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.
The right to health
Under international human rights law, states must ensure the right to health. This also requires states to address living conditions that affect health. All of this must do done in a way that does not discriminate against people based on their nationality or visa status.
In reality, however, people’s ability to access the health care they need depends on their visa or residence status.
Health systems across Europe are very different, but 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 that everyone living in Europe can access care.
Undocumented migrant’s use of health services
Even in countries where health services are available as a matter of law, there are many administrative and other practical barriers that can prevent people who are undocumented from receiving the care they are entitled to. They may fear denounced to the authorities or receiving large bills they cannot pay as a result of accessing services. They may also be incorrectly denied care and turned away because of complicated and inconsistently applied rules or due to a lack of awareness among administrative personnel in hospitals.
As a result, people who are undocumented often do not use even the health services they are entitled to. When they do access health services, it is often late, in emergencies.
The local reality
A growing number of regional and local governments facilitate greater access to health services for undocumented migrants than what is provided for under national law. Some do this by enacting progressive regional laws and policies. Others work in partnership with volunteers and public interest organisations and clinics to find pragmatic solutions. In some countries, consultations organised through such partnerships are the only possibility for people without status to get health care without risking being reported.
Whatever the legal situation, medical professionals are often important partners in addressing gaps and upholding their professional duty to serve all patients on the basis of need.
Why linking access to health care to residence status is a problem
Limiting access to health care based on residence status hurts individuals and communities. People unable to access the health system are deprived of comprehensive information about prevention and promotion and can therefore not properly manage health-related risks.
Health care providers are also often the first points of contact for people who have experienced violence. They provide an essential connection with other key services and supports, including access to justice. Linking health care and residence status also puts health providers in the position of compromising their medical ethics and human rights principles.
Shutting people who need care out of the health system can have disparate effects on children, who may be unable to go to school without vaccinations; on women, who cannot benefit from gynecological screenings without access to primary health care; and others, like people with disabilities or chronic conditions, whose condition can worsen irreversibly without early and appropriate attention.
This means that treatable, even preventable, conditions are unaddressed until it may be too late, which is costly for the individual as well as for the health system.
For legal, medical, financial, ethical and practical reasons, providing health care services to all residents, regardless of status, is beneficial, practical and necessary.
- Reform laws and policies that limit access to health services on the basis of a person’s visa or residence status, and reduce administrative barriers to accessing services.
- Clearly detach service provision from immigration control by creating a ‘firewall’ between health care services and immigration control. This means prohibiting immigration enforcement actions near health facilities and the sharing of personal data between the health system and immigration authorities.
- Work in partnership with health and migrant organisations to find pragmatic local solutions to address gaps in law and practice, while calling for long-term and sustainable reforms.
- The European Union should promote rights- and evidence-based policy dialogue among member states, the exchange of promising practices, and coherence with health objectives across all relevant EU policies.
CONTACT: Alyna Smith