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Conférence des ministres européens de la santé: discours d'Andrej Zernovski (english only)

Bratislava 22-23 November 2007

Discours d'Andrej Zernovski

PACE Committee on Migration, Refugees and Population

Prime Minister,
Secretary General,
Your Excellencies,
Ladies and gentlemen,

It gives me great satisfaction to take part on behalf of the Parliamentary Assembly in this important Conference which has the potential to touch lives of more than 52 million regular migrants, 2 million refugees and asylum seekers, and 13.5 million irregular migrants in Europe.

The figures represent a large group of people in very different situations. Many are regular migrants with well paid jobs who are well integrated. However, many are also migrants in low skilled jobs who work in dirty, dangerous and demeaning jobs, and are therefore vulnerable. Refugees and asylum seekers who fled persecution or war in their country are in a particularly vulnerable situation and in need of special protection. Irregular migrants – who are perhaps the most vulnerable and unprotected group - live in the shadows  of society in fear of expulsion and  prey to all forms of exploitation.

Within the groups I have just mentioned, children, women and elderly are particularly vulnerable.

The concern of our Parliamentary Committee is for the most vulnerable.

We all know that migrants, asylum seekers and refugees are particularly vulnerable to a number of health problems and many have difficulties to access health care.

Refugees and asylum seekers face specific health problems as a result of traumatising experiences and they fear persecution in case of expulsion. Stress-related symptoms such as peptic ulcers, severe headaches, anxiety attacks, dermatitis and sleeping disorders are frequent. This vulnerable group therefore needs very specific medical care and psychological counselling.

Over the years, we have all witnessed distressing images of mass arrivals of irregular migrants and asylum seekers in the Mediterranean and in the Atlantic to the Canary Islands. Those who survive the crossing, are in very poor health condition and need emergency medical care. It is therefore crucial to equip the reception centres with such facilities.

Let me now highlight the vulnerability to health problems related to work.

According to the research studies, occupational accident rates are approximately two times higher for immigrant workers than native workers in Europe.

Migrants – both regular and irregular - who work in construction, heavy industry or agriculture, are particularly exposed to health risks due to exploitation and lack of basic occupational health and safety standards.

In the agriculture sector for example, chronic and often unprotected exposure to pesticides and other chemical products leads to the high incidence of depression, headaches, neurological disorders and miscarriages.

Many reports across Europe point out not only to problems of very low pay, extremely long working hours and withholding of pay, but also to the degrading life in overcrowded shelters without electricity or running water, and to brutal practices by foremen and employers.

Medecins Sans Frontières interviewed in one country in Europe 770 people both regular and irregular migrants working in agriculture and reported that 40% of those interviewed lived in abandoned buildings, 30% had to share their mattress with another person, more than half did not have any running water or toilets, and over 70% had chronic disease.

More than half the pathologies were from various infections, such as skin diseases, mostly due to the fact that they were exposed to pesticides without any kind of protection. The percentage of respiratory infections was high including cases of tuberculosis. 30% of persons examined declared they had been victims of physical violence or bad treatment.

In terms of living conditions, irregular migrants are particularly vulnerable. They are exposed to communicable diseases such as tuberculosis or hepatitis, and respiratory diseases which are associated with poor nutrition, with cold, with overcrowding, and with poor sanitation.

Our parliamentary Committee on migration, refugees and population, heard several testimonies of work exploitation and bonded labour. Exploitation and occupational health risks are not limited to the vast fruit and vegetable farming in the South of Europe, but it is a Europe wide phenomena.


In terms of access to healthcare, migrants, asylum seekers, refugees and displaced persons are vulnerable because they often lack information on their rights and on services that are available to them.

Migrants with low wages and those in irregular situation generally lack money to pay for healthcare.

They are also vulnerable to discrimination or may be subject to reporting by medical or administrative staff.

They may also have cultural and language barriers which give them little confidence to seek medical care and doctor’s advice until it is usually very late.

Prime Minister, Secretary General, your Excellencies,
Ladies and gentlemen,

In terms of policy recommendations, allow me to draw your attention to two important texts which we have adopted in the Parliamentary Assembly:

Recommendation on health conditions of migrants and refugees in Europe (2001)

and our Resolution on human rights of irregular migrants (2006)

The Assembly considers that the right to health associated with access to health care is one of the basic universal human rights and should be equally applied to all people - including migrants, asylum seekers, refugees and displaced persons.

However, very few countries in Europe have developed comprehensive health policies concerning these vulnerable groups. In general, migrants, asylum seekers and refugees are not provided with health services that are socially and culturally adjusted to their needs.

We therefore encourage member states:

- To review national laws and policies to be more culturally and socially adjusted to the needs of migrants, asylum seekers, refugees and displaced persons

- To improve their access to preventive, promotional and curative health services

- To train medical staff and civil servants to adapt better to the specific needs of these vulnerable groups

- To review policies for the protection of migrants in the face of occupational risks

- To develop information programmes for migrants, asylum seekers and refugees covering their rights in the field of health care, and to make this information easily accessible

- To provide interpretation facility where needed

- And to work in partnership with associations which provide help and assistance to migrants, asylum seekers, refugees and displaced persons

In the Assembly, we consider that there is an urgent need to provide clarity on the issue of the rights of irregular migrants, knowing that it is both a difficult and sensitive issue for the member states.

While there is no single legal instrument which deals with the rights of irregular migrants, the most relevant international instrument is the UN International Convention on the Protection of the Rights of All Migrant Workers and Members of their Families. We regret that this Convention has been ratified by only 3 member states of the Council of Europe: Azerbaijan, Bosnia and Herzegovina and Turkey.

From the human right perspective, but also from the public health perspective, we consider that:

- Emergency healthcare should be available to irregular migrants and states should seek to provide more holistic health care, taking particularly into account the specific needs of vulnerable groups such as children, disabled persons, pregnant women and elderly

- Children are in a particularly vulnerable situation and they should be entitled to social protection, including health care, which they should enjoy on the same footing as national children. The Assembly notes that the European Committee on Social Rights has dealt with the health care issue in the Collective Complaint under the European Social Charter brought by the International Federation of Human Rights v. France. In this case it found that children of irregular migrants were entitled to medical assistance.

- We are very concerned that access to health care can be seriously compromised by the reporting obligation for the medical staff and we would strongly encourage those member states, which have such legal provisions, to reconsider them.

Prime Minister, Secretary General, your Excellencies,
Ladies and gentlemen,

Let me conclude and repeat that:

The right to health associated with access to health care is one of the basic universal human rights and should be equally applied to all people - including migrants, asylum seekers, refugees and displaced persons.

I wish you a successful Conference and thank you for your attention.