The COVID-19 vaccines and undocumented migrants in Spain

As part of our efforts to monitor access to the COVID-19 vaccines for undocumented migrants in Europe, we’re speaking with national-level advocates about the situation in their countries. This interview was conducted in July 2021 with Pablo Iglesias Rionda from Medicos del Mundo to discuss the situation in Spain. It is not meant to offer an exhaustive picture of the legal and practical context in Spain. Please get in touch at if you have information you’d like to share, and follow our Twitter page @PICUM_post to get more recent updates.

What does the Spanish vaccination strategy say about undocumented migrants?

The Spanish federal vaccination strategy explicitly mentions undocumented migrants and other marginalised populations as groups to be vaccinated. They’re not identified as a priority group, and the strategy doesn’t detail how to reach them. Several regional strategies, which implement the federal framework, equally mention undocumented migrants.

Let’s look at how the booking system works.

The mainstream booking systems are managed by the regions. In some regions, the local health centres call people who are registered in the regional health care database. In others, like in Madrid, the booking can be done via an app, but it still needs a valid health insurance number.

That’s where it gets tricky for some undocumented people.

Why some?

Since 2018, a law allows for access to health care to undocumented people who can prove that they’ve lived in Spain for at least 3 months, and that their country of origin doesn’t cover their medical expenses. If you’re undocumented and you can prove these two points, then you can get a health insurance number that grants you access to some health care, including the COVID-19 vaccines.

How easy is this?

It’s not. Many undocumented migrants aren’t able to prove these points. Proving that you’ve lived in Spain for at least 3 months is already quite challenging. The means of proof are regulated by the regions, and some ask for documentation which isn’t readily available to undocumented migrants. For instance, some regions ask for registration with a local municipality, which can be difficult to get if you don’t have a lease contract or other proof of residence. It’s really a chain of subsequent barriers, and you always need something to unlock the next one. And this is just the first point.

The second point, proving that your country of origin won’t cover your medical expenses, can be even more challenging. To prove this, you need to get a certificate from your country of origin, and for certain countries, this document is not provided by the embassy. So it means that you have to go back to your country of origin to get it, and then try to enter Spain again, with no more regular ways to get here than there were at the first attempt.

And then it’s not just undocumented migrants who face challenges in accessing health care, and the COVID-19 vaccines.

Do you have other groups in mind?

Yes, for instance those who arrive to Spain as part of family reunification. These are people who in principle would have a residence permit in Spain. Partners and children who come to Spain via family reunification are covered by public health insurance, but parents are not. As parents, they’re often older than the average, and at higher risk of developing strong COVID-19 symptoms. But they face greater hurdles to access the vaccination, since they wouldn’t be registered in the public health databases.

Are regions trying to reach out to undocumented people, beyond the mainstream booking system?

There are some good practices at the regional level. Most regions are proposing that NGOs like Medicos del Mundo act as a bridge between undocumented people and the health care system. At Medicos del Mundo, for instance, we have contacts of undocumented people we work with, so we provide their telephone number to regional health care authorities, who will call them and administer the one-dose Jansen vaccine in mainstream vaccination points. But we don’t have access to all undocumented people of course. So while this cooperation with NGOs is useful, it has to be complemented by broader outreach campaigns.

Are there any particular groups that would be harder to reach?

Well, for instance, undocumented people working in secluded areas like the fields in southern Spain. The regions should deploy medical teams to those areas. Then there are undocumented sex workers, and homeless people too. We’re asking the authorities to develop a protocol to reach these and other marginalised groups.

Are there any risks of immigration checks as a result of people accessing the COVID-19 vaccines?

No, our data protection framework has an absolute prohibition for immigration authorities to get and use personal data from health care providers. That said, media have recently reported that in Ceuta some hospitals have been calling the police when an undocumented person couldn’t provide proof of coverage for their health care.

Cover: Harrison Fitts – Unsplash