Filling the gap - until others step in

Administrative procedures in hospitals are regulated to such a degree that getting past the reception point is a major obstacle for undocumented people.

MSF built a network of doctors who were willing to see and treat people at no charge outside of their normal practice hours.

At the same time, the organization established a phone number for immigrants to call if they needed care but felt unable to approach regular health services. Two full-time nurses employed by MSF answer the phone and mediate among the undocumented immigrants, the MSF network and hospitals.

Doctors and nurses taking part in MSF's project for undocumented immigrants in Sweden conducted more than 500 consultations in 2004. The vast majority (87%) of the 168 patients involved say they turned to MSF because they were afraid of going directly to a hospital. Administrative procedures in hospitals are regulated to such a degree that getting past the reception point is a major obstacle for undocumented people. Their legal rights are poorly defined, which creates confusion and negative attitudes towards this group among administrative health care staff.

In comparison with other Western European countries such as Italy, Spain, Belgium and France, in which similar MSF projects seek to facilitate access to health services for undocumented immigrants, Sweden has far worse legislation. Its legislation on health care for undocumented migrants is among the most restrictive, and Sweden is one of the few countries that actually charge these people for emergency care.

A newborn delivery costs, for example, about 3,000 euro - if there are no complications. This makes undocumented immigrants extremely vulnerable.

"Access to health care for rejected asylum seekers and other undocumented people is, first of all, a problem on the political level," says Mattias Ohlson, the director of the program. "If decision makers made a commitment to provide health care to this small group, a large part of the problem would be solved. The visceral fear among many of our patients for any public institution, including hospitals, is much harder to come to terms with," says Ohlson.

The children of undocumented immigrants have suffered from the country's policies as well, although their legal right to health care was recently improved.

"Some of the children we meet have been refused care previously at a hospital due to their status, while others have had to pay 250 euros to see a doctor or up to 1,100 euros for surgery," adds Ohlson. "In addition, many parents have been too afraid to take their child to the hospital. They feared that someone would turn them into the immigration authorities or the police - something that is rare but unfortunately has happened."

Ohlson concludes: "Sweden is a country where an organization like MSF should not be needed for providing health care. The main difficulties facing undocumented migrants accessing health care in Sweden are clearly part of a structural problem. I'm hopeful that we will soon not be needed here anymore."