Dr. Angela Skuce:

There are a number of organisations across the country working with Roma people. We all came together and we held teleconferences every two weeks because we knew that they would be very vulnerable to Covid, as they are to every other illness. Organisations, including the HSE and public health services, went into the local communities and populations of Roma people were identified across the country that previously nobody knew about. At all levels, some of them were well established and working in mainstream jobs, but many of them for cash-in-hand or on zero hours contracts. These people are not on anybody's radar because they are bunking in with other people, friends and families who might have tenancies. Covid revealed this and attempts are now under way to try to map the Roma population across Ireland to identify need, including for services.

We started collecting ethnic identifiers for health, especially in regard to Covid. That revealed two things. Prior to the vaccination coming on stream, we reckoned that Roma people were ten times more likely to die from Covid than the background population in Ireland. That is, probably, a reflection of their general health and the circumstances they live in, the social determinants of health more than anything. Now that we have such good vaccination rates, Roma people are approximately 50 times more likely to die from Covid because they have enormous vaccine hesitancy. They see the vaccine as an instrument of State control. They have such distrust in the health service, they think it is going to do them harm. It has proven very difficult to get any significant vaccine uptake with the Roma community.

On the health in general of the Roma community, they suffer the same health problems as everybody else but their conditions tend to be worse, to occur at higher frequency and to be less well looked after. They have higher rates of infectious diseases such as hepatitis and tuberculosis, TB. They tend to have lower childhood vaccination rates and, as such, they might have greater incidence of measles and so on. They are things that GPs and hospital can manage and the kinds of things that we are used to. They tend to have large families, starting at a very early age. That has health and social implications going forward. When they are able to access good healthcare, good maternity care and appropriate contraception, they do access it. That improves the outlook for the families as well.

On transiency, it is a huge problem.

Our waiting times for hospitals are long and the bureaucratic processes onerous. If I refer people to a hospital for something, they might get a validation letter six months' later to ask if they still want to be on the list, because they have moved and missed an appointment. Those people then come in to tell me that they have moved, and I have to re-refer them to the hospital in the area where they live now, which means that they are back at the bottom of the waiting list. It is especially striking in cases involving children with special needs because the waiting times in those services are years' long. There are many instances of children with autism spectrum disorder, ASD, or learning disabilities who have moved only a few miles each time, but on each occasion they go back to the bottom of the waiting lists. Children have got to secondary school age without ever having been assessed. If we could have a provision where it would be possible for people to go in on the same place on the waiting list as they were at when they were at their last address, that would really help people.

We have had one good example of how an integrated system and of organisations working together can help. Early in the pandemic, the HSE funded a self-isolation facility for people who could not access any other such facility. In the end, as we suspected, most of the people who came through that facility were Roma people. Many of them were people newly arrived in Ireland, or newly arrived back in Ireland, and who did not have anywhere to quarantine. It was a nurse-led facility, so everybody coming in got health assessments and their initial applications completed. They were linked with the health services then and that meant that once they left the facility they were able to continue on in those services. People presented in labour in that facility and babies were almost born there, but at least there was a nurse on-site who was able to get them into the right place. However, that facility closed recently.

Team members have been following up with those who have come through City West, which is closing. Yesterday, they visited one family in homeless accommodation. When the family arrived, I think the dad had a job in the waste recycling industry. They could not afford accommodation, so they applied for Dublin Region Homeless Executive, DRHE, homelessness accommodation. They were eligible, and they were placed in a bed and breakfast in private emergency accommodation. Unfortunately, there was a problem with domestic violence, and the dad had to leave the facility because his behaviour was unacceptable. The mum and the five children are now living there. They are provided with a room to sleep in, bathroom facilities and breakfast every day. It turns out, however, that the mum's only income is from the children's allowance payments for her four children. She has no other income, so she is feeding her children for the rest of the day on approximately €500 a month, as well as buying school uniforms and schoolbooks etc. As a result, the 14-year-old in the family is wearing shoes that are two sizes too small. All that family needs is an intermediary who can help them to apply for what they are entitled to.