The Asylum Act foresees that asylum seekers shall have equal rights to health care, in accordance with the regulations governing health care for aliens.[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 examination shall be conducted by medical doctors at the health care centres.[3] The examination includes anamnesis (infectious and non-infectious diseases, inoculation status), an objective 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 health care system in an equal manner to Serbian nationals and when it comes to primary and secondary care, but also referrals to specialist examination. The costs of health care for asylum seekers and persons granted asylum are always covered by the Ministry of Health which also enjoys support of the EU and its funds. However Health Care Act (HCA),[6] as well as the Health Insurance Act (HIA),[7] are not harmonized with the Asylum Act. Particularly, the right to health care although prescribed to every person, is provided on the basis of the health insurance[8]. Thus, in order for an asylum seeker to obtain medical assistance which is not covered by the EU funds, 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 health care insurance by themselves, and in that way secure adequate therapy.[9]
In reality, not all employed staff of 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 by the person. That amount in 2022 was 3,607.57 dinars (around 30e). This is an obstacle, since asylum seekers are not able to work in the first nine months, and they do not receive financial support. Thus, for the inclusion in the health insurance system, they can rely only on the financial help of international organisations or CSOs. This especially represents a problem for people who suffer from chronic diseases and need of constant or expensive therapy.[10]
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 because they are not issued with health care cards, nor are they introduced into health care records in local medical centres. There are no indications that this state of affairs will change.
What was determined to be the most contentious problem in 2022 was the fact that, due to the lack of EU funding, the financial means which are designated for expensive therapies ceased to exist. This has led to the situation in which seriously ill-asylum seekers (for instance, those who are HIV+) were deprived of the possibility to take therapy. IDEAS legal team, in cooperation with the Republic fund for Health Insurance, and financial support of the UNHCR introduced the applicant into to the health care insurance scheme through the legal provisions of the Health Insurance Act which were interpreted in favour of persons who have the status of asylum seekers.
When it comes to mental health care 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,[11] which was adopted by the Ministry of Health and Commissariat for Refugees and Migration. This Guidance stipulates 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.[12]
The COVID-19 lockdown led to a high rate of overcrowding which contradicted recommendations of WHO and CPT (see Freedom of movement).
The Republic of Serbia was one of the first countries in the world which allowed refugees, asylum seekers and migrants to get, under the same conditions as the local population, Covid-19 vaccines.[13] 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.
[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] Official Gazette no. 25/19.
[7] 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.
[8] Ibid. 3
[9] Article 17, HIA.
[10] That was the case with several asylum seekers suffering from AIDS.
[11] 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. Serbia, Belgrade: World Health Organization, available at: https://bit.ly/3r7wBEZ.
[12] Ibid.
[13] WHO, Refugees and migrants hosted in Serbian reception centres get their COVID-19 vaccine doses, 12 May 2021, available at: https://bit.ly/3jZUsFb.