins University centers indicates that abuses persist.

After the March 6 protests, the national Human Rights Secretary condemned the “violence by police officers.” However, in a politically charged statement, he also criticized what he called a “permanent campaign of discredit by the hegemonic media against the provincial government.”

The office’s response failed to prioritize the rights of victims or focus on its primary function to document human rights violations during the mostly peaceful protests, Human Rights Watch and the Johns Hopkins University centers said.

The national human rights secretary is the main human rights official with the capacity to promote and protect rights nationwide, but his office reports to the Ministry of Justice and Human Rights and is therefore not independent from the executive branch. The Ombudsperson’s Office, a body that is structurally independent from the executive and would have the capacity to document and report on abuses, has not been functioning normally since 2013, when the mandate of the then-deputy ombudsperson expired. Congress has failed to appoint an ombudsperson since 2009.

Human Rights Watch and the Johns Hopkins University centers recommend that the administration of President Alberto Fernández work with Congress to appoint an ombudsperson who can ensure credible, independent, and reliable reporting of human rights conditions in Formosa and elsewhere in Argentina.

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