Rapport   European survey on undocumented migrant's access to health care

EDITORIAL

The European Union now has 27 countries. Some have long been prosperous, whereas others are emerging from decades of poverty and have briskly growing economies.The goal is to create a free-trade zone fostering the wealth of all, but it must include fighting against pockets of poverty and precariousness that are still too common. To do so the European Union has adopted several strong principles, including abolition of capital punishment and the right of all to the best health care. But those statements of intention must become reality.Today, the continent’s poorest and most vulnerable populations live in conditions that threaten their health and often exclude them from basic care. The various EU countries’ health care systems are still very different from each other. Not all of them can offer the same level of care, but the EU must strive towards that goal. Organising member states’ health care systems is not a European priority, although the fight against major epidemics (HIV, tuberculosis) and threats (bird flu) is.The fact cannot be overlooked that people in the most precarious situations are the most vulnerable to epidemics and the furthest outside the health care system. Neglecting to include the poorest populations in the health care improvement process would be fundamentally wrong in human, public health and financial terms. Foreign nationals, and in particular undocumented migrants, are among the poorest, most excluded and most discriminated against. That is why we wanted, through this survey, to examine their access to care in several EU countries both, in theory and practice. They must be given the possibility of becoming full-fledged citizens and stakeholders. Access to health care is an indispensable precondition for achieving that goal.The honour of the European Union, which is so strong because of its values, is at stake.

Health-Migration Steering Committee of the Médecins du Monde international network :
Dr. Michel Degueldre, president of Médecins du Monde Belgium,
Dr.Teresa Gonzalez, president of Médecins du Monde Spain,
Dr. Françoise Jeanson, former president of Médecins du Monde France,
Dr. Eleftheria Parthenopoulou, president of Médecins du Monde Greece.

Médecins du Monde, based on its medical practice and in total independence,

- draws attention to potential crises and threats to health and dignity in order to help prevent them,
- mobilizes partners for solidarity actions in the area of health,
- denounces, with the testimonials it gathers, infringements of human rights and in particular obstacles to health care,
- develops new public health approaches and practices around the world based on respect of human dignity,
- promises its donors to maintain totally transparent relationships,
- campaigns to lay the groundwork for the values of humanitarian medicine in accordance with an ethics of responsibility.
Médecins du Monde can now be found in 12 European countries1. In every one, the organisation is carrying out health projects aimed at vulnerable populations experiencing difficulty in accessing both prevention and care. MDM teams in
Europe work on a day-to-day basis with the Romas, homeless people, drug users, prostitutes, isolated people without financial resources, poor migrants with or without papers, children with lead poisoning, children without access to vaccinations, etc.

The Médecins du Monde European network’s first meetings concluded with high hopes because the European Union reaffirmed and extended the basic right to health care for everybody residing on its soil. Several European texts, such as the Convention for the Protection of Human Rights and Fundamental Freedoms and the European Social Charter, recognise the right of all persons to the protection of their health.

The European Convention for the Protection of Human Rights and Fundamental Freedoms has a universal scope. In other words, it must be applied to everybody living in one of the signatory states, regardless of nationality and legal residency status.
Thus, the European Court of Human Rights has laid down the principle of equal treatment between foreigners and nationals based on article 14 of the Convention.

• Article 14 – Prohibition of discrimination. The enjoyment of the rights and freedoms set forth in thisConvention shall be secured without discrimination on any ground such as sex, race, colour, language,religion, political or other opinion, national or social origin, association with a national minority,property, birth or other status.

Thus, when national law provides for a social service, all people are entitled to take advantage of it based on the principle of non-discrimination.
The European Social Charter offers protection in many areas, in particular social protection. A general nondiscrimination clause supplements the enjoyment of those rights.

• Article 11 – Everyone has the right to benefit from any measures enabling him to enjoy the highest possible standard of health attainable.
• Article 13 – Anyone without adequate resources has the right to social and medical assistance.
• Article 16 –The family as a fundamental unit of society has the right to appropriate social, legal and economic protection to ensure its full development.
• Article 17 – Children and young persons have the right to appropriate social, legal and economic protection.
• Article 30 – Everyone has the right to protection against poverty and social exclusion.

The Council of Europe’s Committee of Social Rights has affirmed that the Charter’s protections must extend to undocumented migrants and that this is the “essence” and “general objective of the Charter”.And since access to “health care is an essential precondition” (…) “to human dignity”, any State bound by the Charter must grant the right of medical assistance to all “foreign nationals, even if they are undocumented migrants” (2).

On the basis of these texts, which do honour to the EU, MDM in Europe has chosen to focus on the most vulnerable populations today.This also involves a population with which ALL the MDMs in Europe work: those who do not have an acceptable residence permit at the time we met them - the undocumented. An objective look at their access to health care in the various EU countries should help to identify the most favourable measures for a real public health policy.Then they must be implemented in all the countries, enabling the entire Union to move forward. MDM’s goal is to obtain access to health care for all, in particular the most insecure populations, in every European country by:

• • > obtaining improved health care access for migrants, and in particular children and people without residency permits,
  • > obtaining the non-expulsion of people suffering from serious pathologies if they cannot be treated in their countries of origin, and guaranteeing them access to treatment in Europe.

MDM has created a European Observatory on Access to Health Care that will help us document health care access difficulties in Europe for people in precarious situations.The evidence is based on field observations, surveys and face-to-face interviews with the most vulnerable people in order to convince governments and European institutions of the need to improve access to prevention and health care.
MDM makes no claim to being a research organization, which means we must impose two restrictions on our surveys:

• • > each question the patient is asked must directly bring him or her a benefit in terms of access to health care coverage and treatment;
  • > the questions asked must contribute to knowledge about the problems patients encounter and about their health.

In 2005-06, the Médecins du Monde European Observatory on Access to Health Care developed and conducted a simultaneous statistical survey of undocumented migrants in seven countries.At the same time, the patients interviewed described their situations and we gathered information on national health care access laws.

The first findings of the European Observatory on Access to Health Care show the advantages of this kind of survey, considering the weakness and scarcity (or even inexistence) of national surveys on the social, health and medical situations of foreign nationals living in Europe in precarious administrative situations – much less comparative European surveys. All the observations, descriptive statistics and testimonials point in the same direction: this population is very insecure, lives in difficult conditions, has significant health care needs and usually lacks health care coverage. That is why, given their lack of financial resources, in most cases undocumented migrants do not have effective access to prevention and treatment unless it is free. Will the European Union rise to the challenge of ensuring that no one within its borders goes without health care because they are missing an administrative document, their status has changed due to a law or elections, or reforms have modified the way care is organised ?

What is the value of administrative status worth compared to the fair and equal treatment of everyone in the human community? Which pathologies can a residency permit recognise? We recognise only one kind of human being, and know of no pathology that can be stopped by a piece of paper.

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1. Germany, Belgium, Cyprus, Spain, France, Greece, Italy, the Netherlands, Portugal, the United Kingdom, Sweden and Switzerland.
2. Decision of the Committee of Social Rights of the Council of 3 November 2004, made public in March 2005, pursuant to a complaint lodged by the Fédération
Internationale des Droits de l’Homme (FIDH, International Federation of Human Rights Leagues), in collaboration with the Ligue des Droits de l’Homme
(LDH, Human Rights League) and the Groupe d’information et de soutien des immigrés (GISTI, Immigrant Information and Support Group), filed in 2003
(collective complaint procedure in case 14/2003 FIDH vs. France) - http://www.coe.int