Médecins du Monde : Accès aux soins en Europe en temps de crise et de montée de la xénophobie

Description

Médecins du Monde : Accès aux soins en Europe en temps de crise et de montée de la xénophobie

Sujets

• Médecins du Monde
• Soin
• Europe
• Grèce
• Xénophobie
• Crise

Informations

• Publié par: Fil_actu
• Publié le: 10 décembre 2013
• Nombre de lectures: 15
• Langue: English
• Poids de l'ouvrage: 4 Mo

Extrait

Access to heAlthcAre in
europe in times of crisis
And rising xenophobiA
An overview of the situation of people excluded
from healthcare systems
Outreach work with the homeless, Athens
C : 100
C : 100
M : 60 M : 60
J : 0 J : 0
N : 0 N : 0Belgium | France | Germany | Greece | Netherlands | Portugal | Spain | Sweden | Switzerland | United Kingdom
© MdM GreeceEx EcUTIvE
SUMMARy
In this report, Doctors of the World presents its latest cumented migrants, asylum seekers, drug users, sex wor-
observations on the social health determinants and kers, destitute European citizens and homeless people,
health status of people facing multiple vulnerability have seen a reduction in or a termination of social safety
factors whom we helped in accessing healthcare nets and networks which provide them with basic help.
across our 160 European programmes during 2012.
NGOs and health providers demonstrate active solidarity The report presents some of the results of compa-
but it is ultimately the responsibility of governments to en-rative data collected in 14 cities across seven coun-
sure the protection of the most vulnerable populations, tries. It covers a sample of 8,412 patients, 19,302
which they do not always do anymore. Patients facing consultations (including 10,968 medical consulta-
multiple vulnerability factors need more protection in these tions) and 11,921 diagnoses reported by our volun-
times of crisis and xenophobia, not less. The results of our teer health professionals. In order to capture the
2012 report include the fact that more than 80% of the context in which this data collection took place, a
patients had no possibility to access care without paying concise update on the national legislations of these
the full cost. 59% of pregnant women did not have access seven countries has been included. We also added
to antenatal care. 40% of the patients who spoke out in to the quantitative data a number of qualitative re-
MdM clinics about violence had lived in a country at war; ports from our feld teams on the most important
one ffth had been physically threatened, imprisoned or tor-European trends identifed by our network.
tured because of their ideas. One ffth had been victims of
2012 has been marked by a social and economic crisis violence by the police or armed forces. 49% had unstable
that has generated austerity measures which are having or temporary housing and 26% said they were in a (very)
an impact on social protection schemes, including health- poor overall state of health. And yet, personal health repre-
care services. At the same time, rising unemployment and sented only 1.6% of the reasons for migration given by mi-
poverty across Europe have generated extreme right sta- grant patients, contradicting the idea that social protection
tements stigmatising migrants. We have noticed a rise in mechanisms represent a pull factor for migrants.
xenophobic acts and regulations in Greece and in other Eu-
As health professionals, we clearly demand the right ropean countries. Another effect of the increase in poverty
to provide healthcare – in accordance with medical is a rise in internal migration. EU citizens who are destitute
ethics – to all patients, regardless of their social sta-and have no health coverage are considered in the same
tus or ethnic origin. We call for national public health way as undocumented migrants from outside the EU if they
systems built on solidarity, equality and equity, open need medical care.
to all those living in the EU, rather than systems
The patients we meet daily in our programmes – natio- based on a proft rationale. We ask for a coherent EU
nals and migrants, children and elderly people, pregnant public health policy for the prevention and treatment
women and the chronically ill – continue to be in a worse of infectious diseases. We demand equal access for
state of health overall than the general population. The all to national immunisation schemes and to paedia-
social determinants that are revealed in this report shed tric care. We demand that all pregnant women have
some light on some of the reasons for this. equal access to pre and post natal care. We demand
full protection in Europe for seriously ill migrants who
In its 2010 report the World Health Organization (WHO) cannot access adequate healthcare in their country
