- Pregnant women, minors and asylum seekers without the right to receive care in the National Health System, supported by health and human rights organisations, protest at the Ministry of Health
One year after the entry into force of Royal Decree-Law 7/2018 on universal access to the National Health System, those of us working at civil society organisations urgently request the Spanish government to implement a new comprehensive and protective regulation that centres on the right to health and guarantees access to the health care system under equal conditions for every person living in Spain, without any distinctions.
Amnesty International, the Red de Denuncia y Resistencia al RDL 16/2012 (REDER, Network to Denounce and Resist Royal Legislative Decree 16/2012)âmade up of over 300 organisations, whose core leading group has the participation of Salud por Derecho (Health by Right)- and Yo SĂ Sanidad Universal (YES to Universal Healthcare) herein state their deep concern about the current exclusion from health coverage that hundreds of people living in Spain are experiencing. This is despite the fact that one year ago the Spanish government announced that the country would restore universal access to the National Health System.
For this reason, we who are involved at these organisations congregated this morning in front of the Ministry of Health, Consumer Affairs and Social Welfare to protest this situation. We built a wall that represents the difficulties many people have to face each and every day. Several people who have been excluded from the Health System shared their testimonies and in the end they knocked down the wall.
It is particularly distressing that, beyond these barriers, new legislation does not guarantee health coverage to foreigners in situations of enormous vulnerability in all cases and without exception: pregnant women, minors, human trafficking victims and asylum applicants, as well as care in emergency rooms until medical discharge. We should all remember that the obligation to provide special protection in these situations is recognised by the World Health Organisation (WHO), to the point that even a regulation as restrictive to rights as Royal Legislative Decree 16/2012 considered it explicitly.
They are not isolated cases
Over the course of the last year, associations such as Doctors of the World have amassed over 1300 cases for which the right to health coverage has been violated, including 55 pregnant women, 116 minors, 44 asylum applicants, 85 intakes at emergency rooms, 35 people who participated in reunification processes and 626 people who could not have their right recognised, due to the administrative bureaucracy in place and the ambiguity of legislation.
As the result of these exclusions, people have not received care with diseases as serious as cancer, heart disease, hypertension, HIV and mental illness.
âWe went to six health clinics and all of them refused to provide care. I was almost eight months pregnant and I hadnât had any check-ups or monitoring. I didnât know if the baby was all right, if the baby was healthy (âŠ) and not even the gender. I could only hope that everything would be okay on the day of giving birthâ, explains Josefina (not her real name in order to protect her identity), a Peruvian woman repeatedly excluded from the health care services in the Community of Madrid.
âConflicting information can drive you mad with anguish. Every time I went to the health clinic they told me something differentâ, says Francisca, a Chilean woman who has been in Spain for less than three months.
Further, organisations denounce that the Spanish government has refused to handle the exclusion of the elderly arriving in Spain through a family reunification process so they can live with their sons and daughters. After the recent Spanish Supreme Court sentence that removed the option of recognising their rights to health coverage via judicial proceedings, there is now an urgent need for legislative modifications that guarantee access to the health system for this group, whose advanced ages and weak health conditions admit no delays.
An ambiguous regulation that leads to different interpretations
As we at the signatory organisations warned during the process of drafting Royal Legislative Decree 7/2018, the excessive ambiguity in the wording of the text, as well as the introduction of multiple determinant conditions to have the right to health care recognisedâhaving been in the country longer than 90 days, the obligation to provide difficult to obtain documentation, such as the certificate of non-exportation of the right, and the requirement that there is no third party guarantor for payment (such as private insurance)âare all factors that encourage and abet the persistence of situations of exclusion, as they raise barriers that are simply impossible for many people to surpass.
Despite the fact that RDL 7/2018 did represent an advance for the National Health System to the degree that it repealed the insurance model in the previous regulation (RDL 16/2012), the new regulation is clearly insufficient, as not only has the level of coverage prior to the 2012 reform not been restored, but in some respects it is even regressive with regard to the terms of this reform. This is because it does not expressly mention in all cases and with no exceptionsâas stated aboveâthat foreigners in situations of great vulnerability will receive health coverage.
For this reason, we at the signatory organisations must remind the Government yet again of the commitments taken on in virtue of international human rights agreements, in particular the recommendations issued by the Spanish Government Committee on Economic, Social and Cultural Rights in April 2018 that urged the adoption of the measures necessary so that migrants have access to health coverage with no discrimination.
Health care that prioritises prevention, giving coverage to the entire population, with no exclusions, is more efficient and less costlyâas it reduces the number of hospitalisations and minimises public health risks, among othersâstrengthening the National Health System in benefit of all of society.
Organisations break the wall of exclusion in front of the Ministry
As a consequence of organisations’ commitment to universal access to healthcare, we congregated this morning in front of the doors to the Ministry of Health, Consumer Affairs and Social Welfare to demand a right that is for everybody.
These people who were excluded shared their stories today before this fictitious wall that was built with denunciations and represents the real wall that smothers them in their daily lives.
After reading the manifesto, we at the organisations symbolically knocked down the wall that was raised, in the hope that hundreds of people who suffer exclusion can soon demolish the wall the Spanish government raises against them every day and that health coverage exclusion stops being a fact in our society.
This action was accompaniedÂ byÂ a letter to the Minister of Health, asking for a new comprehensive regulation that places the right to health at the centre of the policies, andÂ guarantees access to the health system on equal terms to all the people who live in SpainÂ without distinction.