Health care

Portugal

Country Report: Health care Last updated: 30/11/20

Author

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The Asylum Act enshrines the right of asylum seekers and their family members to health care provided by the National Health System (Serviço Nacional de Saúde, SNS),[1] and includes a specific provision on the right to adequate health care at the border.[2] The primary responsibility for the provision of health care lies with the Ministry of Health,[3] except for asylum seekers detained at the border that fall under the responsibility of the Ministry of Home Affairs.[4] The latter can however cooperate with public entities and/or private non-profit organisations in the framework of a MoU to ensure the provision of such services.[5]

In accordance with the Asylum Act,[6] the specific rules governing access of asylum seekers and their family members to health care[7] are provided by Ministerial Order No 30/2001 and Ministerial Order No. 1042/2008,[8] according to which:

  1. Access to health care encompasses medical care and medication, and is available from the moment the asylum seeker applies for asylum;[9]
  2. Medical assistance and access to medicines for basic health needs and for emergency and primary health care are to be provided under the same conditions as for Portuguese citizens;[10]
  3. Asylum seekers have access to the SNS free of charge[11] for emergency health care, including diagnosis and treatment, and for primary health care,[12] as well as assistance with medicines, to be provided by the health services of their residence area.[13]

Asylum seekers are entitled to health care until a final decision rejecting the asylum application unless required otherwise by the medical condition of the applicant.[14]  Additionally, the reduction or withdrawal of reception conditions cannot restrict the access of asylum seekers to emergency health care, basic treatment of illnesses and serious mental disturbances or, in the case of applicants with special reception needs, to medical care or other types of necessary assistance, including adequate psychological care where appropriate.[15] This provision remains to be tested in practice due to the extremely limited number of such decisions to date (see Reduction or Withdrawal of Reception Conditions).

The special needs of particularly vulnerable persons must be taken into consideration  in the provision of health care,[16] through adequate medical care,[17] and specialised mental health care including for survivors of torture and serious violence,[18] including in detention.[19] The responsibility for special treatment required by survivors of torture and serious violence lies with ISS.[20]

In practice, asylum seekers have effective access to free health care in the SNS in line with applicable legal provisions. However, persisting challenges have an impact on the quality of health care. According to previous research,[21] and information available to CPR, these include language and cultural barriers (e.g. the lack of interpreters for certain languages and the reluctance of health care services to use  interpretation services such as ACM’s translation hotline); difficult access to diagnosis procedures and medication paid by the SNS due to bureaucratic constraints; or very limited access to mental health care and other categories of specialised medical care (e.g. dentists)[22] in the SNS. The difficulties in accessing specialised care in the SNS, including dentists, also came out as the main concerns in consultations conducted by CPR in October 2017 in the framework of the relocation programme.

It should be noted in this regard that CPR provides financial support to unaccompanied asylum-seeking children and asylum seekers in admissibility and accelerated procedures to cover the costs of diagnosis procedures and medication depending on the individual circumstances and available resources. Unaccompanied children residing at CPR’s CACR have also been able to access dental care in SOL, a clinic managed by SCML that provides specialised care in the field for children living or studying in Lisbon.[23]

 


[1] Articles 52(1) and 56(1) Asylum Act.

[2] Article 56(2) Asylum Act. This provision should be read in conjunction with Article 146-A(3) Immigration Act that provides for the right of pre-removal detainees in CIT to emergency and basic health care.

[3] Article 61(3) Asylum Act.

[4] Article 61(1) Asylum Act. While not included in this provision, SEF should also be considered responsible for providing access to health care to asylum seekers in pre-removal detention given its managing responsibilities of CIT: Article 146-A(3)-(4) Immigration Act.

[5] Ibid.

[6] Article 52(1) in fine Asylum Act.

[7] The legal and operational background pertaining to the access of asylum seekers to health care was revisited by the ACSS and the DGS in an internal guidance note issued on 12 May 2016 in the framework of the European Agenda for Migration, available at: http://bit.ly/2jdBIFW.

[8] Ministerial Order No 1042/2008 extends Ministerial Order No 30/2001 ratione personae to applicants for subsidiary protection and their family members.

[9]  Ministerial Order No 30/2001, para 2. Under Article 52(2) Asylum Act, the asylum seeker is required to present the certificate of the asylum application to be granted access to health care under these provisions. The internal guidance note issued on 12 May 2016 by the ACSS and the DGS provides for possible documents entitling the asylum seeker to access health care and includes a complete list of documents issued to the asylum seeker by the SEF during the asylum procedure (e.g. renewal receipts of the certificate of the asylum application, provisional residence permit, etc.)

[10] Ibid.

[11] Article 4(1)(n) Decree-Law 113/2011.

[12] For the purposes of free access to the SNS, primary health care is to be understood as including among others: (i) Health prevention activities such as out-patient medical care, including general care, maternal care, family planning, medical care in schools and geriatric care (ii) specialist care, including mental care (iii) in-patient care that does not require specialised medical care, (iv) complementary diagnostic tests and therapies, including rehabilitation and (v) nursing assistance, including home care: Ministerial Order No 30/2001, par.6.

[13] Ministerial Order No 30/2001, par.5.

[14] Ministerial Order No 30/2001, par.8.

[15] Article 60(7) Asylum Act.

[16] Article 77(1) Asylum Act.

[17] Articles 52(5) and 56(2) Asylum Act.

[18]Articles 78(3)-(4) and 80 Asylum Act.

[19] Article 35-B(8) Asylum Act.

[20] Article 80 Asylum Act.

[21] Italian Council for Refugees et al., Time for Needs: Listening, Healing, Protecting, October 2017.

[22] In this regard, DGS noted in the past that such difficulties are similar to those faced by Portuguese citizens.

[23] For more information see: https://bit.ly/2x2l8Ak.  

 

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