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RECOMMENDATIONS ON ACCESS TO HEALTH SERVICES FOR MIGRANTS IN AN IRREGULAR SITUATION: AN EXPERT* CONSENSUS

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INTRODUCTION

In this document the term ‘irregular migrant’ (abbreviated throughout as ‘IM’) is used to refer to the target group of migrants in an irregular situation within the EU/EAA, i.e. those who “do not fulfil conditions for entry, stay or residence” (FRA 2011b). Most IMs in these countries originate from outside the region and are thus referred to as ‘third country nationals’ (TCNs), but people migrating within the region may also find themselves in situations of irregularity. Moreover, both migrants and non-migrants (for example, some members of the Roma community) may be denied access to health services for a variety of reasons. Most of this document applies to any group excluded from the benefits of Universal Health Coverage.

This document has been produced within the framework of the IOM’s EQUI-HEALTH project, in collaboration with COST Action IS1103 ADAPT (Adapting European health systems to diversity). The recommendations reflect a consensus that was developed in the course of a series of joint international meetings in 2012-2016 attended by experts on migration, health policy, human rights law, health economics and epidemiology, as well as by representatives of intergovernmental and civil society organisations concerned with migrant health.

The document has the following structure. Firstly, the Recommendations are presented followed by brief summaries of the evidence and arguments on which they are based. This is followed by an Overview giving a more complete account of the evidence and arguments (research studies, reports, international treaties, policy initiatives and debates). At the end of each recommendation, a hyperlink leads directly to the relevant section of the Overview, which has three sections:

I. The present situation and its shortcomings
II. Arguments for change
III. What is required in order to improve access?

Why are these recommendations being launched now? The global importance of this topic was underscored at the UN Summit for Refugees and Migrants, which on 19th September 2016 adopted the “New York Declaration for Refugees and Migrants”. Member States committed themselves to protect the human rights of all refugees and migrants regardless of status. In the past 15 years a great deal has been written and said about the denial of IMs’ right of access to affordable health services: a list of selected publications is given in the Bibliography. In the course of this work, a considerable degree of consensus has been built up regarding the nature of the problems and the solutions they call for. However, against the background of an economic crisis and hardening attitudes to migrants across Europe, there seems to have been little improvement in the policy environment. In several countries, the situation has in fact worsened.

Although most IMs initially entered the EU regularly, using documents that only later became invalid, the steep increase in the ‘mixed migration flows’ entering the region irregularly since 2014 adds new urgency to the topic of irregular migration. Many of these migrants were fleeing organised violence and subsequently regularised their presence by claiming asylum, but an unknown number did not. Moreover, many asylum claims will be rejected, adding further to the IM population in Europe.

At the same time, governments are adopting policies which restrict even more their rights and benefits (see Section III), in the hope of encouraging existing IMs to leave and deterring new ones from arriving. The tension between these restrictions and the demands of responsible health system governance is particularly acute at the present time, when Universal Health Coverage (UHC) is increasingly recognised as a marker of development and forms a key element of the UN’s 17 Sustainable Development Goals (SDGs) (which include six migration-related indicators). European and other industrialized countries are often assumed to have implemented UHC, whereas in fact few provide full coverage for all migrant members of the population. In contrast, great strides have recently been made by developing countries in implementing UHC (WHO 2015). This document aims to present clearly the arguments for improving IMs’ access to health services, as well as that of all other groups excluded from proper coverage.

 


