Immigrant health in the World and in Turkey
Migration, regardless of reason, structure and duration, is defined as population movements where pe-ople change their locations individually or collectively.(1) Throughout the history, every country has been affected from migration in terms of their geographical, strategic, political, economic, social and cultural characteristics. Especially the 20th century has witnessed collective population movements. The world has nearly one billion immigrants today, 258 million of whom are international immigrants.(2,3)
Since 2009, migration has been accepted as an important social determinant of health.(4) The impact of migration on health varies according to reasons and types of migration, living conditions in the destination country and the residence period therein.(5) And said impact is closely related to the policies of countries related to migration and immigrant health.
According to the Article 25 of the Universal Declaration of Human Rights, every individual has the right to spend a life where his/her basic health requirements are met inclusive of items such as food, clothing, sheltering, medical care and social services.(6) According to Article 12 of the International Agreement on Economic, Social and Cultural Rights, everybody has the right to possess the highest possible health standards and to access all health services in case of illness.(7) According to the Enactment dated 2006 and titled: “Human Rights of Irregular Immigrants” of the Council of Europe Parliamentary Assembly, integrated health services should, in addition to emergency health services for undocumented immigrants, be provided in order to meet health requirements of special groups such as children, pregnant women, disabled and aged persons.(8)
International agreements define the health rights of immigrants independently from the legal statuses and rights granted to immigrants. From a worldwide perspective, it is seen that different policies and applications are implemented/present in the European countries and the USA.(9) Differences in implementation occur depending on whether immigrants are documented or undocumented. Whereas documented immigrants represent those with legal status, undocumented immigrants represent those without any legal status due to illegal entry or the expiry of their visas.
Also the concepts of hidden/illegal/irregular immigrant have the same meaning.(1) Whereas undocumented immigrants are granted limited rights for benefiting from health services worldwide, documented immigrants are granted more comprehensive rights due to their legal status. The research by Cuadra, which examines the immigrant health policies of 27 European Union (EU) member states on undocumented adult immigrants, states that when access to emergency care is accepted as the minimum right, health service providers are divided into three groups, which are those providing less then minimum rights, as much as minimum rights and more than minimum rights.
It is stated that health services are provided less then minimum rights by 10 states, at a minimum level by 12 states and more than minimum rights in 5 states (France, Italy, Portugal, the Netherlands and Spain). But there are differences between the countries of the same group especially in terms of the economic dimension of service.(10) The research by Hjern et al, which examines the health policies in Europe and Australia on immigrant children, states that only in four countries (France, Italy, Portugal and Spain) provide health services to immigrant children equivalent to their own citizens without regard to their legal statuses. These rights are granted according to legal statuses in other countries.
In Europe, children that are undocumented immigrants can only receive emergency service.(11) The research by Stubbe Ostergaard et al also adds Norway to four countries previously mentioned.(12) The systematic compilation made by Winders et al states that in European countries, undocumented immigrants use health services less then the domestic population, which usage does not meet their necessities. It is further stated that this situation owes to policies in favor of deportation and limited access to health services.(13)
In addition to European countries, the USA, Scandinavia and Canada also pursue policies that prevent migration and limit the access of immigrants to health services.(9) Especially in the USA, policies on migration and immigrant health vary when administration changes and during the recent periods the administration has taken decision to prevent migration.(14) Despite these policies, immigrants remaining in the USA face the problem of health insurance as they try to access health services. In terms of insurance, immigrants face problems such as being employed in sectors that do not provide insurance and the inability to get insurance coverage.(15)
When the Syrian war broke out, more than a million Syrians have migrated to Turkey, Lebanon, Jordan and other countries.(16) There are 3.6 million Syrian immigrants only in our country. This situation created a need in our country to develop migration & immigrant health policies for Syrian immigrants.(17,18) Turkey pursues an “Open Door” policy for the Syrian immigrants. As per the Foreigners and International Protection Law Numbered: 6458 that took effect on 04.04.2013, Syrian immigrants are given “temporary protection” status and granted temporary protection identity cards.
Temporary protection status; is granted to foreigners that were forced to leave their country, could not return to same, and that have collectively migrated in order to find emergency & provisional protection as per the liabilities of the States not to send them back. Temporary protection aims at finding emergency solutions to collective migration movements.(19,20)
Provision of health service to Syrians, who represent a majority of the immigrants in our country, are based on legal arrangements. The “Temporary Protec-tion Regulation” dated: 22.10.2014 and numbered: 29153, which was effected with reference to the Law on Foreigners and International Protection, has defined the provision of health services for Syrian immigrants. Accordingly, the basic & emergency health services and second/third step health services, which are provided to immigrant that possess temporary protection identity cards, are paid by the general directorate of the Turkish Migration Administration under the supervision of the Turkish Ministry of Health and at a level manner not exceeding the fee established by the directorate of the Turkish Social Security Institution for insurees.
On the other hand, undocumented immigrants that do not possess identity cards can benefit from emergency health services and health services for protection against contagious and epidemic diseases. And the “Principles on Health Services to be Provided to Those Brought under Temporary Protection”, which was effected on 25.03.2015 as per the said regulation with number: 29153, brought into agenda the establishment of health centers where immigrants inhabit intensely.
