AS (2016) CR 18



Second part)


Eighteenth sitting

Friday 22 April 2016 at 10 a.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.       The text of the amendments is available at the document centre and on the Assembly’s website. Only oral amendments or oral sub-amendments are reproduced in the report of debates

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

5.       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.

(Ms Mateu, Vice-President of the Assembly, took the Chair at 10.05 a.m.)

      The PRESIDENT* – The sitting is open.

1. Time limit on speeches

      The PRESIDENT* – On Monday morning, the Assembly decided to limit speaking time to three minutes. Given the number of people who have asked to speak in this morning’s debates, I propose that we increase the speaking time to four minutes. Does anyone object? That is not the case.

2. The handling of international public health emergencies

      The PRESIDENT – The first item of business this morning is the debate on the report, Document 14012, presented by Ms Sílvia Eloďsa Bonet on behalf of the Social Affairs Committee. I remind you that speaking time is limited to four minutes. We will aim to finish this item by about 11.00 a.m. I call Ms Bonet to present the report. You have 13 minutes in total, which you may divide between the presentation of the report and the reply to the debate.

      Ms BONET (Andorra)* – I am delighted that an Andorran Vice-President is chairing this debate.

      This report is much more wide ranging than you might think at first sight. We are going to discuss what international public health emergencies mean in a global context, not in a purely European one. In the past year, three such emergencies have had an impact on member States of the Council of Europe, as well as on the whole world. We have learned lessons from these public health emergencies and we now have a better idea of what we need to do. We had avian flu; we had the Ebola crisis; and we are now experiencing the Zika crisis. All three have had an impact on human rights, on the right to life and on the right to best possible health care in the best possible conditions.

      To confront this phenomenon efficiently, consistently and coherently, it is absolutely essential to take public policy measures to prevent these threats from arising in the first place. We need to raise awareness among the population and to upgrade our public health systems to protect all citizens, and the World Health Organisation (WHO) plays the key role. The WHO needs to support and empower other agencies and to introduce any measures necessary to ensure that all countries can update their public health systems to confront international public health emergencies. We need to show responsibility in providing the right answers at the right time. The WHO emergency committee that addresses these matters needs to act swiftly and decide how countries should confront international public health emergencies, and then the committee’s recommendations need to be carried out.

      Let us address these points one by one. First, what happened with avian flu? I am sure that you all remember that we had a big problem managing the avian flu vaccine. I am a nurse, and I have worked in a primary healthcare unit where we had a protocol on vaccine use. However, we were initially told to use just one dose. After two weeks, we were told that we needed to use two doses. After three or four more weeks, we were told that we needed to use three doses, and so on. There was no consistent protocol on how we should protect the population in that international public health emergency. That led to mistrust, even among healthcare professionals.

      Of course these emergencies are also addressed at the political level, and I did so as a health minister, when I dealt with vaccine stocks. All our countries follow the WHO’s recommendations. We ended up with stocks, but we did not quite know what to do with them. Unfortunately, a lot of the stock was not used and had to be destroyed, and then we had the Ebola crisis shortly thereafter.

      We faced incredible problems during the Ebola crisis. The WHO set up a committee of independent experts to draft a report on how to handle this extremely serious international public health crisis. In fact, its consequences are the most serious that we have witnessed in recent times. That report pointed out shortcomings in the WHO and failings in implementing international health regulations – IHRs. We need to improve how we manage these international public health emergencies. We need to step up to the plate and deal with any contagion. As professionals, we know that these diseases are pandemics; they do not stop at borders. They go on and on progressively, and they have no limits. Anyone can be affected. You must take the necessary measures to protect yourself. We are all legally obliged to follow the WHO’s instructions on IHRs.

      In 2011, a number of recommendations were issued on how to improve our handling of crises such as avian flu. If we had incorporated those recommendations, the Ebola crisis would have been much better handled and we would have been more prepared. Unfortunately, that did not happen. We did not have enough effective preventive measures in place. We pay lip service to how important health is, but when push comes to shove, what about the resources and the actions needed? We are not quite up to the mark, and health somehow gets relegated to second position. That is not acceptable.

      Making changes to our public health systems in a time of crisis is not good enough. The changes need to be brought in upstream, before emergencies arise. We need more investment, more infrastructure and better training for healthcare professionals. We need good epidemiological data to hand. We need early detection and warning systems, good diagnostic tools and medicines. Trying to implement all of that at a time of crisis is extremely difficult and complicated. In the past, international health regulations have not been properly implemented.

      The report draws on a number of recommendations made by a committee of experts in this field, and we think those recommendations are still very valid today. We need to revise the IHR. We need a better compilation of data. We need to shore up all measures advocated by the WHO on issues such as travel protection – how can people protect themselves when travelling to affected zones? There needs to be a consensus on how we handle travel as a whole. If we fail to do that, there will be political, economic and social consequences, particularly for at-risk and affected countries. We noticed that with Ebola and the prohibition on travelling to certain areas. Compulsory declarations to the WHO of international public health emergencies must be improved. With the Ebola crisis, there was unfortunately a delay in declaring outbreaks.

      The WHO needs to be strengthened, because it is, after all, the key actor when it comes to managing international public health emergency issues. It needs more funding in order to better manage these situations. We, as politicians, can make an important contribution to that. The WHO needs to be better prepared for and have a quicker response to emergencies. Of course, it must also have the human resources necessary to act effectively and efficiently on every occasion. We need to ensure the WHO can take decisions quickly. Resources, working methods and information all need to be shared and adapted to the realities of the countries concerned by these crises.

      Europe needs to step up to the plate and be more involved in the global management of health issues. We need to be far more active and do more through the relevant committees, in particular intergovernmental committees. That is a responsibility for our governments and for us as members of parliament. We need to follow all of this very closely and be far more active, so that when an emergency breaks out, we can be far more effective. There must be co-operation between the WHO, European Union member States, European Union organisations and non-governmental organisations. That is a sine qua non. Look at what happened with the Ebola crisis. The lack of co-ordination between different agencies gave rise to a great number of problems.

      The main message to emerge is this: we are aware there are difficulties, and we have improved a lot. Nevertheless, there are still issues that need to be dealt with. For instance, the Zika virus could affect Europe. We need to look to Brazil, which is on the frontline, and to the other Latin American countries affected. Without co-ordination, we might be promoting vaccines that will never be used, and some States might be doing one thing while others do another. We need co-ordination in order to work effectively. We need to generate trust and provide a lot more support to the World Health Organisation. We need to ensure that its recommendations are adopted by all member States in a co-ordinated fashion, based on consensus, without policy discrepancies between us.

      Before I conclude, let me thank the Secretariat for its important support in producing this report. I would like to extend thanks to the ministry of health and social affairs in Spain for the assistance given by the director responsible for international public health emergencies. I would like to thank the French Government and its ministry of health. We spoke to experts there who deal with international public health emergencies. Finally, I thank my own ministry, which provided technical support in drafting the report. Thank you so much for all your help.

      The PRESIDENT* – Thank you very much, Ms Bonet. You have slightly more than one minute left to respond to what speakers say during the discussion. I open the general debate, starting with Mr Jónasson.

      Mr JÓNASSON (Iceland, Spokesperson for the Group of the Unified European Left) – My group supports the report and its recommendations. I thank the rapporteur for her work and her initiative. In essence, the report says that global epidemics and health emergencies are, indeed, global and require a global approach as well as a national effort. I agree with the rapporteur that international health regulations should be strengthened and better implemented and monitored, while the World Health Organisation’s rapid response mechanism must be reinforced.

      Furthermore, the report says that any action must be community-centred, and it rightly emphasises that national health systems must be strengthened and open to all. In particular, paragraph 4.10 of the draft resolution says that it is important to “promote research and development of medicines, diagnostic kits and vaccines, in a spirit of solidarity, with adequate research ready to be tested during an epidemic, with a view to fast-track authorisation procedures and ensuring that any medicines or vaccines so developed are accessible and affordable, in particular to vulnerable groups, and keeping a reasonable stock following strict security conditions”. That calls attention to the powerful and often lucrative pharmaceutical industry, which, through patents and monopolies, is in a position to hold the world to ransom, particularly at times of global epidemics.

      Strong global defence mechanisms need to be developed, and authorisation procedures should be highly critical. Who wants to say “No” when pharmaceutical companies say that buying their product is a matter of life or death? I welcome the emphasis on solidarity and on making vaccines available to all. The pharmaceutical companies need to be held at bay in all countries, not least in the poorer parts of the world.

      Mr GHILETCHI (Republic of Moldova, Spokesperson for the Group of the European People’s Party) – I congratulate the rapporteur on this timely and necessary report. We support the draft resolution. Ms Bonet tackles the important issue of health emergencies such as H1N1, Ebola and Zika that seriously threaten public health. It is important to offer a response. Among the principles Ms Bonet proposes, I will underline several that I believe are important.

      Monitoring is important, including through the WHO. In a globalised world, we need to keep an eye on everything that goes on around us. That important principle is underlined in the report and the draft resolution.

      As Ms Bonet said, co-operation and co-ordination are important because they lead to solidarity. When we have good co-ordination, we have good solidarity. Without solidarity, we will be unable to face those tough challenges. We as a community, particularly in Europe, need to show solidarity.

      Another important aspect is transparency and data sharing. Two years ago, we discussed in this Assembly the difficult issue of vaccines and pandemics. Serious concerns were raised and there was a suspicion of a conspiracy among pharmaceutical companies. We need transparency in that regard because people can be left with the impression that something is going on behind the scenes that leads to shortcuts and vaccines that avoid all the procedures. Transparency is therefore extremely important and I am glad that it is mentioned in the report.

      Rehabilitation, and psychological and spiritual help, are important. It is not confirmed, but it looks like the sudden death of Prince, the American music legend, was linked to a flu virus. That once again tells us how important it is to tackle those issues. Our thoughts and prayers should be with his family and loved ones.

      My only reservation is the proposal to create new financial structures for pandemic risk management in paragraph 4.5. I am cautious because abuses are connected to such funds. When an emergency takes place, governments should and do act promptly. With that reservation, I support the report and congratulate Ms Bonet on it and the draft resolution.

      Ms RAWERT (Germany, Spokesperson for the Socialist Group)* – I thank Ms Bonet for her pioneering report, which is important for the better management of international health crises. The report attributes great importance to us all of public health systems. As a member of the Bundestag who is interested in health policies, I believe the report is extremely important.

      Health is a human right, and the Socialist Group supports Ms Bonet’s demands. The report does not just talk about management of acute services. Paragraph 4.12 says that, after a crisis, rehabilitation and psychological measures must be made available so that discrimination is prevented.

