Background information
Applicants for international protection often suffer from severe traumas, impacting their health and mental well-being, and sometimes leading to lack of trust in authorities, excessive fear of stigma and negative coping mechanisms. Additionally, they might have pre-existing medical conditions that require immediate attention upon arrival at the reception facilities.
The health literacy of applicants plays a significant role in their ability to navigate and engage with healthcare services effectively. Health literacy refers to the capacity to obtain, understand, and apply health information to make informed decisions. This includes skills such as reading medical instructions and prescriptions, comprehending healthcare systems, and making informed health-related choices. Factors such as socioeconomic status, cultural background, past experiences, cognitive abilities, and mental health can influence an individual's health literacy. Low health literacy can result in increased use of healthcare and higher costs, often due to reliance on emergency care and little use of preventive services. Therefore, addressing health literacy barriers is essential for promoting equitable access to healthcare services and improving health outcomes among applicants in reception.
In accordance with the recast reception conditions directive (2013/33/EU), (RCD (recast)), Member States are obligated to provide applicants with information regarding established benefits and obligations, including health care, as well as on organisations or groups of persons that might be able to help or inform them concerning the available reception conditions (Article 5(1) RCD (recast)). Specifically, Member States are required to provide applicants at least with essential healthcare, including emergency care, treatment for illnesses, and support for serious mental disorders. Moreover, they must offer necessary medical or other assistance to applicants with special reception needs, ensuring access to appropriate mental health care as required (Article 19 RCD (recast)). These basic services should be available to applicants at all times, irrespective if they have been subjected to a reduction or cancellation of the material reception conditions (Article 20 RCD (recast)). Additionally ‘Member States shall ensure that persons who have been subjected to torture, rape or other serious acts of violence receive the necessary treatment for the damage caused by such acts, in particular access to appropriate medical and psychological treatment or care’ (Article 25 RCD (recast)). Member States can also require medical screenings on public health grounds (Article 13 RCD (recast)).
In accordance with Directive 2013/32/EU on common procedures for granting and withdrawing international protection (recast), Member States may employ medical examinations to ascertain the age of unaccompanied minors during the asylum procedure. However, these procedures can only be conducted with the consent of the child and their representative, and must be carried out with careful consideration of the best interests of the child principle.
Most Member States grant free of charge access to secondary, non-emergency care for applicants, who are entitled to the same treatments as insured residents and citizens. Special reception needs, especially for vulnerable cases like children, particularly unaccompanied ones, should be met, and include access to rehabilitation and appropriate mental healthcare services (Article 23 RCD (recast)).
For additional information check the healthcare sections of the EASO Guidance on Reception Conditions – Operational standards and indicators, 2016, and the EASO Guidance on Reception Conditions for Unaccompanied Children – Operational standards and indicators, 2018.
Information provision messages
Inform applicants on the below.
- The health examination they will undergo, focusing on the ‘5W’ (why, what, by whom, when, how). Explain the possibility of having same-gender medical staff and interpreters during the screening and medical checks, when possible.
- Physical and mental healthcare services available inside and outside the reception facility including brief information regarding:
- relevant procedures and schedule for accessing them;
- costs (if any) and available resources (transportation, vouchers).
- The fact that staff can facilitate contacts with relevant stakeholders (e.g. NGOs, international organisations) providing additional healthcare support networks and resources for beneficiaries, such as consultations and treatment, peer support groups, physically accompanying them to visits etc.
- The importance of applicants communicating their health condition and needs in order to receive adequate care, including treatment and monitoring. Provide messages to promote destigmatisation of certain healthcare conditions, such as mental health issues, chronic diseases, substance addictions etc. Examples of such messages could include information on the relation between mental and physical health, on the presence of chronic disease in many people’s lives and the importance of seeking support, on addictions as medical conditions that can be treated and lead to full recovery, on disability as a human condition whose negative effects can be overcome through respect, dignity and accessibility.
- The confidentiality of the information shared and how this applies to sharing health records Emphasise on the importance of preventive measures and promotion of healthy habits and coping mechanisms. Promote health education sessions and encourage applicants’ participation. When organising sessions on personal and family hygiene practices, highlight the link with respecting house rules, e.g. cleaning.
- The available and/or mandatory immunisation services.
- The available reproductive healthcare services.
- The availability of interpreters and cultural mediators* to facilitate communication between healthcare providers and applicants.
- Consider separate sessions with female applicants to discuss sensitive issues such as reproductive health and contraception. If the applicants come from a region where FGM (female genital mutilation) is practised, they need to hear about possible remedies for women who underwent FGM as well as prevention of FGM for young girls.
Note: A cultural mediator is a professional who facilitates the communication (including interpretation) between people speaking different languages and coming from different cultural backgrounds (European Commission, Asylum and Migration Glossary).
Practical tips
- Adjust communication for applicants and ensure to avoid or to properly explain healthcare terminology. Applicants might not be familiar with terms such as ‘psychologist’, ‘condition’, ‘diagnosis’ etc. Use visual support, such as pictograms and explanatory animations, to facilitate understanding and eradicate misconception. Address any rumours or stigma associated with health conditions and access to healthcare as soon as possible by providing concrete examples.
- Involve healthcare providers in developing information materials and have them participate in information sessions when possible. Support them in increasing their intercultural competencies to effectively deliver messages to applicants.
- Take an intersectional approach to healthcare when providing information to people with special needs, considering a range of specialised services.
- Organise individual sessions as needed to provide targeted information and to build trust with applicants to ensure their willingness to disclose vulnerabilities, medical conditions, and to seek treatment.