Doc. 8878

16 October 2000

Health conditions of migrants and refugees in Europe

Opinion

Social, Health and Family Affairs Committee

Rapporteur: M. Francisco Arnau, Spain, Socialist Group

I.       Conclusions of the committee

1.       The committee fully supports the proposals put forward by the rapporteur of the Committee on Migration, Refugees and Demography and particularly draws the attention of the member states to the need to develop national policies that address more specifically the health needs of migrants, refugees and other displaced persons.

2.       The Council of Europe should indeed facilitate this process and develop guidelines in consultation with the relevant governmental and non-governmental organisations (draft recommendation, paragraph 9 iii).

3.       Furthermore, migrant workers should enjoy equal opportunities and treatment in respect of employment and social security, in accordance with the relevant international instruments.

4.       Finally, the committee points to the "Solidarity Card" recently introduced in Valencia (Spain), which enables illegal immigrants living in that region to receive the same medical care as other citizens, as one possible way of guaranteeing this fundamental human right.

II.       Explanatory memorandum

1.       Common features of the problem

1.1       Introduction

5.       Migrant workers and refugees have something in common: the fact that they reside in a country which is not their country of origin, which may entail particular difficulties in gaining access to essential services, such as health and education.

6.       These difficulties may mean that, compared to the nationals of the host country, migrant workers and refugees are discriminated against with regard to these fundamental rights. When the problem is one of preventing or curing an illness, ie the right to health, the situation may become irreversible if migrant workers and refugees are not given the medical care they require under the same conditions as nationals of the country of residence.

7.       The report of the Committee on Migration, Refugees and Demography describes the situation of migrants and refugees in Europe and risks to their health. The Social, Health and Family Affairs Committee considers it appropriate, from its point of view, to concentrate on the legal aspects and, in particular, the right of groups of migrants and refugees to health care.

2.       Migration in Europe

2.1       The proposals of the European Union's Commissioner for Justice and Home Affairs

8.       The European Union is in the midst of a reform of its institutions with a view to adapting them to the new situation in Europe, one feature of which is the massive flow of migrants looking for work in the fifteen member countries.

9.       The Commissioner for Justice and Home Affairs proposes to define a common immigration policy for the future based on the following three pillars: appropriate relations with third countries, control of migration flows and the integration of non-Community residents into the countries of the European Union.

10.       Account must be taken of the fact that, according to a recent UN report, at the present rate of decline in births and with the ageing of the population, Europe will need some 160 million foreign workers over the next 25 years to compensate for labour shortages and to be able to maintain its current standard of living. Even if the figure may seem excessive, it is obvious that the European Union needs to have a common immigration policy in which the countries which have applied for membership and the remaining European countries should participate.

2.2       From Schengen to Tampere

11.       The Schengen Agreement on the abolition of frontier controls began to be applied, not without some difficulty, as from 25 March 1995; it has therefore been deemed necessary to amend the Agreement on the basis of the conclusions adopted at the European Council Summit in Tampere (Finland) in October 1999.

12.       In Tampere, the Heads of Government of the countries of the European Union decided to establish an area of freedom, security and justice in Europe, and this will have significant consequences for the measures to be taken in the field of asylum and migration as from 1 January 2005.

13.       For the time being, however, it can be said that there is no common immigration policy in the European Union, even if intergovernmental co-operation in this field continues, given that Title VI of the Treaty of the European Union, Article K. 1, provides for joint action with regard to the conditions for new immigrants' access to the European Economic Area.

2.3       Need for a common policy for the social integration of immigrants

14.       European construction requires not only a common policy on migration but also joint action to promote the social integration of immigrants, their harmonious co-existence with nationals and equal rights. The Council of Europe should act as a guarantor in all these areas of work.

15.       The social integration of foreign workers also calls for resolute action against racism and networks dealing in illegal immigration.

