The material aid an asylum seeker is entitled to includes the right to medical care necessary to live a life in human dignity.1 This entails all the types of health care enumerated in a list of medical interventions that are taken charge of financially by the National Institute for Health and Disability Insurance (RIZIV/INAMI). For asylum seekers, some exceptions have explicitly been made for interventions not considered to be necessary for a life in human dignity, but also they are entitled to certain interventions that are considered to be necessary for such a life albeit not enlisted in the nomenclature.2
In most collective reception centres a doctor is present in the centre. This doctor may refer asylum seekers to a specialist if necessary. If no doctor is present in the reception structure, asylum seekers are referred to a local doctor. Asylum seekers who are staying in official reception structures are not allowed to visit a doctor other than the one they are referred to by the social assistant. In other words asylum seekers do not have a free choice of medical doctor, unless they are willing to pay the cost of another doctor of their choice themselves. In some areas in Belgium there is a general lack of general physicians which has an impact on asylum seekers as well. Certainly for some LRIs it’s difficult to guarantee a doctor. Asylum seekers, unlike nationals, do not have to pay a so-called “franchise patient fee”,3 unless they have a professional income or receive a financial allowance.
There are services specialised in the mental health of migrants, but they are not able to cope with the demand. Public centres for mental health care are open to asylum seekers and have adapted rates, but mostly lack specific expertise. Additionally there is a lack of qualified translators. Those centres that have this kind of asylum-related expertise have to work with waiting lists. In Wallonia, there is a specialised Red Cross reception centre for traumatised young asylum seekers, but this centre also has a waiting list. Furthermore, medical care in LRI is reimbursed by another fund than the other reception infrastructures. This generates differences in access to certain treatments e.g. private psychologists. The Reception Act allows for Fedasil or reception partners to make agreements with specialised services. Although the necessary royal decree which should define the rules for this type of agreement was never created.
When the material reception conditions are reduced or withdrawn as a sanction measure, the right to medical aid will not be affected.4 Although in practice accessing medical care can be difficult. Asylum seekers who are not staying in a reception structure (by choice or as a sanction) have to ask for a (promise of repayment (requisitorium) before going to a doctor. This can be a very time-consuming process. It can take up to a few weeks before the medical service of Fedasil answers. Once the asylum application has been refused and the reception rights have come to an end, the person concerned will only still be entitled to emergency medical assistance, for which he or she must refer to the local PCSW.5
- 1. Article 23 Reception Act.
- 2. Article 24 Reception Act and Royal Decree of 9 April 2007on Medical Assistance.
- 3. “Remgeld / ticket moderateur”, which is under the Belgian health care system the amount of the medical cost the patient needs to pay without being reimbursed for it by the health insurance.
- 4. Article 45 Reception Act.
- 5. Article 57 Article 57ter/1 of the Organic Law of 8 July 1976 on the PCSW.