Author
During the asylum process and until the asylum seeker leaves Sweden or is granted a residence permit, they are entitled to a free medical examination, emergency health care and urgent medical or dental care that cannot be “postponed” (“vård som inte kan anstå”). They are also entitled to gynaecological and prenatal care, including health care on the occasion of childbirth, as well as health care in accordance with the Swedish Communicable Diseases Act (smittskyddslagen).[1]
Children and teenage asylum seekers under the age of 18 are entitled to the same health care as all other children living in the county council area where they are seeking treatment.[2]
County councils are the authorities responsible for primary health care centres (vårdcentralen), hospitals and the National Dental Service (Folktandvården).
Should there be a need for health care beyond the free medical examination, mentioned above, patient fees (co-ays) may differ depending on the county council, region and type of care involved. But in general asylum seekers pay SEK 50 (€ 4.60) to see a doctor at the district health centre or to receive medical care after obtaining a referral. Other medical care, such as with a nurse or physical therapist, costs SEK 25 (€ 2.30) per visit. Medical transportation costs SEK 40 (€ 3.70). Gynaecological and prenatal care, including health care on the occasion of childbirth, as well as health care in accordance with the Swedish Communicable Diseases Act is free of charge. The fee for emergency care at a hospital varies from county to county. Asylum seekers pay no more than SEK 50 (€ 4.60) for prescription drugs. Children are in most cases entitled to health care free of charge until they turn 18 years old. Dental care is free of charge for children until they turn 23 years old. However, there may be a patient fee (co-ays) for emergency care for children in some of the regions.[3]
If an asylum seeker pays more than SEK 400 (€ 37.00) for visits to a doctor, medical transportation and prescription drugs within 6 months, they can apply for a special allowance. The Migration Agency can compensate for costs over SEK 400. The “400 SEK rule” applies individually for adults and common for siblings under 18. The cost of emergency medical or dental care is not covered.[4]
However, adults without children can be left without shelter and money if they refuse to leave Sweden voluntarily within 4 weeks of an expulsion order gaining legal force. Persons in that situation are entitled to the health care mentioned above, but the Migration Agency does not provide any financial assistance for health care or medicine.
As mentioned above, the health care an asylum seeker is entitled to is limited to urgent medical or dental care that cannot be “postponed” (“vård som inte kan anstå”). It is the treating physician or dentist that makes the assessment if the person seeking health care is in need of health care that cannot be postponed. Critics highlight that the concept of “health care that cannot be postponed” is inexplicit and difficult to interpret for the health care staff.[5] Transkulturellt Centrum (a part of the County Council of Stockholm, Region Stockholm) has expressed concern that persons seeking health care rarely gets questions about torture and health care staff are seldomly educated in recognising, documenting and treating injuries of torture.[6] This means that the access to treatment for injuries of torture in practice is limited and depending on which physician or dentist that medically examines the asylum seeker.
A study conducted by the Swedish Red Cross revealed that although persons who stay in Sweden beyond 4 weeks after the date when their expulsion order gained legal force are entitled to (some) health care, there may be a number of practical obstacles on an individual basis. These might include the fear of authorities and a lack of knowledge about the duty of confidentiality these persons may have. The study also highlights the lack of knowledge on the part of healthcare staff about the laws on this matter as an obstacle for these persons to actually get the health care they are entitled to.[7]
The new Swedish government, following the general election in September 2022, has proposed that employees that come in contact with persons that live in Sweden with an expulsion order that has gained legal force should report these persons to the police or the Migration Agency. Critics point out that this is not in accordance with the health care ethics and could risk that persons in need of health care wait even longer before contacting a health care provider and could by that be even sicker when getting the medical examination.[8]
A study conducted by the Karolinska Institute revealed that the suicide rate among asylum-seeking young people reached 51.2 out of 100,000 persons; while for the general population (same age group) the suicide rate was as low as 5.2 out of 100,000 persons. The study further documented 43 suicides by 2017, an issue that persisted up until 2020 as six suicides and three suicide attempts were recorded during that year.[9] In another study from 2020, the Red Cross University College and the Swedish Public Health Agency looked at the prevalence of post-traumatic stress among young newcomers living at the municipalities between 2014-2018. The results indicated that 56% of asylum-seeking young people from Afghanistan suffered from post-traumatic stress. [10]
As regards access to health care in the context of Covid-19, such health care is considered as urgent care, meaning that asylum seekers and undocumented migrants have access to it. Covid-19 vaccines have been and will continue to be offered for free to everyone in Sweden, including asylum seekers and undocumented migrants.
[1] Section 6 of Law (2008:344) on health care for asylum seekers etc. (lag (2008:344) om hälso- och sjukvård åt asylsökande m.fl.) section 7 of Law (2013: 407) on health care for certain foreigners staying in Sweden without the necessary permits (Lag (2013:407) om hälso- och sjukvård till vissa utlänningar som vistas i Sverige utan nödvändiga tillstånd), chapter 7, section 3 of The Communicable Diseases Act (2004:168) (Smittskyddslagen (2004:168)).
[2] 1177 Vårdguiden, ‘Healthcare in Sweden for asylum-seekers, people with no papers and people in hiding’, available at: http://bit.ly/2GoMC3k.
[3] 1177 Vårdguiden, ‘Healthcare in Sweden for asylum-seekers, people with no papers and people in hiding’, available at: http://bit.ly/2GoMC3k.
[4] Migration Agency, ‘Fees for medical care’, available at: https://bit.ly/37Y350F.
[5] Läkare Utan Gränser, ‘Ge asylsökande och papperslösa vård på lika villkor’, 28 January 2018, available in Swedish at: http://bit.ly/403TZFS.
[6] Transkulturellt Centrum, ‘Tortyrskadade patienter’, available in Swedish at: http://bit.ly/3Jf9zIx
[7] Swedish Red Cross, Nedslag i verkligheten – tillgång till vård för papperslösa, 2018, available at: https://bit.ly/3Px1nnE.
[8] AftonBladet, ‘Vi kommer att vägra ange våra patienter’, 21 December 2022, availble in Swedish at: http://bit.ly/3kFLEYD.
[9] EvaMärta Granqvist och Joel Larsson. Find a humane solution for Sweden’s unaccompanied young people – now!, October 2020, available at: https://bit.ly/3ugPWpB.
[10] Röda Korsets Högskola, ‘Study on post-traumatic stress among newly arrived children and young people points to continued need for support’, 16 April 2021, available at: http://bit.ly/3JfqqLy.