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.
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 Refer to the definition given by the World Health Organization https://www.who.int/news-room/fact-sheets/detail/primary-health-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.
- Bozorgmehr K., Dieterich A., Offe J., 2019. “UN Concerned about the Right to Health for Migrants in Germany”, The Lancet, vol. 393, p. 1202–1203. DOI : 1016/S0140-6736(19)30245–4
- Carin Björngren Cuadra, 2012. “Right of access to health care for undocumented migrants in EU : a comparative study of national policies”, European Journal of Public Health, Volume 22, Issue 2, April, p. 267–271, https://doi.org/10.1093/eurpub/ckr049
- Huschke S., 2014. “Performing Deservingness. Humanitarian Health Care Provision for Migrants in Germany”, Social Science & Medicine, vol. 120, p. 352–359. DOI : 1016/j.socscimed.2014.04.046
About the author
Jérémy Geeraert is a postdoctoral researcher at the Centre de recherches sociologiques sur le droit et les institutions pénales (Cesdip).
|↑1||Refer to the definition given by the World Health Organization https://www.who.int/news-room/fact-sheets/detail/primary-health-care|
Cite this article
Jérémy Geeraert, “Access to healthcare for irregular migrants in Germany. An improving outlook?” [trad. Victoire Hernandez], in Betty Rouland (dir.), Issue “State Medical Assistance and the making of a fake problem”, De facto [Online], 31 | February 2022, [English] published online on February 2023. URL : https://www.icmigrations.cnrs.fr/en/2022/07/25/defacto-031–07/
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