Health Inequalities and Female Migrant Domestic Workers: Accessing Healthcare As a Human Right and Barriers Due to Precarious Employment in Greece

HEALTH INEQUALITIES AND FEMALE MIGRANT DOMESTIC WORKERS: ACCESSING HEALTHCARE AS A HUMAN RIGHT AND BARRIERS DUE TO PRECARIOUS EMPLOYMENT IN GREECE

DESIGUALDADES DE SALUD Y TRABAJADORES DOMÉSTICOS MIGRANTES FEMENINOS: ACCESO A LA SALUD COMO DERECHO HUMANO Y BARRERAS DEBIDO AL EMPLEO PRECARIO EN GRECIA

THEODOROS T FOUSKAS* PARASKEVI GIKOPOULOU** ELISAVET IOANNIDI*** GEORGE KOULIERAKIS****

RESUMEN el marco de los Derechos Humanos, este Las desigualdades en el acceso a los ser- artículo revisa el contexto legal y examina vicios de salud comprenden un problema las respuestas de política con referencia a complejo que enfrentan principalmente la salud, para revelar las debilidades del los nacionales de terceros países (NTC) en contexto institucional griego, y presentar todos los países de la Unión Europea. Uno datos sobre el acceso de las trabajadoras de los principales indicadores para exami- migrantes a los servicios de salud. La ex- nar el grado de integración de las NTC en la periencia de investigación en Grecia enfa- sociedad griega es su acceso a los servicios tiza que los servicios que están abiertos a de salud, tanto a nivel del marco institucio- los terceros países, que incluye un sistema nal como en los problemas que enfrentan elíptico de política social y de salud que durante la demanda y la utilización de los no aborda los reclamos y aspectos impor- servicios de salud. En Grecia, las trabaja- tantes de la protección social. La natura- doras migrantes provienen no solo de los leza incompleta del sistema restringe la países de los Balcanes, sino también de los capacidad de responder eficazmente a las países asiáticos y africanos, con un perfil necesidades específicas que resultan de la epidemiológico completamente diferente presencia de terceros países. al de los griegos y otros europeos. Uno de los mayores desafíos que Grecia enfrenta PALABRAS CLAVE: cuidado de la salud; actualmente es la existencia de dispari- desigualdades de la mujer; migración; de- dades significativas en la cobertura de la rechos humanos; Grecia. población para los servicios de salud. En

* Sociologist, PhD, External Associate, Department of Public Health Policy, University of West Attica, 196 Alexandras Ave., Athens, 11521, Greece. E-mail address: [email protected]; [email protected] ** Sociologist, PhD, External Associate, Department of Public Health Policy, University of West Attica, 196 Alexandras Ave., Athens, 11521, Greece. E-mail address: [email protected] *** Sociologist, PhD, Department of Public Health Policy, University of West Attica, 196 Alexandras Ave., Athens, 11521, Greece. E-mail address: [email protected] **** Associate Professor, PhD, Department of Public Health Policy, University of West Attica, 196 Alex- andras Ave., Athens, 11521, Greece. E-mail address: [email protected]

VOL. 6, NÚM. 2. JULIO-DICIEMBRE (2019) 71 ABSTRACT the framework of human rights, this article Inequalities in access to health services com- revisits the legal context and examines the prise a complex problem faced predomi- policy responses with reference to health, in nantly by third-country nationals (TCNs) in order to reveal the weaknesses of the Greek all European Union countries. One of the institutional context, and present data con- main indicators for examining the degree of cerning female migrant workers’ access to integration of TCNs in Greek society is their healthcare services. The research experience access to healthcare services, both at the in Greece emphasizes that services which level of institutional framework and in the are open to third-country nationals are in- problems they face during demand and uti- cluded in an elliptical system of health and lization of health services. In Greece, female social policy which fails to address signifi- migrant workers come not only from the cant claims and aspects of social protection. Balkan countries but also from Asian and The sketchy nature of the system restricts African countries, with a completely different the ability to respond effectively to the spe- epidemiological profile than that of Greeks cific needs that result from the presence of and other Europeans. One of the greatest third-country nationals. challenges Greece is currently facing is the existence of significant disparities in cover- KEYWORDS: healthcare; inequalities; age of the population for health services. In women; migration; human rights; Greece

1. INTRODUCTION dition”. The International Covenant on Economic, Social and Cultural Rights of One of the main indicators for examining 1966, declared the right to “enjoyment of the degree of integration of third-coun- the highest attainable standard of phys- try nationals (TCNs) in Greek society is ical and mental health” (World Health their access to healthcare services, both Organization, 2018a, p.6). This article at the level of institutional framework departs from the legal canon that sets and in the problems they face during de- the basis for the realisation of basic hu- mand and utilization of health services. man rights, in order to reveal the extent According to the World Health Organi- to which the healthcare rights of female zation (2018a, p.3) migrants are enti- migrants in concert with their work- tled to the same universal human rights ing rights are actualised or negated in and fundamental freedoms as all people, Greece. which must always be respected, defend- The right to health is a basic human right ed and safeguarded. The Constitution of (World Health Organization, 2018a, the World Health Organization of 1948, p.11). The right to access preventive, cu- stated that “enjoyment of the highest at- rative and palliative healthcare, but also tainable standard of health is one of the the right to the underlying social pre- fundamental rights of every human be- conditions for health, is a basic human ing without distinction of race, religion, right under the 1966 International Cov- political belief, economic or social con- enant on Economic, Social and Cultur-

