The four missing digits that could be fatal

The Local
The Local - [email protected] • 30 Jun, 2006 Updated Fri 30 Jun 2006 13:09 CEST

Sweden makes much of its committment to the United Nations and trumpets the welcome it gives to refugees. But it is under fire from the UN for turning some migrants without personal numbers away from hospital. Aidan Isherwood reports.


A man, let’s call him Michael, walked into an emergency eye hospital in Sweden last year with a bit of metal stuck in his eye: he was turned away because he couldn’t pay; even though he’d finally struggled in there after waiting a week to pluck up the courage to go.

How could this happen in Sweden? Simple, Michael was an undocumented migrant.

Like many of those living in hiding in Sweden, Michael was afraid of hospital staff informing the immigration authorities if he checked in. According to the report Experiences of Gömda in Sweden (Gömda means “hidden”), published late 2005, it is this fear, as well as knowing they cannot afford to pay, that stops many undocumented migrants from seeking medical help in the first place.

Those who do make it to a hospital with the right amount of money in their wallets are far from guaranteed to see a medical professional.

Sweden makes much of its commitments to human rights and the United Nations. Indeed, the government boasts on its website that Sweden has a tradition of “promoting questions of human rights”.

But the United Nations says the country is still failing to meet international human rights standards by denying access to medical treatment for undocumented migrants.

When you go to the accident and emergency department of a Swedish hospital you will be asked for your personal number (made up of date of birth and four identity numbers). And then you will be asked to pay. In Stockholm district this also happens if you take a child, even if the child is in a serious condition. But you get used to it: all countries’ health services have bureaucratic procedures to contend with.

If you don’t have a personal number, things can be more complicated. Tourists with passports and insurance coverage will have no problems. Migrants with no documents, on the other hand, may well find themselves turned away – even when they are seriously ill.

Their fate is basically in the hands of whoever is on the admissions desk. Sometimes the administrative assistant will ignore their missing last four numbers and sign them in to see a doctor. If they come up against less flexible staff member however, they may be turned away. Even if they do get to see a doctor they will be charged the full non-subsidised rate for all treatment. Inability to pay upfront often leads to the patient being sent away.

Back in January 2006, the UN Special Rapporteur, Professor Paul Hunt, visited Stockholm and firmly expressed his dissatisfaction with “Swedish law and practice regarding the health services available to asylum seekers and undocumented people”. He said Sweden did not meet the demands of international human rights law, which calls for all states to provide equal access to health services, regardless of legal status.

Swedish law currently guarantees emergency treatment to all, but definitions of emergency need are often left to administrative staff. And undocumented patients – often living in poverty – face the added barrier of being charged the full rate.

Sandra Dolietis, of the Red Cross, gives examples of patients being asked for SEK 2,000 to see a specialist; 21,000 to have a baby delivered; and 180,000 for access to treatment for breast cancer.

Helena Ganslandt, a Stockholm-based doctor who does voluntary work with undocumented migrants, says the definition of emergency treatment is applied erratically and often brutally.

“Patients with chronic conditions like diabetes, hypertension and anaemia are often not considered as being in need of emergency treatment,” she says.

“Obviously, though, the lack of their prescribed drugs could quickly lead to an emergency.”

Most health professionals say they want to treat all patients, but don’t get to see them. Some, like Helena Ganslandt, give up a few hours a month to go to hospitals who discretely allow treatment to be provided on their premises under the auspices of the Gömda project.

The people that come in have all sorts of medical conditions – many of them life-threatening. In one case a stroke victim, whose condition was so serious that she was given emergency treatment and even kept in hospital for ten days, was then discharged with no follow-up or rehabilitation. This means there is no saying how she has fared since.

In another case seen by Sandra Dolietis, a 17-year-old pregnant girl was refused antenatal care because she did not have the ability to pay; thus, in the eyes of the UN, the rights of two children were denied — the teenage mother-to-be and her unborn child.

The Swedish police have about 15,000 undocumented migrants on their files, but the exact number is, of course, anybody’s guess. Most are assumed to be failed asylum seekers. Perhaps victims of successive tightenings of asylum regulations?

The Gömda report was produced by Médecins Sans Frontières. In 2004 they began a project to provide treatment for undocumented migrants. MSF’s Swedish arm, Läkare utan Gränser, is a very well-known organization, though some might be surprised to find out that they have volunteer doctors providing services in Stockholm and not just in the usual global disaster zones.

In March of this year, MSF handed the project over to the Swedish Red Cross. The Red Cross explain that, as in all their projects, they provide support until such a time as a local government and its agencies are able to do it themselves.

After Paul Hunt’s criticisms of Swedish practice, the Swedish government promised to review existing legislation. According to Bengt Westerberg, chairman of the Swedish Red Cross, the review has been quietly shelved pending September’s general election.

Ingmar Olsson, spokesman for health minister Ylva Johansson, admits that “nothing significant” will happen on the issue before the election.

But he defends the government’s record in the treatment of migrants.

“Sweden has always been one of the countries that has welcomed most asylum seekers,” he says.

“Sweden tries to be generous in terms of offering asylum and permission to stay. We want people to get full legal status so do not want undocumented migrants to join a parallel system,” he argues.

But what about the 15,000 undocumented migrants that, for whatever reason, still don’t join the system?

“They do have access to emergency care, but they have to pay – and children do get free healthcare,” he says.

The government also claims that since the MSF report the National Board of Health and Welfare has introduced a programme to instruct healthcare staff about the rights of undocumented migrants to medical care.

But the message seems to be taking time to filter through the health service – the Gömda project is certainly not short of patients.

And the 65 percent of undocumented migrants interviewed in the Gömda report who said their health had deteriorated since coming to Sweden, are unlikely to get better just yet.

Aidan Isherwood

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