The law restricts health care for asylum seekers to instances “of acute diseases or pain”, in which “necessary medical or dental treatment has to be provided including medication, bandages and other benefits necessary for convalescence, recovery, or alleviation of disease or necessary services addressing consequences of illnesses.” The law further contains a special provision for pregnant women and for women who have recently given birth. They are entitled to “medical and nursing help and support”, including midwife assistance. Furthermore, vaccination and “necessary preventive medical check-ups” shall be provided.1
In addition, the law states that further benefits can be granted “if they are indispensable in an individual case to secure health”.2
The term “necessary treatment” within the meaning of the law has not conclusively been defined but is often taken to mean that only absolutely unavoidable medical care is provided. However, the wording of the law suggests that health care for asylum seekers must not be limited to “emergency care” since the law refers to acute diseases or pain as grounds for necessary treatment. Accordingly, it has been argued that a limitation of treatment to acute diseases is not in accordance with the law, since chronic diseases are equally likely to cause pain. This latter opinion has been upheld by courts in several cases. Nevertheless, it has been reported that necessary but expensive diagnostic measures or therapies are not always granted by local authorities, which argue that only “elementary” or “vital” medical care would be covered by the law.3
A common problem in practice is caused by the need to obtain a health insurance voucher (Krankenschein). These vouchers or certificates are usually handed out by medical personnel in the initial reception centres, but once asylum seekers have been referred to other forms of accommodation they usually have to apply for them at the social welfare office of their municipality. There have been reports that necessary treatment has been delayed or even denied by staff of social welfare offices, due to incompetence to decide on these matters.4 The necessity to distribute health insurance vouchers individually also imposes significant administrative burden on the social services. In response, the Federal States of Berlin, Brandenburg, Bremen, Hamburg and Schleswig-Holstein issue “normal” health insurance cards to all asylum seekers, enabling them to see a doctor without permission from the authorities. In some Federal States (North Rhine-Westphalia, Lower Saxony and Rhineland-Palatinate) the health insurance card for asylum seekers has been introduced in principle, but municipalities have largely failed to implement the system.5 Other Federal States (e.g. Bavaria and Baden-Württemberg) have announced that they will not participate in the scheme.
In reception centres, the limited availability of health care professionals and volunteers has also been reported as a problem, especially on weekends.6
According to Section 1a of the Asylum Seekers Benefits Act, reception conditions can be reduced for reasons defined in the law (see Reduction or Withdrawal of Reception Conditions).7 However, the law states that “irredeemably necessary” benefits still have to be granted in these cases. Accordingly, at least “essential treatment” has to be provided for in these cases, and it has also been argued that treatment should be on the same level as it is for other asylum seekers, especially if the need for medical treatment has been the result of an emergency which has not existed at the time of arrival in Germany.8
After 15 months of having received benefits under the Asylum Seekers’ Benefits Act, asylum seekers are entitled to social benefits as regulated in the Twelfth Book of the Social Code (Sozialgesetzbuch).9 Once people are entitled to the “standard” social benefits, this includes access to health care under the same conditions that apply to German citizens who receive social benefits.
Specialised treatment for traumatised asylum seekers and victims of torture can be provided by some specialised doctors and therapists and in several specialised institutions (Treatment Centres for Victims of Torture – Behandlungszentren für Folteropfer). Since the number of places in the treatment centres is limited, access to therapies is not always guaranteed. The treatment centres often have to cover costs for therapies through donations or other funds since therapies are often only partially covered by the authorities, e.g. costs for interpreters are frequently not reimbursed. Large distances between asylum seekers’ places of residence and treatment centres may also render an effective therapy impossible in practice.
- 1. Section 4 Asylum Seekers' Benefits Act.
- 2. Section 6 Asylum Seekers' Benefits Act.
- 3. Georg Classen, Leitfaden zum Asylbewerberleistungsgesetz (Guideline to the Asylum Seekers’ Benefits Act), September 2016; Krankenhilfe nach dem Asylbewerberleistungsgesetz (Medical assistance according to the Asylum Seekers’ Benefits Act), Updated version, May 2012. 6-7.
- 4. Ibid, 7-8.
- 5. Die Zeit, ‘Warten auf die Gesundheitskarte für Flüchtlinge’, 15 May 2016, available in German at: http://bit.ly/1rMOmL6; ndr.de, ‘Warum die Gesundheitskarte umstritten ist’, 23 May 2016, available in German at: http://bit.ly/2mjd3vV.
- 6. FRA, Monthly overviews: March 2016, available at: http://bit.ly/2lkcqVm, 13.
- 7. However, it should be noted that this provision generally only affects asylum seekers whose application has been (finally) rejected. Furthermore, the admissibility of this provision is now under dispute (see Criteria and Restrictions to Access Reception Conditions).
- 8. Georg Classen, Krankenhilfe nach dem Asylbewerberleistungsgesetz (Medical assistance according to the Asylum Seekers’ Benefits Act), updated version, May 2012. 3.
- 9. However, the reduction of benefits may apply for more than 48 months (i.e. without any time-limit) to persons who have “abused the law to affect the duration of their stay”.