Presentation by Stéphane Heymans, Doctors of the World, on the occasion of the EESC hearing on Better Roma inclusion through civil society initiatives: focus on health and anti-discrimination (Brussels, 12 May 2014)

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Destitute Roma & access to healthcare
Médecins du monde – Doctors of the World International Network
European Economic and Social Committee – Public Hearing – 12/05/2014
© Christina Modolo

2. 2Médecins du monde – Doctors of the World
 160 domestic programmes with medical and social service provision
to the most vulnerable: homeless people, drug users, sex workers,
undocumented migrants, asylum seekers, destitute European citizens
and… Roma communities;
 20% multidisciplinary centres for access to healthcare – 80% mobile
programmes (street work, squats, camps, isolated villages, etc. with
working hours adapted to the people)
 Specific Roma programmes in Bulgaria (Roma health mediators in
Sliven – vaccination, SSR, access to healthcare), in Greece, France +
2011 research project in NL + 2013 survey in BE

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4. 4Example: destitute Roma in France
 Mobile Roma units going to squats and slums (Marseille, Lyon,
Nantes, Bordeaux, Strasbourg and Saint-Denis) and specific actions
in Toulouse, Grenoble and Nancy
 In 2012: 3,186 medical consultations for 2,171 patients
 60% women – on average 23 years – 44% are minors – mainly RO
 40% received care too late according to our doctors
 Worryingly low vaccination rates: 2010-2011 survey in 4 cities: only
8% completely up to date (with booklet) according to French
immunisation calendar
 Barriers to healthcare: lack of knowledge, language + administration,
discrimination + financial

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© Steven Wassenaar

6. 6Example: destitute Roma in France
 Occupation of vacant lots with hardly any access to water & sanitation
facilities or waste disposal  frequent expulsions by authorities of
living places without any warning or delays + violence by neighbours
 Unannounced expulsions = loss of vaccination cards, loss of
important documents, interruptions of treatment and immunisation
schedules
 Inter-ministerial notification (‘circulaire’) of 26/08/2012 specifies that
individual solutions (education, shelter, work, healthcare) need to be
identified before expulsion. But very heterogenic application…
 Structural slum ‘integration’ plan announced… to be evaluated
 Good practice: health mediation with support from the Health Ministry

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8. 8Health mediation pilot program in France –
results
 Improved access to existing rights
 More frequent (autonomous) use of the existing health services offer,
better adherence to treatments
 Significant increase in vaccination rates (e.g. from 15 to 68% of
children < 6 years vaccinated against hep B)
 The majority of women now knew about a place where to get
contraception – about half of the women effectively used it
 Mediation works in both ways: understanding and adaption from the
side of the community AND from the health service

9. 9Focus on ‘Roma’ or… on ‘destitute EU citizens’?
 Destitute mobile Italian, Spanish, Portuguese, French, British…
citizens often face the same type of barriers as Bulgarians,
Romanians… and as extra-EU undocumented migrants
 Regulation 2004/883 on coordination of social security systems and
Directive 2011/24 on cross-border healthcare but…
 Barriers for insured citizens who try to access the public healthcare
system under the same conditions as insured nationals with their
EHIC (European Health Insurance Card);
 Not all public providers of health insurance across Europe effectively
deliver the EHIC (e.g. areas in BG and RO). Consequent
unreasonable waiting times before a patient can prove health
coverage status in his/her country of origin with no access to
healthcare during this period (often > 6 months);

10. 10‘Roma’ or… destitute EU citizens?
 Insured but destitute EU citizens who cannot afford to advance the
costs in those countries where health insurance only reimburses costs
afterwards.
 EU citizens without health insurance or revenues who overstay 3
months of residence and can consequently be considered as irregular
in accordance with Directive 2004/38/EC – in most countries this
group has no access to healthcare at all.
 MdM International Network Observatory: EU citizens make out 14.9%
of all patients in the 2013 data collection (n = 16,881 patients seen in
25 cities across eight European countries) and 16% of all people not
authorized to stay.

11. 11How EU institutions can help
 Help ensure universal public health systems built on solidarity,
equality and equity, open to everyone living in a European Member
State. All children must have full access to national immunization
schemes and to pediatric care. All pregnant women must have access
to ante- and postnatal care.
 Improved data collection on Roma health & social determinants in
order to deconstruct myths.
 Promote health mediation and mobile outreach teams as a good
practice + empowerment of Roma communities.
 Fight against xenophobia, hate speech and scapegoating, anti-
migrant and anti-Roma discourse.