      Ms Bonet mentioned the Ebola and Zika epidemics. Those diseases do not have borders – they do not just stop in one country – so we are all affected. There is therefore a need for international action. We need a global plan to protect us from disaster, and the WHO has a crucial role in that. Learning lessons from previous outbreaks is an opportunity but also a duty. We need to make active plans so that, in future, the reaction time of the WHO can be stepped up and so that we can act more rapidly. We must therefore take steps to reform it. WHO must play a leading role because it is the only international institution that has such a wide and comprehensive membership. It has universal political legitimacy on health issues, and it has 150 country offices and the necessary structures to act in situ.

      As colleagues have said, it is important to have better co-operation and co-ordination between the WHO, the European Union and other organisations. All countries should respect WHO standards and the international health regulations it has developed. Those standards are good, but they need to be implemented. Member States have a great responsibility and it cannot be delegated to anyone else.

      Ms Bonet rightly said that the most severely affected States must be supported in managing epidemics. She was also right that we should be involved in financial structures. Countries in the global south need direct support. Germany spends €700 million annually on that. Secure, sustainable and durable financial support is essential.

      Before I finish, we should remember the many helpers in situ, particularly Médecins sans Frontičres.

      Ms PALLARÉS (Andorra, Spokesperson for the Alliance of Liberals and Democrats for Europe) – I thank the rapporteur for the report and the draft resolution. My colleague from Andorra has worked very hard in preparation for today, and the result is a good, informed report.

      As is well expressed in the report, in the past few years, we have had to face different devastating epidemics: H1N1 swine flu, Ebola and Zika in the recent past. In 2014, we were all terrified as we watched the news of Ebola killing people in West Africa and realised how difficult it was to tackle the disease. The lack of resources and efficient protocols that medical services had to face then underlines the importance of the report.

      The report clearly describes the global scope of the epidemics and how the mistakes of the past can help us improve international and national programmes. Prevention, early detection and a quick response are necessary. We should review relations between the WHO and all other specialised agencies such as the European Centre for Disease Prevention and Control and international non-governmental organisations. I stress that the Committee of Ministers must take quick action on the matter.

      Personally, I feel that the report is missing a direct reference to the impact of climate change on the outbreak of some of these diseases. We must consider the global scope of the problem and the need to implement new protocols and procedures so that we are prepared for any other outbreak of disease, wherever and whenever it happens. I emphasise the necessity of fulfilling the recommendations in paragraph 4 of the resolution to make “scientific knowledge and information available on time to all”, to put in place a financial structure capable of providing the necessary resources and to develop a partnership between the private and public sectors to improve information management systems, logistics and medical supplies.

      ALDE agrees that it is necessary to strengthen and improve the worldwide health system. We support the report.

      Mr WOOD (United Kingdom, Spokesperson for the European Conservatives Group) – The international response to public health emergencies must be swift, effective and co-ordinated. In the face of such emergencies, every day counts because every day that is lost means more lives lost.

      It is too early to assess the effectiveness of the response to the Zika virus, but evidence presented to the parliamentary inquiry into the international response to Ebola in 2014 found fundamental weaknesses in the WHO’s initial response. It was the largest Ebola virus outbreak in history, and it was first diagnosed in Sierra Leone in March 2014. Médecins Sans Frontičres raised serious alarm by June, yet the WHO did not declare a public health emergency until August. That meant that the international response was not fully mobilised until September, six full months after the first cases had been diagnosed. The delay was certainly fatal. Only the extraordinary work of many people risking their lives on the ground in West Africa meant that that fatal delay did not become catastrophic.

      The response also needs to be effective. Different countries offer many different things in responding to such emergencies, whether people and agencies on the ground, civil and military forces that can be deployed to help the support effort or a financial contribution. In responding in 2014, my country already had countless NGOs and agencies on the ground in West Africa, largely for historical and cultural reasons. It was also able to deploy more than 1 000 staff – armed forces and health service staff – and spend nearly €400 million in supporting the relief effort.

      The response must also be co-ordinated. It is always tempting for international organisations to set up their own structure, whether at European Union, Commonwealth or any other supra-national level. Such duplication wastes not just money, but resources that are desperately needed on the ground and prevents the response from being effective and quick enough to save enough lives.

      Notwithstanding the weaknesses that we have identified in the WHO’s response in 2014, I think that it is still best placed to fulfil that role. However, there needs to be a fundamental transformation in the WHO’s culture and practices before I could support the recommendations to transfer more powers and control to it.

      We need to work on how we support resilience and capacity building, particularly in developing and middle-income countries. Again, the United Kingdom has committed €270 million to help develop vaccines, drugs and diagnostics for some of the world’s deadliest diseases, and the rapid support team can be deployed at 48 hours’ notice. However, we also need to look at what more can be done in those countries. Cultural factors, for example, burial traditions, hampered some of the response and in some cases worsened the transmission of Ebola in 2014. We perhaps also need to ensure that those countries rely less on international aid funds and build up some of their own capacity and resources so that they can respond to such emergencies in future

      Mr NEGUTA (Republic of Moldova)* – My Socialist colleague, Ms Bonet, has done a very good job. The report gives a clear and precise analysis of the situation today. At the same time, it outlines an urgent action plan.

      Moldova has adopted a law that establishes rules about participation in international missions, including for health specialists. They must provide effective help to international missions, but at the same time, it is necessary to protect those who take part from the different diseases. I agree that the role of international health organisations is vital.

      The World Health Organisation is represented in the Republic of Moldova, but it has to deal with other problems. It is currently incapable of acting. It cannot introduce international health regulations. What are the difficulties? First, they are financial. A great deal of money is needed to deal with such emergencies. The United Nations, its countries and their citizens paid 0.7% of their GDP to several States including Moldova. Today, that is not possible.

      Secondly, let us consider reform of the WHO. Its main function is being the co-ordinator of global health emergencies. I agree with the report that the management of emergencies does not wait. It is a challenge to the international community.

      Ms BULIGA (Republic of Moldova)* – I thank Ms Bonet for a very full report, which gives us so many examples. We are living in a world full of challenges, crises, armed conflicts and biological risks, and it is our duty to build societies that are stronger and better equipped to minimise the impact of the threats facing humanity. That is our duty as parliamentarians and we have the tools necessary to strengthen our health systems through a policy of prevention and to deal with epidemics through the effective use of resources for public health and by strengthening the architecture of our national, European and international health systems.

      We have seen several times how porous our frontiers are and how quickly some diseases spread. I take this opportunity to thank the World Health Organization for its ongoing support to Moldova to help us consolidate our national health system. Our government has a central hub which receives information from the national system for monitoring and reporting and from customs posts, as well as from official and unofficial international sources, and then disseminates the information in aggregated form to our health networks. We have worked very hard but, even so, we have not been able to avoid some loss of life.

      We decided that we would highlight health as one of the priorities for our government. At this stage we know what the threats facing us are, and we can share the possibility of using preventive methods with other countries. Therefore, it is important that our communications technology is improved along with our working methods. We need to be able to respond quickly, so we need to be able to co-operate at all levels.

      It is now an obligation on all countries to carry out preventive measures and to ensure that any medical efforts do not come up against either local or international barriers to their work. If we are to succeed in this, co-operation between European institutions and agencies, the United Nations and national governments is a primary necessity.

      Mr HOWELL (United Kingdom) – I, too, thank the rapporteur for producing this report and for the debate that is now taking place. The report makes some excellent points and I agree with her about the importance of this issue for us all. Public health affects us all in our own countries and as citizens of the world. The report mentions the speed with which modern public health outbreaks spread and the preparedness of the world to handle such emergencies. Speed is a crucial issue in this but the preparedness of the world to handle emergencies is also a major factor to be borne in mind.

      I recognise that the Ebola crisis was a major crisis and my sympathy goes to the families of the people who died. I will say a few words about that in a moment. But actually, if we look at the way in which the Ebola crisis took place, it was contained within a restricted area of the world, in West Africa; it was, eventually, the subject of much co-ordination; and there was, in the end, a successful outcome. We should keep those things in mind.

      The rapporteur also places a great deal of emphasis on the WHO. The WHO has come in for much criticism – much of it well founded – from, among others, the former chief executive of Oxfam, Barbara Stocking. She pointed out two things that were wrong with the WHO: first, it does not have a robust emergency operation capacity; and, secondly, it does not have the culture to be able to deal with emergencies. By that she did not mean the culture we have been talking about of how individual countries cope with these things but the corporate culture of the WHO. She pointed out that the WHO did not seek support from other United Nations agencies when it could have done. If it had asked for that support, it could have averted what became a substantial crisis. The ability to carry out robust emergency operations is a function of resources. I encourage all governments to look at how the WHO is resourced. But the issue of culture is far more serious and something that only the WHO can deal with. Early warnings were not picked up. There was a huge failure in its communications department, which caused enormous despair with the message of hopelessness that came out on the Ebola crisis, and it failed to take into account the effect this had on local economies.

      In the United Kingdom we have a prosperity fund for Africa. As the United Kingdom Prime Minister’s trade envoy to Nigeria, I am used to seeing that being disbursed. It will encourage countries to become prosperous in their own right, which will give them the capability to stand up against these diseases and to work with the WHO, if it can change its culture, in a far more fundamental way.

      Mr OLIVER (Observer, Canada) – It is an honour to be here today as an Observer from Canada for this discussion on handling international public health emergencies. I thank the rapporteur for introducing this issue and presenting the report and draft resolution.

      The matter of public health emergencies is one of global concern that requires a concerted and co-operative global approach. We know that all regions, regardless of population or economic status, must collaborate to effectively and efficiently design and implement protocols for such emergencies. In the recent past, multiple geographical locations have simultaneously faced public health threats: severe acute respiratory syndrome – SARS – in North America in 2003; H1N1 influenza in 2009; more recently, the Ebola virus disease in 2014; and now the Zika virus disease has emerged as a public health issue.

      A serious public health emergency such as Ebola quickly overwhelms the health systems of under-resourced and impoverished regions. Therefore, all nations must be prepared, not only to have adequate training and preparation at home should a disease be detected domestically but to provide assistance abroad. The Public Health Agency of Canada was created in 2006 following the SARS outbreak. It is responsible for public health emergency planning and response, and our response to public health issues has improved dramatically with its creation. Recently, Canada’s international contributions during the Ebola outbreak included financial, technical and human resources. Specifically, Canada sent rapid diagnostic support in mobile labs to Sierra Leone and developed an experimental vaccine against the Ebola virus. Ebola virus disease rapid response teams were established to respond domestically if necessary; fortunately, they were not required to be deployed.

      It is important to acknowledge that the plans put in place by the WHO and governments for co-ordinated responses to public health emergencies should rely also on the contributions of private sector players. Private companies supply and manage the distribution of pharmaceuticals, vaccines, medical devices and mobile technologies that are essential to an effective response. For example, I have been made aware of the advances at the Fio Corporation, where innovative mobile health technology can help connect health professionals and on-site diagnostics in remote locations to larger health centres.

