Trinidad and Tobago: Availability of State Protection and Healthcare Access

This report addresses two interrelated questions central to protection claims from Trinidad and Tobago: whether the state provides effective protection to persons at risk of serious harm; and whether healthcare — including HIV treatment and chronic disease care — is accessible in practice to vulnerable individuals, including non-nationals and returning migrants. Prepared for asylum and immigration proceedings by Expert Witness | Country Expert Witness Reports | The Human Rights.

1. Introduction

This report addresses two interrelated questions that are central to the assessment of protection claims arising from Trinidad and Tobago: (1) whether the state of Trinidad and Tobago provides effective protection to persons at risk of persecution or serious harm; and (2) whether healthcare services, including HIV treatment and care for chronic conditions, are accessible in practice to vulnerable individuals, including non-nationals, returning migrants, and members of marginalised groups.

Trinidad and Tobago is rated “Free” by Freedom House with a Global Freedom Score of 82 out of 100, comprising 33/40 for Political Rights and 49/60 for Civil Liberties. While this rating places the country among the formally freer states in the Caribbean, the disaggregated data reveal critical weaknesses in rule of law, policing, and access to justice that are directly relevant to the availability of effective state protection. This report draws on reports by Freedom House, UNHCR, PAHO, WHO, the US Department of State TIP Report, Amnesty International, UN Special Rapporteurs, and peer-reviewed public health literature.

2. Political and Institutional Framework

Constitutional and Democratic Structure

Trinidad and Tobago is a parliamentary republic with a bicameral Parliament, an independent judiciary, and regular multiparty elections. The 1976 Constitution enshrines fundamental rights including the right to life, liberty, and security of the person, freedom from discrimination on grounds of race and religion, and due process rights. The judiciary is formally independent and there is a free press.

Freedom House rates press freedom at 4/4, academic freedom at 4/4, and the rights to organise and bargain collectively at 4/4, reflecting genuine space for civil society. However, the overall civil liberties score of 49/60 reflects significant deficits in rule of law, personal safety, and equal application of legal protections to all sections of the population.

Rule of Law and Judicial Independence

Freedom House rates judicial independence at 3/4, noting that the judiciary is “generally independent but is subject to some political pressure and corruption”. Due process rights receive a score of 2/4, reflecting challenges from rising crime rates and institutional weakness, producing severe case backlogs in the courts. The long delays in the administration of justice are documented and represent a structural barrier to effective legal redress for victims of crime.

The death penalty is retained in Trinidad and Tobago. Amnesty International records Trinidad and Tobago as a retentionist state, and the country has been the subject of petitions before the Judicial Committee of the Privy Council in capital cases. The retention of the death penalty is indicative of the state’s broader approach to criminal justice.

3. Police Conduct, Corruption, and Criminal Violence

Homicide Rates and Public Safety

Trinidad and Tobago recorded 576 homicides in 2023, described by Freedom House as “the second-highest number on record”. The vast majority of these killings are attributed to organised criminal groups involved in the drugs trade and gang violence. Freedom House gives the personal safety score a rating of 2/4, characterising the country as one where “organised crime contributes to high levels of violence”.

The homicide rate translates to approximately 37.6 per 100,000 population — a rate that places Trinidad and Tobago among the highest in the Western Hemisphere. The International Crisis Group and other regional analysts have documented the entrenchment of criminal gang structures, their penetration of state institutions, and the climate of fear that pervades many communities, particularly low-income urban areas.

Police Corruption

Freedom House gives corruption a score of 2/4, specifically noting that corruption “persists, especially within the police force and among high-ranking government officials”. The Trinidad and Tobago Police Service (TTPS) has been the subject of sustained criticism from civil society organisations, oversight bodies, and international human rights monitors for endemic corruption, use of excessive force, extrajudicial killings, and lack of accountability.

The Police Complaints Authority (PCA) provides a formal mechanism for complaints against officers, but its effectiveness is constrained by capacity limitations and the structural relationship between the investigative body and the institution it oversees. In the trafficking context specifically, the 2024 US TIP Report documented ongoing investigations involving police officers who remained in their positions without administrative sanction pending investigation — demonstrating that accountability mechanisms are non-deterrent.

Extrajudicial Killings and Use of Force

Human rights organisations, including Amnesty International, have documented concerns about extrajudicial killings and excessive use of force by the TTPS. Reports by the UN Special Rapporteur on Extrajudicial, Summary or Arbitrary Executions have noted the problem of police killings in the Caribbean region, and Trinidad and Tobago has featured in country-specific observations. The Inter-American Commission on Human Rights (IACHR) has received petitions involving Trinidad and Tobago related to excessive force, detention conditions, and the rights of minorities and vulnerable groups.

4. State Protection for Vulnerable Groups

LGBT+ Individuals

The state of Trinidad and Tobago criminalises consensual same-sex conduct (Sexual Offences Act, Chapter 11:28, ss 13 and 16), offers no anti-discrimination protection on grounds of sexual orientation (Equal Opportunity Act 2000, Chapter 22:03), and has failed to enact any legislative measure to protect LGBT+ individuals from violence or discrimination. The state is not merely a passive bystander to discrimination — it is the active agent of criminalisation.

