Author
Primary health care
Applicants are entitled to health care. In 2023, the LITP was amended to extend applicants’ access to medical care beyond emergency situations, upon a doctor’s recommendation.[1] The LITP prescribes that the health care of applicants includes emergency medical assistance and the essential treatment of illnesses and of serious mental disorders in accordance with medical indication. An applicant who needs special reception and/or procedural guarantees, particularly victims of torture, rape or other serious forms of psychological, physical or sexual violence, shall be provided with appropriate health care related to their specific condition, i.e., the consequences caused by said acts.[2] The costs of the health care shall be borne by the ministry responsible for health care.[3]
In 2020, an Ordinance on health care standards for applicants for international protection and foreigners under temporary protection entered into force regulating, amongst other, initial and supplementary medical examinations and the scope of health care for applicants for international protection.[4] Additionally, the Ordinance lists the different vulnerable groups entitled to health care as follows: persons deprived of legal capacity, children, unaccompanied children, elderly and infirm persons, seriously ill persons, persons with disabilities, pregnant women, single parents with a minor children, people with mental disabilities and victims of human trafficking, victims of torture, rape or other psychological, physical and sexual violence, such as victims of female genital mutilation. These categories of persons have a right to psychosocial support and assistance in appropriate institutions. A pregnant woman or a parturient woman who requires monitoring of pregnancy and childbirth is entitled to health care to the same extent as an insured person benefiting from a compulsory health insurance. Children up to the age of 18 are guaranteed the entire right to health care in accordance with the legislation governing the right to health care from compulsory health insurance.[5]
Medical assistance is available in the Reception Centres for Applicants for International Protection in Zagreb and Kutina. While no newer information is available for the period from 2019 until the end of 2024, at the beginning of 2019, the Ministry of Interior reported that health care is also provided by the health care institutions in Zagreb and Kutina designated by the Ministry of Health.[6] In the Health Centre, a competent ambulance (family medicine) has been designated to provide health care from the primary health care level for chronic and life-threatening illnesses. A specialist ambulance for vulnerable groups has been appointed by the Ministry of Health and Local Health Centres. This includes: paediatric ambulance, gynaecological ambulance, school medicine ambulance, neuropsychiatric ambulance at the Hospital of Kutina, ambulance for addiction treatment; dental ambulances and Psychiatric Hospital in Zagreb.
In addition, applicants are referred to local hospitals, i.e., in Sisak for those accommodated in Kutina, and the Hospital of Zagreb. Vaccination is performed by doctors in health centres or by specialists of school medicine.
In April 2024, the Ministry of the Interior adopted a decision on the allocation of financial resources for the implementation of the project “6P – Support in Providing Healthcare to Applicants for International Protection” under AMIF. The purpose of the project is to promote and protect the health of applicants for international protection and to prevent disease by ensuring access to medical consultations at the level of primary healthcare.[7]
In 2024, the organization “Médecins du Monde ASBL – Dokters van de Wereld VZW” (MDM-BELGIQUE)[8]
continued to provide multidisciplinary and linguistically -adapted care to applicants for international protection (especially in identifying and supporting the most vulnerable among them (i.e., women, children, minors, LGBTQ+ individuals, survivors of gender – based violence, human trafficking or torture, persons with disabilities, children with developmental difficulties and their families, single parents etc.)) in the Reception Centers for Applicants for International Protection in Zagreb and Kutina.
Direct services to applicants for international protection were provided every working day in the Reception Center in Zagreb, with team member also present on weekends and holidays. The medical and mental health teams, depending on needs and availability, also provided services at the Kutina Reception Center approximately once a week.
In 2022, MDM-BELGIQUE’s team developed info-prevention posters/leaflets on three different topics: “How I feel matters”, “Everyone has the right to birth control” and “There is no room for violence in the family”; as well as a brochure on mental health.[9] In 2023, MdM issued the publication “Physical and mental health of applicants for international protection in the Republic of Croatia – new trends, observations, challenges and recommendations”.[10]
Complementary services by NGOs
MDM-BELGIQUE[11] continued to provide multidisciplinary and linguistically adapted medical and mental health care to applicants for international protection during 2024.