      I am pleased to be part of this debate and to discuss the options for further strengthening the world’s response to such threats. Alongside the rapporteur, I encourage the World Health Organization to provide ongoing and strengthened leadership in this area. Thank you for this opportunity to address the Assembly.

      Ms GÜNAY (Turkey)* – I start by thanking Ms Bonet, the rapporteur, for this comprehensive report. I hope that, as the Parliamentary Assembly of the Council of Europe, we will attract the attention of the international community and secure some collective wisdom on this subject.

      The world becomes more global every day, advanced technology has led to more interaction between people, and people are more mobile than ever before. Individuals and goods can reach remote parts of the world in a matter of hours. That is a good thing in many ways, but it could be considered not to be so as far as public health is concerned because human and animal borne diseases can spread. Swine flu, Ebola, SARS, the Zika virus and mad cow disease have been significant issues; although they were eventually brought under control, we should be careful to ensure that they do not recur. All States must take the necessary measures, as the report says.

      War is another reason behind pandemics and epidemics; when it breaks out, public order disappears and infrastructure is damaged. All of that is conducive to disease, as we have seen in the war in Syria. Turkey plays host to nearly 3 million Syrian citizens and we are trying our best to provide them with health services – not only emergency health services, but the health services that Turkish citizens enjoy, provided that the Syrian citizens register in Turkey. We also place special importance on the health of children. Nearly 152 000 babies have been born in our country over the period, and they have been vaccinated against polio, measles and other diseases.

      The Turkish Red Crescent continues to provide health services to Syrians in Syria. Unfortunately, polio, which we thought had been eradicated in Syria in 1999, has re-emerged. The Turkish Red Crescent is providing polio and other vaccines to doctors and health care professionals in the north of Syria. I remind colleagues that all States must work together to prevent the human tragedy in Syria so that we can provide a healthy future for Syrian children.

      Mr Don DAVIES (Observer, Canada) – I congratulate the rapporteur on her excellent report. As politicians, we well know that health is one of the most important values to our fellow citizens. It is a foundational concern – one of the very bases on which we are able to pursue our personal, social, economic and cultural goals. If we are not healthy, our ability to participate meaningfully in society is compromised.

      However, in our globalised world, the health of our citizens is no longer just a national matter; indeed, it has never been more inter-dependent. As the rapporteur said, viruses, pandemics and disease know no borders, and our collective health depends on our ability to work closely and collaboratively. It is therefore our obligation not only to build the strongest possible domestic health care systems, but to increase our ability to co-operate to solve international health issues. I would like to highlight three such challenges that require our focused attention: the Zika virus, anti-microbial resistance and treatable illnesses affecting the global south.

      First, the Zika virus is known to be spread by certain strains of mosquito and by sexual and blood-borne contact. It is now confirmed to cause microcephaly in certain children born to infected mothers. This is particularly worrisome because very often the infected mother is asymptomatic and unaware of the infection which can cause such devastating harm to her foetus and infant child. Brazil has been especially hard hit, and with the summer Olympics occurring in a few months, there is a great risk of this virus being spread on a large scale and to many other countries. Already, cases have been confirmed in the United States and Canada, and it is only a matter of time before European countries and nations in all corners of the world are affected. Although Canadian and other labs around the world are hard at work, the latest prognosis is that we are many months away from developing an effective vaccine.

      Secondly, we are facing a pending global health emergency with respect to anti-microbial resistance. Medical personnel and researchers the world over are reporting dangerous resistance to many life-saving antibiotics. The causes of this are varied, but chiefly arise from excessive use of antibiotics in livestock and over-prescription to humans. If we do not get in front of this crisis, we risk losing millions of people to infectious disease that is currently easily treated.

      Finally, there is the persistence of treatable diseases primarily in the global south, including tuberculosis, malaria and HIV. These have persisted for far too long, and raise important questions of international equity and the availability of affordable medicines for everyone.

      All three examples point to the critical need to create international health systems and broader policies that will enable us to share information and work together to find effective treatments. Our economic and trade policies must take into account their impacts on global health, as intellectual property rules, agriculture practices and scientific pursuits will all affect the spread of illness and our ability to ensure that every nation can deal with them. We have an obligation to support properly all international health agencies, starting with the World Health Organization. I call on all of us in this Assembly to take these messages back to our domestic governments to ensure that our international bodies have the proper financial and political support that they need. Our collective health depends on it.

      The PRESIDENT* – Thank you, Mr Davies. That brings our list of speakers to an end. Would anyone else like to make a contribution for one minute? I call Ms Quintanilla.

      Ms QUINTANILLA (Spain)* – I join the chorus of congratulation for Ms Bonet, the rapporteur, who has presented us with a magnificent report that addresses epidemics that emerge in a globalised world where people travel from one country to another. Travel has many advantages, but there is a drawback: a virus can infect millions of individuals and transfer from one country to the next much more easily than in the past.

The report is extremely important in discussing the vital role played by international organisations such as the World Health Organization, which need to play a strong role when faced with epidemics. In Spain, we had experience of Ebola; two of our missionaries were infected, but we had the major advantage of being able to save them and others from the virus thanks to our specialised centre. We also have specialised centres internationally and great professionals at work. Thanks to them, we saved people such as a nurse who had also been infected by Ebola. We are also fortunate because we can work with the WHO. We have the European Centre for Disease Prevention and Control, with which we work, as well as the member States of the European Union. That is a great advantage. We also have the expert panel on health. We work together with many others to combat this international epidemic.

      Like I said, the epidemic affected many countries – not just African countries but the entire world. Ms Bonet, with your draft resolution you aim to enhance co-operation between member States of the Council of Europe as well as around the world. The WHO must be there to help us face those great threats and risks, which, unfortunately, affect us all in this globalised world. Congratulations, Ms Bonet. I will gladly support your report.

      The PRESIDENT* – Thank you, Ms Quintanilla. I call Ms Bonet: you have one minute and 20 seconds to reply.

      Ms BONET (Andorra)* – I thank all colleagues who contributed to the debate for their input. We have shown that we stand united. We agree that it is important for us to work on public health and that we must enhance the WHO’s role when it comes to international public health emergencies, which is so important, and it is also important to ensure that we rectify aspects that have posed problems in the past. We must ensure co-ordination between our actions.

      We have mentioned research and vaccines and I wholeheartedly agree that vaccines are of fundamental importance, but we cannot just focus on that or on developing vaccines in full crisis mode. We need to be more effective than that, because it is very difficult to operate in a crisis situation. There are also doubts about the vaccine that might be developed in a time of crisis – will it prove effective in countering epidemics?

      I refer to the WHO’s budget, which does not have a particular section earmarked for dealing with international public health emergencies, but I think we could respond more quickly if we had such a budget. That would allow for a better, faster response.

      Of course climate change is leading to changes, with mutations in certain diseases, viruses and so on. Migratory crises can also give rise to the emergence of certain diseases that we thought were pretty much relegated to the past. However, that is happening and that will cause problems. Our health systems will have to face up to that new reality. I could say a lot more, but unfortunately I do not have more time. Thank you once again for all your support.

      The PRESIDENT* – Thank you, Ms Bonet.

      The debate is closed.

      The Social Affairs Committee has presented a draft resolution, to which no amendments have been tabled.

      We will now proceed to vote on the whole of the draft resolution contained in Document 14012. A simple majority is required.

      The vote is open.

      The draft resolution in Document 14012 is adopted, with 36 votes for, 0 against and 1 abstention.

3. Forced migration: a new challenge

      The PRESIDENT* – The next item of business this morning is the debate on the report entitled “Forced migration: a new challenge”, Document 13983, presented by Mr Bies on behalf of the Migration Committee.

      We will aim to finish this item by about 12 noon. I remind you that speaking time is limited to four minutes.

      I call Mr Bies to present the report. You have 13 minutes in total, which you may divide between presentation of the report and reply to the debate. Mr Bies, you have the floor.

      Mr BIES (France)* – Our committee is looking at the present situation, particularly in the Mediterranean, and the consequences of the Syrian conflict. That is quite natural. I thought it would be a very good idea to deal with a subject that may be a less timely topic but is quite important: forced migration, particularly linked to climate change, which was mentioned in the framework of a previous report. This issue is not considered often by politicians or international organisations such as NGOs.

      I would like to say something about the title, “Forced migration: a new challenge”. Anyone who is not migrating for personal reasons could be considered a forced migrant and that is something that I would like to come back to later. Perhaps the title could lead one astray, because while it talks about a new challenge, forced migration is not new. Migration because of natural or man-made catastrophes such as wars, which we see currently, has marked the history of our continent and even that of humanity for centuries. However, what is new is the scale of the phenomenon, which needs concerted action from member States.

      The fact is, as things stand at present, we could downplay the negative effects of all the environmental factors such as nuclear accidents, drought, the use of pesticides and the acidification and damage to our seas and forests. We can see the catastrophic results of those and that forced migration is linked to environmental factors. There is also the serious situation of the Syrian refugees, which we must devote attention to. We must not neglect the situation because some experts feel that those factors could affect as many as 150 million to 200 million people by 2050. We therefore really need to look ahead and try to prevent such things from happening. We could try to pre-empt phenomena like the First World War better than we have done in the past.

      So far, no international legal instrument provides protection for people who are forced to move for reasons other than those that are political or security-related. There is a debate to be had on that at the international level. We do not yet agree on the terminology to be used for the definition of victims of forced migration. The International Organization for Migration tried in 2007 to define those forced to migrate for climatic reasons, which I can come back to, which gave rise to a debate, but it is not the subject of unanimous agreement.

      Today, the environmental factors are not discriminatory, so they cannot be defined as persecution. Therefore, people who are victims of those factors cannot claim to be refugees in the legal sense of the term. Article 1 (A) of the Geneva convention does not provide for protection.

      Some countries, such as Sweden and Finland, have good practices and provide protection on so-called environmental displacements. The actions carried out by Norway and Sweden, aimed at protecting people following natural, chemical or nuclear disasters, might make it possible for us to make headway on this question.

      This is a quick outline of the situation today. The World Bank has drawn up a list of countries threatened by worsening climatic conditions – Bangladesh makes frequent appearances on such lists, but other countries are under threat – and such phenomena lead to population displacement, often on an intra-continental level. We need to be able to respond and think about our future recommendations and decisions, as I point out in the report. I highlight the need for better identification than the World Bank has achieved of the populations and regions that are at risk, and the need to protect them better by drafting policies and standards for protection of the victims of natural catastrophes, nuclear or chemical accidents or other disasters linked to extreme climate change. I also suggest a revision of the international codification by the introduction of the status of climate migrant to force international recognition of this phenomenon.

