With high rates of tuberculosis and malnutrition, the Gypsy people of Romania have specific health problems. After working in Romania, John-Paul Smith considers the health difficulties facing this marginalised population

On this hot and sticky mid-summer's day in Bucharest, I am on a tram making its way through the busy streets. A couple board with two young children. Their skin is much darker than everyone else's, and the adults have badly drawn tattoos on their arms of initials alongside cupid's heart. They are unkempt and the other passengers on the tram look away. The children scamper in front of a woman approaching an empty seat and clamber on to it. Instantly recognisable, this family is among the 5-10% of Romanians who are Gypsy (Roma or Rroma) people. Of any country, Romania has the largest proportion of Gypsy people--more than two million.

The politics of social identity and nationality are contentious in today's Europe, and the situation of the Gypsies in Romania is no exception. They have lived in the country for hundreds of years, but are not integrated because of widespread discrimination and stigma. An important cause of this disharmony is their determination to retain their own distinctive customs and lifestyle irrespective of their situation. In Bucharest, horses and carts are considered by the inhabitants of the city to be an embarrassment and the noisy night-time parties a disruption. The view of most of the population is that Gypsies fit uncomfortably into 21st century Romania, and make a convenient scapegoat to blame for crimes and other ills of society.

The Gypsy people have always been outsiders in Romania, but after the demise of the communist regime--which offered them some protection--they are further marginalised. This has both caused and is exacerbated by higher than average levels of poverty and unemployment, poor levels of education, and overcrowded living conditions. One way in which their particular needs have been neglected is in healthcare policy and research, and indeed data on the health of the Gypsy people are scarce and fragmented. An estimated 63% of Gypsies live below subsistence levels, and their life expectancy is up to 10 years below average.¹² Poor living conditions--including overcrowding and inadequate sanitation--make Gypsy communities more susceptible to communicable diseases--for example, hepatitis and tuberculosis--and skin diseases, such as eczema.³ In Bulgaria, Romania, and Macedonia, the last reported cases of poliomyelitis were in Gypsy communities.

MARK HAKNASSON/PANOS

Romanian Gypsy children

Gypsy women marry at a younger age and have higher birth rates resulting in larger families compared with other ethnic groups. This, along with inadequate access to health care, unhealthy lifestyle, and a higher abortion rate, affects the reproductive health of Gypsy women and the health of children, who have high perinatal and infant mortality rates, which are up to four times higher than that of the rest of popultation.² Research on the prevalence of congenital disorders is limited, but estimates show that rates may be higher among Gypsies because of relative isolation and increased intermarriage.

When working in hospitals in Bucharest, it became obvious that Gypsy people had high rates of ill health. Children were often malnourished and had rickets, rates of tuberculosis were high, many parents were illiterate, and they lived in impoverished overcrowded surroundings. A combination of social isolation, lack of education, and absence of community health care have, among other factors, left children severely disadvantaged.

Life in Romania is not easy for most of the population. Life expectancy is low in comparison with western Europe (66 years for men and 73 years for women¹). Poverty is extreme with high rates of unemployment, alcoholism, and malnutrition, and tuberculosis is a serious problem. The Gypsy people have the same difficulties as the rest of the population, but neglect of health and social care has left them in a particularly vulnerable position. To compound this isolation, their customs mean that they accept some aspects of health and social care, and they reject others. For example, a disproportionate number of Gypsy children are in institutions, and infection with tuberculosis is high, partly due to non-compliance with treatment. In addition, the prevalence of drug misuse among Gypsies is thought to be higher, and they are less likely to seek help for testing and counselling. The social situation of the Gypsy people is a stark reminder of the difficulties a minority population faces when they are discriminated against and stigmatised.

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