Author
Beneficiaries of international protection have the right to benefit from health insurance under the conditions provided by the law for the Romanian citizens.[1] Persons suffering from mental health problems, including torture survivors and traumatised persons also have access to treatment in the same conditions as Romanian nationals.
Challenges in practice include lack of awareness of how the National Health Insurance House (Casa Națională de Asigurări de Sănatate, CNAS) works and what it entails. Therefore, NGOs play a key role in assisting beneficiaries of international protection to overcome all the practical obstacles, which would be insurmountable without this type of support.
Although Romanian law grants refugees the same access to healthcare as Romanian citizens, in practice, they often face significant barriers that prevent them from effectively accessing medical services.
Challenges faced by beneficiaries of international protection in the healthcare system[2]
- Limited understanding and financial barriers:
- Many beneficiaries struggle to understand how the health insurance system works;
- Lack of financial resources to pay for social health insurance;
- Even if insured, certain treatments and investigations are not covered and must be paid for by beneficiaries.
- Bureaucratic & administrative challenges:
- Complex and lengthy procedure to obtain health insurance, register with CNAS, find a family doctor, and get specialist appointments;
- More complicated for unemployed refugees who must pay for their own insurance.
- Limited access to healthcare providers:
- High waiting times for certain medical investigations;
- In big cities, family doctors often lack available slots or refuse refugee patients due to language barriers.
- Language & cultural barriers:
- Most healthcare staff do not speak foreign languages, and hospitals/clinics do not provide interpreters;
- Difficulty navigating the healthcare system due to language barriers;
- CNRR provides support with interpretation services, medical accompaniment, assistance with forms, and communication with doctors.
- Mental health challenges:
- Mental health is often overlooked for both refugees and host communities;
- There is a need for psycho-social support (PSS), psychological first aid (PFA), and trauma management, but Romanian healthcare and NGOs are not well-prepared.
In 2023, information from CNRR[3] and IOM Romania[4] highlighted significant challenges faced by beneficiaries of international protection (BIPs) in accessing healthcare. CNRR reported that many BIPs lack awareness of their healthcare rights, with those unemployed experiencing major difficulties in accessing medical services. Language barriers further complicate their situation, as hospitals rarely provide interpreters, forcing beneficiaries to rely on acquaintances for translation. Additionally, some family doctors have refused to register BIPs. IOM Romania supports BIPs by covering medical expenses and insurance costs through project funding, but these funds are often insufficient, particularly for those with chronic conditions. Language barriers also hinder communication with doctors, necessitating interpreters and accompaniment, though cooperation from medical professionals is not always guaranteed. JRS Romania confirmed similar issues in Region 2, emphasizing that the high cost of state medical insurance (RON 1,800/year) makes it unaffordable for many, especially when combined with high living expenses. Under an AMIF-funded project, BIPs in Region 2 received health insurance coverage for six months, but funding ended in October 2023. Medication costs remain high, and those who have completed the integration program face even greater difficulties. Beyond financial constraints, JRS noted that BIPs suffer from the broader inefficiencies of Romania’s healthcare system, with specialist referrals taking up to six months. Private healthcare remains inaccessible due to high costs, further exacerbating their vulnerability.[5]
According to JRS Romania’s representatives in Galati, in 2024 most beneficiaries of international protection do not have health insurance, however according to the Law,[6] certain groups are exempt from paying social health insurance contributions, including minors, young people up to 26 years old who are students or from the child protection system, dependents without their own income, persons with disabilities, patients under national health programs, and pregnant or lactating women, etc. Those who are unemployed and do not qualify for these exemptions can access emergency medical assistance at hospital Emergency Reception Units, while some medical costs, medications, psychological assistance, and health insurance may be subsidized through the integration programs run by NGOS, depending on funding. For insured beneficiaries, such as minors or those receiving minimum inclusion income, JRS has facilitated their registration with family doctors, assisting with language barriers by preparing written descriptions of symptoms. In cases requiring emergency unit visits, JRS has provided telephone mediation, and cultural mediators (Arabic and Ukrainian) are available to support communication. Non-urgent but acute medical issues occurring outside regular consultation hours are referred to Permanence Centers, which provide free primary healthcare in Galați between 3:00 PM and 8:00 AM on weekdays and operate 24 hours on weekends and public holidays. These centres offer medical assistance for acute conditions, referrals to specialists, emergency treatment administration, and the issuance of medical letters.[7]
Despite the legal provisions ensuring equal access to healthcare for beneficiaries of international protection, practical challenges such as bureaucratic hurdles, language barriers, and limited awareness of the healthcare system continue to hinder their ability to receive proper medical care. The role of NGOs in bridging these gaps is crucial, as they provide essential support in navigating the system, accessing medical services, and overcoming cultural and linguistic barriers.
Moving forward, a more coordinated approach involving authorities, healthcare institutions, and civil society is necessary to ensure that refugees and other vulnerable groups can fully exercise their right to healthcare. Strengthening integration programs, improving access to interpreters, and enhancing mental health support are key steps toward a more inclusive and efficient healthcare system. By addressing these challenges, Romania can foster a healthcare environment that is not only legally inclusive but also practically accessible to all.
[1] ibid.
[2] Information provided by IOM in February 2022 and by CNRR in February 2025.
[3] Information provided by CNRR, 15 January 2024.
[4] Information provided by IOM, 4 January 2024.
[5] Practice observed by JRS Romania, April 2024.
[6] Article 224 Law 95/2006.
[7] Information provided by JRS Romania, January 2025.