Author
According to national law, access to health care must be guaranteed for asylum seekers during the entire procedure and even after dismissal or rejection of the application under the regime of emergency aid. Like most public allowances, health care falls within federal competence during the period spent in the reception and processing centre, while it becomes a cantonal one after the cantonal assignation. During the stay in a federal centre, asylum seekers should have access to all necessary medical basic care and dental emergency care.[1] Medical care within federal centres is delegated to the company or organisation in charge of general logistics and management of the centres (see section on Types of Accommodation).
The national law provides for a generalised affiliation of all asylum seekers to a health insurance, according to the Federal Act of 18 March 1994 on Health Insurance.[2] This means that every asylum seeker has health insurance. The Asylum Act provides specific dispositions that allow cantons to limit the choice of insurers and service providers for asylum seekers. Psychological or psychiatric treatment is covered by health insurance. Health care costs are included in the social assistance and are therefore under cantonal competence from the moment of allocation to the canton. Since 1 August 2011, rejected and dismissed asylum seekers with a right to emergency aid are also affiliated to a health insurance.[3]
According to the health concept implemented by SEM,[4] all federal asylum centres benefit from a health personnel service, composed mainly of nurses and administrative staff, run by private management companies mandated by the Confederation. The medical service is the first point of contact for asylum-seekers regarding the various health problems they may encounter. Upon arrival in the centre, asylum seekers must submit to a compulsory medical briefing within 3 days of arrival at the centre. Carried out by means of a computer programme available in the main languages spoken by asylum seekers,[5] the main objective of this information session is the detection, prevention and treatment of transmissible and infectious diseases. The health concept in federal structures focuses mainly on acute and urgent health problems. At the request of an asylum seeker or if the medical staff deems it necessary, an initial medical consultation within the centre may be scheduled in order to determine whether the asylum seeker should be redirected to a doctor or a specialist but also to make an initial assessment of their state of health. This “triage” or gatekeeping process is carried out not only for this first optional consultation but also during the entire stay of the asylum seekers in the federal structures.
This health concept and its implementation were externally evaluated in 2023. The report highlights that asylum seekers receive initial medical information as well as access to a counselling service and qualified nursing staff as soon as they arrive in a federal centre. On the contrary, many cantonal centres do not have qualified care staff on site. The evaluation team identified marge of improvement in several areas of implementation, for example regarding the transmission of patient files when asylum seekers are transferred, the possibility to resort to professional interpreters or the management of epidemics. A very severe problem is that asylum seekers often need to cope with long waiting times to see specialists, such as psychiatrists, due to staff shortages.[6]
Medical care and the establishment of medical facts in the examination of asylum applications appear to be one of the main issues induced by the acceleration of procedures (see: Use of medical reports). The identification of vulnerabilities, including psychological problems and psychiatric diseases, remains a significant challenge. A psychological screening at arrival in the centre could be a useful measure and also a tool to prevent suicides. According to the NCPT, within the accelerated procedure, access to psychiatric care is limited to the most acute situations, however an early identification of psychiatric and trauma-related problems and orientation towards the competent services already during the stay in federal asylum centres is recommended.[7] The NCPT also reports that a phone translation service is available to the medical staff, but that there is too little use of it.[8]
The organisation of health support in the cantonal reception centres is under cantonal competence. Similar obstacles as in the federal centres may occur regarding the triage by the staff of the centre, even though some cantons do provide for medical staff within the reception centres.
COVID-19: Asylum seekers are entitled to vaccination and testing in the same way as Swiss citizens. To facilitate return and Dublin procedures, the parliament agreed[9] to allow forced COVID-19 testing in September 2021, which was criticised by the Swiss Refugee Council.[10] This provision was extended until 30 June 2024.[11]
[1] Article 8 Ordinance of the FDJP on the management of federal reception centres in the field of asylum.
[2] Federal Act on Health Insurance, Loi fédérale du 18 mars 1994 sur l’assurance-maladie (LAMal), RS 832.10.
[3] Article 92d Ordinance on Health Insurance of 28 June 1995, RS 832.102, in connection with Article 82a AsylA and Article 105a Federal Act on Health Insurance.
[4] OFSP/SEM, Soins médicaux pour les requérants d’asile dans les centres de la Confédération et les centres d’hébergements collectifs cantonaux, 30 October 2017, available in French (also in German and Italian) at: https://bit.ly/2HBGqX4.
[5] Available at: https://bit.ly/3xOyxqc.
[6] Kägi, Wolfgang, Mirjam Suri, Christopher Huddleston and Denise Efionayi-Mäder, Final report “Formative Evaluation der Gesundheitsversorgung für Asylsuchende: Konzeption und Umsetzung der Massnahmen gemäss dem Konzept Gesundheitsversorgung für Asylsuchende in Asylzentren des Bundes und in den Kollek-tivunterkünften der Kantone“, 6.6.2023, available in German at: https://tinyurl.com/4f8h5x58
[7] NCPT, Report on federal asylum centres 2019-2020, available in German at: https://bit.ly/3cQJj7k, p. 32.
[8] NCPT, Report on federal asylum centres 2019-2020, available in German at: https://bit.ly/3cQJj7k, ch. 139, 33.
[9] See https://bit.ly/3Gp0LOy (in German).
[10] Swiss Refugee Council, Le Parlement restreint encore les droits fondamentaux des personnes en quête de protection, 15 September 2021, available in French (and German) at : https ://bit.ly/37oRrLG.
[11] Art. 72 FNIA, in force until 30 June 2024.