Médecins du Monde has 14 healthcare advice and referral centres (CASOs) and one reception, referral and support centre (CAOA).
© Olivier Papegnies
people visit our healthcare advice and referral centres (CASOs) every year
million people live in inadequate housing in France
people live in precarious situations
Médecins du Monde has developed 54 healthcare access programmes in France.
Find out more about the context of our work and the challenges for our missions.
MÉDECINS DU MONDE, WORKING IN FRANCE SINCE 1986
GUARANTEEING UNCONDITIONAL ACCESS TO CARE
The first humanitarian mission in France
Teams from Médecins du Monde (MdM) have been working in France since 1986, when we opened a centre to provide free healthcare to those in greatest need in Paris. Our original intention was for the centre to close its doors again in six months. The aim of the intervention was to alert the public authorities to the situation of vulnerable and excluded communities by providing them with medical assistance so that everyone would have unconditional access to healthcare.
An ongoing campaign
Over 35 years later, despite the public measures that have been put in place for vulnerable communities, there are persistent problems in France with obstacles to rights and healthcare and repeated humanitarian emergencies. This has led Médecins du Monde to maintain and develop programmes throughout the country, establishing healthcare advice and referral / support centres (CASOs and CAOAs) as well as mobile services.
OUR ACTIVITIES IN FRANCE
HUMANITARIAN STRATEGY FOR FRANCE COMPRISING 54 PROGRAMMES
A five-year strategy
In 2022, Médecins du Monde France was running 54 programmes at 29 locations in France and the overseas departments and regions of Réunion, Mayotte and Guiana. These projects are based on the five-year strategy for France which was adopted in early 2020. They are consistent with Médecins du Monde’s campaigns and principles of intervention, aiming to ensure that everyone is able to fully exercise their fundamental rights and have access to good healthcare.
Empowerment and the cross-cutting approach in healthcare
Our projects are rooted in their communities and are intended to empower both individuals and communities. They support groups campaigning on issues of common concern, they are open to innovation and seek to be environmentally responsible. In addition, the following cross-cutting approaches are integrated into all projects: mental health and psychosocial support, childhood vulnerability and gender.
© Olivier Papegnies
Centre d'accès aux soins et d'orientation Médecins du Monde à Marseille
HEALTHCARE AND ADVICE CENTRES IN FRANCE
MEDICAL AND SOCIAL SUPPORT CENTRES
The CASOs/CAOA provide medical and social support for anyone who has problems accessing their rights, healthcare or prevention services in France. They provide advice for people experiencing serious problems or exclusion who don’t know their rights or are unable to exercise them.
The centres offer nursing care, medical consultations and assistance, information on infectious disease prevention and testing for specific conditions. Migrants can experience problems with their physical and mental health caused by their experiences of migration. In addition, precarious living conditions can seriously affect people’s mental health, so psychosocial support and mental health treatment can be offered.
FREE CONSULTATIONS, NO APPOINTMENT NECESSARY
The CASOs/CAOA provide their services to the public unconditionally and offer free consultations, mostly without any need for an appointment. People can see a range of different healthcare professionals for a medical consultation or assessment before being referred wherever possible to suitable mainstream healthcare facilities. They can also be supported through the process of accessing their rights.
THE PASS DE VILLE
In 2019, the CASO in Marseille introduced a City Pass (Pass de ville) with the aim that it would be transferred to mainstream healthcare. The original one-off initiative has been continued and enables people who don’t have health insurance to receive healthcare without being billed for it. People are treated by local doctors and can undergo a full course of treatment (including pharmacy, laboratory and radiology services) without having to pay while they wait to obtain health insurance. The initiative will be transferred to a dedicated facility in 2022.
COVID-19 RESPONSE BY THE CASOs
In 2020, the CASOs adapted their services to the different phases of the Covid-19 pandemic and / or set up outreach services for communities excluded or isolated from the healthcare system. Covid-19 is now part of routine activities and there are no longer special, dedicated programmes.
PREVENTION – SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS IN FRANCE
Médecins du Monde has a cross-cutting prevention programme on sexual and reproductive health and rights (SRHR) and a specific SRHR programme in the Pays de la Loire region.
A CROSS-CUTTING PREVENTION PROGRAMME
Since 2003, Médecins du Monde has developed a cross-cutting prevention programme focusing on HIV, hepatitis, sexually transmitted infections (STIs) and tuberculosis. We seek to ensure better prevention services, improve access to testing and facilitate access to healthcare for people in France. In 2020, MdM adopted the extended definition of sexual and reproductive health and rights (SRHR) proposed by the Guttmacher Lancet Commission. We want to affirm our commitment to the importance of ensuring that everyone can have a satisfying and safe sex life and that their rights are fully respected.
