Author
Free access to health care for beneficiaries of international protection is provided under the same conditions as for nationals,[1] pursuant to Law 4368/2016. Despite the favourable legal framework, actual access to health care services is hindered in practice by significant shortages of resources and capacity for both foreigners and the local population, as a result of the austerity policies followed in Greece, as well as the lack of adequate cultural mediators. Moreover, administrative obstacles with regard to the issuance of a Social Security Number (AMKA) also impede access to health care. In addition, according to GCR’s experience, beneficiaries of international protection for whom the competent authority is the Headquarters of the Hellenic Police and and who hold the “old type” of residence permit in the form of a “booklet”, have encountered problems in the issuance of AMKA, as this old residence permit contains a number written in a different format than the new residence permits. Hence, the civil servants did not know how to process the issuance of AMKA.
According to the new JMD entering into force in December 2023,[2] the grant of AMKA is conditioned upon possession of a “valid residence title in the country with labour market access”.[3] The requirement of a “valid” residence permit creates substantial obstacles, given that AMKA is deactivated upon (a) interruption of lawful residence in the country; or (b) interruption of access to the labour market; or (c) interruption of actual residence in the country, except for minor beneficiaries; or (d) deactivation of A.M.K.A. of the directly insured person, in the case of indirectly insured persons adults or minors[4]. “Specifically as regards deactivation due to non-legal residence in the country, [deactivation] shall automatically take place on the day following the expiry of validity of the residence title, in the absence of renewal, extension or withdrawal of the status of international or temporary protection”.[5]
According to Guidelines provided by the Registration Department of the Insurance Directorate of the General Directorate for Contributions, “the service of third country nationals for the issuance – activation – re-activation of AMKA will be provided by the Ministry of Migration and Asylum by 22.12.2024. Until this date, third country nationals will be served by e-EFKA and Citizens’ Service Centres” (Κέντρα Εξυπηρέτησης Πολιτών – KEPs).[6]
It should be noted that, in the Guidelines of the Ministry of Labour and Social Affairs, there are neither specimens of residence permits of beneficiaries of international protection issued by the Headquarters of the Hellenic Police, nor specimens of certificates of submission of renewal applications of residence permits for both beneficiaries of international protection granted international protection status either by the Asylum Service or the Headquarters of the Hellenic Police.[7]
The Ministerial Decision 12184/2022 that came into effect on 16 March 2022 provided that the prescription of medicines, therapeutic operations and diagnostic examinations for patients without health insurance will be possible, only by doctors of public hospitals and Primary Health Care structures.[8] This Ministerial Decision affected the vast majority of beneficiaries of international protection, since most of them do not have health insurance and will therefore no longer be able to visit private doctors.
As of July 1, 2022, it is impossible for private doctors to prescribe the uninsured patients under Article 38 Law 4865/2021,[9] in conjunction with Ministerial Decision (M.D) 30268/30-05-2022.[10] The exception from this provision are : a. Uninsured people up to 18 years old. b. Uninsured patients with intellectual or mental disabilities, autism, down syndrome, bipolar disorder, depression with psychotic symptoms, cerebral palsy or severe and multiple disabilities, amputees who receive the extra-institutional allowance with a disability rate of 67% or more, as well as those who have a certified disability of 80% or more, for any condition.c. Uninsured patients with conditions included in the list of diseases for which medicinal products are administered with reduced or no contribution by the insured person, including patients suffering from AIDS d. The prescription of all vaccines without exception to all uninsured patients.[11] All the above apply to every person residing legally in Greece and there is no specific provision for beneficiaries of international protection.
As of March 2023, the “Evangelismos” General Hospital of Athens, the “Aiginitio” Hospital and “Dromokaitio” Psychiatric Hospital of Athens had no interpreters. Conversely, the “Dafni” Psychiatric Hospital of Athens only had interpretation for Arabic and the “Alexandra” General Hospital of Athens covered Arabic, Farsi, French and Lingala.[12] Thus, access to health care is extremely difficult is for beneficiaries of international protection.
According to a survey conducted by UNHCR from July 2022 until June 2023 with 424 beneficiaries of international protection “Twenty-nine per cent of respondents had difficulty accessing healthcare because of language barriers, challenges to securing appointments and lack of information on the national health care system”, while the number of households that have at least one member with specific needs is 36%. Chronic illnesses, mental health issues and physical disabilities are the top three reported vulnerabilities.[13]
[1] Article 30(2) Asylum Code.
[2] JMD Φ80320/109864/14.12.2023, Gov. Gazette Β΄ 7280/22.12.2023.
[3] Article 3(a) of JMD Φ80320/109864/14.12.2023. See RSA and Stiftung Pro Asyl, Beneficiaries of international protection in Greece, Access to documents and socio-economic rights, March 2024, available at: https://bit.ly/3KT41TT, p. 20.
[4] Article 7(1) JMD Φ80320/109864/2023.
[5] Article 7(2) JMD Φ80320/109864/2023. See RSA and Stiftung Pro Asyl, Beneficiaries of international protection in Greece, Access to documents and socio-economic rights, March 2024, available at: https://bit.ly/3KT41TT, p. 20.
[6] Registration Department of the Insurance Directorate of the General Directorate for Contributions, Παροχή Οδηγιών για την απόδοση και τη λειτουργία του Αριθμού Μητρώου; Κοινωνικής Ασφάλισης (ΑΜΚΑ), prot. no. 530132, 10 April 2024, available in Greek at: https://bit.ly/3xmJ3ts.
[7] Ministry of Labour and Social Affairs, Οδηγίες για την απόδοση και τη λειτουργία του Αριθμού Μητρώου Κοινωνικής Ασφάλισης (ΑΜΚΑ), prot. no. Φ80320/25192, 01 April 2024, available in Greek at: https://bit.ly/3RBmkRb.
[8] Ministerial Decision 12184/2022, Gov. Gazette 899/B/28.2.2022.
[9] Law 4865/2021, Gov. Gazette 238/A’/04-12-2021.
[10] Ministerial Decision 30268/30-05-2022, Gov. Gazette, B’, 2673/31.05.2022.
[11] Art. 11(1) Ministerial Decision 30268/30-05-2022 Gov. Gazette 2673, Β’, 31-05-2022.
[12] RSA and Stiftung Pro Asyl, Beneficiaries of international protection in Greece, Access to documents and socio-economic rights, March 2023, available at: https://bit.ly/3KT41TT, p. 26.
[13] UNCHR, Key Findings: July 2022 – June 2023
Protection Monitoring of Refugees in Greece, August 2023, available at: https://bit.ly/4dgyE2l.