The organisation achieved the following results in 2024:
- MDM-BELGIQUE continued to conduct initial health examinations for newly arrived applicants for international protection. The organization facilitated access to medical consultations, interventions, and the distribution of prescribed medication through team work of general practitioners, nurses, and interpreters (for Arabic, Farsi, Urdu, Pashto, Russian, Spanish, Turkish, and French). Additionally, MDM-BELGIQUE worked in partnership with the health center Dom zdravlja Zagreb – Centar to ensure comprehensive care.
- Direct provision of services was provided every working day in the Reception Center in Zagreb, with a team member also present on weekends and holidays. The medical and mental health teams, depending on needs and availability, also provided services at the Kutina Reception Center approximately once a week.
- To ensure accessible and comprehensive care and support, MDM-BELGIQUE’s social worker and interpreters provided timely information and practical assistance to applicants for international protection in accessing their rights. This included scheduling appointments for specialist examinations and diagnostic procedures at public health institutions, organizing transportation (with support from the Croatian Red Cross), and providing interpretation assistance during appointments. By coordinating transportation and accompanying applicants to public health institutions, MDM-BELGIQUE facilitated further medical examinations and treatments, helping to bridge language and cultural barriers between patients and healthcare providers. Interpreters were available for Arabic, Farsi, Urdu, Pashto, Russian, Spanish, and French.
- The MDM-BELGIQUE medical team promptly responded to emergency cases and, in collaboration with the epidemiologist from the Teaching Institute of Public Health “Dr. Andrija Štampar”, actively worked to isolate infected individuals and prevent the spread of infectious diseases within the Reception Center.
- Vaccinations for children of applicants for international protection and medical examinations required for preschool and school enrolment continued in partnership with the health center Dom zdravlja Zagreb – Centar and the Teaching Institute for Public Health “ Andrija Štampar“. MDM-BELGIQUE also ensured healthcare access for pregnant women in the Reception Center, arranging transport/accompanying with interpreters to the Women’s Diseases and Obstetrics Clinic at Clinical Hospital in Zagreb. Postpartum care was provided through visits from home care nurses in collaboration with the health center Dom zdravlja Zagreb – Centar in Dugave.
- Additionally, in cooperation with the health center Dom zdravlja Zagreb – Centar, MDM-BELGIQUE organized necessary dental care for beneficiaries, with successful collaboration continuing in 2024 with dental specialists.
- In 2024, the MDM-BELGIQUE medical team conducted 5,246 medical consultations for 2,495 applicants for international protection, including 2,212 initial medical examinations for newly arrived individuals. Of these consultations, 24.38% were with women, and 14.15% with children. The patients came from a diverse range of countries, highlighting the exceptional cultural and linguistic diversity within the applicant population. The five most common countries of origin among MDM-BELGIQUE patients were the Russian Federation (16.59%), Syria (15.67%), Türkiye (13.03%), Afghanistan (10.66%), and Pakistan (4.73%).
- In addition, MDM-BELGIQUE organized a total of 1,030 transportation and accompaniment services for 433 applicants to public health institutions for specialist and diagnostic exams. This included transportation for pediatric care, vaccinations, and school medicine specialist exams for child applicants.
The most common health issues identified among applicants for international protection were skin diseases (16.34%), respiratory illnesses (13.69%), musculoskeletal problems (10.16%), and digestive issues (8.18%).
Alongside particularly complex cases (including post-operative care following traffic accidents and multiple traumas, severe mental health disorders, chronic diseases, adults and children with disabilities, cancer, and acute conditions), the increase in newly arrived applicants for international protection over the past three years, coupled with a high transit dimension and a rise in incoming transfers under the Dublin III Regulation, has led to a significant increase in the number of medical consultations. This has also resulted in additional administrative tasks related to arranging medical tests, specialist exams, and transportation. In some instances, appointments were cancelled due to individuals leaving Croatia before the scheduled dates. A significant number of applicants also had shorter stays in Reception Centers, preventing them from completing the initial health examination. For all other applicants, initial health examinations were organized daily.
One of the ongoing challenges throughout 2024 in facilitating access to healthcare for applicants for international protection in Croatia was the difficulty in registering employed individuals with family doctors/general practitioners and other primary healthcare specialists. As the number of employed applicants entitled to mandatory health insurance through the Croatian Health Insurance Fund (HZZO) continued to rise, it became increasingly important to provide information and support for these patients in registering with general practitioners, dentists, and gynecologists within the public healthcare system. Despite efforts to assist patients in registering with doctors, a significant number of applicants still remained unregistered and lacked a designated general practitioner. Many doctors refused to register them, citing language barriers, time constraints, or the lack of sufficient spots for new patients as reasons.