      The fundamental rights of the victims must obviously be defended at all levels. The suggestion in the report is that we revise the 1951 Geneva Convention on refugee status by adding an additional protocol, although I recognise that from where we are starting that would be very complicated to implement. The causes of forced migration need to be looked at by setting up international standards that would ban any over-exploitation of natural resources. By happy chance, today in New York the signatories will sign the COP21 agreement which has at least started to deal with these questions of forced migration for environmental reasons. We also need to set up strategies for integrating persons displaced for environmental reasons into the State that has received them if they cannot return to their homes.        Measures should also be taken to promote the resettlement of populations, especially when their land has disappeared for whatever catastrophic reason. We also need to look at the future of environmental migration and reduce the risks linked to it.

      I thank all of those who have helped to prepare the report and conclude by recommending that the Migration Committee and the Parliamentary Assembly continue to follow this issue which will become more urgent and pressing in the future, which is approaching rapidly. We should work more closely with the United Nations so that we can make headway on the status of climate refugee.

      Mr SCHNEIDER (France, Spokesperson on behalf of the Group of the European People’s Party)* – I congratulate the rapporteur on the high quality of his work on this report. In a report entitled “The Impact of Climate Change on Security and Defence”, which I presented in the French National Assembly in February 2012, I stated that environmental migrations are significant for defence and security. The effects of climate change will lead first to internal migration and then to cross-border migration.

      Internal migrations are a particularly thorny problem for countries that are already fragile. In fact, the capacity of States to deal with such situations, both institutionally and economically, will be the determining factor for their own stability. For example, in Egypt, a 50 cm rise in the level of the Mediterranean would provoke an exodus of 4 million people fleeing the Nile delta for higher regions. In Africa, women would be affected by climate change first and foremost because they are the mainstay of agriculture. I know Africa well and it is aware of these risks. The Kampala Convention of the African Union was the first binding international treaty to deal with such issues and it requires States to accept refugees fleeing a natural disaster. Given that, developed countries have a serious responsibility to combat climate change and help the countries likely to be most affected.

      One of the risks is that there might be no possibility of return. In fact, rising water levels mean that some countries may disappear. The President of Tuvalu asked a pertinent question in that respect – “If your nation disappears, what is your nationality?” The changing situation requires that we work to find an appropriate legal response to this new migration pattern. The subsidiary protection offered by the Scandinavian countries to individuals who can never go home provides specific aid to such people. I do not know whether there is any other solution.

      The establishment of a status of climate refugee could be the right response but it does not suit all cases. If a migrant leaves their country because the temperature has risen and it is no longer possible to farm and feed their family, are they an economic migrant or a climate refugee? Many countries – including those in Europe – will be affected by climate change, even if they do not actually disappear. The proposal from the European Parliament for the status of climate refugee is interesting, but I fear it will take many years to finalise. The most important lesson we learn from history is that people learn very little from the lessons of history. Marshal Foch said, “If an individual is deprived of memory, they are deprived of life.” If a nation has no memory, it has no future. It is time that we took on board the challenges thrown down by our tomorrow. We do not want hindsight: we want foresight.

      The status of climate refugee could be applied to men and women from fragile countries to help those countries face up to climate change. According to the United Nations, by 2020 there will be millions of environmental migrants. What we are seeing today is nothing compared to what we will see in the future. We must be prepared. Let us be less selfish and show more solidarity. The light of hope today is the fact that COP21 has been signed by 170 States. I call on colleagues to fully support the report.

      Mr PARVIAINEN (Finland, Spokesperson for the Socialist Group) – This is an important report and I thank the rapporteur for writing it. It looks beyond the current refugee crisis, and that is important. Larger questions are on the horizon. The Intergovernmental Panel on Climate Change (IPCC) noted in its 2014 report that the effect of climate change and conflict has the potential to become a key risk. In 2009, the United Nations Refugee Agency said that international co-operation against climate change is not only expedient, but a human rights obligations.

      Our actions now gravely threaten human rights globally in coming decades. Even if we manage to mitigate climate change, millions of people will be directly affected. In many poor areas, living conditions will deteriorate further and lead to forced migration. Already, many crises around the world have potential connections to climate change. Problems such as droughts and poverty clearly increase the risk of conflict.

      The United Nations Refugee Agency estimates that the number of environmental migrants will reach 150 million in the coming decades. Of course, climate change is not our only concern. We also need the capacity to react to other potential problems and disasters. Our legislation on asylum is typically based on protecting people from persecution or fear of death. Forced migration is a different issue. No form of persecution is involved, yet people’s living environment may have become simply impossible. Forcing people to live in such conditions poses a serious threat to their human rights. People with wealth often have the opportunity to emigrate, but the vast majority of people lack that option. The largest environmental risks and migratory pressures tend to concentrate in fragile States that do not have the capacity to respond. That is where the international community should step in.

      The current international standards concerning environmental displacements are not adequate. Many countries are responding to the current crisis by tightening migration laws even further. In the report, Finland – my home country – is mentioned as a positive example because it provides temporary protection on humanitarian and environmental grounds. Sadly, our parliament abolished that clause last week. I voted in favour of keeping humanitarian protection in our legislation and I am ashamed by the decision that was made. The Finnish Government wishes to harmonise legislation with other European Union countries. When it comes to migration laws, it seems that European States are engaged in a race to the bottom.

      If the current crisis has taught us anything, it is that we must have the capacity to act in the face of unexpected disasters and situations. The Council of Europe should encourage its member States to acknowledge the reality, find common solutions, take forced migration into account, update legislation accordingly and, of course, approve the report.

      Ms ZOTEA (Republic of Moldova, the Alliance of Liberals and Democrats for Europe)* – We support the report because the whole of Europe is affected by the current crisis. The United Nations High Commissioner for Refugees (UNHCR) estimates that there may be 50 million refugees because people are escaping conflict, or because of nuclear, chemical or natural catastrophes. The International Organization for Migration says that there may well be forced migration because of climate change. The flow of migrants might increase to 150 million, or even 200 million, by the year 2050 because of climate change. It is essential to take emergency measures and find a relevant solution to end the alarming rise in the need for migration.

      We need to introduce the measures suggested by the UNHCR and update the 1951 Convention relating to the Status of Refugees to provide protection for those who are fleeing natural catastrophes as well as chemical or nuclear disasters. We must have reasonable and sustainable use of natural resources. We should implement strategies for successful immigration for people fleeing their countries for various reasons. We must introduce protective, united provisions to prevent such catastrophes from occurring, and take proper measures for the legal protection of people fleeing such disasters.

      Ms USTA (Turkey, Spokesperson for the European Conservatives Group)* – The mass migration to European countries caused by the human drama in Syria has put the concept of refugees and migrants on the world agenda again. According to data from the UNHCR, in the past few years, 50 million people were displaced due to armed clashes, oppression, violence, and chemical and nuclear disasters. Refugee law was regulated by the 1951 Geneva convention, which contains the principles and procedures for people fleeing oppression.

      In the report, the rapporteur underlined forced migration in great detail, and indicated that we must take into consideration that there will be new examples of forced migration in the future. The report notes that there is no international agreement on how to help the victims of migration, and no unity of opinion.

      We must find an urgent solution to the people fleeing Syria due to the war and oppression, and we must consider the word “refugee” again. An agreement has been signed between Turkey and the European Union as a remedy to, or an action plan for, the problem. There are three principles to be taken into consideration: the prevention of human deaths in the Aegean Sea; the prevention of human trafficking; and making irregular migration regular. In October 2015, 6 800 irregular migrants a day crossed the Aegean Sea. We definitely need a humanitarian solution to the problem, and that should be a primary point on the agenda of the Parliamentary Assembly of the Council of Europe.

      As of today, with the Turkey-European Union agreement, Europe is more at ease. That is an important development and I hear a new discourse in European quarters. We should not be afraid of the agreement between the European Union and Turkey, and we must support Turkey, which is making a lot of sacrifices to remedy the situation. I do not mean material support, but trust and confidence in Turkey. What Turkey has done for migrants, it has done for refugees because we consider it a humanitarian duty. We must provide an environment for those people to live in human dignity. They are our guests and we have provided them with temporary protection. We have recently adopted new legislation to remedy the problems of the refugees. Obviously, there may be certain gaps in legislation. The report indicates that that is true of the framework of the 1951 Geneva convention, which needs to be updated. I thank the rapporteur and everybody who contributed to the report with all my heart.

      Mr JÓNASSON (Iceland, the Group of the Unified European Left) – We welcome the report. I thank the rapporteur for the initiative and the thought-provoking information provided. All the recommendations are to be commended. The crux of the matter is that, despite the alarming statistics on forced migration due to climate change and other conditions that make migration inevitable, international conventions governing migration only cover political, security-related situations. There is no agreement on a comprehensive definition of forced migration. The report identifies this and explores possible remedies.

      The report refers to international studies which indicate that the biggest single impact of climate change in the coming years could be the movement of people. It is estimated that the flow of environmental migrants could reach 150 million people by 2050, or even 200 million. We do not know what will happen, but these estimates are alarming.

      I come from Iceland, where we would welcome a little warming, but this could boomerang. If the Greenland ice melts, that would cool the sea around us. Even more important is what impact climate change might have on the Gulf stream, which brings warmth from the Gulf of Mexico to make Iceland and north-western Europe at all habitable.

      This is all interconnected. The international community must be on its toes. In particular, it must look to the poorest parts of the world where the biggest vulnerable groups are to be found. I commend the emphasis the report places on this issue. I reiterate our thanks and our support for the recommendations to make provisions to protect vulnerable groups in the world.

      Mr ÖNAL (Turkey)* – As soon as the Syrian crisis occurred, we immediately began to discuss how to deal with the huge migration problem. It was discussed in the international arena, too. Public opinion in European countries has focused on the economic reasons for migration, but the economic reasons are not important here. We should not forget that people are having to migrate due to real and serious difficulties.

      Concepts and definitions of migrants and migrations were determined in the 1950s, when the impact of the Second World War was still being felt. Now, they have to be reviewed. Recent developments have led to an increase in the number of people who need to migrate, changing humanitarian and legal paradigms. The report refers to the regulations contained in the 1951 Geneva Convention. In this new environment, migration will not just happen for political reasons; people will need protection from natural, chemical and nuclear disasters too. The Geneva Convention will therefore need to be taken up, looked at again and updated. The most important and pressing topic before us, however, is whether we are able to apply fully existing migration legislation.

      We have discussed this issue in the General Assembly today. The answer to the migration crisis given by European countries is not sufficient. Some European countries do not want to share the burden of international migration. Since the beginning of the Syrian crisis, Turkey has more than fulfilled its duties. Right now we are hosting 2.7 million Syrians as our guests. We have met the cost of this, amounting to $10 billion.

      Regardless of the reasons for migration, we must emphasise again the need to provide protection for the victims of forced migration. I thank the rapporteur for producing this very important report, which contains some suggestions on how to deal with this problem.

      Ms MIKKO (Estonia) – At a time when Europe is still figuring out ways to deal with the current flow of refugees who have fled their homes because of war and instability, it might seem strange to start talking about migration-related problems and threats that do not yet prevail. In reality, the subject of environmental migration - and the report - is more timely than ever.

