On 26^th November 2024, the Swedish government presented the findings of a public inquiry outlining how a potential new law could oblige some public sector workers to denounce undocumented people they come in contact with to the immigration authorities.

According to the inquiry, the Swedish government should oblige the following governmental agencies in Sweden to automatically report undocumented people to the Police Authority as they come in contact with them: the Public Employment Service, Social Insurance Agency, Prison and Probation Service, Enforcement Agency, Pensions Agency and Tax Agency. The Swedish police may then pass on the information to the Migration Agency or the Security Service. It also proposes that the Swedish Economic Crime Authority and the Prosecution Authority should be obliged to provide information upon request from an enforcement agency.

The inquiry proposes exemptions for health services, schools and social services.

The government’s initiative to launch this public inquiry (included in the government’s coalition programme) had been heavily and widely criticised by several actors, including university teachers, welfare professionals, health care workers, teachers, municipal workers and library staff.

All denounce that mandatory reporting would lead to discrimination and stigmatisation, and fuel growing racism. Public workers would have to act as border guards and compromise their professional independence and integrity.

The public inquiry may form the basis of a new law proposal by the Swedish government in the next months.

Michele LeVoy, Director of the Platform for International Cooperation on Undocumented Migrants, said: “Contrary to the inquiry’s claims, reporting obligations always have significant and harmful consequences for both individuals and society. At a minimum, they foster a climate of fear and hostility, undermining trust in public institutions, while violating Sweden’s human rights commitments. Exemptions will not mitigate these harms. We stand with national partners in urging the Swedish government to reject this reporting obligation and protect the principles of human rights.”

John Stauffer, acting Executive Director at Civil Rights Defenders, said, “Despite exemptions, this proposal risks fueling the fear of being reported, which is already today prevents undocumented migrants from accessing their rights. Rights must be accessible in practice. Realising the right to health, education, housing, protection, and an adequate standard of living requires that people feel able to claim their rights without fear.”

Hannah Laustiola, Executive Director of Doctors of the World Sweden, said, “While we are relieved that there is no proposal of a reporting obligation for health care personnel, the risk for negative consequences of a reporting obligation remains as long as there are institutions bound by the obligation. On the one hand, there is a risk that undocumented migrants, who already live in fear of deportation, will not be reached by the information that their right to health care is unchanged, and on the other hand, we see that the mere proposal of such a law has rendered public servants prone to act in violation of existing laws of classified information and the right to health.”

Ulrika Modéer, Secretary General of the Swedish Red Cross, said, “We welcome that schools, healthcare, and social services are not included in the obligation to provide information in the presented proposal, but some damage has already been done. But we must analyse further what it means that the Swedish Tax Agency will be obliged to provide information to the Police Authority, and what the Agency’s relationship to local social services will mean for victims of domestic violence. The government’s earlier lack of clarity in specifying the directives of the investigation has created fear among undocumented individuals, undermining trust in public institutions and civil society. Many avoid seeking help, which particularly impacts already vulnerable women and children.”

Jacob Lind, Postdoctoral researcher in international migration at Malmö University, said, “Much harm has already been done as the proposal has impacted the trust undocumented migrants have in society. A handful of public authorities, such as the tax and pension authorities, will now have a duty to report and this can still have implications for migrants’ access to their human rights. The main problem is that this new proposed legislation makes it easier to extend the list of authorities at a later stage with less work. The most positive takeaway from this is that collective mobilisation works. The politicians were telling the unions, civil society and other critics to wait for the investigation and then come with their criticism. But if the critics had listened to this and not resisted already before the investigation was published, it could have had a very different outcome.”

The Finnish right-wing government is set to table a draft law that restricts access to public health care for undocumented people in Finland.

According to this proposal, undocumented people would be barred from accessing non-emergency health care, with few exceptions.

Should this become law, conditions like diabetes or asthma could be left untreated, with serious risks for the person and higher chances that they will end up in emergency care in the future.

The proposal, tabled by the right-wing Orpo government, seeks to overturn a 2023 law that had allowed undocumented people to access necessary care beyond emergency situations. Necessary care was defined as any care deemed necessary by a health professional.

The limited exceptions foreseen in the new proposal fail to provide meaningful protections.

While children would retain full access to health care, their undocumented parents or other caretakers would not, which in turn would strongly impact on children’s health.

People who are in an “extremely vulnerable position regarding their health” would still get access to health care, but no clarity is given as to who this concerns and how this would be evaluated.

Other limited exceptions would be made for pregnant women, people with disabilities, and for vaccinations and treatments against certain infectious diseases that are deemed to pose a risk to public health.

Outside these limited exceptions, people would risk finding themselves with untreated conditions and ultimately in life-threatening situations.

