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The COA is responsible for the provision of health care in the reception centres As any other person in the Netherlands, an asylum seeker can visit a general practitioner, midwife or hospital. The Arrangement for Medical Care for Asylum seekers deals with the rules on medical insurance for asylum seekers (Regeling Medische zorg Asielzoekers (RMA) Healthcare).
As addressed above, issues connected to the lack of accessible health care services in emergency locations and crisis emergency locations emerged in 2022. On 3 August 2022, the Inspection of the Ministry of Health Care and Youth warned the Minister of Health Care and Youth and the State Secretary of Justice and Security about the alarming situation with regard to access of health care in crisis emergency locations.[1] The Inspection saw that medical care for asylum seekers in crisis emergency locations is seriously suffering under the current crisis conditions. The care is sometimes limited to emergency care. That is less than the normal medical care to which everyone is entitled. It is also less than the medical care that asylum seekers’ centres and ‘ordinary’ emergency reception locations offer. In crisis emergency locations, care providers often cannot work according to the usual standards and guidelines, no matter how hard they try. This is due to the rapid grow of crisis emergency locations, to a lack of personnel and to the fact that many of the asylum seekers staying at these locations have not yet been registered – making it difficult to arrange the health insurance.
In 2023, many of these problems remain. In March, the Inspection of the Ministry of Health Care and Youth warned that crisis emergency locations are not suited for long term stay, but are being used as such, resulting in urgent risks for the individual health of asylum seekers, public health, and the continuity of health care.[2] Among other things, the Inspection identified a lack of medical intake and tuberculosis screening before placement in crisis emergency locations, thus risking the placement of vulnerable people in unsuitable locations and the spread of infectious diseases, a lack of an electronic patient record and thus insuffient transfer of information between health care professionals, and a delay of necessary health care due to the limitation of health care to emergency care, leading to worsening health care problems.[3] A report from three prominent health care NGOs from June contains similar findings.[4] In September, the Dutch Council for Refugees (VWN) published a report on both emergency locations and crisis emergency locations which confirms regular absences medical screening to identify vulnerable people, and highlights the physical absence of health care services at some locations, forcing residents to travel long distances to other locations to access health care.[5]
The relevant legal provision can be found in Article 9(1)(e) RVA. This provision is further elaborated in the Healthcare for Asylum Seekers Regulation (Regeling Medische Zorg Asielzoekers). According to the latter, asylum seekers have access to basic health care. This includes inter alia, hospitalisation, consultations with a general practitioner, physiotherapy, dental care (only in extreme cases) and consultations with a psychologist. If necessary, an asylum seeker can be referred to a mental hospital for day treatment. There are several institutions specialised in the treatment of asylum seekers with psychological problems, such as Pharos.
When an asylum seeker stays in a reception facility but the RVA is not applicable, health care is arranged differently. Asylum seekers in the POL, the COL, as well as rejected asylum seekers in the VBL and adults in the GL only have access to emergency health care.[6] In medical emergency situations, there is always a right to healthcare, according to Article 10 of the Aliens Act. For this group, problems can arise if there is a medical problem that does not constitute an emergency. Care providers who do help irregular migrants who are unable to pay their own medical treatment can declare those costs at a special government-mandated organisation, the Centraal Administratie Kantoor (CAK) which then pays up to 80 percent of the costs, or 100 percent in case of pregnancy-related care.[7]
Problems might also arise with respect to access to health care where the asylum seeker wants to use a health care provider whose costs are not covered by their insurance.
There is no publicly available information about gender-sensitive healthcare opportunities for victims of violence, except for the general availability of prenatal health care and psychological support.[8] There is a possibility to make use of a translator, usually by phone, during health care visits.[9] In 2022 the Inspection of the Ministry of Health Care and Youth noted a lack of use of translators by hospitals as an obstacle to information provision to the patient.[10] The main obstacles in access to health care for asylum seekers lie in the situation at (crisis) emergency locations, as described above.
[1] Inspection Health Care and Youth, ‘Medische zorg in crisisnoodopvang asielzoekers onder enorme druk’, 3 August 2022, available in Dutch at: https://bit.ly/3Qp954k.
[2] Inspection Health Care and Youth, ‘Factsheet Urgente risico’s voor gezondheid asielzoekers in crisisnoodopvang, 9 March 2023, available in Dutch at: https://bit.ly/3vtviYy, 1.
[3] Ibid, 1-2.
[4] Dokters van de Wereld, Pharos, Rode Kruis, Zorgen in tijden van crisis, June 2023, available in Dutch at: https://bit.ly/422N5Cc.
[5] VluchtelingenWerk, Gevlucht en vergeten?, August 2023, available in Dutch at: https://bit.ly/4205TBR.
[6] Article 10(2) Aliens Act.
[7] CAK, ‘Regeling onverzekerbare vreemdelingen’, available in Dutch at: https://bit.ly/41XAOid.
[8] Regeling Medische zorg Asielzoekers, ‘Geboortezorg’, available in Dutch at: https://bit.ly/41UUhjy; Regeling Medische zorg Asielzoekers, ‘Geestelijke Gezondheidszorg’, available in Dutch at: https://bit.ly/47w3ccr.
[9] GZA healthcare, ‘Veelgestelde vragen’, available in Dutch at: https://bit.ly/3vF2MDb.
[10] Inspection Health Care and Youth, Bevlogen medewerkers houden zorg aan asielzoekers overeind onder zorgelijke omstandigheden, May 2022, available in Dutch at: https://bit.ly/41TXFLs.