72 VOL. 6, NÚM. 2. JULIO-DICIEMBRE (2019) al Rights (World Health Organization, health of migrants, asylum seekers and 2018a, p.11). In 2009, the Committee on refugees in Europe today, additional Economic, Social and Cultural Rights in obstacles are placed by the political- General Comment 20.30 stated, “Cove- ly charged nature of migration (i.e. an- nant rights apply to everyone including ti-immigrant parties, xenophobia, lim- non-nationals, such as refugees, asy- itations in collecting data with regards lum-seekers, stateless persons, migrant to migrants’ needs). At the same time, workers and victims of international there are areas where progress is being trafficking, regardless of legal status made, making health services more ac- and documentation” (World Health Or- cessible and responsive to immigrants ganization, 2018a, p.11). According to while some European countries have the World Health Organization report chosen to provide universal access to (2018b, p.9) access to services varies healthcare, including undocumented mi- considerably between the Member States grants. Despite the fact that the Charter of the European Region WHO, although of Fundamental Rights of the European the right to health and, consequently, the Union stipulates the right of everyone to right to health services should be univer- have access to preventive healthcare and to benefit from healthcare, immigrants sal (World Health Organization, 2018b, and vulnerable groups including asylum p.9). Therefore, it is difficult to general- seekers and irregular immigrants in most ize the findings on the right to access rel- European Union countries still face legal evant services, as well as recognizing and obstacles in access to healthcare. Inter- assessing the health needs of the refugee national and European institutions such and migrant population which are not as the International Covenant on Eco- covered (ibid). nomic, Social and Cultural Rights, and Addressing inequalities in accessing health- the Charter of the World Health Organi- care services by female migrant workers zation (WHO, 1946) established the right must become a priority in the social pol- of immigrants, to the highest attainable icy agenda of Greece. EU countries dif- standards of physical and mental health. fer widely in asylum policies, residence, Although these rights are established citizenship and integration patterns of in signed international conventions, no migrants. Countries with more restric- European Union Member State has yet tive policies not only make life harder for acceded to the International Conven- migrants, asylum seekers and refugees, tion on the Protection of the Rights of All but they are also more likely to limit their Migrant Workers and Members of their access to healthcare. Although there are Families of the United Nations (UN, multiple barriers with reference to the 1990). There is, therefore, a clear need

VOL. 6, NÚM. 2. JULIO-DICIEMBRE (2019) 73 to strengthen the national and European conditions, low income, difficulties in legislation for the protection of migrant communication, exclusion from health workers’ rights and to ensure their im- and other services, racism and xenopho- plementation. bia, has detrimental effects on the health of migrants, on the other hand, poor In the WHO European Region preventive health status leads to social exclusion health care consists of health promo- due to the difficulty in finding formal em- tion strategies and diagnostic tests, but ployment. For female migrants are most- also social support programs, educa- ly employed in precarious, low-status/ tion, training of health professionals and low-wage jobs and particularly in do- awareness-raising initiatives aimed at mestic work (see Table 2), experiencing minority groups (World Health Organi- real income fall. Indeed, international zation, 2018b, p.9). Health promotion literature (Fouskas, Gikopoulou, Ioanni- and education are particularly important di and Koulierakis, 2019; Fouskas, Sid- for refugees and migrants, because they iropoulos and Vozikis, 2019; Souliotis, et are not always familiar with the health al, 2019) reveals that immigrant work- systems of the destination country, and ers lack adequate access to healthcare therefore unaware of the support they and health insurance and self-evaluate can receive, and how to access their their health status as very low. When the rights (ibid). Furthermore, systematic Greek National Health System (NHS) immunization is recommended for new- was founded in 1983, it was designed to ly arrived refugees and migrants under provide a free, and just health insurance the national immunization program of for the entire Greek population, but the each host country due to the level of risk needs of newcomers exposed the NHS to of illnesses refugees and migrants may a plethora of new challenges. face (ibid). Concerning documented TCNs in Greece Female migrants (see Table 1 and Figure 1) (as of April 2019) (Table 1) regarding are a social group with special health the reasons for issuing a residence per- needs, given their generally poor living mit (2013-2018) (see Table 7) one can conditions (both in sending and receiv- see that for female migrants the three ing countries), but also due to addition- primary reasons were “Family reunifi- al problems caused by the difficulties to cation” (127,381), “Other” (112,821) and adapt to a new social and cultural envi- “Employment” (20,999). ronment. Thus, the relationship between social exclusion and the health status of female migrants works in a bidirection- al manner. On the one hand, poor living

74 VOL. 6, NÚM. 2. JULIO-DICIEMBRE (2019) Table 1. Documented Third-Country Nationals

Category Males Females Total Employment 46,952 20,999 67,951

Family reunification 75,651 127,381 203,032

Studies 889 812 1,701

Other 168,764 112,821 281,585

Total 292,256 262,013 554,269

Source: Hellenic Ministry for Migration Policy.

Regarding asylum application per gender 51,053 applications with a monthly av- (Figure 1), in 2013, 4,814 applications erage of 4,254 applications, with a per- were recorded with a monthly average centage difference between 2016-2017 of 688 applications. The percentage dif- increased at 14.9 %. In 2017, 58,642 ference between 2013-2014 increased applications with a monthly average of at 14.3 %. In 2014 respectively, 9,431 4,887 applications, with a percentage applications with a monthly average of difference between 2017-2018 increased 786 applications, with a percentage dif- at 14.2 %. In 2018, 66,966 applications ference between 2014-2015 increased at with a monthly average of 5,581 appli- 39.8 %. In 2015, 13,187 applications with cations. In 2019, 21,155 (April 30, 2019) a monthly average of 1,099 applications, applications with a monthly average of with a percentage difference between 5,289 applications, with a percentage 2015-2016 increased at 287,1 %. In 2016, difference between 2018-2019 at 5.2%.

Figure 1. Asylum applications per gender by year from 07/06/2013 to 30/04/2019

Source: Asylum Service/Hellenic Ministry for Migration Policy, 2019

Furthermore, and until April 2019 applica- migrants can be found in thehousehold tions rose to 30.5 % for women (with sector followed by accommodation and 1,427 applications) and 3,249 applica- food service activities at 17.2 %, manu- tions for men (that accords to 69.5 %). facturing at 7.2 %, agriculture, forestry Concerning female migrants’ participation in the main sectors of econom- and fishing at 3.5 %, and wholesale and ic activity (Table 2), 59.4 %, of female retail trade at 2.7 %.

VOL. 6, NÚM. 2. JULIO-DICIEMBRE (2019) 75 Table 2. Female migrants’ participation in the main sectors of economic activity, 2017

Agriculture, forestry and fishing 3.5% Manufacturing 7.2% Wholesale and retail trade 2.7% Accommodation and food service activities 17.2% Activities of households as employer 59.4% Total of migrant women employed 5.8%

Source: Kapsalis, 2018

Following findings of MIPEX (Huddleston and the UK), there is no legislation or et al., 2015) (Figure 3), according to the policy regarding cultural or health me- EWSI 2018 report (Mikaba, 2018) (see diators for migrants nor patient naviga- Table 4), in half of the Member States tors, impeding many migrants of fully (Bulgaria, Croatia, Cyprus, Estonia, exercising their rights. Cut-backs regard- Greece, Hungary, Ireland, Latvia, Por- ing interpreters are also observed in Ire- tugal, Poland, Romania, Slovenia, Spain land, Estonia and Greece.

Figure 2. Greece - Strand and four dimensions on health

Source: Huddleston et al.

