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]
Basic health care is organised in medical offices within each of the reception centres. The Office for Foreigners informed that in 2021 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 at least for 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.[3]
Health care for asylum seekers includes treatment for persons suffering from mental health problems. In 2021, 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.[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. There is a shortage of psychologists prepared to work with vulnerable and traumatized asylum seekers.[10] Moreover, there are only three specialised NGOs that provide psychological consultations and treatment to asylum seekers.[11] In 2021, some form of psychological support was provided by NGOs, but it was affected by the pandemic (assistance by phone instead of in person).[12]
The medical assistance is provided since July 2015 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. The quality of medical assistance provided under this agreement has triggered wide criticism. In particular, access to a specialised medical care worsened[13] 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.
In 2019, 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.[14] 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.[15] In 2021, new instances of refusals of medical treatment were reported. An asylum-seeking woman with acute respiratory infection was repeatedly not admitted to several hospitals due to the uncertainty who would cover the costs of her treatment. Finally, she was admitted to a hospital after paying for the treatment herself. SIP intervened and those costs were reimbursed. Another asylum seeker was informed that he cannot continue his cancer treatment as the Petra Medica denied paying for it. Again, only after the SIP’s intervention, the treatment was continued.[16]
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.[17] 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. However, NGOs have been expressing concerns in regard to availability and quality of the interpretation provided to asylum seekers in connection with medical consultations. 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.).[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 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 Petra Medica helpline, where the asylum seeker can learn about the time of the visit and ways to get the prescription.[19]
In 2019-2020, the Office for Foreigners registered 13 and 5 complaints respectively, all of which concerned medical assistance. In 2021, 25 complaints about medical assistance were registered (10 from one asylum seeker).[20] They concerned inter alia:
- Long waiting times for the specialist consultation,
- Restrictions resulting from the pandemic, including the ‘max 5 persons in a waiting room’ requirement and the necessity to wait for a doctor’s appointment outdoors,
- The behaviour and professional conduct of doctors and nurses providing medical assistance.
Moreover, the medical facility situated in the Office for Foreigners in Warsaw was strongly criticized. SIP informed that due to the limitations resulting from the pandemic (only 5 persons allowed inside), 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 serious cases) were given medical assistance outside, over the fence, with other foreigners being able to hear about their health problems.[21] The Office for Foreigners explained that this medical facility was particularly burdened due to increased numbers of asylum seekers living in Warsaw in 2021 and the prolongation of social assistance ordered because of the pandemic. In response to the complaints, an additional medical facility was opened for asylum-seeking children in Warsaw.[22]
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.[23]
COVID-19
Due to the COVID-19 pandemic, medical consultations by phone were introduced in 2020 and continued in 2021. 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: disinfectants and masks were provided, ill asylum seekers were separated, the temperature of every person accessing the centre was checked, the access to the reception centres was significantly limited as well as some educational and integration activities were temporarily suspended. Moreover, asylum seekers were encouraged to live privately instead of in the reception centres.[24]
Testing for COVID-19 was possible in the reception centres and outside. Tests prescribed by doctors were free of charge and asylum seekers were entitled to the same access to tests as nationals or legally residing third country nationals. Asylum seekers also could ask for a reimbursement of travel costs that they had to cover in order to be tested.[25]
Overall, 87 asylum seekers were reported positive to COVID-19 in 2020 and 25 in 2021. Only a minority of them was hospitalized (3 persons in 2021).[26] In 2020, one reception centre (in Warsaw – for single women and mothers with children, 111 residents at the time) was quarantined. 70 asylum seekers living there were tested positive for COVID-19.[27] Asylum seekers opposed the limitations that resulted from the COVID-19 quarantine in that centre. According to the Office for Foreigners, thanks to immediate reaction of the Office, medical operator and NGOs, the situation was quickly under control.[28]
