Health care

Poland

Country Report: Health care Last updated: 16/04/21

Author

Independent

Access to health care for asylum seekers is guaranteed in the 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]

Basic health care is organised in medical offices within each of the reception centres. The Office for Foreigners informed that in 2020 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 pediatrician were organised at least for 4 hours a week per 50 children, with extra 2 hours of duty for every additional 20 children. Pediatrician was present in the centres at least 2 days a week.[3]

Heath care for asylum seekers includes treatment for persons suffering from mental health problems. In 2020, 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.[4] Asylum seekers can also be directed to a psychiatrist or a psychiatric hospital. Reportedly, the Office for Foreigners tries to provide the assistance of only one psychologist to a specified asylum seeker, ‘so that the person has a sense of security and does not have to discuss his/her situation several times’.[5]

The psychological assistance in the reception centres is limited to basic consultations, however.[6] Moreover, due to pandemic COVID-19, it was not provided in person by psychologists, but by phone[7]. Some asylum seekers consider psychologists working in the centre as not neutral enough as they are employed (indirectly) by the Office for Foreigners.[8] Furthermore, according to some experts and many NGOs, specialised treatment for victims of torture or traumatised asylum seekers is not available in practice.[9] NGOs still point at the lack of proper treatment of persons with PTSD. The available psychological assistance is considered an intervention, not a regular therapy.[10] There is a shortage of psychologists prepared to work with vulnerable and traumatized asylum seekers.[11] Moreover, there are only three specialised NGOs that provide psychological consultations and treatment to asylum seekers.[12] In 2020, some form of psychological support was provided by NGOs, but it was affected by the pandemic (assistance by phone instead of in person).[13]

The medical assistance is provided since July 2015 by the private contractor Petra Medica,[14] 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. The quality of medical assistance provided under this agreement has triggered wide criticism. In particular, access to a specialised medical care worsened[15] and some asylum seekers are refused access to more costly treatments. It happens that only after NGOs’ interventions and months of fighting for the access to a proper medical treatment, asylum seekers were able to receive it. The access to a treatment is particularly difficult for asylum seekers with HIV and HCV. In 2019, the SIP described its battle to provide the continuation of the treatment for the asylum-seeking women that was HIV-positive and had a Hodgkin lymphoma. The women started the treatment in Germany and afterwards was sent back to Poland under the Dublin III Regulation. In Poland, she faced multiple refusals of the treatment and administrative obstacles to receiving medical assistance from proper doctors and medical facilities. She was not referred to infectious diseases, cardiological nor psychiatric clinics even though the medical documentation from Germany found it was necessary. She was repeatedly misinformed that she is not entitled to the HIV-treatment in Poland. Even though she was in bad health condition, the staff of the centre in Dębak refused calling for the ambulance explaining (falsely) that she was not entitled to it. Moreover, one of the Polish doctors said to her that Poland does not need sick people. Finally, the foreigner received proper treatment in Poland. Thanks to the German doctor who sent her additional medication, she was left without it ‘only’ for two weeks[16] In 2020, SIP described another battle for access to medical assistance for the asylum seeker diagnosed in 2016 with HCV. In March 2018, he contacted SIP due to recurring difficulties in accessing specialized treatment. He was first sent to improper medical facilities; next the Petra Medica denied financing the treatment. The Office for Foreigners was unable to enforce the Petra Medica to cover the expenses of the medical treatment that the asylum seeker needed. Finally, only in September 2019, the asylum seeker started the necessary treatment, but it required multiple interventions on the SIP’s part to enable it.[17]

One of the biggest obstacles in accessing health care that asylum seekers face is the lack of intercultural competence and knowledge of foreign languages amongst doctors and nurses.[18] Petra Medica that 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.[19] According to the governmental information, such interpretation is available in Russian, Ukrainian, English, Georgian, Persian, Arabic, Chechen, Uzbek. Doctors working in the centres are expected to know Russian.[20] However, since 2016 NGOs have been expressing concerns in regard to availability and quality of the interpretation provided to asylum seekers in connection with medical consultations.[21] In particular, it is 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, they cannot understand a doctor during the appointment, etc.)

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 emergency situations. The Office for Foreigners noticed that for those asylum seekers living outside the reception centres health care is provided in voivodeship cities in Poland and that coordination of visits is conducted by the helpline of the contractor, where the asylum seeker can learn about the time of the visit and ways to get the prescription.[22]

In 2019-2020, the Office for Foreigners registered 13 and 5 complaints respectively, all of them concerned medical assistance. In 2020, the Office for Foreigners claimed that the complaints resulted from the lack of understanding of the Polish health system and of the limitations stemming from the pandemic. Some complaints concerned specific doctors and nurses.[23]

Due to the COVID-19 pandemic, medical consultations by phone were introduced. Information about that and necessary telephone numbers has been provided in English and Russian online (website of the Office for Foreigners and Petra Medica) and in the reception centres. According to the Office for Foreigners, in every reception centre, isolation rooms with bathrooms were separated. The state of health of ill asylum seekers was monitored daily by medical staff of the centre, they had also direct telephone number to doctors and nurses in case of feeling worse. Food was served to them in isolation rooms. The measures to limit the spread of the COVID-19 in the reception centres were taken up as well: asylum seekers were advised to stay in their rooms and leave them only to use a bathroom and kitchen, disinfectants and masks were provided, common rooms were regularly disinfected, ill asylum seekers were separated, the temperature of every person accessing the centre was checked, the access to the reception centres for persons not living there was significantly limited. Moreover, asylum seekers were encouraged to live privately instead of in the reception centres.[24]

The SIP informs that due to the limitations resulting from the pandemic (only 5 persons allowed in the Office for Foreigners building where the medical point is situated), everyday a long queue formed in front of the Office, along the fence surrounding the building. Some asylum seekers needing medical assistance were allowed to come in, but others (less grave cases) were given medical assistance outside, over the fence, with other foreigners being able to hear about their health problems.

