A Project funded by DG SancoNOWHERELAND at the Center for Health and Migration/DUK. 1 Right of access health care for irregular migrants in the European Union: is it congruent with human rights standards? Carin Björngren Cuadra, senior lecturer SWSD, Stockholm 11 July 2012

A Project funded by DG SancoNOWHERELAND at the Center for Health and Migration/DUK. Health care in NowHereland – Improving Services for Undocumented migrants in EU

A Project funded by DG SancoNOWHERELAND at the Center for Health and Migration/DUK. Irregular migrants in the EU context Third-country nationals without a valid permit authorising them to reside in the European Union (EU) member states »been unsuccessful in asylum procedures (rejected asylum seekers) »who have violated the terms of their visas (‘over stayers’) »who have entered the country illegally. 3

A Project funded by DG SancoNOWHERELAND at the Center for Health and Migration/DUK. Work package – policy compilation Aim: collect data on policy approaches regarding access to health care for irregular migrants in the EU 27 To identify the extent to which these entitlements are congruent with human rights standards Deliver 27 Country Reports and offer a clustering of the states 4

A Project funded by DG SancoNOWHERELAND at the Center for Health and Migration/DUK. 5 Rational Irregular migrants have gained increasing attention in the EU due to lack of social protection » deprived living conditions » substandard working conditions » exploitation » lack of access to health and welfare services.

A Project funded by DG SancoNOWHERELAND at the Center for Health and Migration/DUK. Methods ‘Desk research »available research and information a questionnaire (in English) sent to experts and NGO five topics »context of migration »policies regarding irregular migrants »welfare system »health care system »health care for irregular migrants statistical information (numbers of irregular migrants, etc.) was obtained from official websites (national authorities) and from secondary sources. 6

A Project funded by DG SancoNOWHERELAND at the Center for Health and Migration/DUK. How to cluster? The Council of Europe, resolution of the Parliamentary Assembly. Council of Europe Resolution 1509 (2006) on Human Rights of Irregular Migrants, article 13.2 »as a minimum right, emergency care should be available for irregular migrants. Less than rights Minimum rights More than minimum 7

A Project funded by DG SancoNOWHERELAND at the Center for Health and Migration/DUK. Cluster 1. Less than minimum rights Member states in which entitlement is restricted to an extent that makes even emergency care inaccessible for irregular migrants member states offering health care only within detention centres Ten member states ‘implementation gaps’ - a better level of care is sometimes provided in practice; however, such exceptions are arbitrary and not predictable from the patients’ perspective or in return of the full cost 8

A Project funded by DG SancoNOWHERELAND at the Center for Health and Migration/DUK. Cluster 1. Less than minimum rights RIGHT OF ACCESSMEMBER STATES TaxInsurance May access emergency care for an unclear cost Finland Ireland May access emergency care in return for payment of the full cost Sweden Austria Bulgaria Czech Rep. Latvia Right to access emergency care, provided they are affiliated to insurance, via employment or privately Luxembourg State medical care and services free of charge within the framework of detention centres Malta Romania 9

A Project funded by DG SancoNOWHERELAND at the Center for Health and Migration/DUK. Cluster 2. Minimum rights Member states in which irregular migrants are entitled to emergency care (‘immediate’ or ‘urgent’) From the patients’ perspective, the provision of care is predictable Twelve member states health care of a more extensive kind might be accessed under certain unpredictable circumstances (e.g. at the discretion of the professional involved), or in return for payment of the full cost. 10

A Project funded by DG SancoNOWHERELAND at the Center for Health and Migration/DUK. Cluster 2. Minimum rights RIGHT OF ACCESSMEMBER STATES TaxInsurance Right to access emergency care free of charge. Germany Hungary Right to access emergency care free of charge. May in principle access primary and secondary care in return for payment of the full cost. Cyprus Denmark U K Estonia Lithuania Poland Slovak Republic Slovenia Right to access “urgent medical aid” (AMU). Involves an administrative procedure by social services centres (CPAS/OSMW) to verify irregular stay and “destitution”. Belgium Right to access emergency care in case of life-threatening conditions at emergency units. Greece 11

A Project funded by DG SancoNOWHERELAND at the Center for Health and Migration/DUK. Cluster 3. More than minimum rights Member states in which entitlement to health care includes services beyond emergency care The relevant provisions are laid down in legislation which explicitly refers to irregular migrants Entitlement might be impaired by administrative procedures Five member states can be found to be applying this level of rights. 12

A Project funded by DG SancoNOWHERELAND at the Center for Health and Migration/DUK. Cluster 3. More than minimum rights RIGHT OF ACCESSMEMBER STATES TaxInsurance Right to access health care free of charge. Access involves an administrative procedure. Italy Netherlands Right to access healthcare for no, or a moderate, fee. Access involves an administrative procedure and is subject to a prerequisite involving the period of stay. Portugal Spain France 13

A Project funded by DG SancoNOWHERELAND at the Center for Health and Migration/DUK. 14

A Project funded by DG SancoNOWHERELAND at the Center for Health and Migration/DUK. Conclusion 1 -right of access to health care differs considerably -international obligations articulated in human rights standards are not fully met in the majority of member states -the variations are independent of the health care financing system and the numbers of irregular migrants -level of rights seem to relate to the intersection between practices of control of migration, the main categories of IM and the ‘moral economy’ of the work society 15

A Project funded by DG SancoNOWHERELAND at the Center for Health and Migration/DUK. Conclusion 2 ‘moral economy’ of the society; the basic collective norms and obligations, concerns which risks should be covered and who are eligible and what are legitimate practices countries in the ‘generous’ cluster mainly harbour irregular migrants whose pathway into irregularity is related to the (informal) working market countries found in the more restrictive cluster mainly harbour irregular migrants who are largely ‘produced’ by the asylum system (rejected asylum seekers) 16

A Project funded by DG SancoNOWHERELAND at the Center for Health and Migration/DUK. Conclusion 3 -irregular “work migrants” tend to be more favourable received than those who are “rejected asylum seekers” -a more complete understanding of the differing policies might be obtained by considering the relationship between the formal and informal economy - the role of human rights standards within the current ‘moral economy’ of the work society. 17

A Project funded by DG SancoNOWHERELAND at the Center for Health and Migration/DUK. 18

A Project funded by DG SancoNOWHERELAND at the Center for Health and Migration/DUK. 19 Thank you!

A Project funded by DG SancoNOWHERELAND at the Center for Health and Migration/DUK. 20 Project funded by DG Sanco, Austrian Federal Ministry of Science and Research, Fonds Gesundes Österreich, MIM. Running time: January 2008 – December 2010 Centre for Health and Migration at the Danube University, Krems (AT) (main coordinator) Platform for International Cooperation on Undocumented Migrants (BE) Azienda Unità Sanitaria Locale di Reggio Emilia (IT) Centre for Research and Studies in Sociology (PT) Malmö Institute for Studies of Migration, Diversity and Welfare (SE) University of Brighton (UK)

A Project funded by DG SancoNOWHERELAND at the Center for Health and Migration/DUK. 21 Collaborative partners University of Geneva (Sandro Cattacin) European Hospital and Healthcare Federation (BE) International Centre for Migration Policy Development (AT) International Organization for Migration (BE) Swiss Forum for Migration and Population Studies (CH) UNITED for Intercultural Action (NL) University of Vienna, Institute for Nursing Science (AT) WHO European Office for Integrated Health Care Services