AA13CR24

AS (2013) CR 24

2013 ORDINARY SESSION

________________________

(Third part)

REPORT

Twenty-fourth Sitting

Wednesday 26 June 2013 at 3.30 p.m.

In this report:

1.       Speeches in English are reported in full.

2.       Speeches in other languages are reported using the interpretation and are marked with an asterisk.

3.       Speeches in German and Italian are reproduced in full in a separate document.

4.       Corrections should be handed in at Room 1059A not later than 24 hours after the report has been circulated.

The contents page for this sitting is given at the end of the report.

(Mr Rouquet, Vice-President of the Assembly, took the Chair at 3.35 p.m.)

THE PRESIDENT* – The sitting is open.

1. Changes in the membership of committees

THE PRESIDENT* – Our first item of business is to consider changes proposed in the membership of committees, set out in document Commissions (2013) 06 Addendum 3.

      Are the proposed changes in the membership of the Assembly’s committees agreed to?

The changes are agreed to.

2. Challenge to the credentials of the parliamentary delegation of Iceland

THE PRESIDENT* – The first debate this afternoon is on the report titled “Challenge on procedural grounds of the still unratified credentials of the parliamentary delegation of Iceland”, Document 13246, presented by Ms Vučković on behalf of the Committee on Rules of Procedure, Immunities and Institutional Affairs.

      I call Ms Vučković. You have 13 minutes in total, which you may divide between presentation of the report and reply to the debate.

      Ms VUČKOVIĆ (Serbia) – At the Assembly sitting on 24 June, Mr Mendes Bota and several members of the Assembly challenged the still unratified credentials of the parliamentary delegation of Iceland, on the ground that it comprised no female representative in violation of Rule 6.2.a of the Rules of Procedure. Rule 6.2 states that national delegations shall include members of the under-represented sex at least in the same percentage as in their parliaments, and at least one member of the under-represented sex appointed as a representative.

The committee has been charged on the ground of Rule 7 of the Rules of Procedure with verifying whether the credentials submitted by the Icelandic delegation following parliamentary elections are in compliance with the procedural requirements set out in this rule. The Icelandic parliamentary delegation is entitled to three representatives and three substitutes. Given that in the new delegation the three representatives are men and two of the three substitutes are women, the Rules Committee concluded that the delegation clearly fails to meet the condition established in Rule 6.2 that national delegations shall include at least one woman as a representative.

The committee looked for precedents as a source of guidance on what action to take. In January 2011, in the cases of Montenegro, San Marino and Serbia – with the same root cause, namely the absence of at least one member of the under-represented sex as a representative – the Assembly decided to ratify the credentials of those parliamentary delegations but to suspend their members' right to vote in the Assembly as from the beginning of the next part-session and until such time as the composition of these delegations is in conformity with the Rules of Procedure.

The committee decided to follow this precedent. It also took note of the explanation provided by Mr Garðarson, chairperson of the Icelandic delegation, who gave the committee assurances that the delegation will be modified in due time for the Assembly October 2013 part-session.

The committee therefore proposes that the Assembly ratifies the credentials of the Icelandic parliamentary delegation, but provides for the automatic suspension of the voting rights of its members in the Assembly and its committees with effect from the beginning of the Assembly’s October 2013 part-session, if the composition of the delegation has not been brought into conformity with the Rules of Procedure by then.

      Lastly, I seize the opportunity of this debate to recall the Assembly’s position on its gender equality principles. National parliaments should ensure that their national delegations to the Assembly comprise a percentage of women in at least the same proportions as they are present in the national parliament “with the aim of achieving, as a minimum, a 30% representation of women, bearing in mind that the threshold should be 40%”. In 2010, only 24 of the 47 national delegations included a percentage of women equal to or greater than 30%, and 12 of them were made up of at least 40% women, so today’s figure is an improvement. The number of delegations with 30% of women has risen to 27. Of those, 17 have 50% or more.

The Committee on Equality and Non-Discrimination produces a very interesting information report annually on progress on achieving gender equality in the functioning of the Assembly, which contains detailed statistics on gender breakdown in Assembly positions. As of June 2013, women represent 32% of the parliamentarians overall in the Assembly. However, 53% of women in the Assembly are substitutes in their delegations. Progress is slow but effective in some areas, such as Assembly’s main leadership positions, where significant improvement can be seen.

THE PRESIDENT* – Thank you, Ms Vučković. You have nine minutes remaining to reply to speakers in the debate. I now call Ms Marjanović on behalf of the Socialist Group.

Ms MARJANOVIĆ (Serbia) – We are talking about more than a rule of the Council of Europe – the rule is clear enough. We are talking about a principle. The rule is based on a principle that the Council of Europe and the Socialist Group believe is important. We are all in favour of balanced representation, but we have not achieved it here or in the majority of member States’ parliaments. Half of our electorates are women, but fewer than half of our parliamentarians are women. We hope to achieve that balance in future. I emphasise once again that we are for balanced representation.

The Socialist Group and the Council of Europe favour greater representation and improvement in the number of women in political and public life. We are aware that the Icelandic delegation probably did not intend to break the rule – sometimes the processes are complicated. This problem happened to my country two years ago. We therefore call on Iceland to remedy the situation before the October part-session.

THE PRESIDENT* – I call Ms Lundgren, on behalf of the Alliance of Liberals and Democrats for Europe.

Ms LUNDGREN (Sweden) – ALDE has a female leader and four out of six delegates from Sweden are female. We are therefore interested in gender representation.

One of the three pillars of the Assembly is the rule of law, so we must follow our own rules. It is good that the credentials were challenged, but at the same time, I must say on behalf of ALDE that the report and the handling of the situation have been excellent. We fully support the report. We have heard from our Icelandic colleagues that they will sort it out by the next part-session.

We must stick to our rules. The suggestions in the report deal with the credentials in an appropriate way, and we hope to see the new Icelandic delegation next time we meet. ALDE fully supports the report and the decisions that have followed.

THE PRESIDENT* – I call Baroness Wilcox, on behalf of the European Democrat Group.

Baroness WILCOX (United Kingdom) – It is a great honour to address the Assembly for the first time.

The EDG supports the rapporteur’s sensible suggestion that the credentials for this part-session for the parliamentary delegation of Iceland should be ratified, but it is pointed out that the rule on gender balance must be supported in future. We learned at meetings of the EDG both this morning and yesterday that the Icelandic delegation will agree, as we will hear in a moment from Mr Garðarson. We understand that having only male delegates was not intentional. Indeed, there are 60 male and 40 female parliamentarians in Iceland, so they have a nice big group to choose from. They went on seniority, thinking that that might be the most impressive thing to do for us, but in fact, we are looking for variety, including youth if we can find it.

I do not believe it was ever intentional that women would not represent such a fine country as Iceland. The delegation recognises that it does not represent the gender balance of their parliament, and will say that it will rectify it. We look forward very much to rectifying the situation, and to welcoming the first woman delegate from Iceland.

THE PRESIDENT* – Thank you. I call Mr Kox on behalf of the Group of the Unified European Left.

Mr KOX (Netherlands) – I have nothing to add to the rapporteur’s report. I totally agree with it. Rules are there to applied, and not to be not applied. The Icelandic delegation is small, with three members and three substitutes. We know that Iceland has financial problems – we all have them, but Iceland has somewhat bigger ones – and it decided not to send substitutes. If they could solve the financial problem, it would be far easier to solve this problem.

I therefore ask one question of the Icelandic delegation – we will hear from a representative of Iceland in a moment. If you are a member of the Council of Europe, you are entitled to send your delegations here. Members and substitutes are treated equally in the Assembly. Substitutes should have the chance to participate in the Council of Europe’s work. All that costs money, but the problems of Iceland are far bigger than that small item. If you can solve that problem, you can solve all your problems. I wish you the best, and I am sure you will come up with a solution before October.

      THE PRESIDENT* – Ms Vučković does not wish to reply at this stage, so I call Mr Garðarson.

      Mr GARÐARSON (Iceland) – On behalf of the Icelandic delegation, I stress that equal rights for men and women is an important issue in Iceland, and we have effective legislation in place to ensure that men and women have the same rights in all aspects of society. The Parliament of Iceland works on the same principle. The fact that the three members of the Icelandic delegation to the Council of Europe are all men is because of internal procedures within the Icelandic Parliament. The delegation was elected on 6 June, when a new parliament came together for the first time for a short summer session.

The election of the delegation was based on nominations by various political parties, without their having consulted each other beforehand. The non-compliance with the conditions laid down in the Rules of Procedure was discovered afterwards. Unfortunately, we were not able to change the composition of our delegation in the short time we had, since we are elected representatives at the Council of Europe and all changes to the delegation require consultation with all political parties concerned. In the short time we had, we were not able to finalise the agreement between the different parties.

Having said that, I stress that we regard Rule 6.2.a of the Rules of Procedure as very important. It is also clear that we need to change our internal rules at the Icelandic Parliament, so that things like this do not happen again. All political parties need to consult each other before selecting candidates for international delegations. Finally, I assure you that the Icelandic Parliament will make a change to the Icelandic delegation before the next Assembly meeting in October.

THE PRESIDENT* – Thank you, Mr Garðarson. The rapporteur may now reply.

Ms VUČKOVIĆ (Serbia) – We will wait for the new Icelandic delegation in October, and I hope that we will have the opportunity to welcome it. I call on all colleagues to support the report and the draft resolution.

THE PRESIDENT* – We will now proceed to vote on the whole of the draft resolution contained in Document 13246.

I remind the Assembly that, under Rule 7.4 of the Rules of Procedure, members of the Icelandic delegation may not participate in the vote.

The vote is open.

The draft resolution in Document 13246 is adopted, with 42 votes for, 1 against and 2 abstentions.

3. Putting an end to coerced sterilisations and castrations

THE PRESIDENT* – The next item of business is the debate on the report titled “Putting an end to coerced sterilisations and castrations”, Document 13215, presented by Ms Maury Pasquier on behalf of the Committee on Social Affairs, Health and Sustainable Development. Ms Saïdi will present an opinion on behalf of the Committee on Equality and Non-Discrimination, Document 13252.

We will aim to finish this debate at 5.30 p.m.

I call Ms Maury Pasquier. You have 13 minutes in total, which you may divide between presentation of the report and reply to the debate.

Ms MAURY PASQUIER (Switzerland)* – Irreversible coerced and forcible sterilisations and castrations constitute serious breaches of human rights and are an affront to human dignity. They are totally unacceptable in member States of the Council of Europe. Those are the findings of the report, which are restated in the draft resolution. The report is intended to provide an overall approach to the issue of coerced sterilisation and castration. Specific cases have been discussed before in the Council of Europe, including in this Assembly, in debates on matters such as discrimination against transsexual people. By “overall approach” I mean that the report and the draft resolution are not intended to address the situation in any particular country; rather, they address all member States. That approach is predicated on human rights and has a historical perspective, because we need to draw lessons from both the past and the current situation. People remain afraid of anyone perceived to be different and therefore inferior, which creates a threat of things getting seriously out of control.

Let us begin by looking backwards. In the first half of the 20th century, new scientific ideas concerning social classes and race were conflated, with a view to bolstering the newly formed nation States. That created propitious and fertile ground for eugenic sterilisation and, to a lesser extent, castration. The Swedish programme, for example, targeted women deemed likely to become a burden on the newly established system of social protection and the welfare State. To begin with, such targeting was deemed positive – it was thought to be in the interests of the people in question and was intended to promote the idea of fitness in an individual. Then eugenics became negative, stigmatising people deemed unfit and therefore inferior and forcing sterilisation upon them.

The practice spread in a number of countries, particularly affecting the poor, members of non-European races and the socially marginalised. Everyone is aware of the situation in Nazi Germany, but North Carolina officially desisted from its forcible sterilisation programme only in 1974 and Scandinavian eugenics laws were abolished at about the same time. As Ms Bernadette Gächter told us in her touching witness statement, forced sterilisations were practised in my country, Switzerland, in the 1970s.

There must be a right not to be submitted to violence or exposed to torture or inhuman or degrading treatment. We must uphold people’s right to decide on the number and spacing of their children and not to be subject to discrimination. In his most recent report, dated 1 February 2013, the United Nations special rapporteur on torture and other cruel, inhuman and degrading treatment, Mr Juan Méndez, stated that unacceptable treatment that should be banned included violence and abuses committed in health care establishments, including forcible and coerced sterilisation. We may also refer to Article 8 of the European Convention on Human Rights.

I turn to the recent past. The report refers to the situation in the Czech Republic, a country that was kind enough to invite me to visit. Under the communist regime, there was a programme that targeted Roma women, and it was also echoed thereafter. None of the people involved in perpetrating the procedures was ever brought to justice, on the ground of action being out of time under the law.

We have to recognise that there are rules on coerced sterilisation, provided by the International Federation of Gynaecology and Obstetrics. At the moment, in 29 member States of the Council of Europe, sterilisation is a precondition for the recognition of the reassigned gender of a transgendered person. Until very recently, Swedish legislation going back to 1972 has imposed sterilisation. The Swedish Parliament has just adopted legislation abolishing such coerced sterilisation as of next July. The question remains whether those who were subjected to forcible sterilisation are to be compensated by the State.

      In general terms, sterilisation carried out without proper consent remains a threat as far as women with disabilities are concerned, yet today people more often discuss castration. There seems to be an argument in support of the castration of convicted sex offenders, because people believe that chemical castration may be one way of tackling such offenders. A question arises, however, about the free and fully informed consent given by the person concerned, because it is possible that rather than give consent freely, some people may simply give in, thinking that that will enable them to escape the confines of a prison or psychiatric institution.

      The Czech Republic and Germany have been the subject of criticism by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment, the CPT. They have adopted new legislation and much tighter rules but I remain to be convinced, as indeed does the CPT, about the freedom of choice available to somebody who is given a take-it-or-leave-it option between chemical or other castration, and lifelong detention.

