US embassy cable - 04KUWAIT276

C O N F I D E N T I A L SECTION 01 OF 02 KUWAIT 000276 
 
SIPDIS 
 
STATE FOR NEA/ARP, NEA/REA, DRL/PHD, INR/NESA, INR/B 
 
E.O. 12958: DECL: 01/25/2014 
TAGS: PHUM, ELAB, PGOV, PREL, PINR, KU 
SUBJECT: (U) DRUGGED OUT: NON-CITIZENS LACK ACCESS TO BEST 
MEDICINES AND TREATMENT 
 
Classified By: Charge d'Affaires Frank C. Urbancic, reason 1.4(b) 
 
1.(C) SUMMARY: As part of Kuwait's lavish citizen welfare 
system, the GOK provides free health care for citizens but 
requires all non-citizens and their family members to pay 
mandatory annual health insurance fees and additional fees 
each time they visit a doctor or receive treatment. Kuwait's 
two-tier health care system also provides a substantially 
lower standard of care for non-citizens. Certain kinds of 
treatment and the best medicines, especially for serious or 
life-threatening illnesses, are officially reserved for 
citizens regardless of whether non-citizens need or can 
afford them. A serious shortage of medicines and medical 
equipment is exacerbating the situation. Non-citizens who 
require medical treatment and cannot afford it are wholly 
dependent on charities and the mercy of doctors. The Kuwait 
Medical Association has long criticized these practices as 
inhumane and unethical. Reform of the health care system is 
unlikely, however, in the absence of widespread public 
concern or a change in policy or budget priorities within the 
Ministry of Health. END SUMMARY. 
 
(U) Fees But Few Benefits 
------------------------- 
 
2.(U) Health care is heavily subsidized by the GOK and free 
for all citizens, including specialized care, 
hospitalization, and medicines. All non-citizens and their 
family members, however, are required to pay a mandatory 
health insurance fee to the GOK (around 40KD or $140 for the 
primary non-citizen employee and around 20KD or $70 for each 
family member) in order to obtain and renew residency 
permits. In exchange for these fees, non-citizens are 
eligible to receive some subsidized care at government 
clinics. They pay additional fees, however, each time they 
visit a doctor, receive treatment, or require tests or 
medication. While fees for basic health services, such as a 
routine doctor's visit or a standard X-ray, are minimal 
(2-4KD or $7-$15), they are nevertheless equivalent to a 
day's wages for many non-citizens. (Note: Unskilled workers 
comprise an estimated 60% of all expatriate labor in Kuwait; 
salaries for unskilled workers average 30-50KD/month. There 
is no minimum wage in the private sector. End Note). An 
ultrasound or a CAT scan might cost a foreign worker around 
40KD ($140), while surgery could cost 250-300KD ($800-$1000) 
or more. If a foreign worker cannot afford the fees, he/she 
cannot receive treatment. There are no waivers or special 
exemptions for emergency or life-threatening cases. Employers 
are not required by law to provide medical coverage for their 
employees beyond payment of medical expenses in the event of 
a job-related accident or injury. 
 
3.(SBU) The mandatory fees charged to non-citizens for all 
but the most routine services can create a burden on doctors, 
who often cannot properly diagnose or treat patients without 
more specialized tests. A retired Kuwaiti physician and 
former Director of Surgery at Al-Sabah Hospital told Poloff 
that it is common for doctors to cover these fees out of 
their own pockets in order to help foreign patients who 
cannot afford them. The only other alternative, he said, is 
to turn patients away without treatment. The retired doctor 
paid for an urgent appendectomy recently for an Indian 
laborer who could not afford the surgery and would have died 
without it. Absent a doctor's generosity, non-citizens who 
cannot afford medical treatment are dependent on charity. 
There is only one official charity, Help for Patients 
Society, that collects private donations specifically to 
assist non-citizens in need of medical care. The charity 
receives little if any GOK funding and, given its limited 
resources, assists only a fraction of the most needy cases. 
There are other NGOs that might provide assistance on a case 
by case basis, but no formal system exists to assist 
low-income workers. Recognizing this, a few large U.S. 
companies with operations in Kuwait recently started to 
provide health coverage for their non-citizen employees to 
facilitate their access to medical care. 
 
