The Tralee International Resource Centre (TIRC) has worked for the past ten years directly with Roma families in Kerry. TIRC commissioned research in 2018, funded by Tusla, to establish a socio-demographic profile of Roma families in Kerry. The need for a clear action plan to support the health needs of Roma families was recognised, and with HSE funding this Health Strategy for Roma in Cork and Kerry was commissioned.

This strategy is based on a consultation process which was conducted between January and April 2023 on behalf of TIRC. The team identified the health needs of Roma in Cork and Kerry, the obstacles to accessing services and possible solutions and presents a strategy which outlines specific actions. All of the consultations were, when possible, conducted with the ‘experts by experience’ and throughout the process information gathered was discussed and analysed with the aim of designing a pragmatic strategy which would lead to better health outcomes for Roma in Cork and Kerry. The consultations focused on the social determinants of health and the needs of Roma across the life course from pre-natal to old age; what they need in relation to accessing health services; if there are barriers; what they are, and how they can be overcome. The strategy is guided by the 10 Common Basic Principles for Roma Inclusion and relevant national policies and human rights and equality legislation and community development principles. The findings have been translated into actions, some of which can be progressed immediately, while others will require longer term planning and resources.

A review of progress in respect of implementation of recommended actions will be conducted annually. The complexity of the issues identified indicate there is a need for the establishment of a multi-agency response and the establishment of an inter-agency steering group is one of the most urgent actions required along with the recruitment of two Roma Peer workers to improve links between the Roma community and health and social services. There appears to be a lack of trust both by service users and service providers and trusted Roma peer workers are vital in bridging the divide.

The consultations support international and national evidence regarding the complexity surrounding enumerating Roma but suggest that there are more than 400 Roma in Kerry and possibly twice that number in Cork. Evidence suggests that there is a lack of understanding by the public and service providers regarding the diversity of Roma as regards age, gender, nationality, religion and migration status, which is reinforced by cultural and gender-based stereotypes. Roma have experienced significant levels of adversity including racism, exclusion, financial hardship, further exacerbated by experiences of historical persecution. A trauma sensitive approach across domains of policy, culture and practice is necessary. The complex experiences of Roma fleeing war in  the Ukraine is compounded by discrimination and antigypsyism in Ireland as elsewhere. Roma in Ireland now represent several generations of Irish born and non-Irish born adults and children and while there is very little information on their health status, the Covid pandemic unearthed some evidence regarding the marginalised position of Roma in Ireland. A longitudinal study of Roma health would provide valuable information across generations.

Barriers to accessing health services include precarious living conditions, discrimination, the habitual residence condition, accessing PPS numbers, health literacy, and language, cultural and economic barriers. Access to screening throughout the life course was identified as a particular need and mobile clinics and outreach work were identified as essential. Screening in relation to hepatitis, bowel, and breast cancer and STIs was identified as important. Improved access to the cervical screening programme is vital for Roma women at a younger age than currently, as is the availability of the HPV vaccine which may not reach Roma girls who leave school at a younger age, or if their attendance is sporadic.

Improving access to information and services could be progressed through the development of a Roma Infoline for Cork and Kerry modelled on the current National Roma Infoline and the development of specific accessible resources for Roma using appropriate technology. The consultation found that for the most part, Roma appear to have access to GP services, but the current stresses in the system mean that it can be difficult to access an appointment in both Cork and Kerry. Recently arrived and homeless Roma have difficulties accessing GP services and paying for prescriptions. Older Roma who join family members in Ireland for support, can have complex health needs, exacerbated by their inability to access health services. Consultation for this strategy suggests that maternity units are trying to meet the needs of Roma women by providing interpretation services when required, but there seems to be an issue of poor- attendance for ante natal care. It was suggested that the waiting area in the Cork University Hospital, and the waiting time is not conducive to young mothers from an ethnic background and that there may be scope for a dedicated Roma midwifery clinic or teen mothers’ clinic.

Poor mental health was identified as an issue for some Roma, associated with historical and intergenerational trauma and discrimination, precarious living conditions, overcrowding, insecurity of tenure and homelessness. For women, there seems to be a very heavy burden associated with becoming mothers at a young age, being multiparous and caring for children, while at the same time carrying the responsibility of caring for parents/ in-laws. Older Roma who are not likely to speak English are likely to experience loneliness and isolation and have difficulty accessing health services. Roma households and communities tend to be patriarchal, and this can have implications regarding sexual and gender-based violence. There is a need for the development of culturally specific support services.

There is strong evidence that Roma families value education, but sometimes precarious living conditions, poverty, early parenthood and marriage and other caring responsibilities can be a barrier to regular school attendance and completion. Access to education, training and employment are crucial to participating in society and to achieving positive mental health. Literacy at all stages of the life cycle can be improved given appropriate services. There is a need to link young Roma into existing youth services and to create opportunities for young Roma to learn about and celebrate their history and culture.

The need for a Romanian team in Cork Simon, similar to that available to other nationalities could provide a response to Romanian Roma. In Kerry, TIRC in Tralee is currently the focal point for Roma but the need is enormous, and a multi-agency response is required. Community transport could be an important resource for Roma in rural areas where services are more difficult to access and could be of tremendous benefit to Roma isolated due to mobility issues and caring for babies and young children. There is a need to develop a visible ‘Roma Hub’ where Roma can meet to celebrate their culture and access support.