Access to health care for asylum seekers is guaranteed in law under the same conditions as for Polish nationals who have health insurance.[1] Health care for asylum seekers is publicly funded. If an asylum seeker is deprived of material reception conditions or they are limited, they are still entitled to health care.[2] See section on Reduction or withdrawal of material reception conditions.
Basic health care is organised in medical offices within each of the reception centres. The Office for Foreigners informed that in 2023, until the end of July, the GP in the centres had 6 duty hours per 120 asylum seekers, while the nurse had 20 hours for the same number of possible patients. Both had 3 hours a week extra for every additional 50 asylum seekers. They were present in the centres at least three times a week. Additionally, in every centre, the duty hours of a paediatrician were organised for at least 4 hours a week per 50 children, with extra 2 hours of duty for every additional 20 children. A paediatrician was present in the centres at least 2 days a week. On 1 August 2023, the rules on medical personnel’s working hours changed. The GP in the centres have now 3 duty hours per 40 asylum seekers, while the nurse or a paramedic have 7 hours for the same number of possible patients. Both have 3 hours a week extra for every additional 40 asylum seekers. The GPs work at least two days a week and nurses/paramedics five days a week. Additionally, since August, the working hours of the medical point in Warsaw were extended by 2 hours per day. [3]
Health care for asylum seekers includes treatment for persons suffering from mental health problems. In 2023, until the end of July, psychologists worked in all centres for at least 4 hours a week for every 120 asylum seekers. This was extended to 1 hour for every additional 50 asylum seekers. On 1 August 2023, the rules concerning working hours of psychologists changed. They have now 5 duty hours per 120 asylum seekers and 1 hour a week extra for every additional 50 asylum seekers.[4] Asylum seekers can also be directed to a psychiatrist or a psychiatric hospital. In 2023, according to the Office for Foreigners, psychological support was provided by five NGOs.[5]
However, the psychological assistance in the reception centres is limited to basic consultations.[6] Some asylum seekers consider psychologists working in the centre as not neutral enough as they are employed (indirectly) by the Office for Foreigners.[7] Furthermore, according to some experts and many NGOs, specialised treatment for victims of torture or traumatised asylum seekers is not available in practice.[8] NGOs still point to the lack of proper treatment of persons with PTSD. The available psychological assistance is considered an intervention, not a regular therapy. There is a shortage of psychologists prepared to work with vulnerable and traumatized asylum seekers.[9] Moreover, there are not enough specialised NGOs that provide psychological consultations and treatment to asylum seekers.[10]
According to the Office for Foreigners, victims of trafficking, gender-based violence and victims of torture or other forms of psychological and physical violence have access to needed assistance during the asylum proceedings. According to the agreement with Petra Medica (see below), it “is obligatory to make every effort to ensure that gynaecological consultations are provided by doctors of the gender preferred by the asylum seeker”.[11]
Medical assistance is provided by the private contractor Petra Medica, with whom the Office for Foreigners has signed an agreement to coordinate medical care for asylum seekers. The Office for Foreigners monitors the application of this agreement. A new agreement has been signed on 31 July 2023, despite the long-standing criticism of the services provided by said contractor.[12]
In particular, the quality of medical assistance provided under this agreement has triggered wide criticism.[13] In particular, access to specialised medical care worsened[14] and some asylum seekers are refused access to more costly treatments. Sometimes, only after NGOs’ interventions and months of fighting for access to proper medical treatment, asylum seekers were able to receive it. Several cases of refusals of medical treatment, drawing from the SIP’s yearly reports, have been described in the previous AIDA reports.[15] The above-mentioned issues were also reported in 2023.
