Author
Spanish law foresees full access to the public health care system for all asylum seekers.[1] Through this legal provision, they are entitled to the same level of health care as nationals and third-country nationals legally residing in Spain, including access to more specialised treatment for persons who have suffered torture, severe physical or psychological abuses or traumatising circumstances.
Since the 2012 reform of access to the Public Health System, which limited the previously guaranteed universal access to health care, asylum seekers had been facing problems in receiving medical assistance, even though it is provided by law. In particular, some asylum seekers were denied medical assistance, because medical personnel were not acquainted with the “red card” (tarjeta roja) that applicants are provided with, or they did not know that asylum seekers were entitled to such right.
In September 2018, the Government approved a decree reinstating universal access to the Public Health System, thus covering irregular migrants as well.[2]
In 2020, the Ministry of Health announced a law proposal establishing measures for the equality, the universality and the cohesion of the national health system,[3] and launched a public consultation.[4] The proposal was sent to the Parliament by the Council of Minister on June 2022[5] and was approved in May 2023.[6]
Although access to special treatment and the possibility to receive treatment from psychologists and psychiatrists is free and guaranteed, it should be highlighted that in Spain there are no specialised structures for victims of severe violations and abuses like the ones faced by asylum seekers escaping war, indiscriminate violence or torture. There are no specialised medical centres that exclusively and extensively treat these particular health problems.
Currently, there are different NGOs in charge of places for asylum seekers with mental health needs. For about 5 years, Accem, in collaboration with Arbeyal, a private company, managed the “Hevia Accem-Arbeyal” centre,[7] specialised in disability and mental health. In 2018, it opened the Centre for the Reception and Integral Assistance to Persons with Mental Health Problems (Centro de Acogida y Atención Integral a Personas con Problemas de Salud Mental), and it is dedicated to asylum seekers and beneficiaries of international protection in a situation of vulnerability. The purpose of the residential centre is to promote the highest level of mental and physical well-being to people whose mental illness hinders their integration process.
In addition, CEAR also manages places specialised in asylum seekers with mental conditions. La Merced Migraciones Foundation also provides reception places for young adult asylum seekers who need special assistance due to mental health-related conditions. Other NGOs have also developed specific resources to assist and accompany asylum seekers with mental health needs, such as Bayt al-Thaqafa (which is member of the Federación Red Acoge)[8] in Barcelona,[9] Progestión,[10] Provivienda[11] and Pinardi. The NGO Valencia Accull (which is member of the Federación Red Acoge) has opened a reception facility in Valencia for single female asylum seekers/refugees. Federación Red Acoge also runs a new facility with 7 places for asylum seekers with addictions or dual pathology.[12] Information on organisations providing such services in Spain is not public.
In April 2021, the Fundación Cruz Blanca opened a new reception facility in Guadalajara, dedicated to the assistance of migrants affected by mental health issues.[13]
In a report published in February 2021, Amnesty International underlines the increasing obstacles that undocumented migrants faced in accessing health services during the COVID-19 pandemic.[14] Such barriers are essentially due to the legislation that does not foresee the universal access to the National Health System, the insufficiency of adequate measures implemented by the Autonomous Communities, and the language barrier in order to access medical assistance by phone.
