Author
Primary health care
Applicants are entitled to health care. However, 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.[1] The costs of the health care shall be borne by the ministry responsible for health care.[2]
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.[3] 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.[4]
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 2023, 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.[5] 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 2023, MDM-BELGIQUE[6] continued to provide multidisciplinary and linguistically-adapted care to applicants for international protection – especially in the process of identifying and providing support to the most vulnerable among them (women, children, LGBT+ persons, survivors of gender-based violence, human trafficking or torture, persons with disabilities, children with developmental disabilities and their families, single parents of minor children, etc.) – at the Reception Centre for Applicants for International Protection in Zagreb with occasional visits depending on needs to the Reception Centre for Applicants for International Protection Seekers in Kutina.
A significant challenge in the implementation of activities of MDM-BELGIQUE included a break in funding after the end of the project “5P – Support in the provision of health care to applicants for international protection ” financed by the AMIF and the Government of the Republic of Croatia. As a result, MDM-BELGIQUE team did not carry out their regular activities in the Reception Centres for Applicants for international protection in the period from May to the end of August 2023.
The continuation of activities at the Reception Centres was financed through the project “Health4AsylumSeekers (CRO) – Strengthening Emergency Migration Management Framework for Healthcare and Mental Health and psychosocial support of asylum seekers in Croatia” (through Rapid Response Fund, State Secretariat for Migration of the Swiss Confederation).
Apart from that period, medical team of MdM was present at the Reception Centre in Zagreb every working day, and in Kutina occasionally depending on needs.
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.[7] 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”.[8]
Complementary services by NGOs
MDM-BELGIQUE[9] continued to provide multidisciplinary and linguistically adapted medical and mental health care to applicants for international protection during 2023.
The organization achieved the following results in 2023: through the cooperation of general practitioners and interpreters (for Arabic, Farsi, Urdu, Pashto, Russian, Spanish, and French language), MDM-BELGIQUE continued to implement the first health examination of newly arrived applicants for international protection, as well as ensuring the availability of medical consultations, interventions and distribution of prescribed medication (in cooperation with the health center Dom zdravlja Zagreb – Centar). Direct provision of services was provided every working day at the Reception Centre for Applicants for International Protection in Zagreb.
To make sure that comprehensive help and care is available, MDM-BELGIQUE social workers and interpreters also provided timely information and practical support to applicants for international protection in exercising their rights – mainly through arranging specialist examinations and diagnostic procedures in public health institutions, organizing transport schedules (including the schedule of transport for the Croatian Red Cross – as well as support in accompanying patients) and organizing the support of interpreters at agreed times.
The organization of transportation and accompaniment of applicants for international protection to public health institutions by interpreters enabled further examinations and treatment and helped to overcome language barriers between patients and health workers. The MDM-BELGIQUE medical team responded promptly in emergency cases and in cooperation with the epidemiology of the Teaching Institute for Public Health, Dr. Andrija Štampar actively worked on isolating patients and preventing the possible spread of infectious diseases in the Reception Center – especially SARS CoV-2, measles and whooping cough in 2023.
Vaccination of children applicants for international protection and/or conducting medical examinations for enrolment in preschool/school continued to take place continuously through cooperation with the Zagreb Health Centre and the Training Institute for Public Health “Dr Andrija Štampar”. MDM-BELGIQUE also provided complete health care to pregnant women accommodated in the Reception Centre in cooperation with the Health Centre Zagreb (including gynaecological examinations and necessary tests) and provided them with accompaniment to the Clinical Hospital for Women’s Diseases and Childbirth in Zagreb.
Given the specific conditions during the migration journey, which include poor nutrition and limited opportunities to maintain oral hygiene, a significant number of beneficiaries needed dental services. Through cooperation with the Health Centre Zagreb, MDM-BELGIQUE provided the necessary care to beneficiaries who needed dental services in order to prevent a series of urgent and complex interventions.
In 2023, the MdM’s medical team carried out 1,908 medical consultations with applicants for international protection, out of which 1,261 were initial medical examinations of newly arrived applicants. Out of the total medical consultations: 20,2% were organized with women and 11,4% with children. The most represented nationalities among MDM’s beneficiaries were Afghans (41%), Russians (17,5%), Burundians (4,4%), Syrians (4,3%) and Turkish (3.6%). In addition, a total of 573 transports of 267 applicants for international protection to public health institutions for the necessary specialist and diagnostic treatment were performed (including transports for children to paediatricians/vaccinations/school medicine specialists). The most common diseases identified among applicants for international protection were skin diseases (29%), respiratory diseases (18%), osteo-muscular problems (9%) and digestive disorders (6%).
The main challenge that the organization faced during the implementation of the program in 2023 was an increase in the number of applicants for international protection as, in 2023, the number was several times higher compared to the same period in 2022.
In addition to particularly complex cases (which included postoperative care after amputation of the arm, lower leg and toes of the foot, cases of severe PTSD, suicidality, severe chronic diseases, disability in adults and children, cancer and acute conditions), such an increase with an extremely high transit dimension and fluctuation of beneficiaries resulted in an increased number of health consultations and examinations, as well as in additional administrative work of ordering diagnostic tests, specialist examinations and planning of transport schedules for health referrals.
An increased number of Dublin transfers of applicants for international protection from other EU countries to Croatia started again in 2022, and that continued in 2023.Back in 2018, there were a number of cases of patients returned from Austria, Germany, the Netherlands, Slovenia and Switzerland suffering from serious (e.g., cancer and Marfan syndrome) and chronic diseases (diabetes, cardiovascular diseases) and people who reported serious mental health difficulties (PTSD, psychosis, chronic depression, postpartum depression). A similar situation was recorded in 2023, and in several situations, it has been observed that the transfer of persons with serious diseases did not include the transfer of their medical records. This can significantly delay the continuation of treatment and continuity of care for the most vulnerable applicants for international protection who were transferred to Croatia.
Mental health
Psychological counselling and support was provided by MdM during 2023.[10]
Regarding mental health care and psychosocial support organized for applicants for international protection, MDM-BELGIQUE psychologists were organizing initial psychological assessments and individual psychological counselling, as well as crisis interventions if necessary. Compared to previous years, MDM-BELGIQUE has noticed an additional increase in cases of sexual and gender-based violence (SGBV) – with 106 recorded cases in 2023 compared to 66 cases in 2022. MDM-BELGIQUE provided psychological support and/or psychiatric treatment to all survivors of violence, as well as support for further referral – in cooperation with relevant service providers.
During 2023, 490 individual psychological consultations were carried out with referrals to “Sveti Ivan“ Psychiatry Clinic and Psychiatric Hospital for Children and Youth and hospital treatment as needed.
Regarding informative and preventive activities, 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.
Info-preventive workshops related to mental health were also regularly organized inside the Reception Center for Applicants for International Protection in Zagreb.
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.[11] 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).[12]
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.
[1] Article 57(1) -(2) LITP.
[2] Article 57 (4) LITP.
[3] Official Gazette 28/2020, available in Croatian at: https://bit.ly/3asTWel.
[4] Article 9 (1) (4) Ordinance on health care standards for applicants for international protection and foreigners under temporary protection
[5] Information provided by the Ministry of Interior, 28 January 2019.
[6] Information provided by MDM-BELGIQUE, 23 February 2024.
[7] Information provided by MdM, 14 February 2023.
[8] 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.
[9] Information provided by MDM-BELGIQUE, 23 February 2024.
[10] Information provided by MdM, 23 February 2024.
[11] Article 57(2) LITP.
[12] Official Gazette 28/2020, available in Croatian at: https://bit.ly/2QKE3ZK.