One of the biggest obstacles in accessing health care that asylum seekers face is the lack of intercultural competence and knowledge of foreign languages among doctors and nurses.[16] Petra Medica which is responsible for the provision of medical assistance to asylum seekers is also obliged to ensure interpretation during the medical and psychological consultations, if it is needed. According to the Office for Foreigners, the interpretation services in English, Russian, Ukrainian, Georgian, Persian, Arab, Chechen and Uzbek are available and no complaints have been registered in this regard.[17] However, NGOs have been expressing concerns regarding the availability and quality of the interpretation provided to asylum seekers in connection with medical consultations. In particular, it has been reported that asylum seekers who are not speaking Polish, English or Russian face great difficulties with being provided with medical assistance (they cannot make the needed appointments as the helpline is available only in English and Russian, and they cannot understand a doctor during the appointment, etc.).[18]
Another challenge is the fact that some clinics and hospitals providing medical assistance to asylum seekers are located far away from the reception centres, so an asylum seeker cannot be assisted by the closest medical facility, except for emergencies. The Office for Foreigners noticed that for those asylum seekers living outside the reception centres health care is provided in voivodeship cities and that coordination of visits is conducted by the Petra Medica helpline, where the asylum seeker can learn about the time of the visit and ways to get the prescription.
In 2023, 8 complaints about medical assistance were registered, all were considered unjustified.[19] They concerned inter alia:
- Long waiting times for the specialist consultation;
- Refusals of being admitted by the doctor (outside of the working hours);
- Doctors and nurses providing medical assistance.
SIP informs that it regularly receives complaints about the Petra Medica’s functioning and in practice, many asylum seekers give up their right to medical assistance during asylum proceedings due to the problems they had with accessing health care designed for them.[20]
Polish-Belarusian border
The humanitarian crisis at the Polish-Belarusian border that started in August 2021 and continued in 2023 left many prospective asylum seekers without access to material reception conditions, including medical assistance (see Access to the territory and pushbacks). For persons stranded at the border, suffering pushbacks to Belarus and violence from both Polish and Belarusian forces, medical assistance was mostly provided by NGOs, activists and independent doctors.[21] The organisation Medecins Sans Frontieres (MSF), once more present at the Polish-Belarusian border since November 2022, during the one-year operation assisted 220 persons (until November 2023), with 10% needing a hospital treatment to save their lives. The organisation trained also some NGOs in providing first aid.[22] In 2023, NGOs, doctors and rescue teams still could not reach third-country nationals staying in the closed near-border area (15m from the border) and behind the fence built at the border.[23] MSF mentioned a case of a group of 30 people prevented from entering Poland by the wall in May 2023: 4 needed urgent medical assistance. However, the paramedics were not allowed to access the area.[24]
People crossing the Polish-Belarusian border often required medical assistance, in particular in winter. They were starved, dehydrated, freezing (some with hypothermia), suffering from food poisoning, beaten up by – according to their accounts – Polish or Belarusian officers, and with other injuries, inter alia foot and leg injuries resulting walking barefoot or climbing through a wired fence.[25] They are often pushed back to Belarus despite their poor medical condition. For example, in its report concerning October 2023, Grupa Granica mentioned a case of two women who were diagnosed with the first-degree hypothermia, who were pushed back to Belarus.[26] Meanwhile, in May, Grupa Granica informed about a 31-year-old man who was pushed back despite having an injured leg. When he was apprehended by the Polish Border Guard, he received some medical assistance (the RTG was done, his leg was put into a medical splint), but then he was forced to go back to Belarus. Unable to move, he lay alone under the fence for a couple of days. Eventually, when the case become a topic of discussion in national media, the injured third-country national was admitted to Poland and taken to the hospital where he was operated.[27] The pushbacks of the third-country national were deemed unlawful by the court in March 2024.[28]
