Author
The Asylum Act foresees that asylum seekers shall have an equal right to health care in relation to Serbian citizens, in accordance with the regulations governing health care for foreign nationals.[1] In exercising the right to health care, adequate health care shall be provided as a priority to severely ill asylum seekers, applicants who have been victims of torture, rape or other serious forms of psychological, physical or sexual violence, or applicants with mental disorders.[2]
Upon their arrival to the reception facility, asylum seekers are obliged to undergo a mandatory medical examination which is conducted in line with the Rulebook on medical examinations of asylum seekers on admission in asylum centres or other facilities designated for accommodation of asylum seekers. The Rulebook on medical examinations envisages that examinations shall be conducted by medical doctors at the healthcare services within ACs and RCs[3], and in practice, where certain service cannot be provided asylum seekers are transported to the outside medical facilities, usually with the assistance of the CRM and DRC. The examination includes anamnesis (infectious and non-infectious diseases, inoculation status), an general check-up and other diagnostic examinations.[4]
Asylum seekers originating from countries with cholera, malaria or other diseases that may pose a threat to public health shall be placed in quarantine or under medical supervision up to the period of maximum incubation for the suspected disease.[5]
In practice, asylum seekers and persons granted asylum have relatively unimpeded access to the national healthcare system in an equal manner to Serbian nationals, including for primary and secondary care, but also referrals to specialist examinations. The costs of healthcare for asylum seekers and persons granted asylum are always covered by the Ministry of Health which also receives financial support from EU.[6] It remains unclear if all the services are solely covered by the EU, especially because there were instances in which medical treatments which were expensive were not covered during the gaps in funding.[7] This was in particularly worrying for the HIV patients and other people with rare diseases which require more expensive and continuous therapy.[8]
However, the Health Care Act (HCA),[9] as well as the Health Insurance Act (HIA),[10] are not harmonized with the Asylum Act. Particularly, the right to healthcare although prescribed to every person, is provided on the basis of the health insurance.[11]
Thus, and in cases in which asylum seekers were not able to obtain more expensive medical assistance, they must be included in the health insurance system which must be paid. The HIA envisages possibility of asylum seekers, qualified as foreigners, to pay healthcare insurance by themselves, and in that way secure adequate therapy.[12]
In reality, not all staff of the Republic Fund of Health Insurance is familiar with this legal possibility and thus, a different approach exists within different organizational units of this institution. Besides, inclusion in the health insurance system requires a monthly contribution from its beneficiaries. That amount in 2023 was 4,134.73 dinars (around 37 Euros).[13] This is an obstacle, since asylum seekers are not able to work in the first 6 months, and they do not receive financial support. Thus, for the inclusion in the health insurance system, they have to rely only on the financial help of international organisations or CSOs who so far have been able to cover the cost due to a low number of asylum seekers in general, and even lower number of persons who require more expensive therapy. This especially represents a problem for people who suffer from chronic diseases and need of constant or expensive therapy.[14]
However, it is important to reiterate that the vast majority of persons accommodated in Asylum or Reception Centres do not enjoy the status of asylum seeker (they did not lodge asylum application) and are thus not entitled to health care, as envisaged in Article 54 of the Asylum Act. However, all persons issued with registration certificates are in practice treated as asylum seekers and are allowed to receive primary medical treatment. Still, even those people who lodged asylum applications can have difficulties in accessing health care services by themselves, especially if they live on the private address, because they are not issued with healthcare cards, nor are they introduced into healthcare records in local medical centres. The health care centres which cover the area where AC Krnjača is located are more familiar with the notion of asylum seekers as beneficiaries of health care. On the other hand, most of other health care centres are not familiar with this and asylum seekers often require to be escorted by lawyer or cultural mediator. There are no indications that this practice will change.
The problems from 2022 were resolved in the same way as in 2023, and all asylum seekers who were seriously ill (e.g., HIV were assisted by IDEAS legal team in order to access health care insurance, in cooperation with the Republic fund for Health Insurance, and with financial support from UNHCR. In 2023, 6 asylum seekers were enjoying mandatory health care insurance for therapies for AIDS.