In addition, and according to the EWSI re- not adopted standards on cultural me- port (2018), Greece lacks a national diators, and on free interpreters and has health strategy that targets migrants or not designed health indicators for mi- an integration policy targeting health- grants (see also IOM, 2016). care. At the same time, the country has

76 VOL. 6, NÚM. 2. JULIO-DICIEMBRE (2019) Table 3. Indicator-based health systems?

Health strategy Health in- targeting mi- Integration strategy Standards on cultu- Free interpreters dicators for grants targeting health ral mediators migrants Greece N/A N/A N/A N/A N/A

Source: EWSI Editorial Team.

According to the World Health Organization ger period of recovery is required due (WHO), the concept of equity in health to poor nutrition, bad living conditions implies that everyone should have equal and lack of social/welfare support (ibid). opportunity to exercise their health Also, financially disadvantaged regions rights to the maximum extent, and real- tend to have higher rates of diseases in istically, to be able to avoid one’s state of relation to the more prosperous (ibid). weakness in order to achieve the above Therefore, a contract calculated at av- objective (WHO/ECHP, 1999:9). Ac- erage costs of a particular treatment or cording to Whitehead, equity in health- average per capita cost, may fail to cover care is defined as, (i) equal access to the real costs of these patients’ treatment available care for equal need, (ii) equal (ibid). On the other hand, geographic ac- utilization for equal need, and (iii) equal cess is usually associated with the equi- quality of care for all (Whitehead, 1985, table distribution of services in different areas (e.g., of a country), and particularly 1991, 2006, 2007). Adopting this defini- with the possibility of movement of the tion, Townsend et al. (1992) argue that patient (e.g., local difficulties with trans- access to health services is divided into port) through the recourse of appropriate three types: economic, geographic and services (ibid). Finally, cultural access is cultural. In particular, economic access associated with the relationship between is associated with the equal provision patients and health professionals or em- of goods regardless of the economic ca- ployees of agencies and the extent to pacity of the individual and by offering which differences in education, gender, social goods based on needs and not on culture, religion or nationality create the cost of the institution and econom- barriers to communication and effective ic return/contribution of the individual use of social/welfare services (ibid).1 (Townsend et al. 1992:358). Based on this logic, issues of unequal service pro- 1 Townsend et al. (1992) emphasize that these three types regarding access and quality must vision emerge in the health sector, when be analyzed with focus on: (i) monitoring the effect of funding arrangements, changes in healthcare services offered to patients policy, and rationing processes on provision from disadvantaged groups cost more of services for different sections of the population (ii) monitoring uptake rates and patterns than average as they tend to suffer from of service use and acceptability (iii) monitoring quality of premises, staff numbers and chronic illnesses (ibid). Moreover, a lon- their training, and the distribution of services

VOL. 6, NÚM. 2. JULIO-DICIEMBRE (2019) 77 2. THE RIGHT OF FEMALE MIGRANTS’ emergency and non-emergency did not ACCESS TO HEALTHCARE: apply was when it came to minors (ibid). INSTITUTIONAL AND POLICY Moreover, exemption from health services RESPONSES in undocumented residents did not apply when the patient, regardless of na- Greece in the past, due to the fact that tionality and residence status, was HIV third-country nationals were mostly un- positive or suffered from other infectious documented and therefore uninsured, diseases. In those cases, free hospitalisa- they were excluded from healthcare ser- tion and medical care was provided, if vices while the cost of their healthcare the individual was in need of treatment was higher than that of insured individ- which could not be effectively provided uals, making migrants less able to afford in the country of origin (Fouskas, 2017). the cost of care needed. Undocumented For the period that the effective treat- migrant residents lacked national health ment took place, third country nation- insurance and social security rights and als were entitled to temporary residence did not have free access to health services and work permits (ibid). In addition, free other than in emergencies (Fouskas, medical care and hospitalisation was 2017). Hospitalization of undocument- provided to victims of trafficking, since ed third country nationals was feasible they were excluded from national health only for emergencies and their health insurance and were financially deprived, was stabilised (Article 84, paragraph 1, for as long as protection and assistance Law 3386/2005) (Government Gazette, measures lasted, provided they held a 2005). This distinction between emer- certificate which had been issued by the gency and non-emergency incidents was Police Directorate in charge of their case greatly criticized since a non-emergency (ibid). case could develop into a life threatening one if not properly and timely addressed As highlighted in the programme “Local Al- (UNHCR, 2007). The stabilization rather liance for Integration”2, according to the than the full recovery of patient’s health Greek State with Article 33 “Health cov- comprised a typical wording of the law thus further limiting the extent of the 2 National School of Public Health (NSPH/ESDY), University of Gent, PRAKSIS, European Public care provided (Fouskas, 2017). The Law Organization (EPLO), CMT PROOPTIKI and Syn-Eirmos, “Local Alliance for Integration only case where the distinction between (776213/LION) (AMIF-2016-AG-INTE) (Decem- ber 2017- November 2019)”, Asylum, Migration and Integration Fund/European Union/Na- in different localities, (iv) including equity con- tional School of Public Health (NSPH/ESDY), siderations in the setting and monitoring ar- University of Gent, PRAKSIS, European Public rangements for contracts and (v) auditing re- Law Organization (EPLO), CMT PROOPTIKI and ferral and treatment patterns by social group Syn-Eirmos, 2019 http://allianceforintegration. (Townsend et al. 1992, pp. 358-359). eu/