noted, that “Those who are most vulnerable are beco- of origin.
ming even more vulnerable, not only in terms of access
to health care services, but also with regard to other Although “health is formally a Member State competence”,
determinants of health, including the degree of social ex- the EU has an important role to play in encouraging Mem-
clusion, education, housing and general living conditions, ber States to protect health systems and social protection
1quality of diet, vulnerability to violence”… . mechanisms during times of crisis and even rendering
them more accessible.
A signifcant number of Member States have raised out-of-
pocket expenditure for patients. Spain has legally restricted The European Union Agency for Fundamental Rights (FRA)
access to care for undocumented migrants. In Greece, the carries the hopes of many citizens in these times of crisis – we
entire public health system is under enormous pressure ask Member States to fully put into practice their opinions.
due to austerity measures. And while the general popu-
The Council of Europe has an important role to play in lation is facing increasing poverty, populist political parties
protecting fundamental rights throughout Europe. The are taking advantage of the situation by laying the respon-
European Committee of Social Rights has given strong sibility on destitute migrants, as easy scapegoats.
signals by confrming that the right to healthcare as des-
At the same time, groups who were already facing nume- cribed in the European Social Charter clearly applies to
rous vulnerability factors before the crisis, such as undo- all, whatever their administrative status.
1 WHO (2010) Equity, social determinants and public health programmes.
2  ExECUTIvE SUMMAR y . . . . . . . . . . . .2 D ESTITUTE EUROPEAN CITIzENS
AND ACCESS TO HEAl THCARE . . . . . 27
 DOCTORS OF THE WORlD –
WHO WE ARE AND WHAT WE DO . . . .4 RISE OF xENOPHObIA AS
THE CRISIS DEEPENS . . . . . . . . . . . . 28
 I MPACT OF THE ECONOMIC AND SOCIAl
CRISIS ON ACCESS TO HEAl THCARE IN F OCUS ON MDM GREECE, SPAIN
EUROPE FOR PEOPlE CONFRONTED AND PORTUGAl IN THE CRISIS . . . . . 30
WITH vUlNERAbIlITy FACTORS . . . . .5 Doctors of the World Greece in action . . 30
Médicos del Mundo España
 defending universal health . . . . . . . A NAlySIS OF THE SOCIAl AND
coverage for all . . . . . . . . . . . . . . . . 32MEDICAl DATA COllECTED IN 2012 . .7
Médicos do Mundo Key fgures . . . . . . . . . . . . . . . . . . . .7
Portugal facing the crisis. . . . . . . . . . 34 Methods . . . . . . . . . . . . . . . . . . . . . .7
Statistics. . . . . . . . . . . . . . . . . . . . . .8
 OUR DEMANDS - TIME FOR ACTION . . . 36
Demographics and countries of origin . . .8
legal status . . . . . . . . . . . . . . . . . . 10  lEGISlATION UPDATE IN 7 COUNTRIES
Reasons for migration . . . . . . . . . . . 11
(bE, DE, FR, El, Nl, ES, UK) . . . . . . . . 38
living conditions . . . . . . . . . . . . . . . 13
Access to healthcare in belgium . . . . 38
Available emotional support . . . . . . . 13
e in France . . . . . 39
Work and income . . . . . . . . . . . . 14
e in Germany. . . . 40
Violence. . . . . . . . . . . . . . . . . . . 14
Access to healthcare in Spain . . . . . . 41
Coverage of healthcare costs . . . . . . 16
e in Greece . . . . . 42
barriers to accessing healthcare . . . . 18
e in the Netherlands 43 Language barriers. . . . . . . . . . . . 18
Access to healthcare in the UK . . . . . 44 Limited mobility due
to the fear of being arrested . . . . . 19
 Denial of access to healthcare FOCUS ON SWEDEN . . . . . . . . . . . . . 45
and racism. . . . . . . . . . . . . . . . . 19
 Giving up seeking healthcare. . . . . . . 20 FOCUS ON SWITzERlAND . . . . . . . . 46
Health conditions . . . . . . . . . . . . . . . 20
Reasons for consulting  AUTHORS. . . . . . . . . . . . . . . . . . . . . 47
MdM clinics . . . . . . . . . . . . . . . . 20
Perceived health status. . . . . . . . . . . 20
Health problems . . . . . . . . . . . . . . . 22
Chronic disease
and necessary treatment . . . . . . . . . 22
Urgent care . . . . . . . . . . . . . . . . . . . 23
Access to care for pregnant women. . 23
Access to vaccination. . . . . . . . . . . . 25
TAblE OF
CONTENTS
TAblE OF CONTENTS 3DOcTOrs Of ThE WOrlD
WHO WE ARE
AND WHAT WE DO
Médecins du Monde (MdM) – Doctors of the World have MdM promotes a harm reduction approach based on
been working to improve access to healthcare and pro- scientifc evidence which has also demonstrated its
tection of human rights since 1980. We are an international added value in terms of cost-effectiveness. Fostering a
aid organisation that provides medical care and a