A COMMUNITY APPROACH
Adopting a community approach that involves the people affected means that some programmes offer community sessions and activities around health promotion, focusing on selected topics. In particular, a programme in Nantes is using a health promotion approach to improve the access to and quality of SRHR services for people living in inadequate, unhealthy, substandard and / or informal housing in the Pays de la Loire region.
A GENDER-BASED APPROACH TO HEALTHCARE
We are continuing to train our teams to implement a ‘gender-based’ approach to certain healthcare issues, such as screening for gender-based violence. The programmes are also committed to screening for gynaecological cancers, providing information about contraception and antenatal care.
© Olivier Papegnies
RESPONDING TO MIGRATION ISSUES
Médecins du Monde has developed 8 programmes aimed specifically at the challenges around migration, exile, rights and health, including 3 programmes for unaccompanied minors.
IN FRANCE – A HUMANITARIAN MISSION FOR MIGRANTS
Médecins du Monde runs programmes for migrants (on the border with Italy, in Paris, along the coast in the Hauts-de-France region in Calais/Grande Synthe/Dunkerque, in Toulouse and in Angoulême). In early 2017, a partnership of several organisations (CAFI) was established with the aim of pooling knowledge and tools to stop the rights of refugees and migrants on the borders being violated.
HELPING UNACCOMPANIED MINORS
- In 2015, a programme was set up which was specifically aimed at unaccompanied minors.
- In Paris – support with procedures (this ended in 2022).
- In Nantes – a similar programme came to an end during 2016.
- Two other programmes for unaccompanied minors were developed in Normandy.
- In Caen – the programme was set to be transferred during 2022 and replaced by a health mediation programme for young migrants.
- In Rouen – dedicated activities ended in 2018. The teams support unaccompanied minors, providing sympathetic listening in spaces where they can go for respite, access to healthcare and help to exercise their rights.
CAMPAIGNING AGAINST INADEQUATE HOUSING IN FRANCE
Médecins du Monde has 17 healthy environment programmes for people who are isolated, living on the streets or in poor housing.
SUPPORT AND AWARENESS-RAISING
On the streets and in shelters and day centres the teams provide support with administrative processes, health monitoring, medical consultations, psychosocial support and health mediation.
They provide information and raise awareness among professionals in health and social care on issues relating to precarious housing. They expose the impacts of homelessness on health and highlight the problems experienced by people in these situations as they seek to exercise their rights and access healthcare.
GUARANTEEING ACCESS TO HEALTHCARE IN SQUATS AND SLUMS
Programmes are also involved in working in squats and slums to offer people access to healthcare and support with exercising their rights. These programmes also refer them to healthcare facilities, with a particular focus on women’s and children’s health. Health mediators work with partner organisations and mainstream services to improve care and treatment for people living in slum conditions and to empower them to access healthcare and rights independently.
IMPROVING LIVING CONDITIONS
In 2020, a number of regional offices took action to seek to improve the living conditions of people living in squats and slums. The hazards of living in inadequate housing were exacerbated by the Covid crisis – lack of access to water and sanitation made it difficult for people to implement preventive measures.
The Lotus Bus is a programme run by Médecins du Monde focusing on harm reduction in sex work and promoting access to healthcare and rights.
© Boris Svartzman
HARM REDUCTION IN DRUG USE AND SEX WORK IN FRANCE
Médecins du Monde has set up 5 dedicated harm reduction programmes in France focusing on drug use and/or sex work.
INFORMING AND EMPOWERING
Médecins du Monde works with sex workers through 4 programmes in 3 cities (Montpellier, Paris and Rouen). These programmes aim to inform and empower people in relation to harm reduction and sexual and reproductive health. They also promote access to healthcare and rights within the mainstream system and through services provided by a mobile unit and drop-in centre. Finally, they seek to encourage community participation. MdM also runs a national prevention programme to promote access to justice and healthcare services for sex workers who have experienced violence (Jasmine Programme).
A CRITICAL SITUATION IN EASTERN PARIS
In response to the risks associated with drug use, in late 2021 Médecins du Monde decided to resume its work to address the worsening situation of people who use drugs in public spaces in north-east Paris. Everyone working in this area was reporting a critical situation with an absence of support from the public authorities and a desperate lack of resources. Tensions with local residents were significantly exacerbated by the Covid crisis and the associated restrictions. Media coverage of the situation reinforced political positions taken for electoral purposes and this has contributed to a climate that is particularly hostile and harmful to the health of these very vulnerable people. The project was redefined during 2022 and is scheduled to last for 5 years.
