"The most vulnerable are also the least well cared for." That is the conclusion of the NGO Doctors of the World (DoW), which published its 18th annual report on access to healthcare in France. Migrants are particularly vulnerable and often see their health deteriorate once they arrive in France due to poor living conditions.
Growing too discouraged to seek helathcare, living on the street or in unsanitary camps, seeing physical and mental health deteriorate without being able to do anything about it: In the more than 140-page report made public on October 16, Doctors of the World (DoW) warned of the “consequences of the lack of dignified and unconditional care in France.”
“In our health centers, 98% of the people we meet live below the poverty line and it is their living conditions that weigh on their health. When they leave their countries, they are in good health. It is here that they fall ill," Yannick Le Bihan, MdM's Director of Operations for France, said at a press conference.
Poor sanitation and malnutrition undermine the health of migrants
Of the 24,338 people accommodated in DoW centers in 2017, almost all (96.6%) were foreign nationals - whether legal or not, mainly from sub-Saharan Africa (45.1%), the Maghreb ( 23.8%) and the European Union (13.1%).
Their reason for visiting the center was primarily health-related (84.6%) and the main problems diagnosed were digestive, respiratory and osteoarticular, as well as acute respiratory infections and viral hepatitis. "The absence of or poor housing conditions (overcrowding, squalor, dampness) and the challenges of maintaining a diet both quantitatively and qualitatively sufficient make [the patients] all the more vulnerable to these disorders," the report says.
"A delay in accessing healthcare is noted in almost one consultation out of two," the report says.
Psychological violence on the migratory route and in France
Also not to be overlooked: the psychological health of particularly vulnerable patients who have been through traumatic events. "A lot of them come from, or have traversed countries at war," says the report. "Some have been arbitrarily imprisoned, have suffered extreme violence, have witnessed the death of relatives or have themselves been threatened with death. The migratory routes appear increasingly long, difficult and violent."
But these disorders also develop in France. This is particularly the case for many women: "Their housing conditions and their often precarious administrative situation expose them to all forms of violence such as harassment, marginalisation, physical aggression, robbery, exploitation, marriage or pregnancy for papers, survival sex, etc.," DoW wrote, referring to a study by the NGO France Terre d'Asile that was released earlier this year.
In 2017, a psychological disorder such as anxiety or depression was identified in nearly 9% of DoW patients. That figure is most likely an underestimation, according to the NGO, which adds that "migrants face cultural and linguistic barriers that can complicate interactions. In addition, their level of resilience is particularly high, leaving no indication of the underlying suffering and making the diagnosis of such disorders difficult."
Given the findings, which also pertain to minors (who comprised 14% of the patients seen by DoW in 2017), the NGO is calling for the creation of reception centers for migrants throughout the country that are “truly unconditional and hospitable”. It is also calling for "the development of a more supportive system" with easier recourse to interpreters and health ombudsmen to improve access to health services.
As part of the program to fight poverty that he presented in mid-September, President Emmanuel Macron announced a budget of €8 billion dedicated to childhood, youth, returning to work, but also the extension of free health insurance (CMU-C) to simplify access for the most vulnerable people. The plan is to come into effect on January 1st.