The fence built at the Polish-Belarusian border did not stop third-country nationals from crossing this border but contributed greatly to their increased suffering.[29] As reported by Grupa Granica, many persons suffered injuries while climbing and coming off the fence, including fractures of the bones. Crossing the border through swamps, wetlands and rivers (paths that are now used more due to the construction of the fence) increased the risk of drownings, injuries, hypothermia and – in consequence – death.[30] In February 2024, MSF claimed that:
Between January and September 2023, almost 40% of the 187 patients treated by MSF had injuries that they had sustained while attempting to climb the wall or falling off it. Physical trauma included blunt injuries, sprains, deep cuts and suspected fractures. During this period, MSF responded to 14 cases of confirmed or suspected fractures, and almost half (46%) of the referrals to hospital were related to wounds and orthopaedic injuries, requiring urgent inpatient care and/or orthopaedic intervention.[31]
MSF also mentions mental health problems of third-country national they treated at the Polish-Belarusian border: “People stuck in the forest are often also in acute psychological distress by the time they are seen by the medical team. Between January and September 2023, MSF responded to 12 patients with psychological trauma, three of whom were referred to hospital due to their critical condition”.[32]
In practice, seeking assistance of the ambulance and referrals to hospitals are treated as a measure of last resort, since the Border Guard has been known to take third-country nationals from hospitals and push them back to Belarus.[33] In April 2023, following his visit at the Polish-Belarusian border, the UN Special Rapporteur on Human Rights of Migrants remarked: “On both sides of the border, fear of being subjected to further acts of violence or other repercussions, such as pushbacks or detention, has prevented affected migrants from seeking medical and non-medical assistance to address their needs”.[34]
Actions of the Polish forces (the Border Guard, but also military) increase even further the risks for health and life of third-country nationals. In the PRAB report, “a case of a Syrian asylum seeker with symptoms of hypoglycaemia who was beaten and suffered fractures after he fainted for his insulin dependency” was mentioned.[35] Despite his medical condition, he was pushed back to Belarus. As reported by Grupa Granica, in November 2023 “a Syrian citizen was shot in the back at the border. Fortunately, the bullet missed the spine and the vital organs. According to his account, he crossed the border with his group through a hole in the fence. They walked a few kilometres into Polish territory where they heard the polish services. They broke off to flee, the man was shot in the back. (…) The man underwent more than six hours of surgery at the University Clinical Hospital in Bialystok.”[36] Moreover, in October 2023, Grupa Granica reported that the pepper spray throwers were used for the first time at the border towards a group of approx. 100 third-country nationals. This action put them at further health risk, as they could only remain in clothes that were soaked in toxic spray or undress, thus risking hypothermia.[37]
Between August 2021 and February 2024, at least 55 persons died at the border.[38] For example, HFHR reported in November 2023 that 60 persons were found dead on both sides of the border since the beginning of the crisis in August 2021. [39] In January 2023, the body of a Yemeni doctor was found in the woods near the Polish-Belarusian border. The third-country nationals that were accompanying the ill Yemeni national informed the Border Guard about his location and critical condition. Their requests to send medical assistance were ignored and they were instead pushed back to Belarus. The Yemeni national was found only when another patrol was informed about his serious condition, but he was already dead by then.[40] In 2023, the death of an Ethiopian woman raised particular concerns as reportedly the Polish Police and Border Guard were informed by other third-country nationals about her bad medical condition, but – instead of transporting her to the hospital – they pushed her back to Belarus. The Human Rights Commissioner is investigating this case; however, the Border Guard and Police seem to be unwilling to cooperate.[41]
The death toll at the Polish-Belarusian border and the risks accompanying crossing this border were also noticed by the UN Special Rapporteur on Human Rights of Migrants:
