Migrants without documents have a right to health care

Published 30.10.2015

Migrants without documents
have a right to health care

Over 20,000 asylum seekers have already arrived in Finland this year, which predicts a growth in the number of undocumented people in the near future.

People usually become undocumented for three main reasons: some have entered the country with a visa which has since expired, another group comprises asylum seekers who have not been granted entry but have not left the country and the third are victims of human trafficking and others who originally entered the country with no documents.

In terms of health care, Romanian and Bulgarian Romas, who are in the country legally but without any kind of health care insurance, are also considered to be undocumented.  The same applies to students from non-EU countries whose insurance has expired or does not cover all the required treatments.

Can people be left without treatment?

The Finnish Health Care Act requires medical care to be provided for patients regardless of their place of residence when they are in need of immediate treatment and cannot be safely transported.

– In practical terms, it is a matter of the treating physician’s evaluation. The physician determines what is necessary and what is not, points out Pekka Tuomola, medical director of Luona Oy and initiator of the Global Clinic for undocumented migrants.

Diabetes is not treated in principle, for example, but if it leads to a coma, the law requires the patient to receive treatment.

– One might ask whether it would be cheaper in the long run to treat the diabetes in the first place. Urgent care is always expensive.

Tuomola refers to the notion of health care as a mirror that reflects society’s mentality.

– Can we therefore with justification call a country that leaves thousands of people outside of the health care programme a civilized country, he asks.

The Finnish approach

In Finland, those who promote limiting people’s rights to health care have invoked health tourism, for example. Some politicians fear that providing everyone with access to health care will encourage people to come from Russia, for example, to treat HIV infections and for maternity care.

– In reality there are no signs of anything like this.

Finland cannot invoke European practises either as the ways of organising health care for undocumented migrants vary from one country to another. In Spain and France, for example, undocumented migrants are provided with full access to health care.

In Finland, access to health care is hindered in many ways for undocumented migrants, few of whom are aware where they can get treatment and what they are entitled to receive. They are also often worried about being discovered.

– There have, for example, been cases in Finland where a woman, who had come to hospital to give birth, was reported to the police. This is not acceptable ever.

However, there are positive examples too. The city of Helsinki has decided to offer healthcare to all under-18s and pregnant women even in non-emergency situations, for example.

A hidden clinic

Other undocumented migrants can receive help at the Global Clinic. Its operations are based on the conviction that no person should have to suffer and that a lack of money must not prevent people from receiving treatment. The human rights principle comes before the cost principle.

According to Tuomola, arranging health care is first and foremost a question of moral and ethics.

Tuomola compares the clinic with medicine in developing countries – but right in the heart of Helsinki. The clinic does not have its own laboratory and patients are diagnosed based on clinical features.

The clinic operates at a secret location.

– It is a matter of safety. We have received bomb and death threats. That’s why the address is not publicly available.

The police are, however, aware of the location and, according to Tuomola, the authorities have regarded the clinic’s operations in a humane and ethical manner.

– The police do not interfere with the clinic’s operations in any negative way.

Medical ethics

The clinic receives patients of all ages. The largest language groups that have attended are Romanian and Bulgarian and there’s a constant need for interpreters.

The most common reasons for patients to come to the Global Clinic are pregnancy, infections, musculoskeletal conditions and dental problems.

– There are a great number of dental problems in particular, as many of the patients do not get proper and regular nutrition.

Tuomola also estimates that many of the patients may have mental health problems but the symptoms are left undetected because of other problems.

– To put it crudely, when your mind is fully occupied with figuring out where to find food for the day and shelter for the night, there’s no time to get depressed.

The treatment pathways of the clinic involve referring patients in acute situations to public health care units. The clinic now has its own treatment pathway for tuberculosis. Children’s vaccinations have also been discussed but the problem is that vaccination schedules often get interrupted.

Global Clinic uses the financial resources and material donations from private individuals, associations and independent sources for the purposes of medical examinations and medicine costs for their clients. The clinic does not receive donations from the pharmaceutical industry.

The public’s responses to the clinic have been twofold, varying from negative comments to rather encouraging messages.

– When someone struggling with limited resources themselves writes to us to say that they want to help and donate a small amount of money, it gives us the strength to continue.

The clinic has also received support from rather influential individuals. The distinguished Finnish physician, archiatre Risto Pelkonen has strongly supported the clinic, stating: “Global Clinic represents exactly the kind of ethics that every physician should follow in their work.”

Text and photo: Hanna Hyvärinen

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