Europe. Providing care collecting data obtaining positive changes. Doctors of the World Médecins du monde International Network.

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1 1 Migrants health needs across 1 Europe Providing care collecting data obtaining positive changes Doctors of the World Médecins du monde International Network Nathalie SIMONNOT Berlin, 12 September 2015 Doroftei, aged 10, has not been vaccinated: «I still cannot go to school» Saint-Denis France Denis Rouvre

2 2 2 Doctors of the World Médecins du monde Improving access to healthcare for excluded people all over the world ü82 countries ü355 worldwide programmes ü180 domestic programmes ü ü free first line medical & social services destitute nationals, drug users, sex workers, Roma, undocumented third-country nationals and EU citizens, etc. ü15 autonomous organisations ü US in Germany: Ärzte der Welt - AR, BE, CA, FR, DE, EL, JA, LU, NL, PT, ES, SE, CH, UK,

3 3 3 survey on the health (2014) - 9 European countries, and Turkey - 25/171 European programmes - 23,040 individuals - 42,534 social & medical consultations examples of emergency responses to the migrant reception crisis

4 4 4 MdM Greece Idomeni 2015

5 » Lesbos September Lesbos, septembre Kristof Vadino

6 6 6 MdM France Vintemille 2015

7 7 7 Olivier Pappegnies Calaisis 2015

8 8 8 Why do we run domestic programmes in all 15 MdM associations?

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14 survey on the health (2014) Key general figures: % foreign citizens - 6.4% nationals (16.5% in Germany) - 78% citizens of non-eu countries % migrant EU citizens (53.3% in Munich, Germany) % live below the poverty line % live in unstable or temporary accommodation - 84,4% suffered at least one experience of violence (n= 1,809 patients) - 24,4% of all women (n= 379) had been raped

15 survey on the health (2014) Key health figures: % perceived their physical health as bad or very bad % perceived their mental health as bad or very bad % had no medical attention before MdM (among the patients who suffered from one or more chronic conditions) % had at least one health problem needing treatment (never treated before MdM consultation)

16 survey on the health (2014) Key health figures: n=310 pregnant women % had no access to antenatal care % came to receive care too late (after the 12th week) n= 645 Children - vaccination rate for children, very low - 42,5% Tetanus - 38,7% Hepatitis B - 34,5% MMR - 39,8% Pertussis (Whooping Cough)

17 17 17 Giorgos Moutafis London 2014 I am a lesbian. I had a forced marriage which is why I m pregnant. I had to flee for my life. At the hospital here they gave me an estimate for the cost of my delivery of 5,000 to 12,000. MdM UK, London, 2014.

18 18 survey on the health (2014) 18 Barriers to Health Care: % no healthcare coverage (in European countries) - 52% without permission to reside, restricted their movement or activity for fear of arrest % needed interpreter - 4.5% had experienced racism in healthcare setting ( 12 months) - Most cited barriers to access healthcare % paying for care % administrative problems % Lack of knowledge/understanding of healthcare system & their rights

19 19 19 Legal restrictions making healthcare coverage impossible Germany à undocumented migrants, including children, have effective access to emergency care ONLY (because of civil servants duty to denounce (against FRA or ECDC opinions and CoE and EP recommendations)) à undocumented pregnant women with a temporary tolerance to reside (Duldung) can access antenatal and postnatal care à but no coverage during the 6 first months of pregnancy à No coverage for undocumented EU migrants (recent) positive examples of Belgium, France, Sweden

20 Focus on Violence % reported surviving at least one violent experience % had lived in a country at war % reported violence by the police or armed forces - 10% reported violence after arriving in Europe % of women reported sexual assault % had been raped - with experience of violence 12,4% perceived mental health as very bad (vs. 1,7% with no experience of violence) Healthcare professionals must address patients experiences of violence to avoid misdiagnosis & better respond to specific needs

21 Perceived health status according to violence 21 21

22 22 22 Giorgos Moutafis

23 The Myth of Health Tourism % (of all seen in Europe) no access unless they paid 100% of costs % (with chronic diseases) did not know before coming to Europe - 3% only had migrated for health reasons, % economic reasons % political reasons % family reasons - on average 6.5 years living in surveyed country before consulting MdM

24 Policies dangerous to migrant health Need for access to health - Restrictions in access to healthcare, denunciation (against FRA and ECDC opinions, and CoE and EP recommendations) - expulsion of seriously ill migrants to countries where they have no effective access to adequate healthcare - Need for safe migration routes - 3,500 deaths in the Mediterranean (2015)

25 Policies dangerous to migrant health Need for secure living - lack of appropriate reception and care facilities - re- traumatizing living conditions - family separation & missed social integration opportunities (due to the Dublin III regulation) - Need for protection for children - unreliable: wrist/collar bone X-rays, dental and/or sexual maturity examinations, undertaken without consent of the child

26 MdM European policy recommendations Member States and European institutions must ensure universal public health systems: - built on solidarity, equality and equity, - open to everyone living in an EU Member State, - starting with full access to national immunization schemes, pediatric care; and antenatal and postnatal care and safe delivery.

27 MdM European policy recommendations MdM urges Governments: - ensure safe and legal migration channels - Provide free choice of where to apply for asylum - Do not require medical examinations for migration control - Protected seriously ill migrants from expulsion (when effective access to adequate healthcare cannot be ensured in the country to which they are expelled)

28 Healthcare professionals Fight for medical ethics when confronted with institutions or authorities that deny anyone access to essential healthcare services! 28 28

29 Health professionals make the difference. NOW! Put medical ethics first. Respect patient needs independent of status. - Practice multidisciplinary approach. Low threshold, outreach, interpreters. - Include questions on violence as a part of the medical history in all consultations - Refuse medical examination purely for migration control. - Take social determinants into account when working with refugees.

30 30 Health professionals make the difference. NOW! - Ensure access to care for children & pregnant women. 30 (as stated in the United Nations Convent for the rights of the child) no national law should stop a health professional from giving children & pregnant women full adapted prevention & care - Patients needs determine needed care, not regulations or health coverage - European example of the Granada Declaration (2014): - calling on European governments to protect the health of migrants and ethnic minorities, even in times of crisis