1. Rubrik Arial fet 36 mfdfkdmföemfö Arial 28 –eimiemföemf 24 eimeöeöfmfiöem 24 –eiemfömeömföe 20 »eimföemmemaljefi 20 »eiefmöfemfömf 20 »aiemfeöfmföa 20 1 The Right to Health and Migration We strive for equal health and social care The National Board of Health and Welfare works to ensure good health, social welfare and high-quality health and social care on equal terms for the whole Swedish population. Elis Envall

2. The Right to Health WHO Constitution UDHR art. 25 ICESCR art.12 ICERD art. 5 CEDAW art. 14 CRC art. 24 CRPD art. 25 European Social Charter African Charter on Human and Peoples’ Rights San Salvador Protocol Alma-Ata Declaration Ottawa Charter Vienna Declaration and Program of Action General Comment no. 14 Bangkok Charter

3. Background Approx. 35,000 asylum seekers/yr Estimate: 10,000 – 35,000 UDM:s Underground clinics –Rosengrenska 1998 –MdM & Red Cross Reports by NGOs PICUM & MSF UN Special Rapporteur – Mission to Sweden Right to Health Care-Initiative

4. Official inquiry - remit Health care and medical services to be made more appropriate than today for –Asylum seekers, 35 000/yr –Undocumented migrants (UDMs), 10 000 – 35 000 In the light of international commitments (The right to health) –suggest how subsidized health care can be provided Proposals must not affect the asylum process and the numbers of asylum seekers or UDMs

5. Current legislation Equal access to care –Children seeking asylum/residence permit –Children denied asylum/residence permit full cost for medicines on prescriptions Care that cannot be deferred –Adult asylum/residence permit seekers Immediate care, non-subsidised/full cost –Adults denied asylum/residence permit –Children and adults not applied for residence permit

6. Understanding the Right to Health The right of everyone to the enjoyment of the highest attainable standard of physical and mental health (art. 12) Obligations of State Parties –respect, protect and fulfill General Comment no. 14 –AAAQ availability, accessibility, acceptability and quality General Comment no. 20 –Non-discrimination UN Special Rapporteur: Mission to Sweden

7. Push and pull factors Push factors –migrants decide to leave their country of residence –factors to push UDM:s out of country of asylum Pull factors –migrants decide where to move to EU enlargement 2004 – “Social tourism” Abortion legislation 2008

8. Controversial issues No personal identity number –Patient safety –Communicable disease prevention and control Conflicting interests –”One agency should not counteract another agency’s authority and practice” –Health Care policy and Migration policy are two entirely separate matters Health care that cannot be deferred –Suffering for the individual –Health care becomes more expensive without preventive care –Ethical dilemmas for the professionals

9. Economic consequences of Equal access to health care for all Asylum seekers –1,230 million SEK Undocumented migrants –280 to 970 million SEK (10,000 – 35,000 UDM:s) Total share of health care costs –0.6 % – 0.9 % Not calculated –benefit of cheaper care –benefit of preventive care

10. Conclusions Current legislation is not fully complying with the international commitments “Care that cannot be deferred” does not meet the requirements for preventive, curative and palliative health services. In conclusion it can be said that no reason to limit access to health care for asylum seekers and undocumented persons can be presupposed.

11. Proposals Care according to needs and on equal terms – a Human Right

12. The Right to Health? The right of everyone to the enjoyment of the highest attainable standard of physical and mental health or “... not prepared to extend the rights directory to all groups...”