Access to healthcare for irregular migrants in Germany. An improving outlook ?

Jérémy Geeraert, sociologist

In Germany, irregular migrants have difficulties accessing healthcare due to restrictive migration policies that force them to seek care within charitable organisations. Recent evolutions indicate improvements in the situation. 

Introduction

Germany appears to be one of the coun­tries in the Euro­pean Union that least protects irre­gular migrants’ health. Although the country has committed to respec­ting various funda­mental rights through inter­na­tional and Euro­pean trea­ties (such as the right to primary heal­th­care^[1] Refer to the defi­ni­tion given by the World Health Orga­ni­za­tion https://​www​.who​.int/​n​e​w​s​-​r​o​o​m​/​f​a​c​t​-​s​h​e​e​t​s​/​d​e​t​a​i​l​/​p​r​i​m​a​r​y​-​h​e​a​l​t​h-care), struc­tural obstacles restrain the fulfilment of the latter. Irre­gular migrants, as well as Euro­pean natio­nals, face multiple obstacles to access care – and it is the result of dissua­sive migra­tion poli­cies inter­fe­ring with health poli­cies. Discourses portraying forei­gners as a threat to the Social State have prompted the deve­lop­ment of regu­la­tory instru­ments that directly and indi­rectly exclude these groups from the German heal­th­care system. Addi­tio­nally, budget strin­gency poli­cies have tended to aggra­vate these issues. However, recent demo­gra­phic evolu­tions suggest that things are changing.

The exclusion of undocumented migrants from public healthcare

From a legal stand­point, an irre­gular migrant can benefit from the same heal­th­care rights as an asylum seeker, which would entail that they have access to a range of heal­th­care services that are restricted to acute pains and severe illnesses. Even so, legal dispo­si­tions on the right of resi­dence (Aufen­thalts­ge­setz) render these rights almost unusable. Indeed, civil servants have the obli­ga­tion to report any undo­cu­mented migrants they might encounter at work to the immi­gra­tion services. Thus, this has a highly deter­ring effect on one’s will to seek care. Conse­quently, it is the fear to be deported that dissuades undo­cu­mented migrants to resort to social protec­tion services.

There is an excep­tion to the obli­ga­tion of repor­ting policy that exclu­si­vely applies to urgent and vital care. In this case, social welfare services are bound to medical confi­den­tia­lity if one requests to be taken care of. Effec­ti­vely, the protocol to follow is too complex, the period too short and the chances of success too slim that hospital services would rather decline care to undo­cu­mented patients. Alter­na­ti­vely, they would bill the patient or their family on the spot, there­fore signi­fi­cantly indeb­ting the patient and their family due to the high cost of emer­gency care. Subse­quently, the health and social sector are parti­cu­larly impacted by the conjunc­tion of immi­gra­tion and auste­rity policies.

“Discourses portraying foreigners as a threat to the Social State have prompted the development of regulatory instruments that directly and indirectly exclude these groups from the German healthcare system.”

Jérémy Geeraert, sociologist

It is the fear of depor­ta­tion and of exces­sive debts that forces undo­cu­mented migrants to turn to the volun­tary and huma­ni­ta­rian sector as it protects their iden­tity. They become dependent on it for all their health concerns, whether it be for acute problems, the mana­ge­ment of chronic illnesses or situa­tions that require hospital inter­ven­tion (child­birth, opera­tions, etc.). 

None­the­less, having inter­na­lised their ille­gi­ti­macy to receive health protec­tion, patients tend to only seek help when the pain becomes unbea­rable. Delays in care are further exacer­bated by the fact that these aid struc­tures, esta­bli­shed by civil society and financed through dona­tions, can only provide a frag­mented and incom­plete range of care. Addi­tio­nally, they are only avai­lable in major cities. Illnesses that are too compli­cated or too expen­sive are often not treated due to the lack of resources.

Growing awareness and incoming improvements ? 

Since 2015 and the rise in Germany’s immi­gra­tion rates, the number of irre­gular migrants has increased, but so has the expo­sure to the issues they face. This led to rapid growth in care supply for those excluded from public heal­th­care. There has been a signi­fi­cant increase of heal­th­care esta­blish­ments within chari­table orga­ni­sa­tions and through local initia­tives on a regional (the Land) and city-scale (the Clea­ring­stellen). These orga­ni­sa­tions offer social welfare, as well as (limited) access to heal­th­care to those who do not benefit from health insu­rance, inclu­ding confi­den­tia­lity for irre­gular migrants. This initia­tive was part of the demands of the Medibüro asso­cia­tion –an asso­cia­tion that fights for undo­cu­mented migrants’ right to heal­th­care– since 1995. This renewed interest in issues regar­ding the right to heal­th­care in civil society and the poli­tical sphere suggests further struc­tural changes are to catch on. Thereby, since last year, nation­wide campai­gning was set out by Méde­cins du Monde (Germany), Medibüro and about 50 other orga­ni­sa­tions. The aim is to change the para­graph of the law on the right to remain that instructs civil servants to denounce irre­gular migrants. This recom­men­da­tion was included in the coali­tion agree­ments of the new govern­ment that took office in November 2021, thus revi­ving hope for better conditions.