In May 2021, six NGOs called on the Minister of Inclusion, Social Security and Migration to reform the Regulation of the Immigration Law in a way that guarantees adequate protection to all migrants, especially in light of the COVID-19 pandemic, as more than half million persons cannot exercise their right to health due to their impossibility to fulfil administrative requisites, given their lack of valid documents.[15]
Various obstacles were registered regarding access to the vaccination campaign for migrants, generally due to linguistic barriers and lack of access to digital services. Even though the migrant population – comprising also undocumented migrants – was included in the Spanish vaccination strategy, the administration often delegated to NGOs the responsibility in terms of information provision and facilitation in access to the campaign.[16] The NGO APDHA urged the Government of Andalucía to adopt a comprehensive vaccination strategy which includes undocumented migrants, including those persons who do not hold a healthcare card.[17] The call derives from the concern that the public vaccination strategies in Andalucía do not include specific plans to address the specific situation of undocumented migrants living in the Autonomous Community. Stateless persons were instead included in vaccination plans.[18]
A report published in March 2023 focused on the challenges that asylum seekers and refugees face in accessing health, especially due to administrative barriers (i.e. the necessity to be enrolled at the municipality).[19]
UNHCR observed an increasing need to address mental health and psychosocial support (MHPSS) related needs of asylum seekers and refugees in the asylum system. In June, UNHCR organized a protection dialogue on the mental health of refugees, asylum seekers and stateless persons in Madrid, aimed to identify challenges and opportunities for improving refugees’ mental health and psychosocial support. Special emphasis was placed on the need to strengthen coordination among key actors, incorporate an intercultural perspective in the services provided, promote specialized training and care for professionals, and promote the effective participation of refugees. Following the Protection Dialogue, UNHCR established a reference group on mental health with key stakeholders, including authorities, NGOs, and refugee-led organizations, to assist UNHCR in implementing its strategy related to MHPSS, to strengthen the network and identify initiatives and measures to reinforce refugees’ wellbeing and mental health.[20]
[1] Article 15 Asylum Regulation.
[2] El País, ‘El Congreso aprueba el decreto para recuperar la sanidad universal’, 6 September 2018, available in Spanish at: https://bit.ly/2Nt140c.
[3] El País, ‘Sanidad quiere prohibir por ley nuevos copagos y asegurar la atención a inmigrantes’, 20 October 2020, available in Spanish at: https://bit.ly/3bhV4Bl.
[4] Ministerio de Sanidad, ‘Consulta pública previa sobre el anteproyecto de ley de medidas para la equidad, universalidad y cohesión del sistema nacional de salud’, October 2020, available in Spanish at: https://bit.ly/3dmGUBG.
[5] La Moncloa, ‘El Gobierno refuerza la equidad y la universalidad del Sistema Nacional de Salud’, 14 June 2022, available in Spanish at: https://bit.ly/3LtBrd8.
[6] Boletín Oficial del estado, ‘Ley 16/2003, de 28 de mayo, de cohesión y calidad del Sistema Nacional de Salud’, May 2023, available at: https://tinyurl.com/ms68dx6u.
[7] See the dedicated website at: http://www.accemarbeyal.com/.
[8] Federación Red Acoge, see: https://redacoge.org/.
[9] Information provided by Federación Red Acoge on 1 March 2022.
[10] Asociaicón Porgestión, see: https://progestion.org/.
[11] Provivienda, see: https://www.provivienda.org/.
[12] Information provided by Federación Red Acoge on 1 March 2022.
[13] Information provided by Fundación Cruz Blanca on April 2021.
[14] Amnistía Internacional España, ‘La otra pandemia. Entre el abandono y el desmantelamiento: el derecho a la salud y la Atención Primaria en España’, February 2021, available in Spanish at: https://bit.ly/3qcdBnT.
[15] Red Acoge, ‘Seis ONG estatales instan a la Secretaría de Estado de Migraciones a reformar el Reglamento de Extranjería para garantizar la protección de las personas migrantes tras la pandemia’, 25 June 2021, available in Spanish at: https://bit.ly/3NsmHda.
[16] Newtral, ‘¿Sanidad universal? La dificultad de que la vacunación llegue a toda la población inmigrante’, 25 August 2021, available in Spanish at: https://bit.ly/2X295jb.
[17] Asociación Pro Derechos Humanos de Andalucía – APDHA, ‘Exigimos al Gobierno andaluz una estrategia de vacunación integral que incluya a todas las personas en situación administrativa irregular’, 9 April 2021, available in Spanish at: https://bit.ly/3FSOsY4.
[18] EUAA, Asylum report 2022, 2022, available at: https://bit.ly/3FvgydY.
[19] CEAR, ‘Sin barreras para nadie. Personas migrantes y refugiadas en el acceso a los Derechos Económicos, Sociales y Culturales (DESC)’, March 2023, available at: https://tinyurl.com/5xnmr4t7.
[20] Information provided by UNHCR in April 2024.