C Explanatory memorandum by Ms Yuliia
Ovchynnykova, rapporteur for opinionNote
1. According to the World Health
Organisation (WHO), over 281 million individuals reside outside
their native countries. The WHO European Region accounts for the
largest proportion of this displaced population worldwide, hosting
nearly 36% of all international migrants. The report by Ms Pelin
YıIık takes a commendable and courageous stance against the outsourcing
of border controls to third countries – such as Niger, Libya, or Tunisia
– and the establishment of offshore 'return hubs', exemplified by
the Italy-Albania model in Gjader. By shedding light on severe human
rights violations, including documented cases of self-harm, suicide attempts,
and a critical lack of essential medicines within these facilities,
the text effectively exposes how shifting international protection
burdens systematically compromises human dignity and public health safeguards.
2. Access to healthcare for migrants and refugees is not a matter
of charity. It is a matter of fundamental social rights, human dignity
and the rule of law. Under the European Social Charter (ETS No.
35 and ETS No. 163), Article 11 recognises the right to protection
of health, while Article 13 guarantees the right to social and medical
assistance. These are not abstract promises: they require effective
access to healthcare systems for every person, including those who
arrive in our countries in vulnerable circumstances. Indeed, several
other articles of the Charter describe the needs and rights of vulnerable
population groups that require special attention of policy makers
(such as children and young persons, pregnant women, migrant workers
and their families, older persons and persons with disabilities)
(see amendments A, C and G).
3. Migrants and refugees often face language barriers, administrative
obstacles, discrimination, deprivation and exclusion. Yet, health
cannot depend on nationality, residence status or legal category.
The right to health must be applied to all persons without any discrimination
as a pillar of human dignity. When certain groups of the population
are denied care, society as a whole does not become stronger; it
becomes less fair, less healthy and less resilient.
4. The Parliamentary Assembly has on many occasions stressed
that migrants and refugees should be guaranteed effective access
to healthcare from the moment of their arrival on the European soil.
That approach is fully consistent with the spirit of Articles 11
and 13 of the Charter: protection of health requires prevention, treatment
and access to essential services, while social and medical assistance
must be available to those who are in need, especially the most
vulnerable.
5. Access to healthcare is also a question of equal opportunities.
If we want integration to succeed, if we want children to learn,
adults to work and families to live in safety, then we must ensure
their timely access to healthcare. Early access is not only humane;
it is also in the societal interest. It prevents emergencies, reduces public
health risks and supports cohesion. The Council of Europe Development
Bank as a bank with a social vocation can contribute to supporting
member States in strengthening their health infrastructure and services so
that all the population is adequately protected (see amendment G).
6. Rather than relying solely on moral obligations, the report
presents a pragmatic economic perspective balanced with public health
needs. Citing studies from Switzerland and Germany, it demonstrates
that investing in early, accessible primary healthcare and medical
check-ups at first arrival dramatically reduces long-term healthcare
expenditure and avoids overloading emergency services (see amendment
B).
7. While the explanatory memorandum rightly identifies the brain
drain of medical professionals to the private sector and acute nursing
shortages as critical institutional bottlenecks, the draft resolution
fails to offer possible solutions to mitigate this crisis. Member
States could establish institutional and financial incentive frameworks
– such as hardship allowances, specialised training credits and
targeted public service protections – to retain and motivate public
sector healthcare workers deployed in reception facilities and transit
border zones. Member States could also integrate into the mainstream
health systems highly qualified refugees and migrants who are trained
as healthcare professionals, so that they can contribute to domestic
health systems and to delivering culturally and linguistically appropriate
care to migrant populations (see amendment F).
8. The report demonstrates a structural friction between long-term
health needs and the reality of rapid migration transits, noting
that mobile populations rarely remain in one country long enough
to receive sustained psychological or medical assistance. To address
this, the Assembly should look beyond static national frameworks
and recommend the development of secure, interoperable and portable
digital health records across migration routes (see amendment D).
This is essential to guarantee cross-border continuity of care and avoid
the dangerous fragmentation of medical records.
9. The report rightly criticises European Union directives for
their restrictive and vague definitions of essential medical treatment,
which often leads to exclusionary national policies. However, the
draft resolution falls into the same semantic trap by calling for
'emergency and other necessary healthcare' without further specification.
To provide greater legal certainty, the text could clarify the substantive
scope of 'necessary healthcare' (see amendment E).
10. The finding that some member States permit healthcare facilities
to pass interpretation fees onto migrants and asylum seekers represents
a high barrier to human-rights-compliant healthcare. The Assembly should
condemn such a practice and urge member States to fully fund interpretation
and mediation services, making them entirely free of charge for
the patient.
11. Moreover, the operational reality in transit zones reveals
insufficient access to pharmaceuticals, exemplified by the Red Cross
being restricted to funding a mere 30 essential medicines, which
leaves specific or severe chronic illnesses unaddressed. The problem
could be tackled through the creation of centralised emergency medical
funds or standardised 'migrant-essential medication lists' under
the joint stewardship of the Council of Europe and WHO. This would
help bypass restrictive donor clauses and better equip transit points with
a full range of life-saving pharmaceuticals.
12. Member States should better handle the public health risks
posed by restrictive clauses in the new EU Returns Regulation. These
clauses deter undocumented migrants from seeking treatment for diseases
like tuberculosis and HIV out of fear of deportation. Strict, statutory
'firewalls' in national legislation are needed. Domestic legal frameworks
must explicitly prohibit healthcare providers and hospital administrations
from reporting a patient's irregular status to immigration authorities,
treat any such unauthorised disclosure as a punishable breach of
medical confidentiality, and ensure that the delivery of healthcare
remains decoupled from the administrative status of patients and
is grounded solely in humanitarian and public health needs. Moreover,
migrants in transit should not suffer from "medical history amnesia":
digital health records are a public health necessity, not just an
administrative convenience.
13. As rapporteur for opinion, I believe that we should affirm
a simple principle: protecting the health of migrants and refugees
protects the health of society as a whole. A rights-based approach
grounded in human dignity, non-discrimination, equal opportunities
and solidarity is not just legally correct. It is morally necessary and
socially wise. I therefore propose to the Social Affairs Committee
to approve these amendments as set out above in order to highlight
the importance of the European Social Charter in defending fundamental
rights which should be read together with those spelt out in the
European Convention on Human Rights. The inclusion of these amendments
will transform the draft resolution into a clear political and legal
shield that protects the rights of migrant and refugee patients
and strengthens public health systems, contributes to overcoming
the shortage of medical professionals in Europe and underpins progressive
reforms that advance social justice in member States and their neighbourhood.
