Access to health care is free for asylum seekers living in Direct Provision and therefore has no legislative basis. Once in Direct Provision, they receive medical cards which allow them to attend a local doctor or general practitioner who are located in or attend the accommodation centres. A person with a medical card is entitled to prescribed drugs and medicines but must pay a charge for prescribed medicines and other items on prescription from pharmacies. The prescription charge is €2.50 for each item that is dispensed to under the medical card scheme and is up to a maximum of €25 per month per person or family. The Department of Health has recently stated that there are no plans to exempt asylum seekers from prescription charges,1 despite claims they adversely impact asylum seekers and that some people spend all of their weekly allowance of €19.10 on prescription charges.2 However the situation changed in 2015 when the Minister for Health announced that the levies for prescription charges would not apply to asylum seekers when accessing health care. Therefore asylum seekers living in direct provision are to be exempted from paying the prescription charge of €2.50 per item levied on medical-card holders.3
RIA’s website states “Health Screening is made available in our Reception Centre to all asylum seekers on a voluntary and strictly confidential basis. Screening covers Hepatitis, TB, HIV, immunisation status and any other ailments or conditions that the medical officers feel require further investigation and/or treatment. Screening staff also check the vaccination needs of the resident and their family. Arrangements are in place in various parts of the country to offer this service to those who did not avail of it in Dublin. The outcome of any medical tests undergone by an asylum seeker will not affect their application for a declaration as a refugee in any way.”4
Specialised treatment for trauma and victims of torture is available through an NGO called SPIRASI which is a humanitarian, intercultural, non-governmental organisation that works with asylum seekers, refugees and other disadvantaged migrant groups, with special concern for survivors of torture. SPIRASI staff have access to certain accommodation centres e.g. Balseskin reception centre in Dublin and can help to identify victims of torture. No formal arrangements or agreements exist to deal with torture survivors in a way that is different to someone who has not experienced torture. An article in the newspaper the Medical Independent stated that the number of asylum seekers and refugees being referred to SPIRASI was the highest level in more than a decade.5
A particular health issue in for asylum seekers in Ireland is access to abortion due to the restrictive abortion legislation in Ireland, as well as the treatment of asylum seekers in the Direct Provision system.6 The Irish Family Planning Association (IFPA) stated that asylum-seeking women seeking an abortion face insurmountable obstacles in trying to travel abroad in order to access terminations. The IFPA has raised these concerns with the UN Human Rights Committee and expressed concerns about the restrictive laws on abortion with the Government.7
There are significant issues about access to particular medical care which may arise from the location of asylum seekers away from specialised centres of treatment. Sue Conlan, CEO of the Irish Refugee Council, stated in April 2014 that “[s]o many people with serious health issues cannot access the healthcare they need because of either geographical location or they can’t afford to fund the prescriptions they are given or can’t get to appointments because of a lack of funding.”8 Furthermore the actual system of Direct Provision can exacerbate the mental health concerns of individual asylum seekers. The Irish Refugee Council reported that children as young as 11 living in Direct Provision have expressed thoughts of suicide. Social services have been alerted to more than 1,500 cases of welfare concerns at Direct Provision centres across the country.9
Frances Fitzgerald, TD, Minister for Justice and Equality in response to a parliamentary question reported that between 2002 and 2014, 61 people have died in the Direct Provision system, 16 of whom were children aged five and under.10
The Royal College of Physicians of Ireland, Faculty of Public Health Medicine wrote a position paper on the health of asylum seekers, refugees and relocated individuals in June 2016.11 It set out a number of important recommendations:
There should be early and adequate screening for chronic diseases and mental health issues, as well as for infectious diseases, and referral to specialised services as required. Community medical/nursing services, primary care, mental health and acute services should be adequately resourced as a priority to meet current and projected requirements;
There should be immediate and adequate access to primary care, sexual and reproductive health;
Care and mental health services, which are culturally and linguistically competent. These services should be adequately resourced to provide treatment for the complex physical and mental health needs of asylum seekers and refugees;
Funding for additional vaccinations for asylum seekers and refugees should be ring-fenced so that all necessary vaccines can be administered in a timely manner;