      While it is true that countries such as India or Bangladesh are in much greater danger from natural disaster or food insecurity than, for example, my home country of Estonia, which has an abundance of clean water and forests, it is important to realise that the global village we live in is highly interconnected. Events that take place in geographically distant locations affect us all. There is a saying that one should never waste a good crisis. While I refuse to use it to describe the circumstances that have caused as much suffering and loss of life as the current migration crisis, there is a point to be made about the lessons that Europe needs to learn from it.

      European countries, much less Europe as a whole, were not ready to deal with migration flows of this magnitude. Given just how multidimensional and dynamic the modern world is, it is evident that it is impossible to predict specific future problems and work out detailed solutions for challenges that have not yet emerged. What we have to do our very best to think through possible threat scenarios, and investigate and plan possible measures to deal with them. This is the main reason why I really appreciate this report and its contribution to the better understanding of the nature of forced migration. The report makes an important distinction between climate processes and climate events. It highlights that while the world is interconnected, there are hardly any workable one-size-fits-all solutions. Every country and region therefore needs to be assessed separately.

      I agree with the premise that the 1951 Geneva Convention provides the basis of our action when it comes to dealing with migration, but an additional protocol would be helpful. In my mind, it should outline our commitment to not only receive people who have been given refugee status, but do more to help them better integrate into our societies.

      Dear colleagues, to tackle the problems of the future, whether they are migration-related or not, will need the ability to put problems into context, evaluate threats and act confidently on chosen strategies. Most importantly, we need to show a reinforced commitment to upholding human rights and the principle of equal treatment. Political agreement on how to solve a major problem will not be enough. Workable solutions need to involve the whole of society. As parliamentarians, it is our responsibility to make sure we leave a better world for future generations. We must also inspire them to cherish the values we share and carry on our belief that, first and foremost, it is our values that bind Europe together.

      Ms DOBEŠOVÁ (Czech Republic) – I would like to thank the rapporteur for presenting this report, which deals with the biggest task of our times. According to some estimates, about 50 million people have been displaced worldwide in recent years owing to conflicts, persecution and violence or as a result of natural disasters. Some experts forecast that the flow of environmental migrants could reach about 150 million in 2050 – an alarming statistic.

      One of the recommendations proposed by the rapporteur is a review of the relevant international rules with a view to including a definition for forced migrants owing to natural, chemical or nuclear disasters and a revision of the 1951 Geneva Convention relating to the Status of Refugees. In addition, it is recommended that Council of Europe member States give greater priority to devising policies to protect the victims of natural, chemical or nuclear disasters and to acknowledge their vulnerability and ensure that their fundamental rights are fully observed, while adopting measures to curb the over-exploitation of natural resources.

      I do not agree with these recommendations. At present, Europe is facing the great challenge of managing the current migration crisis. If we started to review the relevant international rules, we could expect another wave of migration – this time, migration owing to natural disasters. How could we manage that when we in Europe are unable to solve today’s influx of war refugees? In my opinion, any review of the Geneva Convention could be very dangerous and have unintended consequences. There are even different opinions on how to deal with this problem in the United Nations between the North and South. I therefore cannot vote in favour of this resolution.

      The PRESIDENT* – I do not see Mr Kürkçü, so I call Mr Wells.

      Mr WELLS (Observer, Canada) – I thank the Assembly for this opportunity to participate in the debate on forced migration. I also thank the rapporteur, Mr Philippe Bies, for his report on this important matter.

      The rapporteur refers to the estimate from the Office of the United Nations High Commissioner for Refugees that about 50 million people are displaced worldwide, which is an all-time high. Talking specifically about environmental migrants, the rapporteur cites figures three times greater, thus suggesting that 150 million to 200 million people will be displaced by changes in their natural environment by 2050. However, it is often difficult to distinguish between refugees, as defined under the 1951 United Nations Convention relating to the Status of Refugees, and other people in need of protection.

      Migration is motivated by various causes. Indeed, evidence suggests that environmental degradation is already a contributory factor in the world’s refugee-producing conflicts. Furthermore, disasters and slow-onset natural hazards are causing displacement, generally internally, but also across international boundaries.

      The draft resolution proposes that the 1951 Refugee Convention be revised, with a view to improving protections for those displaced for environmental reasons. In considering this proposition, I want to echo the UNHCR’s concern that enlarging the refugee regime to include environmentally displaced people should not jeopardise protection for the persecuted. In truth, the global community struggles to respond adequately to those already covered by the convention, as was evidenced by the recent summit on Syrian refugees, which fell short of the commitments sought by the United Nations High Commissioner for Refugees.

      Let me speak about how Canada has used immigration policy to respond to climate events or natural disasters in the past. For example, after the January 2010 earthquake in Haiti, which killed more than 300 000 people and devastated infrastructure in the Port-au-Prince region, the then government announced a series of special protection measures, including granting both temporary and permanent residence for people directly and significantly affected by the earthquake. Under those special measures, family sponsorships were accelerated, temporary visas were issued and extended, and international adoptions were facilitated through Operation Stork.

      Such ad hoc temporary measures in response to natural disasters might not be sufficient, and greater priority might need to be given to devising protection policies and norms for the victims of natural disasters, so that there is a more systematic approach. Such an undertaking requires concerted international co-operation and an increase in generosity. It may be a difficult task, but one that is ultimately in the best interests of both the displaced and those who receive them.

      Mr PALLARÉS (Andorra)* – I thank the rapporteur for this important report on an issue that we face right now: forced migration and people displaced for environmental reasons. Migration and refugees are always on the agenda – they are part and parcel of our debates – and we must address the issue, but it is good to have a different perspective. The report is very timely and necessary, so I thank you for organising this debate.

      Andorra is affected by the consequences of climate change. In fact, 70% of our economy is based on tourism – in particular, winter tourism – and according to reports and studies, perhaps in the next 30 or 35 years, the quantity of snow could diminish. We could lose our snow and our ski slopes. That would be a major change for us, so we are taking preparatory measures and considering what we could do with our mountainous regions, because it is likely that this will happen. Every winter, the skiing season gets shorter and shorter, which has an impact on our economy.

      Our country is trying to face up to the economic consequences of global warming and climate change. We simply cannot afford to forget that we are talking about the future and that future generations will be affected. In fact, the impact has been felt already in some areas of the world, and these emergencies, natural disasters and catastrophes are difficult to handle. This is an issue for the future, but it is also affecting us right now. I am sure that you are all aware that we need to put a lot of effort into managing and getting a grip on the situation.

      The report mentions a couple of best practices and explains what is happening in Finland, Norway, Switzerland and elsewhere, as well as the methods that we could use to deal with climate refugees and how we could best welcome them. In Andorra, we have a fairly large immigrant population, comparable with that of other countries mentioned in the report. This is a question of goodwill. We are one of the signatories to the Geneva Convention and its protocol. We have always been willing to welcome refugees and we need to organise this activity. Things may be set down on paper, but it is important to take action, and we want to do so.

      I like the idea that we should review or revise the Geneva Convention, because we need to update it and bring it up to speed with the current situation. A country such as ours could perhaps bring new perspectives to the issue. It is important to have a solid legal basis to protect the rights of individuals who have been forced to migrate for climate reasons or, indeed, for other reasons. I thank the rapporteur for his report, which we will certainly support.

      Mr SCULLY (United Kingdom) – I congratulate the rapporteur on this report and its forethought on this important issue. We have talked a lot this week about the situation in Syria. The UK’s response has been quite different from that of a number of other European countries. We have used our international development budget to support refugees in and around Syria, to stop the pull factors that encourage people to make the dangerous journey across the sea.

      In February I was in Burma, where my father was born. I met a number of Rohingya Muslim advocates, who spoke about the terrible situation in Rakhine State. People there have been denied their citizenship and a number of other basic human rights, which has driven them to make some equally perilous journeys across the waters. On 19 April, just a few days ago, another boat capsized with an estimated 60 people in it, 21 of whom lost their lives. I emphasise those examples from around the world because this is a global phenomenon that needs global partnership and collaboration.

      There are undoubtedly pressures on populations around the world. When we think about the future, we must consider climate change and the other natural phenomena that have been emphasised today. The report cites African countries, Japan, Bangladesh, India, the Maldives, Burma, Pakistan and islands in the Asia-Pacific region. Regional responses will be needed in those areas.

      It is fine for us to look to the future and to take a lead, as we often have. The Geneva convention was signed here in Europe. Europe has always taken a lead on issues relating to refugees and asylum seekers. However, I would err on the side of caution when it comes to reviewing or revising the convention or international legal frameworks unilaterally, as a group of member States, in order to extend the circumstances in which people qualify for international protection, as outlined in the proposal. In order to work effectively, we can take a lead, but we need to work towards a global solution through global institutions and mechanisms. I welcome the forward-looking nature of the report.

      The PRESIDENT* – I do not see Mr Tarczyński. That concludes the list of speakers. Mr Bies, you have four minutes.

      Mr BIES (France)* – I would like to thank my colleagues for their comments and contributions to this report. As Mr Schneider said, we of course must help the most vulnerable countries; that is self-evident, and it is one of the purposes of the report. As Ms Zotea said, we evidently need to revise the legislation. The last speaker reminded us that if we are to be the ones who initiate these measures, we must mobilise the whole of the international community to be as effective as possible. I would also like to thank Mr Jónasson for confirming the need to revise legislation. Mr Önal reminded us that the texts today are somewhat outdated because they go back to the 1950s. The world is moving on, and the challenges today are different. We need to keep abreast of them. I will come back to that point briefly in my conclusion.

      Ms Mikko said that we are not alone, but rather truly interconnected at a global level. What happens outside of our own continent is therefore something we should be concerned about. Ms Dobešová said that we should not expand the refugee status, because it is already pretty difficult for us to respond to challenges. The objective of the resolution is precisely to look ahead as far as possible, so that in five, 10, 20 or 50 years, we do not have to respond to an emergency situation for which we are unprepared.

      We need to act on climate change. The COP21 agreement is being signed in New York today. We must act on development in our countries and warn our governments of the need to be eco-responsible. There is also a legal aspect, which we cannot settle today. As I said in my introductory words, the International Organization for Migration attempted to define environmental migration and the refugee status, but we need to discuss that. Others have said that changing the legal refugee status might undermine it. However, I call on my colleagues who have not been convinced this morning to think carefully about the need to look ahead. The role of the Parliamentary Assembly of the Council of Europe must be to ensure that the present rights are fully complied with and respected, and to think as far ahead as possible to the creation of new rights that consider society’s development. The modest objective of the report is to create something that will continue in our institution, in the international community and in the United Nations.

      The PRESIDENT* – Does the Chairperson of the Migration Committee wish to speak? Ms Gafarova, you have two minutes.