78 VOL. 6, NÚM. 2. JULIO-DICIEMBRE (2019) erage of uninsured and vulnerable social agement Communication, 2018). Those groups” (Table 6) of Law 4368/20163, who are uninsured (including pregnant the Joint Ministerial Decision (JMD) women, minors, patients with chronic Α3(c)GP.ec.25132/4-4-2016 “Provisions illnesses, etc.) and do not have a Nation- to ensure access for uninsured persons al Insurance Number6 or cannot acquire to the Public Health System”4 and the one, must necessarily hold a Foreigner’s Circular Α3c/GP.ec.39364/31.05.2016 Health Care Card7 (NSPH, University of “Clarifications on ensuring access for the Gent, PRAKSIS, EPLO, CMT PROOPTI- uninsured and socially vulnerable groups KI and Syn-Eirmos, 2019). Third-coun- to the public health system”5 provide all try nationals can apply for a National In- refugees and migrants with the right to surance Number and Number of Health free access to all public health institu- Care of Foreigner8 at any Citizens’ Service tions for the provision of nursing and Centre9 while they can acquire a Foreign- health care (Ministry of Health, 2019) er’s Health Care Card from Health Pro- (Table 9). The Hellenic Government’s tection Offices of Rights of Health Care interventions were from the outset in Receivers or from the Social Services of support of treating refugee populations their local hospital (NSPH, University of like all citizens, without any discrimi- Gent, PRAKSIS, EPLO, CMT PROOPTI- nation, as the only way to protect pub- KI and Syn-Eirmos, 2019). lic health. Law 4368/2016 refers to the In Article 33 of Law 4368/2016 a new provi- most vulnerable groups of migrants and sion wasestablished regarding the right refugees living in Greece with direct ac- to access the Greek NHS by all people on cess to the National Health System, ir- the move (regardless of status), as well respective of their legal status (Ministry as those residing in Greece on humani- of Digital Policy, Telecommunications tarian grounds or for exceptional health and Media/Secretariat for Crisis Man- reasons. The law of 2016 also guaranteed free access to health services to vulner- 3 Government Gazette (2016a). Law 4368: Mea- sures to speed up government work and other able groups, such as minors, pregnant provisions. Athens: National Printing House, (in Greek) https://www.synigoros.gr/resources/ women and people with disabilities. The docs/160817-n4368.pdf 4 Government Gazette, (2016b). Joint Ministeri- table below provides an overview of ac- al Decision (JMD) No. A3(c)/GP.ec.25132 - Ar- cess rights depending on legal status of rangements to ensure access for uninsured persons to the Public Health System. Athens: migrants. National Printing House. (in Greek) https:// www.synigoros.gr/resources/160817-kya.pdf 5 Ministry of Health (2016). Circular No. A3c/ GP.ec.39364 Clarifications on ensuring access for the uninsured and socially vulnerable 6 Greek acronym AMKA. groups to the public health system. Athens: 7 Greek acronym KYPA. Ministry of Health, (in Greek) https://www.syn- 8 Greek acronym AIPA. igoros.gr/resources/160817-egkiklios.pdf 9 Greek acronym KEP.

VOL. 6, NÚM. 2. JULIO-DICIEMBRE (2019) 79 Table 4. Legal Status and type of access

Legal Status Τype of Access Nationals Access all public structures using AMKA number Non-national residents Access all public structures using AMKA number Undocumented residents belonging to vulnerable groups that need Entitled to Foreigners’ Health Care Card (KYPA) in order to immediate health care (pregnant women, chronically ill, people with access Public Health Structures. Once KYPA is issued, he/she mental disorders, etc.) is entitled to access all hospitals and diagnostic departments of public hospitals. All people, irrespective of their legal status Entitled to access the Emergency Departments

Source: Ministry of Health, 2019.

Table 5. Article 33 “Health coverage of uninsured and vulnerable social groups” of Law 4368/2016

Paragraph Sub-section 1. Uninsured and vulnerable social groups as defined in paragraph 2 hereof have the right to free access to Public Health Structures and are entitled to nursing and health care. Nursing care is provided through the Hospitals of the Legislative Decree 2592/1953 (Α΄ 254), of supervised and subsidized by the Ministry of Health nursing institutions, of those supervised and subsidized by the Ministry of High cost medicines, which fall within the scope of paragraph 2 of Health Legal Entities of Private Law10 of the Mental Health Units Article 12 of the Law 3816/2010 (Α΄ 6), are provided exclusively by Law 2716/1999 (Α΄ 96), of Primary Health Care Units of the Natio- Hospital pharmacies and the National Organization for Health Care nal Health System, those supervised and subsidized by the Ministry Provision12. of Education, Research and Religious Affairs Hospitals, Municipal Hospitals, as well as supervised by the Ministry of Labour, Social Security and Social Solidarity rehabilitation and other social care institutions. Pharmaceutical care is provided by private pharmacies affiliated with the National Organization for Health Care Provision11. i) minors under 18 years of age, ii) women in pregnancy, ix) beneficiaries of international protection (recognized refugees and beneficiaries of subsidiary protection) and stateless persons and members of their families (spouse and minor or protected children) are either holders of a valid residence permit or a decision is pending on an application for the renewal of the regime for international protection appeal or appeal against a decision rejecting a request for renewal or at the time when there is a right of appeal or appeal, x) those residing in Greece with a residence permit for humanitarian or exceptional reasons and their family members (spouse and minor or protected children), in accordance with Article 28 of the Presi- 2. Beneficiaries of the rights referred to in paragraph 1 hereof are the dential Decree 114/2010 (Α΄ 195) or the Law 3386/2005 (Α΄ 212) or following: the Law 4251/2014 (Α΄ 80) whether they are in possession of a valid (a) non-directly or indirectly insured Greek citizens or Greeks of residence permit or a decision is pending on an application for the Greek origin, citizens of EU Member States and other third countries renewal of an international protection regime or on a civil action or who have legalization documents in Greece, and family members an appeal against a decision rejecting a request for renewal or at the (spouse and minor or protected children) of all the aforementioned, time when there is a right of redress or appeal, (b) (the spouse and minor or protected children) who have lost their insurance cover due to debts and are not entitled to health benefits; xi) applicants for international protection and their family members (c) the persons of the following categories, irrespective of their legal (spouse and minor or protected children) from the date of the decla- status and the possession of legitimate residence documents in the ration of intent to lodge an application for international protection country: (initial or subsequent) and until the decision on their application for international protection becomes final by decision of the relevant au- thority requesting the annulment of a decision of a Board of Appeal or if the time limit for filing an appeal has expired, xii) victims of crimes of Articles 323, 323Α, 349, 351 and 351Α of the Criminal Code (in accordance with Presidential Decree 233/2003 (Α΄ 233), who are uninsured and for as long as the protection and assistance measures are in force and aliens that fall under the provisions of Law 3875/2010 (Α΄ 158) “Ratification and implementation of the United Nations Convention against Transnational Organized Crime” and for as long as protection and assistance measures are in place. Citizens of third countries with a written certificate of postponement of expulsion pursuant to the provisions of paragraph 4, article 24 of Law 3907/2011 (Α΄ 7) [17]. Source: Government Gazette, 2016.

