Doc. 9304

21 December 2001

Health conditions of migrants and refugees in Europe

Recommendation 1503 (2001)

Reply from the Committee of Ministers

adopted at the 778^th meeting of the Ministers’ Deputies (19 December 2001)

The Committee of Ministers has examined Parliamentary Assembly Recommendation 1503 (2001) on the health conditions of migrants and refugees in Europe.

The Committee of Ministers attaches great importance to promoting health equity and improving the health status of vulnerable sectors of the population. It draws the Assembly’s attention to its recent Recommendation Rec (2001) 12 on the adaptation of health care services to the demand for health care and health care services of people in marginal situations, which has enhanced the series of recommendations on vulnerable populations. The definition of persons living in insecure conditions and in marginal situations is applicable to migrants and refugees. Many of the measures put forward by the Assembly in its recommendation are compatible with the policy guidelines set out in Recommendation Rec (2001) 12.

It recommends the introduction of a coherent and comprehensive policy framework based on the principles of equity, human dignity and participation. In order to protect and improve the health of people in marginal situations, this recommendation proposes a multi-sectoral approach for carrying out preventative work, ensuring a favourable context for social reintegration, avoiding stigmatisation and improving knowledge of this field. The measures adopted to facilitate access to health care for vulnerable persons are also of benefit to the population as a whole, and help to avoid the pitfall of “second-class medicine for the poor”.

As the Council of Europe has noted whilst carrying out the activities on access to social rights for vulnerable persons (i.e.: access to social protection, access to housing and access to employment), measures aimed at facilitating access to health care for persons in marginal situations should not on any account be disassociated from the design and implementation of integrated approaches aimed at improving effective access to social rights.

The activities on access to social protection, access to housing and access to employment, have lead to the adoption, in 2001, of guidelines for the improvement of access to these respective rights. The Group on access to social rights will carry forward the results of these activities and, by following an integrated approach which will take account of the health and education aspects, will draw up in 2002 a comprehensive report on access to social rights.

The Assembly’s attention is also drawn to the activities of Working Table II of the Stability Pact as part of the “Initiative for Social Cohesion” Working Group. The health component is called “South-East Europe Strategic Review on Social Cohesion - Health Network” and focuses on a survey to improve access to health care for vulnerable and marginalized persons.

This work was used to prepare the Health Ministers’ Forum in Dubrovnik, which was a particularly important event in developing regional co-operation for health development in South-East Europe, promoting access to health and reducing vulnerability. Amongst the achievements of the Forum was the adoption and signing by the Ministers of a commitment to meet the health needs of vulnerable populations in South-East Europe - “the Dubrovnik Pledge”. The Health Network will continue its work throughout 2002 in order to identify priority issues in policy development and offer practical solutions, including projects of a regional dimension.

This activity is a response to the concern expressed by the Health Ministers of the Council of Europe member States in 1999 at their 6th Conference with regard to the impact of the crisis in South-East Europe on the life and health of refugees, displaced persons and all persons living in the area, as well as on health and social services in countries directly affected.

The Committee of Ministers has carefully studied the Assembly’s suggestion that it examine national laws and policies in regard to the health of migrants and refugees with a view to developing a comprehensive, harmonised approach in all member states. It is true that, at the present time, equal access to health care in the majority of member states is only guaranteed to legal immigrants and refugees, whilst other migrants receive only emergency health care.

As regards developing new policy guidelines on the health conditions of migrants and refugees in Europe, the Committee of Ministers is examining the possibility of launching a joint activity by the European Committee on Migration (CDMG) and the European Health Committee (CDSP). In particular, the second committee’s work could focus on examining the organisation of health care in a multicultural society.

The CDMG’s work could draw on the conclusions of the report on “Diversity and Cohesion: new challenges for the integration of immigrants and minorities”, in which the issue of access to health services was considered at length. Equal treatment is an aspect of integration policy and community relations. Another facet of the CDMG’s activity could focus on reviewing policies to protect migrants against occupational hazards. The Convention on the Legal Status of Migrant Workers could serve as the basis of this work.

The Committee of Ministers has brought Recommendation 1503 (2001) to the attention of the governments of its member states, with a view to informing them of the various measures recommended by the Assembly. It welcomes the renewed invitation to member states to sign and ratify the relevant legal instruments, and is pleased to note the willingness, expressed by the Parliamentary Assembly, the Congress of Local and Regional Authorities and the European Committee on Migration, at the Conference on “Irregular Migration and Dignity of Migrants: co-operation in the Mediterranean region” held in Athens on 3 and 4 October 2001, to pursue a joint campaign to encourage signature and ratification of the Council of Europe’s relevant legal instruments.