When arranging medical referrals, insufficient account is still taken of the needs of residents of the Caribbean Netherlands. This is evident from research conducted by the National Ombudsman into the problems with medical referrals.

For residents of Bonaire, Saba and St Eustatius, many types of specialist medical care are not available locally. For this care they must travel to another island or country. This is referred to as a medical referral

Insufficient information

For many people, a medical referral is a major event. They are ill, facing uncertainty, and want clarity about their treatment as soon as possible. Discussions held by the National Ombudsman with people who have been involved in a medical referral show that things still regularly go wrong. Applications often take a long time to process, people have no insight into the status of their application, and refusals are insufficiently substantiated.

National Ombudsman Reinier van Zutphen: “Many people who are ill and in need of medical care are already in a vulnerable position. If they then also have to travel to another island or country for treatment, this brings additional stress. It is therefore important that information about a medical referral is clear and transparent.”

Too little attention to residents’ needs

The investigation also shows that too little account is taken of patients’ personal circumstances when applications are assessed. It is difficult to establish personal contact with staff of Care and Youth Caribbean Netherlands (ZJCN). This is a cause for concern, not least because ZJCN is responsible for both the policy and the implementation of medical referrals.

The National Ombudsman believes that this must change. He calls for more personal contact with people who are transferred for treatment, so that their personal circumstances and needs can be taken better into account. Staff should also be given more scope to depart from standard procedures when the situation requires it. Only in this way can decision-making better reflect what patients actually need.

The complaints procedure can be improved

When people are dissatisfied with their medical referral, they often do not know how or where they can submit a complaint. Many people also do not dare to lodge a complaint because they fear negative consequences for a future application.

Reinier van Zutphen therefore advises: “Make the complaints procedure as simple and clear as possible. And do not wait for complaints afterwards. Before, during and after the transfer, actively ask people about their experiences.”

Se solicitará información a las administraciones competentes en vivienda, salud y servicios sociales, y se recogerán aportaciones de entidades especializadas y de profesionales del sector, así como de familias afectadas.

El Síndic de Greuges de Cataluña ha abierto una actuación de oficio para analizar si las ayudas y los beneficios existentes en materia de vivienda –incluido el acceso a vivienda pública, las subvenciones o las medidas de adaptación de las viviendas– responden de forma efectiva a las necesidades de las familias con niños y adolescentes con enfermedades crónicas, avanzadas o terminales.

Estas situaciones a menudo requieren condiciones residenciales específicas para seguir los tratamientos médicos y la decisión de abrir esta actuación de oficio se ha tomado después de estudiar casos concretos que evidencian el impacto de la precariedad residencial en la salud de estos niños y jóvenes, y después de mantener reuniones con trabajadores sociales de referencia de los servicios de crónicos y paliativos pediátricos.

Estos profesionales alertan de las crecientes dificultades para que estas familias tengan unas condiciones de vida adecuadas. Si no se tiene un domicilio estable, por ejemplo, no se pueden garantizar las condiciones básicas para el tratamiento, como la conservación de medicación que requiera refrigeración, el uso de dispositivos de soporte respiratorio o la realización de terapias diarias. Estas situaciones pueden derivar en ingresos hospitalarios que podrían evitarse o en un deterioro acelerado de la salud de estos niños y adolescentes.

En este contexto, la síndica, Esther Giménez-Salinas, señala que “el acceso a una vivienda digna es un elemento imprescindible para garantizar el derecho a la salud, especialmente en situaciones de máxima vulnerabilidad como las de niños con enfermedades graves, que dependen de cuidados y condiciones materiales muy específicas”.

La actuación de oficio tiene por objeto analizar si los protocolos de intervención frente a situaciones de riesgo de desahucio tienen en cuenta estos casos, si los recursos residenciales disponibles permiten garantizar la continuidad de los tratamientos y si existe una coordinación efectiva entre los servicios sociales, sanitarios y de vivienda. Además, se valorará si es necesario establecer mecanismos específicos de priorización o ayudas para estas familias, en la línea de otras medidas del ámbito sanitario, como son las facilidades de desplazamiento en tratamientos especializados.

Una vez finalizada la actuación, la institución podrá formular recomendaciones para reforzar las políticas públicas y garantizar que ningún niño o adolescente vea comprometido su derecho a la salud por no tener una vivienda adecuada.

Uno de los casos en los que se está trabajando en la institución es el de una familia con un joven de diecisiete años que tiene una enfermedad neurodegenerativa. La familia fue desahuciada en noviembre de 2025 y, seis meses después, sigue sin alojamiento estable. Esto compromete seriamente el seguimiento de los tratamientos médicos y ha provocado un empeoramiento del estado de salud del menor, con posibles consecuencias irreversibles.