The Directive dated: 03.09.2015 on Migrant Health Centers/Units has defined first step health services for immigrants. This aims that first-step health services be, and under the coordination of public health centers, provided by immigrant health units/centers in places where immigrants intensely inhabit and by family health centers in places with less intense immigrant populations.
Migrant Health Centers (MHC) are being established in the country’s generality by the Turkish Ministry of Health since 2015. These centers offer free-of-charge first-step health services to both non-Syrian immigrants and undocumented immigrants that do not possess temporary protection identity cards. On December 2016, the Project titled: “Improving the Health Status of Syrians that are Under Temporary Protection and the Related Services Offered by the Republic of Turkey” (briefly “SIHHAT”) was initiated through the collaboration of the Turkish Ministry of Health and the EU. The Project is financed by the EU Facility for Refugees in Turkey/FIRT and its planned for completion in December 2019.
The project aims at supporting and improving the first and second step health services relating to Syrian immigrants. Within the scope of the project, Syrian health workers are employed and the number & service provision capacity of MHCs are being increased. In addition, new centers titled “Enforced Migrant Health Center” are established that have physicians specialized on internal diseases, pediatrics, obstetrics & gynecology as well as dentists, psychologists and screening services. Some centers also function as “Migrant Health Training Centers” where training is given to Syrian health workers that will be employed in the MHC’s. As the number of MHC’s increasing every day, the project aims at providing service at 178 centers.(21)
As a health service presentation model implemen-ted in our country, “the provision of service by immigrant health workers to their own citizens within our country’s health system” eliminates communication difficulties that owe to linguistic and cultural differences. The thesis study conducted on this subject reveals that those receiving service from these centers are highly satisfied.(22) As the number and service provision capacities of Migrant Health Centers increase, a first-step health service provision will become sustainable, which covers all documented and undocumented immigrants, which conform to requirements by international agreements and which protects human rights.
- Uluslararası Göç Örgütü. Göç Terimleri Sözlüğü. (çev.ed) Çiçekli B. 2009; 22-36. http://www.goc.gov.tr/files/files/goc_terimleri_sozlugu.pdf adresinden 01.11.2018 tarihinde erişilmiştir.
World Health Organization. Refugee and Migrant Health, 2018. http://www.who.int/migrants/en/ adresinden 12/11/2018 tarihinde erişilmiştir.
- T.C. İç İşleri Bakanlığı Göç İdaresi Genel Müdürlüğü. Türkiye ve Göç 2015. http://www.goc.gov.tr/files/files/goc_tasar%C4%B1m_icler.pdf. adresinden 12/11/2018 tarihinde erişilmiştir.
International Organization for Migration. Social Determinants of Migrant Health 2018. https://www.iom.int/social-determinants-migrant-health. adresinden 12/11/2018 tarihinde erişilmiştir.
- Landrine H, Klonoff EA. Culture change and ethnic-minority health behavior: an operant theory of acculturation. Journal of behavioral medicine 2004;27(6):527-55.
UNICEF. İnsan Hakları Evrensel Beyannamesi 1948. https://www.unicef.org/turkey/udhr/_gi17.html. adresinden 12/11/2018 tarihinde erişilmiştir.
United Nations Human Rights Office of The High Commissioner. International Convention on Economic, Social and Cultural Rights 1966.
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Parliamentary Assembly. Basic Rights of Irregular Migrants 2006. http://assembly.coe.int/nw/xml/XRef/Xref-XML2HTML-en.asp? fileid=17456&lang=FR. adresinden 12/11/2018 tarihinde erişilmiştir.
Hacker K, Anies M, Folb BL, Zallman L. Barriers to health care for undocumented immigrants: a literature review. Risk management and healthcare policy 2015;8:175-83.
Cuadra CB. Right of access to health care for undocumented migrants in EU: a comparative study of national policies. Eur J Public Health 2012;22(2):267-71.
Hjern A, Ostergaard LS, Norredam M, de Luna CM, Goldfeld S. Health policies for migrant children in Europe and Australia. Lancet 2017;389(10066):249.
Stubbe Ostergaard L, Norredam M, Mock-Munoz de Luna C, Blair M, Goldfeld S, Hjern A. Restricted health care entitlements for child migrants in Europe and Australia. Eur J Public Health 2017;27(5):869-73.
Winters M, Rechel B, de Jong L, Pavlova M. A systematic review on the use of healthcare services by undocumented migrants in Europe. BMC health services research 2018;18(1):30.
Migration Policy Institute. Data and Analysis of Trump Administration Actions Related to Immigration and Refugee Policy 2018. https://www.migrationpolicy.org/programs/us-immigration-policy-program/data-and-analysis-related-trump-administration-actions. adresinden 12/11/ 2018 tarihinde erişilmiştir.
Migration Policy Institute. Health Care for Immigrant Families: Current Policies and Issues 2013. https://www.migrationpolicy.org/research/health-care-immigrant-families-current-policies-and-issues. adresinden 12/11/2018 tarihinde erişilmiştir.
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