The C-MISE Guidance provides extensive information on practices that municipalities across Europe have adopted to provide access to healthcare to irregular migrants. These practices may offer a blueprint for other local authorities promoting access to healthcare to irregular migrants.

Migrants with irregular status face various obstacles when accessing healthcare services. In many European countries, they may be eligible only to receive emergency care, as various national legislations restrict their entitlements to access treatment. Also in relation to treatments they are legally entitled to receive, they may meet hurdles trying to access healthcare due to practical and administrative obstacles related to their immigration status. For instance, the lack of ‘firewalls’ in national legislation, which exposes migrants attending public facilities to the risk of being reported to the immigration authorities, further deters them from seeking medical care. Moreover, some healthcare systems based on enrolment in a national insurance scheme prevent irregular migrants from obtaining health coverage, ultimately preventing them from obtaining care, including urgent care, due to high costs or obscure administrative procedures. The lack of clarity or awareness regarding the medical treatments available to irregular migrants under national law often deters patients from seeking care. As a result, irregular migrants may not seek medical help until their medical condition deteriorates to the point where emergency treatment is needed, which is riskier and more costly for hospitals than preventative care.

As per international human rights law (Art. 12 of the International Covenant on Economic, Social and Cultural Rights), authorities at all levels of governance are required to ensure the fulfilment of everyone’s right to health. This is even more so for the most vulnerable individuals, such as children, pregnant women, the elderly, disabled individuals, those with chronic diseases, including irregular migrants who often experience utter destitution. As made more evident by the COVID-19 pandemic, providing access to healthcare to all segments of society and being able to interact with all potentially ill residents is also a matter of public health, in the interest of the whole community. Providing trusted and safe access to care, may prevent the spread of communicable diseases locally, including for instance COVID-19.  In addition, where preventative and non-urgent care is provided, this proves more cost efficient instead of emergency services for public finances and releases pressure from vital services. 

Local authorities, where responsible for healthcare, can play a key role in facilitating access to healthcare for irregular migrants. Some have established ‘firewalls’ reassuring migrants seeking healthcare from the risk of being reported to immigration authorities, thus increasing trust and access to local health facilities. In other cases, local authorities have increased the levels of treatments available to irregular migrants by setting up or supporting medical facilities dedicated to offering healthcare to these migrants beyond national entitlements. When high costs of care are the main obstacle to accessing care, municipalities may provide a safety net for migrants who are excluded from health insurance coverage. Municipalities may, for instance, make budget reservations and provide funding to cover the expenses incurred by patients and hospitals for treatments offered to uninsured individuals, irrespective of nationality and immigration status. In addition, if migrants tend to refrain from accessing care because of cumbersome administrative procedures or requirements that are difficult to meet for certain irregular migrants (such as having a fixed address or certain identity documents), municipalities can, in partnership with NGOs, develop simplified procedures refraining from requiring documentation that irregular migrants may not be able to produce.

If you want to learn more about local initiatives in the area of healthcare, follow the link below and access the C-MISE Guidance (pages 49-56).

With the emergence of COVID-19, access to healthcare for all residents has assumed a completely new relevance. European countries have taken specific measures to grant irregular migrants access to treatment and testing for COVID-19. Similarly, cities have responded by either extending their already existing measures in the area of healthcare or by adopting new initiatives.

Access to healthcare during the pandemic is a focus area of the C-MISE briefing on irregular migrants during the COVID-19 pandemic. More information can be found in the C-MISE COVID-19 briefing. 

As the C-MISE briefing was developed before the approval of vaccines against COVID-19, this document does not cover access to vaccinations. However, ongoing C-MISE city dialogues are including a focus on reaching out to migrants with irregular status to ensure comprehensive coverage of vaccines locally. As research on access to vaccines develops, more information will be shared in this website.

For more information on the practices presented in the guidance or the COVID-19 briefing, you can contact the C-MISE team at: