1. 1 The Belgian health care context Belgium was evaluated the sixth best country in the world, according the the UNDP-list Health insurance is compulsory for Belgian citizens (implies a SIS-card) Health care is not free but the health insurance covers a large part Belgians living in poverty can apply for a ‘third-party-payment’ Hospital bills since recently have a ‘ceiling-arrangement’

2. 2 Right to health care for asylum seekers When an asylum seeker arrives in the country an asylum centre is appointed to him/her. The person can stay there but can also decide to live somewhere else. The asylum centre is responsible to pay for any medical costs, whether the person in inside or outside the centre Psychological support: depends on the asylum centre and the doctor inside the centre

3. 3 Right to health care for illegal immigrants Belgian law of 1996 gives illegal immigrants the right to health care. The law is called ‘Aide Médicale Urgente’ Not only urgent but most aspects of health care are included Health care is for free for illegal immigrants Health care suppliers can get payment from the local Public Centre for Social Assistance (CPAS)

4. 4 Cases of concern Difficult administration: different procedures for each CPAS Lack of communication between CPAS, health care suppliers and patients Delays in payment by the federal government and by the CPAS No continuity of care – saturation of facilities Mental health is neglected

5. 5 Testimonial Mohammed, 34 years, Moroccan Eye problems in Morocco, looking for treatment in Belgium Diagnosed with diabetes in Belgium, after arrival in 2001 Delays in treatment, complications Now regularised situation, handicapped for life

6. 6 Access to health care by MSF General objective: To assure a systematic and structural access to health care for the excluded in the cities of Antwerp, Brussels and Liège – medical, social and psychological

7. 7 Access to health care by MSF Specific objective: To assure before the end of 2005 the acceptation of an operational model by the local authorities, which would allow a medical, social and psychological access to health care for asylum seekers and illegal immigrants in the cities of Antwerp, Brussels and Liège. For non-medical problems refer the patients to the most adequate structures.

8. 8 The work of MSF Result 1: integrating patients into the existing health care structures by Offering social, medical and psychological consultations for people with a difficult access to health care Referring to adapted services Specific identification and reference to the services concerning mental health care

9. 9 The work of MSF Result 2: making the intervention of MSF unnecessary by Lobbying so that services and procedures are functioning efficiently –Simplification of procedures (federal, regional, local) –Promotion of an access to health care model, –More knowledge between GP’s about the specific procedures (AMU) –More visibility for the project

10. 10 Number of patients 2003 9947 consultations for 4407 patients in 2003, from which –4884 in Brussels –2967 in Antwerp –2096 in Liège

11. 11 Status of the patients 2003

12. 12 Nationality of the patients 2003

13. 13 Lobbying strategy Focus on all levels involved: Collaboration with local and regional NGO’s and institutions Federal: Ministry of Social Integration Regional: Flemish, Brussels and Walloon Unions of Cities – section CPAS Local: CPAS, city Health care suppliers: GP’s Political: inform party or opposition members Media attention (International)

14. 14 Solutions could be simple Ensure a number of principles in the procedures applied by the CPAS such as a ‘medical card’ Promotion of good practices Promotion of follow-up by GP Recognize importance of mental health care Faster payment Information