Destitute Roma & access to healthcare

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1 Destitute Roma & access to healthcare Médecins du monde – Doctors of the World International Network European Economic and Social Committee – Public Hearing – 12/05/2014 © Christina Modolo

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Presentation by Stéphane Heymans, Doctors of the World, on the occasion of the EESC hearing on Better Roma inclusion through civil society initiatives: focus on health and anti-discrimination (Brussels, 12 May 2014)

Transcript of Destitute Roma & access to healthcare

Page 1: Destitute Roma & access to healthcare

1Destitute Roma & access to healthcare

Médecins du monde – Doctors of the World International NetworkEuropean Economic and Social Committee – Public Hearing – 12/05/2014

© Christina Modolo

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2Médecins du monde – Doctors of the World

160 domestic programmes with medical and social service provision to the most vulnerable: homeless people, drug users, sex workers, undocumented migrants, asylum seekers, destitute European citizens and… Roma communities;

20% multidisciplinary centres for access to healthcare – 80% mobile programmes (street work, squats, camps, isolated villages, etc. with working hours adapted to the people)

Specific Roma programmes in Bulgaria (Roma health mediators in Sliven – vaccination, SSR, access to healthcare), in Greece, France + 2011 research project in NL + 2013 survey in BE

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4Example: destitute Roma in France

Mobile Roma units going to squats and slums (Marseille, Lyon, Nantes, Bordeaux, Strasbourg and Saint-Denis) and specific actions in Toulouse, Grenoble and Nancy

In 2012: 3,186 medical consultations for 2,171 patients

60% women – on average 23 years – 44% are minors – mainly RO

40% received care too late according to our doctors

Worryingly low vaccination rates: 2010-2011 survey in 4 cities: only 8% completely up to date (with booklet) according to French immunisation calendar

Barriers to healthcare: lack of knowledge, language + administration, discrimination + financial

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© Steven Wassenaar

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6Example: destitute Roma in France

Occupation of vacant lots with hardly any access to water & sanitation facilities or waste disposal frequent expulsions by authorities of living places without any warning or delays + violence by neighbours

Unannounced expulsions = loss of vaccination cards, loss of important documents, interruptions of treatment and immunisation schedules

Inter-ministerial notification (‘circulaire’) of 26/08/2012 specifies that individual solutions (education, shelter, work, healthcare) need to be identified before expulsion. But very heterogenic application…

Structural slum ‘integration’ plan announced… to be evaluated

Good practice: health mediation with support from the Health Ministry

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8Health mediation pilot program in France – results

Improved access to existing rights

More frequent (autonomous) use of the existing health services offer, better adherence to treatments

Significant increase in vaccination rates (e.g. from 15 to 68% of children < 6 years vaccinated against hep B)

The majority of women now knew about a place where to get contraception – about half of the women effectively used it

Mediation works in both ways: understanding and adaption from the side of the community AND from the health service

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9Focus on ‘Roma’ or… on ‘destitute EU citizens’?

Destitute mobile Italian, Spanish, Portuguese, French, British… citizens often face the same type of barriers as Bulgarians, Romanians… and as extra-EU undocumented migrants

Regulation 2004/883 on coordination of social security systems and Directive 2011/24 on cross-border healthcare but…

Barriers for insured citizens who try to access the public healthcare system under the same conditions as insured nationals with their EHIC (European Health Insurance Card);

Not all public providers of health insurance across Europe effectively deliver the EHIC (e.g. areas in BG and RO). Consequent unreasonable waiting times before a patient can prove health coverage status in his/her country of origin with no access to healthcare during this period (often > 6 months);

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10‘Roma’ or… destitute EU citizens?

Insured but destitute EU citizens who cannot afford to advance the costs in those countries where health insurance only reimburses costs afterwards.

EU citizens without health insurance or revenues who overstay 3 months of residence and can consequently be considered as irregular in accordance with Directive 2004/38/EC – in most countries this group has no access to healthcare at all.

MdM International Network Observatory: EU citizens make out 14.9% of all patients in the 2013 data collection (n = 16,881 patients seen in 25 cities across eight European countries) and 16% of all people not authorized to stay.

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11How EU institutions can help

Help ensure universal public health systems built on solidarity, equality and equity, open to everyone living in a European Member State. All children must have full access to national immunization schemes and to pediatric care. All pregnant women must have access to ante- and postnatal care.

Improved data collection on Roma health & social determinants in order to deconstruct myths.

Promote health mediation and mobile outreach teams as a good practice + empowerment of Roma communities.

Fight against xenophobia, hate speech and scapegoating, anti-migrant and anti-Roma discourse.