L 4368/2016, which provides free access to public health services and pharmaceutical treatment for persons without social insurance and vulnerable, is also applicable for asylum seekers and members of their families. However, in spite of the favorable legal framework, actual access to health care services has been consistently hindered in practice by significant shortages of resources and capacity for both foreigners and the local population, as the public health sector is under extreme pressure and lacks the capacity to cover all the needs for health care services, as well as the lack of adequate cultural mediators. A recent research documents the impact of the ten years financial crisis and the austerity measures on the Greek public Health System.
In addition to the limited capacity of the public Health system, applicants’ access to healthcare has been further hindered as far back as 2016, due to the reported “generalised refusal of the competent public servants to provide asylum seekers with an AMKA”  (i.e. social security number), which up to the entry into force of article 55 IPA served as the de facto requirement for accessing the public healthcare system. This was further aggravated following a Circular issued on 11 July 2019, which in practice revoked asylum seekers’ access to the AMKA. As noted by Amnesty International in October 2019, “the administrative obstacles faced by many asylum seekers and unaccompanied children in issuing an AMKA have significantly deteriorated following 11 July 2019, when the Ministry of Labour revoked the circular which regulated the issuance of AMKA to non-Greek citizens. Following the circular’s revocation, no procedure was put in place for the issuance of AMKA to asylum seekers and unaccompanied minors”.
Article 55 of the IPA, introduced a new a Foreigner’s Temporary Insurance and Health Coverage Number (Προσωρινός Αριθμός Ασφάλισης και Υγειονομικής Περίθαλψης Αλλοδαπού, PAAYPA), replacing the previous Socila Security Number (AMKA). PAAYPA is to be issued to asylum seekers together with their asylum seeker’s card. With this number, asylum seekers are entitled free of charge access to necessary health, pharmaceutical and hospital care, including necessary psychiatric care where appropriate. The PAAYPA is deactivated if the applicant loses the right to remain on the territory. Said provisions of the IPA entered into force since 1 November 2019. However, it has not been activated by the end of 2019.
Due to the obstacles in issuing AMKA, the circular revoking the issuance of AMKA in July 2019 and pending the implementation of article 55 IPA, newly arrived applicants and/or applicants who had up to then been unable to issue an AMKA, even in highly vulnerable cases and including unaccompanied minors, have been de facto excluded from access to the public healthcare system, with the exception of emergency cases.
Indicatively, in December 2019, GCR undertook the case of a 25-year-old asylum seeker from Pakistan, with a form of rapidly progressive cancer, who was unable to access healthcare services, be hospitalised, or acquire necessary medication, due to the lack of a social security number (AMKA or PAAYPA). His hospitalisation was made possible only through the good will of the General Hospital of Athens, while following the notification of the case to the Greek Ombudsman, the latter called the competent authorities to find an immediate solution for his free of charge hospitalisation, inter alia stating that “the gap in the implementation of the law cannot burden the asylum seeker who is facing an immediate danger to his life”.
Moreover, as further noted by MsF in December 2019, “Our medical and mental health teams witness daily the harmful health consequences of the intentional exclusion of asylum seekers and undocumented people accessing their fundamental right to health. Between July and November this year, in our day centre in Athens we have seen a steep rise in the number of patients seeking care who don’t have AMKA, going from 18% of patients in January to 43% in November. Many health conditions our patients present with are manageable with regular treatment, yet, as people are unable to access this, their conditions are at risk of deteriorating”.
Similarly, on the Eastern Aegean islands, access to health remains particularly restricted due to the chronic lack of staff, the aforementioned lack of a social security number, and persisting overcrowding which, especially in the second half of the year, was even further accentuated. Indicatively, for the most throughout 2019, the RIC of Lesvos had only 2 state-provided (military) doctors, the RIC of Chios 1, the RIC of Leros 1, the RIC of Samos 2 and the RIC of Kos 2, with the number of resident at the end of 2019 being respectively at 18,615, 5,784, 2,496, 7,765 and 3,765. Moreover, by the end of January 2020, in the RIC of Lesvos there were only three doctors present to cover the medical needs of an increased population of 19,419 resident. At the same time, there were two ambulance drivers, even though the RIC does not have an ambulance,  thus further hindering applicants’ access to the public healthcare system even in cases of emergency.
Meanwhile, attempts to cover the primary healthcare needs of the population throughout 2019 were to the largest extent covered by personnel provided by NGOs and/or other actors, who, however, are lack the authority for assessing vulnerabilities. As such, and amongst others, the average times for the assessment of vulnerabilities of newcomers ranged between 2-6 months in Lesvos, 1-8 months in Chios, 2-3 months in Samos, 3-4 months in Leros and 4 months in Kos.
In a welcome development, the publication of the Joint Ministerial Decision for the issuance of the PAAYPA was issued on 31 January 2020, officially triggering the mechanism, whose implementation remains to be seen. The activation of the PAAYPA number has been announced in April 2020.
As noted by UNHCR (December 2019), “Asylum-seekers may now have access to medical services with a new temporary health card, however full implementation of this provision falls short. EODY’s staffing capacity was overall reinforced with incoming staff, but the reception centres on the islands and Evros continue to lack doctors and interpreters – both a major obstacle to the provision of medical services and psychosocial support.”
 Article 33 L 4368/2016.
 Joint Agency Briefing Paper, Transitioning to a Government-run Refugee and Migrant Response in Greece: A joint NGO roadmap for more fair and humane policies, December 2017, available at: https://bit.ly/2S3yiVn, 12.
 Amnesty International, “Greece must immediately secure the free access of asylum seekers, unaccompanied minors, and children of undocumented migrants to the public healthcare system”, 14 October 2019, available (in Greek) at: https://bit.ly/372T4sz.
 Article 55(2) IPA.
 Article 55(2) IPA.
 Efsyn, ‘Medicines du Monde on children with chronic diseases who don’t have AMKA’, 29 January 2020,
available in Greek at: https://bit.ly/39bS5ri.  GCR, Intervention of the Ombudsman for the cancer patient without AMKA, 6 December 2019, available (in Greek) at: https://bit.ly/2Sjledm; Intervention of the Greek Ombudsman on the “Non issuance of AMKA to asylum seeker applicant of international protection – immediate need of hospitalisation of cancer patient” on 6 December 2019.
 Information provided by the RIS in Lesvos, on 29 January 2020.
 Information provided by the RIS on 7 February 2020.
 Joint Ministerial Decision 717/2020, Gov. Gazette 199/Β/31-1-2020.