      Ms GAFAROVA (Azerbaijan) – First, I would like to thank Mr Bies for his work on this timely report. While we are trying to deal with the latest waves of migrants and refugees from Syria and other countries shaken by conflict, another cause of displacement deserves our attention.

      Europe was slow to react to the Syrian refugee crisis. It should learn from that mistake and recognise risks as they emerge. Environmental migration is already a terrible reality in some parts of the world. The risk of an exponential increase is very real, and it is likely to happen soon. I therefore encourage colleagues to not only adopt the resolution but take it back to their countries and urge their authorities to follow up on the recommendations it contains. That starts with the necessary establishment of more solid international regulations and an agreement on the definition of forced migration. Concerted and co-ordinated action is then needed to make the minimisation of climate change and the security of energy supplies an absolute priority.

      Countries with advanced systems and technologies must help less developed, more vulnerable countries to overcome the challenges of providing for their populations’ immediate needs while avoiding natural and chemical disasters that destroy whole regions and render them uninhabitable for future generations. Protectionist policies for victims of natural, chemical or nuclear disasters should be contained in preventive measures taken to stop the exploitation of natural resources. I congratulate Mr Bies once again for this report and draw colleagues’ attention to its importance.

      The PRESIDENT* – Thank you, Ms Gafarova. The debate is closed.

      The Migration Committee has presented a draft resolution, to which no amendments have been tabled.

      We will now proceed to vote on the whole of the draft resolution contained in Document 13983. A simple majority is required.

      The vote is open.

      The draft resolution in Document 13983 is adopted, with 30 votes for, 0 against and 3 abstentions.

      I congratulate all members who contributed to the report.

4. The case against a Council of Europe legal instrument on involuntary measures in psychiatry

      The PRESIDENT – The next item of business this morning is the debate on the report entitled “The case against a Council of Europe legal instrument on involuntary measures in psychiatry”, Document 14007, presented by Ms Magradze on behalf of the Committee on Social Affairs, Health and Sustainable Development. We also have a statement by Mr Nils Muižnieks, Human Rights Commissioner. I remind you that speaking time is limited to four minutes.

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

      Ms MAGRADZE (Georgia) – Some of you may be aware that, since June 2013, the Committee on Bioethics of the Council of Europe has been drawing up an additional protocol to the Oviedo Convention aimed at protecting the human rights of people with mental health problems against abusive involuntary treatments and involuntary placements in psychiatric institutions.

      I thank the Committee on Bioethics for accepting right from the start that the Assembly should be associated with the drafting process, and for hearing my point of view and that of the Social Affairs Committee on more than one occasion over the past few years. That point of view is that, while I understand the laudable intentions of the Committee on Bioethics, there are two main concerns about the proposed new legal instrument: first, its possible incompatibility with the United Nations Convention on the Rights of People with Disabilities; and, secondly, the drafting of the instrument behind closed doors, without the direct involvement of disability rights organisations.

      The Committee on Bioethics agreed to make public for consultation a draft version of the additional protocol last year. During the public consultation, around 40 submissions were received, including from a number of high-profile human rights bodies, including our own esteemed Commissioner for Human Rights, the Parliamentary Assembly general rapporteur on the rights of Lesbian, Gay, Bisexual and Transgender (LGBT) people, and several United Nations bodies and United Nations special rapporteurs.

      Our Commissioner and the United Nations bodies I mentioned have fundamental concerns about the draft additional protocol for very similar reasons to mine, but they go one step further: not only do they underline that the approach of the legal instrument is incompatible with the Committee on the Rights of Persons with Disabilities (CRPD), but they request that the proposal of drawing up a protocol be withdrawn. In the report I am submitting to you today, I join their call.

      You may be asking what the problem is with this new legal instrument when it is meant to be protective of people with psychosocial disabilities. The main problem is that the draft additional protocol maintains a direct link between mental health problems and involuntary measures. Basically, according to the draft, a person with mental health problems can be placed and treated against their will if they are dangerous to themselves or others. Up until now, that was considered a very normal and acceptable scenario in many of our member States. Indeed, mental health laws in almost every country authorise involuntary measures against people with mental health problems under certain conditions, in particular when they are dangerous to themselves or to others. Some Council of Europe instruments also authorise such measures but strictly regulate them with a view to protecting people with mental health problems against abuses. However, both the mental health laws and our older Council of Europe instruments fall behind the standards of the United Nations Convention on the Rights of People with Disabilities.

      The United Nations convention is the first global treaty on the rights of people with disabilities. With 163 States parties as of February 2016, the CRPD is one of the most widely ratified of the United Nations human rights treaties. A total of 41 member States of the Council of Europe and the European Union have ratified it. It is currently the reference instrument in the field of disability, in the light of which measures taken at international and national levels are evaluated. The CRPD does not create new rights or rights specific to people with disabilities but reaffirms a number of substantive rights for them. It induced a paradigm shift in the way we deal with disabilities.

      According to the committee responsible for monitoring its implementation, the laws that deny the legal capacity of people with mental health problems to decide about treatment and admission to a hospital violate their right to equal recognition before the law. The CRPD committee also considers those mental health laws to be incompatible with the right to liberty and security, because they are discriminatory against people with mental health problems. Indeed, other people who might be at risk of being a danger to themselves or others are not placed in institutions and treated against their will.

      That does not mean that people with mental health problems cannot be lawfully subject to detention for care and treatment. I believe that there may be cases where involuntary measures are unavoidable and in the best interest of both the patient and society. However, such cases should be the exception and most of all they should be neutrally defined so as to apply to all persons and not just to people with mental health problems.

      I understand that that paradigm shift can be challenging. However, I believe that the questions we should be asking are questions of principle. Can the Council of Europe go ahead with drawing up an additional protocol that is incompatible with the CRPD, or at least considered to be so not only by all relevant United Nations bodies, including the CRPD monitoring body established under international law, but by the Commissioner for Human Rights of the Council of Europe itself? Can it do so without undermining its own credibility and taking the risk of creating an explicit conflict between international norms at the global and European levels? Can an additional protocol drawn up in such a controversial way fulfil the advisability criterion required by the Committee of Ministers for drawing up new legal instruments? I truly do not think so. I believe that the Council of Europe should acknowledge the CRPD Committee’s position and act accordingly. Therefore, we should ask for the proposal of drawing up an additional protocol to be withdrawn.

      In a constructive approach, the draft recommendation also proposes that, instead of regulating involuntary measures in the context of psychiatry, the Committee on Bioethics focuses its work on promoting alternatives to involuntary measures. Finally, if a decision to go ahead with the additional protocol is taken by the Committee of Ministers or the Committee on Bioethics, the draft recommendation proposes that disability rights organisations should be directly involved in the drafting process. That is a requirement not only of the CRPD but of the Assembly itself in its resolution on equality and inclusion for people with disabilities, which was adopted in 2015.

      I thank you for your attention and ask for your support for the recommendation.

      (Mr Agramunt, President of the Assembly, took the Chair in place of Ms Mateu.)

      The PRESIDENT – Thank you very much, Ms Magradze. You have five minutes remaining. We now welcome Mr Nils Muižnieks, Human Rights Commissioner, who will make a statement.

      Mr MUIŽNIEKS (Human Rights Commissioner of the Council of Europe) – I would like to express my support for this draft report and recommendation, which fully reflects my concerns about the additional protocol that is currently being prepared to the Oviedo Convention.

      The draft additional protocol is a well-intentioned attempt to solve the problem of human rights violations in the context of psychiatry, but it is unable to fulfil that aim. I frequently examine this issue in my country visits and I regularly see that legal safeguards, such as those that the draft protocol envisages, do not prevent those violations because our legal systems are not designed to hear the voices of persons with psychosocial disabilities.

      Like the rapporteur, I also have serious concerns about creating a Council of Europe instrument that would directly contradict the global standard, which is the United Nations Convention on the Rights of Persons with Disabilities. As has already been said, I am not alone in that. All the United Nations bodies that commented on the draft expressed the same view as me that the Council of Europe should avoid the risk of such incompatibility. It would be a big step backwards and detrimental to our Organisation, to the United Nations system and, ultimately, to people with disabilities, whose protection such an instrument would roll back.

      In my comments on the draft, which are available on my website, I suggest that, instead of a protocol, the Committee on Bioethics should work on guidelines on how to reduce coercion in psychiatry. That is what is needed today and the Committee on Bioethics could really make a contribution to that without a legally binding instrument.

      I fully share Ms Magradze’s views. The proposed instrument could be discriminatory, is risky and does not present sufficient added value in terms of human rights. It should be withdrawn. I therefore urge you to vote in favour of the recommendation.

      The PRESIDENT – Thank you very much, Mr Muižnieks, for your most interesting address.

      We now come to the list of speakers. I first call Ms Rawert. You have four minutes.

      Ms RAWERT (Germany, Spokesperson for the Socialist Group) – I thank Ms Magradze most warmly for the report. It is important that the Parliamentary Assembly protects the rights of people with disabilities. It has already done this through Ms Quintanilla’s report on equality and inclusion for people with incapacities or disabilities. It was a milestone in protecting the rights of people with disabilities.

      It is important to start with the United Nations Convention on the Rights of Persons with Disabilities. I support the report’s intentions, which are to protect people with psychosocial incapacities from unjustified intervention. The discussion on the additional protocol should be continued, and medically initiated forced treatment should also be discussed. We already have the United Nations convention, and we must consider the compatibility of treaties and conventions on the treatment of severely mentally ill people.

      In particular, we must consider whether those who are acutely ill can be treated if there is danger to them or others and whether they can be treated against their will. There are different interpretations of this and of whether the convention is totally against measures that are taken against a person’s will and reduce a person’s ability to make decisions for themselves. It is difficult in our national parliaments to weigh up the pros and cons of such treatment. Of course, treatment against a person’s express will is intervention, but sometimes the lack of such treatment can create problems because the person is not properly looked after and could damage their own health.

      In Germany, we have prepared such legislation. It is important to have a balance between the right to self-determination and protection from danger to one’s health or that of others. Forced medical intervention can be carried out only with a judicial decision because it should be the ultima ratio – the last possible resort against the threat of serious health problems, which can be carried out only when other measures have failed. We must protect people against unnecessary medical intervention to ensure that they are treated voluntarily.

      Some member States do not have such measures and there is a danger of legal intervention and uncertainty. We should therefore establish a legal certainty to prevent unjustified intervention. We are happy to involve non-governmental organisations in our discussions. Legal systems must also take account of the views of people with mental health problems.

      Ms PALLARÉS (Andorra, Spokesperson for the Alliance of Liberals and Democrats for Europe) –

On behalf of my group, I would like to thank the rapporteur for her strong plea against a Council of Europe legal instrument on involuntary measures in psychiatry. Representing political parties with a long-term tradition of safeguarding the rights of the individual and promoting humanitarian and humanist values in society, I cannot but feel sympathy towards the intentions in Ms Magradze’s memorandum. I share her grave concerns about the protection of human rights and dignity of persons with mental disorders and I fully support her recommendation to promote and develop alternatives to involuntary measures in psychiatry.