Asylum seekers had the same access to COVID-19 vaccinations as Polish citizens. Vaccinations were administered as a rule in prescribed medical facilities and occasionally in the reception centres (two times in Bezwola, once in Linin). They were free of charge and asylum seekers also could ask for a reimbursement of travel costs that they had to cover in order to be vaccinated. 511 asylum seekers were vaccinated in 2021.[29]
In 2021, special educational campaigns for asylum seekers were organized quarterly by the Office for foreigners on the COVID-19 prevention and vaccinations. Information about vaccinations was also provided on the boards in the reception centres and by the doctors working there. Asylum seekers living outside the centres received a letter explaining how they could get vaccinated in Poland.[30]
While in principle asylum seekers should have the same access to vaccinations as Polish nationals, obstacles in this regard were reported: referrals for the vaccinations were sometimes refused by doctors, asylum seekers felt disinformed and the assistance with regard to vaccinations in foreign languages was lacking.[31]
Polish-Belarusian border
The humanitarian crisis at the Polish-Belarusian border in 2021 left many prospective asylum seekers without access to material reception conditions, including medical assistance (see Access to the territory and push backs). In those circumstances, medical assistance was mostly provided by NGOs, activists and groups of doctors. However, its scope and effectiveness were greatly limited after the introduction of the emergency state. Medical staff repeatedly applied to the Government to be allowed to enter the restricted area at the Polish-Belarusian border. The access was not allowed.[32] Therefore, medical assistance was available only in the woods surrounding the restricted area. In January 2022, Médecins Sans Frontières (MSF) announced that, three months after sending an emergency response team to assist migrants and refugees at the Polish-Belarusian border, it must withdraw MSF teams ‘after being repeatedly blocked by Polish authorities from accessing the forested border region, where groups of people are surviving in sub-zero temperatures, in desperate need of medical and humanitarian assistance’.[33]
Foreigners 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.[34]
Medical assistance for those foreigners was provided by doctors, nurses and paramedics from all over Poland, many volunteering their free time to help at the border.[35] Since 7 October, the temporary group ‘Medycy na granicy’ (Medics at the Border) assisted foreigners (141 adults and 78 children) in the woods near the Polish-Belarusian border. They acquired funding through public collection.[36] In November 2021, they ceased their activities and the role was assumed by the Polskie Centrum Pomocy Międzynarodowej (PCPM). Polska Misja Medyczna also decided to support hospitals near the border that were overburdened since the humanitarian crisis started (due to the crisis but also the pandemic).[37] In the face of the lack of systemic support, hospitals were supported also by other NGOs, activists and local communities.
Asylum seekers were given medical assistance, where possible, in the woods near the border. With regard to those needing hospital treatment, NGOs informed that they struggled with ensuring transport to hospitals, as ambulances were not willing to take such foreigners; the requests to send ambulances were denied or conditioned on the Border Guard’s presence. Moreover, after receiving a treatment in the hospitals, some foreigners were deported back to the Belarusian woods by the Polish Border Guard. Some doctors decided to prolong the foreigners’ stay in the hospital only to avoid their push-back (that would worsen their medical condition again).[38] Some foreigners did not agree to call an ambulance – even though it was needed – knowing that afterwards they may be send back to Belarus.[39]
Doctors, nurses and paramedics working at the border experienced hostility, threats and violence.[40] For instance, four cars of the ‘Medycy na granicy’ group were damaged in November 2021. Earlier that month, the tires of their cars got deflated.[41]
In 2021, in numerous interim measures, the European Court of Human Rights indicated that Poland must provide the applicants with food, water, clothing, adequate medical care and, if possible, temporary shelter.[42]
21 deaths of foreigners were reported at the Polish-Belarusian border in 2021.[43]
[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 2022.
[4] ibid.
[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 2022.
[8] 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.
[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] 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.
[11] 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. The Office for Foreigners mentions three NGOs in 2021: Fundacja Ocalenie, Fundacja EMIC and Fundacja Polskie Forum Migracyjne (information of 26 January 2022).
[12] Information provided by the Office for Foreigners, 26 January 2022.
[13] 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.
[14] 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.
[15] 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.
[16] 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, 73-74.
[17] 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.
[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.
[19] Information provided by the Office for Foreigners, 1 February 2017.
[20] Information provided by the Office for Foreigners, 22 January 2020, 26 January 2021 and 26 January 2022.