RECOMMENDATIONS 

    1. The principle of universal and equitable health coverage should be applied to all persons residing de facto in a country, regardless of their legal status.
    2. Governments should honour their obligation to implement signed and ratified treaties committing them to uphold health-related rights, and are encouraged to ratify the treaties they have signed. More prominence should be given to the health-related rights of IMs and more legal action should be undertaken to defend these rights. 
    3. In keeping with basic principles of public health, states should grant full access for IMs to all forms of primary care available to nationals.
    4. In keeping with basic principles of cost effectiveness, governments should take into consideration the increasing amount of evidence that restricting access to primary care in fact costs more money than it saves.
    5. In accordance with human rights treaties as well as legislation on data protection, privacy and confidentiality of information, reporting of IMs by health workers or service provider organisations to police or immigration authorities should be explicitly prohibited. This prohibition should be strictly enforced and IMs should be given explicit reassurance that such reporting will not take place.
    6. In accordance with the treaties and directives that Member States have signed and ratified, special attention must be paid to protecting the health-related rights of particularly vulnerable groups such as children, pregnant women and trafficked persons, regardless of whether such persons are residing regularly in the country.
    7. Increased research efforts are needed to identify the health problems for which IMs are particularly at risk. Existing knowledge about their help-seeking behaviour should be improved, while sound epidemiological methods should be used to estimate the health risks affecting them.
    8. In order to improve our understanding of the health of IMs, the serious shortage of reliable and up-to-date information about their numbers, living conditions and employment, as well as their demographic and other characteristics, must be remedied urgently by funding and carrying out more research.
    9. Efforts to combat myths and misunderstandings about IMs should be intensified using all forms of media, especially in relation to health and health care utilization and alleged ‘pull’ factors. This also involves carrying out more research on the contributions of IMs to societies (for example in the health sector and in home care), and disseminating the results.
    10. In order to be equitable and politically acceptable, access to health services for IMs should be accompanied by contribution arrangements that will not be perceived as unfairly privileging this group over nationals and regular migrants. More work is required to identify appropriate modalities of contribution to services by IMs and their employers.
    11. As well as improving effective health coverage for IMs, it is essential to ensure that health services are responsive to their special needs and to remove other barriers to reaching care.
    12. National governments, IGOs, NGOs, CSOs, public health experts and researchers must join forces and present a united front in support of the health-related rights of IMs. The aim should be to integrate IMs fully into mainstream service provisions, while CSOs can continue to perform a vital role in the development, implementation and monitoring of new policies.

  


ENDORSERS

INDIVIDUAL EXPERTS

  • Dr. Gina Netto, Reader/Associate Professor in Migration - Urban Institute, Heriot Watt University, Edinburgh. www.hw.ac.uk
  • Dr. Philipa Mladovsky, Assistant Professor - International Development Department, London School of Economics and Political Science. www.lse.ac.uk
  • Dr. Maria van den Muijsenbergh, Family doctor/Senior researcher - Radboud University Medical Centre, Nijmegen - The Netherlands. www.radboudumc.nl 
  • Paolo Ruspini, PhD, Senior Researcher - International Migration University of Lugano (USI), Faculty of Communication Sciences - Lugano, Switzerland. http://usi.to/h9w // Honorary Research Fellow - Department of Social Sciences University of Roehampton, London, United Kingdom. www.roehampton.ac.uk
  • Daniel La Parra Casado, Associate Professor - University of Alicante - Spain. www.ua.es/es/index.html
  • Julia Puebla Fortier, Director - DiversityRx - Resources for Cross Cultural Health Care, France. www.DiversityRx.org
  • Margherita Giannoni, Associate Professor Public Economics - Department of Economics Finance and Statistics University of Perugia, Italy. www.economiatr.it/
  • Ricardo Mexia, President - Portuguese Association of Public Health Doctors - Lisbon, Portugal. www.anmsp.pt // Public Health Doctor - National Health Institute Doutor Ricardo Jorge - Lisbon, Portugal. www.insa.pt/sites/INSA/Portugues/Paginas/portalInicio.aspx   
  • Ana Rico, Research Fellow - National School of Health, Health Institute Carlos III - Madrid, Spain. www.isciii.es 
  • Marie Dauvrin, Senior researcher and lecturer - Institute of Health and society / Faculty of public health, Université catholique de Louvain - Brussels, Belgium. www.uclouvain.be/irss.html  
  • Tona Lizana Alcazo, Head of Migration and International Health - Agency of Public Health of Catalonia, Ministry of Health of the Catalonian Government, Spain. http://salutpublica.gencat.cat
  • Prof. Dr. Theda Borde - Alice Salomon Hochschule Berlin - Germany. www.ash-berlin.eu/
  • Monika Steffen, CNRS Senior Research Fellow - PACTE Interdisciplinary Social Science Research Unit, University Grenoble-Alps, France. www.pacte-grenoble.fr/
  • Prof. Yoram Mouchenik, Senior Lecturer for cross-cultural clinical psychology - University Paris 13 Sorbonne, Paris. https://utrpp.univ-paris13.fr/
  • Marie Rose Moro, Transcultural Psychiatrist, MD, PhD, Professor of Child and Adolescent Psychiatry - Paris Descartes University Sorbonne, Paris, CESP INSERM 1178 // Chief of the Department - Maison des Adolescents de l’hôpital Cochin, Assistance Publique des Hopitaux de Paris, France. www.mda.aphp.fr/
  • Rahmeth Radjack, Transcultural Psychiatrist - Maison des Adolescents de l’hôpital Cochin, Assistance Publique des Hopitaux de Paris, France.www.mda.aphp.fr/
  • Dr. Ursula Trummer, Head - Center for Health and Migration, Vienna. www.c-hm.com
  • Dr. Sonja Novak-Zezula, Managing Director - Center for Health and Migration, Vienna. www.c-hm.com
  • Dr. Nazmy Katherine Villarroel Williams, Public health researcher - University of Edinburgh. www.ed.ac.uk
  • Dr. Michael Knipper - University Justus Liebig, Giessen, Germany. www.uni-giessen.de/index.html
  • Marie Jelínková, PhD - Charles University in Prague, Czech Republic. http://fsveng.fsv.cuni.cz/
  • Dr. Helena Hnilicová - Senior lecturer - Institute of Public Health and Medical Law, First Faculty of Medicine, Charles University, Czech Republic. www.lf1.cuni.cz/en
  • Dr. Karolína Dobiášová - Senior lecturer - Institute of Public Health and Medical Law, First Faculty of Medicine, Charles University, Czech Republic. www.lf1.cuni.cz/en
  • Dr. Elena Tulupova - Senior lecturer - Institute of Public Health and Medical Law, First Faculty of Medicine, Charles University, Czech Republic. www.lf1.cuni.cz/en
  • Magda Faltová - Director - SdruÅžení pro integraci a migraci/Association for Integration and Migration, Czech Republic. www.migrace.com/
  • Albert Persaud, Co-founder and Director - The Centre for Applied Research and Evaluation-International Foundation (careif) - Centre for Psychiatry, Barts & The London School of Medicine & Dentistry, London. www.careif.org
  • Prof. Dr. Stéphanie De Maesschalck - Departement of Family medicine and Primary Health Care, research group "Equity in Health Care", Ghent University, Belgium. www.ugent.be
  • Professor Emeritus Mark R D Johnson - De Montfort University Leicester, UK. www.dmu.ac.uk/home.aspx
  • Gurch Randhawa, Professor of Diversity in Public Health & Director - Institute for Health Research, University of Bedfordshire - Luton, England. www.beds.ac.uk/research-ref/ihr
  • Dr. Ghazala Mir, Associate Professor - Inequalities Research Network, Leeds Institute of Health Sciences, University of Leeds - UK. http://medhealth.leeds.ac.uk/profile/600/611/ghazala_mir/1
  • Dr. Sundari Anitha, Reader - School of Social Sciences, Faculty of Health, Life & Social Sciences, University of Lincoln - UK. http://staff.lincoln.ac.uk/sanitha
  • Cláudia de Freitas, Postdoctoral Research Fellow - EPIUnit - Institute of Public Health, University of Porto & Centre for Research and Studies in Sociology, University Institute of Lisbon. www.researchgate.net/profile/Claudia_De_Freitas2
  • Dr. Harshad Keval, Senior Lecturer in Sociology - Department of Psychology, Politics and Sociology, Canterbury Christ Church University, Canterbury - UK. http://bit.ly/2lC3bkv
  • Dr. Ines Keygnaert, Postdoctoral Researcher & Team Leader Priority Team - Ghent University-International Centre for Reproductive Health (ICRH), Belgium. www.icrhb.org
  • Dr. Gorik Ooms, Professor of Global Health Law and Governance - London School of Hygiene and Tropical Medicine, UK. www.lshtm.ac.uk/ 