With regards to mental healthcare problems, in 2018, PIN and WHO developed the Guidance for protection and improvement of the mental health of refugees, asylum seekers and migrants in Serbia,[15] which was adopted by the Ministry of Health and the Commissariat for Refugees and Migration. This Guidance provides that mental health protection services should be delivered on four levels – initial screening, prevention activities, psychological interventions, and psychiatric care. It is recommended that these services be available throughout the public healthcare system, while civil society organisations would fill in the gaps in line with identified needs.[16] Still, and in practice, psychological support is provided by CSOs, such as PIN, IAN, but also other NGOs such as APC. Their psychosocial workers regularly visit asylum centres, as well RC in Šid. Psychosocial support is also provided by the IOM. Special assistance to SGBV survivors is provided by DRC, while ATINA supports survivors of trafficking in human beings, and in coordination with local social welfare centres.
What is important to note is the fact that asylum seekers with psychiatrist issues who require institutionalization are not provided with such opportunity. Namely, in 2023 several asylum seekers were assessed by CSO psychologist and psychiatrists as eligible for institutional are within psychiatric clinics, but these facilities decided not to allow them hospitalization. Thus, in Asylum Center in Krnjača and RC in Bujanovac, there are several individuals who pose threat at least to themselves, but also to others.[17]
The Republic of Serbia among the first countries in the world to allow refugees, asylum seekers and migrants to receive, under the same conditions as the local population, Covid-19 vaccines.[18] Also, all residents of asylum and reception centres have had an unhindered access to PCR and other forms of COVID-19 tests. Each asylum and reception centre has designated rooms for quarantine.
In line with Article 17 of the Asylum Act, asylum seekers who fall under vulnerable categories are entitled to special reception guarantees, which also implies health care needs should be properly addressed. In general, it is possible to access gender-sensitive health care opportunities, meaning that female doctors provide health care services to female asylum seekers. There were no reports which indicate that pregnant women, children or other vulnerable asylum seekers were deprived of specific health care services. IAN provides support to survivors of torture and other forms of ill-treatment, but only when these people are identified as asylum seekers.
However, it is important to note that there is no systematically designed vulnerability assessment for vulnerable foreign nationals when they arrive to reception facilities, and thus, it is impossible to determine to which extent vulnerable categories are identified and referred to support networks of state institutions and CSOs. Usually, identification of vulnerable refugees and asylum seekers is conducted in relation to those individuals who are willing to apply for asylum, while those who stay for shorter periods of time in the country go undetected.
[1] Article 54 Asylum Act.
[2] Article 54(3) Asylum Act.
[3] Article 2 Rulebook on medical examinations.
[4] Article 3 Rulebook on medical examinations.
[5] Article 4 Rulebook on medical examinations.
[6] The Government of the Republic Serbia, Press Statement, EU to help Serbia prevent illegal migration, 7 October 2022, available at: https://bit.ly/41w4qli.
[7] Practice-informed observation by IDEAS, 2022-2023.
[8] Ibid.
[9] Official Gazette no. 25/19.
[10] Official Gazette no. 107/25, 109/05 – correction, 57/11, 110/12 – Constitutional Court Decision, 119/12, 99/14, 123/14, and 126/14 – Constitutional Court Decision.
[11] Ibid. 3
[12] Article 17, HIA.
[13] The current amount of fee for the introduction in the mandatory health care insurance can be found on the following link: https://bit.ly/3WDt0A3.
[14] As outlined, that was the case with several asylum seekers suffering from AIDS.
[15] Svetozarević, S., Vukčević, Marković, M., Pejušković, B., & Simonović, P. (2019), Guidance for protection and improvement of mental health of refugees, asylum seekers and migrants in republic of Serbia, available at: https://bit.ly/3r7wBEZ.
[16] Ibid.
[17] Practice-informed observation by IDEAS, 2022-2023 which were related to several highly vulnerable asylum seekers who are prone to self-harming, violent episodes and alcoholism.
[18] WHO, Refugees and migrants hosted in Serbian reception centres get their COVID-19 vaccine doses, 12 May 2021, available at: https://bit.ly/40PxXHI.