Quotes

Aino Tuomi-Nikula, Advisor, Physicians for Social Responsibility, said, “Those who tabled this proposal pretend that we don’t have enough money for everyone and that full access to health care would invite more people to Finland. We know this is not true, and that it’s actually cheaper to treat conditions in advance by primary health care than leaving them to emergency care. This measure is a political stunt to crack down on marginalised people and bank on public fears of migrants.”

Louise Bonneau, Advocacy Officer, Platform for International Cooperation on Undocumented Migrants, said, “Healthcare is a basic human right, not a privilege reserved for some. This law, if passed, would lead to suffering and betray Finland’s commitment to equality and justice. It must be rejected.”

Dr Christiaan Keijzer, President of the Standing Committee of European Doctors (CPME), said “A discriminatory healthcare policy can only further endanger public health. We stand by the position of the Finnish Medical Association that adoption of this law would contradict fundamental medical ethical principles and would only serve to increase the overall cost to health services by limiting access to necessary care.”

Kirsi Marttinen, Senior Adviser, SOSTE Finnish Federation for Social Affairs and Health, said, “The bill would weaken the constitutionally guaranteed right to necessary care and adequate health services. It would undermine the right to health without discrimination, as secured by international treaties, and goes against other government initiatives to combat racism and promote equality. The proposal itself is based on the wrong assumption that healthcare rights act as a pull or retention factor—there is evidence of precisely the contrary, and it’s concerning when flawed economic arguments become a reason to curb fundamental rights.”

Michelle Gripenberg-Wik, Refugee Advice Centre (Pakolaisneuvonta ry), said, “The right to health is a fundamental and human right that belongs to everyone despite their residence status. Providing only urgent care is not enough to secure this right which Finland has agreed to respect through international agreements. International human rights treaty bodies have even previously criticized Finland for only providing urgent health care for undocumented migrants. The suggested law is very problematic and breaches international human rights obligations.”

Notes to the editors

• This draft law was to be presented to the Finnish Parliament in the week starting on 23rd  September 2024 but this was later delayed. It was first published on 12 June 2024 and subjected to a public consultation until 24 July 2024. Physicians for Social Responsibility submitted their statement (in Finnish) here.
• After its presentation to the Finnish Parliament, the draft law will be sent to the competent parliamentary committees (the Finnish Parliament has only one chamber).
• The cost of necessary care for undocumented people in Finland has been estimated to be approximately 300,000 euros (the reference is the draft law published on the Finnish Official Journal), a drop in the wellbeing service counties’ 24 billion euro budget (data from the government).
• More information about the current 2023 law can be found in this blog.

Campaigners in Italy are fighting immigration detention by asking doctors to stop declaring anyone fit for detention. We spoke to Nicola Cocco of the Italian Society for Migrations’ Medicine to know more.

In Italy, sending a person to an immigration detention centre requires a doctor’s certificate proving that they are “fit for detention” (conditions are regulated by a 2022 ministerial directive). Often, this certification is done at the emergencies by overworked doctors, with little time and no serious medical check-up. The exam typically lacks the person’s consent and is not accompanied by a cultural mediator. The result is that doctors often merely certificate that the person does not have communicable diseases.

Most times, police are present for the whole duration of the exam. In some cases, the doctors performing the “fit for detention” exam are hired by the immigration detention centres themselves.

At the start of 2024, civil society organisations led by the Italian Society for Migrations’ Medicine (Società Italiana di Medicina delle Migrazioni, SIMM), the network “No More Lager” (Mai più lager – No ai CPR), and the Italian Association for Legal Studies on Immigration (Associazione per gli Studi Giuridici sull’Immigrazione) launched a campaign to stop doctors from declaring people “fit for detention”. In this campaign, the associations link the health risks of immigration detention with the ethical risks faced by doctors when sending someone to a place of harm.

The immigration detention centres are often unhealthy places, where broken windows, lack of hot water and dirt are commonplace. Besides the negative effects on the physical health of the people detained, the confinement and lack of activities weigh on their mental health too. For many, the harms of immigration detention add to those experienced during the migration journey.

Immigration detention centres are closed institutions, where every aspect of the life of detained people is controlled by others, and where no perspective of release is known to the person in detention.

“The only possible reaction to this environment is violence” said Cocco, “Violence from detention guards. Violence from health care personnel, which often overly prescribes psychotropic drugs. Violence from people in detention against themselves, from self-harm to suicide”.

Deportations are also violent practices. Typically, they would happen without notice, during the night, at 4 am. Police would enter the cell in riot gear and give the person 10 minutes to throw their few possessions into a garbage bag, less than 10 minutes to call a loved one. The person undergoes a quick “fit to fly” visit and are brought to the airplane.

“The point is, is it ok for a doctor to approve that a person be sent to a torturing environment?” said Cocco.  