10 Greek acronym NPID. 11 Greek acronym EOPYY. 12 Greek acronym EOPYY.

80 VOL. 6, NÚM. 2. JULIO-DICIEMBRE (2019) Regardless of the previous law of 2016, re- instability not only in the workplace cent developments froze all previous but also in their relationships with fel- efforts to secure social security number low migrant workers. This workforce is to third country nationals. In July 2019 distinguished by its lack of work rights in particular, the new cabinet of Greece and trade union representation. Sassen suspended the right to issue social secu- (1998, pp.153-154) mentions that “the rity number for TCNs without however growth of an informal economy in highly developed countries has been explained releasing further guidelines. In other as the result of immigration from the words, the authorities that were other- Third World and the replication here of wise responsible for issuing AMKA, halt- survival strategies typical of the home ed all legal procedures. As of September countries of migrant workers”. More and 2019, neither the relevant institutions more immigrants, regardless of their nor TCNs are informed with regards to country of origin, are becoming a part of their health insurance (Suspension of a workforce reserve that is continually re- Circular no. 80320/28107/1857/20-6- newed and is divided into sectors accord- 2019) (Hellenic Ministry of Labour, So- ing to type of employment. In Greece, cial Security and Social Solidarity, 2019). Italy, Spain, and Portugal, the underground economy constitutes a structural 3. REPERCUSSIONS OF PRECARIOUS element. Greece comes first among the EMPLOYMENT AND DOMESTIC WORK 21 OECD country-members where 24% IN FEMALE MIGRANTS’ ACCESS of Greek GDP is formed by the under- TO HEALTHCARE SERVICES IN GREECE ground/shadow economy (Williams and Schneider, 2013, pp.52-57). Precarious work is employment that lacks all the standard forms of labour secu- Moreover, the percentage of uninsured rity. It typically takes the form of wage workers is among the world’s highest work, and is characterized by excep- (37.3 %) and so is the percentage of undocumented migrants working (4.4 %) tionally limited social benefits and legal (Williams and Schneider, 2013, pp.90- rights, job insecurity, low wages and high 96; Williams, Demetriades and Patra, risk of ill health (Vosko, 2006, pp.3-4). 2016). According to data from the Hel- Precarious work creates enormous and lenic Ministry of Labour, Social Securi- complex barriers to labour organization ty and Social Solidarity/Unified Social strategies due to the isolated, atomized Security Fund (2017)13 (December 2017, and non-unionized nature of immigrant 14/06/2018)14, out of the total number of employment (Choudry and Thomas, 2012, pp.180-181). With regards to la- 13 Greek acronym EFKA. 14 http://www.efka.gov.gr/_stats/files/apasxoli- bour rights, migrants experience intense si_12_2017.zip

VOL. 6, NÚM. 2. JULIO-DICIEMBRE (2019) 81 insured individuals, 90.32% have Greek menos, 2013, pp.15-17). Following the nationality, 1.58% other EU nationali- previous argument, one could also add ty, and 8.10% non-EU nationality15. Out all types of helpers for the care and safe- of the total number of individuals in- ty of persons and properties, beauty care, sured in joint businesses, 90.98% have entertainment, agricultural work, manu- Greek citizenship, 1.57% other EU citi- al labour, constructions, crafts, food ser- zenship and 7.45% non-EU citizenship, vices, entertainment industry, itinerant while the corresponding percentages in trade and the street economy occupa- the domain of construction works are tions, all of which are characterized by 54.44%, 2.38% and 43.17% respectively. similar types of inequality, the erosion Out of the total number of insured for- and deregulation of labour gains, collec- eigners, 52.65% are of Albanian citizen- tivities and capabilities of tackling labour ship. With regards to TCN men, 54.25% market exploitability (Psimmenos, 2013, are of Albanian citizenship, followed by pp.15-17). According to international re- 10.08% of Pakistani origin and 4.87% of search, female migrant domestic workers Bangladeshi nationality. With regards are depicted as being cut off from family to TCN women, 49.68% are of Albanian and community ties, shattered networks nationality, followed by 8.17% of insured of solidarity and disassociation from Bulgarian nationals and 7.48% of Roma- collectivities and claims as they are en- nians. trapped in exploitative servitude, servile Regarding domestic work, it is argued that and precarious, low-status/low wage la- more than 67.1 million (International bour. The impact on health and therefore Labour Organization, 2016) women and an important occupational safety and men of different age, class and nation- health hazard in the sector (including ality are pushed nowadays to work in food and water, body pain and injuries, businesses, households and for individ- dermatological issues, allergic reactions, ual employers undertaking various tasks abuses, including verbal, physical, sexu- such as cleaning, and providing care, al abuse), is well-documented (Fouskas, companionship and supervision (Psim- 2016; Svensson, 2018).

15 Third-country: A country that is not a member of the European Union as well as a country or Under precarious, low-status/low wage jobs territory whose citizens do not enjoy the Euro- immigrants are exposed to an unsafe pean Union right to free movement, as defined in Art. 2(5) of the Regulation (EU) 2016/399 working environment, facing stigma and (Schengen Borders Code). Source: Europe- an Migration Network (EMN). (2018). Asylum exposed to physical and moral exploita- and Migration Glossary 6.0: A tool for better tion. Immigrant workers acquire special comparability. Brussels: European Migration Network (EMN)/European Commission, (p. relations with official forms of social pro- 378) http://emn.ie/files/p_20180521043751in- teractive_glossary_6.0_final_version.pdf tection (Psimmenos, 2011, pp.228-230).

82 VOL. 6, NÚM. 2. JULIO-DICIEMBRE (2019) In the Greek labour market female migrant fort. The jobs in which female migrants workers are mainly found in precarious, are employed are defined as non-attrac- low-status/low wage occupations, in un- tive as they offer no social prestige, are declared work and underground econ- marginal and secondary; they are paid or omy/informal sectors of the economy not paid occupations outside the margins which demands for its constant repro- of formal employment and since they are duction a cheaper, uninsured, mobile, not registered they are considered infe- temporary and flexible workforce (Psim- rior by society. There are various jobs in menos, 2011, pp.228-230). Precarious, every society which have a clear and of- low-status/low wage employment en- ten necessary function within the overall traps female migrant workers while inte- division of labour but which are seen by grating them in a context outside labour the public as ‘dirty’ – in a metaphorical inspections, labour law and taxation, or literal way- and somehow regarded as without social insurance contributions morally dubious by the public (Hughes and defiance, and without regulations 1958 in Watson, 2008, p.189). concerning labour rights. These jobs are Female migrant domestic workers are usually concealed from the state so that the employer pays less or no tax at all, no pushed to meet their healthcare and social security contributions and avoids social care needs in informal or private adhering to worker rights regulations. practices, which go beyond the safety of Social and financial restructuring, along the employee, forming a grid of solidar- with government policies have led to the ity and stability in this particular labour development of financial activity which market (Psimmenos, 2009, pp.145-146). drives this mobile workforce out of the According to Psimmenos (ibid) mostly formal labour market and places female concerning their health: (i) Regarding migrants in precarious employment. medical care clientele relationships with One problem here is that the workforce nursing personnel are developed while is distinguished by the absence of rights they may also turn to charity foundations and union representation. More and and non-governmental organizations, more female migrants are becoming part (ii) for pharmaceutical coverage they of a workforce reserve that is continually turn to the private market, (iii) for hospi- renewed and is divided into sectors ac- talization and emergency cases they turn cording to types of employment. These to employers, relatives or informal net- female migrants facilitate adjustable works, (iv) for medical examinations and production, low technical and technolog- visits they turn to private doctors and ical intervention as well as personal and also visit the country of origin, (v) im- sentimental contribution to the work ef- migrants do not conduct any preventive