IMPROVING ACCESS TO HEALTH FOR THE PRISON POPULATION IN FRANCE
Médecins du Monde has started 2 programmes to work with offenders.
Since 2014, MdM has been using a community approach at a prison in Nantes, working on health promotion and better access to healthcare for people in prison.
TRIALLING AN ALTERNATIVE TO PRISON
In addition, Médecins du Monde is working closely with relevant ministries, operational partners and universities on an experimental project in Marseille to provide an alternative to prison from early 2022. The AILSI project will offer independent housing and assertive community treatment as an alternative to prison for homeless people with severe psychiatric disorders. The project also includes a research element.
© Olivier Papegnies
Médecins du Monde working in Haute Vallée de l’Aude, described as a medical desert.
ADDRESSING HEALTH VULNERABILITIES IN RURAL PARTS OF FRANCE
HEALTH MEDIATION TO TACKLE VULNERABILITY
Médecins du Monde has developed two programmes to use health mediation to improve access to rights and health for people living in precarious situations in rural areas. The first programme was set up in 2013 in Combrailles, in Puy-de-Dôme Department, and the second has been operating in Haute Vallée de l’Aude in southern France since 2016. The health mediation bridges the gap between the communities struggling to access care and medical and social services in the area.
LOCAL MEDICAL SERVICES IN FRANCE
In 2020 and 2021, the Combrailles programme transferred its activities to local healthcare facilities. In Haute Vallée de l’Aude, Médecins du Monde is supporting vulnerable people to access healthcare. The team is responding to the healthcare crisis by providing accessible medical and social services open to all, as well as mobile facilities for people who live a long way from services.
SUPPORTING A RETURN TO HEALTHCARE IN SENSITIVE URBAN AREAS
A programme to promote access to healthcare and rights in sensitive urban areas was established in Lille in 2015. It uses an outreach approach to help people whose healthcare has been disrupted. The programme provides support to tackle the main obstacles collaboratively and is working actively with mainstream and third-sector organisations to build individual and collective capacity.
In 2020, the programme continued its outreach activities and adapted them in light of the public health crisis. This involved organising welfare and healthcare outreach to maintain contact and ensure continuity of services and to provide people with information about Covid-19. The programme ended in April 2021.
OUR HUMANITARIAN PROGRAMMES IN FRANCE’S OVERSEAS TERRITORIES
Médecins du Monde has developed 3 specific programmes to tackle health issues in France’s overseas departments and regions.
CAMPAIGNING AGAINST POOR HOUSING IN MAYOTTE
In Mayotte, the programme provides medical, nursing and social welfare consultations (focusing on rights) through both fixed and mobile services. It also runs health promotion and disease prevention activities in the Kawéni slum and refers people to mainstream services where possible. In 2021/22, with rising numbers of evacuation and demolition orders in Mayotte, Médecins du Monde engaged in advocacy work to seek appropriate rehousing solutions and slum clearance.
THE IMPACT OF POOR HOUSING ON HEALTH IN RÉUNION
In 2020, Médecins du Monde ran an exploratory humanitarian mission on the island of Réunion to look at the impact of poor housing on health. The results highlight the fact that vulnerable people who are living in inadequate housing and / or are geographically isolated have poorer health overall compared to the general population. This is due to being unable to access adequate healthcare because of their living conditions and / or where they live. Based on these results, since November 2021 the Médecins du Monde team in Réunion has been running a project which aims to encourage people to seek healthcare and to help isolated people in poor housing in the south and west of Réunion to register with mainstream services. The project is also helping to develop tailored health mediation to meet the specific needs of these communities. Based on the model adopted in mainland France, it prioritises interactions between the health sector and the diverse population of Réunion to bring them closer together.
CROSS-CUTTING HUMANITARIAN ACTIVITIES IN GUIANA
In French Guiana, 2021 was marked by the ongoing crisis concerning the reception of asylum seekers and the social tensions around migration. In addition, in response to the continuing Covid-19 health crisis the Médecins du Monde team increased its health mediation work through ‘mobile health teams’ and visits to informal settlements to provide information and prevention measures adapted to the local health context.
In 2021 the Pass de Ville project was resumed after having been postponed because of the health crisis and reforms to AME (the State Medical Aid system). The team worked on the preparation phase to ensure a successful operational launch and the first patient registrations in early 2022.
They support our actions
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