Asylum seekers under the regular procedure, like any other third-country nationals below a certain income level, have access to healthcare thanks to the universal healthcare insurance (PUMA) system.1 Asylum seekers are exempted from the 3 month residence requirement applied to other third-country nationals,2 and this applies to asylum seekers under the Dublin procedure as well. As both asylum seekers under accelerated procedure and Dublin procedure are granted an asylum claim certification (see section on Registration) they benefit from the PUMA. Even if no legal provision has been provided in this specific issue of asylum seekers under the Dublin procedure, it has been observed in practice that the social security services allow them to be provided with the same healthcare insurance as other asylum seekers. The request to benefit from the PUMA is made to the social security services (CPAM) of the place of residence or domiciliation. The asylum seeker must submit documentary evidence of the regularity of his or her stay in France, marital status and the level of his or her resources.
Access to the PUMA insurance is provided for free if the annual resources of the claimant do not exceed €9,534 per household. In the absence of an official document attesting the level of resources, the claimant may make a sworn statement on the level of his or her resources.
CMU is a social benefit for migrants who are not granted leave to remain on the territory, which enables the beneficiaries to receive free treatments in hospitals as well as in any doctors’ offices.3
On 1 March 2011, access to the State medical aid (AME) had been made conditional upon payment of an annual fee of €30 per beneficiary but the French Parliament abolished this tax on 19 July 2012. It should be noted that access to the AME is possible only after 3 months of residence in France. The AME remains available to asylum seekers even if other reception conditions have been reduced or withdrawn.
Individuals with low income and who are still awaiting health insurance and needing healthcare quickly can turn to the All-Day Healthcare Centres (PASS) at their nearest public hospital. This is therefore also a possibility for asylum seekers under the accelerated and Dublin procedures. There, they will receive care and, if necessary, the medical letter needed to speed up the processing of their application for public health insurance. According to the law, all public hospitals are required to offer PASS services, but in practice, this does not always occur.
As a general rule, difficulties and delays for effective access to healthcare vary from one city to another in France. Access to the PUMA is functioning well in most of the regions of France, and is effective within one month. This access has been considerably improved in 2016, even if some difficulties remain, in particular for subsequent applicants. The duration of access to the healthcare insurance is in theory linked to the duration of validity of the asylum claim certification. In practice, it can be noted that CPAM deliver healthcare insurance for a one-year duration. In fact, at the end of the validity of the asylum claim certification, access to health care is not guaranteed anymore. It may then occur, at the moment of renewing their certification, that some asylum seekers get their healthcare insurance suspended.
Finally, some of the problems with regard to medical care are not specific to asylum seekers. Some doctors are reluctant to receive and treat patients who benefit from the AME or PUMA and tend to refuse booking appointments with them even though these refusals of care can in theory be punished.4
National legislation does not guarantee any specific provision for access to care related to mental health issues. Asylum seekers can theoretically benefit from psychiatric or psychological counselling thanks to their health care cover (AME or PUMA). However, access remains difficult in practice because many professionals refuse to receive non-French speaking patients as they lack the tools to communicate non-verbally and / or funds to work with interpreters.
Victims of torture or traumatised asylum seekers can be counselled in a few NGO structures that specifically take care of these traumas. This adapted counselling is provided, for instance, at the Primo Levi Centre in Paris as well as the Osiris centres in Marseille, Mana in Bordeaux, Forum réfugiés – Cosi Essor Centre in Lyon. These specialised centres are however too few in France, unevenly distributed across the country and cannot meet the growing demand for treatment.
The difficulties are in fact even more aggravated by the geographical locations of some reception centres where the possibility to access mental health specialists would mean several hours of travel.
The “regular” health system cannot currently cope with this adapted care for victims of torture and political violence. These regular structures lack time for consultations, funds for interpreters and training for professionals.
To make up for this deficiency, Forum réfugiés-Cosi set up the first mental health centre (called Essor) in 2007 in the Rhône area specialising in the treatment of and support to victims of torture and trauma resulting from the conditions of their exile. In 2015, 2,597 appointments have been conducted in this centre that provides a multidisciplinary approach where a doctor, psychologists, a physiotherapist and an art-therapist offer a comprehensive and multifaceted care to patients. 503 persons have benefited from the services of the centre, among them 164 unaccompanied children. An important feature of the proposed treatment is to allow the patient to express themselves in their own language, through interpretation.
- 1. Article L.380-1 Social Security Code, as amended by Law n. 2016-1827 of 23 December 2016.
- 2. Article D.160-2, 3° Social Security Code.
- 3. Ministry of Interior, Social Rights of Asylum Seekers, available at: http://bit.ly/1EvEcCF.
- 4. Circular DSS n° 2001-81, 12 February 2001 on the care refusal for beneficiaries of the CMU.