Access to health care for undocumented migrants

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Access to health care for undocumented migrants

• PICUM Platform for International Cooperation on
  Undocumented Migrants

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PICUM

• Platform for International Cooperation on
  Undocumented Migrants
• European network of NGOs, mainly in Western
  Europe
• Promotes respect for the human rights of
  undocumented migrants
• Research, advocacy and projects related
  activities
• Giving visibility to the reality of undocumented
  migrants
• Bringing undocumented migrants to policy agendas
  (at national and at EU level)

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UNDOCUMENTED MIGRANTS

• Migrants without residence permit
• An extremely vulnerable group
• Difficult to access housing and extremely poor
  housing conditions
• Difficult working conditions exploitation
• Continuous fear to be expulsed
• Lack of/ insufficient access to health care ?
  worsening of health conditions after arrival
• Persons with rights

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Right to health, guaranteed in Europe?

• The international standard is not being
  guaranteed
• Everyone has the right to the enjoyment of the
  highest attainable standard of physical and
  mental health
• (Art. 12, UN International Covenant on Economic,
  Social and Cultural Rights)
• The right of the child to the enjoyment of the
  highest attainable standard of health, ensuring
  also that no child is deprived of his or her
  right to access such health care services
• (Art. 24, Convention of the Rights of the Child)
• Lots of barriers in terms of law and practice in
  all countries
• Many differences among Member States

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Right to health, guaranteed in Europe?

• Access to health care for undocumented migrants
  is becoming more restrictive
• States are using access to social rights as a way
  to fight illegal migration
• The EU only speaks about UDM in the context of
  border control no attention to their rights

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LEGAL BARRIERS

• Limited access to the public health system in
  many countries the different approaches
• The duty to denounce
• Ambiguous legislation
• Lack of definitions urgent medical care
  essential care emergency care

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BARRIERS IN PRACTICE

• From the side of the local administration
• No uniformity in the implementation of the law
• Problems of interpretation of the law
• Lack of information
• From the side of the health provider
• Lack of information
• Language and cultural barriers
• Discrimination
• From the side of the undocumented migrant
• Lack of information about rights
• Language and cultural barriers
• Fear to be denounced

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Improving access a priority

• For Undocumented migrants
• For the general society
• For local administrations

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A priority for undocumented migrants

• Access to health care is one of their most
  pressing needs
• Risk of serious consequences for their health and
  life

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A priority for the general society

• Risk for public health
• Higher economic costs
• Risk of social exclusion, public disorder
• The creation of a second-class citizen

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A priority for local actors

• NGOs
• Health care providers
• Local authorities
• Burden on local actors
• Forced to improvise solutions
• Ethical dilemmas

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EU ProjectAccess to Healthcare for
Undocumented migrants
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EU Project

• Framework Social Inclusion Strategy
• 19 partners, 11 countries
• Innovative approach different type of partners
• NGOs
• Health providers
• Local authorities

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EU Project 11 COUNTRIES

• AUSTRIA
• BELGIUM
• FRANCE
• GERMANY
• HUNGARY
• ITALY
• PORTUGAL
• SPAIN
• SWEDEN
• THE NETHERLANDS
• UK

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Objectives

• Improve access to health care for undocumented
  migrants
• Map the situation in eleven countries
• Improve the methodology for data collection
• Target undocumented migrants in the Social
  Inclusion Strategy
• Undocumented migrants are not yet a target
  group of the Social Inclusion Strategy!!
• Support and multiply good practices and
  partnerships at local level

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Building partnerships our experience

• Many possibilities
• Partnerships are crucial in this field
• There already exists a lot of partnerships at
  local level
• Also difficulties
• Defining the role of local authorities vis-à-vis
  data collection
• Defining the role of local authorities vis-à-vis
  the Social Inclusion Strategy
• Adapting the instruments of the project to the
  local authorities

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Undocumented migrants in urban areas

• Many undocumented migrants live in excluded urban
  areas
• Difficult access to housing
• Link between housing and health conditions (i.e.
  childhood lead poisoning)

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Undocumented migrants Housing Strategies

• Own Networks
• Private Housing Sector
• Social Housing Sector
• Homeless Shelters
• NGOs
• Other Housing Strategies shantytowns, abandoned
  buildings

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1. Own networks

• Family, friends, community members
• Most common type of housing strategy of UDM
• French study of 200 UDM (1997)
• More than 50 sheltered by own networks

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2. Private Housing Sector

• Second most common strategy of UDM
• Barriers to renting in some countries
• Landlords required to ensure that tenants
  register at town hall (Italy, Germany, Austria)
• Most likely to occupy worst housing
• Pay disproportionate share of income
• UDM vulnerable to exploitation from landlords
• The system of Camas Calientes in Spain
• The role of NGOs

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3. Social Housing Sector

• Legislation in all EU countries excludes UDM from
  social housing
• Rare occasions, local authorities allow UDM
  access if in regularization procedure

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4. Homeless Shelters

• Increased demand from UDM, difficulty of shelters
  to adapt
• Main problem different public and needs
• Exceptions for vulnerable UDM (minors women with
  children, sick, the elderly)
• Easier access to night shelters, but depends on
• Payment of small fee
• Availability
• Shelter subject to police controls
• Ideology and source of funding of shelter

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5. NGOs

• Limited capacities and funding
• Emergency situations for most vulnerable
• Unable to cope with high demand

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6. Other Housing Strategies

• Cheap hotels
• Caravans
• Shantytowns, huts
• Abandoned buildings
• Accomodation in workplace (e.g. warehouse, farm)

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Challenges to fight health inequalities

• Local authorities have to be informed about the
  law on access to health care
• Local authorities have to have a bigger voice in
  policy-making
• The need of building partnerships with NGOs to
  solve problems

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• Any questions?
• Sara Collantes sara.collantes_at_picum.org
• www.picum.org
• Thanks