Author
Access to health care for asylum seekers covers the right to receive free primary care and appropriate treatment, emergency hospital care and free health care and treatment in cases of acute or chronic illnesses considered imminently life threatening, through the national emergency health care system and qualified first aid. These services shall be provided, as the case may be, through the medical service of the Regional Centres and/or other health care facilities accredited and authorised by law.[1]
In addition, asylum seekers have the right to be included in national public health programmes aimed at preventing, monitoring and controlling contagious diseases in epidemiological risk situations.[2]
Asylum seekers are assigned a personal identification number which figures on their temporary identity documents in order for them to enjoy all the rights provided by the law.[3] After receiving the personal identification number, asylum seekers may register in the public health insurance system and, if they pay healthcare contributions and register at a general practitioner’s office, they have the status of an insured person with the same rights and benefits as nationals.
Asylum seekers benefits from free medical care through the medical network of the MoI – GII and the costs are covered by the same structure and, for these services, do not have the obligation to pay the contribution for the public health insurance. In specific cases, medical insurance could be covered through projects financed through AMIF. However, medical services are mainly related to health checks upon accommodation in a Regional Centre and emergencies. Certain medical services are not included by the National Medical Insurance System (e.g. rehabilitation services, certain medicines and medical materials).
In 2022, not all the regional centres had a medical doctor employed.
In 2023, according to IGI-DAI[4], the situation in each centre was as follows:
- Bucharest: 1 doctor and 3 nurses were employed; the position of psychologist is vacant.
- Giurgiu: 1 psychologist and 1 medical assistant were employed; the position of doctor is vacant.
- Rădăuţi: the positions of psychologist and doctor are vacant.
- Şomcuta Mare: there are a psychologist and a doctor employed. Timisoara: there are a psychologist and a doctor employed. Galati: there is a psychologist employed, and an external doctor has a collaboration contract with IGI-DAI.
With regard to vulnerable persons (e.g. pregnant women, persons with disabilities, victims of human trafficking, etc.), IGI-DAI specifies that, in accordance with internal procedures, medical assistance is given with priority, periodic monitoring is carried out, information is provided concerning the administration of the medicines, people are accompanied to the hospital. Also, through projects implemented with funding from European funds, vulnerable people benefit from complementary medical and psychological assistance (e.g. from NGOs). No other details were provided, including from other actors than IGI-DAI.
According to CNRR,[5] regarding medical care, asylum-seekers have access to free primary and emergency medical care and treatment and they can be included in the national public health programs. but, there is a lack of doctors and psychologists in the reception centres, therefore they are heavily relying on NGOs services in this matter.
On reception conditions, UNHCR reported[6] that 91% of the respondents reported having access to some health services.
According to CNRR[7], the language barrier is an important obstacle to accessing socio-economic rights, including healthcare. Moreover, procedures for accessing national public health programmes, health insurance, applying for social benefits (unemployment or child allowance), school enrolment, are characterised by heavy bureaucratic procedures that are very difficult to navigate without any guidance or assistance. Public institutions services are not adapted to the specific needs of asylum seekers, the public servants are not aware of the legislation in this field and therefore their access to these rights is oftentimes denied requiring direct interventions from NGOs.
In 2022, the situation was as follows:
In Giurgiu, according to the director there is a nurse and a psychologist. However, since August 2021, there has been no medical doctor in the centre. The director of the centre reported that the psychologist provided counselling to 577 asylum seekers during 2022 and three counselling session were held with an interpreter.
In Rădăuţi, two medical assistants were hired in 2020. A medical doctor was contracted as a service provider, and a medical doctor of the ICAR Foundation was hired. In 2022 IGI-DAI did not hire a medical doctor, so there was only the doctor from the ICAR Foundation, who is present once a week. There are two tents in the courtyard, where transferred asylum seekers undergo medical screening, which is conducted swiftly. The medical screening includes the medical history of the asylum seeker. The interpreter is only called when there are exceptional issues. In 2021 there was also a psychologist at IGI-DAI.
In Timișoara, a medical doctor is present in the centre 3 hours per day and two nurses are provided by IGI-DAI. The nurses work on 8h shifts. The medical screening conducted by the medical doctor in Timișoara was done without an interpreter, however he is speaking Arabic. A summary evaluation is made without an interpreter, after which the medical file is drafted. There was no psychologist in the centre from December 2021 until November 2022. A social assistant was also hired in 2022, who has responsibilities mainly during the integration programme.
Bucharest: In 2022, the centre had three medical assistants and one medical doctor and the psychologist position has been vacant since August 2021.
Galaţi: There is a medical doctor, present in the centre twice a week or when a transfer arrives, one nurse and a full-time psychologist as of 15 October 2019. In addition, there is also a medical doctor hired by the ICAR Foundation present twice a week. The medical screening is done by the doctor and nurse, in general without an interpreter. The medical staff often relies on other asylum seekers. However, an interpreter was provided for the Afghan asylum seekers evacuated by Romania at the medical screening.
Şomcuta Mare: The medical screening is done by the medical doctor of IGI-DAI. It is basically a general consultation which includes the medical history, taking the pulse, heart rate and visual check-up to check scars. As of April 2022 the centre also has a psychologist. The centre had a medical assistant from the beginning of the year until end of March 2022 (she took over the psychologist position) and as of June 2022 a new medical assistant was hired.
In Bucharest, according to the medical doctor, the medical screening is conducted by her and the nurse when the asylum seekers are accommodated in the centre. They are visibly checked to see if they present any signs of eczema, rabies, lice and a medical record is drawn up. In case of medical issues, the asylum seekers are referred to the Ministry of Internal Affairs hospitals. The screening is conducted without the assistance of an interpreter, or sometimes with the help of the cultural facilitator, who is present on weekdays.
From 26 September 2020 until December 2022 the ICAR Foundation was implementing the project “Health Insurance for Asylum Seekers in Romania (ASIG – RO)” in partnership with AIDRom. Under this project at least 432 asylum seekers were to benefit from medical services and at least 216 asylum seekers were to benefit from specialised psychological assistance and counselling.[8]
Specialised treatment
The Asylum Act provides for the right of asylum seekers with special needs to receive adequate health care.[9] In practice, the ICAR Foundation is the only organisation with the necessary experience in providing psychological assistance to torture survivors and traumatised asylum seekers in all the reception centres.
In Timișoara, as of 2022 ICAR personnel conduct the medical screening. IGI-DAI is notified if there are asylum seekers suffering from mental health issues and they are referred to specialised hospitals, if necessary. The ICAR Foundation doctor is present in the centre once a week. According to the JRS representative, AIDRom representatives carry out a more detailed screening.
In 2022 in Rădăuţi an asylum seeker who was HIV positive was treated through the state scheme.
[1] Article 17(1)(m) Asylum Act.
[2] Article 17(1)(m^1) Asylum Act.
[3] Article 17(1^1) Asylum Act.
[4] Information provided by IGI-DAI, 18 January 2024.
[5] CNRR, Input by civil society organisations to the Asylum Report 2024, 2023, available here.
[6] UNHCR, Regional Protection Monitoring Report Romania, 28 March 2024, available here.
[7] CNRR, Input by civil society organisations to the Asylum Report 2024, 2023, available here.
[8] AIDRom, News Release, available in Romanian at: https://bit.ly/38pzGtl.
[9] Article 17(1)(n) Asylum Act.