No papers, no rights?Undocumented Migrants, Health Problems

and Health Care

- front line experiences from health care provision to undocumented migrants in Oslo

Frode Eick, Health Care Responsible Health Centre for Undocumented Migrants, Oslo

What is meant by undocumented?

Undocumented migrants; people with no legal resident permit

Undocumented doesn’t necessary mean no passport or ID-papers

Our patients: 2/3 previous asylum seekers (with final rejection), the rest never registered, overstayed visum/resident permit

No paper, no rights?

- right to emergency care- right to necessary treatment before and after giving birth,

abortion and treatment/medicines of communicable diseases (tub, hiv)

- and new political expression; ”health care that can not wait” – open to individual interpretations!

- rights do not guarantee access

No paper, no rights?No right to ”fastlege”

Children: right to all types of health care (and primary education) but still no ”fastlege”

For all: the patients have to pay themselves, no financial system, no reimbursement

Social service: no rights

Background

• Aftenposten ran a feature article series in 2007• Oslo City Mission did a needs assessment in 2008• Uncovered great needs especially for health care• No other Norwegian actors were engaged• Started a collaboration with Red Cross Feb. 2009• Clinic opened 27th October 2009

The Health Centre

• Run by Oslo Church City Mission and Oslo Red Cross

• 2.3 paid employees, aproximately 100 volunteers including professional health workers: doctors, nurses, psychologists, physiotherapists, bioengineers, etc.

Objectives• Offer and provide health care to undocumented migrants

• Give health information to undocumented migrants

• Facilitate undocumented migrants access to health care in the ordinary health system

• Convey information, documentation and experiences about the health situation and needs of undocumented migrants to external actors

• Ultimate goal: to become superfluous, close the centre

What do we offer?Opening hours (drop in): Tuesday evening, Thursday daytime

- Primary health care- Consultation (with general practitioner, psychologists, psysioterapists etc)

-10 -12 volunteers- 6 treatment rooms- specialists (gynecologist, neurologist, nephrologist)

- Medicines- Laboratory tests, vaccines- Treatment and follow-up whenever possible (both somatic and mental)- Volunteer and professional translators

What do we offer?

• Referrals to volunteer network (dermatologist, urologist, dentists)

• Cooperation agreement with Diakonhjemmet Sykehus• Cooperation agreement with psychiatric centre• Cooperation with public hospital for postpaid abortions• Cooperation with pharmacy close by and the ordinary health

system

Our patients

• 720 patients (per 1st August 2011)• 60 nationalities • 35 % women• 20-40 pasients every opening day• 2,000 consultations to date; 4/5ths somatic, 1/5th mental

health related

CountriesNasjonalitet

0

20

40

60

80

100

120

Afgha

nista

n

Albania

Algerie

Brasil

Bulgar

ia

Burund

i

ButanChad

Chile

Colombia

Djibout

i

Ecuado

r

Egypt

El Salv

ador

Eritre

a

Etiopia

Gambia

Ghana

GuineaIra

nIra

kIta

lia

Kamer

un

Kenya

DR Kon

goKina

Kirgisi

stan

Kurdist

an

Kviter

ussland

Libano

n

LiberiaLib

ya

Litau

en

Mau

ritan

ia

Mold

ova

Mon

golia

Mar

okko

Nepal

Niger

ia

Pakist

an

Palesti

na

Papua

Ny G

uinea

Polen

Portu

gal

Romania

Russlan

d

Rwanda

Seneg

al

Serbia o

g Mon

tene

gro

Sierra

Leo

ne

Somali

a

Sri La

nka

SudanSyr

ia

Tadjik

istanTog

o

Tunisi

a

Tyrkia

Ukrain

a

Urugu

ayUSA

Usbek

istan

Ukjent

/stat

sløs

Venez

uela

Vietnam

Zambia

Zimba

bwe

Østerik

e

Gender and ageFordeling kjønn

Kvinner

Menn

Alder

0

50

100

150

200

250

300

350

<18 18-29 30-44 >45

Health problems

Top six (from ICPC-2)

-Digestive (Fordøyelsessystemet)-Musculoskeletal (Muskel og skjelett)-Psychological (Psykisk)-Respiratory (Luftveier)-Skin (Hud)-Reproductive/sexual health

Mental health problems

0

5

10

15

20

25

30

Psykiske diagnoser

kvinne

mann

Challenges

• Identifying target group• Confident and consistent IDs • Translation• Referral and follow-up

Challenges

Economy - need for external funding from 2012 or reduced opening hours / less patients - who should pay the medicine / treatment for patients with chronic diseases?

Capacity- increase in patients - limit how many patients can serve/treat/follow-up- operations are based on volunteers

Mental health- patients with severe mental problems- limited possibility for referral- not enough capacity nor continuity to treat all the patients in need

Ethical considerations

• professional ethics vs. the law• uncover undocumented• humanity prolongs suffering?• test but not treat