Overall, 87 asylum seekers were reported positive to COVID-19 in 2020. According to the Office for Foreigners, all asylum seekers who were ill or had symptoms of COVID-19 had access to medical assistance. Only a minority of them was hospitalised. One person died, although it is not clear whether COVID-19 was the reason of death.[25]

One reception centre (in Warsaw – for single women and mothers with children, 111 inhabitants at the time) was quarantined. 70 asylum seekers living there were tested positive for COVID-19. First infections were confirmed on 22 May 2020, the quarantine of the centre lasted from 7 June to 2 July.[26] The Office for Foreigners notes that for the duration of the quarantine asylum seekers had access to medical and psychological assistance, food was delivered, contact with staff working in the centre was provided. Healthy asylum seekers from the Warsaw reception centre could move to another centre in Dębak.[27] According to some media, asylum seekers staying in the quarantined centre were terrified and felt left alone. NGOs stepped in to satisfy some of their needs (providing laptops, food and cosmetics, online classes for children, psychological support by phone or online).[28] The Office for Foreigners informed that one protest occurred in that centre as asylum seekers opposed the limitations that resulted from the COVID-19 quarantine. According to the Office for Foreigners, thanks to immediate reaction of the Office, medical operator and NGOs, the situation was quickly under control.[29]

As regards access of asylum seekers to COVID-19 vaccines, the situation is still unclear. The Commissioner for Human Rights asked the government for guidance on this matter, but there has been no response yet.[30]

 

 

[1] Article 73(1) Law on Protection.

[2] Articles 76(1) and 70(1) Law on Protection.

[3] Information provided by the Office for Foreigners, 26 January 2021.

[4] Information provided by the Office for Foreigners, 22 January 2020.

[5]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, 80. 

[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]  Information provided by the Office for Foreigners, 26 January 2021.

[8] M. Pachocka, K. Pędziwiatr, K. Sobczak-Szelc, J. Szałańska (2020) ‘Reception Policies, Practices and Responses: Poland Country Report’, RESPOND Working Papers 2020/45, available at: http://bit.ly/3jLCvsV, 71.

[9] 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.

[10] Information provided by the Association for Legal Intervention, October 2016.

[11] 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.

[12]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.

[13]  Information provided by the Office for Foreigners, 26 January 2021.

[14]Information from the Office for Foreigners website: http://bit.ly/1XqYMIQ; Office for Foreigners, Guidebook Department of Social Assistance (2019), available at: https://bit.ly/39ljreM, 6.

[15]  M. Pachocka, K. Pędziwiatr, K. Sobczak-Szelc, J. Szałańska (2020) ‘Reception Policies, Practices and Responses: Poland Country Report’, RESPOND Working Papers 2020/45, available at: http://bit.ly/3jLCvsV, 70.

[16] O. Hilik, ‘Leczenie osób zarażonym wirusem HIV w postępowaniu w przedmiocie udzielenia ochrony międzynarodowej’ in Stowarzyszenie Interwencji Prawnej (SIP), SIP w działaniu. Prawa cudzoziemców w Polsce w 2018 r. (2019), available (in Polish) at: https://bit.ly/2viZkz5, 46-48.

[17] A. Chrzanowska, ‘Dostęp do leczenia wirusowego zapalenia wątroby (WZW)’ in SIP, Prawa cudzoziemców w Polsce w 2019 roku. Raport, 2020, available (in Polish) at: https://bit.ly/3jT7weM, 60-62.

[18] 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 (Instutut Spraw Publicznych 2019), 43.

[19] Information provided by the Office for Foreigners, 1 February 2017.

[20] Ministerstwo Pracy, Rodziny i Polityki Społecznej, Informacja o sytuacji osób starszych w Polsce za 2018 r. (2019), 146.

[21]  Centrum Pomocy Prawnej im. H. Nieć, Situation of Dublin Returnees in Poland. HNLAC Information Note – July 2016, available at: http://bit.ly/2lkV08v, 8; HFHR, Letter to the Head of the Office for Foreigners, 1765/2016/BD, 13 September 2016. Information confirmed by SIP, 8 January 2020.

[22] Information provided by the Office for Foreigners, 1 February 2017.

[23] Information provided by the Office for Foreigners, 22 January 2020 and 26 January 2021.

[24]  Information provided by the Office for Foreigners, 26 January 2021.

[25] Information provided by the Office for Foreigners, 26 January and 4 March 2021.

[26] Information provided by the Office for Foreigners, 4 March 2021.

[27]See information from the Office for Foreigners available (in Polish) at: http://bit.ly/3tVoP3m and http://bit.ly/37doFun.

[28] A. Sowa, ‘Wirus w ośrodku dla uchodźców. Zdrowi i chorzy są tu razem”, Polityka, 5 June 2020, available in Polish at: http://bit.ly/3rOFL9H. However, some NGOs claimed that the situation was not as dramatic as media tried to present it, see A. Ambroziak, ‘Organizacje walczące o prawa uchodźców krytykują OKO.press. Odpowiadamy, przepraszamy’, 10 June 2020, available in Polish at: http://bit.ly/3tUz2Nw.

[29] Information provided by the Office for Foreigners, 26 January 2021.

[30] The Commissioner for Human Rights, Letter from 23 January 2021, available at: https://bit.ly/2OHd68J.

Table of contents

  • Statistics
  • Overview of the legal framework
  • Overview of the main changes since the previous report update
  • Asylum Procedure
  • Reception Conditions
  • Detention of Asylum Seekers
  • Content of International Protection
  • ANNEX I – Transposition of the CEAS in national legislation