There is a debate in this Assembly on these issues, but I believe that any pressure, even involuntary or induced by the prison context or the power structure in the relationship between patient and doctor, must be examined carefully. We must stop things getting out of hand. After all, the previous Swedish system was allegedly a system of voluntary sterilisation, but it was voluntary in name and on paper only. People were given inducements and told that they would be released from an institution. If it was not the carrot, the stick was used and people were threatened with losing custody of their children. Therefore, we must observe how society lived quite comfortably with such dreadful breaches of human rights, and take steps to ensure that such things never, ever happen again. We must abolish such practices and change people’s mind-set about difference. We must change the paternalist views entrenched in the medical profession, protect and rehabilitate the victims of such practices, and bring those responsible for more recent offences to justice. Only then will we have fully embraced the ideals of the Council of Europe.

THE PRESIDENT* – Thank you, Ms Maury Pasquier, for that extremely thorough presentation. You will have four minutes to reply to speakers in the debate. Ms Saïdi, you have the floor to present an opinion on behalf of the Committee on Equality and Non-Discrimination.

Ms SAÏDI (Belgium)* – The Committee on Equality and Non-Discrimination congratulates Ms Maury Pasquier and supports the draft resolution. Her report is thorough and in-depth, and she adopted an approach based on human rights, which is perfectly in step with the views of the committee. We would like to say something more about violence against women and transgender people.

Women have been affected disproportionately by the forced sterilisation that has taken place. The United Nations Convention on the Elimination of All Forms of Discrimination against Women considers sterilisation a form of violence against women. In the fight against violence against women and domestic violence, we must also look at the Istanbul Convention, which covers forced abortion and sterilisation and states “Parties shall take the necessary legislative or other measures to ensure that the following intentional conducts are criminalised…performing surgery which has the purpose or effect of terminating a woman’s capacity to naturally reproduce without her prior and informed consent”. The entry into force of that convention and its application by the parties will make possible an effective fight against any form of sterilisation that would affect women.

Transgender persons are consistently subjected to forced or coerced sterilisation. Let us recall the Yogyakarta principles that were presented to United Nations on 26 March 2007 and inform us of the rules with which States must comply. Principle 3 States “Each person’s self-defined sexual orientation and gender identity is integral to their personality and is one of the most basic aspects of self-determination, dignity and freedom. No one shall be forced to undergo medical procedures, including sex reassignment surgery, sterilisation or hormonal therapy, as a requirement for legal recognition of their gender identity. No status, such as marriage or parenthood, may be invoked as such to prevent the legal recognition of a person’s gender identity.”

I wanted to make those two points on behalf of the committee about a text that we support and do not seek to amend. Some amendments have been tabled and we are afraid that they may undermine the strength of the resolution, or even exclude from protection certain groups of the population such as transgender people.

THE PRESIDENT* – Thank you, Ms Saïdi. In the debate I call Ms Acketoft, on behalf of the Alliance of Liberals and Democrats for Europe.

Ms ACKETOFT (Sweden) – I thank the rapporteur for a well-written and comprehensive report, and the committee’s opinion will serve as an educational and legislative tool to us all. Speaking on behalf of my group, I would not normally concentrate on one country. However, I am Swedish and since Ms Maury Pasquier visited Sweden to collect material for her report, I will refer extensively to Sweden today. The Swedish eugenic sterilisation programme ran between 1934 and 1976, and the coerced sterilisation of transgender persons actually up until this coming Monday. That is not a pretty picture. It has been estimated that 63 000 people, mainly women, fell victim to that social engineering with the greater purpose of creating a sound, homogeneous population.

How could a modem welfare State like Sweden engage in such a programme and continue even after the Nazi programme had been totally discredited? On paper, sterilisation was voluntary, although in reality it was anything but. Victims were under heavy pressure to sign the consent forms in order to be released or to get access to their own children again. In Sweden, we believed that the Nazi programme was evil, violent and irrational, but that the Swedish programme was good for the patient and the welfare State and therefore rational. In reality, both programmes were intolerable human rights violations.

I am sure we all agree that sterilising women because they “hang around in amusement parks" –that was actually used as an excuse to sterilise women – is totally intolerable. However, we must ask ourselves whether it is less intolerable to sterilise or castrate the modern outcasts of our societies today such as Roma women, sex offenders, ill or disabled people or transgender people.

      Yesterday, when the Assembly voted down the monitoring of Hungary, I thought I had seen it all, but then I saw the amendments tabled by some of our colleagues – amendments that deny the lessons of history and deny that coerced sterilisations and castrations are still taking place. As a matter of fact, the amendments endorse them and even manage to throw in the question of abortion, which is equally incomprehensible. It makes me wonder whether those colleagues are actually pro-life or against it. The only thing they are consistent about is that somebody else always has to rule over the individual’s body, not the individual themselves.

      We no longer have mass sterilisations. However, there are a small but significant number of sterilisations that would fall under the definition of “coerced”. Coerced sterilisations and castrations, by whomever, whenever, and for whatever reason, are in breach of the European Convention on Human Rights. I urge you all to oppose the amendments and to support Ms Maury Pasquier’s appeal: never, ever again. Let each and every one of us rule over our own bodies.

      THE PRESIDENT* – I call Ms Gerasimova to speak on behalf of the European Democrat Group.

      Ms GERASIMOVA (Russian Federation)* – Today, we are looking at a question that is not easy for any State in Europe. The national parliaments of countries that have adopted legislation on sterilisation have not done so lightly. They were brought to those decisions because of tragic circumstances that have resulted in thousands of innocent victims.

      Statistics show that 50% of all sex-related crimes are committed against our children. That means they are committed against our future. In recent years the number of recorded cases of paedophilia has increased exponentially. Despite the World Health Organization including paedophilia in its international statistical classification of diseases and health-related problems, there is still an ongoing controversy: is paedophilia an illness or an instance of depravity? Medical practice shows that 97% of paedophiles reoffend within two to five years of being released. In countries where chemical castration is practised, the number of crimes against children has been halved.

      Despite all that, many people are not in agreement with this type of punishment. Some scientists consider it a medieval form of punishment. They also claim that a castrated paedophile is no less dangerous to society. Yesterday the media in Russia reported the deaths of two young girls, aged 11 and 13, at the hands of a man who had twice been convicted of sex-related crimes in the past. Clearly, we have the right to expect our legislation to ensure that the punishment fits the crime and that there can be no going back to that crime. No one can evade their responsibility. Any lawful State has to guarantee that its citizens can live and work in safety. It is safety and the inviolability of the person, especially minors, that led countries such as Germany, Denmark, Sweden, Canada, the United Kingdom and others to use chemical castration when appropriate, with the consent of the person concerned – that is, a person who has been convicted of a sex-related crime – and when appropriate information is provided and human rights education is given.

      In the Russian Federation, sterilisation and castration are possible only with the consent of the patient. Thus far, there have been no such cases in Russia in accordance with our legislation. For that reason, the European Democrat Group supports the report and the recommendations. Forcible or coerced sterilisation and castration can never be considered legitimate. As for paying compensation or issuing official apologies to victims – which is referred to in paragraph 6 of the draft resolution – we think this is a matter that should be resolved at the national level.

      THE PRESIDENT* – I call Ms Andersen to speak on behalf of the Group of the Unified European Left.

      Ms ANDERSEN (Norway) – On behalf of the Group of the Unified European Left, let me say that we support the draft resolution and reject all the amendments, for the same reasons set out by Ms Acketoft on behalf of the Alliance of Liberals and Democrats for Europe. I support every word she said.

      The report is comprehensive and takes a human rights-based approach, as is necessary. Castration and sterilisation have often been promoted as being in the interests of society and the person concerned. We have heard a speech about the terrible situation with sex offenders. I can understand all the thoughts that one can have when such terrible things happen, but we have to ask whether this approach works. Is sterilising or castrating a sex offender any guarantee that they will not reoffend? There is no medical evidence that it is.

      Measures other than castration and sterilisation have to be taken if we are to protect our children and others from sexual offenders. If colleagues can find any medical evidence that castration or sterilisation makes us any safer in society, I invite them to present it. I can understand that argument, but I am sorry – it does not work. We have to take a principled approach to this question, because we are talking about a grave violation of basic human rights and the integrity of the body. Society has to take other measures to protect vulnerable people from offenders and, importantly, prevent them from being molested.

      As Ms Acketoft said, some of the measures we are talking about in this debate are voluntary, but in practice they seldom are, because there are certain circumstances that make people take such a decision.

      I would like to emphasise the difficult situation facing transgender persons. In 29 of the 47 Council of Europe member States, sterilisation is a requirement for surgery to recreate a person’s natural gender. I think that includes my country, and as we heard, Sweden is amending its law this week. That tells me that we still have a long way to go to put the security, safety and human rights of transgender persons in their rightful place. These questions are not on the table every day. We are not talking about a large group of people who put pressure on us as politicians, and they are not highly regarded in society. As such, it is easy to neglect them.

      This debate is an important reminder to us all. Every country in Europe should stick to these principles of human rights.

      THE PRESIDENT* – I call Mr Ghiletchi to speak on behalf of the Group of the European People’s Party.

      Mr GHILETCHI (Republic of Moldova) – I thank Ms Maury Pasquier for this report. It has to be acknowledged that Europe has a sad history of forced sterilisations and castrations imposed on minority groups in the name of eugenics or enforced behaviour change. In the case of people with mental disabilities or minority ethnic communities such as the Roma, this continued until relatively recently. However, the report is not just about those sad cases, which were clear breaches of human rights.

The report concentrates on creating a new offence for which there is to be retrospective punishment in the form of demands for compensation and a public apology. This offence is named “coerced sterilisations and castrations of transgender persons”. What this means in plain terms is that those States that have been willing to respond positively to the pleading of persons who do not feel comfortable in the gender that they outwardly display, and experience a conflict between it and their interior perception of themselves, are now to be criticised as human rights abusers. These States have made provision in their national laws for persons to legally register a change of sex, which has to be recognised for all public purposes.

However, the condition for the permanent change of legal status is that gender reassignment surgery has to be undergone. This implies consensual castration or sterilisation. Without that, the display of the outward features of the desired gender is not possible. The effect of accepting the demands of the report as it currently stands would be to make it possible for a legal change of sexual status to be registered without a change in outward appearance.

The report also states some concerns with chemical castration legislation in some member States, such as Poland and Moldova. In summer 2012, Moldova adopted legislation that intends to apply chemical castration to paedophiles. Chemical castration is a reversible process. How can this process, which in basic terms reduces the level of sexual activity of a paedophile, be considered a breach of human rights in the light of the sexual abuse of children? In my view, the greatest good is protecting children from paedophile activity.

I regret that none of the amendments that were tabled have been accepted. I am afraid that without a clear definition what “coerced sterilisation and castration” is, we cannot support this resolution. Another matter of concern is that member States that have legislation concerning a change of sexual identity are not allowed to have preconditions for such changes, one of which is gender reassignment surgery. As the amendments were rejected, I express the view on behalf of the EPP that we will not support this draft resolution.

The PRESIDENT* – I call Mr Schennach on behalf of the Socialist Group.

Mr SCHENNACH (Austria)* – I thank the rapporteur for this extraordinary job of work. I must be perfectly frank. I am a little taken aback by what my esteemed colleague Mr Ghiletchi has just said. The report is incisive. Some terrible things have happened in our societies. There was Nazi Germany, of course, and then there is India where, under Prime Minister Gandhi, women were forcibly sterilised and many died.

I am grateful to Ms Acketoft for having spoken so freely. I can speak equally freely on behalf of my own country. Until the 1990s, it was standard practice in our country for young girls who had mental problems, whenever they came into contact with hospitals, to be forcibly sterilised. I am talking not about the Nazi era but about something appalling, tantamount to torture, that happened up until the 1990s. Regardless of whether someone has a physical or mental disability, they have the right to their dignity and physical integrity.

We are just starting a debate on sex offenders. I have been fortunate enough to speak on behalf of the Council of Europe in the Duma, and I said that only 1% to 3% of sex offenders are deviants. The problem with sex offenders is not physical as such but rather is in their heads, in their minds. Regardless of whether you castrate them, the problem is going to persist in their mind. That is why we cannot use such punishment as a pretext for violating the rights of individuals.

Another important matter has already been touched on: the rights of transgender people. We in Europe say to people that they can decide whether to be a man or a woman. That is something that parents decide when a child is born with indeterminate gender. The other course of action is a form of violation of sexual integrity. I therefore believe that the report is showing us the right way forward for our countries.

This report is just as bold and courageous as the committee has been in other matters. I think that we all agree in condemning female genital mutilation, but we also have to address the circumcision of boys, because that again is an issue of physical integrity.

I thank everyone involved in the report. We respect all the experts who spoke to the committee and who impressed us with their personal accounts. Regardless of what the previous speaker said, I very much hope that the report musters a clear majority. I certainly do not want it to have any so-called improvements along the wrong lines. This is an issue that we have to address head-on in European societies.

The PRESIDENT* – Ms Maury Pasquier does not wish to reply now and will have four minutes to do so later. I call Ms Virolainen.

Ms VIROLAINEN (Finland) – I thank the rapporteur for raising this important issue in her excellent report. Forced sterilisation and castrations are a disturbing and embarrassing part of our history. Whether we are talking about forced coercion or voluntary consent, we must remember that the procedure is irreversible. I hope that each of us in this Chamber thinks that such acts of ill treatment constitute a grave violation of human rights and human dignity.

People have been talking freely about their own countries, so I also intend to do so. My country, Finland, banned forced sterilisations in 1970 but still there is a provision in our legislation that forces the sterilisation of transgender persons undergoing corrective sex surgery. In his last report for Finland, Human Rights Commissioner Muižnieks recommended the removal of this practice. I am happy to note that his report was a wake-up call for my government, and the minister of health is currently looking into it.

I strongly support the guidelines of the International Federation of Gynaecology and Obstetrics, which state, among other things, that only women themselves can give ethically valid personal consent to the procedure and that there must be sufficient information about the irreversibility of the procedure in a language that the person understands.

