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Sounding the Silent Alarm on Migrant Health Care

Irregular migrants lie sick on the sidelines of the health care debate, as member states remain deaf to the EU call for uniform treatment

by Jasmine Papillon-Smith

A Roma woman, seen as illegal by the healthcare system, leans against a parking meter on a sidewalk in Brussels, Belgium, breastfeeding her newborn. She speaks neither French nor English.

White paint peels in flakes from the doors at 46, Rue d’Artois, Brussels, where old notices hang precariously from boarded-up windowpanes. “Everyone is treated equally here,” reads the sign facing a woman, who glances over both shoulders before walking through the double doors at the derelict address.
She is at the entry to the Belgian headquarters of Médecins du monde, where she hopes someone will help her. As of today, the EU is not that person.

The problem
A recent report by the Fundamental Rights Agency shows that the situation for access to health care by irregular migrants has not improved in spite of EU legislation on the matter, dating from 2007.

The report states that depending on the member states, migrants will either be charged a fee, or denounced to authorities, or simply not made aware of their rights in regards to health care. According to the report, children and pregnant women are made out to be the worst victims.

Stéphane Heymans is a project coordinator at Médecins du monde. He says the NGO, which was once a first response facility, has become a permanent solution for many of the migrants who cannot find a way to move forward in the immigration system.
“Over the past 18 months, things have become more complex. There has been a real degradation of the situation—we have too many patients, and the possibilities for references to general practitioners are decreasing as they become overloaded,” he says.
Over 10 000 people received treatment last year at the NGO’s Belgian division. More than 75% were illegal migrants.

The doors to the Medecins du monde headquarters in Brussels, 46, rue d'Artois

A call for uniformity
The woman, nameless, walks up to the two men sorting mail at reception. She extracts a plastic bag—reverently—from her purse. It is filled with papers, which she hands them. She then takes a seat in the waiting room, her sunken eyes belying the reality of her situation.

Ludovica Banfi is a project manager at the Fundamental Rights Agency of the European Union. She hopes the EU will pave the way for a more inclusive and harmonized pan-European treatment process.
“One positive thing was the resolution by the EU parliament in March 2011. It addressed the fundamental right to health care for these migrants and it called for member states to assess the possibility for the member states to provide, for example, a common definition of the basic elements of health care,” she says.
Many NGOs are calling for member states to provide this common definition—it would allow for more binding laws with regards to access to treatment, as well as make sanctioning a possibility.

Passing the buck: whose jurisdiction, exactly?

Decorating the walls of the Médecins du monde clinic are posters declaring universal rights of peoples and solemn, anti-racial philosophies. The woman we have followed through the clinic speaks neither French nor English, the language these signs are printed in.

The basic premise of health care advocates is that the lack of access is a direct violation of the EU Charter of Fundamental Rights, which decrees that all persons on EU territory have a right to free health care.
But the EU has no jurisdiction over health care—it is up to the member states.
Judge Egils Levits, of the Court of Justice of the European Union, stresses that in spite of EU legislation, interpretation of the charter is often left to member states.

“While the member states and the institutions are clearly part of the charter, the charter does not apply in situations where EU law is not involved or does not apply,” he says, stating that it is up to national entities, including their courts, to enforce fundamental rights.
Judge Levits stresses that questions dealing with the validity of EU law must be addressed, at the risk of having 27 different standards of protecting fundamental rights—one for each member state.
Jérôme Unterhuber, Press Officer for the Council of the European Union in Budget; Health and Consumer Affairs, says that the Council has not discussed the issue since the adoption of legislation in 2007. The matter is not on the upcoming agenda.
The cost-effectiveness of prevention
NGOs continue to advocate that preventive care is worth more than emergency care in the long run.
“It might be that countries in economic crisis invest more in primary healthcare because it seems more cost-effective (than emergency care),” suggests Banfi, who believes the path to common health care legislation lies in the economic benefits of preventive care.
The risk on public health continues to pose a problem, as studies have shown that people in irregular situations are more at risk for infectious diseases, like HIV, tuberculosis or hepatitis, which can spread if left untreated.

From member state to member state

What is presumably a doctor comes out to greet the woman. Luckily she is in Belgium, where the authorities will not be notified of her visit here.

Access to health care varies between member states. In Italy, for instance, migrants can obtain an anonymous identification card, which allows free access to treatment. In Germany, it is much the opposite: unless a migrant is seeking emergency care, doctors are obligated to report their consults to welfare authorities, which then take custody of the migrants.

This leads to complications. In once case in Brussels, a migrant woman received a blood transfusion of the wrong type due to the fact that she used her friend’s medical card to access treatment, resulting in her death.
In other instances, migrants flee hospitals to avoid payment. Doctors treat patients in their spare time.

Heymans cites the perverse effects of the system. He mentions the case in which it is beneficial to contract HIV, because member states are not allowed to return migrants to countries where treatment for infectious diseases is not available. Having HIV thus allows for easier integration.

Back to basics

The woman exits the examination room, tightens her shawl about her, and leaves the clinic, glancing once again over each shoulder.

For Heymans, the immediate problem lies in migrant access to health care in the EU. But on the long term, he believes the real problems lie abroad.
“What’s interesting in the debate is that people do not usually migrate out of the pleasure of doing so. If they’re moving, it’s that there are problems in their home countries: war, famine, poverty, etc., that are preventing them from accessing health care, or making them sick. We are trying to limit the influx of people without looking at where they come from, and if we could do something to stop the problem at the source,” he concludes.