2.4       Immigrants have rights

16.       Immigrant workers must be considered not only as a source of labour but as people with rights, for example the right to equal treatment without discrimination of any kind, particularly in the field of health.

2.5       The right to medical care

17.       The right to health, which is a universal right, cannot be secured if the right of everyone to have access to health care services is not recognised. However, the problem of non-recognition of the right to medical care is one that affects undocumented or illegal migrants, especially as regards access to emergency services.

2.6       Situation under international law

18.       Minors under 18 years of age, irrespective of their legal situation or that of their parents in the country of residence, have the right to health care under the terms of the 1989 Convention on the Rights of the Child.

19.       Before the Second World War, the International Labour Organisation (ILO) worked for the introduction of international rules governing the migration of workers, but the only outcome was Convention 21 on the Inspection of Emigrants on Board Ship and Convention 86 on migrant workers, which did not even come into force.

20.       After the Second World War, in 1949, the ILO adopted Convention 97 on migrant workers, setting forth the principle of equality of treatment with nationals of the country of residence, but the Convention applies only to legal migrants.

21.       However, ILO Convention 143, adopted in 1975, obliges signatory states to respect the basic human rights of all migrant workers, irrespective of whether they are legal or illegal migrants; as a result very few States have ratified the Convention.

22.       The International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families, adopted by the UN General Assembly, Resolution 45/158 of 18 December 1990, distinguishes between migrant workers in a documented or regular situation and migrant workers in a non-documented or irregular situation.

23.       Under this Convention, migrant workers in an irregular situation are entitled to more or less the same legal treatment as documented migrants in a regular situation. All migrant workers and the members of their families are entitled, under the terms of Article 28, to "receive any medical care that is urgently required for the preservation of their life or the avoidance of irreparable harm to their health on the basis of equality of treatment with nationals of the State concerned". Particular reference is made to the fact that "such emergency medical care shall not be refused them by reason of any irregularity with regard to stay or employment".

24.       Moreover, it is stipulated in Articles 43 and 45 of the same UN Convention that migrant workers and the members of their families shall enjoy equality of treatment with nationals of the State of employment in relation to access to social and health services, provided that the requirements for participation in the respective schemes are met.

3.       Refugees in Europe

3.1       The situation in the European Union

25.       During the Tampere European Council, the Heads of State and Government discussed the joint measures to be applied in the fields of immigration and asylum as from 2005.

26.       The number of applications for asylum since the Balkans War has obliged European countries to co-ordinate their policies and made it necessary to define the concept of refugee as a starting point for formulating their rights. This led to the establishment of the Eurodac system for identifying asylum-seekers by their fingerprints.

4.       Migrants and refugees in Europe: common problems

27.       Illegal migrants and refugees in the process of legalising their situation represent a major problem in the area of health-care provision.

28.       Different European countries deal with the problem of resident aliens' access to health services in different ways. There are different practices, even within one and the same country, but the highest degree of protection is afforded to children, pregnant women, people suffering from infectious diseases and people requiring emergency medical care.

5.       The new "Solidarity Card" introduced by the Autonomous Community of Valencia (Spain)

29.       The health authorities of the Autonomous Community of Valencia have just introduced a "Solidarity Card" which enables illegal immigrants living in this region to receive the same medical care as other citizens. This solution ensures that all resident citizens have access to public health services, irrespective of their legal status. Immigrants' personal details are registered on a file which is available to all public health centres.

30.       The solution found in Valencia for providing medical care to all those in need of it – reflected in the very name of the Card – points to one possible way of guaranteeing one of the fundamental human rights.

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Reporting committee: Committee on Migration, Refugees and Demography (Doc. 8650)

Committee for opinion: Social, Health and Family Affairs Committee

Reference to committee: Doc. 8105 and Reference No. 2287 of 26 May 1998

Opinion approved by the committee on 31 August 2000

Secretaries to the committee: Mr Newman, Mrs Meunier and Mrs Clamer