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Access to health care is free for protection applicants living in Direct Provision and is expressly provided for in the Reception Conditions Regulations.[1] The Minister for Health is required to ensure that a recipient has access to emergency health care, treatment for serious illnesses and mental disorders, other health care for maintaining their health, and mental health care assessed as necessary for vulnerable persons.
In practice, a recipient of material reception conditions must apply for a medical card, which allows them to attend a local doctor or general practitioner who are located in or attend the Direct Provision accommodation centres. A person with a medical card is entitled to prescribed drugs and medicines and protection applicants living in Direct Provision are exempt from paying the prescription charges levied on medical-card holders.[2]
Following numerous complaints to the Department of Health and the Ombudsman, the HSE’s Medical Card Unit have amended their policy to enable eligible international protection applicants who are not living in Direct Provision to obtain medical cards and access to free medical services from GPs accepting medical card patients, prescription medicines and hospital care. Under previous policy, international protection applicants residing outside of Direct Provision were deemed ineligible for medical cards, with many struggling to access healthcare as a result. In the experience of the Irish Refugee Council, issues accessing medical cards for those living outside of Direct Provision have been minimal as of May 2025.[3]
In 2019, the Ombudsman received 12 complaints against the HSE regarding medical cards. Only one medical sector-related complaint was recorded for 2020. This related to a resident’s difficulty in accessing mental health services and getting information on a stay in hospital.[4] In 2021, the Ombudsman received 16 complaints regarding healthcare. The vast majority of these complaints related to the provision of medical cards.[5] In 2022, residents of Direct Provision made three complaints against the HSE regarding medical care.[6] Data in respect of 2023 and 2024 was not available at the time of updating.
IPAS’s website states that “Health screening is made available in our reception centres to all protection applicants on a voluntary and strictly confidential basis. Screening covers Hepatitis, TB, HIV, immunisation status and any other ailments or conditions that the medical officers feel require further investigation and/or treatment. Screening staff also check the vaccination needs of the resident and their family. Arrangements are in place in various parts of the country to offer this service to those who did not avail of it in Dublin. The outcome of any medical tests undergone by an asylum applicant will not affect their application for a declaration as a refugee in any way.”[7]
Specialised treatment for trauma and victims of torture is available through an NGO called SPIRASI which is a humanitarian, intercultural, non-governmental organisation that works with protection applicants, refugees and other disadvantaged migrant groups, with special concern for survivors of torture. Spirasi staff have access to certain accommodation centres e.g. Balseskin reception centre in Dublin and can help to identify victims of torture. However, no formal arrangements or agreements exist to deal with torture survivors in a way that is different to someone who has not experienced torture.
Applicants who hold a medical card are entitled to access women’s health services, including maternity and infant care and family planning free of charge through the applicant’s GP or family planning service.[8] A specialist FGM treatment service is provided by the Irish Family Planning Association. The service includes both medical and psychological care.[9] The service is provided by the Association’s Dublin-based clinics only and patients residing outside of Dublin must travel in order to access the service.
The HSE Women’s Health Service (WHS) and Anti-Human Trafficking Team is a statutory service provided by the HSE. The WHS operate a health clinic for women who are victims of human trafficking. Additionally, the AHTT has responsibility for care planning for both male and female victims of trafficking.[10]
In 2018, the constitutional provision which constituted a prohibition on abortion in Ireland was removed by way of referendum. This meant that access to abortion was made available in Ireland up to twelve weeks’ gestation from January 2019. The previous ban on access to abortion was a particular difficulty for protection applicants who had to apply for travel documents in order to travel to another jurisdiction such as the United Kingdom. This led to enormous emotional distress, delay, and uncertainty for the women affected. Access to abortion is provided by General Practitioners in the first place, with hospital referrals after nine weeks gestation. If the woman’s pregnancy has reached the twelve-week point, abortion will only be available in exceptional circumstances, including where there is a risk to the life or a risk of serious harm to the health of the woman, or a fatal foetal abnormality. A protection applicant who has reached twelve weeks of pregnancy and does not meet one of the exceptional circumstances noted above, may still have to travel outside of Ireland for a termination.
In the experience of the Irish Refugee Council, international protection applicants experience numerous practical and logistical difficulties in accessing healthcare. These include obstacles such as the availability of translation services, which are inconsistent across the Irish health service and create communication barriers for patients. Difficulties with transportation to medical facilities from remote accommodation locations also hinder access to healthcare. This is particularly the case whereby international protection applicants are moved from one centre to another without adequate notice and therefore, continuity of healthcare provision may be lost or disrupted. Moreover, there is no specific mental health service established for the purposes of providing support to international protection applicants. While many voluntary organisations such as those listed above provide specific supports in respect of survivors of torture, sexual violence, and human-trafficking. Mainstream mental health services are already under-resourced and therefore operate long waiting lists. Moreover, they may not have the specialist expertise to effectively deal with the unique experiences of international protection applicants and persons with international protection status.[11]
[1] Regulation 18 Reception Conditions Regulations 2018.
[2] Citizens Information, ‘Prescription Charges for Medical Card Holders’, 10 October 2018, available: here.
[3] Information provided by Irish Refugee Council Information and Advocacy Service, January 2025.
[4] Ombudsman, ‘The Ombudsman & Direct Provision: Update for 2020’, March 2021, available: here.
[5] Ombudsman, ‘The Ombudsman & Direct Provision: Update for 2021’, March 2022, available: here.
[6] Office of the Ombudsman, March 2023.
[7] RIA, Medical, available: here.
[8] Information provided by Irish Refugee Council Information and Advocacy Service, February 2024.
[9] Irish Family Planning Association, ‘Free FGM Treatment Service’, available: here.
[10] HSE, ‘Women’s Health Service and Anti-Human Trafficking Team’, available: here.
[11] Information provided by Irish Refugee Council Information and Advocacy Service, February 2024.
For further analsyis, see: RCSI Faculty of Public Health Medicine, ‘Migrant Health – The Health of Asylum Seekers, Refugees and Relocated Individuals’, June 2016, available: here.