Health care of refugees and migrants in the Republic of Serbia: current situation and recommendations for sustainable solutions
Since the beginning of the migrant and refugee crisis in 2015, the Republic of Serbia has been faced with new challenges regarding the asylum and migration system, as well as the mechanisms of integration of the migrant population into society. One of the most important challenges was redefining and establishing an efficient health system. The circumstances in which refugees and migrants travel carry great risks for their health, and in this regard, health can be seen as the greatest value for refugees and migrants, in their integration and empowerment. Understanding and improving the healthcare of migrants and refugees in the Republic of Serbia requires a comprehensive approach that addresses various aspects of their well-being.
How the right to health care of migrants and refugees is woven into the international and national legal framework?
The right to health is incorporated into numerous documents adopted at the level of the United Nations, the Council of Europe, and the European Union. The standards for the treatment and protection of refugees and migrants are defined as part of International Humanitarian Law, International Refugee Law, and International Human Rights Law. The 1951 United Nations Convention relating to the Status of Refugees from,[1] accompanied by its 1967 Additional Protocol,[2] is one of the key legal instruments for the health care of refugees.[3] Namely, Article 23 of the Convention relating to the Status of Refugees stipulates that refugees have the right to the same treatment as the nationals of that country in terms of public relief and assistance, which includes health care.[4] Additional international instruments concerning the health care of migrants and refugees are: the Universal Declaration of Human Rights,[5] the United Nations Convention on the Rights of the Child,[6] the Council of Europe Convention on Preventing and Combating Violence against Women and Domestic Violence[7] and the International Covenant on Economic, Social and Cultural Rights.[8]
There are two types of protection guaranteed to migrants and refugees: temporary protection and international protection. Temporary protection is the first type of protection, and it is provided to persons who are unable to return to their countries of origin/residence from which they fled due to armed conflict, i.e., to persons who were victims of systemic violence, that is, violations of human rights in countries of origin/residence and international refugee protection. International protection includes refugee and subsidiary protection. Refugee protection is provided to a person who has been granted refugee status (a person who has been granted asylum, that is, refuge). Subsidiary protection is granted to a person who does not meet the requirements for obtaining refugee status, but who, in case of returning to the country of origin, or place of previous residence, would face serious risks to life and safety.
The right to health care for migrants and refugees is guaranteed by international and national legal frameworks. Article 68 of the Constitution of the Republic of Serbia stipulates that everyone has the right to the protection of their physical and mental health.[9] This means that every person, regardless of their legal status, has the right to health care in the same way that this right is exercised by the nationals of the Republic of Serbia, because according to Article 17 of the Constitution, foreigners, in accordance with international agreements, have all the rights guaranteed by the Constitution and relevant laws.[10] The issue of health care for migrants and refugees is regulated by: the Law on Health Care, [11] the Law on Health Insurance,[12] the Law on Public Health,[13] the Law on Asylum and Temporary Protection[14] and the Law on Migration Management.[15]
The procedure of providing primary and secondary health care to refugees and migrants can begin after they cross the border and enter Serbia, depending on the needs of the migrants and refugees. In any case, it certainly begins after they are placed in asylum centers and reception centers. Primary health care is provided in health centers, while secondary and tertiary health care facilities are available to migrants and refugees upon admission to the accommodation facility and a mandatory medical examination. In addition to the enjoyment of the right to health care in the context of access to health services, the process of integrating the migrant and refugee population into the health system involves several important aspects in the domain of information exchange, analysis, and use. Data on the health, cultural and social context of the origin of migrants and refugees, on their health history and habits, are the basis for forming an approach to integration by the state and adapting the relevant integration mechanisms.
It is necessary to mention that the health system has relied on the capacities and involvement of the civil society sector from the beginning. The role of numerous civil society organizations, especially international organizations, consisted in filling the missing capacities of the health sector and still many non-governmental organizations provide psychosocial support services in asylum centers and reception centers.
Identified shortcomings and recommendations for sustainable solutions
In terms of the frequency of certain health problems, mental health disorders are predominant such as those related to stress; mechanical injuries: nasal bone fractures, head injuries, contusions and dislocations; skin diseases; surgical conditions; gynecological diseases; diseases in children and infectious diseases.[16]
Medical staff in Serbia have been meeting with patients from the migrant and refugee population for many years now, but insufficient understanding of the sociocultural context of the countries from which migrants and refugees come is one of the most important shortcomings in terms of health care, and it is directly related to access to health services.