VOL. 6, NÚM. 2. JULIO-DICIEMBRE (2019) 83 monitoring, (vi) for deliveries or abor- country of origin are left behind and tions they turn to private health facilities work acquires, among others, a sense of or charity foundations, (vii) for psycho- skills of development of personal and so- logical needs they adapt themselves to cial relations (ibid). the current requirements, they try to pre- Moreover, female migrants are employed dict the situations and to develop skills. as contracted live-in domestic workers Two main obstacles distance immigrants (cleaning-care giving) with direct-hire from health services. Objective parame- in households of Greek employers so as ters: First, the lack of legal documents of to support themselves and their families residence and work leads them to infor- back in their homeland. There is still de- mal and uninsured work (Psimmenos, mand in parts of the Greek society for 2010, pp.99-102). In turn, informal and domestic servants, and in particular Fil- uninsured work hinders the acquisition, ipina female overseas contract workers, or renewal and maintenance of legal doc- due to deficiencies observed in the Greek uments (ibid). Second, in order to ensure welfare system, not only from the upper the well-being of the labourer in precari- class but from the middle class as well, ous, low-status/low wage work, there are both for household’s social reproduc- conditions, rules and practices to be fol- tion and also social status attainment. lowed, such as multi-share employment Female migrant domestic workers have or sub-contracting that hinder formal multiple duties (maids,maidservants, social protection (ibid). And third, fail- babysitters, housekeepers, carers and ure to develop collective bonds distances nurses) depending on employer’s de- them from solidarity networks and fur- mands: household cleaning and chores ther hampers access of male and female (such as laundry/cooking meals), and/or immigrant workers to formal social pro- caring/nursing of the elderly, and child- tection (ibid). Subjective parameters: care. They reside in employers’ residenc- Difficulties of access are solidified and es six days a week. They rent and share are not only explained through the legal flats with other live-in domestic workers status and income or the function of the and go there at weekends; the only time worker in his occupation (ibid). During they are allowed to leave the employer’s work employees acquire or develop hab- residence. Multiple cases of verbal and its, values and practices that strengthen physical abuse were reported, including the informal part of social protection shouts and gesticulation. (ibid). One example is the development of work orientations that boost infor- Furthermore, they are hired with false labour mal protection. Plans of immigrants for contracts that often the worker has nev- instant profits and speedy return to the er read, thus being vulnerable and sus-

84 VOL. 6, NÚM. 2. JULIO-DICIEMBRE (2019) ceptible to various forms of exploitation relationships in the country of origin, (Fouskas, 2016, 2018). The situation and interaction with their compatriots, seems further burdened by the control colleagues and community associations that employers exercise over the domes- (ibid). tic worker which results in prolonged stay in domestic work, as they are un- 4. CONCLUSION able to seek other occupations (ibid). In In this article we have argued that possible many cases, employers confiscated their health problems may limit the ability of documents, constantly survey them and migrants to maintain a job, since the ma- threaten to denounce them to the au- jority is drawn to precarious low-status thorities resulting in further exploitation and low wage occupations (Pajnik and by their employers who demand disci- Campani, 2011; Fouskas 2013, 2014), or pline, consent and subordination, obe- to ones where there is a high incidence of dience and dependency of the domestic work accidents and occupational health worker and thus emerge pseudo-fami- issues. Furthermore, we have included ly relationships and pseudo-mothering the international legal context regarding feelings and roles (ibid). rights into the Greek narrative in order to reflect upon the ways in which health- Female migrant live-in domestic workers care rights alongside exploitative work- rarely claim work rights as they are in ing conditions of female migrants coexist an isolated work space. They often leave in the country. Social policy challenges their employer without having received are insurmountable as general measures full pay and blame themselves for not may lead to unemployment and/or an looking into the details of their employ- increase of informality. Instead, further ment conditions beforehand (Fouskas, training and direction of this workforce 2016, 2018). Through this attitude, they to employment in other jobs is needed. try to maintain low-profile as hard la- Due to the situation many immigrants lack the protection of national health bourers in order to gain the employer’s insurance, and may be unable to meet trust and improve the reception soci- the cost of even a simple hospitalization. ety’s perception about them, or even Female migrant workers are often based to achieve higher wages (ibid). The re- on an inhomogeneous provisional or cession seems to have created greater temporary healthcare system where the insecurity and increased dependency role of non-governmental organizations upon their employers out of their need or charitable initiatives is significant, to achieve some level of social protection stressing the importance of safeguard- (ibid). This dependency further isolates ing healthcare rights at an institutional female migrants, undermining family level. They are thus forced to turn to this

VOL. 6, NÚM. 2. JULIO-DICIEMBRE (2019) 85 system as they have no other option, a communicable diseases such as tuber- fact that illustrates the repercussions culosis, hepatitis and HIV are general- of discriminatory access, as well as the ly high. Especially for migrant workers informal, private and individualistic employed in precarious, low-status/low practices that immigrants are pushed to wage employment, there is a higher risk and ultimately choose. Female migrants of accidents and they are more likely to are often uninsured and excluded from be absent from work due to illness or healthcare, while their cost care is high- injury while they work without nation- er than the insured, making immigrants al health insurance and protection gear. less able to pay the care needed. Difficul- Moreover, Greece does not collect sys- ties such as informal and discriminato- tematic data on the health of migrants. ry policies of health professionals and The data available often refer only to perceptions developed by immigrants the health status and do not cover wider on welfare, hinder and prevent the use determinants on health. There is a clear of services by the latter. The end result need for a consistent approach towards is that immigrants are much less likely improving the monitoring system of mi- to use preventive health services, hospi- grants’ health in Greece and other Euro- tal services, emergency medical services pean Union countries. It is important to and dental care than native citizens. The collect data beyond disease-based health main barriers for immigrant workers and monitoring, focusing for example on age, ethnic minorities in accessing healthcare gender, social determinants of health, and social care services are summarized behaviours of migrants when seeking in the following points: (a) cost of care, health services, rights, behaviours of (b) lack of information on access to ser- healthcare workers/providers/profes- vices such as health, social insurance and sionals and on how the health system of the welfare system (e.g., vaccinations Greece functions in relation to services and the places of available services), (c) provided to migrants. language difficulties in communicating with health professionals and workers in social work/care, (d) prejudices and ste- reotypes of health professionals towards these groups, (e) fear of these groups towards the operation of public services. Furthermore, we have also argued that migrants, asylum seekers and refugees have specific vulnerabilities regarding communicable diseases as they come from countries where diseases are prevalent, health systems are weak, and rates of

