To Build a Bridge

Training for Health Professionals and Law Enforcement Officers

Summary Report on the MIPEX Health Strand and Country Reports

EQUI HEALTH Public Report

Border Management and Detention Procedures: Health Perspective




Migration Health: Better Health for All in Europe


Assisting Migrants and Communities


Improving HIV data comparability


HIV-related data on migrant and ethnic minority populations in EU/EEA/EFTA


Mobility of Health Professionals

MHD RO Brussels Publications

The Health Situation at EU Southern Borders - Migrant Health, Occupational Health, and Public Health - SPAIN

Full Report available here

barrio chino waiting border

The rapid economic growth, the needs of an increasingly fragmented labour market, and an aging population have turn Spain into an attractive destination for migrants in the last few decades, particularly during the 90’s and 2000’s. Under these circumstances, the Spanish legislation has been modified several times in order to address the increase of migration flows and challenges derived from it. These modifications have been generally focused on the control of migration flows and combating illegal migration rather than addressing the social integration and the wellbeing of migrants, however, gaining importance. Although the Spanish legal framework complies with European and international agreements, some State laws regulating detention centres as well as migration control practices, including ‘hot returns’ and disproportionate police practices at Spanish borders have been in discordance with European and Spanish legislation. Furthermore, under the 2012 Health Care Reform (RDL 16/2012)1, free access to public health care services was denied to undocumented migrants and restricted to minors, pregnant women and access to hospital’s emergency rooms. Despite the announcement made by the Ministry of Health in March 2015 intending to revoke the above mentioned, yet no change to the legislation has been made.

The Situational Analysis Report, part of the EQUI-HEALTH project – Southern EU Borders sub-action, presents the results of the assessment on Migrant, Occupational and Public Health that took place in November 2013 in Spain.

Based on desk research, field visits and interviews with different stakeholders, including law enforcement officers (LEOs), health professionals, and public authorities, the assessment provides an analysis of the national public health policies and practices addressing migration related challenges in Spain.

The work was undertaken in line with the IOM/WHO/Spanish Presidency of the EU “Global Consultation on Migrant Health” conceptual framework (Madrid 2010).

Although the Spanish legal framework complies with European and international agreements, some civil society organizations have pointed out incompatible State laws regulating reception centres and disproportionate police practices at Spanish borders. Furthermore, the implementation of the 2012 Health Care Reform in which migrants’ access to health-care services was restricted, has resulted in a variety of contradictory models in Spain, where health entitlements vary depending on the region and infrastructure and living conditions in reception centres differ from one facility to another.

SAR findings registered several complains mostly concerning the insufficient financing, inadequate living conditions, overcrowding, and lack of social activities, a situation that worsens during pick arrival periods (i.e. summer season)

“The main problem is overcrowding. We are many people sleeping in each room, coming from all countries. We spend the day outside because inside there is no enough space, children do not sleep well and have no good hygiene. You get sick a lot”. (Hamed, A Syrian migrant form Homs, El País, 5th June) – Reception centre in Melilla.

Theoretically, migrants’ access to health care and other social services in reception centres is guaranteed by law. Findings highlight the actual restrictions in the provision of these services, mainly as a result of insufficient medical staff present in reception centres. Quality in the provision of these services is severely downgraded due to lack of proper training for health professionals and law enforcement officers in issues related to health protection, intercultural competences, and international migration laws.

“We need to know about immigration law. It changes every now and then, and I don’t know it. And not only immigration issues, but professional issues (…), unions (…). And every time there is something new, we look it up ourselves, and we do the internet search ourselves.” (LEO)

Recommendations based on the assessment carried out, and further revised during the National Consultative Committee (NCC) meeting held in Spain in October 2014, were structured in line with the 4 pillars of the IOM/WHO “Global Consultation on Migrant Health” conceptual framework:

1) Policy and legal framework
2) Partnership, network and multi-country framework
3) Monitoring migrant health
4) Migrant-sensitive health system.

In this context, the existing EU legislation and procedures have to be strengthened in order to efficiently manage migration flows and allow safe entry into the EU. On the other hand, the reception system in Spain needs to guarantee respect for Human Rights as well as ensure compliance with National, European, and International legislation.

Additionally, while a stronger exchange of practices, and more effective cooperation and solidarity is needed at regional and European level, particularly important between Spain and Morocco, a structured response in Spain needs to be established during the entire reception process by developing shared protocols outlining roles and responsibilities.

Analysis of the findings also leads to the conclusion that Spain has to develop a more systematic and comprehensive health assessment to better analyze the health conditions of migrants, and to provide quality health assistance and services in reception zones. Furthermore, specific vulnerability identification protocols should be created as well as prioritize standardized health assessments for health related data collection.

In addition, reception centres lack sufficient resources to adequately assist a high number of migrants. Health services need to be improved and expanded, particularly towards mental health evaluations and psychological assistance. Finally, there is urgent need to increase the working conditions of health professionals and law enforcement officers through the creation of training programmes focus on overcoming cultural barriers and other health related competences.

The Assessment Report was completed under IOM Migration Health Department, Regional Office Brussels guidance by Manuel Garcia-Ramirez, Rocío Garrido, Violeta Luque-Ribelles and Marta Escobar-Ballesta, based on the initial draft report produced by EASP. Giuliana Urso, Mariya Samuilova, Marina Rota and Roumyana Petrova-Benedict also peer-reviewed and edited the report. Dj Krastev copy-edited, proofread and assisted the general editing.




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