Through daily direct work with applicants and beneficiaries of international protection, MDM-BELGIQUE observed that many applicants for international protection returned under Dublin III Regulation suffer from various physical and/or mental health issues. This contrasts with the generally healthier population of applicants entering Croatia through non-EU countries. In 2024, Dublin transfers included oncology patients, individuals with chronic illnesses, people with disabilities, children with developmental disorders and special needs, and individuals who had started treatment in their previous country of residence (including interruptions in hospitalization). There was also an increase in patients undergoing psychiatric and psychotherapeutic treatment for severe mental health conditions. It was noted that transfers often did not include the transfer of medical records, which delayed the continuation of treatment and disrupted the continuity of care for those arriving in Croatia under Dublin III.
Croatian Red Cross reported that in 2024 access to healthcare services was provided to 599 applicants for international protection through specialist paediatric examinations, gynaecological check-ups, consultations at the clinic for child and adolescent psychiatry, dental care, as well as a range of other aids prescribed by the competent physician.[12]
Mental health
Psychological counselling and support was provided by MdM during 2024.[13]
Regarding mental health care and psychosocial support organised for applicants for international protection, throughout 2024 MDM-BELGIQUE psychologists were available for initial psychological assessments and individual counselling every working day at the Reception Centre for Applicants for International Protection in Zagreb, as well as for crisis interventions when needed.
In 2024, there was also an increase in the number of applicants suffering from mental health disorders. Notably, 64% of patients with mental health conditions staying at the Reception Center for Applicants for International Protection in Zagreb were transferred under Dublin III Regulation. These patients had previously been treated for various disorders, including paranoid schizophrenia, unspecified non-organic psychosis, suicidality, post-traumatic stress disorder, major depressive episodes, addiction syndrome, anxiety disorders, panic disorders, personality disorders, and adjustment disorders. In many cases, symptoms were exacerbated or new mental health issues developed after the transfer. This situation led to frequent crisis interventions and hospitalizations organized by the MDM-BELGIQUE team following transfers. Given the intense and often traumatic stress associated with involuntary transfers, it is crucial to highlight the retraumatizing risks of transferring applicants for international protection under Dublin III, especially for vulnerable individuals (i.e., people with pre-existing mental health conditions, severe chronic or acute conditions, individuals who have scheduled medical procedures, those subjected to force during transfer, people separated from family or support networks, and individuals who have lived in the transfer country for an extended period). Involuntary transfers under the Dublin III Regulation can severely impact the mental and physical health of applicants for international protection, as they can undermine their sense of stability and security, interrupt their recovery, worsen their conditions, and lead to long-term health consequences that permanently affect their well-being.
Compared to previous years, 2024 saw a decrease in cases of sexual and gender-based violence (SGBV), with 63 recorded cases compared to 106 in 2023. MDM-BELGIQUE provided appropriate psychological support, psychiatric treatment, and further referrals for all survivors of violence, in collaboration with relevant service providers.
Throughout 2024, 956 individual psychological counselling sessions were held, and referrals were made to a psychiatric specialist from the MDM-BELGIQUE team (170 psychiatric exams). When needed, referrals were also made to the Psychiatric Clinic “Sveti Ivan”, the Psychiatric Hospital for Children and Youth, the Addiction Department at Clinical Hospital Sestre Milosrdnice, and for hospital treatment where indicated.
Additionally, in 2024, MDM-BELGIQUE organized 32 workshops for women applicants for international protection at the Reception Center in Zagreb. These workshops aimed to inform beneficiaries about MDM-BELGIQUE services, foster group cohesion, and encourage the development of support networks among participants. Activities included jewellery making, henna drawing, music and dance workshops, and other creative and relaxing activities.
Regarding informative and preventive activities, in 2023 MDM-BELGIQUE developed a platform for basic psychological support “Mental Health Zone” (www.mental-health-zone.com) available in eight languages – Croatian, English, French, Spanish, Arabic, Farsi, Turkish and Bajaj. The platform was designed as an interactive online tool which goal is to provide support to beneficiaries of the MDM-BELGIQUE team’s services, as well as to all interested parties, in dealing with short-term and long-term reactions to crisis events and traumatic experiences and their psychological consequences. The platform contains psycho-educational content with practical advice and exercises that can help people integrate the crisis experience more healthily and strengthen natural mechanisms for dealing with stress while encouraging psychological resilience.