86 VOL. 6, NÚM. 2. JULIO-DICIEMBRE (2019) BIBLIOGRAPHIC REFERENCES quences on Immigrant Workers’ Organi- zation. International Review of Sociolo- Asylum Service/Hellenic Ministry for Migra- gy: Revue Internationale de Sociologie, tion Policy (2019). Asylum Applications 23(3), 671-698. per gender by year from 07/06/2013 to Fouskas, T. (2014). Nigerian Immigrants in 30/04/2019. Athens: Asylum Service/ Greece: Low-Status Work, Community, Hellenic Ministry for Migration Policy and Decollectivization. New York: Nova http://asylo.gov.gr/en/wp-content/up- Science Publishers. loads/2019/05/Greek_Asylum_Stats_ Fouskas, T. (2016). Precarious, Low-Status Apr2019_EN.pdf?source=post_ Labor, Broken Families and Commu- Choudry, A. and Thomas, M. (2012). Orga- nities, Shattered Networks of Solidar- nizing Migrant and Immigrant Workers ity and Collectivity, Racial and Class in Canada. In: Ross, S. and Savage, L. Inequalities, and Ethnic and Gendered (Eds.) Rethinking the Politics of Labour Division of Labor: Migrant Filipina Live- in Canada. (pp.171-183). Halifax: Fern- in Domestic Workers and Palestinian wood. Refugee Unskilled Manual Laborers in European Migration Network (EMN). (2018). Greece in Times of Crisis, European Pol- itieia, 3(2), 430-461. Asylum and Migration Glossary 6.0: A Fouskas, T., Gikopoulou, P., Ioannidi, E. and tool for better comparability. Brussels: Koulierakis, G. (2019). Gender, trans- European Migration Network (EMN)/ national female migration and domestic European Commission, (p.378) http:// work in Greece: An intersectional review emn.ie/files/p_20180521043751inter- of research on access of female migrants active_glossary_6.0_final_version.pdf to labor, healthcare and community as- European Union Agency for Fundamen- sociations. Collectivus: Special Issue tal Rights (FRA). (2018). Fundamen- Migrations and gender from a transna- tal Rights Report 2018. Vienna: Publi- tional perspective, 6(1), 101-131. cations Office of the European Union. Fouskas, T., Sidiropoulos, S. and Vozikis, https://fra.europa.eu/sites/default/ A. (2019). Leaving no one out? Pub- files/fra_uploads/fra-2018-fundamen- lic health aspects of migration: Health tal-rights-report-2018_en.pdf risks, responses and accessibility by asy- Fouskas (2017). Repercussions of precari- lum seekers, refugees and migrants in ous, low-status work regarding access to Greece. International Journal of Health healthcare services by immigrant work- Research and Innovation, 7(1), 13-28. ers in Greece: Seasonal flu or an incur- Government Gazette (2016a). Law 4368: able disease?”. In J. Jaworski (Ed.) Ad- Measures to speed up government vances in Sociology Research. Volume work and other provisions. Athens: 18. (pp.13-74). New York: Nova Science National Printing House, (in Greek) Publishers, https://www.synigoros.gr/resources/ Fouskas, T. (2013). Low-Status Work Conse- docs/160817-n4368.pdf

VOL. 6, NÚM. 2. JULIO-DICIEMBRE (2019) 87 Government Gazette, (2016). Joint Min- 2019). Athens: Hellenic Ministry of La- isterial Decision (JMD) No. Α3(c)/ bour, Social Security and Social Solidarity GP.ec.25132 - Arrangements to ensure (in Greek) https://diavgeia.gov.gr/doc access for uninsured persons to the /%CE%A8%CE%A1%CE%9F8465%C Public Health System. Athens: National E%981%CE%A9-%CE%A86%CE%A8 Printing House. (in Greek) https://www. ?inline=true&fbclid=IwAR3Kxc_zaQgE- synigoros.gr/resources/160817-kya.pdf gvcIDuUg4WY8HEKYa2qWa62s_ Government Gazette, (2016b). Law 3386: SUEk9xLTYuwHnNMTGNY-m8 Entry, stay and social integration of Hellenic Ministry of Labour, Social Securi- third country nationals in the Greek ter- ty and Social Solidarity/Unified Social ritory. Athens: National Printing House Security Fund (2017). Data on Em- (in Greek). https://www.synigoros.gr/ ployment. Athens: Hellenic Ministry of resources/docs/02-n3386.pdf Labour, Social Security and Social Soli- Hellenic Ministry for Migration Policy darity/Unified Social Security Fund (in (2019). Legal Immigrant Population Greek). in Greece on April 24th, 2015. Athens: Huddleston, T., Bilgili, O., Joki, Anne-Linde Hellenic Ministry for Migration Poli- and V., Zvezda (2015). Migrant Integra- cy (in Greek) http://www.immigration. tion Policy Index 2015 (MIPEX). Barce- gov.gr/documents/20182/45177/Stats- lona/Brussels: CIDOB and MPG http:// Metan_30042019.xls/c52052be-ad93- www.mipex.eu/greece#/tab-health 4067-90c2-662f0a828566 International Labour Organization (ILO) Hellenic Ministry of Health (2016). Circular (2016). Migrant Domestic Workers No. Α3c/GP.ec.39364 Clarifications on Across the World: Global and region- ensuring access for the uninsured and al estimates Labour Migration Branch socially vulnerable groups to the public (MIGRANT). Conditions of Work and health system. Athens: Hellenic Ministry Equality Department. Internation- of Health, (in Greek) https://www.synig- al Labour Office https://www.ilo.org/ oros.gr/resources/160817-egkiklios.pdf wcmsp5/groups/public/---ed_protect/- Hellenic Ministry of Health (2019). Access --protrav/---migrant/documents/brief- of the uninsured to the public health ingnote/wcms_490162.pdf system. Athens: Hellenic Ministry of International Organization for Migration Health (in Greek) http://www.moh.gov. (IOM). (2016). Summary Report on the gr/articles/health/anaptyksh-monad- MIPEX health strand and country re- wn-ygeias/3999-prosbash-twn-anasfal- ports. IOM Migration Research Series, istwn-sto-dhmosio-systhma-ygeias 52. Geneva: International Organization Hellenic Ministry of Labour, Social Security for Migration (IOM). Retrieved from: and Social Solidarity (2019). Regarding https://bit.ly/2kmwR3G the provision of AMKA to foreign na- Kapsalis, Α. (2018). Migrant Workers in tionals (80320/31355/D18.2084/11-7- Greece. Athens: Papazisis (in Greek).

