C Explanatory memorandum by Mr Cederbratt,
rapporteur for opinion
1. The report presented by our colleague Mr Jean-Louis
Lorrain tackles a large subject and synthesises very well the main
issues to be addressed. He takes fully into account that there were
two motions which created the basis for the report, including one
on guaranteed access to health care for migrants/foreign nationals.
2. In his report, he has tackled many of the problems that migrants,
refugees and asylum seekers face in having access to health care,
including the problematic issue of certain health care officials
being put under pressure to denunciate irregular migrants who seek
health care (so-called putting a “firewall” on reporting obligations).
1 Access to health care for pregnant women and children
(Amendment D)
3. One difficult but important issue that the rapporteur
touches on at the end of his report is that of access to health
care for pregnant women and children. He cites problems in Greece,
which the Committee on Migration was also made aware of: namely
new born children being held in hospitals until payment of charges have
been made. This has reportedly been a particular problem for undocumented
women, following the birth of their children. However, the issue
for undocumented pregnant women and children goes well beyond this example
and in many countries these women have numerous problems accessing
pre and post-natal health care.
4. Our societies today may be facing all sorts of economic and
other issues, but if we cannot guarantee health care to pregnant
women and the safety of their children during and following pregnancy,
there is a problem with our society and our humanity. The United
Nations Convention on the Rights of the Child states clearly in
Article 24 that States Parties must recognise the right of the child
to “the enjoyment of the highest attainable standards of health”
and must “ensure that no child is deprived of his or her right of
access to such health care services” and this includes (in 24.2.d) “pre-natal and post-natal health
care for mothers”.
5. Doctors of the World have undertaken a study of 16 countries
to show the level of access to health care for undocumented pregnant
women and children in these countries, the results of which are
shown in the table below.
Note
|
Group
1
|
Group
2
|
Group
3
|
|
Countries where the rights
of undocumented children and pregnant women are nearly identical
to nationals, sometimes with some differences in terms of conditions
of access
|
Countries where certain
rights for undocumented children and pregnant women are guaranteed,
but there is discrimination against one or both of these groups
|
Countries without rights
for undocumented children and pregnant women, except in rare circumstances, such
as an emergency
|
|
Belgium, France, Italy,
Malta, Portugal, Romania, Spain
|
Czech Republic, Greece,
Netherlands, Slovenia and United Kingdom
|
Cyprus, Germany, Poland
and SwedenNote
|
6. The problems these women and children face include
issues such as fear of reporting if they seek medical care or enter
a hospital, the problem of financing the care, communicating with
health officials and, knowing their rights. These are some of the
standard concerns, but different groups and sub-groups may have other
specific problems. For example, asylum seekers in the United Kingdom
may face particular problems as they are often moved around the
country, sometimes several times, uprooting them from family and
friends and their midwives and care. Some countries suspend the
removal of migrant women in an irregular situation for a specific
period of time but this does not give them the right to health care.
Note Some countries provide treatment only in
emergency situations, but even this raises questions as to what
amounts to an emergency.
7. I am aware that this issue may appear to be relatively small,
but it is one which the Assembly should take a position on and express
itself clearly. Furthermore, it is an issue to which member States
should pay immediate attention, even during a period of economic
austerity.
2 Health-care needs of detainees and refugees (Amendment
B and C)
8. Health care in immigration detention is an issue
that the Committee on Migration, Refugees and Population has had
to deal with on numerous occasions in different member States. It
is one that I have been confronted with on several visits to detention
centres in France, Greece and Italy, and it is also an issue I have experience
of in my own country Sweden, where I previously worked as a police
officer.
9. Persons in detention are particularly vulnerable, whether
they are in prison or whether they are migrants in detention centres.
I am therefore proposing to mention them as a particular vulnerable
group amongst the other vulnerable groups highlighted in paragraph
3 of the draft resolution.
10. In the same context, refugees arrive after having suffered
persecution. They may have both physical and mental health care
needs as a result of what they have suffered. Furthermore, they
may have undertaken long, arduous and dangerous journeys to reach
their country of asylum. As such, they are also a vulnerable group which
should be mentioned.
3 Mental health (Amendment A)
11. As I mentioned above, many refugees, but also irregular
migrants, caught up in long dangerous journeys, may arrive with
pronounced mental health problems. These may be exacerbated for
children. Furthermore, migrants living in the host society may have
problems accessing mental health care for a range of different reasons,
including problems of communication, understanding what is available,
cultural sensitivity, etc. In a new report from the United Nations
Special Rapporteur on the right of everyone to the enjoyment of the
highest attainable standard of physical and mental health,
Note the rapporteur
recommends that States “ensure access to mental-health facilities,
goods and services, including social support groups and family reunification programmes,
for all migrant workers – including irregular and returnee migrant
workers”.
12. Mental health care issues are important for the whole population
and are particularly important for vulnerable groups such as migrants,
refugees and asylum seekers. I am thus proposing a general reference to
mental health care in paragraph 3 of the draft resolution.
