Author
Asylum seekers are entitled to the same health care as nationals.[1] Under the law, the SAR has the obligation to cover from its budget the health insurance fees of asylum seekers.
In practice, asylum seekers have access to available health care services, but do face the same difficulties as Bulgarian nationals due to the general state of deterioration in the national health care system, that suffers from great material and financial deficiencies. In this situation, special conditions for treatment of torture victims and persons suffering mental health problems are not available. According to the law, medical assistance cannot be accessed if reception conditions are reduced or withdrawn.
Until 31 December 2018, Dublin returnees faced significant obstacles in accessing medical care upon return, mainly resulting from the delay for the asylum and health care administration to restore their insurance coverage in the national health care database. These delays could vary from a couple of days to several weeks or even months in certain cases. Since 1 January 2019 the health care database has been re-organised to automatically restore the Dublin returnees’ health care status and register them as individuals with uninterrupted medical insurance as soon as their asylum procedures is being reopened at the SAR. However, this applies only to those who left Bulgaria in 2019 and were subsequently returned back. Access to healthcare for asylum applicants who left Bulgaria prior to 1 January 2019, and who are now being returned under Dublin III, is still not ensured. In order for them to access medical care, the SAR must issue a written notification to the national IRS. Only then can the access to the medical care be restored, which takes couple of days in the majority of the cases, although there have been cases in which it took longer periods of time. To solve the issue, in 2020 the law was amended to explicitly provide uninterrupted health care rights for asylum seekers whose procedures were re-opened after being previously discontinued – a situation that typically applies to Dublin cases.[2] However, the arrangement is not applicable for the Dublin returnees whose applications have been decided on the substance in absentia before their return to Bulgaria. In practice, Dublin returnees whose procedures were reopen experience delays of a couple of months before being able to re-access the health care system.
Presently, all reception centres are equipped with consulting rooms and provide basic medical services, but their scope varies depending on the availability of medical service providers in the particular location.
Bulgaria’s fundamental shortage of general practitioners is the main reason the medical care of asylum seekers is mainly carried out in the surgeries organised in Sofia and Harmanli reception centres.
Basic medical care in reception centres is provided either through own medical staff or by referral to emergency care units in local hospitals. Also, in the framework of an AMIF project supported by Caritas in partnership with UNICEF, a new mobile ambulance unit operated in Sofia with a nurse providing health counselling and basic medical care, and an ambulance available to transport patients to health facilities.[3]
A total of 29,071 outpatient examinations were implemented in the reception centres’ surgeries until the end of 2022.[4] However the access of asylum seekers to following and specialized medical treatment remained impeded.
[1] Article 29(1)(5) LAR.
[2] Article 29(8) LAR.
[3] EUAA, Annual Asylum Report (2022), available at: https://bit.ly/3JbdHYK.
[4] SAR, reg. No.РД05-72 from 26 February 2023.