      However, ALDE does not have a shared position on this sensitive issue and I would like to express our differing point of view. It is well expressed in the report that the United Nations Convention on the Rights of Persons with Disabilities presents new definitions, new concepts, and new paradigm that every country has to try to consider and develop carefully. We are not just talking about protecting people with mental health problems from human rights abuse. We must also consider the rights and security of the relatives who are completely dedicated and fully involved in their care. Because it is such a sensitive issue, we do not support the rapporteur’s recommendation to instruct the Committee on Bioethics to withdraw the proposal to draw up an additional protocol with regard to involuntary placement and involuntary treatment.

      Contrary to the position of the rapporteur, in our opinion it is more advisable to ask the Committee on Bioethics to speed up the process and present a proposal, preferably this year, as the deliberations on a proposal started three years ago. Contrary to the position taken by the rapporteur, the ALDE group would like to see the protocol remain in line with the articles laid down in the European Convention on Human Rights, the Oviedo Convention and the 2004 recommendation of the Committee of Ministers.

      We do not subscribe to an outdated medical model of disability, and what the rapporteur prefers to call psychosocial disabilities are in fact mental disorders. In itself that is not enough to justify involuntary treatment or placement in an institution. Actual and dangerous behaviour of the patient, caused by the disorder and not remediable by other means, may make involuntary treatment necessary but, if so, only under very strict and preferably judicial conditions and for a restricted period of time.

      As soon as the Committee on Bioethics has made a proposal for an additional protocol, the Assembly will have ample opportunity to discuss its pros and cons and then to decide on it, just as the rapporteur stated in the last sentence of her conclusion. In line with that, we have no objections to paragraph 12 of the draft recommendation, but the ALDE group will not support it.

      Mr SCULLY (United Kingdom, Spokesperson for the European Conservatives Group) – I welcome this report and congratulate the rapporteur on her work.

      In my constituency of Sutton in south London, I have seen the transformative nature of care, led by a fantastic, forward-thinking council officer called Shaun O’Leary. He took people out of institutions that they had been in for many decades and brought them into independent living, giving them a new lease of life and tearing down buildings that were effectively reflections of the 16th century United Kingdom poor laws. They were able to do simple things such as going to the shops for the first time to choose their own food, whereas previously everything was done for them; they had very limited lives despite having the capacity to live more independently. They were able to sit in front of the television with the remote control and realise that they were allowed to change the TV channel to watch what they wanted to watch rather than just what was on in the corner. These were people who had been institutionalised for many years and written off as having a limited life when there was so much more that they could offer.

      In 2004, the Council of Europe adopted a recommendation regulating involuntary placement and treatment. Obviously, I was not here then but I question how much input there was from people either in receipt of care or giving care, and organisations working on human rights. It seems that few people working in healthcare are aware of the recommendation. Therefore, we need to work on the implementation of that recommendation. The additional protocol to the Oviedo Convention has the status of the convention itself. That therefore requires far more detailed scrutiny from us. I would hate it if the work done on pushing through a protocol would result in any duplication and diversion of resources away from implementing the existing recommendations. Frankly, if you have a protocol that needs ratifying and if it is not something that countries want to ratify, it defeats the object of having a protocol in the first place. I would rather see education and work on the matter of coercion, as we have heard from the Commissioner for Human Rights.

      I know the Committee on Bioethics has consulted on the draft protocol. When it meets again in a few weeks’ time on 31 May, it needs to show that it has taken on board the views of human rights organisations and mental health practitioners, and how it is going to get round any unintended consequences of moving towards a draft protocol rather enforcing the recommendations to date.

      Ms QUINTANILLA (Spain, Spokesperson for the European People’s Party)* – On behalf of the EPP group, I say to Ms Magradze that this is not an easy report. It is a difficult report. It must have taken you a lot of time to draft. It must have been time consuming and you must have been very committed to your task.

      The report talks about a legal instrument of the Council of Europe regarding psychiatric measures that may be applied to individuals who do not wish to subject themselves to treatment against their will. As Vice-Chair of the Sub-Committee on Disability and Inclusion, which comes under the Equality and Non-Discrimination Committee, I agree with you: internment and involuntary treatment give rise to a number of questions when it comes to protecting the human rights of individuals who are suffering from psychosocial disabilities. In addition to that, of course, we have the United Nations Convention on the Rights of Persons with Disabilities. How does it fit with that? Very often we think we are coming to the rescue of these individuals, to help them, but if we release them from institutions or take alternative measures, it can be problematic in terms of their involvement in society.

      My German colleague, Ms Rawert, mentioned the report I presented to the Assembly last year about the millions of people who suffer from disabilities in the member States of the Council of Europe. A resolution was adopted at the time in which I asked the Assembly to talk about this and to work on the case of these individuals. We should not have a culture of institutionalisation and we should put an end to public funding for these massive institutions for persons with disabilities. I asked for some thinking about this, which is precisely what the report talks about: alternative measures; how we can respect the freedom and will of persons living with disabilities.

      That said, rapporteur, I also think we need to talk about the situation of people who have psychological disturbances or problems. We need to think about them and protect them and their families. In Spain we are making major progress in the right direction for psychiatric help. That is the context and that is where we need to talk about protection. Sometimes psychological disturbance can be a great problem, not only for those who are suffering from it but those who take care of them: their carers and families. Therefore, if we are going to work on a legal instrument that makes freedom possible while allowing us to protect these individuals who are living with a psychological disturbance, we have the United Nations; we also have various international organisations that work on the issue of people with disabilities, motor or otherwise, which have all said, “Nothing about us without us.” We must bring them on board.

      Therefore, Ms Magradze, for all those reasons, I commend your report but I say again that this must have been a difficult report for you to draft. Of course, we need to move forward. That is the only alternative but we must move forward towards the greater freedom of individuals who are living with a psychological disability and we must not in any way impinge upon their human rights.

      The PRESIDENT – The rapporteur will reply at the end of the debate but does Ms Magradze wish to respond at this stage? No. In the main debate, I call Ms Beselia. You have four minutes.

      Ms BESELIA (Georgia) – I thank the rapporteur for an interesting and useful report on the legal instrument on involuntary measures in psychiatry. We believe strongly that the position of the Council of Europe will fundamentally change the principles of non-discrimination of the CRPD in respect of traditional mental health care and human rights provisions.

      Last year, important changes were made to Georgian legislation in this field. A new definition, “psychological disability”, was adopted instead of “mental health problem”, which had been used in Soviet countries. New European standards could be found in this legislation, which was based on human rights requirements. One is the role of the “assisting person”; by law, the court can decide to appoint a special person with responsibility to protect the rights of the person with the psychological disability in all instances. Georgia actively promotes the high standards and principles of the Council of Europe and we urge members to support the draft recommendation. I thank Commissioner Muižnieks for his comments and Ms Magradze for the report.

      Ms GÜNAY (Turkey)* – I am grateful for the comprehensive report, with its critical perspective. I thank the Social Affairs Committee for the 2013 motion. Human rights have always existed without interruption; under all conditions, human beings and States have to safeguard rights and freedoms and prevent human rights violations. This report should be seen within a framework of human rights with a view to preventing human right violations.

      We cannot cure patients against their will, with or without a court decision. Of course we should detain a psychiatric patient if need be, but that does not mean that health service workers should be able to use involuntary treatment and medication. Such treatment should be considered only when there is a risk of a severe health problem if it is not given – and that does not mean that the patient should not be consulted and provided with treatment options.

      The United Nations Convention on the Rights of Persons with Disabilities has been signed by 160 countries and is the most comprehensive international text on the subject. An additional protocol, however, includes provisions inconsistent with the gist of the convention. The Commissioner for Human Rights expressed concerns about the additional protocol, including the issue of extreme authorisations for health workers.

      Another concern is that NGOs were not sufficiently consulted in the drafting of the text, which contrasts with the inclusive approach of the Council of Europe. As has been stated, the text should incorporate freedoms but not restrictions. The disputed provisions should be eliminated and more humanitarian provisions should be included where necessary. In that way we can overcome any further disputes and develop practices in line with the needs of psychiatric patients.

      Mr OLIVER (Observer, Canada) – Mr President, members of the Assembly, I thank you for this

opportunity to participate in the debate on whether there is a need for an additional Council of Europe legal instrument to address the use of involuntary placement and treatment measures in psychiatry. I thank the rapporteur for a thoughtful report.

      As the rapporteur highlights, the United Nations Convention on the Rights of Persons with Disabilities reflects a paradigm shift in attitudes and approaches towards persons with disabilities, including persons living with a mental illness. The CRDP has aroused significant debate internationally and in Canada regarding the rights of individuals with mental illness in the face of mental health laws that allow for involuntary psychiatric hospital admission and treatment. Although Canada ratified the CRDP in March 2010, it included reservations with respect to Article 12: equal recognition before the law. In its interpretative declaration, Canada recognised that persons with disabilities are presumed to have legal capacity on an equal basis with others in all aspects. However, it reserved the right to maintain supported and substitute decision-making arrangements in appropriate circumstances and in accordance with the law. 

      In Canada, mental health is an area of shared jurisdiction, where provinces and territories are primarily responsible for the delivery of mental health services. All provinces and territories have mental health legislation that allows for the involuntary admission and treatment of individuals with mental illness. However, provincial and territorial mental health legislation must be in strict compliance with the Canadian Charter of Rights and Freedoms. Specific provisions of the charter relevant to the interpretation of mental health legislation include section 7: "the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice"; section 9: "the right to not be arbitrarily detained or imprisoned"; and section 15(1): "the right to the equal protection and equal benefit of the law without discrimination and, in particular, without discrimination based on race, national or ethnic origin, colour, religion, sex, age or mental or physical disability."

      Many individuals living with mental illnesses in Canada believe that a lack of services and supports in the community are a contributing factor in the deterioration of an individual’s mental health, which can, at times, lead to involuntary committal and/or treatment. Similarly, the Mental Health Commission of Canada has articulated that involuntary treatment measures, such as seclusion and restraint, need to be re-examined to see whether they represent failures of the mental health treatment system. To address these challenges, the Government of Canada is currently working with the provinces and territories on a new mental health accord to improve access to mental health services across the country, so that individuals living with mental illness and their families get the treatment and support they need before they face a crisis.

      I support the rapporteur’s call for supported decision-making mechanisms and reinforce the need for improved community-based care models. Those models should be based in part on preventing acute episodes of care and the avoidance of involuntary treatment while focusing primarily on improving the ongoing health status of the client. Thank you for the opportunity to address the Assembly and share the Canadian experience of this important topic.

      The PRESIDENT – Thank you, Mr Oliver. That concludes the list of speakers. I call Ms Magradze to reply. You have five minutes.

