Andrey Rylkov Foundation
for Health and Social Justice

Individual complaint UN Special Rapporteur on the right of everyone for health

Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health 

United Nations

Geneva, 2013 

Individual complaint based on the Commission on Human Rights resolution 2002/31[1]




1. Name of the organization: Andrey Rylkov Foundation for Health and Social Justice

 2. Location and nationality: Citizen of the Russian Federation      

 3. Activity: Non-governmental organization

 4. Address (registration):

 5. Telephone number:

 6. Name of representative: Anya Sarang, President of the Foundation

 7. E-mail:

 8. Website:


13. Russian Federation


14.1 This  is a follow up application regarding the violations of the right to the highest attainable standard of health  (Article 12 of the International Covenant on Economic, Social and Cultural Rights. The initial request for urgent appeal was submitted to the Special Rapporteur in 2010 with regard to the alarming situation with Tuberculosis treatment in HIV positive drug dependent patients in the Tuberculosis clinic in Yekaterinburg, located at 620050, Yekaterinburg, ulitsa Kamskaya, 37.

14.2 Taking into account that this is a follow up complaint, we would like to focus on the new information, hoping that this information will be appreciated, considering both the 2010 complaint (Appendix 1) and the activities undertaken in its regard by the Special Rapporteur.


14.3. From  September 9 through September 11, 2012, the representative of the Andrey Rylkov Foundation met with several former and current patients of the clinic at Kamskaya,  medical practitioners , and staff members of the non-governmental organization Chance + that provides social support to drug dependent people. Transcripts of the interviews, as well as the audio files, are available. The participants were coded as M1, М2 …М7 (Men) and as F (Woman).

14.4 Transcripts of the interviews are in Appendix 2.

14.5 Interviews with patients, doctors and social workers demonstrate that the changes that have occurred are cosmetic, and the overall situation still does not conform to the World Health Organization (WHO) standards. Rights of patients with HIV, Tuberculosis and drug dependency have still being violated in circumstances amounting to health-based discrimination.

Key facts

Positive changes.14.6 Two years past after the complaints to the local authorities and to the Special Rapporteurthere are some positive changes at the clinic (patients are allowed to walk outside, ARVT is delivered directly to the clinic and patients do not have to pick it up themselves; patients are observed by an infectionist).

No changes.

14.7 Most of the patients suffer drug dependence of which the health authorities and the clinic administration are aware. he concept of patient retention in treatment with help of  evidence based drug dependency treatment has not been implemented. Opioid substitution therapy is sill unavailable as well as any type of drug dependence treatment. The special vulnerability of the drug dependent patients has not been taken into account. Hence these patients are discriminated against when clinic administration expels them from the clinic for drug use or other petit deviation from the clinic regiment which chiefly rooted in the patients need to use illicit drug or alcohol in absence of any treatment of dependency.

14.8 Palliative care is still absent despite the high mortality among the patients of the clinic. The clinic does not have enough painkillers, and opioid analgesics are absent.   

14.9 Patients are coerced to sign a written undertaking promising not to violate the treatment regiment and the clinic rules which include a strict rule not to take illicit drugs or alcohol. This undertaking serves as a basis for for future dismissal of drug users from the clinic.

14.10 Overall atmosphere at the clinic remains gloomy, with discriminative personnel that treats drug using patients “as animals”.

14.11 The clinic still does not provide quality HIV treatment. Contrary to the national laws on the access to medical information, patients cannot receive information about their condition and about their treatment process.

14.12 Many of those who signed the complaints in 2010 later dismissed from the clinic despite the fact that the treatment was incomplete and the TB continued progressing. The dismissal was a way of retaliation by the clinic administration. Because of this the the mere notion of any new complaints or other actions seems absurd to the patients; nobody agreed to provide their personal details or sign anything.

14.13 All medical doctors who have commented on this situation did that anonymously.


15.1 We request the Special Rapporteur to call the Russian Federation for the urgent action:

15.2 To ensure that TB treatment and care at the above-mentioned clinic corresponds to the Clinical Protocol No. 4 for WHO Europe Management of Tuberculosis and HIV co-infection[2].

 15.3 To ensure that people with drug dependency have access to opioid substitution therapy with methadone or buprenorphine in accordance with WHO recommendations outlined in the Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence, 2009.

 15.4 To establish a permanent mechanism for in-service training and refresher courses for medical practitioners dealing with TB patients in order to provide them with adequate ethical and legal information as well as evidences regarding the effective treatment of patients with HIV, TB, substance use and dependency.

 Attachment: Interviews with patients of the Yekaterinburg TB clinic

[1] Contact person (Russian, English): Anya Sarang, President of the Andrey Rylkov Foundation

Email:, Cellphone number: +79268708518

[2] World Health Organization Management of Tuberculosis and HIV Co-infection. Clinical Protocol for the WHO European Region

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