Translation services should be readily available in primary care and to all health providers that care for asylum seekers and refugees;
Specialised services, such as psychotherapy for survivors of torture and other traumas, should be available and accessible for those who need them, wherever they are resettled;
A formal assessment of the broader health needs of asylum seekers, refugees, and relocated individuals in Ireland should be undertaken;
There is a need for much greater investment by the Irish government in health services for asylum seekers, refugees, and relocated individuals. These services will largely be provided by the Health;
Services Executive, GPs, and voluntary organisations, and require appropriate funding;
The processing of asylum applications should be done in a timely fashion. Time spent in direct provision and other accommodation centres (including European Relocation and Orientation;
Centres- EROCs should be limited to the absolute minimum;
There should be intersectoral collaboration to ensure the development of health and social policies that promote inclusion and integration of all migrants into Irish society, minimising the negative impact of migration, and reducing health inequity. Asylum seekers, refugees, and relocated individuals should be represented and involved in all decisions and policies that affect them;
Long term housing, education, employment and health needs of all asylum seekers must be addressed as a government priority;
In August 2016 an asylum seeker tragically committed suicide in a Direct Provision centre, highlighting the failings of identifying specific mental health needs.12 An inquest concerning her death found that no-one could have foreseen that she was going to take her own life on the day she died in her hostel accommodation. A member of the HSE mental health team had met the woman four days before her death but she told her to leave as she didn’t want to talk about her mental health.13
In November 2016 a man in Direct Provision also went on hunger strike for approximately 35 days after receiving a transfer decision to the UK under the Dublin Regulation.14 After being hospitalised he was subsequently admitted to the asylum procedure in Ireland following interventions from local groups and politicians.15
In response to a Seanad Debate raised on the health needs of asylum seekers in October 2016 Minister of State Stanton stated that “Health services for asylum seekers are mainstreamed and provided on the same basis as for Irish citizens. Asylum seekers in direct provision accommodation qualify for a medical card and do not have to pay the prescription charge. They can access the same GPs, mental health and other health supports as any other medical card user in their locality.”16
- 1. Irish Medical News, ‘No exemptions on prescriptions fee-Department’, 31 March 2014.
- 2. Medical Independent, ‘Outside Looking in’, 3 April 2014.
- 3. The Irish Times, ‘Direct Provision residents exempt from prescription charge’, 7 July 2015, available at: http://bit.ly/1P9Ltvm; Department of Health, ‘Prescription Charges waived for asylum seekers’, 10 September 2015, available at: http://bit.ly/1XEta4B.
- 4. More information available at: http://bit.ly/2matETK.
- 5. Medical Independent, ‘Increase in torture treatment service numbers for refugees’, 3 April 2014.
- 6. See for ex.: The Medical Independent, Slipping through the gaps, Dr. Sara Burke, 11 September 2014, available at: http://bit.ly/1TTDxQh ; and The Irish Times, Ms. Y plans legal action against HSE and other agencies, 22 January 2015, available at: http://bit.ly/1JAv50T. See also Irish Times, ‘Ms Y to sue 11 respondents over abortion refusal’, 19 September 2015, available at: http://bit.ly/1SzTpGq.
- 7. The Irish Times, Dozens of migrant women unable to travel for abortions, Carl O’ Brien, 15 December 2014, available at: http://bit.ly/1gQ54nh; The Irish Times, Odds against migrant women trying to travel abroad for abortion, 15 December 2014, available at: http://bit.ly/1Mn0UiZ.
- 8. Medical Independent, ‘Outside Looking in’, 3 April 2014.
- 9. The Irish Examiner, ’11-year olds ‘expressing suicidal thoughts’ in asylum-seeker centres, 9 August 2014, available at: http://bit.ly/1CSaWGI.
- 10. The Journal,ie, ‘Why have 16 children died in Direct Provision?’, 22 January 2015, available at: http://bit.ly/1HUtBya. No further information was provided on the cause of death of individuals in the Direct Provision system.
- 11. Royal College of Physicians of Ireland Faculty of Public Health Medicine, the Migrant Health-the Health of Asylum Seekers, Refugees and Relocated Individuals, June 2016, available at: http://bit.ly/2mayikR.
- 12. The Irish Times, Korean woman found dead in direct provision centre, 24 August 2016, available at: http://bit.ly/2n58qX1; The Irish Examiner, Campaigners call for an end to Direct Provision after young mother dies at Cork centre, 25 August 2016, available at: http://bit.ly/2mvl4Sd.
- 13. The Irish Times, Woman’s suicide in hostel was not foreseen – inquest, 26 January 2017, available at: http://bit.ly/2mLn3SW.
- 14. The Journal.ie, Asylum Seeker enters 35th day of hunger strike in Sligo centre, 14 November 2016, available at: http://bit.ly/2maCuRx.
- 15. The Journal.ie, Hunger-striking Iranian man to be granted access to asylum process, 15 November 2016, available at: http://bit.ly/2mWjo1I.
- 16. Seanad Debate, Direct Provision System, 4 October 2016, available at: http://bit.ly/2mb23C4.