      Ms MAGRADZE (Georgia) – I thank all who have participated in the debate, in particular the Commissioner for Human Rights, with whom I fully agree. I want to underline the fact that almost all the speakers said that using involuntary treatment and placement was not the right approach. You never know how a legally binding instrument will be used in practice. That is why it is much better for there to be guidelines for the treatment of those with mental disabilities. We are against a legally binding document. I can give examples of many cases, and you will know well that terrible things have happened in the past. We must remember the abuse of psychotrine in the Soviet Union, where involuntary placements and treatments were used to silence government critics, and the electro-shock treatments forcibly administered on homosexuals in the 1960s and 1970s in the West.

      Remembering is not enough. In many of our countries, people with psychosocial disorders are still being confined to psychiatric hospitals and treated against their will. In some cases, involuntary measures may be unavoidable and indeed in the best interests of both the patient and society. However, in many cases they are neither. We must stop stigmatising people and assuming that just because they were ill once, they cannot decide anything for themselves. The most blatant example is the involuntary placement and treatment of women with postnatal depression. Such women have good prognoses, so it is nothing short of scandalous to lock them up.

      We ask you to support our recommendation because the liberty of such patients is important. We need to stop the involuntary placement and treatment of such people.

      The PRESIDENT – Thank you, Ms Magradze. Does the vice-chairperson of the Committee on Social Affairs, Health and Sustainable Development wish to say a few words?

      Ms BONET (Andorra)* – Let me thank the rapporteur on behalf of the committee for her excellent, important work, presented to the Assembly in plenary. I also thank the Commissioner for his contribution to support the report. I recall that the rapporteur met with the Committee on Bioethics on several occasions to discuss the issue and the proposed additional protocol that deals precisely with psychosocial problems and involuntary measures in psychiatry.

      The report was unanimously approved by the committee at our last meeting on 15 March in Paris. As vice-chairperson of the committee, I would like to point out that we all agree that we need to help improve on the situation: everything that has to do with human rights and human rights violation, particularly on involuntary measures such as psychiatric treatment and involuntary placements. It is important to make it clear that we all want to improve the situation, and the report goes very much in that direction.

      Our committee has met with various experts such as the Commissioner for Human Rights and the general rapporteur, who deals with the rights of LGBT individuals. Furthermore, we have met with several representatives of United Nations bodies, including some of their rapporteurs. I ask you to support the report so that we can continue this valuable work.

      The PRESIDENT – Thank you, Ms Bonet.

      The debate is closed

      The Social Affairs Committee has presented a draft recommendation, to which no amendments have been tabled.

      We will now proceed to vote on the whole of the draft recommendation contained in Document 14007. A simple majority is required.

      The vote is open.

      The draft recommendation in Document 14007 is adopted, with 18 votes for, 6 against and 1 abstention.

      The PRESIDENT – I call Ms Magradze.

      Ms MAGRADZE (Georgia) – First, I want to express my gratitude and thank all the people listening today – it is Friday. I thank the assistants of our committee for their great work, especially Ayşegül and Tanja. I hope that we will work with the Committee on Bioethics and create an excellent document with guidelines on how to treat people with psychosocial disabilities.

5. Progress report of the Bureau and the Standing Committee

      The PRESIDENT - The Bureau has proposed several references to committees. They are set out in the Progress Report, Document 14016 Addendum III. Are there any objections to these references?

      There are no objections, the references are approved.

      I now propose that the other proposals in the Progress Report, Document 14016 Addendum III, be ratified. Are there any objections?

      There are no objections, so the progress report is approved.

6. Voting champions

      The PRESIDENT – I am pleased to be able to announce the names of our voting champions: those members who have taken part in the most votes during this part-session.

      They are: Ms Christoffersen, Mr Koç, and Ms Pallarés.

      I congratulate all of them. As is traditional, we have small gifts for the champions and I invite them to come and collect them.

7. End of the part-session

      The PRESIDENT – We have now come to the end of our business.

      I thank all members of the Assembly, particularly rapporteurs and chairpersons of committees, for their hard work during this part-session.

      I would also like to thank all the Vice-Presidents who have assisted me by presiding over sittings of the Assembly this week. They are Sir Roger Gale, Ms Gambaro, Ms Guzenina, Ms Mateu, Ms Oomen-Ruijten, Ms Palihovici and Mr Rouquet.

      In addition, I would like to thank the staff and interpreters, both permanent and temporary, who have worked hard to make the part-session a success.

      The third part of the 2016 session will be held from 20 to 24 June 2016.

      I declare the second part of the 2016 Session of the Parliamentary Assembly of the Council of Europe closed.

      The sitting is closed.

      (The sitting was closed at 12.50 p.m.)


1. Time limit on speeches

2. The handling of international public health emergencies

Presentation by Ms Bonet of the report of the Committee on Social Affairs, Health and Sustainable Development, Document 14012

Speakers: Mr Jónasson, Mr Ghiletchi, Ms Rawert, Ms Pallarés, Mr Wood, Mr Neguta, Ms Buliga, Mr Howell, Mr Oliver, Ms Günay, Mr Don Davies, Ms Quintanilla.

Draft resolution in Document 14012 adopted

3. Forced migration: a new challenge

Presentation by Ms Bies of the report of the Committee on Social Affairs, Health and Sustainable Development, Document 13983

Speakers: Mr Schneider, Mr Parviainen, Ms Zotea, Ms Usta, Mr Jónasson, Mr Önal*, Ms Mikko, Ms Dobešová, Mr Wells, Ms Pallarés, Mr Scully.

Draft resolution contained in Document 13983 adopted

4. The case against a Council of Europe legal instrument on involuntary measures in psychiatry

Presentation by Mr Magradze of the report of the Committee on Migration, Refugees and Displaced Persons, Document 14007.

Statement by Mr Muižnieks, Human Rights Commissioner of the Council of Europe.

Speakers: Ms Rawert, Ms Pallarés, Mr Scully, Ms Quintanilla, Ms Beselia, Ms Günay, Mr Oliver.

Draft recommendation contained in Document 14007 adopted

5. Progress report of the Bureau and the Standing Committee

6. Voting champions

7. Next public business

Appendix I

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



Brigitte ALLAIN*

Jean-Charles ALLAVENA*

Werner AMON*


Lord Donald ANDERSON*



Sirkka-Liisa ANTTILA*



Volodymyr ARIEV*





Gérard BAPT/ Philippe Bies

Doris BARNETT/ Mechthild Rawert

José Manuel BARREIRO/ Teófilo De Luis

Meritxell BATET*


Guto BEBB*

Marieluise BECK*





Włodzimierz BERNACKI

Anna Maria BERNINI*

Maria Teresa BERTUZZI*




Tobias BILLSTRÖM/ Boriana Ĺberg

Oleksandr BILOVOL*

Ľuboš BLAHA*


Maryvonne BLONDIN*

Tilde BORK*

Mladen BOSIĆ*


Piet De BRUYN*

Margareta BUDNER

Valentina BULIGA


Nunzia CATALFO/Carlo Lucherini




Vannino CHITI*







Katalin CSÖBÖR*

Geraint DAVIES*






Sergio DIVINA*

Aleksandra DJUROVIĆ*

Namik DOKLE*

Francesc Xavier DOMENECH*

Jeffrey DONALDSON/ Mike Wood


Daphné DUMERY*

Alexander [The Earl of] DUNDEE*


Josette DURRIEU*



Lady Diana ECCLES*

Franz Leonhard EẞL*

Markar ESEYAN*

Nigel EVANS*



Cătălin Daniel FENECHIU*

Doris FIALA/Raphaël Comte

Daniela FILIPIOVÁ/Ivana Dobešová





Pierre-Alain FRIDEZ*

Martin FRONC*


Sir Roger GALE/Paul Scully








Mihai GHIMPU/Alina Zotea

Francesco Maria GIRO

Pavol GOGA*

Carlos Alberto GONÇALVES


Rainer GOPP*

Alina Ștefania GORGHIU/Maria Grecea




Gergely GULYÁS*

Emine Nur GÜNAY




Maria GUZENINA/Olli-Poika Parviainen



Andrzej HALICKI/Jarosław Obremski

Hamid HAMID*

Alfred HEER/Roland Rino Büchel

Gabriela HEINRICH*






Johannes HÜBNER*

Andrej HUNKO*


Ekmeleddin Mehmet İHSANOĞLU*






Tedo JAPARIDZE/ Guguli Magradze

Andrzej JAWORSKI/ Daniel Milewski

Michael Aastrup JENSEN*

Mogens JENSEN*


Florina-Ruxandra JIPA*


Aleksandar JOVIČIĆ*











Bogdan KLICH/Aleksander Pociej


Haluk KOÇ

Željko KOMŠIĆ*





Elvira KOVÁCS*

Tiny KOX*

Borjana KRIŠTO*


Eerik-Niiles KROSS*


Ertuğrul KÜRKÇÜ




Pierre-Yves LE BORGN’*

Jean-Yves LE DÉAUT*


Valentina LESKAJ*





Filippo LOMBARDI/Elisabeth Schneider-Schneiter

François LONCLE*


Philippe MAHOUX*

Marit MAIJ*


Thierry MARIANI*

Soňa MARKOVÁ/Marek Černoch



Alberto MARTINS*

Meritxell MATEU/Sílvia Eloďsa Bonet

Liliane MAURY PASQUIER/Manuel Tornare

Michael McNAMARA*

Sir Alan MEALE*



Ana Catarina MENDES*

Jasen MESIĆ*


Jean-Claude MIGNON/André Schneider

Marianne MIKKO

Anouchka van MILTENBURG*




Thomas MÜLLER/Hannes Germann



Marian NEACȘU*



Miroslav NENUTIL


Aleksandar NIKOLOSKI*





Judith OEHRI




Joseph O’REILLY*




Florin Costin PÂSLARU*


Agnieszka POMASKA/Tomasz Cimoszewicz

Cezar Florin PREDA*






Mailis REPS*

Andrea RIGONI*



Helena ROSETA*





Nadiia SAVCHENKO/Sergiy Vlasenko




Ingjerd SCHOU




Predrag SEKULIĆ*

Aleksandar SENIĆ*











Olena SOTNYK *




Ionuț-Marian STROE*


Damien THIÉRY*




İbrahim Mustafa TURHAN/Burhanettin Uysal


Konstantinos TZAVARAS*

Leyla Şahin USTA


Snorre Serigstad VALEN*

Petrit VASILI*





Vladimir VORONIN/Liliana Palihovici

Viktor VOVK*



Karl-Georg WELLMANN*

Katrin WERNER*

Jacek WILK


Morten WOLD*

Gisela WURM



Leonid YEMETS*

Tobias ZECH*

Kristýna ZELIENKOVÁ/Pavel Holík


Emanuelis ZINGERIS



Vacant Seat, Cyprus*


Representatives and Substitutes not authorised to vote





Jennifer O’CONNELL

David M. WELLS

Partners for democracy