Author
According to the Law, asylum seekers without adequate resources are entitled to free medical care in public medical institutions, covering at a minimum emergency health care and essential treatment of illnesses and serious mental disorders.[1] Welfare beneficiaries and residents in the reception centre are indicated as eligible for free medical care and, in that respect, have access to free health care. The level of resources needed to receive free medical care in the case of asylum seekers who do not receive welfare assistance is not specified.
In practice all asylum seekers have free access to public medical institutions, regardless of whether they receive material reception conditions. From May 2022 onwards, asylum seekers during the first year after the application for asylum is submitted are able to access public health institutions just with their Confirmation Letter. A year after the date of the application of asylum, asylum seekers need to apply for a medical card at the Ministry of Health, by submitting a simplified application. Hospital cards are either issued on the spot at the Ministry of Health or can be sent to beneficiaries by post. They are typically valid for one year.
On 1 June 2019, a National Health System (GESY) came into effect for the first time in Cyprus, introducing major differences in the provision of health care services such as the concept of a personal general practitioner (GP) in the community as a focal point for referrals to all specialised doctors. For most of the population (Cypriots, EU citizens, BIPs), health services are now provided almost exclusively under the new health system.
Asylum seekers, along with other persons that are part of the migrant population, are not included in the provisions of GESY.[2] Their access to health services continues under the provisions of the previous system, which basically entails treatment by public, in-patient and out-patient departments of the public hospitals. The same applies for asylum seekers who are working, despite the fact that since the implementation of GESY, they contribute to GESY as employed persons.[3]
With the introduction of GESY, all private pharmacies have been included under the new system and beneficiaries of GESY access a wide range of medications at subsidized cost from private pharmacies. Asylum seekers do not have such access and can only access medications for free or at subsidized cost from public pharmacies situated in the public hospitals, however these pharmacies do not provide a wide range of medications, leading to many instances of asylum seekers having to pay for medications or not having access to these, including medications for very serious medical conditions. In many cases NGOs have provided such medications, however with limited capacity to meet the needs.[4] Access to medication has become a serious gap in the provision of health care to asylum seekers.
There are no interpretation services available in State hospitals and communication between asylum seekers and medical staff is extremely challenging. Medical staff will often refuse to provide services to an asylum seeker due to lack of means to communicate. Asylum seekers often have limited information on serious medical conditions, including cases involving children. NGOs are often called upon to cover such needs but have very limited capacity to respond to these.
Access to gender-sensitive health care opportunities (including access to female medical personnel, access to a paediatrician, gynaecologist, or prenatal health care and psychosocial support) is limited, even in cases of victims of trafficking, gender-based violence and victims of torture or other forms of psychological and physical violence/ including. There is no information or procedure to make such a request, and even if requested it would depend on availability of medical staff.
Access to mental health care is also problematic and heavily affected by the lack of interpretation services. In 2023, there was a development in accessing a psychiatrist with an interpreter however this often requires intervention from an NGO to be arranged. [5] Asylum seekers have access to State psychologist but not psychologist on GESY, however there is a long waiting list and additionally interpretation services are not provided which significantly restricts access.
Asylum seekers who need to receive essential treatment which is not available in the RoC are not included in the relevant scheme introduced by the Ministry of Health transposing the Directive on patients’ rights in cross-border healthcare. In practice, however, the Ministry has covered the costs, upon approval of the Minister of Health, for many cases of child asylum seekers to receive medical treatment outside the country.[6]
In a number of cases, asylum seekers reported to the CyRC that they faced racist behaviour from medical staff, often in relation to their poor Greek language skills and the reluctance of the latter to communicate in English. Such reports continued in 2023.
Specialised Health Care
Asylum seekers without adequate resources who have special reception needs are also entitled to free of charge necessary medical or other care, including appropriate psychiatric services.[7] The Refugee Law incorporates the provision of the recast Reception Conditions Directive in relation to identifying and addressing special reception needs, including for victims of torture.
In practice, the identification of vulnerabilities is conducted mainly in the Reception Centres from appointed professionals, albeit not without gaps. The situation is much more challenging in the community due to the lack of a specific mechanism and procedures to timely identify and address those needs. In addition, there are no specialised facilities or services, except for the ones available to the general population within the public health care system. Currently, there is only one NGO, the Cyprus Refugee Council, offering specialised social and psychological support to victims of torture and gender-based violence, operating through the funds of United Nations Voluntary Fund for the Victims of Torture (UNVFVT).[8] During 2023, 136 persons received relevant services and the fund is renewed for 2024.[9]
[1] Article 9ΙΓ(1)(a) Refugee Law.
[2] Ygeia Watch: Οι αιτητές ασύλου δεν είναι δικαιούχοι ΓΕΣΥ, available at: https://bit.ly/3Q4p34H.
[3] Information provided by Cyprus Refugee Council
[4] Information provided by Caritas Cyprus
[5] Information provided by Cyprus Refugee Council and Caritas Cyprus.
[6] Information provided by Cyprus Refugee Council.
[7] Article 9ΙΓ(1)(b) Refugee Law.
[8] Information provided by Cyprus Refugee Council.
[9] Ibid.