wma 7-2.indd - World Medical Association

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ment). While the scope and practice of
many healthcare professions change and
will change throughout the world, so is and
will be the regulation model. Regulation
encompasses many aspects of the healthcare
professionals’ life, from their education
to their activities and their entry in the
profession. Each of the chosen themes will
explore these aspects of regulation and how
each profession may best contribute to the
constructive evolution of health professions
regulation worldwide.
The objectives for the themes of WHPCR
2010 are to:
• Debate the future control and direction of
health professional regulation within the
context of changing scopes of practice;
• Examine the regulatory and professional
issues related to the international migration
of health professionals;
• Critically evaluate the relationship between
health professional education, regulation
and standards of practice.
The 2 nd World Health Professions Conference
on Regulation (WHPCR 2010) 18-19
February, 2010 Geneva. For more information
on the programme and how to register,
please visit www.whpa.org/whpcr2010
Julia Seyer, WMA Medical Advisor
Accessing Health Care for Undocumented
Migrants - European observations
An integrated and efficient health system
that provides primary, secondary and tertiary
care is an essential element of a healthy
and equitable society. In many parts of the
world, where access to health care is limited
to certain groups of the population, there
is a persistence of profound inequalities in
health status.
Undocumented migrants are among the
most vulnerable groups in society and they
occupy a position from which accessing
health care is very difficult. While health
care provisions are often in place for refugees
and asylum seekers, undocumented
migrants are repeatedly excluded from social
protection plans.
Definition
Undocumented migrants are people without
any residence permit authorising them
to stay in their desired country of residence.
They may have been unsuccessful in the
asylum procedure, entered irregularly by
evading boarder control, entered using false
documentation, or overstayed their visa. In
referring to this group we do not include
those who have been granted refugee status
nor asylum seekers who have applied for
refugee status and whose requests are being
processed. Asylum seekers whose application
for refugee status has been denied and
whose residency is not officially tolerated
are considered undocumented migrants. Irregular
residency status, ineligibility to work
legally, insufficient and ambiguous health
care entitlements, all in combination with
the constant fear of being denounced, prevent
undocumented migrants from seeking
health care along normal paths.
In referring to this group, the term “undocumented
migrant” as opposed to “illegal
migrant” or “illegal alien” is preferred.
In employing this alternative terminology
we avoid the negative and discriminatory
stigma of ‘criminal” that is implied by ‘illegal
migrant”.
Pregnant women, child birth and children
are particularly sensitive areas within the
larger discussion of health care for undocumented
migrants. While this article does
not provide specific details of these issues,
it recognizes that they may deserve the particular
attention of the WMA and national
medical associations.
Lack of Data
There is little quantitative data about this
population’s general health status and access
to health care. There is a need for publication
of data where it exists and further research
where it does not. Even the number of undocumented
migrants in Europe remains at
best a rough estimate. Increased publication
of data, and research would prevent instances
in which legislation is developed based
on qualitative or anecdotal evidence.
The 2007 the Hamburg Institute of Economics
was involved in a study funded by
the European Commission, DG Research,
under the Sixth Framework Programme,
called “Clandestino: Counting the Uncountable”.
This project estimates that in
2005, 2.8 - 6 million undocumented immigrants
resided in Europe. This number
includes foreign nationals without any valid
residence permit and working tourists, but
excludes asylum seekers and officially tolerated
persons [1].
A report by Médecins du Monde in 2007
published the findings of a survey given to
835 undocumented migrants from seven
countries within Europe (Belgium, Spain,
France, Greece, Italy, Portugal, and the United
Kingdom). Among other findings, the
most common reported health concerns were
digestive, musculoskeletal, physiological and,
for women, gynaecological [2]. This survey,
similar to others like it, is not representative
of the health status of the entire population
of undocumented migrants, as participants
had already made contact with a treatment
center when they completed the survey.
Barriers to accessing health care for undocumented
migrants vary significantly among
migrant-receiving countries, as national
legislation varies. Though not providing
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