Spanish law foresees full access to the public health care system for all asylum seekers. 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 was 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.
During 2020, the Ministry of Health announced project of law establishing measures for the equality, the universality and the cohesion of the national health system, and launched a public consultation.The project of law was sent to the Parliament by the Council of Minister on June 2022.
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.
Currently, there are different NGOs in charge of places for asylum seekers with mental health needs. For about 5 years, Accem, in collaboration with Arbeyal, a private company, managed the “Hevia Accem-Arbeyal” centre, specialised in disability and mental health. In 2018, it opened the Centre for the Reception and Integral Assistance to Persons with Mental Health Problems (Centro de Acogida y Atención Integral a Personas con Problemas de Salud Mental), and it is dedicated to asylum seekers and beneficiaries of international protection in a situation of vulnerability. The purpose of the residential centre is to promote the highest level of mental and physical well-being to people whose mental illness hinders their integration process.
In addition, CEAR also manages places specialised in asylum seekers with mental conditions. La Merced Migraciones Foundation also provides reception places for young adult asylum seekers who need special assistance due to mental health-related conditions. Other NGOs have also developed specific resources to assist and accompany asylum seekers with mental health needs, such as Bayt al-Thaqafa (which is member of the Federación Red Acoge) in Barcelona, Progestión, Provivienda and Pinardi. The NGO Valencia Accull (which is member of the Federación Red Acoge) has opened a reception facility in Valencia for single female asylum seekers/refugees. Federación Red Acoge also runs a new facility with 7 places for asylum seekers with addictions or dual pathology. Information on organisations providing such services in Spain is not public.
In April 2021, the Fundación Cruz Blanca opened a new reception facility in Guadalajara, dedicated to the assistance of migrants affected by mental health issues.
During the COVID-19 pandemic, health professionals from the Lavapiés neighbourhood in Madrid asked for more interpreters in order to assist migrants.
In a report published in February 2021, Amnesty International underlines the increasing obstacles that undocumented migrants faced in accessing health services during the COVID-19 pandemic. Such barriers are essentially due to the legislation that does not foresee the universal access to the National Health System, the insufficiency of adequate measures implemented by the Autonomous Communities, and the language barrier in order to access medical assistance by phone.
In May 2021, six NGOs called on the Minister of Inclusion, Social Security and Migration to reform the Regulation of the Immigration Law in a way that guarantees adequate protection to all migrants, especially in light of the COVID-19 pandemic, as more than half million persons cannot exercise their right to health due to their impossibility to fulfil administrative requisites, given their lack of valid documents.
Various obstacles were registered regarding access to the vaccination campaign for migrants, generally due to linguistic barriers and lack of access to digital services. Even though the migrant population – comprising also undocumented migrants – was included in the Spanish vaccination strategy, the administration often delegated to NGOs the responsibility in terms of information provision and facilitation in access to the campaign. The NGO APDHA urged the Government of Andalucía to adopt a comprehensive vaccination strategy which includes undocumented migrants, including those persons who do not hold a healthcare card. The call derives from the concern that the public vaccination strategies in Andalucía do not include specific plans to address the specific situation of undocumented migrants living in the Autonomous Community. In addition, Spain included stateless persons in vaccination plans.
In occasion of the World Health Day, the NGO Kifkif called for the right to health of LGTBI+ migrants and asylum seekers to be comprehensive and effective, including the support for mental health issues. The organisation highlights that, during the first quarter of 2021, 56% its beneficiaries indicated that bureaucratic processes and the discrimination impede to receive a quality health assistance.
 Article 15 Asylum Regulation.
 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 in Spanish at: https://bit.ly/3dmGUBG.
 Information provided by Federación Red Acoge on 1 March 2022.
 Information provided by Federación Red Acoge on 1 March 2022.
 Information provided by Fundación Cruz Blanca on April 2021.
 Amnistía Internacional España, ‘La otra pandemia. Entre el abandono y el desmantelamiento: el derecho a la salud y la Atención Primaria en España’, February 2021, available in Spanish at: https://bit.ly/3qcdBnT.
 Red Acoge, ‘Seis ONG estatales instan a la Secretaría de Estado de Migraciones a reformar el Reglamento de Extranjería para garantizar la protección de las personas migrantes tras la pandemia’, 25 June 2021, available at: https://bit.ly/3NsmHda.
 A sociación Pro Derechos Humanos de Andalucía – APDHA, ‘Exigimos al Gobierno andaluz una estrategia de vacunación integral que incluya a todas las personas en situación administrativa irregular’, 9 April 2021, available at: https://bit.ly/3FSOsY4.
 El Foro de Ceuta, ‘KifKif exige atención sociosanitaria de calidad para las personas migrantes y solicitantes de protección internacional LGBTIQ+’, 7 April 2021, available at: https://bit.ly/34k9Ck6.