PICUM REPORT Access to Health Care for Undocumented Migrants in Europe by Eve Geddie 13th February 2008

1. PICUM REPORTAccess to Health Care for Undocumented Migrants in Europe by Eve Geddie 13th February 2008

2. NGO that aims to promote respect for the human rights of undocumented migrants within Europe • Over 180 members in approx. 20 countries • Research, advocacy, awareness raising and capacity-building activities • Givingvisibility to the reality of undocumented migrants • Bringing undocumented migrants to policy agendas (at national and at EU level)

3. UNDOCUMENTED MIGRANTSHAVE RIGHTS! Many people think that undocumented migrants have no rights since they are living without permission to legally reside in a country which is not their own THIS IS A MYTH ! PICUM promotes respect for the basic social rights of undocumented migrants.

4. Undocumented Migrants • Without residence permit: unsuccessful asylum process visa over-stayers entered irregularly • Estimates in Europe – up to 8 million? • NO income and NO access to basic social services • They are invisible to policy makers and this creates an enormous strain on local actors • Clashes between professional ethics and incriminatory discourse

5. Access to Health Care for Undocumented Migrants in Europe • PICUM 2 year Project co-funded by the European Commission • 11 Countries • 19 Partners • Field trips: 250 people involved 92 individual interviews 7 networking meetings • Results: International Conference124 page ReportReporting tools (9 languages)

6. PARTNERS LOCAL AUTHORITIESresponsible for public health and implementing legislation at the local level 2.NGOs witnessing barriers in state health servicesand are often left alone to fill the gaps 3.HEALTH CARE PROVIDERSethical obligation of providing care to those in need COUNTRIES Austria Belgium France Germany Hungary Italy Netherlands Portugal Spain SwedenUnited Kingdom Project Overview

7. Project Objectives • Improve access to health care for undocumented migrants • Map the situation in eleven countries • Improve the methodology for data collection • Target undocumented migrants in the European Social Inclusion – Social Protection Process • Support and multiply good practices and partnerships at local level

8. Report Structure I. INTRODUCTION II. COUNTRY PROFILES • General health care system • Health Care for undocumented migrants - legal entitlements - situation in practice • Role of Civil Society and Local Actors(highlighting good practices) III. POLICY RECOMMENDATIONS

9. Summary of Findings • National competence • Lack of compliance with international obligations • No member state’s legislation specifically forbids access • HOWEVER, publicly subsidised health care is NOTentirely guaranteed in Europe • Health care, instrument of immigration control policies • Increasingly restrictive

10. Undocumented Migrants Legal Entitlements • many differences regarding legal entitlements • entitlements need more publicity • relevant actors not familiar have difficulties to describe entitlements • lack of clear cut definitions • some countries lack specific legislation

11. Categorisation of Countries 5 DISTINCT SITUATIONS • Wide public health care coverageSpain, Italy • “Parallel” administrative systemsFrance, Belgium, Netherlands • Wider coverage but legislation unclear and ambiguousUK, Portugal • Free health care in very limited casesHungary, Germany (entitlements over-ridden by duty to denounce) • All care provided only on payment basisAustria (exception: TB), Sweden (some exceptions: children)

12. Implementation at regional / local level • High decentralisation of competences • Gaps between law and implementation and differences of implementation and interpretation • Complicated procedures and bureaucracy • Lack of information • Frequently, enforceability depends on NGO pressure or mediation

13. Formal and informal networks • Insufficient access has boosted networking at local level • High recurrence to informal networks (sometimes, public authorities also involved) • Many partnerships at local level: local authorities, NGOs and hospitals

14. Undocumented migrants’ use ofhealth care services • They mainly seek health care when they are seriously ill.Survival is the priority • For them, a worsening of health status is more likely to occur(poor access and insecurity) • A high percentage do not access health care even if entitled • Most frequently, they go to NGOs’ clinics or to the emergencysystem • Many of them are unable to pay medical fees

15. Enormous pressure on civil society • Filling the gaps of the mainstream system and correcting failures • General shortage of human, technical and financial resources • Sometimes under high pressure from public authorities(e.g. Germany and Austria) • Many undocumented migrants rely on them • In some countries, NGOs and religious hospitals are the only providers of health care to undocumented migrants

16. Policy Recommendations • Comply with international obligations and therefore, progressively guarantee that the right to the highest attainable standard of physical and mental health is guaranteed to all • Address health needs of vulnerable undocumented migrants equally and on the same basis as for comparable national population • Take necessary measures to guarantee entitlements to health care are uniformly implemented by regional and local authorities • Ensure information about entitlements is accessible to all actors and eliminate all practical barriers • Detach health care from immigration control; patient related medical confidentiality should not be undermined by direct or indirect reporting mechanisms

17. Policy Recommendations • Civil society should only have a complementary role, the ultimate responsibility for providing health care rests on the national government. • Member states should not criminalise civil society for providing health care and health related assistance • Member states and EU institutions should include undocumented migrants in European Social Inclusion – Social Protection Process • Civil Society should increase involvement in consultation processes to inform authorities and policy makers about barriers encountered by undocumented migrants in accessing health care • Ratify & implement the International Migrant Workers ConventionRight to receive ‘urgently required’ medical care ‘on the basis of equality of treatment with nationals’ and such care ‘shall never be refused…by reason of any irregularity with regard to stay or employment’

18. END CONCLUSIONS • Despite the efforts made by civil society, many undocumented migrants are not accessing care or accessing it too late • New strategies and actions needed to continue addressing the problems of insufficient access • States must take on their responsibility and comply with their obligations and not continue relying on civil society as an alternative provider of health care.

19. END THANK YOU FOR YOUR ATTENTION. For more information please visit www.picum.org Send comments and queries to info@picum.org