Author
Asylum seekers without adequate resources are entitled to free medical care in public medical institutions, covering at a minimum emergency health care and essential treatment of illnesses and serious mental disorders.[1] Welfare beneficiaries and residents in the reception centre are indicated as eligible for free medical care and, in that respect, have access to free health care. The level of resources needed to receive free medical care in the case of asylum seekers who do not receive welfare assistance is not specified.
Up until November 2020, free access to health care was granted upon the presentation of a “Type A” Hospital Card, issued by the Ministry of Health. This document was provided to all residents of the Kofinou Reception Centre, while for persons residing in the community, a welfare dependency report indicating the lack of resources was required by the Ministry of Health. The fact that many asylum seekers were not receiving welfare assistance created difficulties in securing free access. Still, the majority of asylum seekers were able to receive the hospital card granting them access to public health institutions.
In November 2020, the Ministry of Health granted free access to hospitals for all asylum seekers, regardless of whether they received MRC, and since May 2022, asylum seekers during the first year after the application for asylum are able to access public health institutions just with their Confirmation Letter.
A year after the date of the application of asylum, asylum seekers need to apply for a medical card at the Ministry of Health, by submitting a simplified application. Hospital cards are either issued on the spot at the Ministry of Health or can be sent to beneficiaries by post. They are typically valid for one year.
On 1 June 2019, a National Health System (GESY) came into effect for the first time in Cyprus, introducing major differences in the provision of health care services such as the concept of a personal general practitioner (GP) in the community as a focal point for referrals to all specialised doctors. For most of the population (Cypriots, EU citizens, BIPs), health services are now provided almost exclusively under the new health system.
Asylum seekers, along with other persons that are part of the migrant population, are not included in the provisions of GESY. Their access to health services continues under the provisions of the previous system, which basically entails treatment by public, in-patient and out-patient departments of the public hospitals. The same applies for asylum seekers who are working, despite the fact that since the implementation of GESY, they contribute to GESY as employed persons.
The transition to the new health system impacted access of asylum seekers to health services as, until 18 December 2019, when a relevant decision by the Council of Ministers was issued, there were no official decisions on the exact procedures regarding asylum seekers’ access to health services.[2] The transition created vast confusion among medical and hospital staff regarding asylum seekers’ rights to health care. In various instances across Cyprus, and as it was reported to CyRC and other NGOs, persons were denied access to treatment in the hospital and were asked to register with GESY instead. Scheduled appointments with doctors who, in the meantime, had joined GESY were cancelled and access to particular medicine was also restricted. During 2020, the situation somewhat improved; however, up until today, due to the vast majority of public health services, including medicine prescriptions, being delivered under GESY, asylum seekers enjoy a bare minimum of health services and often need to pay for medicines not offered through the hospitals. Access to medication remains particularly problematic.
The transition to the new health system is particularly relevant in view of the measures tackling COVID-19. According to such measures, the public is expected to consult personal GPs before visiting the hospitals. As asylum seekers are not covered by GESY, they do not have access to personal GPs, which has created a serious shortcoming in accessing appropriate health care services. In addition, language barriers also prohibited asylum seekers from receiving health related information about COVID-19 through the hotline which was set-up for this purpose (1420). NGOs, UNHCR, and volunteers in the community tried to address this gap and facilitate access to information for asylum seekers by translating and disseminating important COVID-19 related announcements in the most widely used refugee languages and by providing advice and guidance.
Asylum seekers residing both in Kofinou and Pournara Centres as well as the community are included in the National COVID-19 Vaccination Plan.[3] Because asylum seekers are not covered by GESY, participation in the program for those residing in the community was granted with submission of an application form, accompanied by a copy of a valid hospital card.[4] During the course of 2021, walk-in vaccination arrangements were organized by the Ministry of Health, which provided easier access for the population, and large numbers of asylum seekers received their vaccination doses.
Asylum seekers who need to receive essential treatment which is not available in the RoC are not included in the relevant scheme introduced by the Ministry of Health transposing the Directive on patients’ rights in cross-border healthcare. In practice, however, the Ministry has covered the costs, upon approval of the Minister of Health, for several cases of child asylum seekers to receive medical treatment outside the country.[5]
In a number of cases, asylum seekers reported to the CyRC that they faced racist behaviour from medical staff, often in relation to their poor Greek language skills and the reluctance of the latter to communicate in English. Such reports continued in 2022.
Specialised Health Care
Asylum seekers without adequate resources who have special reception needs are also entitled to free of charge necessary medical or other care, including appropriate psychiatric services.[6] The Refugee Law incorporates the provision of the recast Reception Conditions Directive in relation to identifying and addressing special reception needs, including for victims of torture. In practice, the identification of vulnerabilities is conducted mainly in the camps from appointed professionals, albeit not without gaps. The situation is much more challenging in the community due to the lack of a specific mechanism and procedures to timely identify and address those needs. In addition, there are no specialised facilities or services, except for the ones available to the general population within the public health care system. Currently, there is only one NGO, the Cyprus Refugee Council, offering specialised social and psychological support to victims of torture and gender-based violence, operating through the funds of United Nations Voluntary Fund for the Victims of Torture (UNVFVT) and the EU.[7] During 2021, 118 persons received relevant services and in 2022, 142 persons. The fund has been renewed for 2023.
[1] Article 9ΙΓ(1)(a) Refugee Law.
[2] Απόσπασμα από τα Πρακτικά της Συνεδρίας του Υπουργικού Συμβουλίου Ημερομηνίας 18/12/2019, available in Greek at: https://bit.ly/2TRello.
[3] Ministry of Health, National vaccination plan for COVID 19, 2020, available at: https://bit.ly/3lpBJCY.
[4] Document for the registration of citizens who are not GHSY beneficiaries, to the Cyprus portal for Covid-19, available at https://bit.ly/3cOkSa4.
[5] Information provided by CyRC
[6] Article 9ΙΓ(1)(b) Refugee Law.
[7] For more information see Future Worlds Centre, UNVFVT, available at: http://bit.ly/1HQVYfJ.