Angelika Dobrieva, phycisian, deputy head of Civic Assistance committee on medical issues, talks about access to Russian healthcare for foreign citizens, related challenges and help from charitable organizations
- What are main challenges of access to healthcare services for migrants and refugees in Russia?
- Such access depends on a person’s status in the country. We can single out following categories: people who have applied for temporary refuge; people who have applied for refugee status; stateless people and labor migrants.
People who have applied for temporary refuge, are denied healthcare access during the whole time of the application processing.
People who have applied for refugee status, can receive an obligatory medical insurance (OMI) policy and use basic medical services covered by it, right after the application.
Stateless people only have access to emergency care.
Labor migrants, when applying for a labor patent, are obliged to purchase a voluntary medical insurance (VMI) policy. But it only covers emergency care, which is in any case free of charge for all people in Russia, no matter their legal status.
Thus, migrants have no access to acute and routine medical care.
- This means that named categories of people may only rely on commercial healthcare?
- They only have access to free emergency and rescue care. Usually, people are not denied help in case of life-threatening exacerbation of a chronic disease; but there is no access to routine healthcare.
In addition, even an OMI policy does not cover all medical services which a person in a vulnerable position may need. For example, to receive high-tech medical care, a person should be a Russian citizen. High-tech care includes endoprosthetics, transplants, etc. There are people in need of such help, although not thousands of them; their problems stay unsolved.
- Who asks for your help most often?
- According to our statistics, these are 30 to 55 year old people with exacerbation of chronic diseases.
- How does Civic Assistance help?
- There is a physician at Civic Assistance committee, who may refer patients for additional tests or specialist consultations, if needed. We have contracts with several medical institutions in Moscow, where we can refer patients for diagnostics and treatment. Unfortunately, our financial resources are limited, and sometimes we cannot help everyone. Nevertheless, we always try to quickly organize an urgent hospitalization and examination.
- Thus, if we are talking about healthcare for migrants and refugees, there is no chance without support of a charitable organization?
- Exactly! In addition, these people are in difficult financial situation. They struggle to buy food, not to mention using commercial healthcare. Such non-governmental organizations are a great help.
Other difficulties include poor command of language and biased attitude to migrants and refugees. For example, a person can apply for refugee status, get an OMI policy, and go to a medical center. But nobody has considered that this person speaks Russian poorly; 80% of people who come to Civic Assistance for help, do not or almost do not speak Russian.
So, in a city polyclinic, the person is denied access, and the medical personnel explain it by the fact that the number of patients already exceeds available resources. Our volunteers and translators help in such cases; they go together with a migrant and advocate for their rights. Only after that, a medical center gives access to its services.
- How has coronavirus pandemic affected the healthcare access for migrants and refugees?
- During the pandemic, the medical organizations in Moscow provided healthcare services to all people, legal status irrelevant. I should highlight that I am talking about Moscow; outside of the capital, everything is different, even for Russian citizens.
The Moscow healthcare department well reacted to the pandemic. Ambulance was sent every time when needed, and everyone received complete medical care. Sometimes we just had to help translating prescriptions. People were denied hospitalization only if it was not indicated, and in such cases, they received care at home. Later, computer tomography and blood tests were provided for free at public medical centers.
Even people with acute disorders unrelated to COVID-19 were not denied help, they were admitted for hospitalization, received necessary drugs for free.
- How can access to health services for migrants and refugees be improved?
- First of all, such access should be provided to people who have applied for temporary refuge. They should have a right to obtain OMI policy while waiting for the decision. With this objective, the Refugee Law (Federal Law 95 from 1997) should be modified in the part of medical help for people who have applied for temporary refuge.
Next important step is to oblige employers to provide VMI policy when contracting migrants; such a policy should cover acute and routine medical care.
I also want to mention tuberculosis, a socially significant disease. In Moscow, inpatient care for patients with tuberculosis is free of charge, but when a patient is discharged, troubles start. Antituberculosis clinics work based on area, which means a patient should use a clinic at the place of household registration. Our applicants often do not have registration and are denied outpatient care. This needs to change.
Types of medical care:
Emergency care is provided in case of acute disorders and conditions of sudden onset, life-threatening exacerbations of chronic diseases (acute respiratory failure, cardiogenic shock, pulmonary embolism, etc.). This involves hospitalization after calling the emergency number 112.
Routine medical care is provided for diseases and conditions which are not life-threatening and do not require emergency or acute care; in such cases a delay in medical help for some time would not lead to the impairment of a patient’s condition or threaten their life and health (diagnostic tests, vaccination, dynamic and outpatient follow-up for chronic diseases, pregnancy, etc.). There is no free of charge access to this type of care.
Source: How to work with refugees in Russia by Need Help Foundation
Author: Ekaterina Ivashchenko