- Pushback practices at the border have cost migrants’ lives. Continued reports of migrants stranded at the Polish-Belarusian border, especially new arrivals, confirm that harsh border governance measures and the construction of the physical fence have not deterred irregular border crossing attempts but have heightened the risks to migrants and increased their suffering. Serious concerns remain over the physical and mental integrity of all migrants stranded at the Polish-Belarusian border, particularly in view of incoming arrivals and the increasingly harsh circumstances after the installation of the fence, including during winter weather. These conditions may also amount to cruel, inhuman or degrading treatment and may result in violations of the rights to life and security of person.[42]
In an increasing number of judgments issued in 2022 and 2023 courts condemned pushbacks at the Polish-Belarusian border, also in cases concerning pushbacks from Polish hospitals. In judgment no. IV SA/Wa 615/22, the Voivodship Administrative Court in Warsaw considered a case of a Syrian national who was pushed back to Belarus in November 2021 after a short stay in a Polish hospital and in spite of his pleadings for asylum. In Belarus, he was subject to violence from the Belarusian authorities forcing him to go back to Poland. A decision ordering his immediate removal was issued and challenged by the HFHR’s lawyer. The court annulled the decision, explaining that the Border Guard did not rigorously assess the factual situation of the third-country national, in particular, the circumstances of his arrival to Poland and his situation upon return. The court highlighted that the principle of non-refoulement still applies at the Polish-Belarusian border.[43] In May 2023, the Voivodship Administrative Court in Białystok issued a judgement concerning a pushback of a third-country national, who was seeking help for an Ethiopian woman in a worsening medical condition. He was apprehended by the Border Guard and pushed back to Belarus. The Border Guard did not search for the ill woman. Her body was found couple days later by the activists. The court considered the pushback to be illegal.[44] Similarly, in the case decided in March 2024, the Voivodship Administrative Court in Białystok (case no. II SA/Bk 71/24) condemned pushbacks of an Ethiopian national who was firstly forced to go back to Belarus upon his release from the Polish hospital with a leg in a medical splint and a referral for a surgery. When he returned to Poland, he again was hospitalized and a cast was put on his leg. However, once more, he was pushed back to Belarus, despite his pleadings for asylum and inability to walk.[45] A case concerning a pushback from a hospital was also communicated to the Polish government by the ECtHR in June 2022.[46]
[1] Article 73(1) Law on Protection. In February 2024, a new law was proposed that, inter alia, facilitates access to medical assistance for new-borns whose parent(s) seek asylum in Poland.
[2] Articles 76(1) and 70(1) Law on Protection.
[3] Information provided by the Office for Foreigners, 16 February 2024.
[4] Information provided by the Office for Foreigners, 16 February 2024.
[5] Information provided by the Office for Foreigners, 16 February 2024.
[6] See Pachocka, M. and Sobczak-Szelc K., ‘Refugee Protection Poland – Country Report’, Multilevel Governance of Mass Migration in Europe and Beyond Project (Horizon2020), January 2020, available at: https://bit.ly/2U1A9uL, 70. The Office for Foreigners claims that those psychologists’ assistance concentrates on psychological support and counselling and also on diagnosis of mental disorders, including PTSD.
[7] M. Pachocka, K. Pędziwiatr, K. Sobczak-Szelc, J. Szałańska, ‘Reception Policies, Practices and Responses: Poland Country Report’, 2020, RESPOND Working Papers 2020/45, available at: http://bit.ly/3jLCvsV, 71.
[8] See e.g. M. Szczepanik, ‘Right to healthcare and access to medical services for asylum seekers and beneficiaries of international protection in Poland’, May 2017, available at: http://bit.ly/2CxXokd. See also Małgorzata Jaźwińska and Magdalena Sadowska, ‘Osoby, które doświadczyły przemocy’, in SIP, Prawa cudzoziemców w Polsce w 2019 roku. Raport, 2020, available in Polish at: https://bit.ly/3jT7weM, 13-14, pointing out that persons who were subject to violence are not properly identified.
[9] Pachocka, M. and Sobczak-Szelc K., ‘Refugee Protection Poland – Country Report’, Multilevel Governance of Mass Migration in Europe and Beyond Project (Horizon2020), January 2020, available at: https://bit.ly/2U1A9uL, 71.
[10] M. Szczepanik, ‘Right to healthcare and access to medical services for asylum seekers and beneficiaries of international protection in Poland’, May 2017, available at: http://bit.ly/2CxXokd.
[11] Information provided by the Office for Foreigners, 16 February 2024.
[12] Information provided by the Office for Foreigners, 16 February 2024.
[13] See e.g. HFHR, Input to the EUAA’s Asylum Report, February 2023, available in English here: https://bit.ly/3VgXwOZ, 9.
