MIGRATION: The 'Undocumented' Languish in German Health Care System

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By Rajiv Kunwar*

Although officially not allowed to work, undocumented migrants living in Germany provide cheap labour for the country's economy, one of the richest in the world. However, what is shocking is that the Government has a very lackadaisical approach towards the health status of this segment of the population.

Germany's immigration policies focus mainly on combating illegal immigration, without any attention to the rights of undocumented migrants. In principle, there are certain minimal rights available to undocumented immigrants in Germany, including a reduced level of medical treatment.

Several studies, however, have shown that in practice these migrants are hardly in a position to avail of their right to seeking medical care. The exclusion from full social benefits stems from the Government's fear of creating any additional pull factors which might encourage further immigration.

Undocumented migrants' human rights are in no way sufficiently protected in Germany where the access to healthcare is governed by highly restrictive regulations. Medical assistance to this segment of the population is hampered as well as criminalised through the legal framework.

Paragraphs 87 and 96 of the 'Aufenthaltsgesetz' (The Residence Act), which are commonly referred to as 'Denunziationsparagraphen', require public institutions to report illegal immigrants to the foreigners' registration office. While hospitals and independent physicians are not obliged to do so, social welfare offices have to adhere to this law.

This dismal situation is putting tremendous pressure on healthcare professionals and social workers who often work with limited resources to defend migrants' fundamental rights to healthcare.

My research during the fieldwork in various parts of Germany in the year 2009 underlines the plight of undocumented Punjabi migrants from India, the single largest South Asian ethnic community in Germany, with regard to this their health problems, health-seeking behaviours and ploys and tactics used in accessing health care due to stringent health care regulations in Germany.

In an often free-wheeling conversation with me, some of the Punjabi undocumented migrants volunteered to explain that getting any kind of job and ambition to earn quick money in Euros, even at the risk of having an illegal status, was their main objective while entering Germany through different European Union countries sharing borders with Germany.

Like most countries of the world, Germany accepts the Universal Declaration of Human Rights (Article 25:1) that includes an individual's right to seeking medical care. However, the fact is that undocumented migrants forego exercising these rights for fear of having their identities revealed.

Like asylum seekers, foreigners who are under obligation to leave the country, and refugees holding a 'Duldung' (temporary suspension of deportation) undocumented migrants are entitled to limited medical care according to 'Asylbewerberleistungsgesetz' (German Social Law for asylum seekers). This includes basic medical care as well as health care in case of illness, pregnancy and birth. However, treatment is only granted in the event of acute pain and afflictions. The situation is far from clear in respect of chronic diseases.

Another section of the Residence Act which is relevant in this context is 'Aufenthaltsgesetz'. The so-called 'Schlepperparagraph' (referring to the facilitation of undocumented migration) states that anyone who aids a person without documents might be liable to prosecution. The degree of culpability depends however on certain criteria such as the question whether a prolongation of the patient's illegal stay is encouraged through the medical treatment, whether the doctor gains any financial advantage, as well as the frequency of such acts.

Health care professionals, particularly doctors I interviewed during this research found themselves on the horns of a dilemma when providing healthcare to undocumented migrants. On the one hand, they have the professional obligation to help illegal immigrants following the principles of medical ethics and humanity, on the other they are confronted with unpaid medical bills and the risk of legal consequences.

The 49-year-old Dr. Andreas L. renders his voluntary medical care to people irrespective of their legal status at the behest of 'Medinetz', an NGO in Mainz. Speaking with an air of nonchalance, he shares the popular notion of the medical fraternity and other social organisations about healthcare rights of undocumented migrants.

"Why should someone be deprived of his right to seek medical care due to his illegal status?" he questions and emphasises in the same breath, "a doctor's primary task is to identify the ailment and cure the same."
Dr. Timo H. and his wife Anne, who are part of the 'Buero für Medizinsche Flüchtlingshilfe' (The office for medical assistance for refugees) in Berlin, working under the slogan 'Kein Mensch ist illegal' (no one is illegal) strongly advocate that it is for the Government to ascertain the legal status of an individual and that a patient's illegal status should not have any bearing on a physician's duty.

Most of the doctors and social workers involved with NGOs and private initiatives committed to serving undocumented migrants argue that, when the Government knows that there is a certain population of such people residing in Germany, at least the access to medical care should be hassle-free.

If this segment of the population is denied access to healthcare, the overall health of society is sooner or later bound to become vulnerable. "After all, don’t we know that these people provide a cheap labour force to the country in one or the other way?" says one Goettingen-based gynaecologist on the condition of anonymity.

The argument regarding access to healthcare makes sense because most undocumented immigrants rarely undergo any medical examination before entering Germany. And in order to rule out the spreading of contagious diseases through them, it is imperative for the Government to let these people have access to medical care.

Various findings of my research point to the fact that the level of medical care available to undocumented migrants in Germany is highly unsatisfactory. Although illegal residents do have a theoretical right to minimum healthcare according to German law, the access to these healthcare services is not guaranteed as it is to a great extent blocked by the implications that come along with the regulations in the relevant sections of German health policies.

Note: All the names of undocumented migrants and health care professionals in this write-up have been changed due to interviewees' request.

A longer version of the article with detailed findings of the writer's research are available at: http://www.indepthnews.net/documents/Undocumented_Migrants_Languish_in_Stringent_German_Health_Care_System.pdf

*The writer holds a post-graduate diploma in journalism from Bharatiya Vidya Bhavan, New Delhi, and M.A. in Ethnology from the University of Heidelberg, Germany. In India he worked as a print media and TV journalist for 13 years investigating issues related to health and society. Currently he is an independent researcher and interpreter of ethnographical data related to South Asian projects undertaken by Dr. Gabriele Alex, Professor of Social Anthropology, and Eberhard Karls, University Tuebingen, Institute of Ethnology/ Social Anthropology, Germany. He is also also involved in two short-term projects pertaining to social dynamics of immigrants' health status in Spain, France and Italy. - IDN-InDepthNews

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