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The Right to Health and Migration

We strive for equal health and social careThe National Board of Health and Welfare works to ensure good health, social welfare and high-quality health and social care on equal terms for the whole Swedish population.

Elis Envall

The Right to Health

• WHO Constitution• UDHR art. 25• ICESCR art.12• ICERD art. 5• CEDAW art. 14• CRC art. 24• CRPD art. 25

• European Social Charter• African Charter on Human

and Peoples’ Rights• San Salvador Protocol

• Alma-Ata Declaration• Ottawa Charter• Vienna Declaration and

Program of Action• General Comment no. 14• Bangkok Charter

Background

• Approx. 35,000 asylum seekers/yrEstimate: 10,000 – 35,000 UDM:s

• Underground clinics– Rosengrenska 1998– MdM & Red Cross

• Reports by NGOs• PICUM & MSF

• UN Special Rapporteur – Mission to Sweden• Right to Health Care-Initiative

Official inquiry - remit

• Health care and medical services to be made more appropriate than today for – Asylum seekers, 35 000/yr– Undocumented migrants (UDMs), 10 000 – 35 000

• In the light of international commitments (The right to health)

– suggest how subsidized health care can be provided

• Proposals must not affect the asylum process and the numbers of asylum seekers or UDMs

Current legislation

• Equal access to care– Children seeking asylum/residence permit– Children denied asylum/residence permit

• full cost for medicines on prescriptions

• Care that cannot be deferred– Adult asylum/residence permit seekers

• Immediate care, non-subsidised/full cost– Adults denied asylum/residence permit – Children and adults not applied for residence permit

Understanding the Right to Health• The right of everyone to the enjoyment of the highest

attainable standard of physical and mental health (art. 12)

• Obligations of State Parties– respect, protect and fulfill

• General Comment no. 14– AAAQ

• availability, accessibility, acceptability and quality

• General Comment no. 20 – Non-discrimination

• UN Special Rapporteur: Mission to Sweden

Push and pull factors

• Push factors– migrants decide to leave their country of residence– factors to push UDM:s out of country of asylum

• Pull factors– migrants decide where to move to

• EU enlargement 2004 – “Social tourism”• Abortion legislation 2008

Controversial issues• No personal identity number

– Patient safety – Communicable disease prevention and control

• Conflicting interests– ”One agency should not counteract another agency’s authority

and practice”– Health Care policy and Migration policy are two entirely separate

matters

• Health care that cannot be deferred– Suffering for the individual– Health care becomes more expensive without preventive care– Ethical dilemmas for the professionals

Economic consequences ofEqual access to health care for all• Asylum seekers

– 1,230 million SEK

• Undocumented migrants– 280 to 970 million SEK (10,000 – 35,000 UDM:s)

• Total share of health care costs – 0.6 % – 0.9 %

• Not calculated– benefit of cheaper care – benefit of preventive care

Conclusions

• Current legislation is not fully complying with the international commitments

• “Care that cannot be deferred” does not meet the requirements for preventive, curative and palliative health services.

• In conclusion it can be said that no reason to limit access to health care for asylum seekers and undocumented persons can be presupposed.

Proposals

Care according to needs and

on equal terms

– a Human Right

The Right to Health?

The right of everyone

to the enjoyment of the highest

attainable standard of physical and mental health

or

“... not prepared to extend

the rights directory

to all groups ...”