      I should also like to say a few words about prejudice and intolerance. Disabled persons were, for a long time, at the top of the list of people undergoing forced sterilisation, and there are still those who think that they should not be able to reproduce, but they are people, just as you and I are, and they have the same human rights as all of us. I therefore urge colleagues to support the resolution, which calls for all our legislatures to end the practice of coerced sterilisation for good. Let us leave the practice in the past, where it belongs.

Ms BLANCO (Spain)* – I congratulate Ms Maury Pasquier and my colleague from the Committee on Equality and Non-Discrimination, Ms Saïdi, and thank them for this magnificent report. Ms Acketoft, you were very courageous to talk about this complex subject as it pertains to your country.

It is felt that these practices have almost been eradicated, but they continue to some extent in a number of countries, including member States of the Council of Europe. Those particularly affected are the vulnerable groups cited in the draft resolution: young mothers and young women, the poor, people who are marginalised and those with disabilities. We in the Council of Europe realise that there are people who still do not accept transgendered people’s expression of their identity. Roma women, too, seem to be targeted. In all these cases, we are talking about people in fragile and vulnerable situations, on the margins of society.

I am concerned about consent, which is addressed in the draft resolution. What does “consent” consist of? In most cases, it has not been free and fully informed consent. Victims have often been groomed, as it were, into giving consent; think of what happens elsewhere in the world, including in China and India. If the person has not fully thought through the consent, and given it of their own volition, it does not count.

As for the idea of using the practice as a way of combating sex offenders, that sums up the practice. We have seen Margarethe von Trotta’s film, and we think of Hannah Arendt’s comments on these issues. We are talking about the banality of evil. People always pick on those weaker than them.

THE PRESIDENT⃰ – Ms Kyriakides is not present, so I call Mr Gunnarsson.

Mr GUNNARSSON (Sweden) – I thank both rapporteurs and their respective committees for doing a good job on the report. Eugenic sterilisation and castration is a dark part of the history of many European countries, including mine, as we have heard. I am proud to say that we recently threw out the last pieces of our very cruel legislation on the subject. Sadly, many parts of our continent have not yet done likewise. In around two thirds of member States of the Council of Europe, transgender persons have to undergo sterilisation to be recognised in the gender of their choice.

Although the issue of the coerced sterilisation of transgender persons has not yet been tested in the European Court of Human Rights, there can be no doubt that this practice constitutes cruel, inhuman and degrading treatment, as prohibited under Article 3 of the European Convention on Human Rights. It is also a grave violation of the right to health. Indeed, in the past few years, courts in Germany, Austria and Sweden have found coerced sterilisation to be unconstitutional. As the explanatory memorandum points out, the United Nations special rapporteur on torture and other cruel, inhuman or degrading treatment has, in relation to transgender persons, specifically called on States to outlaw coerced sterilisation in all circumstances.

It is deeply disturbing, then, that according to the Commissioner for Human Rights, around two thirds of Council of Europe member States require transgender persons to undergo sterilisation as a precondition of changing their civil status to reflect their gender identity. That a grave human rights violation is conducted on the authority of the State is bad enough; the fact that this violation takes place in so many member States, on State authority, must surely mean that it is without parallel in the Council of Europe.

How has this shocking situation come about? The reassignment of a person’s gender involves two processes: a legal process, in which a person’s recorded sex and first name are changed in identity documents and other documents; and a medical process, in which the individual’s physical characteristics may be brought into line with their preferred gender. The extent of this medical process should be determined by the needs and wishes of the individual. It can range from little or no medical intervention to extensive gender reassignment surgery. Human rights law requires that these processes be kept separate. In practice, as has already been noted, in at least two thirds of Council of Europe member States, legal recognition of one’s gender identity is made conditional on medical interventions. This is not in any way acceptable, and that is why this report is so very important.

Mr R. FARINA (Italy)* – I thank the rapporteur for the report, because in the historical part of it, I learned things that are hidden and secret, and of which I was quite unaware. It is a thorough report, and I think that it should be divided into several parts, one of which should be about surgery and transgender operations, so as not to obscure the central issue, which is this: it is important to include in our condemnation those European countries and international organisations that finance these operations, and campaigns of forced sterilisation, unwittingly or otherwise.

According to The Observer, the United Kingdom had £66 billion devoted to a multi-annual plan involving the forced sterilisation of 2 million women. I wonder if they are to be put on plane and paraded in front of the Queen, so that she can apologise to each of them. Perhaps that would result from the recognition of individual sexual rights.

Rather than giving a historical analysis of what happened, I point out that today there are sterilisation campaigns going on. This happens in Brazil. There is an interesting book about this, which says that 43% of all women in Brazil who have access to family planning are sterilised. A distinction is drawn between “forced” and “coerced” sterilisation, but if you are poor and you are facing somebody much better educated than you, who can say whether you are being coerced or forced?

I have found out all sorts of things that I did not know. I learned that in 1974, the United Nations Secretary-General gave a prize to a Chinese minister for family planning after the sterilisation of hundreds of millions of people. We should also talk about abortion, because abortion and forced sterilisation are two sides of the same coin. Are we saying that abortion is a human right while condemning sterilisation? When we talk about so-called therapeutic abortion in European countries, we are talking about eugenics before birth. What about those with Down’s syndrome who are sterilised to ensure that no child is born? Do they have the right not to have a forced abortion? We have not drawn enough of a distinction between those things.

      One thing that the report ought to mention is that a particular kind of social democratic ideology underlies the question of forced sterilisation. Although the proponents do not talk about creating a better race, they talk about a better society. Karl Gunnar Myrdal and Alva Myrdal were distinguished scientists, and their ideology underpinned forced sterilisation. Should the Nobel Prize be taken away from them? How many Europeans know that in the Scandinavian countries, hundreds of thousands of people were forcibly sterilised? We should carry out an investigation and find out. The ideology behind those sterilisations should form the basis of a further in-depth report. Euthanasia is part of the same approach; it is the latest manifestation of the same disguised and sinister message. When we are talking about human rights, we should look at the whole issue across the board.

      Mr LEBEDA (Czech Republic) – I will start with a trip to the rapporteur's country. In 2004, a Swiss hotel owner, who was the father of a family and who had no criminal record, underwent surgical castration. Since puberty, he had suffered from what he called “libido flushes”, which made his life unliveable. Having consulted a psychiatrist, he first opted for hormonal treatment known as chemical castration. That helped him to manage the unbearable sexual impulses but he also suffered from a number of negative side effects, such as chills, weight loss and depression. Therefore, two years later, having consulted his doctor again, he chose surgical castration. His life improved and he has never regretted his decision, despite the side effects he had to face, which included weight gain and reduced sexual life. As he said, his identity had not changed, but he felt calm, relaxed and confident that he could manage his life.

In 2012, the rapporteur met a psychiatric patient in Prague. He, too, had suffered from overbearing sexual impulses. Unlike the Swiss patient, he was not able to manage them; he killed someone and was detained in a psychiatric hospital. He, too, underwent psychotherapy and hormonal treatment. He, too, suffered from negative side effects. In the end, he also chose surgical castration, after which he felt calm, relaxed and confident that he could manage his life.

Here, however, the similarity between the two patients ends. If we follow the logic of the rapporteur’s memorandum, the patient in a psychiatric hospital was coerced into making that choice, his human rights were gravely violated and the doctor who offered him the treatment should be prosecuted. Why? Because when the patient was considering his future treatment, he was aware that it might bring about not only the end of his suffering, but also the beginning of a new life and freedom. According to the rapporteur, the patient was incapable of making a free decision about any treatment that offered him the possibility of being released, regardless of the fact that it might help his condition. Such treatment is simply dismissed as coerced.

We cannot accept such an assertion. Patients in involuntary placement are certainly vulnerable and deserve special protection. However, such protection should be based on strengthening the safeguards against possible abuses and not on denying patients access to effective treatment. It is not undignified to undergo treatment that has irreversible effects, but it may be undignified to limit treatment options in a way that leaves some patients with no chance of improvement and condemns them to an endless life in detention. The choice should be left to the patient. We should not take a path that leads to patients being put in the situation described in an article by a leading expert on medical ethics, which had the title “Rotting with their rights on”.

Mr RECORDON (Switzerland)* – I might describe myself as someone with quite a serious disability. That being so, over the course of my life I have asked myself a lot of questions, including whether it was worth my while to have children. That is a delicate issue, which each person has to resolve for themselves. There can be no one-size-fits all answer to such a question. I would be very upset to think that people with disabilities were not allowed to think through such issues. It is difficult enough to think such a question through, but in today’s world it is simply unacceptable for a State authority to think it through for you and not allow you to do so for yourself. No one – whether they have a disability or not – should be deprived of the fundamental choice whether to have children.

      Ms Maury Pasquier has shown us how sometimes we have lumped together Roma, transgender persons and people with disabilities, which runs totally counter to what we are all about here. It is an aberration. People are put in categories. Sometimes someone is in two categories. What if you are Roma and you have a disability? Then they are in two categories at once, I suppose. We did that and then we said that they had to be given special treatment, treated as children and as people who could not think for themselves. They had to be totally emasculated in their thinking; sometimes they were literally emasculated.

In my part of Switzerland, in the canton of Vaud, that ideology prevailed at certain times. Children were taken from their parents at certain times because of the same kind of thinking. Only two months ago, the Swiss Interior Minister had to apologise for that and for the terrible conditions in which children were kept when they were taken from their parents because of that kind of thinking. People really suffered and someone has to apologise for that – perhaps not the queen, but someone. Highly placed authorities have to apologise officially for what has been done to so many people. As civilised persons, we must recognise that. I am glad to see here so many people from different countries recognising the terrible things that have happened, that they were aberrations and that it is now time to apologise for them.

Let us now do our utmost to right that wrong, and let us not give in to the amendments that have been tabled that would serve only to weaken the report. Let us bear in mind what we are talking about here: the fundamental value of free and enlightened consent, a value that must be available to all. That is the only criterion that we can take a stand on. Any other approach is a dangerous one. It is true that there may be people who find it difficult to give free informed consent. Let us help them to give that, to do what they can and what is their right, as it is all our right.

THE PRESIDENT* – The rapporteur has four minutes to reply to the debate.

Ms MAURY PASQUIER (Switzerland)* – I thank all those who have spoken in the debate. It was not an exceedingly long list, but it made up in quality what it may have lacked in quantity. I thank the committee secretariat, who have been of immense assistance to me in the sensitive and delicate task of putting the report together.

People have argued that there may be a role for this in relation to preventing convicted sex offenders from reoffending. I am not talking about taking away protection for victims of such terrible crimes, or indeed preventing people from suffering in future, but I do not think that the argument holds. The only certain way of stopping such things happening again would be to have recourse to the death penalty, and I do not think anyone here would support that. We must think of an effective way of dealing with people who are convicted of sex crimes.

There is no proof that chemical castration is genuinely effective. We heard a number of experts in the committee. Ms Pimenoff, who is a member of the CPT, said that chemical castration of a sex offender is by no means a guarantee that there will be no recidivism. A simple testosterone injection could restore the hormone levels to what they were before the chemical castration took place: it could be more dangerous if someone were subjected to chemical castration, because the testosterone injection would have immediate effect.

Another expert, a psychiatrist, Dr Jean-Georges Rohmer, reported that sexual aggression is not merely about the sexual act; it is also about power. We have to treat those people and give them support. We are against coerced sterilisations and castrations. I say to Mr Lebeda that it is not I who am challenging castrations in these instances – it is the CPT that has stated that it objects to the idea of chemical castration. I refer you to paragraph 30 of the report, where it makes its case.

On transgender people, we do not need to have another specific report, because they are human beings like the rest of us. They have the same rights as everyone else. There is no point in singling them out in a special report. On forced abortions, a point we will come to when we deal with the various amendments, like Mr Farina, I am appalled at the idea of forced abortions. I will stand shoulder to shoulder with you against forced abortions, but this is not the report in which to do that. I would be happy to work with you on that on another occasion.

The human rights and dignity of everyone living in member States in the Council of Europe is at stake here. It is easy to stand up for the rights of people who are part of the silent majority – people like you and me. It is a lot more difficult to defend the rights of people who are deemed to be different or indeed dangerous, whose actions we condemn, but we have to base our actions on inalienable principles, as we set out in paragraph 1 of the draft resolution, which says: “Coerced, non-reversible sterilisations and castrations constitute grave violations of human rights and human dignity, and cannot be accepted in Council of Europe member States.” That is why we are here.

THE PRESIDENT* – Would anyone like to address us now on behalf of the committees?

Sir Alan MEALE (United Kingdom) – There is no real need. We had a full and frank debate in the committee and all the amendments were discussed and defeated, so we are grateful for that.

The PRESIDENT* – The debate is closed.

The Social Affairs Committee has presented a draft resolution, to which 13 amendments have been tabled. They have been organised in the order in which they relate to the report as published.

I remind you that speeches on amendments are limited to 30 seconds.

We come to Amendment 1, tabled by Mr Ghiletchi, Mr Volontè, Ms Guţu, Mr Zingeris and Ms Palihovici, which is, in the draft resolution, delete paragraph 2.

If the amendment is adopted, Amendments 9, 10 and 11 will fall.

I call Mr Ghiletchi to support Amendment 1.

Mr GHILETCHI (Republic of Moldova) – If we create a new offence or a new concept, we must have a clear definition of that. It is not enough to say that the concept is evolving. How can we validate, or invalidate, something that is still evolving and is not defined clearly? For that reason, I propose to delete paragraph 2.

The PRESIDENT* – Does anyone wish to speak against the amendment? I call Ms Maury Pasquier.

Ms MAURY PASQUIER (Switzerland)* – I am against Amendment 1 because it takes the heart out of the report. We are trying to change legislation in this way. If we change the wording, the whole way in which human rights law is developing will be called into question. Mr Juan Méndez, the United Nations rapporteur on cruel, inhuman and degrading treatment or punishment, has made that point. If we adopt the amendment, we will run counter to what he and all these other bodies have done. They have all indicated that we need to change legislation in this way, as the paragraph states.

