Health Should Not Depend on a Passport

[This post has been published in Spanish in 3.500 millones-El País]

The right to health is a fundamental human right that is not dependent on the possession of a passport

The right to health is a fundamental human right that is not dependent on the possession of a passport. This is a basic principle of human dignity, established by universal agreements on human rights and consecrated by international norms accepted by democratic states. For millions of migrants, however, this clear principle has proved to be an illusion.

This week, I had the opportunity of hearing about this situation in person at a symposium organised in Rabat by the Barcelona Institute for Global Health (ISGlobal), the Moroccan Health Ministry and the International Organisation for Migration (IOM) with the support of the Spanish Agency for International Development Cooperation (AECID). At the event, the Mediterranean Health Observatory presented the results of their work in this field and representatives of five countries in the region (Libya, Yemen, Morocco, Tunisia and Egypt) shared their experiences in the field of health care for migrants and the construction of national health care systems capable of meeting the challenge posed by shifting migrant populations.

Photo: Chefchaouen (Morocco). Sergey Pesterev. 

There are around twenty-one million Africans in the world living as migrants, mainly in African countries other than their own

The problems posed by migrant health are not simple. There are around twenty-one million Africans in the world living as migrants, mainly in African countries other than their own.  And, in contrast to the myth that has become established in the European imagination, nine out of ten migrants leave their homes for economic reasons and not to seek asylum. Most of the countries in the region simultaneously represent points of origin, transit and destination for migratory flows (and, by the way, can we say that Spain is any different?). This situation obliges them to consider the risks and opportunities the situation poses for the health of their societies.

The situation in Morocco perfectly illustrates the challenges facing an emerging economy in this respect. Today, Morocco is an important route of migration and very probably the migratory flows will continue to increase in the coming years. Fortunately, not all the actions undertaken are coercive measures aimed solely at expelling migrants from the national territory: the regularisation of the situation of some 25,000 undocumented immigrants in Morocco in 2014 (official data) has made the country an outstanding example in the management of this problem in the region.

The regularisation of the situation of some 25,000 undocumented immigrants in Morocco has made the country an outstanding example in the management of this problem in the region

This was the most noteworthy of a series of measures undertaken to align Moroccan public policy with the country's international commitments on rights and immigration and to improve its international reputation, which had been tarnished by the diffusion of images showing immigrants living in the mountains around the city of Melilla. Within a year, all of the immigrants who gained legal status had been incorporated into the public health system. Currently, Morocco’s national strategic plan for immigrant health (2017-2021) proposes a battery of measures aimed at ensuring that all foreigners legally resident in the country (including students) have a health card.

Undocumented immigrants whose situation remains irregular continue to be excluded from all but the most basic health care, and immigrants whose situation has been legalised are subject to the same limitations of service and co-payments as Moroccan nationals. Nonetheless, a great step forward has undoubtedly been made. Today, Morocco is laying down the legal bases and institutional and social framework for a complex process requiring considerable creativity as well as political will and economic investment. International donors are in a position to support this effort through cooperation, and also by adopting a migratory approach focussed less on control and more on the management of population flows.

Undocumented immigrants whose situation remains irregular continue to be excluded from all but the most basic health care

Although it may appear to be in another universe, Libya is a country that offers an interesting example.  Libya, described candidly by the IOM representative as "a country with more than one government”, is estimated to be hosting more than one million immigrants (not counting internally displaced populations). Of these, 390,000 have been identified by international organisations and between 60,000 and 70,000 are being held in 24 detention centres, which are prisons in all but name.

Basic humanitarian care is provided, including measures designed to minimise human trafficking and to support people who wish return to their own country. In the current situation , it is impossible to make plans for more ambitious interventions. But the policy does encompass the idea that not everything is acceptable in the effort to prevent immigrants from crossing the Mediterranean, which is an achievement.

The Mediterranean Health Observatory can contribute to the search for answers to some fundamental questions

With its work in the field of migration, the Mediterranean Health Observatory can contribute to the search for answers to some fundamental questions. What are the current conditions and health needs of immigrant populations? Which organisations and countries have devised effective responses to these challenges that can be replicated elsewhere? How can the countries in the region provide public health policies appropriate for changing societies? What support and training is needed for both health professionals and those responsible for migrant health policies?

I trust that very soon we will be able to inform you in this blog about some of the answers to these questions.