Health Care for Undocumented Migrants discussed from three perspectives: Human rights, Public health, and Economics

Ursula Karl-Trummer (Center for Health and Migration, Vienna)

Access to health care is defined as a human right laid down in various documents and has been ratified by all European member states (Pace, 2007). At the same time, access to health care is regulated by national law, which in most cases connects access to certain preconditions like insurance, citizenship, or another defined regular status. Undocumented migrants who by definition do lack a regular status are a specific group of interest concerning access to health care. They live in a parallel world that is characterised by exploitation, insecurity, and constant fear of being trapped. Their health is a key issue in several aspects

• They face extreme physical and mental strains.
• Although a majority seems to be working, they have no insurance as they do not hold regular work contracts.
• They increase the overall risk of communicable diseases as they do not appear in any monitoring and do not have access to preventive treatments.

A growing body of knowledge on public health regulations in EU member states has been built up in the last years in the framework of various projects funded by the EU (IOM, 200; HUMA, 2009; PICUM, 2007; Karl-Trummer, Novak-Zezula, 2011; FRA, 2011). Reliable numbers on UDM in the EU are not at hand. A database on irregular migration states that only estimates are available, in most cases of low quality (Clandestino, 2009). Estimates on the share of UDM in 2008 for EU 27 vary with 0.39 %-0.77 % of the total population or 7% and 13% of the foreign population (Vogel 2009).

It can be shown that in a majority of European countries, be it tax based or insurance based systems, undocumented migrants are excluded from regular health care services, with emergency care being the only official gateway into the system. It is often argued that this causes humanitarian costs as it violates in some respect the human right to health, but that such restrictions are necessary as open access would cause high costs for treatments of people who do not pay into welfare systems. Additionally, open access irrespective of regular status and/or financial contributions would cause unwanted additional attraction for undocumented migration.

It may as well be argued that, recognising that “there will always be a number of irregular migrants present in Europe, regardless of the policies adopted by governments to prevent their entry or to return them speedily.” (European Parliament resolution of 8 March 2011 on reducing health inequalities in the EU, 2010/2089(INI) this exclusion from regular care causes not only costs in a humanitarian dimension, but also unnecessary economic costs due to inefficient postponed treatment processes and resulting “forces emergencies”. The evidence base on these subjects so far is poor.

The workshop intends to open a floor for discussing the issue of health care for undocumented migrants from three angles: the human rights perspective (how can national policies incorporate human rights obligations?), public health perspectives (given the care for the most vulnerable as a core principle of public health), and economic arguments (is it more expensive to exclude than to include? What is the contribution of undocumented to national economies?)

Ursula Karl-Trummer, Ph.D, MSc., is Head of the Center for Health and Migration and
Executive Director of Trummer & Novak-Zezula OG. She lectures at various universities,
as well as being an independent expert to the European Commission,
DG SANCO and DG Research, and a reviewer for the German Ministry for
Education and Science and for the Norwegian Research Council.
She also works as a consultant and coach,
specialising in diversity management, risk management, and management coaching.

Wednesday 5 September, 10.15-12.00
Uni Rokkansenteret, Nygårdsgaten 5, 6. etg.
Poster