The PRESIDENT* – What is the opinion of the committee?

Sir Alan MEALE (United Kingdom) – The committee is against the amendment.

The PRESIDENT* – The vote is open.

Amendment 1 is rejected.

      We come to Amendment 9, tabled by Sir Edward Leigh, Mr Neill, the Earl of Dundee, Mr Kalmár and Mr Gruber, which is, in the draft resolution, paragraph 2, replace the words “is not as self-evident as defining ‘forced’ sterilisations and castrations, which” with the following words: “is important. ‘Forced’ sterilisations and castrations”.

      I call Sir Edward Leigh to support Amendment 9.

      Sir Edward LEIGH (United Kingdom) – We believe that the draft resolution should be based on clearly defined, well-established terminology. We should avoid the risk of creating a breeding ground for far-reaching interpretations, some of which could inappropriately limit the patient’s access to health care.

      THE PRESIDENT* – Does anyone wish to speak against the amendment? I call Ms Maury Pasquier.

      Ms MAURY PASQUIER (Switzerland)* – I am against this amendment for the same reasons that I outlined earlier when I spoke against Amendment 1. In fact, this amendment denies what is actually happening. When talking about coercion, it is important that we evolve how we think, but the amendment does not acknowledge that.

      THE PRESIDENT* – What is the opinion of the committee?

      Sir Alan MEALE (United Kingdom) – The committee is against.

      THE PRESIDENT* – The vote is open.

      Amendment 9 is rejected.

      We come to Amendment 10, tabled by Sir Edward Leigh, Mr Neill, the Earl of Dundee, Mr Kalmár and Mr Gruber, which is, in the draft resolution, paragraph 2, delete the words “currently evolving in human rights law”.

      I call Sir Edward Leigh to support Amendment 10.

      Sir Edward LEIGH (United Kingdom) – For sake of clarity, we propose to retain the first definition provided by the rapporteur, which clearly defines the circumstances under which even a written consent can be invalid, and to drop all the others, which are referred to as “the emerging new concepts”.

      THE PRESIDENT* – Does anyone wish to speak against the amendment? I call Ms Maury Pasquier.

      Ms MAURY PASQUIER (Switzerland)* – If we deleted the words “currently evolving in human rights law”, we would deny evolution of how we look at the issue. We need a change of mind-set.

      THE PRESIDENT* – What is the opinion of the committee?

      Sir Alan MEALE (United Kingdom) – The committee is against.

      THE PRESIDENT* – The vote is open.

      Amendment 10 is rejected.

      We come to Amendment 11, tabled by Sir Edward Leigh, Mr Neill, the Earl of Dundee, Mr Kalmár and Mr Gruber, which is, in the draft resolution, paragraph 2, replace the last two sentences with the following sentence:

      “However, the choice made by the patient in involuntary placement about his treatment cannot be considered coerced or otherwise involuntary simply because the treatment offers him the possibility of acquiring control over his dangerous behaviour and, consequently, the possibility of being released.”I

      I call Sir Edward Leigh to support the amendment.

      Sir Edward LEIGH (United Kingdom) – The draft resolution should make it clear that the patient’s freedom of choice of treatment cannot be invalidated by the mere fact that he is in involuntary placement and the treatment he chooses offers him the possibility of being released. It is recognised by the Council of Europe Lanzarote Convention that even in the context of involuntary placement the patient can make voluntary decisions about his treatment. The addition we propose does not change the presumption that the patient’s decision can be coerced if it is made in the absence of efficient safeguards ensuring free and informed consent.

      THE PRESIDENT* – Does anyone wish to speak against the amendment? I call Ms Brasseur.

      Ms BRASSEUR (Luxembourg)* – We have listened to the rapporteur and to other speakers whose contributions were based on the views of experts. The amendment’s argument has never been proven and it does not correspond to scientific reality, so we should not accept it.

      THE PRESIDENT* – What is the opinion of the committee?

      Sir Alan MEALE (United Kingdom) – The committee is against.

      THE PRESIDENT* – The vote is open.

      Amendment 11 is rejected.

      We come to Amendment 12, tabled by Sir Edward Leigh, Mr Neill, the Earl of Dundee, Mr Kalmár and Mr Gruber, which is, in the draft resolution, paragraph 4, replace the last 3 sentences with the following sentences:

      “However, sterilisations and castrations which could be considered ‘coerced’ either occur or are possible under some existing laws. In law or in practice, these are mainly directed against or may affect particularly vulnerable groups, such as transgender persons, Roma women or convicted sex offenders. Neither forced nor coerced sterilisations or castrations can be legitimated in any way in the 21st century – they must stop or be prevented.”If

      If adopted, Amendments 2 and 3 will fall. I call Sir Edward Leigh to support Amendment 12.

      Sir Edward LEIGH (United Kingdom) – We propose a wording that takes into account the fact that, for example, the latest case of coerced sterilisation of a Roma woman in Europe was reported in 2008 – five years ago. The draft resolution states that coerced sterilisations and castrations have occurred and that they must stop. To that, we simply want to add that even when they do not occur they must be prevented. We also propose to broaden the scope of paragraph 4 by including not only interventions directed against various vulnerable groups, but those that, while they may not be specifically directed against them, may affect them nevertheless.

      THE PRESIDENT* – Does anyone wish to speak against the amendment? I call Ms Maury Pasquier.

      Ms MAURY PASQUIER (Switzerland)* – I am against this amendment because once again it seeks to water down the thrust of the resolution. Last year, the European Court on Human Rights found against some member States in cases involving forced sterilisation. This is not past history; it is current.

      THE PRESIDENT* – What is the opinion of the committee?

      Sir Alan MEALE (United Kingdom) – The committee is against.

      THE PRESIDENT* – The vote is open.

      Amendment 12 is rejected.

      We come to Amendment 2, tabled by Mr Ghiletchi, Ms Guţu, Mr Zingeris, Ms Palihovici and Mr Preda, which is, in the draft resolution, paragraph 4, replace the word “would” with the following word: “could”.

      I call Mr Ghiletchi to support the amendment.

      Mr GHILETCHI (Republic of Moldova) – As I have said, there is no clear definition, but we affirm that a significant number fall into this category and that is why I propose to replace the word “would” with the word “could”. That would be a much fairer assumption.

      THE PRESIDENT* – Does anyone wish to speak against the amendment? I call Ms Maury Pasquier.

      Ms MAURY PASQUIER (Switzerland)* – I am against this amendment because it denies reality. There are a number of known cases, including 77 in the Czech Republic. As we say in paragraph 1 of the draft resolution, coerced sterilisations “constitute grave violations of human rights”. This is a significant issue, so we should keep the original wording.

      THE PRESIDENT* – What is the opinion of the committee?

      Sir Alan MEALE (United Kingdom) – The committee was against.

      Amendment 2 is rejected.

      We come to Amendment 3, tabled by Mr Ghiletchi, Mr Volontè, Ms Guţu, Mr Zingeris and Ms Palihovici, which is, in the draft resolution, paragraph 4, delete the words “transgender persons”.

      I call Mr Ghiletchi to support the amendment.

      Mr GHILETCHI (Republic of Moldova) – How can we say that this practice is directed mainly against transgender persons when they agreed to it? We cannot say that gender reassignment surgery is coerced castration or sterilisation when it has been agreed to.

      THE PRESIDENT* – Does anyone wish to speak against the amendment? I call Ms Saïdi.

      Ms SAÏDI (Belgium)* – There is no reason for us to delete the reference to transgender persons, particularly because, as I have said, they are the only category of people who are still obliged to undergo sterilisation under the legislation of a large number of European countries. It is important that we keep the wording as it stands.

      THE PRESIDENT* – What is the opinion of the committee?

      Sir Alan MEALE (United Kingdom) – The committee is against.

      THE PRESIDENT* – The vote is open.

      Amendment 3 is rejected.

We come to Amendment 7, tabled by Mr Ghiletchi, Mr Volontè, Ms Guţu, Mr Zingeris and Mr Toshev, which is, in the draft resolution, paragraph 7.1, after the word “coerced into”, insert the following word: “abortion,”.

I call Mr Ghiletchi to support Amendment 7.

Mr GHILETCHI (Republic of Moldova) – Historically, we know that forced abortion has also been practised in Europe. More recently, the European Parliament adopted a resolution that condemns the practice of forced abortions and sterilisations globally. I am glad to hear that Ms Maury Pasquier is willing to work on such a report, but as abortion is part of reproductive rights, I believe it is relevant to include abortion with sterilisation and castration.

THE PRESIDENT* – Does anyone wish to speak against the amendment? I call Ms Saïdi.

Ms SAÏDI (Belgium)* – Abortion is not relevant to this report, because there is no link between abortion and forced sterilisation and castration, which is the subject of the resolution.

THE PRESIDENT* – What is the opinion of the committee?

Sir Alan MEALE (United Kingdom) – The committee is against.

THE PRESIDENT* – The vote is open.

Amendment 7 is rejected.

We come to Amendment 4, tabled by Mr Ghiletchi, Mr Volontè, Ms Guţu, Mr Zingeris and Ms Palihovici, which is, in the draft resolution, paragraph 7.1, delete the words “in any way for any reason”.

I call Mr Ghiletchi to support Amendment 4.

Mr GHILETCHI (Republic of Moldova) – I proposed to delete the words “in any way for any reason”, because we should consider whether there is a life-threatening situation. Can we be sure that there are no such legitimate cases at all?

THE PRESIDENT* – Does anyone wish to speak against the amendment? I call Ms Maury Pasquier.

Ms SAÏDI (Belgium)* – As was the case earlier, if we remove the words as proposed in the amendment, it would considerably weaken the resolution. I remind the Assembly that we are talking about coercion in castration and sterilisation; this is not a matter of free choice. That is why we need to keep the words.

THE PRESIDENT* – What is the opinion of the committee?

Sir Alan MEALE (United Kingdom) – The committee is against.

THE PRESIDENT* – The vote is open.

Amendment 4 is rejected.

We come to Amendment 6, tabled by Mr Ghiletchi, Mr Volontè, Ms Guţu, Mr Zingeris and Mr Toshev, which is, in the draft resolution, paragraph 7.2, after the word “coerced”, insert the following word: “abortion,”.

I call Mr Ghiletchi to support Amendment 6.

Mr GHILETCHI (Republic of Moldova) – Abortion may not seem to be part of this report, but I repeat that it would be relevant to include it, as it is part of reproductive rights.

THE PRESIDENT* – Does anyone wish to speak against the amendment? I call Ms Saïdi.

Ms SAÏDI (Belgium)* – I would make the same argument as I did for Amendment 7.

THE PRESIDENT* – What is the opinion of the committee?

Sir Alan MEALE (United Kingdom) – The committee is against.

THE PRESIDENT* – The vote is open.

Amendment 6 is rejected.

We come to Amendment 5, tabled by Mr Ghiletchi, Mr Volontè, Ms Guţu, Mr Zingeris and Mr Toshev, which is, in the draft resolution, paragraph 7.3, after the word “coerced”, insert the following word: “abortion,”.

I understand that Mr Ghiletchi will not move this amendment. Is that the case, Mr Ghiletchi?

Mr GHILETCHI (Republic of Moldova) – Yes.

THE PRESIDENT* – Amendment 5 is not moved.

       We come to Amendment 8, tabled by Mr Ghiletchi, Mr Volontè, Ms Guţu, Mr Zingeris and Ms Palihovici, which is, in the draft resolution, after paragraph 7.4, insert the following paragraph:

“The Assembly recognises the right of Member States to insist on gender reassignment surgery (including where this may necessarily involve sterilisation or castration) as a precondition for permanent legal recognition of a change of sexual identity. In such circumstances where the State is seeking to respond compassionately to a firmly expressed desire to change sex, there can be no presumption of guilt for coercion or requirement for retrospective apology or compensation.”

I call Mr Ghiletchi to support Amendment 8.

Mr GHILETCHI (Republic of Moldova) – This is the most important amendment for the Group of the European People's Party. It is important to allow member States the right to insist on gender reassignment surgery. This is very important for the legislation of our member States and falls within the margin of appreciation. It is also important for the reasons I mentioned in my speech. If this amendment is defeated, the Group of the European People's Party cannot support the resolution.

THE PRESIDENT* – Does anyone wish to speak against the amendment? I call Ms Saïdi.

Ms SAÏDI (Belgium)* – The most advanced legislation on transgender allows people to choose their identity. The imposition of surgical reassignment would go against that.

THE PRESIDENT* – What is the opinion of the committee?

Sir Alan MEALE (United Kingdom) – The committee is against.

THE PRESIDENT* – The vote is open.

Amendment 8 is rejected.

We come to Amendment 13, tabled by Sir Edward Leigh, Mr Neill, the Earl of Dundee, Mr Kalmár and Mr Gruber, which is, in the draft resolution, paragraph 8, replace the word “coerced” with the following words: “free and informed consent to”.

I call Sir Edward Leigh to support Amendment 13.

Sir Edward LEIGH (United Kingdom) – This is a matter of terminology. It would be preferable to use a reference to the all-encompassing term “free and informed consent”, which covers all forms of involuntary interventions. That would also be consistent with the fact that the CPT has never referred to any castrations as coerced.

THE PRESIDENT* – Does anyone wish to speak against the amendment? I call Ms Maury Pasquier.

Ms MAURY PASQUIER (Switzerland)* – I do not think that this is merely a drafting issue. I remind the Assembly that the CPT has to take account of possible inhuman or degrading treatment as applied to prisoners, and “free and informed consent” is a matter for the Bioethics Committee, because such issues are part of its mandate and remit. I would prefer to keep the original wording.

THE PRESIDENT* – What is the opinion of the committee?

Sir Alan MEALE (United Kingdom) – The committee is against.

THE PRESIDENT* – The vote is open.

Amendment 13 is rejected.

We will now proceed to vote on the whole of the draft resolution contained in Document 13215. A simple majority is required.

The vote is open.

