Author
The COA is responsible for the provision of health care in the reception centres. As any other person in the Netherlands, an asylum applicant can visit a general practitioner, midwife or hospital. The Arrangement for Medical Care for Asylum applicants deals with the rules on medical insurance for asylum applicants (Regeling Medische zorg Asielzoekers (RMA) Healthcare).
As addressed above, issues connected to the lack of accessible health care services in emergency locations and crisis emergency locations emerged in 2022. On 3 August 2022, the Inspection of the Ministry of Health Care and Youth warned the Minister of Health Care and Youth and the (then) State Secretary of Justice and Security (now Minister of Asylum) about the alarming situation with regard to access of health care in crisis emergency locations.[1] The Inspection reported that the quality of health care on these locations was severely inadequate and sometimes limited to only emergency care. This was due to the rapid grow of crisis emergency locations, to a lack of personnel and to the fact that many of the asylum applicants staying at these locations had not yet been registered – making it difficult to arrange the health insurance.
In 2023, many of these problems remained. In March, the Inspection of the Ministry of Health Care and Youth warned that crisis emergency locations are not suited for long term stay, but are being used as such, resulting in urgent risks for the individual health of asylum applicants, public health, and the continuity of health care.[2] A report from three prominent health care NGOs from June 2023 contained similar findings.[3] A report from the Dutch Council for Refugees (VWN) also confirmed regular absences of medical screening to identify vulnerable people, and highlighted the physical absence of health care services at some locations, forcing residents to travel long distances to other locations to access health care.[4]
In 2024, according to the follow-up report from Doctors of the World, Pharos and the Red Cross, some minor improvements have taken place as residents are registered and almost all residents have received a medical screening, allowing for the identification of their special reception needs.[5] However, the organisations call these improvements almost inconsequential, as the situation has otherwise remained the same. Residents continue to experience deterioration of their mental and physical health due to living conditions, such as unsuitable locations, poor sleep, a lack of privacy and activities, and problems with hygiene and nutrition. As more people are staying in these (crisis) emergency locations for longer periods compared to a year and a half ago, the problem has in fact worsened. Additionally, the many transfers of applicants impede the continuity of care. According to a follow-up report from VWN, residents on seven out of twenty researched (crisis) emergency locations experience difficulties accessing health care.[6] At fifteen out of twenty (crisis) emergency locations healthcare services provide on-site consultations, while at five locations residents are required to travel to a regular AZC nearby. While eleven locations offer psychological support, other locations lack these services, despite residents indicating a need for it.
Recent scientific publications have brought attention to the still-existing increased risk of perinatal mortality for asylum applicants, which is up to seven times as high compared to the national population.[7] According to the Inspection of Health Care and Youth, this risk is due to political and policy causes as well as the provided healthcare. In nearly half of the cases researched, pregnant asylum applicants only saw healthcare providers after twelve weeks of pregnancy, therefore missing crucial tests. Regularly, this was caused by capacity problems from COA which led to the absence of medical intakes upon arrival.[8] Additionally, health care providers often lose sight of pregnant applicants because of the numerous transfers; 70 percent of women in reception centres are transferred to a different location at least once, and nearly a third are transferred two or more times.
The relevant legal provision on health care for asylum applicants can be found in Article 9(1)(e) RVA. This provision is further elaborated in the Healthcare for Asylum Applicants Regulation (Regeling Medische Zorg Asielzoekers). According to the latter, asylum applicants have access to basic health care. This includes inter alia, hospitalisation, consultations with a general practitioner, physiotherapy, dental care (only in extreme cases) and consultations with a psychologist. If necessary, an asylum applicant can be referred to a mental hospital for day treatment. There are several institutions specialised in the treatment of asylum applicants with psychological problems, such as Pharos.
When an asylum applicant stays in a reception facility but the RVA is not applicable, health care is arranged differently. Asylum applicants in the POL, the COL, as well as rejected asylum applicants in the VBL and adults in the GL only have access to emergency health care.[9] In medical emergency situations, there is always a right to healthcare, according to Article 10 of the Aliens Act. For this group, problems can arise if there is a medical problem that does not constitute an emergency. Care providers who do help irregular migrants who are unable to pay their own medical treatment can declare those costs at a special government-mandated organisation, the Centraal Administratie Kantoor (CAK) which then pays up to 80 percent of the costs, or 100 percent in case of pregnancy-related care.[10]
Problems might also arise with respect to access to health care where the asylum applicant wants to use a health care provider whose costs are not covered by their insurance.