For an LGBT+ individual who reports harassment, violence, or discrimination to the police, the following risks arise: (1) the very act of reporting may involve disclosing same-sex conduct, which is itself criminalised; (2) the absence of legal protections means officers have no legal framework compelling them to take the complaint seriously; and (3) documented cases of police corruption and institutional hostility towards LGBT+ individuals make them particularly vulnerable to secondary victimisation upon engagement with the police.

Trafficking Victims

State protection for trafficking victims is analysed in detail in the companion expert report on human trafficking. In summary: the state has documented complicity by Coast Guard and police officers in trafficking crimes; the victim identification and referral system is characterised by the US TIP Report as “weak and inconsistent”; the state has deported trafficking victims for acts committed as a consequence of their trafficking; and only 2 convictions have been secured in 11 years under the Trafficking in Persons Act.

Refugees, Asylum Seekers, and Non-Nationals

Trinidad and Tobago is a destination and transit country for migrants, particularly from Venezuela. The country is not a signatory to the 1951 Refugee Convention. There is no domestic asylum law. Refugee status determination is conducted by the UNHCR Trinidad and Tobago office under its mandate, and “letter of protection” holders have limited formal rights.

Freedom House notes that “the government struggled to provide adequate asylum systems” and that Venezuelan refugees faced ongoing threats of deportation. Amnesty International has raised concerns about the deportation of Venezuelan nationals from Trinidad and Tobago, including individuals who may be at risk in their country of origin, and about the conditions of immigration detention. The UNHCR has called on the government to accede to the Refugee Convention.

5. The Healthcare System of Trinidad and Tobago

Structure of Public Healthcare

The public healthcare system of Trinidad and Tobago was devolved from the Ministry of Health to five Regional Health Authorities (RHAs) pursuant to the Regional Health Authorities Act 1994. The RHAs operate primary care facilities (Health Centres), secondary hospitals, specialist tertiary hospitals, and a quaternary hospital (the Eric Williams Medical Sciences Complex). For Trinidad and Tobago citizens, public healthcare is provided completely free of charge at all levels of the system.

The Chronic Disease Assistance Programme (CDAP), introduced in 2005 and administered through the Ministry of Health, provides free prescription medications for ten chronic conditions — including diabetes, hypertension, asthma, cardiac disease, arthritis, epilepsy, and mental health conditions — at over 250 community pharmacies. This programme significantly expands access to treatment for chronic illness for citizen populations.

Health Indicators

Key health indicators for Trinidad and Tobago include: life expectancy at birth of 73.6 years (2024); public health expenditure of 3.32% of GDP (2021), representing 11.07% of total public expenditure; out-of-pocket health spending of 45.97% of total health spending (2021); and 100% of births attended by skilled personnel (2022). The country’s predominant health burden comprises non-communicable diseases, accounting for over 60% of all deaths.

Despite these formal indicators, the healthcare system faces structural challenges. PAHO has documented an imbalance between oversupply of medical interns and undersupply of specialist doctors. Waiting times at public hospitals are prolonged. The high proportion of out-of-pocket spending (45.97%) suggests that significant costs fall on individuals despite the formal public healthcare provision, reflecting the burden on the private sector for specialist and elective care.

6. Healthcare Access for Non-Nationals, Asylum Seekers, and Returning Migrants

Formal Exclusions from Free Healthcare

The free public healthcare system in Trinidad and Tobago is restricted to citizens and, in some respects, to permanent residents. Non-nationals face the following formal exclusions from the free healthcare system:

• HIV/AIDS antiretroviral medication (ARVs) is not provided free of charge to non-nationals
• Cancer treatment and chemotherapy are not available free of charge to non-nationals
• Chronic disease medications under the CDAP are not available to non-nationals
• Dialysis for renal failure is not available free of charge to non-nationals

Non-nationals may access emergency care at public hospitals, but the absence of coverage for ongoing medication and specialist treatment means that individuals requiring long-term treatment for HIV, cancer, or chronic disease face substantial ongoing costs.

HIV Treatment for Non-Nationals

HIV testing and counselling is available for a reduced fee through the Family Planning Association of Trinidad and Tobago, which provides services to both nationals and non-nationals. The UNHCR office in Trinidad and Tobago and the NGO Living Water Community provide limited assistance to refugees and asylum seekers in accessing healthcare services. However, access to antiretroviral therapy — the lifesaving medication required for HIV-positive individuals — is not guaranteed for non-nationals and must be self-funded or sourced through NGO support, which is constrained in scope.

For an HIV-positive individual who is a non-national and who returns to Trinidad and Tobago, the cost of antiretroviral therapy without state subsidy represents a significant financial barrier. The WHO estimates that the cost of first-line ARV regimens in middle-income countries is between USD 100 and USD 500 per person per year. In a context where many returnees may lack formal employment and stable income upon return, this cost is likely prohibitive.