[14] M. Pachocka, K. Pędziwiatr, K. Sobczak-Szelc, J. Szałańska, ‘Reception Policies, Practices and Responses: Poland Country Report’, 2020, RESPOND Working Papers 2020/45, available at: http://bit.ly/3jLCvsV, 70.
[15] See AIDA, Country Report Poland – 2021 Update, May 2022, available at: https://bit.ly/3ZydJ2R.
[16] M. Koss-Goryszewska, ‘Służba zdrowia’ in A. Górska, M. Koss-Goryszewska, J. Kucharczyk (eds), W stronę krajowego machanizmu ewaluacji integracji: Diagnoza sytuacji beneficjentów ochrony międzynarodowej w Polsce, Instytut Spraw Publicznych 2019, 43.
[17] Information provided by the Office for Foreigners, 16 February 2024.
[18] A. Chrzanowska, ‘Dostęp do leczenia osób ubiegających się o ochronę międzynarodową’ in SIP, Prawa cudzoziemców w Polsce w 2020 roku. Raport, 2021, available in Polish at: https://bit.ly/3sGmlXS, 74-75. See also HFHR, Input to the EUAA’s Asylum Report, February 2023, available in English here: https://bit.ly/44EE82F, 9.
[19] Information provided by the Office for Foreigners, 16 February 2024.
[20] A. Chrzanowska, ‘Dostęp do leczenia osób ubiegających się o ochronę międzynarodową’ in SIP, Prawa cudzoziemców w Polsce w 2020 roku. Raport, 2021, available in Polish at: https://bit.ly/3sGmlXS, 74.
[21] See e.g. PRAB, ‘Pushbacks at Europe’s borders: a continuously ignored crisis’, 31 January 2024, available in English at: https://bit.ly/4akALAz, 12.
[22] Medicins Sans Frontieres, ‘Polska: Lekarze bez Granic prowadzą działania na granicy polsko-białoruskiej’, 2023, available in Polish at: https://bit.ly/4aGsBC6.
[23] ECRE, ‘Seeking Refuge in Poland: A Fact-Finding Report on Access to Asylum and Reception Conditions for Asylum Seekers’, April 2023, available at: https://bit.ly/41hGgdJ, 14; PRAB, ‘What we do in the shadows’, May 2023, available in English at: https://bit.ly/4cInDXp, 9.
[24] Medicins Sans Frontieres, ‘Death, Despair and Destitution: The Human Costs of EU’s Migration Policies’, February 2024, available in English at: https://bit.ly/4cDYlK3, 29.
[25] See e.g. Medicins Sans Frontieres, ‘Polska: Lekarze bez Granic prowadzą działania na granicy polsko-białoruskiej’, 2023, available in Polish at: https://bit.ly/4aGsBC6.
[26] Grupa Granica, ‘October 2023. Report from the Polish-Belarusian border’, November 2023, available in English at: https://bit.ly/4cHrMe3, 8.
[27] B. Rumieńczyk, ‘Uchodźca z granicy polsko-białoruskiej nareszcie w szpitalu. Ale co z innymi wyrzuconymi za mur?’, 8 May 2023, Oko.press, available in Polish at: https://bit.ly/4cJ93z6.
[28] HFHR, ‘Mężczyzna ze złamaną nogą wywieziony na granicę w bagażniku – kolejny wyrok stwierdzający bezskuteczność pushbacków’, 11 March 2024, available in Polish at: https://bit.ly/4dFRdgS.
[29] SIP, EUAA Asylum Report CSO Input, 6 February 2023, available here: http://bit.ly/3ZAnGga; Medicins Sans Frontieres, ‘Death, Despair and Destitution: The Human Costs of EU’s Migration Policies’, February 2024, available in English at: https://bit.ly/4cDYlK3, 29.
[30] PRAB, ‘Beaten, punished and pushed back’, January 2023, available in English at: https://bit.ly/3kYwJc9, 14.
[31] Medicins Sans Frontieres, ‘Death, Despair and Destitution: The Human Costs of EU’s Migration Policies’, February 2024, available in English at: https://bit.ly/4cDYlK3, 29.