So far, 40 to 50 doctors have adhered to the campaign, which have collectively avoided that about 100 people be sent to immigration detention. Regional medical associations have not yet responded to the campaign, leaving the ethical burden on individual doctors.

However, the national committee currently reforming the medical code of ethics has proposed to include a clause whereby doctors cannot be requested to declare a person “fit for detention”.

Stopping the “fit for detention” certificates would mean that thousands of people would be spared the suffering of immigration detention. It would save the professional dignity and ethics of doctors. And it would send a strong message to the institutions against the legitimacy of immigration detention.

In June, the network “No More Lager” (Mai più lager – No ai CPR) launched a petition targeted at health care professionals calling for the closure of immigration detention centres across Italy.

But Europe is going in the opposite direction. The EU Migration Pact is thought to lead to the detention of 70-80,000 people every year, especially at the borders, where it is harder to check abuse and respect for safeguards. The Italy-Albania deal (which would see Albania hosting people rescued at sea by Italian authorities for the examination of their asylum claims) poses serious doubts as to how people with vulnerabilities will be treated and makes rights’ monitoring extremely difficult.

In Germany, a 1990 law obliges most public sector workers to report undocumented people to migration authorities. We spoke to Sarah Lincoln from Gesellschaft für Freiheitsrechte (Civil Liberties Association) to know more about this law and what civil society is doing to have it repealed.

Paragraph 87 of the German Residence Act forces any public authority, including social welfare offices, police, and courts, to report undocumented people they come in contact with to immigration enforcement.

The only exception to this rule was carved out in 2011 for schools and kindergartens.

What this obligation means in practice is that undocumented people avoid any contact with public authorities. They do not go to the police to report abuse or seek justice in courts. Many do not even go to the doctor or end up seeking care only in life-threatening situations.

When it comes to health care, the picture is complex: while undocumented people have a right to limited health care on paper, reporting obligations prevent them from accessing it.

According to the Asylum Seekers Benefits Act, undocumented migrants are entitled to limited medical services in the event of acute illnesses or painful conditions as well as during pregnancy and childbirth. Doctors are not obliged to report undocumented patients because they are not public workers (the German health care system is based on private insurances) and are therefore not covered by the Residence Act.

In fact, doctors are not permitted to report undocumented patients because of a legal duty to confidentiality.

But there have been instances where hospital staff reported undocumented patients nonetheless.

And going to the doctor without an insurance, as is the case for undocumented people, often means paying high medical fees and long-term debt. While emergency life-saving care would be provided, the hospital would still claim medical fees in the absence of insurance.

Getting treatment covered by the state requires a person asking for a permission from the social welfare offices, which are obliged to report undocumented people to the police or the migration office.

“The person would probably not even be able to leave the office. Police would come and arrest them and then put them in immigration detention”, said Lincoln.

As a result, undocumented people do not apply for official health care. Some seek treatment through charities and medical students who provide limited health care for free, in many cases severe Illnesses remain untreated.

In one case, a person who came to Germany from the Balkans in the early 90s and later lost his status, was unable to get a heart operation to avoid a (second) heart attack. In another case, a woman from Northern Africa who had been living in Germany for years was diagnosed with late-stage breast cancer by volunteering doctors and found herself with no option to get treatment.

Official data about health outcomes for undocumented people not accessing health care is lacking. But reports from organisations providing free health care and testimonies show that stories like the ones above are commonplace.

Campaigners and advocates have been fighting this law for years. In 2011, they managed to carve out an exception for schools and kindergartens. Since 2021, a coalition led by Doctors of the World and the Gesellschaft für Freiheitsrechte has been campaigning against paragraph 87 of the Residence Act to allow undocumented people to access health care without risking immigration enforcement. The campaign is being supported by over 80 civil society organisations, with the German doctors’ association and German Churches also repeatedly criticising reporting obligations.

The UN Committee on the Elimination of Discrimination against Women noted in its 2023 concluding observations that Germany has no intention of repealing or amending section 87 of the Resident Act and called on Germany to reconsider its position.

In August 2021, Gesellschaft für Freiheitsrechte filed a complaint to the European Commission against paragraph 87 of the Residence Act, denouncing violations of the EU data protection rules (the General Data Protection Regulation) and the right to health care as enshrined in the EU Charter of Fundamental Rights.

While the German government assured that they were considering the complaint (the proposal was in fact taken up by the German government in their coalition programme), they eventually backtracked and on the contrary passed new cuts to social benefits for asylum-seekers, bowing to a political climate ever more hostile to immigration.

Advocates also pursued strategic litigation in German courts, not without challenges. For undocumented complainants, access to courts remains difficult given the court also has an obligation to report to the immigration authorities. And procedures often last too long compared to their urgent medical needs.

Gesellschaft für Freiheitsrechte is currently awaiting to hear about the outcomes of a second complaint filed to the Commission in April 2024.