The draft resolution in Document 13215 is adopted with 48 votes for, 17 against and 3 abstentions.

The resolution received a large majority, and I congratulate and thank the rapporteurs and the team who worked on this important text.

4. Equal access to health care

THE PRESIDENT* – The next item of business this afternoon is the debate on the report titled “Equal access to health care”, Document 13225, presented by Ms Maury Pasquier on behalf of the Committee on Social Affairs, Health and Sustainable Development and in place of Mr Lorrain, the rapporteur. Mr Cederbratt will present an opinion on behalf of the Committee on Migration, Refugees and Displaced Persons, Document 13249.

I call Ms Maury Pasquier. You have 13 minutes in total, which you may divide between presentation of the report and reply to the debate.

Ms MAURY PASQUIER (Switzerland)* – I wish to start by paying tribute to the remarkable work done by my colleague, Senator Jean-Louis Lorrain, on this report on equal access to health care. It is my honour to present it to you today. I am sorry to say that he cannot be with us today because he has serious health problems. I assure him and his family that we are thinking of them at this particularly difficult time.

      By way of an introduction to the report, I remind the Assembly that the right to health is a fundamental right, just as the rights to life and freedom of expression are. We should proclaim that loud and clear, because I believe there has been a trend recently to put in place a kind of hierarchy of fundamental rights, which has led some people to consider that social and economic rights are a commodity and not necessary. In fact, the right to health is not a commodity or a niche right, but a basic and fundamental right.

      The European Social Charter enshrines the right to the protection of health in Article 11 and requires member States to put in place accessible and effective structures for the whole of the population. I stress the word “whole” because it lies at the heart of Mr Lorrain’s report. His point is that health care should be available to all people in practice as well as in law.

      Unfortunately, in many Council of Europe member States, many people are wholly or virtually excluded from the health system, because they do not have a work contract or legal residence. Many people cannot pay the costs of their health care when they are not reimbursed by the health system. What is more, some sections of the population have only limited access to hospitals, clinics or health professionals as a result of the areas in which they live – I am thinking of people who live in isolated areas or out in the countryside. We should not forget the many patients who have great difficulty explaining what their problems are, either because they have a sensorial incapacity or because they do not master the language of the host country sufficiently well. Some might not properly grasp the complicated rules of the health system, which are often difficult to understand even for an informed population. There is often too much red tape or doctors expect bribes before they dispense any kind of health care. All that has at its root the way in which health systems are organised and operated.

      Another factor that leads to inequality of access is the current trend in Europe for increasingly stringent migratory and security policies. Current debates on the fundamental rights of irregular migrants are often linked to the debate on illegal immigration. That puts a requirement on health professionals or civil servants to report irregular migrants. Above and beyond any implied ethical considerations for health professionals, that means migrants are deterred from going to hospitals or clinics by the fear of being reported to the authorities. Regardless of their origin, vulnerable groups in society such as the unemployed, single-parent families, children, the elderly, Roma, migrants – particularly undocumented migrants – and the homeless, are affected by such inequality. In fact, those groups in society most need health care but experience the most difficulty in accessing it.

      We should realise that such inequality of access not only jeopardises the lives of the people concerned, but constitutes a potential breach of their fundamental right to health. It also leads to public health problems and an increase in health spending. What is the upshot of such a situation? People either do not go to see a doctor, or go to see one very late in the day, when they are obliged to do so. Transmissible diseases such as tuberculosis could pose a threat to the population as a whole, because there is an increased risk of transmission if people do not see a doctor. Delayed access to treatment ultimately increases health costs either because people have to be dealt with in emergency rooms, or because care is ultimately more costly.

      I draw your attention to the impact of the current economic crisis on health systems, and particularly on the accessibility of care. For one thing, it would appear that the budget cuts that have been imposed across Europe as a result of austerity policies and cuts in public spending have had repercussions on socio-economic factors, particularly access to employment and housing. Less money is available for health care when there are more health care needs. Health coverage is often linked to employment, so economic crisis means that an increasing share of the population is excluded from entitlement to health care. In that regard, I recommend reading the chapter in the report on the committee’s fact-finding mission to Athens in April, which is a good illustration of the impact of the economic crisis and the perverse effects of austerity on health care.

Samia Hurst, a doctor and bio-ethicist at the university of Geneva, said that “austerity kills” in a book co-written by an epidemiologist. The book highlights the usually ignored links between health and politics. Let me give one example. During the economic crisis in the United States between 2007 and 2010, there were many thousands more suicides than the number that would have been ordinarily expected given prevailing trends. That is possibly an inevitable effect of recession – in recessions, we see bad health and unemployment. We know, and knew throughout the 20th century, of the implications of unemployment. Essentially, people are hit twice by austerity policies, their morale is sapped, and their prospects and life chances are gloomy.

      I emphasise one point on our responsibility as policy makers to take specific measures on employment and housing. The enforcement of austerity policies can have terrible effects on health. The draft resolution contains proposals designed to try to reduce the inequality of access to health care I have described. They would ensure that health spending is directed to the most disadvantaged in societies. We want to disassociate health spending from security and immigration policies and ensure that we give priority to vulnerable groups. Against the backdrop of the economic crisis and austerity policies, the draft resolution also warns of the dangers of austerity for the accessibility of health care.

      Turning to our recommendations, I remind the Assembly that the Council of Europe no longer has an inter-governmental health committee. It ceased to exist in 2012. For that reason, the Council of Europe has to use every means at its disposal to continue to safeguard the right to health, which is enshrined in Article 11 of the revised European Social Charter. The objective of the recommendations is therefore to strengthen the role of the Committee of Social Rights in protecting that right.

      I thank the Assembly for listening and commend to it the proposals in the draft resolution. I will obviously be happy to answer any questions.

      THE PRESIDENT* –Thank you, rapporteur. You will have two minutes to respond at the end of the debate.

I call Mr Cederbratt to present the opinion of the Committee on Migration, Refugees and Displaced Persons. You have four minutes.

      Mr CEDERBRATT (Sweden) – I congratulate the Committee on Social Affairs, Health and Sustainable Development and its rapporteur, Mr Jean-Louis Lorrain, on their report on an extensive and difficult subject. I am particularly pleased to see that the rapporteur has been sensitive on the issue of migrants.

      My committee’s opinion covers four areas, and I would like to highlight the issues at stake. The first is access to health care for people belonging to vulnerable groups. Two groups that I believe need to be added to those already mentioned in the draft resolution are detained persons and refugees. As a former police officer and a member of the Committee on Migration, Refugees and Displaced Persons, and having visited places of detention, I am well aware of how difficult the issue of health care in detention can be. I have been confronted with it when visiting detention centres in France, Greece, Italy and my home country of Sweden.

      The second group in need of specific mention is refugees. As the opinion states, they arrive in a country having suffered persecution and sometimes having undergone highly dramatic journeys. Yesterday, the committee heard the testimony of Mr Abu Kirke, a refugee and one of the survivors of the boat that we discussed in the “Lives lost” debate in the Assembly last year. He explained how people on his boat died while being ignored by naval and commercial vessels. Many refugees have both physical and mental health care needs when they arrive, as a result of what they have suffered.

      The third issue that I wish to discuss is mental health care, which is important for the whole population, particularly for vulnerable groups such as migrants, refugees and asylum seekers. I therefore consider that reference to it in the resolution is necessary.

      My final point relates to a rather specific issue, but I hope that colleagues will agree strongly about it. The rapporteur touches on it in his report, but it is worth highlighting: access to health care for pregnant women and children. We have heard reports of mothers being denied access to their children until charges have been paid to the hospital. The problem goes beyond that for undocumented pregnant women and children, who in many countries have numerous problems accessing pre-natal and post-natal health care. I hope that the Assembly will support Mr Lorrain in his report and accept the amendments that I have tabled.

THE PRESIDENT* – I call the Earl of Dundee on behalf of the European Democrat Group.

Earl of DUNDEE (United Kingdom) – I congratulate Mr Lorrain on his excellent report. As he clearly states, equal access to health care is an obvious human right. There is no doubt about that. The challenge for us is how to produce much more effective delivery.

In that respect, the current economic downturn might be used as an excuse for procrastination and delay. In fact, the opposite should be the case. Mr Lorrain notes that paradox, pointing out that an economic crisis is exactly the time for us to rethink health systems and increase their efficiency. He recommends more health literacy and education programmes and urges our States to adopt a far more methodical approach than they often do. In the first place, they need properly to identify aspects of inequality in access to health care. Then they should base remedial action not on some arbitrary prescription but on careful study and comparison of certain proven ways to improve the situation.

I would like briefly to connect two themes. The first is equal access to health care not just around Europe but elsewhere too – that is our human rights focus in the Council of Europe. The second is the scope that often exists for producing better results through partnerships than through individual health agencies. One example, which started in 1952, is the partnership between the World Health Organisation and the Council of Europe. As Chairman of the Assembly’s Sub-Committee on Public Health, I have tabled a motion this week to update the purpose and context of that partnership. It revisits the earlier resolution of co-operation and invites the Assembly to call on the WHO and the Committee of Ministers to work together in a variety of ways, through regular contact and the sharing of information.

Not least, a Council of Europe-WHO partnership can also back useful working synergies among different health bodies. One such already exists between the WHO and UNICEF: their current joint action plan being to end preventable child deaths by 2025. There are as well those proposed between other health bodies and initiatives so that a combination of better hygiene, nutrition and vaccination can be provided all together rather than through the intermittent deployment of single benefits unaccompanied by the others.

As the report outlines, to promote equal access to health care, we must adopt a better methodology and develop better practices, which can include more partnerships, more combined initiatives and much more focused co-ordination and pooling of resources among the health bodies concerned.

THE PRESIDENT* – I call Ms Andersen, on behalf of the Group of the Unified European Left.

Ms ANDERSEN (Norway) – The Group of the Unified European Left strongly supports the report. I want to underline the fact that inequalities in access to health care are growing in Council of Europe member States. We should ask why that is happening. The report states that one reason is the austerity measures being taken in many countries. It seems that they are damaging health and social policy in many countries, and they are not good for the economy or for the fair distribution of health resources. In fact, they do not seem to be good for anything, because they are not helping the economy recover either.

Another reason for the inequalities is an economic policy that does not put enough emphasis on the fair distribution of resources. Health care is unfairly distributed and is linked to economic policy and people’s economic position in society. The primary goal of further public health work should be not to improve the health of people who are already in good health but to bring the rest of the population up to the same level – a levelling up. That requires a fairer distribution of resources in society, and must be a basis for all policy.

      I have often heard reference to the book, “The Spirit Level: Why More Equal Societies Almost Always Do Better”. Research from more than 20 countries showed that for many societal issues, countries with small economic differences do better. Health is a significant one of those issues. If we want better health, therefore, we must share resources more evenly.

      The report does not address what the rapporteur said at the start of her speech which was that health is not a commodity; indeed, it is not. Health and social rights cannot be treated as a commodity, which is why the UEL highlighted the effects of the privatisation of health care in many countries. Privatisation does not make health care more effective or cost-effective; it does not even make it more up to standard, at least not for those who cannot afford it. This is about social responsibility for the authorities. If countries privatise their health care systems, standards of health will be more uneven and unjustly distributed among the population. That important side of the debate is not addressed in the report, although austerity measures were covered, as we have said. It is important to underline that we are talking about economic politics as the basis for every social right.

      THE PRESIDENT* – I call Ms Kyriakides, on behalf of the Group of the European People’s Party.

      Ms KYRIAKIDES (Cyprus) – On behalf of the Group of the European People’s Party, I thank the rapporteur, Mr Lorrain, for his excellent report. It tackles a subject that involves fundamental human rights, but that is currently under threat in many member States. Health in its broadest sense relates to the state of “physical, mental and social wellbeing” – that is the definition used by the World Health Organisation – and health involves more than just the absence of disease.

      Health is a right that must be safeguarded and promoted, with equality of access as one of the key protective components for many vulnerable groups. The report highlights what determines equal access, as well as noting the problems faced today in many countries that are due especially to the economic crisis, inadequate health systems, and linguistic, geographical and religious barriers. Besides the United Nations and the Council of Europe, other organisations have focused on strengthening patients’ rights, leading to the European Charter of Patients’ Rights that seeks to empower and raise awareness of the rights of patients and citizens.

      Is enough being done? Do patients and citizens across Europe have a real understanding of the conventions and treaties, and of what protecting patients’ rights actually entails? Is equal access to health being safeguarded? Cultural and linguistic barriers, as well as austerity measures, are threatening that fundamental human right, and we in this Assembly must address those issues and raise our voices as political groups to support those who are today facing extreme inequalities in access to health care.

      Health systems in our member States are funded and structured in diverse ways. Progress in the science of medicine has allowed diseases that were previously considered untreatable to be treated. Prevention programmes have effectively combated diseases such as tuberculosis and measles, we have managed to address HIV as a chronic disease, and women can survive breast cancer due to early detection. We have put our efforts into the future, research and quality of life. Those values cannot and should not be sacrificed due to barriers in equality of access to health care.

      In times of economic crisis, we should make access to health services easier for those most in need and the most vulnerable populations, but in fact we are seeing the exact opposite. Barriers are being put up so that vulnerable groups cannot access services easily, and policies discriminate against the most vulnerable. The cost of health care is being transferred on to the shoulders of patients, the elderly, the disabled, migrants, and those most in need.

      As general rapporteur for children, I must mention that one of the most vulnerable groups for whom equality of access to health care is crucial, is children. Developmentally, children will suffer permanently, and their developmental needs, both physical and psychological, must be protected. Inequality of access for children is unacceptable. Health is not a luxury but a fundamental human right that we must protect and promote. We must all make such a commitment and it must be an item in all our agendas. We must be the voices of the most vulnerable.

      THE PRESIDENT* – I call Ms Ohlsson, on behalf of the Socialist Group.

      Ms OHLSSON (Sweden) – I thank the rapporteur for this excellent report. If followed up together, such reports can make changes for many Europeans and give them the possibility of receiving relevant health care. The right to health is a fundamental human right. Protection of health is an essential condition for social cohesion and economic stability, and represents one of the indispensable pillars of development. Access to care is a key aspect of the right to health.

