*This text is an answer to the question of Pascal Detzler “How is Healthcare for Asylum Seekers Regulated in the EU and in Russia?”
This paper provides an introduction to the Directive 2013/33/EU (Reception Directive (recast)) and of the status and consequences of its legal transposition into the domestic law of an former communist state, namely Romania. It then proceeds to outline how the nationally existing legal framework – weak or strong – influences the real options available and highlights the incomplete and, at times, distorting approach of the Romanian legislator. Finally, some past and future legal implications on the reception conditions of asylum seekers and recommendations are put forward.
EU level: Asylum seekers’ access to healthcare. Reception Directive (recast)
The Reception Conditions Directive (recast)1 establishes common standards of living conditions for asylum applicants. (The previous version of the Directive was valid until 21 July 2015 when the new one became applicable). It ensures that applicants have access to housing, food, health care and employment, as well as medical and psychological care. The new Reception Conditions Directive aims to ensure better as well as more harmonised standards of reception conditions throughout the Union2.
Reception Directive also sets out the necessary provisions in relation to health care. Member states shall ensure that applicants receive the necessary health care which shall include, at least, (i) emergency care and (ii) essential treatment of illnesses and of serious mental disorders.
For applicants who have special reception needs it requires necessary medical or other assistance, including appropriate mental health care where needed.
Implementation of Reception Directive in the Romanian primary legislation
The Reception Directive was implemented in the domestic law through Law no.122 of 4 May 2006 regulating the Asylum in Romania.
Article 17 prescribes the rights of a person applying for a form of protection during the asylum procedure .
In this respect, the person who has no means of existence shall, upon request:
- have benefit of material conditions, guaranteeing subsistence and protecting physical and mental health. The amount of funds required for the material reception conditions are established by Government Decision and are provided from the state budget;
- be included in national health programmes that aim to prevent, supervise and control transmissible diseases and epidemiological risk situations;
- receive free primary care and appropriate treatment, hospital emergency care and medical care and free treatment in cases of acute or chronic diseases that put their lives in imminent danger, through the national health emergency system and qualified first aid.
These services shall, where appropriate, be provided through the medical services of the accommodation centres / hospitals and other centres accredited and authorised by law;
Special provisions are being laid down with respect to adequate medical care for vulnerable asylum seekers and those with special needs.
In view of the specific legislation outlined above, the main aspects to be concluded are as follows.
The main healthcare services to be provided to asylum seekers in Romania are:
- through the emergency system
- treatment for chronic diseases
- medical services (e.g. colds, diseases)
In the last case, payment for services granted is made by the beneficiary and the cost repaid at a later stage following a request to the GII integration officer This has proved to be a difficult procedure, which can take up to a month, making it difficult for an asylum seeker to manage .
In addition to the basic services mentioned above, there are non-governmental organisations that have specific programmes on health care, managing and contracting family doctors to provide medical services to asylum seekers.
Practices likely to violate foreigners’ civil rights in Romania have been identified as:
- Romania’s public health system problems together with the medical staff’s lack of preparation for multicultural interaction, especially with individuals with distinctive physical characteristics4.
- lack of interpreters in relation to the doctor
- lack of awareness regarding refugees’ or asylum seekers’ rights, thus making them dependent on NGOs’ support for medical care
In Romania there are private medical systems, such as Queen Mary social clinics, ensuring asylum seekers receive the care they need even if they are not medically insured.
The Queen Mary Foundation opened its second social clinic in 2015 to provide integrated medical services for low-income people in Bucharest. This is a medical social project, which complements the medical services offered to people with no income and no health insurance.
Some NGOs offer specific programmes on health care including psychiatric, psychological or basic medical services. One of them is the ICAR Foundation5. It grants former political prisoners, refugees, asylum seekers and their close relatives medical care, psychiatry, cardiology, urology, physiotherapy and kinesiology care.
Another good example is the Association of Jesuit Refugee Service6. There, the asylum seekers receive medical and psychological services, throughout the country. Asylum seekers may have general medical tests, medications, treatments, medical devices for recovery, counselling and psychological support from specialists.
“Most problems have been reported in people who arrive already with negative emotional baggage and thus medication or psychological care is not enough; it also requires a better understanding by the administrative staff who take care of them,” says Catalin Albu, the director of the Association of Jesuits Refugee Service in Romania, in an interview on the website Immigrants in Romania7 (in Romanian, Imigranti in Romania). The same news website says it has frequently encountered the situation where medical staff do not know a foreign language, which hampers communication and treatment. Ability to interact with patients from other cultures seems to be poor. Therefore, the creation of protocols and establishing mechanisms for continuous interaction between doctors and specialised NGOs is one of the main recommendations.
