Bahzad Al Akhras
Health Policies Researcher, ImpACT International for Human Rights Policies

Often perceived as the castle that defends human rights, Europe is the most common destination for refugees and migrants, particularly in the wake of the conflicts that have plagued the Middle East since 2011. And, in fact, a wide range of laws and standards have been enacted to ensure respect for and protection of diversity within the continent.

However, access to health care for migrants and asylum seekers in the European Union continues to be inadequate. The question is: What polices will guarantee quality, humane practice?

Overview of the current state

Developing insight into the state of health care for immigrants and refugees in Europe is challenging. It requires examination of the population’s physical and mental health as well as the policies that govern delivery of and access to medical services across the 28 European countries.

“The Migrant Health Deficit Effect” is a French study that describes the deterioration of the health status of immigrants as a result of dynamics such as poor work settings and discrimination. An Austrian study resulted in similar findings, concluding that migrants suffer more in terms of physical health than native residents, including higher rates of heart disease, dermatologic problems and urogenital complaints. The relationship between health status and inadequate employment conditions and community inclusion is clear. Other reports on health conditions among migrants and asylum seekers across Europe came to a common conclusion: This population suffers disproportionately from both communicable diseases, such as HIV and tuberculosis, and non-communicable illnesses, including diabetes and conditions of the heart, eyes and the urogenital system.

A newly published review of the various studies of the health of refugees and immigrants in Europe from 2011 to 2017 offered a particularly interesting perspective on mental health. Generally speaking, across all papers reviewed, mental health problems were higher among immigrants than non-immigrants. Post-traumatic stress disorder (31%) and depression (20%) were most common. For many, the process of seeking asylum or becoming a refugee is traumatic. Eighty-nine percent of refugees suffering from PTSD report that the journey itself was traumatic, and 80% say just the status of being a refugee is traumatizing, including internment in detention camps after arrival.

Other issues of concern are health care for women and children.

Europe’s response

Since 2003, the European Commission and WHO European Regional Office have offered services designed to improve access to health care for refugees and immigrants. The development of such services accelerated along with the influx of migrants into Europe over the last 10 years—especially after 2015, when the term “refugee crisis” became common on the continent. The WHO Regional Committee (2016) and the European Commission (2018 and 2020) both weighed in with reports. In addition, a three-year project called Mig-HealthCare launched in 2017 with a consortium of 14 partners from 10 European countries: Greece, France, Germany, Italy, Austria, Malta, Spain, Sweden, Bulgaria and Cyprus. Co-funded by the European Commission, the project published its final report this year, offering many recommendations to improve health care for migrants and refugees.

Many people who arrive to Europe illegally find themselves without formal health care, especially before they file for asylum or when their application is denied and their status becomes “irregular.”

 

Results of European response

Despite these efforts, significant challenges and obstacles remain on the ground. In May 2018, a study published by the International Journal of Environmental Research and Public Health concluded that the programs lack the long-term vision needed to protect the rights of refugees and immigrants. Thus, programs often are uncoordinated and even contradictory, especially in the arena of health. These challenges were documented by Doctors of the World UK and the University of Birmingham in their 2019 ”Vulnerable Migrants And Wellbeing Study.” The report outlined the lack of sustainable funding, as well as the language and cultural gaps between health professionals and patients and the poor coordination between international NGOs and local health authorities.Another challenge is the absence of data on refugees and immigrants in the various European states, including numbers, socioeconomic status and impact of local health policies. Many people who arrive to Europe illegally find themselves without formal health care, especially before they file for asylum or when their application is denied and their status becomes “irregular.”

Promising new approaches

Promising new strategies to provide better health care to immigrants and refugees can be observed in the updates from the European Commission, such as the previously mentioned Mig-HealthCare project.  Its recommendations for the future include campaigns to educate local residents on the benefits of accepting refugees into their communities, initiatives to accelerate social inclusion and efforts to decrease discrimination. It also advocates for a stepwise approach to implementing a long-term, structured strategy for refugee integration across Europe, especially in first-arrival countries such as Spain and Greece.

Accessibility of health care is a fundamental human right, regardless of ethnic, religious and political backgrounds. Immigrants and refugees in Europe still face difficulties in this regard; however, measures are underway at national and European levels to tackle the challenge.