      Having regard to the Council of Europe’s principles and values is of paramount importance to continuing to protect the right to health. Enshrined in part 1, paragraph 11, of the European Social Charter we read that “Everyone has the right to benefit from any measures enabling him to enjoy the highest possible standard of health attainable”, and paragraph 13 states that “Anyone without adequate resources has the right to social and medical assistance.” We should ask ourselves: is that the situation today? I say no.

      Statistics on the mortality rate and the state of European health reveal substantial inequalities both between countries and between socio-economic groups in the same country, and that situation cannot be explained solely by inequalities in access to health care. Socio-economic factors play an important part in health inequalities, and such disparities are due in particular to socio-economic factors such as income, employment, education, as well as living and working conditions and their unequal distribution among the population. Inequality is not in any sense a “natural” phenomenon; it is the result of politics that prize the interests of some groups over those of others. Together, however, we can make a difference.

      As we know and can read in the report, inequalities particularly affect vulnerable groups, including people who are experiencing financial problems such as the unemployed, single-parent families, children, the elderly and so on. Some countries have a public medical insurance system based on employment, but an employment-based system now excludes many people because unemployment is so high, especially among young people. The best thing, of course, would be to struggle for equality, education and work for all, and we should also ratify and implement the Social Charter. 

      To guarantee the fundamental right to health, the conclusion in the report is a very good one: we in this Assembly should recommend that everyone living in Europe should be able to enjoy equal access to health care, regardless of their financial situation, residency status or place of residence. We are the representatives of the States in Europe, so let us go home and look at the situation in our own countries, so that we can make a difference today.

      THE PRESIDENT* – I call Mr Hancock to speak on behalf of the Alliance of Liberals and Democrats for Europe.

      Mr HANCOCK (United Kingdom) – I thank both rapporteurs for their reports. Let me also say a special thank you to the chairman of the committee, Ms Maury Pasquier, for the eloquent and forceful way in which she defended her position on the previous group of amendments – I expect the same on the next group of amendments, if they are opposed – and for the splendid way in which she introduced this vital issue. I am proud to say that we in the Alliance of Liberals and Democrats for Europe are in favour of the report and want to see the things it describes materialise.

      This is a very important issue. Of all the things we discuss in this Chamber, your health is the one thing that, rich or poor, whatever group you are in, whatever country you come from, you have no control over. It is the most important thing to all of us; it touches all of us. The ability to get good health treatment when you need it is of paramount importance to you as an individual, and to your family and everything that goes on around you. It is important that this report clearly establishes a way to develop that.

      I have been the beneficiary of some excellent health care over the past 12 months. I will be for ever grateful to the doctors who saved my life. For a very brief period, I felt that my life would come to an end a year ago, but fortunately I was in the right place at the right time and with doctors who had the right skills. They were able to prevent that from happening to me and have given me a second chance at life.

      I am very privileged to have that opportunity, but there are many people throughout Europe who will never have that opportunity, for various reasons. This report tries to unravel those circumstances. It does so forcefully in a way that we should all be committed to defending. The report talks about how people are excluded. Health is about inclusion, not exclusion, but the report eloquently demonstrates that in many countries, many categories of people – whether poor, elderly or simply in the wrong place – cannot partake of the services that are available. There is not an equal share of health facilities.

      All those who spoke before me emphasised the importance of what health means to a society. If we work together and if we are prepared to fund it properly, health care should be universally available at the point of need to every citizen of Europe. Surely that is something we should all aspire to. This Assembly should put that at the forefront of the other important things that we care about so much – the three pillars of this establishment. The ability of people to access proper health care is fundamental.

      Paragraph 3 of the draft resolution is very important. It talks about the exclusion zone that exists in many places. Another point that needs to be underlined is the reference in paragraph 6.2 to taking appropriate “incentive measures”. Incentive measures in health have never delivered better care; indeed, they have acted as a deterrent in some instances. It is difficult to see how we can overcome this idea that league tables of successful surgeons or first-class hospitals deliver benefits. I have some doubts whether they make a difference anywhere.

      It does not matter whether you are in the far east of Russia or the north of Norway. What people want is proper health care, available when they are sick. They and their loved ones want to be assured that we as politicians are defending their right to that health care. That is why this report is so fundamental to this Assembly and to all of us.

      THE PRESIDENT* – Thank you, Mr Hancock, for that very optimistic and inspiring speech.

      The rapporteur, Ms Maury Pasquier, is saving her speaking time for later, so I call the first speaker in the general debate, Ms Schou.

      Ms SCHOU (Norway) – I thank our rapporteur for putting this very important topic on our agenda. Equal access to health care is not a given in Europe today. As elected representatives, we must do what we can to ensure that no Europeans are suffering from lack of access to basic health care. The right to health is a fundamental human right. Violations occur, especially now that most of Europe is going through economic difficulties, but we as politicians cannot hide behind difficult times. We must work hard to ensure that people with limited resources do not lose access to health care and a healthy life.

      The rapporteur referred to the WHO’s definition of universal health care coverage. Universal coverage means access for everyone to the health services they need without suffering financial difficulties to pay for them. “Not suffering financial difficulties” is the key phrase. We should aim for all necessary health care to be free of charge, although a good model of patients paying for the services provided is the most feasible solution. However, the system must not discriminate against people with limited financial means.

      Some people end up losing access to health care because of the status of their health. The long-term cost of treatment means that people can be discriminated against on the ground of their diagnosis. It is important to ensure that those suffering from chronic and long-term illness are not crippled by the cost of their disease.

      I give an example from Norway. When you are ill and need medication, you get a prescription from your doctor. We have two categories: regular, white prescriptions and blue ones. If you are suffering from a chronic disease or long-term illness, you might qualify for a blue prescription, which reduces what the patient is charged and limits it to 520 Norwegian kroner, or about €65. This relieves the burden on that group of patients.

      I emphasise the importance of emergency care. A system in which you risk being refused treatment at the emergency room is not acceptable. A system in which you have to prove financial means before receiving treatment is not in line with the principle of universal health care coverage. In times of economic difficulties, it is especially important that we find efficient and cost-effective ways of organising our health care sector, so that the universal right of access to health care is not violated.

      Mr SKINNARI (Finland) – The effects of the banking crisis on health are long term. Differences in income levels also lead to differences in health. Not all can afford good, healthy food and a healthy lifestyle. Not all can afford the health care they need. The banking crisis has deepened this divide. Poverty and sickness are becoming increasingly intertwined.

      The European Union should urgently react to make the creators of the banking crisis – the bank managers – accountable for their bad investments and the excessive debt of their banks. Failed bank managers should be replaced. The banking crisis has messed up the economies of those States that have guaranteed and paid for loans. This has caused mass unemployment in Europe, difficulties in earning a living and a blatant imbalance in the distribution of income. For these reasons too, the Council of Europe finds itself in a new situation. Its position as a human rights defender is emphasised as a consequence of the banking crisis.

We must ensure the physical and psychological well-being of the Europeans. A healthy workforce is the basis for success in Europe. It is also important to ensure the health of children, ageing persons and the disabled. Language problems, living in remote areas and religious differences cannot be obstacles for access to health care. The Council of Europe must co-operate more with the World Health Organisation and the International Labour Organisation. Thank you.

Mr KAYATÜRK (Turkey) – I express my sincere appreciation to the rapporteur. As he underlines in his report, access to health care is a key aspect of the right to health – there is no doubt about that. A lack of adequate and timely health care, a lack of available drugs and health professionals, unaffordable user fees and geographical and language barriers can have a negative impact on the disease outcomes of our citizens and migrants in our countries. It is very unfortunate to see that the number of people with an inadequate level of access to health care is growing in the member States.

The report rightly focuses on the issues that lie at the heart of the management of the challenges regarding access to health care. In this regard, the sharing of best practice among the member States carries the utmost importance. I draw your attention to Turkey’s experience, with a view to supporting the rapporteur’s elaboration of how to achieve equal access to health care. In Turkey, the so-called health transformation programme has been implemented for the past 11 years. The main purpose of the programme can be defined as the provision of quality and sustainable health services, accessible for everyone in an effective, quality and equitable manner. As a result of this effort, 98% of the population in Turkey are covered by public health insurance and emergency cover, while intensive care is provided to everyone free of charge.

I emphasise our awareness of the importance of this issue and the role that our parliaments could play in improving access to health care. I thank both rapporteurs and the Committee on Social Affairs, Health and Sustainable Development.

THE PRESIDENT* – Mr Schennach is not here. I call Ms Bonet Perot.

Ms BONET PEROT (Andorra)* – I congratulate the rapporteurs on their excellent work. From the point of view of human rights, everyone has the basic right of access to effective health care to alleviate their suffering if they are ill, to prevent the spread of diseases, and to keep themselves in good health should they find themselves in good health at any point. The right to health is fundamental.

One aspect of the current economic difficulties is that they are jeopardising that right to health. People’s access to outpatient or specialist treatment may well be overwhelmed because people are finding themselves in emergency situations. The report reveals that national health systems are crumbling when trying to deal with the health issues of the most vulnerable people in society. There is a profound negative impact on health care as part of social protection. Indeed, it has been established that in seven European countries 20% of people who are seeking health care are not getting the right care, and there are people who are denied basic access unless they have the money to pay the bills on the spot or have made contributions in the past. We must have equal access to health care, irrespective of one’s social position, otherwise there is a risk of social exclusion from our societies for these vulnerable people.

European governments should be encouraged to take immediate measures to guarantee that there is a consistent European policy on the detection and prevention of transmittable diseases and that there is equal access to paediatric healthcare, and the same should apply to pregnant women and those with diseases who otherwise cannot access adequate treatment. There are people who are running the risk of losing their homes and becoming homeless because of the economic crisis.

Solidarity, equality and justice are the principles that underpinned the creation of the provision of health care, but migrants have been turned into the scapegoats of the economic crisis. We are talking about a very low proportion of migrants – the figure has been estimated at 1.6% – who migrate because of pre-existing health reasons. In 2010, only five European countries offered migrants access to health care apart from primary or emergency care. Studies show that barriers to access to health care hold up diagnoses, which are made later and later. That pushes up the subsequent costs of treatment, and you end up with problems such as TB or measles that affect the rest of the population as well. I fear that we will see the full effects of this problem only in a few years’ time

The PRESIDENT* – I do not see Ms Pashayeva, Ms Clune or Mr Korodi. I call Ms Maghradze.

      Ms MAGHRADZE (Georgia) – I thank the rapporteur for this report, which is timely, because everybody considers the right to life and health to be a primary, fundamental value; economic sustainability or development, and democracy, come after it. That is why we think that every person has a right to health care, whether or not they have money. Financial barriers are the most significant of the barriers to health care. As regards health insurance, it is continually shown that when there is high unemployment in an economic crisis, even in developed European countries, some people have no access to health care.

      In Georgia, the situation was even worse. There, patient charges reportedly accounted for 74% of total health expenditure and inequalities led to extremely high health expenditure, sometimes exceeding 40% of household income. The report underlines that the cost of care should not place an excessive burden on individual patients. That is why our new government decided dramatically to change its policy on health care. Our government came to power with a clear determination to improve the social and health care status of the Georgian population. The strong political pledge at the election was translated into an unprecedented, almost twofold expansion of the health budget, which was 365 million Georgian lari in 2012, and is 635 million Georgian lari this year.

The second major step towards securing health rights in Georgia was the launch of a universal health care programme in February 2013. Until December 2012, the country’s health insurance programme covered only 30% of the population. About 400 000 people worked and had private insurance, and about 800 000 were pensioners and children under five. It was a small, basic health care package. When our government came to power, we decided that all citizens of Georgia must have, from February, a general health care package that covered all primary health care and an urgent medical service.

From 1 July 2013, our government is expanding the universal health package to include an expanded primary health care package, coverage of maternity services countrywide, and coverage of additional emergency and elective surgical care. Targeted social and health care assistance for poor, disabled and other vulnerable groups was the focus of State policy under the previous administration. However, we decided to shift from a targeted model to a universal health care model. The decision was naturally the subject of wide debate and controversy, but we think that when there is high unemployment in a country, the State’s obligation is to ensure equal access to health care for every citizen. Maybe that holds good for any country, or maybe not, but we are sure that when a country’s economy is in a serious situation, and there is high unemployment, the State needs to be more engaged in the health care system, and needs to provide equal assistance to every citizen in the country.

(Ms de Pourbaix-Lundin, Vice-President of the Assembly, took the Chair in place of Mr Rouquet.)

Mr ARIEV (Ukraine) – Health care can be a good business that brings good profit. Like food, health care is vital for human beings, but there is one difference: rich people in Europe can buy king lobsters, but people on low incomes can still buy quality fish. With medicine, that is not the case. For people who are not rich, the situation resembles a lottery: they may have good treatment, or they may have bad treatment.

The Ukrainian free-of-charge medical system, and its medical equipment and assets – this is the case for all post-Soviet countries – are still in the ’90s of the previous century. State-run medical institutions treat 90% of all people. Private clinics are usually well equipped, but prices make them inaccessible to the majority of the population. For many years, Ukraine has been unable to bring about real reforms to health care, and has not been able to introduce an appropriate medical insurance system. The current so-called reforms are pulling the wool over the eyes of society, and 90% of Ukrainians are very much dependent on State budgetary allocations. The health service in Ukraine represents only 3.2% of its gross domestic product. That is something like €30 per year, per person. As there is corruption in the Ukrainian health service, the situation is extremely bad. Patients can count on just €1 per month, which has to cover medicine, equipment, doctors’ salaries, the heating of hospitals, fuel for ambulances and so on. This means that HIV, cancer, haemophilia, hepatitis C and other serious diseases are a condemnation to death.

