Does Germany need to rethink its policies on healthcare for refugees?

Granting more access to healthcare would push down costs and improve refugees’ well-being, says global health expert.

David InglebyAccording to Dr. David Ingleby from the Centre for Social Science and Global Health at the University of Amsterdam, the biggest room for improvement in refugee healthcare lies outside of the camps. We talk to Ingleby about his latest research.

RG: In your opinion, what changes does Germany need to make to improve its healthcare system for refugees?

David Ingleby: My concern is with the highly restrictive policy environment. The fact that asylum seekers and undocumented migrants are not legally entitled to proper healthcare is a more fundamental  problem than the practical and financial difficulties of providing it.

The first thing that needs to be done is to abolish restrictions on the care that asylum seekers are allowed to receive in the first 15 months of their stay. These restrictions were introduced in 1993 in the hope of deterring asylum seekers from coming to Germany. During these 15 months, asylum seekers only have access to necessary medical and dental treatments in case of acute pain and illness. Aside from this emergency care, they are granted access to vaccinations and pregnant women are provided with maternal care. However, chronic illness (such as high blood pressure or diabetes) and mental health problems are only covered in exceptionally acute cases and even then, only after special authorization has been obtained.

Yet denying easy and early access to healthcare not only ignores the right to health, but actually increases costs: a new study estimated that since their introduction, these restrictive policies have increased the cost of healthcare by 376-euros per year for each asylum seeker. It should also be clear by now that the policies don’t deter asylum seekers from coming to Germany.

The problem of entitlements is even greater for undocumented migrants, whose healthcare is restricted to the same level as that of asylum seekers during the 15-month ‘waiting period’.  In addition, the threat of being reported to the authorities forms a serious barrier to undocumented migrants seeking healthcare in Germany.

RG: Can you point out a European country that has the best healthcare system for refugees?

Ingleby: Yes, France – all categories of migrants, including asylum seekers and undocumented migrants, are entitled to the same healthcare benefits as national citizens, though they are administered in different ways. Reporting undocumented migrants to the authorities is forbidden. Turkey has also granted full entitlement to Syrians fleeing from the war, despite being a much poorer country than Germany.

RG: Can you comment on the health of refugees in Europe in general? What are the most commonly reported health problems?  

Ingleby: As the World Health Organization (WHO) has emphasized, all human beings are vulnerable to a common core of health problems that are mainly determined by sex, age and social position; these are the most common problems among refugees. In addition, people fleeing violence may have both physical and psychological traumas, though the latter term should not be used as a blanket description for any form of distress. To the extent that infectious diseases have been found in the present influx, these mostly result from poor living conditions.

RG: What realistic measures, health and otherwise, should be implemented to improve the journey across Europe for refugees?

Ingleby: The main problems here seem to be political. This crisis has revealed a shocking inability among governments to see beyond their own short-term interests and work towards solutions that benefit all, including the refugees. It should not be necessary to trek for weeks across mountains and muddy fields when budget airlines can sell you a ticket to the same destination for less than 100-euros. But assuming it will continue to be necessary, the European Commission has initiated projects to ensure that health risks are reduced and necessary care is given.

RG: Is there anything you’d like to add?

Ingleby: Health is only one aspect of the enormous challenge with which the ‘refugee crisis’ has confronted Europe. There are signs that the response of education systems is also inadequate and badly thought-out. What we should have learned from the 1990s is that there will be no successful integration without energetic measures to integrate migrant children into the education system – regardless of their parents’ legal status – and to prepare adults for the labor market. Here again, denying migrants adequate services in the hope of deterring more from coming is going to hurt us, in the long run, even more than it hurts them.

Featured image courtesy of Phalinn Ooi.