ROMA AND EGYPTIANS IN MONTENEGRO LIVE AN AVERAGE OF TWO DECADES SHORTER THAN THE MAJORITY POPULATION: Poverty Kills Early

Women in these communities live even shorter lives than men due to the hardships they face, despite the fact that women generally have a longer life expectancy than men worldwide.
Đurđa RADULOVIĆ

"I have diabetes. I get free medication. The doctors told me I need to change my diet completely, but I can't afford to," says Ema (real name known to the editorial office), a 35-year-old woman from the Egyptian community. She is pregnant with twins and already has three children. Sitting on the floor next to a wood-burning stove in a modest but clean room, her disabled mother-in-law lies on the bed. Ema speaks quietly and seriously, checking on her lunch every hour.

Her blood sugar, she says, is often around 20, nearly four times the normal level. If untreated, diabetes can cause severe, even fatal, complications such as heart disease, kidney failure, vision loss, and gangrene.

Because of her pregnancy with twins, Ema needs extra calories. "I eat the same things I ate before the diagnosis: bread, pasta, legumes. Doctors told me not to eat that, but I had no choice. After a meal, I take an insulin shot—that's all I can do," she explains.

Roma and Egyptians in Montenegro have an average life expectancy of about 55 years, which is about 20 years shorter than the majority population. There has been no serious study on why this gap exists. Such a short life expectancy is typical of the world’s poorest countries, such as the Central African Republic.

"Women in the Roma and Egyptian communities in Montenegro live shorter lives than men due to the high number of births and the challenging life of raising many children," explains Dr. Melisa Spahić, a family medicine specialist at the Podgorica Health Center in Konik, where many members of these communities are patients.

While this is the doctor's observation, Dr. Spahić notes that no specific studies have been conducted on the life expectancy of Roma and Egyptian women. This trend is unusual, as women in the majority population in Montenegro—and globally—typically live about five years longer than men.

CIN-CG has previously reported that Roma women in Montenegro have children at a young age, often as minors, and that they give birth to far more children than women in the majority population. They also frequently lack proper medical care during pregnancy and reproductive health. This leads to chronic health problems at a relatively young age.

A 2018 UNICEF survey in Montenegro found that 36.9% of women aged 20 to 24 had given birth to at least one child before their 18th birthday.

According to a 2022 study by the Center for Roma Initiatives (CRI) in the Riverside settlement, some stateless women had never seen a gynecologist, gave birth at home, and faced discriminatory attitudes from doctors, even in emergencies.

"I gave birth to two children at home, without registering them in the birth register, because they sent me away from the hospital for lack of documentation, even though I was in severe pain. My mother-in-law and daughter-in-law helped me give birth," one respondent shared during the research.

Multiple global studies confirm the negative effects of having many children and giving birth at a young age on women’s health and longevity.

A 2016 study from the University of California, based on a sample of over 20,000 women, found that women who had their first child after age 25 lived longer than those who gave birth earlier.

Other research, including a major study conducted in Utah in 2016, found that having many children throughout life can negatively affect health even after the reproductive years end. It was concluded that men lived longer than women in Utah until the late 19th century and that women began to live longer only after a decrease in uncontrolled births, along with improvements in healthcare.

Poverty and Chronic Diseases—An Inevitable Link

Chronic diseases such as cardiovascular disease, diabetes, and hypertension are the primary factors contributing to the shortened life expectancy of Roma and Egyptians, according to Dr. Spahić.

"Roma and Egyptians don’t get enough physical activity and tend to eat unhealthy foods. In their circumstances, it’s hard to afford a balanced diet. Many live without basic living conditions, which leads to a higher incidence of diseases like metabolic syndrome, including obesity, diabetes, high blood pressure, fatty liver, and heart problems," explains Dr. Spahić.

Enisa (real name known to the editorial office), an 18-year-old Roma girl from the Riverside settlement in Berane, tells CIN-CG, "I'm overweight and have a hormonal imbalance. I can't lose weight. It’s hard for me to stop eating sweets." Enisa suffers from insulin resistance, a condition that can lead to diabetes and metabolic syndrome. She says she can't afford a proper diet: "I eat sweets, I eat bread. Sometimes I’m very hungry, and that’s all we have at home," she explains.