La síndica recuerda que el último informe anual sobre los derechos de los niños ya denunciaba que la legislación actual en materia de vivienda no da un tratamiento específico ni prioritario a los niños ni a sus necesidades residenciales. De hecho, el tiempo medio de adjudicación de una vivienda social es más largo para las familias con niños a cargo. Aunque los reglamentos de las mesas de emergencia consideran la presencia de niños como un criterio para el reconocimiento de las situaciones de emergencia residencial, no existe una priorización real en el acceso ni protocolos de atención especial de las situaciones de exclusión residencial o pérdida de la vivienda para las familias con niños a cargo.

From Office of the Ombudsman 

Published on 27 April 2026

Last updated on 27 April 2026

We have published our new Statement of Strategy - Towards 2030. The strategy sets out our Vision, Values, Strategic Themes and Objectives bringing us up to 2030.

The theme – Towards 2030 – is underpinned by our Vision and Values, which are:

• Independence

• People Focus

• Fairness

• Respect

• Integrity

Towards 2030: Statement of Strategy

The Ombudsman, Mr. Endrit Shabani, received in an official meeting the Commissioner for Protection from Discrimination, Mr. Robert Gajda. This meeting reconfirmed the common will to consolidate bridges of cooperation in the protection of fundamental human rights and freedoms.

At the center of the discussion was the need for a coordinated approach to the complex challenges dictated by the digital age, where the protection of privacy and human dignity remain exposed to new forms of infringement. Our institutions remain maximally committed to identifying and addressing with rigor any abusive phenomenon or behavior that conflicts with the principles of good administration.

During the meeting, perspectives were exchanged on the strengthening of protective mechanisms, with the aim of guaranteeing an environment where every citizen of Albania is treated with integrity, transparency and full respect by the public administration. The synergy of our actions remains an unwavering priority to ensure that the law and human dignity triumph over any contemptuous practices.

Parliamentary Ombudsman Jari Råman has assessed the procedure of the Finnish Defence Forces where chairpersons of personnel organisations in the military sector have been paid wages while on leave of absence. The personnel organisations had returned the paid wages to the Defence Forces. According to the Parliamentary Ombudsman, this arrangement violated the principle of procedures being bound to purpose, which is a part of the legal principles of administration, and the requirement of the equal treatment of public officials.

The Parliamentary Ombudsman investigated the matter based on an article published in Ilta-Sanomat on 20 October 2024. The Defence Forces had granted three public officials leave of absence while they acted as chairpersons of military personnel organisations and paid the chairpersons wages during the leave of absence. The personnel organisations had returned the wages to the Defence Forces, including indirect wage costs.

The Ombudsman estimates that the primary purpose of the arrangement was to retain benefits related to military pension. This kind of arrangement had to be considered to be contrary to the principle of procedures being bound to purpose, which is a part of the legal principles of administration.

Information concerning the matter was requested from the Ministry of Finance, the Ministry of Defence and the Defence Command. The received reports could not convincingly lay out how the wage payment arrangement concerning the chairpersons of military personnel organisations contributes to the management of the tasks assigned to the Defence Forces under the Act on the Defence Forces. The Parliamentary Ombudsman agreed with the assessment made by the Ministry of Defence that it is not decisive whether the chairperson is still actively engaged in their military employment while managing their trusteeship tasks or whether they have an assignment in a wartime formation, which were justifications presented in the report by the Defence Command and in organisation-specific protocols.

The Parliamentary Ombudsman also found the Ministry of Finance’s view justified in that the procedure blurred the lines between paid and unpaid leave of absence. The Parliamentary Ombudsman assessed that the content of the wage arrangement partly matched the characteristics of paid leave of absence, even though it had been formulated as a separate contractual arrangement. Public officials on leave of absence had been paid wages that the personnel organisation had returned alongside indirect wage costs to the Defence Forces, which resulted in said public officials remaining within the scope of the military pension system.

In addition, the arrangement resulted in different treatment of the chairpersons compared to other public officials. The chairpersons retained their military pension benefits during the leave of absence, while other public officials in the Defence Forces who were employed by another employer during their leave of absence did not. The Parliamentary Ombudsman considered that there were no acceptable grounds for such exceptional treatment.

The Parliamentary Ombudsman has brought his view to the attention of the Defence Command. In addition, the Ombudsman considered it appropriate for the Ministry of Defence to take action in response to the matter, and the ministry was asked to inform the Parliamentary Ombudsman of subsequent measures by 2 October 2026.

Decision EOAK/5821/2024 is available (in Finnish) on the Parliamentary Ombudsman’s website at www.oikeusasiamies.fi

Further information is available from the Principal Legal Adviser acting as head of division Kristian Holman, tel. +358 9 432 3368.