People are being denied access to essential health services simply because they do not have the right paperwork to be in the country they live in. These are men, women and children that are residing, studying, working and raising families in Europe.

Denying them health care damages their health, the health of their families and communities. It violates human rights, public health principles and medical ethics.

Entitlements to access health services

Health systems across Europe vary significantly. However, European governments have identified common values and principles that underpin Europe’s health systems. These include universality, access to good quality of care, equity and solidarity. These principles and the functioning of health systems are undermined when there is no safety net to ensure all residents can access care.

In the majority of European Union countries, undocumented migrants are only entitled to access emergency care. In some of these countries, they may receive a bill for even this care. They may also be entitled to some services for contagious diseases.

There are nonetheless a number of countries that provide much broader subsidised health care coverage to undocumented migrants, or at least to pregnant women and children. In a few, this extends to a wide range of emergency, primary and secondary care services, to a near equal or equal level as nationals can access.

Undocumented migrants’ use of health services

There is a big gap between law and practice. There are many administrative and other practical barriers that can prevent undocumented migrants from receiving the care they are entitled to in practice. For example, they may be incorrectly denied care and turned away. They may fear – and risk – being denounced to the authorities or receiving large bills they cannot pay as a result of accessing services.

As a result, undocumented migrants often do not use even the health services they are entitled to. They access health services late, often in emergencies.

The reality at local level

Further, in many countries, regional and local governments provide more health services to undocumented migrants than what is provided by national law. Some are able to do this through regional laws and policies. Others find ways to provide care in practice. They often work in partnership with civil society. Whatever the legal situation, medical professionals strive to fill the gaps and uphold their professional duty to serve all patients on the basis of need.

Laws that limit health services for undocumented migrants have several negative effects: on health systems administration, regulation and finances; on individual, community and public health; on health care professionals and medical ethics; and on human rights.

For legal, medical, financial, ethical and practical reasons, providing health care services to all residents, regardless of status, is beneficial, practical and necessary.

PICUM’s recommendations

  • Reform law and policy that limits access to health services on the basis of residence status. This must include regulations to remove practical barriers to accessing services.

  • Clearly detach service provision from immigration control. There should be a ‘firewall’ between health care services and immigration control. A prohibition on carrying out immigration enforcement actions near health facilities or sharing personal data should explicit in law and implemented in practice. This should apply to all those involved in health services, including related administration.

  • Service providers at regional and local level should work with civil society to improve access to health services in practice. Local and regional authorities should provide services, medicines, funding, information and training to improve access to health services for all residents in their communities. They should work in partnership to call for high standards at national level and across Europe.

  • The European Union should promote high evidence-based policy dialogue, exchange of promising practices, and coherence with health objectives in all relevant EU policies. Inclusive and efficient health care provision for undocumented migrants in all EU member states across the European Union is necessary to achieve public health objectives, and can be better achieved through cooperation at European level. 

Sexual and Reproductive Health Rights (SRHR)

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