There is no publicly available information about gender-sensitive healthcare opportunities for victims of violence, except for the general availability of prenatal health care and psychological support.[11] There is a possibility to make use of a translator, usually by phone, during health care visits.[12] In 2022 the Inspection of the Ministry of Health Care and Youth noted a lack of use of translators by hospitals as an obstacle to information provision to the patient.[13] The main obstacles in access to health care for asylum applicants lie in the situation at (crisis) emergency locations, as described above.
Since 2014, the Centre for Transcultural Psychiatry Veldzicht (CTP Veldzicht), a TBS clinic, has also provided reception to COA-residents and undocumented asylum claimants who required acute psychiatric care.[14] At the start of 2025, COA and CTP Veldzicht renewed their collaboration agreement.[15] This is partially due to an increase in TBS sentences, for which CTP Veldzicht needs to create extra capacity. Additionally, it is seen as disproportionate to have applicants who require psychiatric care but pose no serious security threat reside at such a high-security location. Applicants whose care and security needs are aligned with the high-security environment of CTP Veldzicht will continue to be treated there for the time being, although alternative healthcare providers are being looked into. Applicants who require no or low-level security will no longer be treated at Veldzicht, but will be transferred to regular health care providers.
[1] Inspection Health Care and Youth, ‘Medische zorg in crisisnoodopvang asielzoekers onder enorme druk’, 3 August 2022, available in Dutch at: https://bit.ly/3Qp954k.
[2] Inspection Health Care and Youth, ‘Factsheet Urgente risico’s voor gezondheid asielzoekers in crisisnoodopvang, 9 March 2023, available in Dutch at: https://bit.ly/3vtviYy, 1.
[3] Dokters van de Wereld, Pharos, Rode Kruis, Zorgen in tijden van crisis, June 2023, available in Dutch at: https://bit.ly/422N5Cc.
[4] VluchtelingenWerk, Gevlucht en vergeten?, August 2023, available in Dutch at: https://bit.ly/4205TBR.
[5] Dokters van de Wereld, Pharos en Rode Kruis, Uitzichtloos in de opvang, 18 December 2024, available in Dutch at: https://bit.ly/3BZS9Pb.
[6] VWN, Gevlucht en Vergeten? No. 2, January 2024, available in Dutch at: https://bit.ly/4hfWkVP.
[7] J.B. Tankink, J.P. de Graaf, P.J.A. van der Lans, and A. Franx, ‘Aanbevelingen voor persoonsgerichte gezondheidszorg voor asielzoekers en statushouders in Nederland’, October 2024, Erasmus MC, available in Dutch at: https://bit.ly/4fYyZXB; Inspection Health Care and Youth, ‘Brief IGJ aan VSV-besturen over geboortezorg aan zwangeren in asielopvang’, 11 April 2024, available in Dutch at: https://bit.ly/42cz8DB.
[8] NOS, ‘Geboortezorg voor asielzoekers van ‘onacceptabel’ niveau, concluderen onderzoekers’, 27 November 2024, available in Dutch at: https://bit.ly/4hjjIBJ; J.B. Tankink, J.P. de Graaf, P.J.A. van der Lans, and A. Franx, ‘Aanbevelingen voor persoonsgerichte gezondheidszorg voor asielzoekers en statushouders in Nederland’, October 2024, Erasmus MC, available in Dutch at: https://bit.ly/4fYyZXB.
[9] Article 10(2) Aliens Act.
[10] CAK, ‘Regeling onverzekerbare vreemdelingen’, available in Dutch at: https://bit.ly/41XAOid.
[11] Regeling Medische zorg Asielzoekers, ‘Geboortezorg’, available in Dutch at: https://bit.ly/41UUhjy; Regeling Medische zorg Asielzoekers, ‘Geestelijke Gezondheidszorg’, available in Dutch at: https://bit.ly/47w3ccr.
[12] GZA healthcare, ‘Veelgestelde vragen’, available in Dutch at: https://bit.ly/3vF2MDb.
[13] Inspection Health Care and Youth, Bevlogen medewerkers houden zorg aan asielzoekers overeind onder zorgelijke omstandigheden, May 2022, available in Dutch at: https://bit.ly/41TXFLs.
[14] KST 24587, nr. 1007, available in Dutch at: https://bit.ly/4aggrkF.
[15] Ibid.