Destitute Roma & access to healthcare
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Destitute Roma & access to healthcare

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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 ...

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)

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Destitute Roma & access to healthcare Destitute Roma & access to healthcare Presentation Transcript

  • 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
  • 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
  • 5 © Steven Wassenaar
  • 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
  • 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);
  • 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.
  • 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.