Access to healthcare in Europe in times of crisis and rising xenophobia

1. Access to healthcare in Europe in times of crisis and rising xenophobia Doctors of the World Workingwith people facing multiple factors of vulnerability

2. Destruction of Healthcare System in Spain • Royal Decree-Law 16/2012 on “urgent measures to ensure the sustainability of the national health system” • €7,000 millioncuts

3. Destruction of Healthcare Systems • Introduction or raise of out-of-pocket payments (Spain, Portugal, Greece) • Spain: Exclusion of adult undocumented migrants. In practice, even some pregnant women and children have been excluded… REALITY Universal healthsystem Basedonwork

4. WHAT INVOLVED RDL Humanrights: UNFAIR 6 Untrueideas abouttheSpanish RDL Migrantsovercrowdprimarycare Migrants= healthcaretourists. Healthsystemisonlyfinancedbywork-relatedtaxes. Undocumentedmigrants do notcontributetoHealthSystemsustainability Theexclusionisneededto converge withEurope Thisreformwillconsolidatetheexpectedbudget. Economical: INEFFECTIVE Public Health: DANGEROUS Medicalethic: INCOHERENT

5. Destruction of HealthcareSystemsdespite the fact that… • Health is a basic human right • Exclusion is a costly and ineffective policy tool • In contradiction with medical ethics • Inefficient and dangerous from a public health perspective

6. Severe cuts in health – Greece • Troikaimposedcuts : healthcosts < 6% of GDP (MoU) (expected€2·122 billion cuts by 2015) • 5€ entrance fee in hospitals • Shortage of medical supplies and drugs • Parents cannotpaytheirchildren’s vaccination anymore • Foreignersshouldpay double price • 26 000 public health workers (up to 9100 doctors) could lose their jobs by 2015

7. Severe cuts in healthcare – Spain - 22% of cuts in 2013 (more thananyothersector) - Creeping privatisation of health care providers - Increasedout of pocketpayment for medicines - Froma universalsystem to limitedbeneficiaries

8. Severe Cuts in Health - Portugal • €670 million savings (MoUTroïka - Portugal) • higher user fees but a larger part of the population has the right to exemption of co-payment • Lack of knowledgeconcerning the possibility of exemption especiallyhomelesspeople • Undocumentedforeigners have to pay 100% of the costs

9. Direct impact on Health • Greece - 30 to 40% rise in suicides - 51% of MdM patients have a (very) bad perceived mental health in 2012 - 49% of the patients seen are Greeks now (88% in Perama) - % of vaccinated kids go down - Rise in the number of drug users, spreading of very dangerous cheap drugs, constant rise of HIV contamination among Greek drug users • Spain - closure of health-care services - reductions in the number of hospital beds and working hours - women and children often don’t access care in real life - 53% rise in childrenpoverty (2007-2010 Unicef) - death of Alpha Pam, 28 years old… • Portugal - Isolatedelderly situation isworsening in times of crisiswhenfamiliescan’t help - increase of people looking for healthcare at MdM programmes - destitute cannot afford to pay for medicines: MdM has to supply them (13% of elderly renounce to medicines)

10. Direct impact on health Other key figures (MdM 2012 survey 14 cities in 7 countries DE, BE, ES, FR, EL, NL, UK) • 81% of patients had no possibility of accessing care without paying full costs • 55% of the patients who were EU citizens were not permitted to reside in the host country • 59% of pregnant women did not have access to antenatal care when we met them (“only” 46% in France) • 60% of all patients did NOT know where to go to get vaccinations • Over 50% of the patients in need of essential treatment hadn’t had any before MdM • Of the reasons given for migration, personal health reasons represented only 1,6% and lack of knowledge on how to access care is the main barrier… Health tourism is a myth.

11. Direct impact on the health of children • Lack of access to vaccinations in Greece (costs) and all EU countries (1/3 no vaccine or don’t know) • Most EU countries go against interests of children treating them as UDM • Increasing housing difficulties – 49% of MdM patients had unstable or temporary housing  negative impact on children’s health & development

12. MdM response • In Greece, MdM doubled the programs (homeless, polyclinics, elderly, shelters, mobile units, migrants…) • In Spain: large campaignagainstthe destruction of the public health system (derecho a curar) • In Portugal: more programs withdestituteelderly + givingmedicines to NGOs and MdM patients

13. Rise of Xenophobia • Scapegoating of foreigners in Spain, Greece, the UK, etc. • Some high levelpoliticians (Cameron in UK, HealthMinistry EL, Copé in FR…) stir the hatred up and use the MYTH of healthtourism • Racist violence recording network in Greece: 154 racistattacks in 2012…+ over 70% of the violence suffered by migrants occuredafterarrival (MdM Patras EL 2011)

14. Golden Dawn initials and logo carvedinto MdM patient’s backphoto: GiorgosMoutafis

15. MdM demands • Eachhumanbeing MUST have an equalaccess to care in EU public open healthsystems • In times of crisis, more protection and not less • In times of crisis more humanrights and more protection againstxenophobic violence (EL) • Protection of seriouslyillundocumented migrants: wecannotacceptdeathsentence based on administrative decisions • General mobilisation againsthate speech and destruction of solidarities