(U) Low Quality Drugs and Treatment 
----------------------------------- 
 
4.(C) The Ministry of Health, as part of a policy change 
implemented about five years ago under Health Minister Dr. 
Mohammed Al-Jarallah, makes available certain medications 
only to Kuwaiti citizens. A Kuwaiti doctor told Poloff that 
the Ministry maintains separate "approved" lists of drugs for 
citizens and non-citizens, and that the best, most effective, 
newest drugs are reserved for citizens only. Even for serious 
or life-threatening illnesses, non-citizens receive 
lower-quality drugs regardless of whether they can afford 
more effective medication. There have been credible reports 
of non-citizen patients offering bribes to doctors in 
exchange for better quality medication. The current shortage 
of critical medications, such as insulin, is exacerbating the 
problem. The same doctor acknowledged that "upper-class" 
Kuwaiti citizens with sufficient connections often receive 
priority in access to key medicines, particularly those in 
short supply, over other citizens. The former Director of 
Surgery at Al-Sabah Hospital called the current drug 
provision system "inhumane" and "unethical," and said many of 
the drugs given to foreigners are "little better than chalk," 
manufactured in shoddy pharmaceutical factories, usually in 
the Gulf, with limited quality control. The children of 
Kuwaiti women married to foreign men and the bidoon 
(stateless) family members of Kuwaiti citizens receive the 
same discriminatory treatment as other foreigners in the 
provision of drugs. In addition to lower-quality drugs, there 
are reports that non-citizens also often receive poorer 
treatment than citizens do for the same illnesses. A recent 
article by a liberal columnist in a local Arabic daily 
highlighted the apparent use of low-quality, risky equipment 
to treat arterial blockage for foreigners versus more modern, 
better quality equipment used for citizens with similar heart 
problems. 
(U) Where Is the Money Going? 
----------------------------- 
 
5.(C) The mandatory health insurance fees paid by 
non-citizens generated roughly 30 million KD ($100 million) 
in 2003 for the Ministry of Health, according to the former 
Director of Surgery at Al-Sabah Hospital, yet Kuwait 
continues to face a severe shortage of critical medicines, 
such as insulin, and a shortage of specialized equipment, 
such as for kidney dialysis. Kidney dialysis, at present, is 
only available for citizens. Foreign nationals with kidney 
disease must return home or travel to a third country for 
dialysis treatment. Numerous press reports criticized the 
Ministry of Health for reportedly spending about $200 million 
recently to replace the ceramic tiling in government 
hospitals with marble tiling despite more urgent (and 
obvious) health sector needs. The same Kuwaiti doctor told 
Poloff that basic medical supplies and equipment, such as 
sterilized rubber gloves and catheters, are not subject to 
regular, stringent quality- or safety-inspections or other 
controls. Poor quality catheters, he said, have been known to 
break during surgery and it is not uncommon for doctors to 
use expired rubber gloves.  MP Ahmed Al-Saadoun, leader of 
the Popular Action Bloc, an opposition group in the National 
Assembly, has been an outspoken critic of the GOK's health 
policies and has called for the resignation of current Health 
Minister Dr. Mohammed Al-Jarallah on corruption and other 
charges. (Note: The same Kuwaiti doctor told Poloff that MP 
Al-Saadoun has been unsuccessful in winning parliamentary 
support for Al-Jarallah's resignation largely because of 
strong opposition by Islamist members, who stand behind 
Al-Jarallah, a fellow Islamist. End Note). 
 
6.(C) COMMENT: Limited non-citizen access to advanced 
medicines and medical treatment is a human rights concern. 
Despite some recent press reports and calls for reform from 
the Kuwait Medical Association and an outspoken 
parliamentarian, few, if any, civic groups, NGOs, or others 
have highlighted or taken up the issue. The only human rights 
NGO, the Kuwait Human Rights Society, which concerns itself 
with the treatment of foreign laborers, continues to lack an 
operating license and thus the capacity to raise broad public 
awareness of this and other human rights issues. Due to 
restrictions on freedom of association, foreign workers lack 
the means to voice their concerns officially.  It appears 
unlikely that the current health care situation will improve 
much in the absence of widespread popular concern or a change 
in policy or budget priorities within the Ministry of Health. 
Foreign workers, particularly from South Asia, will continue 
to flock to Kuwait, however, out of economic necessity. The 
quality of life and wages offered here, while poor for many, 
are nevertheless substantially higher than in their home 
countries. END COMMENT. 
URBANCIC