[32] Ibid., 43.
[33] Grupa Granica, ‘October 2023. Report from the Polish-Belarusian border’, November 2023, available in English at: https://bit.ly/4cHrMe3, 11; PRAB, ‘Pushbacks at Europe’s borders: a continuously ignored crisis’, 31 January 2024, available in English at: https://bit.ly/4akALAz, 12; Medicins Sans Frontieres, ‘Death, Despair and Destitution: The Human Costs of EU’s Migration Policies’, February 2024, available in English here: https://bit.ly/4cDYlK3, 44.
[34] ‘Visit to Poland – Report of the Special Rapporteur on the human rights of migrants, Felipe González Morales’, 21 April 2023, available here: https://bit.ly/3QayrUP.
[35] PRAB, ‘What we do in the shadows’, May 2023, available in English here: https://bit.ly/4cInDXp, 7.
[36] Grupa Granica, ‘November 2023. Report from the Polish-Belarusian border’, December 2023, available in English at: https://bit.ly/4cFlkEC, 4.
[37] Grupa Granica, ‘October 2023. Report from the Polish-Belarusian border’, November 2023, available in English at: https://bit.ly/4cHrMe3, 3.
[38] The number provided by: Fundacja Ocalenie, ‘Apel do Premiera’, 9 January 2024, available in Polish at: https://bit.ly/3xtfNAG, 2; Amnesty International, ‘Opinia przyjaciela sądu dotycząca wyroku w sprawie udzielania pomocy na granicy polsko-białoruskiej’, 15 December 2023, available in Polish at: https://bit.ly/3xwfpRW; Medicins Sans Frontieres, ‘Death, Despair and Destitution: The Human Costs of EU’s Migration Policies’, February 2024, available in English here: https://bit.ly/4cDYlK3, 44.
[39] Information provided by HFHR, see: https://bit.ly/3JObHGl.
[40] Stowarzyszenie EGALA, ‘Kolejna śmierć’, 14 January 2023, available in Polish here: http://bit.ly/3Kk0MnV.
[41] Human Rights Commissioner, ‘Śmierć młodej kobiety z Etiopii w lesie na granicy. RPO prosi o wyjaśnienia Policję i Straż Graniczną’, 14 February 2023, available at: https://bit.ly/3TZI9LV and ‘Śmierć obywatelki Etiopii przy granicy. RPO pyta policję, co zrobiła w celu jej odnalezienia i pomocy. Kolejne pismo’, 30 April 2023, available at: https://bit.ly/3TGWSKs.
[42] ‘Visit to Poland – Report of the Special Rapporteur on the human rights of migrants, Felipe González Morales’, 21 April 2023, available at: https://bit.ly/3QayrUP.
[43] HFHR, ‘Wojewódzki Sąd Administracyjny w Warszawie uchylił decyzję Straży Granicznej o zawróceniu obywatela Syrii do granicy z Białorusią’, 10 June 2022, available in Polish here: http://bit.ly/3TVLkm9.
[44] Voivodship Administrative Court in Białystok (Wojewódzki Sąd Administracyjny w Białymstoku), judgment of 30 May 2023, no. II SA/Bk 244/23, described here: PRAB, ‘Surprisingly surprised’, September 2023, available in English at: https://bit.ly/4aGt2MK, 16; and here: HFHR, ‘Prosił o pomoc dla umierającej towarzyszki podróży, został wywieziony do Białorusi. Sąd uznał, że wywózka obywatela Etiopii była niezgodna z prawem’, 3 July 2023, available in Polish at: https://bit.ly/3xloGwl.
[45] HFHR, ‘Mężczyzna ze złamaną nogą wywieziony na granicę w bagażniku – kolejny wyrok stwierdzający bezskuteczność pushbacków’, 11 March 2024, available in Polish at: https://bit.ly/4dFRdgS.
[46] Applications nos. 52405/21 and 53402/21 K.A. and M.A. and Others against Poland.