Author
Access to health care is free for protection applicants living in Direct Provision and is expressly provided for in the Reception Conditions Regulations.[1] The Minister for Health is required to ensure that a recipient has access to emergency health care, treatment for serious illnesses and mental disorders, other health care for maintaining their health, and mental health care assessed as necessary for vulnerable persons.
In practice, a recipient of material reception conditions must apply for a medical card, which allows them to attend a local doctor or general practitioner who are located in or attend the Direct Provision accommodation centres. A person with a medical card is entitled to prescribed drugs and medicines and protection applicants living in Direct Provision are exempt from paying the prescription charges levied on medical-card holders.[2]
Following numerous complaints to the Department of Health and the Ombudsman, the HSE’s Medical Card Unit have amended their policy so as to enable eligible international protection applicants who are not living in Direct Provision to obtain medical cards and access to free medical services, prescription medicines and hospital care. Under previous policy, international protection applicants residing outside of Direct Provision were deemed ineligible for medical cards, with many struggling to access healthcare as a result.
In 2019, the Ombudsman received 12 complaints against the HSE regarding medical cards. Only one medical sector-related complaint was recorded for 2020. This related to a resident’s difficulty in accessing mental health services and getting information on a stay in hospital.[3] In 2021, the Ombudsman received 16 complaints regarding healthcare. The vast majority of these complaints related to the provision of medical cards.[4] In 2022, residents of Direct Provision made three complaints against the HSE regarding medical care.[5]
IPAS’s website states that “Health screening is made available in our reception centres to all protection applicants 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.”[6]
Throughout much of 2021, newly arrived asylum seekers were subject to medical checks at Dublin airport. Applicants were screened on the basis of health questionnaires, subject to temperature checks and were required to self-report symptoms of COVID-19. Applicants were then transferred to designated facilities, usually hotels, for the purposes of self-isolation.
Following the roll-out of the vaccination programme, newly arrived applicants who were fully vaccinated were not required to undergo mandatory hotel quarantine. However, in the experience of the Irish Refugee Council this policy was applied arbitrarily, with a number of fully vaccinated applicants still required to undergo quarantine.
Owing to the increase in COVID-19 cases in the latter part of 2021, applicants were once again required to self-isolate on arrival in Ireland. For further information, please see above Criteria and Restrictions to Access Reception Conditions.
The Health Service Executive (HSE) also identified priority groups for testing, among whom were staff and residents of Direct Provision centres.[7] Healthcare workers, or persons providing home support who live in Direct Provision, were also eligible to apply for alternative temporary accommodation during the pandemic under a scheme established by the HSE.[8] Additionally, two new centres were opened to facilitate off-site self-isolation of residents in Direct Provision.[9] One centre was used to facilitate self-isolation where a resident tested positive for COVID-19, while the other was used to facilitate a mandatory 14-day quarantine period in circumstances where a resident had left their IPAS accommodation temporarily and subsequently sought to return.[10]
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 protection applicants, 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. However, no formal arrangements or agreements exist to deal with torture survivors in a way that is different to someone who has not experienced torture.
In 2018, the constitutional provision which constituted a prohibition on abortion in Ireland was removed by way of referendum. This meant that access to abortion was made available in Ireland up to twelve weeks’ gestation from January 2019. The previous ban on access to abortion was a particular difficulty for protection applicants who had to apply for travel documents in order to travel to another jurisdiction such as the United Kingdom. This led to enormous emotional distress, delay, and uncertainty for the women affected. Access to abortion is provided by General Practitioners in the first place, with hospital referrals after nine weeks gestation. If the woman’s pregnancy has reached the twelve-week point, abortion will only be available in exceptional circumstances, including where there is a risk to the life or a risk of serious harm to the health of the woman, or a fatal foetal abnormality. A protection applicant who has reached twelve weeks of pregnancy and does not meet one of the exceptional circumstances noted above, may still have to travel outside of Ireland for a termination.
[1] Regulation 18 Reception Conditions Regulations 2018.
[2] Citizens Information, ‘Prescription Charges for Medical Card Holders’, 10 October 2018, available at: https://bit.ly/2DHShlW.
[3] Ombudsman, ‘The Ombudsman & Direct Provision: Update for 2020’, March 2021, available at: https://bit.ly/2PbgkSe.
[4] Ombudsman, ‘The Ombudsman & Direct Provision: Update for 2021’, March 2022, available at: https://bit.ly/3qCBwjr.
[5] Office of the Ombudsman, March 2023.
[6] RIA, Medical, available at: http://bit.ly/2matETK.
[7] Irish Examiner, ‘HSE: Direct provision centres receiving priority testing’, 12 May 2020, available at: https://bit.ly/2BrlRwE.
[8] Health Service Executive, ‘Temporary accommodation for healthcare workers during COVID-19’, available at: https://bit.ly/2Y36MsX.
[9] Minister for Children, Disability, Equality, Integration and Youth Roderic O’Gorman, Response to Parliamentary question No 596, 17 November 2020, available at: https://bit.ly/2NbAf2n.
[10] Minister for Children, Disability, Equality, Integration and Youth Roderic O’Gorman, Response to Parliamentary question No 182, 11 February 2021, available at: https://bit.ly/3rQqF3I.