Access to healthcare in Europe in times of crisis and rising xenophobia 1 1 Doctors of the World Working with people facing multiple factors of vulnerability 05/09/2013 EPHA «Brave new world»
2 Doctors of the World Médecins du Monde 2-312 medical and social programmes in 79 countries - Over 160 health programmes across the EU (in 11 Member States), mainly with volunteer health and social professionals - Improving access to healthcare for people who face numerous vulnerability factors: homeless people, drug users, sex workers, undocumented migrants, asylum seekers, Roma communities, destitute EU citizens, etc. - Systematic data collection on (social determinants of) health - Data presented here: collected during 2012 in 14 cities across seven countries, covering 8,412 patients and 19,302 consultations
Negative impact of austerity measures on healthcare systems 3 3 Spain - 7,000 million cuts + another 22% in 2013 (more than any other sector) - Creeping privatisation of health care providers, increased out of pocket payment for medicines, from a universal system to limited beneficiaries - Several special programmes targeting the most vulnerable were cut, for example in the national plan on Drugs or the National Plan on HIV/AIDS - Exclusion of adult undocumented migrants through Royal Decree-Law 16/2012 on urgent measures to ensure the sustainability of the national health system
Negative impact of austerity measures on healthcare systems 4 4 Greece - Troika imposed cuts : health costs < 6% of GDP (MoU) (expected 2 122 billion cuts by 2015) - 5 entrance fee in hospitals - shortage of medical supplies and drugs - parents cannot pay their children s vaccination anymore - foreigners should pay double price - 26 000 public health workers (up to 9100 doctors) could lose their jobs by 2015
Negative impact of austerity measures on healthcare systems 5 5 Portugal - 670 million savings (MoU Troïka - Portugal) - higher user fees but a larger part of the population has the right to exemption of co-payment - Lack of knowledge concerning the possibility of exemption especially among homeless people - Undocumented foreigners have to pay 100% of the costs
6 6 Healthcare services less accessible for many (vulnerable) groups despite the fact that» Health is a basic human right» Exclusion is a costly and ineffective policy tool» In contradiction with medical ethics» Inefficient and dangerous from a public health perspective
Rise of xenophobia across Europe 7 7 - Economic crisis, rising unemployment, lower levels of social protection scapegoating of groups already facing social exclusion before the crisis - E.g. Netherlands, Germany or France: homeless migrants and Roma are often denied access to emergency shelters - Some high level politicians (Cameron in UK, Health Ministry EL, Copé in FR ) stir the hatred up and use the MYTH of health tourism - Spain: exclusion of undocumented migrants from the healthcare system. Only adults in theory in practice many pregnant women and children get excluded as well. - Greece: daily, unpunished brutal attacks and hate crimes - Racist violence recording network in Greece: 154 racist attacks in 2012 + over 70% of the violence suffered by migrants occured after arrival (MdM Patras EL 2011)
Golden Dawn initials and logo carved into MdM patient s back photo: Giorgos Moutafis
Patient story 9 9 Monia, 25, is Slovakian and has been living in Brussels for nine months. She has three young children (aged seven, four and 18 months). My husband used to have a job here, which is why we came to Belgium. We left Slovakia because of the xenophobia and the constant violence suffered by the Roma population there. For example, I witnessed the beating of my cousin by skinheads. She was pregnant and as a result she miscarried. She is still in hospital now. There are no opportunities for us in our town in Slovakia. Here in Brussels we don t know anybody. We lived in a squat for eight months. But early one morning in September 2012 we were suddenly evicted by the police without any warning. For the next 30 days, I slept in a tunnel with my three children on cardboard. It smelt very bad. A lot of people passing by gave us food, nappies, etc. Even in this tunnel, the police came to expel us. Finally, the authorities gave us a return ticket to Slovakia. We went back to our town for only four days where we slept in the street until we caught a bus to come back to Brussels. Even sleeping in a tunnel is better than being in Slovakia. MdM Belgium Brussels September 2012
Rise of xenophobia across Europe The myth of health tourism 10 10 - Increasing use of the idea that restricting migrants right to essential healthcare services can be an effective policy tool in regulating migration flows. - Unethical from a medical ethics and human rights point of view; - Access to care is not a pull nor a push factor for migration; - Undocumented migrants do not know their pathologies before migrating - In 2012, health represented only a 1,6% share of the reasons for migration of the migrant patients questioned in our clinics; - Lack of understanding or knowledge about how to access healthcare is the main barrier for MdM patients.