According to data from the 2019 Global Burden of Disease study, women are generally at a higher risk of disability from chronic diseases, have higher mortality rates from diabetes and cardiovascular disease, and live more years with illness. Cardiovascular diseases are the leading cause of death among women globally, followed by stroke.

In Montenegro, studies show that Roma and Egyptians suffer from chronic and infectious diseases at much higher rates than the majority population. A 2018 UNICEF survey found that one in five Roma children under age five had developmental delays, compared to just a third of that number in the majority population. Over 95% of Roma children under age two were found to be malnourished.

A study by Imperial College London on 1.7 million people found that people of low socio-economic status have a 46% higher risk of early death compared to those in better social standing.

Several global studies also highlight the link between poverty and chronic diseases. People with low incomes are more likely to suffer from conditions such as cardiovascular disease, diabetes, and cancer, with 30% of the risk stemming from the stress caused by poverty. Stress leads to weakened immunity, which then makes people more susceptible to illness, according to the U.S. National Institutes of Health.

Poor Housing Conditions and Health Risks

Living in poor housing conditions has been linked to asthma, cardiovascular disease, mental illness, infections like tuberculosis, and other health problems, according to the World Health Organization (WHO).

Dr. Spahić explains that Roma and Egyptians often do not understand how the healthcare system works—how to make appointments, keep track of examination schedules, or buy medications.

"For chronic diseases, it’s crucial to monitor progression, which requires regular doctor visits and proper treatment," says Dr. Spahić.

A significant portion of the Roma and Egyptian population in Montenegro lacks access to healthcare or insurance due to their unregulated legal status, or they avoid healthcare services due to discrimination. Many also lack awareness of health issues and healthcare systems, as noted in the Strategy for the Social Inclusion of Roma and Egyptians (2021–2025) by the Government of Montenegro.

Limited Access to Health Resources

"I nearly had heart surgery," says Anisa, a 35-year-old Roma woman from Berane, who has been a heart patient for four years. "My condition worsened recently, and I couldn’t wait for the check-up at the public hospital, which wasn’t scheduled until May." She had to pay over 150 euros for an appointment with a private doctor, plus transportation costs to Podgorica.

Only 10% of Roma and Egyptians in Montenegro know about health associates in their communities, according to the government’s Social Inclusion Strategy (2021–2025). Of those, only a fifth have used the service, and around half believe it could be useful for them.

Milica Vujadinović, a healthcare associate in Podgorica, explains, "We help people by arranging several specialist appointments on the same day to reduce travel costs, especially for those who rely on social assistance. In some cases, we even manage to arrange home visits."

The Ministry of Human and Minority Rights told CIN-CG that these healthcare associates will only remain in place until January 2024. However, both the Ministry and international humanitarian organizations are advocating for these positions to become permanent.

Educated Mothers, Healthier Children

The goal of the Social Inclusion Strategy is to increase the life expectancy of Roma and Egyptians. In 2023, the projected average life expectancy is around 57 years, and in 2025 it is expected to rise to 58 years. However, these figures are lower than initially projected—61 years by 2025.

Dr. Melisa Spahić explains that education plays a crucial role in health. "Education is key to understanding and managing one’s health. Unfortunately, many Roma and Egyptians in Montenegro have little to no education, which impedes their ability to access healthcare."

UNICEF’s 2018 research found that the level of a mother’s education is closely linked to her children's health. Among mothers with secondary or higher education, no children were found to be developmentally delayed, while 25% of children born to uneducated mothers had developmental issues.

The Montenegrin Institute for Public Health (IZJZ) advises healthcare workers to consider the full context of Roma and Egyptian communities and emphasizes the importance of healthy eating and food safety. However, CIN-CG found that many health centers in areas with large Roma populations still face challenges in fully implementing these recommendations.