Author
Spanish law foresees full access to the public health care system for all asylum seekers.[1] Through this legal provision, they are entitled to the same level of health care as nationals and third-country nationals legally residing in Spain, including access to more specialised treatment for persons who have suffered torture, severe physical or psychological abuses or traumatising circumstances.
Since the 2012 reform of access to the Public Health System, which limited the previously guaranteed universal access to health care, asylum seekers had been facing problems in receiving medical assistance, even though it is provided by law. In particular, some asylum seekers were denied medical assistance, because medical personnel were not acquainted with the “red card” (tarjeta roja) that applicants are provided with, or they did not know that asylum seekers were entitled to such right.
In September 2018, the Government approved a decree reinstating universal access to the Public Health System, thus covering irregular migrants as well.[2]
In 2020, the Ministry of Health announced a law proposal establishing measures for the equality, the universality and the cohesion of the national health system,[3] and launched a public consultation.[4] The proposal was sent to the Parliament by the Council of Minister on June 2022[5] and was approved in May 2023.[6]
Although access to special treatment and the possibility to receive treatment from psychologists and psychiatrists is free and guaranteed, it should be highlighted that in Spain there are no specialised structures for victims of severe violations and abuses like the ones faced by asylum seekers escaping war, indiscriminate violence or torture. There are no specialised medical centres that exclusively and extensively treat these particular health problems.
From 2025, three NGOs (Accem, Red Acoge and San Juan de Dios) manage a total of 82 places for asylum seekers with mental health needs within the asylum reception system. In 2024, there was also Progestión managing 9 reception places for asylum seekers with mental health needs in Madrid. [7]
The 2024 annual report from CEAR continued to highlight the challenges that asylum seekers, migrants and refugees face in accessing the health system especially due to administrative barriers (i.e. for the lack of the enrolment in the municipal register), despite their right to the physical and mental health support is recognised by law.[8]
UNHCR observed an increasing necessity to address mental health and psychosocial support (MHPSS) related needs of asylum seekers and refugees in the asylum system. In June 2023, UNHCR organised a protection dialogue on the mental health of refugees, asylum seekers and stateless persons in Madrid, aimed to identify challenges and opportunities for improving refugees’ mental health and psychosocial support. Special emphasis was placed on the need to strengthen coordination among key actors, incorporate an intercultural perspective in the services provided, promote specialised training and care for professionals, and promote the effective participation of refugees. Following the Protection Dialogue, UNHCR established a reference group on mental health with key stakeholders, including authorities, NGOs, and refugee-led organisations, to assist UNHCR in implementing its strategy related to MHPSS, to strengthen the network and identify initiatives and measures to reinforce refugees’ wellbeing and mental health.[9]
[1] Article 15 Asylum Regulation.
[2] El País, ‘El Congreso aprueba el decreto para recuperar la sanidad universal’, 6 September 2018, available at: https://bit.ly/2Nt140c.
[3] El País, ‘Sanidad quiere prohibir por ley nuevos copagos y asegurar la atención a inmigrantes’, 20 October 2020, available at: https://bit.ly/3bhV4Bl.
[4] Ministerio de Sanidad, ‘Consulta pública previa sobre el anteproyecto de ley de medidas para la equidad, universalidad y cohesión del sistema nacional de salud’, October 2020, available at: https://bit.ly/3dmGUBG.
[5] La Moncloa, ‘El Gobierno refuerza la equidad y la universalidad del Sistema Nacional de Salud’, 14 June 2022, available at: https://bit.ly/3LtBrd8.
[6] Boletín Oficial del estado, ‘Ley 16/2003, de 28 de mayo, de cohesión y calidad del Sistema Nacional de Salud’, May 2023, available at: https://tinyurl.com/ms68dx6u.
[7] Informattion provided by Accem’s psychological service in March 2025.
[8]CEAR, ‘INFORME 2024. Las personas refugiadas en España y Europa’, June 2024, p. 120, available here.
[9] Information provided by UNHCR in April 2024.