Direct impact on Health 11 11 Greece - 30 to 40% rise in suicides - 51% of MdM patients have a (very) bad perceived mental health in 2012-49% of the patients seen are Greeks now (88% in Perama) - % of vaccinated kids go down - Rise in the number of drug users, spreading of very dangerous cheap drugs, constant rise of HIV contamination among Greek drug users Spain - closure of health-care services - reductions in the number of hospital beds and working hours - women and children often don t access care in real life - 53% rise in child poverty (2007-2010 Unicef) - death of Alpha Pam, 28 years old untreated TB patient Portugal - Isolated elderly situation is worsening in times of crisis when families can t help - increase of people looking for healthcare at MdM programmes - destitute cannot afford to pay for medicines: MdM has to supply them (13% of elderly renounce to medicines)
Direct impact on health 12 12 Other key figures (MdM 2012 survey 14 cities in 7 countries DE, BE, ES, FR, EL, NL, UK)» 81% of patients had no possibility of accessing care without paying full costs» 55% of the patients who were EU citizens were not permitted to reside in the host country» 59% of pregnant women did not have access to antenatal care when we met them ( only 46% in France)» 60% of all patients did NOT know where to go to get vaccinations» Over 50% of the patients in need of essential treatment hadn t had any before MdM
Direct impact on the health of children 13» 13 Lack of access to vaccinations in Greece (costs) and all EU countries (1/3 no vaccine or don t know)» Most EU countries go against interests of children treating them as UDM» Increasing housing difficulties 49% of MdM patients had unstable or temporary housing negative impact on children s health & development
Patient story 14 14 Adamma is a 22-year-old Nigerian woman who has been living in the Netherlands for the last two years. She lives in a three-by-four metre room with her husband. Adamma was delighted when she fell pregnant a year ago, but she never dared to visit a doctor or a midwife because she had no health insurance. Only on the day she went into labour and the contractions began didi she go to the hospital. At the reception desk of the maternity unit she was told that she could only be admitted to the ward upon a payment of 500, even though she was in a great deal of pain. Her husband earns 200 a month as a cleaner, which is all they have to live on. Her husband made a call to secure an advance on his wages, but it took many more calls to find the remainder of the money in the form of loans from various friends. Once the 500 was secured, Adamma gave birth to a healthy daughter. Just a few hours after the birth, she was forced to leave the hospital. The three of them now have to share the tiny 3x4m room. There is no postnatal follow-up. Adamma needs to keep her baby as quiet as possible to be sure not to disturb the other residents. MdM Netherlands Amsterdam September 2012
MdM response 15 15» In Greece, MdM doubled the programs (homeless, polyclinics, elderly, shelters, mobile units, migrants )» In Spain: large campaign for the right to treat anyone in the public health system ( derecho a curar )» In Portugal: more programs with destitute elderly + provision of medicines to NGOs and MdM patients
MdM demands» Each human being MUST have an equal access to care in EU public open health systems» In times of crisis, more protection and not less» In times of crisis more human rights and more protection against xenophobic violence (EL)» Protection of seriously ill undocumented migrants: we cannot accept death sentence based on administrative decisions» General mobilisation against hate speech and destruction of health systems based on solidarity and equity 16 16
More information? Downloadable from www.mdm-international.org 17 17 Access to healthcare in Europe in times of crisis and rising xenophobia. An overview of the situation of people excluded from healthcare systems. April 2013. Full report on the analysis of the data Access to Healthcare of excluded people in 14 cities of 7 European countries Full update (April 2013) on the legislation in ten countries (BE, CH, DE, ES, FR, EL, NL, PT, SE and UK) Contact Nathalie.simonnot@medecinsdumonde.net and / or Frank.Vanbiervliet@medecinsdumonde.net for more information.