Author
Asylum seekers under the regular procedure, like any other third-country nationals below a certain income level, have access to healthcare thanks to the universal healthcare insurance (PUMA)system.[1]Since January 2020,the 3-month residence requirement that applies to other third-country nationals and which used to apply only to asylum seekers under the Dublin procedure is now applicable to all asylum seekers without exception.[2]After this 3-month period, asylum seekers benefit from the PUMA. The request to benefit from the PUMA is made to the social security services(CPAM) of the place of residence or domiciliation. The asylum seeker must submit documentary evidence of the regularity of this or her stay in France, marital status and the level of his or her resources. As a result, asylum seekers cannot see a doctor for free, except in hospitals in case of emergency, which means a postponement of treatment. Other negative consequences since the introduction of the new 3-month residence requirement include the fact that the compulsory examination at the entrance to the accommodation centers cannot be set up, psychological care is not accessible and vulnerability assessments are rendered more complicated.
In the context of COVID-19, this may have prevented asylum seekers from seeing a doctor for a diagnosis. However, testing and vaccine campaigns do not provide for any distinction according to nationality and legal status and are therefore available for asylum seekers if they meet priority criteria.[3] In practice, asylum seekers have access to vaccination similarly to French nationals.
Persons who have no right to remain on the territory, including rejected asylum seekers, benefit from the PUMA for six months after the end of validity of the asylum claim certification. After this period, State Medical Aid (AME) enables them to receive free treatments in hospitals as well as in any doctors’ offices.[4]It should be noted that, prior to 2020, rejected asylum seekers could benefit from the PUMA one year after the end of validity of the asylum claim certification.
Individuals with low income and who are still awaiting health insurance and needing healthcare quickly can turn to the All-Day Healthcare Centres (PASS) at their nearest public hospital. This is therefore also a possibility for asylum seekers under the accelerated and Dublin procedures. There, they will receive care and, if necessary, the medical letter needed to speed up the processing of their application for public health insurance. According to the law, all public hospitals are required to offer PASS services, but in practice, this does not always occur.
As a general rule, difficulties and delays for effective access to health care vary from one city to another in France. Access to the PUMA is functioning well in most of the regions of France, and is effective within one month. Access has been considerably improved since 2016, even if some difficulties remain, in particular for subsequent applicants. However, as explained above, the new policy which introduces a 3-month period before accessing to has rendered the access to healthcare more difficult since 2020.
The duration of access to the healthcare insurance is in theory linked to the duration of validity of the asylum claim certification. In practice, it can be noted that the social security services deliver healthcare insurance for a one-year duration. In fact, at the end of the validity of the asylum claim certification, access to health care is not guaranteed anymore. It may then occur, at the moment of renewing their certification, that some asylum seekers get their healthcare insurance suspended.
Finally, some of the problems with regard to medical care are not specific to asylum seekers. Some doctors are reluctant to receive and treat patients who benefit from the AME or PUMA and tend to refuse booking appointments with them even though these refusals of care can in theory be punished.[5]
National legislation does not guarantee any specific provision for access to care related to mental health issues. Asylum seekers can theoretically benefit from psychiatric or psychological counselling thanks to their health care cover (AME or PUMA). However, access remains difficult in practice because many professionals refuse to receive non-French speaking patients as they lack the tools to communicate non-verbally and / or funds to work with interpreters.
Victims of torture or traumatised asylum seekers can be counselled in a few NGO structures that specifically take care of these traumas. This adapted counselling is provided, for instance, at the Primo LeviCentre and Comede in Paris as well as the Osiris centres in Marseille, Mana in Bordeaux, Forum réfugiés – Cosi Essor Centre in Lyon. These specialised centres are however too few in France, unevenly distributed across the country and cannot meet the growing demand for treatment.
The difficulties are in fact even more aggravated by the geographical locations of some reception centres where the possibility to access mental health specialists would mean several hours of travel.
The general health system cannot currently cope with this adapted care for victims of torture and political violence. These regular structures lack time for consultations, funds for interpreters and training for professionals.
Health care access devices are available in detention centre and transit zones, for all people in these places (including asylum seekers). It is thus possible to ask for a medical examination and to see a doctor.
[1] Article L.380-1 Social Security Code.
[2] Decree n° 2019-1531 of 30 December 2019 relating to the residence requirement applicable to asylum seekers for covering their health expenses, available in French at: https://bit.ly/2tcEvoe.
[3] Ministry of solidarity and health, ‘La stratégie vaccinale et la liste des publics prioritaires’, Available in French at :https://bit.ly/389TeSg.
[4] Ministry of Interior, Social Rights of Asylum Seekers, available at: http://bit.ly/1EvEcCF.
[5] Circular DSS n. 2001-81, 12 February 2001 on the care refusal for beneficiaries of the CMU.