8 reasons why individuals and groups should reject measures that deny undocumented immigrants access to public health care

Médicos del Mundo is calling on health professionals to refuse to comply with this measure that creates serious ethical dilemmas for health care professionals working in a wide range of fields including nursing, pharmacy, administration and social work.

From the Hippocratic Oath to the World Medical Association’s (WMA) adoption of the Geneva Declaration in 1948, the medical profession has consistently embraced a deontological code that has expressed a firm commitment to provide public health care in a fair and indiscriminatory manner. The latter document contains the pledge “I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient” (article of the 1948 Geneva Declaration proposed by the WMA as an alternative to the traditional Hippocratic oath).

The WMA Declaration of Lisbon on the Rights of the Patient clearly states: “Whenever legislation, government action or any other administration or institution denies patients these rights, physicians should pursue appropriate means to assure or to restore them”.

Médicos del Mundo urges medical personnel to respond to this new decree that prohibits them from providing health care to undocumented immigrants by exercising their rights to individual and collective resistance and conscientious objection and showing their support for the provision of medical care to all people, regardless of their administrative status.

1.- This reform affects the basic right to health.
The decree is incompatible with the Constitution and the statutes of Spain’s autonomous communities. Furthermore, it is in conflict with international public law and treaties that recognize the universal right of access to health care without discrimination to which Spain is a signatory. While the government has the power to pass emergency legislation, such measures cannot flout fundamental rights such as the right to health.

2.- Limiting care to emergency services will aggravate pathologies and increase the overall cost of health services.
Limiting health care to emergency services can lead to the aggravation and chronification of illnesses in cases in which diagnosis is delayed or where clinical manifestations (symptoms) seem absent. Denial of more comprehensive care can lead to conditions that require hospitalisation or the application of more intensive treatments, both of which are more expensive, and in the case of certain pathologies, many prove to be less efficient from a medical standpoint.

3.- People with chronic illnesses will lose access to health care.
Undocumented immigrants with chronic illnesses such as HIV, diabetes or arterial hypertension or who require extended treatments (cancer and dialysis) will lose access to health care when their current health care card becomes invalid on September 1. The only services available to them under the terms of this decree will be emergency care, a flawed option that will lead to delayed diagnoses (with all their consequent complications) and hinder access to treatment, follow-up, specialist care, etc.

4.- A discriminatory health care policy endangers public health.
Hindering immigrants’ access to health care runs counter to the basic objectives of public health care. Prohibiting access to standard health care to immigrants without a residency permit is both risky and irresponsible as it leaves a portion of the population without preventive health care and treatment. Lack of access to primary care can make effective treatment of some infectious diseases difficult and can have a serious impact on public health.

5.- NGOs are not the answer to the immigrant health care issue.
Health is a universal right all people are entitled to and that all nations should uphold. The decree supposes the State’s abandonment of its obligation to protect public health and lays the groundwork for a parallel system that relies on the goodwill of “charitable” organizations. NGOs should not, and will not, assume the obligations of government.

6.- Immigrants are not overburdening the primary care system.
Immigrants are not, as is sometimes purported, collapsing the public health system. A number of studies have shown that although immigrants make up more than 10% of the population, they account for only 5% of primary care consultations.

7.- Medical tourism and immigration are two different things.
Immigrants contribute to health care budgets through the various taxes that are used to fund them such as the standard sales tax, special taxes on particular goods and services and the indirect sales tax known as the ‘céntimo sanitario’. Immigrants do not come to Spain to take advantage of health care coverage. During a survey of undocumented immigrants carried out by Médicos del Mundo, only 4% of the subjects surveyed cited access to national health care as a motive for immigrating to Spain.

8.- Spain trails behind the rest of Europe.
The minister of Health’s argument that the exclusion of undocumented immigrants brings Spain in line with the rest of Europe cannot be taken at face value. In terms of policy, this decree brings Spain to the level of Slovenia, Cyprus and Poland: countries in which undocumented immigrants, with the exception of minors, are only eligible for emergency care. With the imposition of this measure, Spain has lost its position in the vanguard of European countries that guarantee universal health care and now ranks among the countries of the European Union that offer the least coverage. In neighbouring countries such as France, Belgium, Italy and Portugal, undocumented immigrants are entitled to receive standard health care.

Health is a right and we stand by our commitment to facilitate universal access to health care.
We are very concerned about the helpless situation this decree is creating for undocumented immigrants. We cannot accept administrative decisions that deprive any person living in Spanish territory of his or her right to health, and we are individually and collectively committed to advocating and ensuring access to health care for all people in need of medical attention and treatment.