The situation leads to incredible corruption. State institutions spend billions of euros on their own privileges and absolutely do not care for patients who do not have money, and that looks very strange. In one case, a son of a health care minister fabricated a deadly, dangerous vaccine using budget money. There have been numerous cases of clinics giving fake diagnoses of serious diseases such as cancer, just to pump money out of patients, and that happens because the free-of-charge medical system exists only on paper and in law. I could go on and give more examples.

Ukraine and other post-Soviet States need urgent changes in their health care systems, accompanied by strong anti-corruption measures. I call on the Committee on Social Affairs, Health and Sustainable Development to pay special attention to health-related issues, both in Ukraine and in the other post-Soviet States. What is happening today in Kiev illustrates my point: a few hours ago, State officials tried to do away with Kiev’s only HIV hospital. Doctors and patients are now clashing with the police. That is going on as we discuss this topic, so it is a very relevant example.

Everything leads to one conclusion: the free-of-charge Ukrainian medical system, mixed with corruption, is basically free of patient care. One quarter of all visitors to my constituency office ask me to help them find some charity fund to finance their treatment outside Ukraine. A vivid example is the case of the former Prime Minister, Yulia Tymoshenko, who was convicted on political grounds. She still cannot overcome her illness, because she cannot get normal treatment in hospital. The only way to heal her and save her life is to move her to Germany for medical treatment.

Mr POPESCU (Ukraine)* – I sincerely thank the rapporteur for this excellent report. The issues that it deals with are extremely relevant today, when governments of member States, against the backdrop of an economic crisis, are having to take austerity measures, including in the area of health care. This, of course, has a negative impact, first and foremost on the most vulnerable social groups. I completely agree that the crisis should be considered an opportunity to rethink the health care system and enhance its effectiveness. Given that legislative bodies play an essential role in guaranteeing the basic rights and freedoms of citizens, including the right to access health care and medical services, national parliaments of member States should drive in-depth reform of the medical sector, taking into account the provisions of the European Social Charter and its protocols.

      Over the years of independence, the Ukraine Parliament has worked to shape, develop and improve health care legislation. In 2010, at the president’s initiative, we began a reform of medical care, the aim of which was to improve the health of the population and ensure equal access for all citizens to high-quality medical services. Thanks to the consolidated efforts of all branches of government, several key pieces of legislation were adopted in 2011, which aimed to achieve that goal. We started to increase the salaries of health care employees, first and foremost those who provide emergency care. We introduced criminal liability for counterfeiting medication, because equal access to health care depends on equal access to high-quality medication. Ukraine in 2012 was the first country to ratify the Medicrime convention, which demonstrated its readiness to protect public health by guaranteeing the right to life. Today, according to experts in the Council of Europe, Ukraine, serves as an example when it comes to combating the counterfeiting of medication.

In overcoming difficulties in ensuring equal access to health care, it is important to bear in mind the founding principles and goals of our organisation. There is no justification for lowering the social standards enshrined in the European Social Charter, and we must continue to be vigilant in ensuring that they are complied with. Europe’s future stability and success depend on that. I ask colleagues to vote for the draft resolution.

      Ms BORZOVA (Russian Federation)* – I thank the rapporteur for this excellent report and wish him the best of health. This subject unites us all, because access to health is one of the basic human rights on which the work of the Parliamentary Assembly is based. The rights to health and to medical aid are enshrined in the European Social Charter, and our job is to protect those rights. The reality is, however, that medicine is suffering as a result of the economic crisis and the difficulties faced by so many European countries. The WHO reports on health in various European countries demonstrate a clear link between social and economic development, health and the principles of justice and fairness in Europe. The reports show that all the basic determinants of health depend on social and economic development. The matter is urgent, and the report that we are debating provides an excellent analysis of access to health care for particularly vulnerable groups, such as the handicapped.

      In my country, over the past few years, we have completely remade and updated our legislation on health care to bring it up to the best European standards. There has been an unprecedented drive in that direction over the past few years, for instance with the adoption of a programme called “The Development of Healthcare in the Russian Federation”. Many changes are afoot. Russia is a huge country, and we have great difficulty in moving anything from one part of the country to another. The programme for modernising our health care is being prioritised. We are improving logistics, improving hospitals that are far from the centre and improving access to specialised centres for those who live far from them. Because of the crisis, the reforms are not easy, but we have ring-fenced the funding for our social programmes, particularly for health for the most vulnerable sectors of the population.

Council of Europe countries should direct their efforts towards optimising and reassessing their own health care systems. I fully support those who have talked about the importance of working together and using our links with the WHO to exchange information and support each other. We should also use the Council of Europe as an important mechanism for European co-operation in the field of health care, and we should continue the work in this area at various different levels, from the specialist level right up to conferences for ministers of health. The draft recommendation should take that into account.

      My country supports the resolution and the text of the report. It is important that we all work together as countries to provide equal access to medicine for all.

      THE PRESIDENT – Mr Labaziuk is not here, so I call Ms Miladinović.

      Ms MILADINOVIĆ (Serbia) – The right to life and the right to health are fundamental human rights. The very existence of humankind and our social and economic development depend on the general health of the population, so access to health care is a key pillar of social development. Health policy is rational only if the health system is well organised and economically accessible to all. On a global scale, that means that every well organised health care system must observe the principle of equal opportunities.

Austerity measures in the European Union are unfortunately having a detrimental effect on the social and health care rights of the most vulnerable, with the result that the situation is getting worse, and the most vulnerable are still marginalised when it comes to access to health. In the long run, dysfunctional health care systems can lead to a drastic increase in the cost of treating serious illnesses and the cost of medical procedures. The crisis we are facing demands financial restrictions and makes health care systems even less accessible.

The resolution on equal access to health care comes against the backdrop of a very difficult health situation, primarily for those who are marginalised and socially vulnerable, and it should help us to overcome the negative effects of the major economic crisis that has struck the European and global economies. We believe that the resolution will unite all those who advocate more equal and socially just societies. In times of crisis, we have to demonstrate solidarity, because it is the only way we will have a chance. The resolution focuses particularly on that aspect of the problem, and it is even more important when we consider the enormous pressure on health funds.

I urge you all to support the resolution and demonstrate that we are a socially responsible society that takes care of the whole human population, regardless of social background, and that we are an economically responsible society that supports the development of economically rational and effective national health care systems. We should not allow inefficiencies in health systems to increase the cost of primary care and prevent equal access to health, which is a fundamental human right.

Mr MARIAS (Greece)* – I congratulate the rapporteur on his report, which points out the huge unemployment and poverty that are hitting Europe because of the economic crisis, which has led to the social exclusion and marginalisation of many people and affected equal access to health and care services for the citizens of Europe. We are examining this issue because of the terrible effects that that has had on the health sector.

The implementation of the rigorous austerity plan has been catastrophic for my country. That was imposed on Greece by the Troika: the IMF, the European Commission and the European Central Bank. We have at least 1.3 million unemployed in Greece. In the last three years, we have received loans from the IMF and many other organisations. We have received huge sums that could have financed a modern Marshall plan to help to re-launch the Greek economy and to pay for public spending and millions of jobs, but the money was not invested in the real economy. It was used instead to pay for old loans and to save the banks.

We also must think about the savings made on health spending, at the expense of public health, to help to improve the figures. The recipients of social security have seen their income and pensions fall because of the financial agreement. They pay a considerable part of their income to access hospitals and medicines, whereas the government has merged hospitals and drastically reduced the wages of health care staff and doctors.

Various cuts have been made. The free provision of equipment for those who need it has been reduced, including for those who need kidney and other treatment. The same applies to physiotherapy and other services. The number of people who receive free medicines has been drastically reduced. Those policies have affected millions of people. Their use of health services has been affected. We have seen how many people have suffered across the country. The deficit is €2.5 billion. Those policies violate the principle of free access for Greek citizens to health services, particularly in the provinces.

In Heraklion, which I represent, two hospitals have suffered in particular. Those who work in the hospitals are protesting at the merger of hospitals and the reduction of hospital beds and they are demanding that additional staff be taken on. Given that situation, problems have increased in the rest of Greece. Social spending has fallen and we have seen that medical dispensaries have increased their services. The Greek people are fighting to reverse the Troika agreement and nefarious effects. These policies are a threat to democracy and social rights.

The PRESIDENT – That concludes the list of speakers.

I call Ms Maury Pasquier to reply. You have two minutes.

Ms MAURY PASQUIER (Switzerland)* – I thank all those who spoke in the debate and recognised the importance of the report’s conclusions. I also thank the secretariat for ensuring that there is continuity in the report, despite the illness of the rapporteur.

On average, people at the bottom of the economic ladder live shorter lives than those who are better off. We deplore that. In 21st-century Europe, the difference is five to 10 years, depending on your status. The same goes for healthy years without disease: the difference is 10 to 20 years. That situation is only getting worse, owing to the policies that have been implemented because of the economic crisis or because of the ideological stance that seeks to limit access to health care.

I want to discuss my visit to Athens in April. Pregnant women who do not have care during their pregnancy give birth in an emergency situation and then cannot obtain the birth certificate for their baby until the fees are paid. Children suffer from malnutrition, which is unacceptable in today’s Europe. It is something that we tend to link with children from third world countries. I also visited the Heraklion medical dispensary, which offers a last chance to many patients, families and cancer victims who are deprived of treatment without warning. I am sorry if I am going beyond my speaking time but we seem to have a bit more time. That service is a reaction by citizens to the situation. They do not want to replace the State in the fulfilment of its responsibilities. The service allows Greek people to continue to stand tall and to react to what is going on, not simply accept it as fate.

That is a good lesson that we should bear in mind. Something needs to be done. Something can be done. I could mention a few other examples. Measures can be developed on the prevention and promotion of health care. There can be training in good health practices. We can also reduce what the most vulnerable pay for medical services, promote the use of generic medication and improve the working conditions and remuneration of health care professionals. Those are some of the measures we can take. I urge you to take steps in your countries and here by adopting the recommendation and resolution.

THE PRESIDENT – Does Sir Alan Meale wish to speak on behalf of the committee? You have two minutes.

Sir Alan MEALE (United Kingdom) – My committee feels that the report is very important. It believes strongly in the right to access health care services. The right to treatment is a fundamental human right. We will be strong on this because of that belief. We do not have that situation in the greater European area. As we have heard from many delegates, the situation is bad in some areas. Therefore, there is a need for such resolutions. It is a sign of the belief in this report that when it went to the committee all the amendments were agreed and the report was agreed unanimously. We are always grateful for that.

THE PRESIDENT – The debate is closed.

The Committee on Social Affairs, Health and Sustainable Development has presented a draft resolution, to which five amendments have been tabled, and a draft recommendation.

The amendments have been organised in the order in which they relate to the report. I remind you that speeches on amendments are limited to 30 seconds.

I understand that the chairperson of the committee wishes to propose to the Assembly that the following amendments, which were unanimously approved by the committee, should be declared as agreed by the Assembly under Rule 33.11. I list them in the order they appear in the compendium and Organisation of Debates. Those are Amendments 1, 4 and 5.

Is that so, Ms Maury Pasquier?

Ms MAURY PASQUIER (Switzerland) – Yes.

The PRESIDENT – Does anyone object? That is not the case.

The following amendments have been adopted:

Amendment 1, tabled by Ms Ohlsson, Mr Gunnarsson, Mr Axelsson, Mr Von Sydow, Mr Haugli and Ms Christoffersen, which is, in the draft resolution, paragraph 3, after the words “in an irregular situation,” insert the following words: “, transgender persons,”.

Amendment 4, tabled by the Committee on Migration, Refugees and Displaced Persons, which is, in the draft resolution, paragraph 3, after the words “especially those in an irregular situation,” insert the following words: “persons in detention”.

Amendment 5, tabled by the Committee on Migration, Refugees and Displaced Persons, which is, in the draft resolution, after paragraph 6.3, insert the following paragraph:

“ensure that pregnant women and children, as a particularly vulnerable group, have full access to health care and social protection, irrespective of their status;”.

      We will proceed to consider the remaining amendments in the order set out in the Organisation of Debates. I remind members that speeches on amendments are limited to 30 seconds.

      We come to Amendment 2, tabled by the Committee on Migration, Refugees and Displaced Persons, which is, in the draft resolution, paragraph 3, after the words “The Assembly notes that inequalities in access to care” insert the following words:        “, including mental health care,”.I

      I call Mr Cederbratt to support Amendment 2.

      Mr CEDERBRATT (Sweden) – Mental health care is, of course, important to anyone who receives it, but particularly to migrants, because they have suffered traumatic experiences when trying to reach Europe.

      THE PRESIDENT – Does anyone wish to speak against the amendment? That is not the case.

      What is the opinion of the committee?

      Sir Alan MEALE (United Kingdom) – The committee agreed unanimously.

      THE PRESIDENT – The vote is open.

      Amendment 2 is adopted.

      We come to Amendment 3, tabled by the Committee on Migration, Refugees and Displaced Persons, which is, in the draft resolution, paragraph 3, after the words “as well as Roma,” insert the following word: “refugees,”.

      I call Mr Cederbratt to support Amendment 3.

      Mr CEDERBRATT (Sweden) – We want to ensure that refugees are recognised as a particularly vulnerable group. Their needs are different from those of migrants in general.

      THE PRESIDENT – Does anyone wish to speak against the amendment? That is not the case.

      What is the opinion of the committee?

      Sir Alan MEALE (United Kingdom) – The committee agreed unanimously.

      THE PRESIDENT – The vote is open.

      Amendment 3 is adopted.

      We will now proceed to vote on the whole of the draft resolution contained in Document 13225, as amended.

      The vote is open.

      The draft resolution in Document 13225, as amended, is adopted, with 38 votes for, 0 against and 0 abstentions.

      We will now proceed to vote on the whole of the draft recommendation contained in Document 13225. A two-thirds majority is required.

      The vote is open.

      The draft recommendation in Document 13225 is adopted, with 39 votes for, 0 against and 0 abstentions.

5. Next public business

      THE PRESIDENT – The Assembly will hold its next public sitting tomorrow morning at 10 a.m. with the agenda which was approved on Monday morning.

      The sitting is closed.

