No place to fall sick: How refugees are barred from healthcare

United Kingdom
Europe
Lebanon
Sweden
Refugees rescued in the Mediterranean

Migrants who were rescued from a boat capsized in the Mediterranean Sea are pictured in Al-Beheira, Egypt. © Reuters/Mohamed Abd El Ghany

Refugees and undocumented migrants around the world are in a precarious legal position.

Administrative and legal barriers, together with prohibitive costs, mean those fleeing conflict and persecution are often left without the most basic rights to healthcare.

At this week’s UN summit, heads of state promised to share responsibility for the 65 million people displaced worldwide. The six wealthiest countries host less than nine per cent of the world’s refugees while poorer countries bear the brunt of the crisis.

Lebanon has the highest number of refugees compared to its population, with over a million Syrians living there.

However, the country did not sign the 1951 UN Refugee Convention and does not protect the legal rights of refugees. Asylum seekers are treated as illegal migrants and do not have a legal status – thus also no access to Lebanon’s fragile and highly privatised healthcare system. Most refugees also just have limited access to the labour market.


Persons of concern (refugees, asylum seekers and internally displaced persons, made up 25 per cent of the Lebanese population in 2015. The world average was only 0.86 per cent.

Some argue Lebanon is circumventing the International Covenant on Economic, Social and Cultural Rights (ICESR) which upholds everyone’s right to work.

‘Syrian refugees are increasingly being pushed towards informal and exploitative labour,’ says Dr Maja Janmyr, a forced migration specialist at the University of Bergen. ‘Under Lebanese law, they are only permitted to work in three sectors: agriculture, construction and cleaning.’

In October 2014, the Lebanese government introduced regulations requiring Syrian refugees to renew their residency permits by paying $200 (£153) every year. The UNHCR estimates that over 55 per cent of Syrian refugees do not have legal residency.

Without this, refugees are vulnerable to arrest, detention and expulsion. They can be sent back to Syria forcibly if they are unable to show the correct documentation at a checkpoint. Sending victims of conflict back to a country where their lives are threatened contravenes the non-refoulement principle, a cornerstone of international law.

‘We know from conversations with refugees that they feel legal residence is key to their safety and that a majority feels that their freedom of movement is restricted,’ says Lisa Abou-Khaled, a UNHCR spokesperson.

Lebanon also doesn’t grant birth certificates to new-borns, leaving them stateless, which some argue shows a serious disregard for their human rights. Two thirds of the 53,000 children born to Syrian refugee parents since March 2011 do not have a birth certificate, according to a report by the Norwegian Refugee Council.

Vulnerable migrants face legal barriers in richer countries, too.

Sweden has cracked down on immigration in the past year. So far, it received 20,117 asylum in 2016, just a fraction of the 162,877 received in 2015.


The number of asylum application to Sweden plummeted after the country passed more restrictive regulations.

Since June, denied asylum seekers in Sweden are no longer entitled to accommodation, a daily stipend, nor to an LMA card, which provides access to healthcare.

‘The law pushes towards self-sufficiency’ explains says Linnea Sandström Lange, a spokesperson for Doctors of the World in Stockholm. ‘To get permanent residency and be united with your family, you have to be financially independent.’

In the UK, the 2014 Immigration Act aims to ‘prevent illegal immigrants accessing and abusing public services or the labour market’, and introduced a health surcharge for non-EEA nationals who stay in the UK for longer than six months.

Undocumented migrants must pay 150 per cent of the cost of any hospital care they receive. According to the Immigration Act, treatment for infectious illnesses should be provided free of charge, but in reality many patients are billed.

Josephine was 27 weeks pregnant when she arrived in the UK from Uganda. She was repeatedly turned away from her GP surgery, and didn’t receive any antenatal care until she was 35 weeks into pregnancy. When she eventually saw a doctor for a scan she received a bill for £329 – and was lucky enough, given that undocumented pregnant women can be charged up to £9,000 for pregnancy care

In Greece, undocumented pregnant women are entitled to free healthcare, after a law was passed in February granting vulnerable uninsured individuals access to the health system.

But unaccompanied children in Greece remain particularly vulnerable. Many are detained, sometimes for months at a time, while they wait for an opening in reception facilities, according to a report by the Platform for International Cooperation on Undocumented Migrants (PICUM) which states that access to healthcare in some detention centres is ‘almost-non-existent’.

According to Human Rights Watch 3,300 unaccompanied children arrived in Greece between January and July this year. Greek police detained 160 unaccompanied children in this period for 40 days on average.

At the UN summit world leaders vowed to protect children from exploitation and help them access education and healthcare.

Human rights organizations say that the commitments should be clear and binding, as they will carry little weight without a clear blueprint as to how they will be realised.

If UN Member States wish to translate their declaration of solidarity into reality, they must not shirk their responsibilities and adopt legislation that protects the rights of refugees and undocumented migrants.

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