Review of healthcare issues among third country national (TCN) communities inside Greece.
The COVID-19 pandemic confirmed the importance of health as well as the ‘’privilege’’ of access to the healthcare system. If that poses a challenge for local people around the world, how much and which are the consequences that affect TCNs?
Marva Arabatzi, Mirela Rosgova, Theoni Spathi (KEMEA), Athens (Greece),
The COVID-19 pandemic and its rapid spread affected people globally, bringing forward the importance of access to the healthcare system that ranges from the need of treatment and hospitalization to vaccination opportunities. Every country has a unique healthcare system as well as an insurance policy structure for its local citizens. But what are the options for TCNs and how can they access the system especially during a pandemic like COVID-19? According to Pavli and Maltezou (2017) as well as Kondilis et.al (2020), TCNs are more vulnerable to various diseases, especially epidemics. This can be explained not only from the fact that they mainly come from countries where vaccination services are limited as stated again by Pavli and Maltezou (2017)[i], but also that during their early settlement they face overcrowded conditions in the reception centers with limited accessibility to hygiene essentials.
The human right to life and personal security (Article 3 of Universal Declaration of Human Rights) is highly interconnected to health. According to WHO, health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Further, it provides an important contribution to economic progress, as healthy populations live longer, are more productive, and save more. As Article 25 of Universal Declaration of Human Right dictates, “everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services (…)”, thus it is immensely important to make TCNs’ access to the health care system easier and more efficient. But which are the major challenges and issues that TCNs populations are facing during their integration in the host country related to health issues?
To begin with, during pandemics time, TCN populations “face similar health threats from coronavirus disease 2019 (COVID-19) as their host populations”. However, several vulnerabilities related to physical, mental, and social health problems may result from the process and the specific circumstances of migration, especially during the migration journeys and the arrival conditions in each host country. This is getting worse, when they face overcrowded and low hygiene situations in the host countries with limited access to sanitation and other basic services, being also excluded from “national programmes for health promotion, disease prevention, treatment and care, as well as from financial protection schemes for health and social services”[v] during the COVID-19 pandemic. In addition to that, the communication barriers between health care practitioners and TCN populations, the cultural barriers commonly associated with the lack of integration of TCNs into local communities, that may hinder the former from visiting doctors when being in need of medical assistance resulting in a potential delay in disease diagnosis, according to Kuan et al. (2020), as well as their existing legal status, are also some of the factors that affect the planning and response healthcare operations during COVID-19 pandemic.
Focusing on Greece, a country that, according to Karnaki (2020) is still recovering from an extended period of economic austerity whereas at the same time is in the forefront of the flows of TCNs arriving in Europe over the last 5 years, TCNs’ access to the health care system is still an issue. According to Douglas et al (2020) as well as IASC Interim Guidance (2020)[vii], TCNs are considered vulnerable populations, and they have to be dependent from Greek authorities, local networks, NGOs and the society in general for humanitarian assistance. More in particular, the Ministry of Migration and Asylum, along with its relevant Asylum Service and RIS (Reception and identification Service) have been the responsible authorities that provided TCN population with all the relevant information since the COVID-19 pandemic outbreak, trying to address all the issues they face when trying to access health services. A recent law saw the distribution of a Temporary Healthcare and Social Insurance Number for Alien Citizens (PAAYPA, Law 4636, O.G. 55.2/01.11.2019) which has contributed to assessing these difficulties in accessing health care services[viii] while most of the services have been transformed to online/electronic versions, to tackle the phenomenon of face -to-face congestion to the relevant offices. Despite all these positive changes that were also complemented with specific guidelines translated to a handful of languages and addressed to safety health preventative measures that TCN populations can adopt to protect themselves from COVID-19, the TCN healthcare situation in Greece is still hard. Having more than 60,000 to reside in 36 overcrowded reception centers and camps[ii], the fact that a proper and coordinated health management of newly arrived TCNs is affected by legal, communication/language, cultural and bureaucratic barriers in accessing healthcare system, has worsened the whole situation, making the integration of TCNs in the Greek national health care plan against COVID-19 an important factor. Especially nowadays, where vaccination for COVID-19 is the only step to get over the pandemic it is crucial for TCNs to have vaccine access and thus, an easier access to the health care system.