The platform was developed by the MDM-BELGIQUE expert team in Croatia as part of the so called OPOPS project, financed by the European Social Fund (ESF) and the Office for Cooperation with NGOs of the Government of the Republic of Croatia.
Special health needs
Applicants who need special reception and/or procedural guarantees, especially victims of torture, rape or other serious forms of psychological, physical or sexual violence, shall be provided with the appropriate health care related to their specific condition or the consequences resulting from the mentioned acts.[14] According to the Law on Mandatory Health Insurance and Health Care for Foreigners in the Republic of Croatia, an ordinance which defines the scope of the right to health care for applicants who have been subject to torture, rape or other serious forms of violence and as well as for those with special health care needs, must be adopted. The Ordinance on health care standards for applicants for international protection and foreigners under temporary protection was adopted in 2020 and entered into force in March 2020 (see Primary health care for more information).[15]
According to national legislation, the procedure of recognising the personal circumstances of applicants shall be conducted continuously by specially trained police officers, employees of the Ministry of Interior and other competent bodies, from the moment of the expression of the intention to apply for international protection until the delivery of the decision on the application. However, according to CLC’s knowledge there is still no further detailed guidance available in the law, nor an early identification mechanism in the form of internal guidance.
The Standard Operational Procedure in Cases of Sexual and Gender-Based Violence in the Reception Centres for Applicants of International Protection” was developed in cooperation with the Ministry of Interior, UNHCR, IOM, MDM-BELGIQUE, the Croatian Red Cross and the Croatian Law Centre. It entered into force in April 2021.
The UNICEF Office in Croatia reported that, in cooperation with its implementing partner, the Croatian Association for Early Childhood Intervention (HURID), is developing an online professional training programme titled “Providing Culturally Sensitive Early Childhood Intervention Services to Migrant Children and Families”. The aim of the programme is to enhance the skills and knowledge of early intervention service providers in working with children and families from different cultural backgrounds, with the goal of improving the development of children at risk of developmental delays or difficulties, aged 0 to 7.[16]
[1] EUAA: National Asylum Developments 2024, June 2024, page 7, available at: https://euaa.europa.eu/sites/default/files/publications/2024-06/2024_National_Asylum_Developments_EN.pdf.
[2] Article 57(1) -(2) LITP.
[3] Article 57 (4) LITP.
[4] Official Gazette 28/2020, available in Croatian at: https://bit.ly/3asTWel.
[5] Article 9 (1) (4) Ordinance on health care standards for applicants for international protection and foreigners under temporary protection
[6] Information provided by the Ministry of Interior, 28 January 2019.
[7] Ministry of the Interior: Decision on the allocation of financial resources for the implementation of the project “6P – Support in Providing Healthcare to Applicants for International Protection”, 25 April 2024, available at: https://eufondovi.mup.hr/UserDocsImages/dokumenti/Odluke%20o%20dodjeli%20financijskih%20sredstava/Odluka%20-%206P.pdf?vel=847607.
[8] Information provided by MDM-BELGIQUE, 17 February 2025.
[9] Information provided by MdM, 14 February 2023.
[10] MdM: Publication “Physical and mental health of applicants for international protection in the Republic of Croatia – new trends, observations, challenges and recommendations”, available in Croatian at: https://bit.ly/3IQ6ZI7; and in English at: https://bit.ly/ 3C4pO6r.
[11] Information provided by MDM-BELGIQUE, 17 February 2025.
[12] Croatian Red Cross: Annual report on the work of the Croatian Red Cross in 2024, page 84, available at: https://www.hck.hr/UserDocsImages/vijesti/2025/AD%205)%20Izvje%C5%A1%C4%87e%20o%20radu%20HCK%20u%202024.pdf?vel=5096156.
[13] Information provided by MdM, 17 February 2025.
[14] Article 57(2) LITP.
[15] Official Gazette 28/2020, available in Croatian at: https://bit.ly/2QKE3ZK.
[16] Information provided by UNICEF Office for Croatia, 4 February 2025.