Refugees and Asylum Seekers’ Healthcare Rights

UNHCR has confirmed that asylum seekers and refugee status holders in Trinidad and Tobago have the right to seek assistance in accessing public healthcare, but this right is not supported by a domestic legal framework and depends on the discretion of UNHCR and NGO intermediaries. Persons with a UNHCR “letter of protection” are in a legally precarious position: they have no domestic legal right of residence, no entitlement to work authorisation, and no guaranteed access to public services, including healthcare.

7. Structural Barriers to Healthcare Engagement

Fear of Disclosure and Stigma

Even for citizens entitled to free healthcare, structural barriers to engagement are documented for members of marginalised groups. For LGBT+ individuals, the criminalisation of same-sex conduct (as restored by the Court of Appeal in March 2025) creates a legal context that discourages disclosure of sexual orientation to healthcare providers, particularly those working in the public sector. Healthcare workers are not subject to a specific legal obligation of confidentiality as regards the sexual behaviour of patients, and the social climate of stigma and discrimination creates well-founded fear of secondary harms from disclosure.

The peer-reviewed evidence from Trinidad and Tobago directly supports this conclusion: a study of 9,629 persons living with HIV at a major treatment centre found that MSM achieved viral suppression at 65.4%, compared with 72.5% for heterosexual patients, despite both groups having access to the same free antiretroviral therapy. The differential suppression rate, controlling for cost, demonstrates the operation of non-financial barriers to treatment engagement among LGBT+ individuals.

Barriers for Trafficking Victims

Trafficking victims face intersecting barriers to healthcare access. The physical and psychological injuries sustained during trafficking may require specialist medical and psychological care that is not readily available in the public system. Foreign national victims face exclusion from free chronic disease and HIV treatment. The documentation of police involvement in trafficking crimes creates a well-founded fear of approaching state institutions, including public health facilities where personal information would be disclosed.

Mental Health Services

Mental health services in Trinidad and Tobago are concentrated in the St. Ann’s Hospital psychiatric facility. Community-based mental health services are limited. The available evidence indicates that persons returning from situations of trafficking, persecution, or prolonged exposure to violence face significant post-traumatic stress, anxiety, and depression, and that adequate specialised mental health care is not accessible in the public system for the majority of returning persons in need.

8. Analytical Assessment

Trinidad and Tobago occupies an unusual position in the comparative assessment of country conditions for protection claims. It is formally classified as a “Free” democracy with functioning institutions, an independent judiciary, and free elections. These features distinguish it from failed or fragile states and require that the analysis engage carefully with the specific evidence of systemic failure, rather than relying on generalised assessments of instability. The case against the availability of effective state protection in Trinidad and Tobago must be made with reference to documented, specific, and structural features — and that evidence, when examined, is compelling.

First, as regards state protection: the formal constitutional framework does not translate into effective protection for the specific categories of individuals who generate protection claims. For LGBT+ individuals, the state is itself the agent of criminalisation — the Court of Appeal’s March 2025 decision restoring the buggery and serious indecency provisions means that approaching the police carries the risk of self-incrimination. For trafficking victims, documented Coast Guard and police complicity in trafficking crimes, a 3% conviction rate over eleven years, and the state’s own practice of deporting victims for acts arising from their trafficking collectively establish that the state protection framework is not effective in practice. For asylum seekers, the absence of any domestic asylum law and Trinidad and Tobago’s non-accession to the 1951 Refugee Convention mean there is no formal legal protection mechanism available under domestic law. The Freedom House scores of 2/4 for both due process and personal safety — in a country rated “Free” overall — illustrate the gap between the formal classification and the lived reality for vulnerable individuals.

Second, as regards healthcare access: the provision of free universal healthcare to citizens is a genuine and significant feature of the country situation, and it is important that it is accurately represented. However, this provision is subject to formal exclusions that are directly material to the categories of persons who most commonly generate protection claims. Non-nationals — who constitute 99% of identified trafficking victims — are excluded from free HIV antiretroviral therapy, cancer treatment, CDAP chronic disease medications, and dialysis. The cost of ARV therapy for an HIV-positive non-national without stable employment is, on the WHO’s own figures, likely prohibitive. And even for citizens, the evidence of structural barriers is not anecdotal: the peer-reviewed study finding that MSM achieve viral suppression at 65.4% compared to 72.5% for heterosexual patients at the same free treatment facility, controlling for cost, is direct evidence that formal availability of treatment does not produce equal access in practice.

Taken together, the evidence indicates that a person from a vulnerable group — whether an LGBT+ individual, an HIV-positive person who is a non-national, or a trafficking victim — who is returned to Trinidad and Tobago cannot reasonably be expected to obtain effective state protection from the risks they face, nor can they be expected to access adequate healthcare without encountering structural barriers, financial costs, or both. In my opinion, the country conditions evidence described in this report meets the threshold required for an adverse country information assessment in the context of protection claims under the 1951 Refugee Convention, the 1967 Protocol, and international human rights law including Article 3 of the European Convention on Human Rights.

9. Sources