There is also a need to provide more accurate and timely information on Greece’s healthcare system, as well as on TCNs ’right to healthcare in accessible form (e.g., oral and/or written formats) and appropriate languages, as generally, according to Sjögren and Mangrio (2017) this is also important for TCNs to have a positive experience and better interact with doctors and healthcare professionals. A further decongestion of the refugee camps along with integrating refugee care in the national Greek healthcare plan can be prerequisites that could bring further benefits to the whole society[vi]. Adding to the aforementioned, a friendly and supportive environment, that counters misinformation, ensures protection, provides adequate education on potential risks, and engages the whole local community to those efforts could be the first step to a proper response to healthcare issues faced not only in Greece but in other countries.
Apart from local, regional, national, EU and International authorities, NGOs/CSOs and other relevant organisations, as well as the media, EU projects are constantly working towards the direction of smooth integration and support of vulnerable populations such as TCNs. WELCOME project, an H2020 EU funded project (GA 870930) has as its main objective research and develop intelligent technologies for support of the reception and integration of TCNs in Europe by offering a personalized and psychologically and socially competent solution for both TCNs and public administrations. Through the application of personalized intelligent multilingual agents, it will provide TCNs with specific information on registration, orientation, language teaching, civic education, health-related guidelines, rights and obligations and social and societal inclusion, through MyWELCOME application, which will be dynamically adapted according to their profile and their inherent characteristics. More in particular, as far as healthcare system in Greece is concerned, MyWELCOME application will try to minimize any possible limitations, supporting TCNs in accessing health facilities, such as Public Health Services, NGOs that provide health services and Social Clinics, also providing them relevant information for the emergency services in a comprehensive language and ensuring access to the National Health Care System.
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 Pavli, A. and Maltezou, H., 2017. "Health problems of newly arrived migrants and refugees in Europe," Journal of Travel Medicine, no. 4.
 Covid-19 and refugees, asylum seekers, and migrants in Greece (bmj.com)
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 Preparedness, prevention and control of coronavirus disease (COVID-19) for refugees and migrants in non-camp settings (who.int)
 Kuan, Ai Seon, et al., 2020. Barriers to health care services in migrants and potential strategies to improve accessibility: A qualitative analysis, Journal of the Chinese Medical Association, vol. 83, no. 1, pp. 95-101
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 Karnaki, P., 2020. Hosting migrants in a crisis: access to COVID-19 health care services for migrants and refugees in Greece, EuroHealthNet magazine. [Online] Available at: Migrants' access to healthcare in Greece during the pandemic (eurohealthnet-magazine.eu)
 Mitigating the wider health effects of covid-19 pandemic response | The BMJ
 Υπουργείο Μετανάστευσης και Ασύλου (migration.gov.gr)
 Sjögren Forss K., and Mangrio, E., 2017. Refugees’ experiences of healthcare in the host country: a scoping review, BMC Health Services Research, no. 17
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v. Kondilis, E. et al., 2020. Covid-19 and refugees, asylum seekers, and migrants in Greece. BMJ 2020;369:m2168 doi: https://doi.org/10.1136/bmj.m2168
vi. Kuan, Ai Seon, et al., 2020. Barriers to health care services in migrants and potential strategies to improve accessibility: A qualitative analysis, Journal of the Chinese Medical Association, vol. 83, no. 1, pp. 95-101
vii. Pavli, A. and Maltezou, H., 2017. Health problems of newly arrived migrants and refugees in Europe. Journal of Travel Medicine, no. 4.
viii. Sjögren Forss K., and Mangrio, E., 2017. Refugees’ experiences of healthcare in the host country: a scoping review, BMC Health Services Research, no. 17
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x. World Health Organization, 2020. Interim guidance: preparedness, prevention and control of coronavirus disease (Covid-19) for refugees and migrants in non-camp settings. [Online] Available at: Preparedness, prevention and control of coronavirus disease (COVID-19) for refugees and migrants in non-camp settings (who.int)