      (The sitting was closed at 6.45 p.m.)

CONTENTS

1. Changes in the membership of committees

2. Challenge to the credentials of the parliamentary delegation of Iceland

Presentation by Ms Vučković of report of the Committee on Rules of Procedure, Immunities and Institutional Affairs in Doc. 13246

Speakers: Ms Marjanović (Serbia), Ms Lundgren (Sweden), Baroness Wilcox (United Kingdom), Mr Kox (Netherlands), Mr Garðarson (Iceland)

Reply: Ms Vučković (Serbia)

Draft resolution in Doc. 13246 adopted

3. Putting an end to coerced sterilisations and castrations

Presentation by Ms Maury Pasquier of report of the Committee on Social Affairs, Health and Sustainable Development in Doc. 13215

Presentation by Ms Saïdi of opinion of the Committee on Equality and Non-Discrimination in Doc. 13252

Speakers: Ms Acketoft (Sweden), Ms Gerasimova (Russian Federation), Ms Andersen (Norway), Mr Ghiletchi (Republic of Moldova), Mr Schennach (Austria), Ms Virolainen (Finland), Ms Blanco (Spain), Mr Gunnarsson (Sweden), Mr R. Farina (Italy), Mr Lebeda (Czech Republic), Mr Recordon (Switzerland)

Replies:

Ms Maury Pasquier (Switzerland)

Sir Alan Meale (United Kingdom)

Draft resolution in Document 13215 adopted.

4. Equal access to health care

Presentation by Ms Maury Pasquier of report of the Committee on Social Affairs, Health and Sustainable Development in Doc. 13225

Presentation by Mr Cederbratt of opinion of the Committee on Migration, Refugees and Displaced Persons in Doc. 13249

Speakers: Earl of Dundee (United Kingdom), Ms Andersen (Norway), Ms Kyriakides (Cyprus), Ms Ohlsson (Sweden), Mr Hancock (United Kingdom), Ms Schou (Norway), Mr Skinnari (Finland), Mr Kayatürk (Turkey), Ms Bonet Perot (Andorra), Ms Maghradze (Georgia), Mr Ariev (Ukraine), Mr Popescu (Ukraine), Ms Borzova (Russian Federation), Ms Miladinović (Serbia), Mr Marias (Greece),

Replies: Ms Maury Pasquier (Switzerland), Sir Alan Meale (United Kingdom)

Amendments 1, 4, 5, 2 and 3 adopted

Draft resolution in Document 13225, as amended, adopted

Draft recommendation in Document 13225 adopted

5. Next public business

Appendix

Representatives or Substitutes who signed the Attendance Register in accordance with Rule 11.2 of the Rules of Procedure. The names of Substitutes who replaced absent Representatives are printed in small letters. The names of those who were absent or apologised for absence are followed by an asterisk

Pedro AGRAMUNT*

Arben AHMETAJ*

Miloš ALIGRUDIĆ

Jean-Charles ALLAVENA

Karin ANDERSEN

Lord Donald ANDERSON/Michael Connarty

Paride ANDREOLI

Khadija ARIB*

Volodymyr ARIEV

Francisco ASSIS*

Danielle AUROI*

Daniel BACQUELAINE*

Theodora BAKOYANNIS*

David BAKRADZE/Giorgi Kandelaki

Gérard BAPT*

Gerard BARCIA DUEDRA/Sílvia Eloïsa Bonet Perot

Doris BARNETT*

José Manuel BARREIRO*

Deniz BAYKAL

Marieluise BECK*

José María BENEYTO*

Levan BERDZENISHVILI

Deborah BERGAMINI*

Robert BIEDROŃ

Gülsün BİLGEHAN

Brian BINLEY/Sir Edward Leigh

Ľuboš BLAHA*

Delia BLANCO

Jean-Marie BOCKEL*

Eric BOCQUET*

Mladen BOJANIĆ

Olga BORZOVA

Mladen BOSIC*

António BRAGA

Anne BRASSEUR

Márton BRAUN*

Federico BRICOLO*

Ankie BROEKERS-KNOL*

Gerold BÜCHEL*

Patrizia BUGNANO*

André BUGNON*

Natalia BURYKINA*

Sylvia CANEL

Mevlüt ÇAVUŞOĞLU

Mikael CEDERBRATT

Otto CHALOUPKA

Irakli CHIKOVANI*

Vannino CHITI*

Tudor-Alexandru CHIUARIU*

Christopher CHOPE

Lise CHRISTOFFERSEN

Desislav CHUKOLOV*

Lolita ČIGĀNE*

Boriss CILEVIČS

Henryk CIOCH*

James CLAPPISON/Baroness Judith Wilcox

Deirdre CLUNE

Agustín CONDE*

Telmo CORREIA

Carlos COSTA NEVES

Katalin CSÖBÖR*

Joseph DEBONO GRECH*

Armand De DECKER/Ludo Sannen

Roel DESEYN*

Arcadio DÍAZ TEJERA

Peter van DIJK

Şaban DİŞLİ

Aleksandra DJUROVIĆ

Jim DOBBIN*

Karl DONABAUER*

Ioannis DRAGASAKIS

Damian DRĂGHICI*

Daphné DUMERY*

Alexander [The Earl of] DUNDEE

Josette DURRIEU*

Mikuláš DZURINDA*

Baroness Diana ECCLES*

Tülin ERKAL KARA*

Gianni FARINA*

Joseph FENECH ADAMI*

Cătălin Daniel FENECHIU*

Vyacheslav FETISOV*

Doris FIALA/Luc Recordon

Daniela FILIPIOVÁ/Miroslav Krejča

Axel E. FISCHER*

Jana FISCHEROVÁ*

Gvozden Srećko FLEGO*

Hans FRANKEN*

Jean-Claude FRÉCON

Béatrice FRESKO-ROLFO

Erich Georg FRITZ

Martin FRONC*

Sir Roger GALE*

Karl GARÐARSON

Tamás GAUDI NAGY

Nadezda GERASIMOVA

Valeriu GHILETCHI

Paolo GIARETTA*

Michael GLOS*

Pavol GOGA*

Jarosław GÓRCZYŃSKI/Iwona Guzowska

Alina Ştefania GORGHIU

Svetlana GORYACHEVA

Martin GRAF*

Sylvi GRAHAM/Ingjerd Schou

Andreas GROSS

Arlette GROSSKOST*

Dzhema GROZDANOVA*

Attila GRUBER*

Gergely GULYÁS*

Pelin GÜNDEŞ BAKIR

Antonio GUTIÉRREZ/ Carmen Quintanilla

Ana GUŢU*

Maria GUZENINA-RICHARDSON

Carina HÄGG/Jonas Gunnarsson

Sabir HAJIYEV

Andrzej HALICKI

Mike HANCOCK

Margus HANSON*

Davit HARUTYUNYAN*

Håkon HAUGLI/Tor Bremer

Norbert HAUPERT

Alfred HEER/Eric Voruz

Martin HENRIKSEN*

Andres HERKEL

Adam HOFMAN*

Jim HOOD*

Joachim HÖRSTER

Arpine HOVHANNISYAN*

Anette HÜBINGER*

Andrej HUNKO

Ali HUSEYNLI/Sahiba Gafarova

Rafael HUSEYNOV*

Shpëtim IDRIZI*

Vladimir ILIĆ/Vesna Marjanović

Florin IORDACHE/Viorel Riceard Badea

Igor IVANOVSKI*

Tadeusz IWIŃSKI

Denis JACQUAT*

Gediminas JAKAVONIS

Stella JANTUAN*

Tedo JAPARIDZE/Guguli Maghradze

Ramón JÁUREGUI*

Michael Aastrup JENSEN*

Mogens JENSEN

Jadranka JOKSIMOVIĆ*

Ögmundur JÓNASSON*

Čedomir JOVANOVIĆ*

Antti KAIKKONEN/Riitta Myller

Ferenc KALMÁR*

Božidar KALMETA/Ivan Račan

Mariusz KAMIŃSKI*

Marietta KARAMANLI/Jean-Pierre Michel

Ulrika KARLSSON/Kerstin Lundgren

Burhan KAYATÜRK

Jan KAŹMIERCZAK*

Serhii KIVALOV*

Bogdan KLICH/Marek Borowski

Serhiy KLYUEV/Volodymyr Pylypenko

Haluk KOÇ*

Igor KOLMAN

Attila KORODI

Alev KORUN*

Tiny KOX

Borjana KRIŠTO*

Dmitry KRYVITSKY*

Václav KUBATA*

Ertuğrul KÜRKÇÜ

Athina KYRIAKIDOU

Jean-Yves LE DÉAUT*

Igor LEBEDEV*

Harald LEIBRECHT*

Orinta LEIPUTĖ*

Christophe LÉONARD/Gérard Terrier

Terry LEYDEN

Inese LĪBIŅA-EGNERE

Lone LOKLINDT

François LONCLE*

Jean-Louis LORRAIN/Bernard Fournier

George LOUKAIDES/Stella Kyriakides

Younal LOUTFI*

Yuliya L'OVOCHKINA*

Saša MAGAZINOVIĆ*

Philippe MAHOUX*

Gennaro MALGIERI*

Pietro MARCENARO*

Thierry MARIANI/André Schneider

Epameinondas MARIAS

Milica MARKOVIĆ*

Meritxell MATEU PI

Pirkko MATTILA/Jouko Skinnari

Frano MATUŠIĆ*

Liliane MAURY PASQUIER

Michael McNAMARA*

Sir Alan MEALE

Ermira MEHMETI DEVAJA

Ivan MELNIKOV

Nursuna MEMECAN

José MENDES BOTA

Jean-Claude MIGNON/Frédéric Reiss

Djordje MILIĆEVIĆ/Stefana Miladinović

Federica MOGHERINI REBESANI/Renato Farina

Andrey MOLCHANOV*

Jerzy MONTAG*

Rubén MORENO PALANQUES*

Patrick MORIAU/Fatiha Saïdi

João Bosco MOTA AMARAL

Arkadiusz MULARCZYK*

Lydia MUTSCH/ Félix Braz

Lev MYRYMSKYI*

Philippe NACHBAR*

Oľga NACHTMANNOVÁ*

Marian NEACŞU/Florin Costin Pâslaru

Aleksandar NENKOV*

Pasquale NESSA

Fritz NEUGEBAUER*

Baroness Emma NICHOLSON*

Brynjar NÍELSSON*

Elena NIKOLAEVA*

Aleksandar NIKOLOSKI

Mirosława NYKIEL*

Judith OEHRI*

Carina OHLSSON

Joseph O'REILLY

Lesia OROBETS/Olena Kondratiuk

Sandra OSBORNE

José Ignacio PALACIOS

Liliana PALIHOVICI

Dimitrios PAPADIMOULIS

Eva PARERA*

Ganira PASHAYEVA*

Lajla PERNASKA*

Johannes PFLUG*

Danny PIETERS/Sabine Vermeulen

Foteini PIPILI*

Ivan POPESCU

Lisbeth Bech POULSEN

Marietta de POURBAIX-LUNDIN/Tina Acketoft

Cezar Florin PREDA

John PRESCOTT/Joe Benton

Jakob PRESEČNIK

Gabino PUCHE

Alexey PUSHKOV*

Mailis REPS

Eva RICHTROVÁ/Pavel Lebeda

Andrea RIGONI

François ROCHEBLOINE*

Maria de Belém ROSEIRA*

René ROUQUET

Marlene RUPPRECHT*

Ilir RUSMALI*

Pavlo RYABIKIN/Iryna Gerashchenko

Rovshan RZAYEV

Giacomo SANTINI*

Giuseppe SARO

Kimmo SASI

Deborah SCHEMBRI

Stefan SCHENNACH

Marina SCHUSTER*

Urs SCHWALLER/Elisabeth Schneider-Schneiter

Senad ŠEPIĆ*

Samad SEYIDOV*

Jim SHERIDAN

Oleksandr SHEVCHENKO/Oleh Pankevych

Boris SHPIGEL*

Arturas SKARDŽIUS*

Ladislav SKOPAL*

Leonid SLUTSKY

Serhiy SOBOLEV

Lorella STEFANELLI*

Yanaki STOILOV*

Christoph STRÄSSER*

Karin STRENZ*

Ionuţ-Marian STROE

Giacomo STUCCHI

Valeriy SUDARENKOV*

Björn von SYDOW

Petro SYMONENKO*

Vilmos SZABÓ*

Chiora TAKTAKISHVILI*

Vyacheslav TIMCHENKO*

Romana TOMC

Lord John E. TOMLINSON

Latchezar TOSHEV*

Mihai TUDOSE /Ana Birchall

Ahmet Kutalmiş TÜRKEŞ

Tuğrul TÜRKEŞ

Theodora TZAKRI

Tomáš ÚLEHLA*

Ilyas UMAKHANOV*

Giuseppe VALENTINO/Oreste Tofani

Miltiadis VARVITSIOTIS*

Volodymyr VECHERKO*

Mark VERHEIJEN*

Anne-Mari VIROLAINEN

Luigi VITALI*

Luca VOLONTÈ*

Vladimir VORONIN*

Tanja VRBAT*

Klaas de VRIES*

Nataša VUČKOVIĆ*

Zoran VUKČEVIĆ

Draginja VUKSANOVIĆ*

Piotr WACH

Johann WADEPHUL*

Robert WALTER*

Dame Angela WATKINSON*

Katrin WERNER

Karin S. WOLDSETH/Øyvind Vaksdal

Gisela WURM*

Karl ZELLER*

Barbara ŽGAJNER TAVŠ*

Svetlana ZHUROVA*

Emanuelis ZINGERIS

Guennady ZIUGANOV*

Naira ZOHRABYAN*

Levon ZOURABIAN

Vacant Seat, Cyprus*

ALSO PRESENT

Representatives and Substitutes not authorised to vote

Maria GIANNAKAKI

Spyridon TALIADOUROS

Konstantinos TRIANTAFYLLOS

Observers

___

Partners for Democracy

Mohammed AMEUR