88 VOL. 6, NÚM. 2. JULIO-DICIEMBRE (2019) Mikaba, P. (2018). Migrant health across Sassen, S. (1998). Globalization and Its Dis- Europe. EWSI - European Web Site contents. New York: New Press. on Integration. Brussels: European Schneider, F. and Williams, C. (2013). The Commission https://ec.europa.eu/ Shadow Economy. London: Institute of migrant-integration/feature/migrant- Economic Affairs. health-across-europe Souliotis, K., Saridi, M., Banou, K., Golna, K. National School of Public Health (NSPH/ Paraskevis, D., Hatzakis A. and Smith, A. ESDY), University of Gent, PRAKSIS, (2019). Health and health needs of mi- European Public Law Organization grants in detention in Greece: Shedding (EPLO), CMT PROOPTIKI and Syn-Eir- light to an unknown reality. Globaliza- mos, “Local Alliance for Integration tion and Health, 15(4), https://global- (776213/LION) (AMIF-2016-AG-INTE) izationandhealth.biomedcentral.com/ (December 2017- November 2019)”, Asy- articles/10.1186/s12992-018-0448-4 lum, Migration and Integration Fund/ Svensson, J. (2018). Young female domestic European Union/National School of workers perceptions of health and safe- Public Health (NSPH/ESDY), University ty. India Briefing Note No.4 December of Gent, PRAKSIS, European Public Law 2018. Findings from Young Domestic Organization (EPLO), CMT PROOPTIKI Workers: a Qualitative Study on the and Syn-Eirmos, 2019 http://alliancefo- Health and Wellbeing of Girls Working rintegration.eu/ in Households in Delhi. London: School Pajnik, M. and Campani, G. (2011). Precar- of Hygiene and Tropical Medicine ious Migrant Labour Across Europe. https://www.lshtm.ac.uk/files/swift- Ljubljana Mirovni Inštitut. india-brief-no.4-young-female-domes- Psimmenos, I. (2009). The Contribution of tic-workers-perceptions-of-health-and- Domestic Work to the Welfare Marginal- safety-dec18.pdf isation of Migrant Women, Social Cohe- Townsend, P. N. Davidson; D. Black, and sion and Development, 4(1), 139-154 (in M. Whitehead (1992). Inequalities in Greek). Health: The Black Report and The Psimmenos, I. (2010). Sociological Research Health Divide. Harmondsworth: Pen- and Female Immigrant Domestic Work- guin. ers in Greece, Encephalos, 47(2), 99-102 United Nations (UN). (1990). Internation- (in Greek). al Convention on the Protection of the Psimmenos, I. (2011). The Welfare Orienta- Rights of All Migrant Workers and tions of Immigrant Domestic Workers Members of Their Families. New York: in Greece, Greek Review of Social Re- United Nations. search, 136(3), 225-248. Vosko, L. (ed.) (2006). Precarious Employ- Psimmenos, I. (ed.) (2013). Work and Social ment: Understanding Labour Market Inequalities. Athens: Alexandria Pub- Insecurity in Canada. Montreal: Mc- lishers (in Greek). Gill-Queen’s University Press.

VOL. 6, NÚM. 2. JULIO-DICIEMBRE (2019) 89 Watson, T. (2008). Sociology, Work and In- World Health Organization, (WHO), (2018a). dustry. London: Routledge. Report on the health of refugees and mi- Whitehead, M. (1985). The Concepts and grants in the WHO European Region: Principles of Equity and Health. EUR/ No public health without refugee and ICP/RPD 414. Copenhagen: WHO Re- migrant health. Copenhagen: World gional Office for Europe. Health Organization (WHO) https:// Whitehead, M. (1991). The Concepts and www.naftemporiki.gr/cmsutils/down- Principles of Equity and Health, Health loadpdf.aspx?id=1444968 (in Greek) Promotion International, 6(3), 217-228. World Health Organization, (WHO), (2018b). Whitehead, M. (2006). Concepts and Prin- Report on the health of refugees and mi- ciples for Tackling Social Inequities in grants in the WHO European Region: Health. Copenhagen: World Health Or- No public health without refugee and ganization (WHO). migrant health. Copenhagen: World Whitehead, M. (2007). A Typology of Actions Health Organization (WHO) https:// to Tackle Social Inequalities in Health, apps.who.int/iris/bitstream/handle/10 Journal of Epidemiology and Commu- 665/311347/9789289053846-eng.pd- nity Health, 61(6), 473-478. f?sequence=1&isAllowed=y&ua=1 Williams, C., Demetriades, S., and Patra, E. (2016). Diagnostic report on undeclared PARA CITAR ESTE ARTÍCULO work in Greece. Athens: International Theodoros, F., Gikopoulou, P., Ioannidi, E. & Kou- Labour Organization (ILO). lierakis, G. (2019). Health inequalities and female migrant domestic workers: Accessing World Health Organization (WHO) (1946). healthcare as a human right and barriiers WHO Constitution. Geneva: World due to precarious employ in Greece. Collecti- Health Organization. vus, Revista de Ciencias Sociales, 6(2), 71-90. World Health Organization (WHO/European DOI: http//dx.doi.org/10.15648/Coll.2.2019.5 Centre for Health Policy (ECHP) (1999). Health Impact Assessment: Main Con- Recibido: 16/11/2018 cepts and Suggested Approach. Gothen- Aprobado: 18/02/2019 burg Consensus Paper December, 1999. Brussels: World Health Organization (WHO/European Centre for Health Pol- icy (ECHP).

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