Print
See related documents
Committee Opinion | Doc. 13431 | 19 February 2014
Migrants and refugees and the fight against AIDS
Committee on Social Affairs, Health and Sustainable Development
A. Conclusions of the committee
(open)1. The Committee on Social Affairs, Health and Sustainable
Development supports the report prepared by Ms Doris Fiala on behalf
of the Committee on Migration, Refugees and Displaced Persons. In
its report entitled “Equal access to health care”, which led to
the adoption of Resolution
1946 (2013), our committee noted that factors such as
discrimination, financial, language and information barriers, socio-economic
inequalities and certain migration and security policies were leading
to growing inequalities in access to health care in Europe. It also
noted that vulnerable groups, including migrants and especially
those in an irregular situation, were particularly affected by these
inequalities. Unfortunately, Ms Fiala's report confirms these findings
in the specific context of migrants and refugees and the fight against
HIV/AIDS.
2. The Committee on Social Affairs, Health and Sustainable Development
would propose some amendments to the draft resolution so as to clarify
certain aspects concerning health which seem important in the light
of its terms of reference.
B. Proposed amendments
(open)Amendment A (to the draft resolution)
In the draft resolution, insert the following new paragraph 1:
“The right to health is a fundamental human right. Because of its universal nature, the right to health applies to all individuals, including migrants, regardless of their status. Access to care is a key aspect of the right to health.”
Amendment B (to the draft resolution)
In the draft resolution, at the end of paragraph 3, add the following sentence:
“All these factors lead to a phenomenon of non-recourse or delayed recourse to care, or an impossibility to access care, which could have disastrous implications for both individual and public health and lead in the long term to an increase in health expenditure.”
Amendment C (to the draft resolution)
In the draft resolution, paragraph 4, replace the words “This allows the virus to spread and represents a serious threat to public health” with “, which may contribute to the transmission of the virus.”
Amendment D (to the draft resolution)
In the draft resolution, paragraph 5, replace the word “infected” with “HIV-positive”.
Amendment E (to the draft resolution)
In the draft resolution, paragraph 6, replace the word “infected” with “HIV-positive”.
Amendment F (to the draft resolution)
In the draft resolution, at the end of paragraph 8.1.3, add the words “or where such treatment is not realistically accessible there for the person concerned in view of his or her individual situation”.
Amendment G (to the draft resolution)
In the draft resolution, after paragraph 8.2.1, insert the following paragraph:
“ensure that migrants have access to information concerning prevention, testing and treatment of HIV;”
Amendment H (to the draft resolution)
In the draft resolution, after paragraph 8.2.6, add the following paragraph:
“dissociate their immigration policy from health policy, where appropriate by abolishing the obligation on health professionals to report migrants in an irregular situation.”
Amendment I (to the draft resolution)
In the draft resolution, paragraph 8.3.3, replace the word “HIV/AIDS-infected” with “HIV-positive”.
C. Explanatory memorandum by Ms Maury Pasquier, rapporteur for opinion
(open)1. The right to health is a fundamental human right
enshrined in international and regional instruments, including the
United Nations International Covenant on Economic, Social and Cultural
Rights (Article 25.1) and the Council of Europe's revised European
Social Charter (ETS No. 163, Article 11). Because of its universal nature,
the right to health applies to all individuals, including migrants,
regardless of their status (regular or irregular). Access to care
is a key aspect of the right to health. I think that these principles
should be reaffirmed at the beginning of the draft resolution with
a view to reinforcing its main message (Amendment A).
2. In her report, Ms Fiala notes, among other things, that migrants
face many barriers in accessing HIV/AIDS preventive care and treatment:
financial constraints, language barriers, lack of information about
the health services available, socio-cultural barriers and restrictive
migration and health-care policies. In this context, to enable readers
to understand what is actually involved in the problem of access
to care, I believe that it is important to add a sentence to the
draft resolution concerning the possible consequences of the above-mentioned
barriers. As already noted in our committee's report entitled “Equal
access to health care” (Doc. 13225),
these barriers lead to a phenomenon of non-recourse or delayed recourse
to care, or an impossibility to access care, which, in the case
of a communicable and potentially fatal disease such as HIV/AIDS,
could have disastrous implications for the health of the migrants
concerned and for public health in general, while leading in the
long term to an increase in health expenditure (Amendment B).
3. With regard to paragraph 4 of the draft resolution, it seems
somewhat contradictory - if not dangerous - first to note that in
most European countries there is a lack of data about HIV transmission
amongst migrants and then to state that insufficient education for
migrants concerning testing and safe-sex practices allows the virus
to spread and represents a serious threat to public health. This
applies especially since paragraph 11 of the explanatory memorandum
acknowledges that determining the exact extent to which migration
impacts on the overall burden of HIV/AIDS in Europe is not entirely
clear. In these circumstances, it is only possible to make assumptions
about the potential consequences of insufficient education for migrants
concerning testing and HIV prevention - not, in my view, to make
statements to the effect that it allows the virus to spread and represents
a serious threat to public health. In this connection, I would also
underline that if Amendment A is accepted, it would be repetitive
to talk of a serious threat to public health (Amendment C).
4. The term “infected” is used in three different paragraphs
of the draft resolution to designate people carrying the HIV virus.
In my opinion, it would be much more appropriate to talk about people
who are “HIV-positive”, thus amendments D, E and I.
5. Moreover, in view of the points made in paragraphs 47 to 49
of the explanatory memorandum, I propose that the conditions for
protecting seriously ill foreigners against expulsion should include
the accessibility of antiretroviral treatments in the countries
to which migrants are to be expelled (Amendment F).
6. The first paragraph of the draft resolution refers rightly
to the “problems that migrants face in accessing information and
treatment for the virus once they are living in Europe”. That is
the issue of accessibility of information concerning health care,
which is one of the key aspects of the problem of access to health
care. In my opinion, this issue should be highlighted more clearly
in the operative part of the draft resolution, thus Amendment G.
7. Lastly, I also propose that a paragraph be added to the draft
resolution asking States to dissociate their immigration policy
from health policy, where appropriate by abolishing the obligation
on health professionals to report migrants in an irregular situation.
An almost identical recommendation was made in Resolution 1946 (2013) on equal access to health care, but I believe that it
is vital to reiterate it in this new text on the specific subject
of migrants. In this connection, I would repeat the following observation
by the HUMA (Health for Undocumented Migrants and Asylum seekers)
network: “The debate concerning undocumented migrants continues
to be rooted in the fight against ‘illegal migration’, and no debate
has yet been opened, if only for public health concerns, about the
need to protect the health of these people”. The migration policies
in question endanger the lives of the people concerned and stigmatise
them still further, and are also a serious public health problem
in the case of communicable diseases, as the inability to access
care or delayed recourse to care exposes the entire population to
possible infection (Amendment H). 