 

ORGANIZATIONS / INSTITUTIONS

  • Center for Health and Migration, Vienna. www.c-hm.com
  • OPU - Organisation for Aid to Refugees/Organizace pro pomoc uprchlikum, Czech Republic. www.opu.cz/en
  • SHERPA research Center - Institut Universitaire au regard des communautés culturelles/University Institute in regard to cultural communities - CIUSSS du Centre-Ouest-de-l'Île-de-Montréal, Canada. www.sherpa-recherche.com
  • The Centre for Applied Research and Evaluation-International Foundation (careif) - Centre for Psychiatry, Barts & The London School of Medicine & Dentistry, London. www.careif.org
  • International Association for Hospice and Palliative Care (IAHPC), Houston - US. www.hospicecare.com/home/
  • Centre for Evidence in Ethnicity, Diversity and Health, A joint enterprise between DMU, Coventry University, and Warwick University, UK. www.dmu.ac.uk/msrc
  • PICUM - Platform for International Cooperation on Undocumented Migrants, Belgium. http://picum.org/en
  • Danish Research Centre for Migration,Ethnicity and Health, Department of Public Health, University of Copenhagen / Forskningscenter for Migration, Etnicitet og Sundhed, Københavns Universitet, Denmark. mesu.ku.dk
  • Escuela Andaluza de Salud Pública / Andalusian School of Public Health. Granada, Spain. www.easp.es
  • International Council of Nurses. Geneva. www.icn.ch
  • The Alliance for Maternal Health Equality. Brussels, Belgium. www.maternalhealthalliance.eu

 

 


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* See full document for complete list of experts.