Such services are provided free of charge by highly trained and experienced professionals and financed by the EU National Fund for Asylum, Migration and Integration (FAMI funds).
EU overviews available
One of the major problems revealed in an evaluation report available in 20038 underlined that the reception conditions provided by member states were too low to ensure asylum seekers’ subsistence and full health9. This is particularly the case where Member States provide a financial allowance to asylum seekers. In some states, the allowance is lower than the level of the minimum social support granted to nationals10.
Recent results on the Recast Reception Directive in the Member States. Difficulties in accessing health care11
Recent studies analysing EU states (2015) have found that there are significant barriers for applicants to access health care effectively, even if it is provided for in legislation. This is due to a variety of reasons, including delays in registering the asylum claim during which applicants are unable to access any services including health care, language barriers, the cost of health care and the location of some of these services.
Other studies12 available highlight the main challenges identified about healthcare provision at reception centres as being: limited entitlements to healthcare; practical/administrative barriers; cost of treatment and/or medicines; limited availability of healthcare professionals; poor sanitation conditions and overcrowded spaces; a lack of interpreters. Nonetheless, none of the member states covered collects systematic data on the health status of newly arrived migrants and persons in need of international protection, nor on their use of the healthcare system.
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|1.||Directive 2013/33/EU of the European Parliament and of the Council of 26 June 2013 laying down standards for the reception of applicants for international protection Available at eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32013L0033&from=EN|
|3.||Article 20 Reduction or withdrawal of material reception conditions: 5. Decisions for reduction or withdrawal of material reception conditions or sanctions referred to in paragraphs 1, 2, 3 and 4 of this Article shall be taken individually, objectively and impartially and reasons shall be given. Decisions shall be based on the particular situation of the person concerned, especially with regard to persons covered by Article 21, taking into account the principle of proportionality. Member states shall under all circumstances ensure access to health care in accordance with Article 19 and shall ensure a dignified standard of living for all applicants.|
|4.||Romanian Academic Society policy brief no 66 November2015 Immigration Policies in Romania: Policy proposals regarding the protection of immigrants’ civil rights in Romania google.com/file/d/0B96enEC_MPU_RFk1ZnoxT3BWSlQySVh4b2RHU2hqQnFxbzJZ/view|
|8.||Odysseus, Comparative Overview of the Implementation of the Directive 2003/9 of 27 January 2003 laying down minimum standards for the reception of asylum seekers in the EU Member States, October 2003 and COM (2007) 745 final, Report on the application of the Directive 2003/9/ EC of 27 January 2003 laying down minimum standards for the reception of asylum seekers, 26 November 2007https://ec.europa.eu/home-affairs/sites/homeaffairs/files/e-library/docs/pdf/odysseus_synthesis_report_2007_en_en.pdf The study does not include Romania, Bulgaria and Croatia.|
|9.||Odysseus, Comparative Overview of the Implementation of the Directive 2003/9 of 27 January 2003 laying down minimum standards for the reception of asylum seekers in the EU Member States, October 2003 and COM (2007) 745 final, Report on the application of the Directive 2003/9/ EC of 27 January 2003 laying down minimum standards for the reception of asylum seekers, 26 November 2007|
|10.||ECRE – Reception and Detention Conditions of applicants for international protection in light of the Charter of Fundamental Rights of the EU January 2015. http://www.ecre.org/wp-content/uploads/2016/07/ECRE-Reception-and-detention-conditions-for-applicants-for-international-protection-in-light-of-the-Charter-of-Fundamental-Rights-of-the-EU_January-2015.pdf|
|11.||ECRE – Reception and Detention Conditions of applicants for international protection in light of the Charter of Fundamental Rights of the EU January 2015. This study has been prepared in the framework of the “Promoting the EU Charter of Fundamental Rights within the legal networks active in the field of asylum and migration in Europe” (FRAME) project. The project partners include the Dutch Council for Refugees and the Romanian National Council for Refugees. Available at http://www.ecre.org/wp-content/uploads/2016/07/ECRE-Reception-and-detention-conditions-for-applicants-for-international-protection-in-light-of-the-Charter-of-Fundamental-Rights-of-the-EU_January-2015.pdf p 38-39|
|12.||Monthly data collection on the current migration situation in the EU, April 2016 monthly report. Available at http://fra.europa.eu/sites/default/files/fra_uploads/fra-2016-monthly-compilation-4-summary_en.pdf|