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 places for asylum seekers with mental health needs within the asylum reception system. [7]
Despite acknowledging the improvements made in the last years, the 2025 annual report from CEAR continued to highlight the challenges that asylum seekers, migrants and refugees face in accessing the health system. According to the organisation, this is especially due to the insufficient number of specialised reception places and to the duration of stay that is not adequate for offering a comprehensive rehabilitation response allowing a real inclusion in society.[8]
[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 here.
[6] Boletín Oficial del estado, ‘Ley 16/2003, de 28 de mayo, de cohesión y calidad del Sistema Nacional de Salud’, May 2023, available here.
[7] Information provided by Accem’s psychological service in March 2026.
[8] CEAR, ‘Informe 2025. Las personas refugiadas en España y Europa’, June 2025, available here.