[21] 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, 75.
[22] Information provided by the Office for Foreigners, 26 January 2022.
[23] 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.
[24] Information provided by the Office for Foreigners, 26 January 2021 and 26 January 2022.
[25] Information provided by the Office for Foreigners, 26 January 2022
[26] Information provided by the Office for Foreigners, 26 January and 4 March 2021 as well as 26 January 2022.
[27] Information provided by the Office for Foreigners, 4 March 2021.
[28] Information provided by the Office for Foreigners, 26 January 2021.
[29] Information provided by the Office for Foreigners, 26 January 2022.
[30] Ibid.
[31] Kseniya Homel (ed.), ‘The impact of coronavirus country measures on asylum and reception systems in Hungary, Slovakia and Poland’, 2021, available at: https://bit.ly/3sHaxVq, 35.
[32] ‘Wypis uchodźców do lasu? To chore – rozmowa z medyczką z Grupy Granica – Przy Słowie’, 2 November 2021, available in Polish at: https://bit.ly/3HI06oV; D. Borodaj, ‘W środku czarnego lasu robimy jej USG. „Zobacz. Tu ma główkę”. Na chwilę gasną igrzyska śmierci’, 5 November 2021, Oko.press, available in Polish at: https://bit.ly/3pChtkN.
[33] MSF leaves Polish border after being blocked from assisting people’, 6 January 2022, Press release, available at: https://bit.ly/3typ6JY.
[34] See e.g. M.J. Pietrusińska, N. Gebert, ‘Leczymy uchodźców. Raport oparty na relacjach pracowników przygranicznych placówek służby zdrowia’, December 2021, available in Polish at: https://bit.ly/3sFrOhQ, 15.
[35] D. Borodaj, ‘W środku czarnego lasu robimy jej USG. „Zobacz. Tu ma główkę”. Na chwilę gasną igrzyska śmierci’, 5 November 2021, Oko.press, available in Polish at: https://bit.ly/3pChtkN.
[36] J. Ojczyk, K. Redmerska, ‘Polacy wspierają medyków pomagających migrantom na granicy, 13 October 2021, available in Polish at: https://bit.ly/3KeFFl9.
[37] D. Zadroga, ‘Polska Misja Medyczna pomoże przy granicy polsko-białoruskiej’, 3 November 2021, available in Polish at: https://bit.ly/3txTDYn.
[38] Grupa Granica, ‘Humanitarian crisis at the Polish-Belarusian border’ , 1 December 2021, available (EN) at:https://bit.ly/3uF6jiF, 14, 23; M.J. Pietrusińska, N. Gebert, ‘Leczymy uchodźców. Raport oparty na relacjach pracowników przygranicznych placówek służby zdrowia’, December 2021, available in Polish at: https://bit.ly/3sFrOhQ, 9-11, 21-22, 25, 30; ‘Wypis uchodźców do lasu? To chore – rozmowa z medyczką z Grupy Granica – Przy Słowie’, 2 November 2021, available in Polish at: https://bit.ly/3to0CmE.
[39] M.J. Pietrusińska, N. Gebert, ‘Leczymy uchodźców. Raport oparty na relacjach pracowników przygranicznych placówek służby zdrowia’, December 2021, available in Polish at: https://bit.ly/3sFrOhQ, 8, 14; Grupa Granica, ‘Humanitarian crisis at the Polish-Belarusian border’ , 1 December 2021, available (EN) at:https://bit.ly/3uF6jiF, 23.
[40] See also ‘MSF leaves Polish border after being blocked from assisting people’, 6 January 2022, Press release, available at: https://bit.ly/3typ6JY.
[41] A Mikulska, ‘PILNE. Uszkodzono 4 samochody Medyków na Granicy. Ślady po siekierze. Sprawę bada policja’, 14 November 2021, available in Polish at: https://bit.ly/3sDAZPH.
[42] ECtHR, ‘Requests for interim measures concerning the situation at the borders with Belarus’, 6 December 2021, Press release.
[43] IOM via Twitter, 14 December 2021, available at: https://bit.ly/3hnQeG2.