Undocumented migrants excluded from accessing health care in Sweden according to survey from MSF

Sweden is one of few countries in EU to charge full costs for emergency care for undocumented migrants. The lack of a legal framework for subsidized health care creates barriers for access, exacerbates their fear to seek care and is a major factor why they are so excluded from access to health care.

Stockholm - High costs and fear of being turned in to the police by health care personnel create major barriers for undocumented migrants to access health care. Many are refused care when they are not able to present required documents at the reception. This is according to a new survey which is released by MSF today.

The survey was carried out between July and September 2005 with 102 patients who had all received medical assistance through MSF's network. As many as two-thirds of the participants in the survey reported that their physical and mental health have deteriorated while living without legal status.

Several people in the survey had serious or chronic diseases such as diabetes and high blood pressure. Had they not been helped through the MSF network, they could have suffered permanent organ damage leading to life-threatening conditions and need for intensive care.

One patient had tuberculosis, which is a contagious disease that should not be left untreated. Twelve of the women in the survey were pregnant and did not have access to maternity care during their pregnancy. Lack of antenatal care for the women would have meant that they were excluded from routine national screening programmes, which could have resulted in detrimental consequences for the mother and the child.

"A majority of our patients have met obstacles when seeking care," says MSF’s Head of Mission, Mattias Ohlson. "It is both about physical barriers such as extremely high costs or being refused care when failing to present the required documents, and indirect barriers such as fear to seek care."

Sweden is one of the few countries in EU to charge full costs for emergency care for undocumented migrants. The lack of a legal framework for subsidized health care creates barriers for access, exacerbates their fear to seek care and is a major factor why they are so excluded from access to health care.

"Undocumented migrants have to pay 210 Euros for a simple consultation at an emergency ward or 2,200 Euros to deliver at the hospital," says doctor in the network, Johanna Kuisma.

"These amounts are way beyond the ability to pay for a group which is already very much dependent on others for their daily support. Today's system leads to unnecessary suffering and can have serious medical consequences. It also puts us doctors in a position where we have to circumvent existing rules in order to follow our professional code of medical ethics."

The Swedish government is currently working on a law proposal regarding 'health care for asylum seekers and others'. In this proposal, undocumented migrants adults are completely excluded, which means that, in the future, they would only have access to the most immediate, life-saving care, for which they will be obliged to bear the full costs for themselves.

MSF believes that everyone should have access to health care regardless of status and has on several occasions demanded a change of the legal framework.

"For the first time a survey clearly shows how excluded undocumented migrants are. The government therefore has to act and has to amend the law proposal. It is unjustifiable not to offer subsidized care to one of our society's most vulnerable and marginalized group" Ohlson says.

Since January 2004, MSF has a medical referral project for undocumented migrants in Stockholm. It started after the organisation got signals that undocumented migrants had difficult access to health care. Between January 2004 and October 2005 MSF provided 1,157 consultations through a volunteer network consisting of over 50 doctors and other health care professionals.