In addition to educating the medical staff, it is necessary to design a form through which the functioning of the healthcare system of the Republic of Serbia will be presented to migrants and refugees in a clear and comprehensible manner.
Attention should primarily be directed to technical problems and the necessity of good communication in the form of information exchange and transparency of all health services.
The introduction of cultural mediation into the health care system would facilitate daily communication between medical staff and patients, and would provide an atmosphere of trust that directly affects the reduction of potential risk factors.
Based on experience and the path traveled, it is possible to sublimate certain guidelines and advice in the form of brochures, education and campaigns that would influence the importance of understanding the sociocultural context in which refugees and migrants lived and the appearance of cultural mediators in public spaces with the aim of speaking about their experience would contribute to a better understanding of refugees and migrants, as well as their migration experience.
Better understanding and the possibility of integration would contribute to support programs within which migrants and refugees would connect, based on their similar experiences, with the local community.
Bearing in mind that the health care system that exists in asylum centers and reception centers is often limited by monetary or donor funds, it is necessary to strengthen the capacities of local health institutions.
Efforts should be made to improve the availability of information on the right to apply for asylum, as many users do not know how to apply for asylum.
The Law on Health Care equates refugees and asylum seekers with citizens of the Republic of Serbia,[17] but users of asylum centers who have been granted temporary protection are not legally recognized as a special category of persons. On the trail of this discrepancy, it can be observed that the Law on Health Insurance provides that foreigners who are employed have the right to health insurance, which excludes those refugees who are unemployed. The National Health Insurance Fund (NHIF) also does not recognize any other category of refugees other than refugees from the former republics of the Socialist Federal Republic of Yugoslavia,[18] which means that persons who have been granted temporary protection do not have the right to mandatory health insurance and the right to be issued a health insurance card.
In this regard, one of the recommendations concerns the amendment of the Law on Asylum and Temporary Protection regarding the necessary recognition of this category of persons as part of legal solutions. In this way, all refugees would have the same health treatment, regardless of their legal status.
Therefore, attention should primarily be directed to technical problems and the necessity of good communication in the form of information exchange, transparency of all health services, additional education of medical staff, as well as the submission of asylum applications, and then develop strategies for recognizing persons who were granted temporary protection in order for them to become a legally visible category. The conclusion is that the role of cultural mediators is insufficiently noticeable, and that the legal recognition of this profession would contribute to additional support for refugees and migrants and easier integration.
* This blog was written as a result of an internship with Save the Children and within the project "Violence Against Children on the Balkans Migration Route - Solutions Through Advocacy and Research (STAR)" supported by the Sexual Violence Research Initiative.
Anđelka Živojinović
Student of Master Academic Studies – International Humanitarian Law and Human Rights Law
University of Belgrade - Faculty of Political Science
[1] Convention Relating to the Status of Refugees.
[2] Protocol relating to the Status of Refugees.
[3] Art. 23, Convention Relating to the Status of Refugees.
[4] UNICEF, Is health care accessible?, 2017. Available at: https://www.unicef.org/eca/sites/unicef.org.eca/files/UNICEF%20Advocacy%20Brief%20Health.pdf (Accessed 06.05.2023).
[5] Universal Declaration on Human Rights.
[6] Convention on the Rights of the Child.
[7] Council of Europe Convention on Preventing and Combating Violence against Women and Domestic Violence.
[8] International Covenant on Economic, Social and Cultural Rights.
[9] Constitution of the Republic of Serbia, Official Gazette of the RS, nos. 98/06 and 115/21.
[10] Ibid.
[11] Law on Health Care, Official Gazette of the RS, no. 25/2019.
[12] Law on Health Insurance, Official Gazette of the RS, no. 25/2019.
[13] Law on Public Health, Official Gazette of the RS, no. 15/2016.
[14] Law on Asylum and Temporary Protection, Official Gazette of the RS, no. 24/2018.
[15] Migration Management Law, Official Gazette of the RS, no. 107/2012.
[16] Dragan Obradović, Branka Antić and Marko Ognjenović, „Migranti - nova kategorija pacijenata u zdravstvenom sistemu Srbije i pojedini problemi“ u: Branislava Knežić i Ivana Stevanović (urs.), Zbornik Instituta za kriminološka i sociološka istraživanja, Institut za kriminološka i sociološka istraživanja u Beogradu, Beograd, broj 2/2019, p. 195.
[17] Article 21, Law on Asylum and Temporary Protection, Official Gazette of the RS, no. 24/2018.
[18] Article 11(10) Law on Health Insurance, Official Gazette of the RS, no. 25/2019.
