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BULGARIA 2014–2015 Field Work

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BULGARIA 2014–2015 Field Work ASSESSMENT REPORT: Health Situation at EU’s Southern Borders - Migrant, Occupational, and Public Health BULGARIA 2014–2015 field work The information and views set out in this report are those of the author, and as such do not necessarily reflect the official opinion of the EC or the IOM. Neither they nor any person acting on their behalf may be therefore held responsible for any use of the information contained therein. Reproduction is authorized provided the source is acknowledged. 1 This document is based on the International Organization for Migration (IOM) assessment conducted within the framework of the “Fostering health provision for migrants, the Roma, and other vulnerable groups” (Equi-Health) project. The Equi-Health project is co-financed under the EU 2012 work plan, within the second programme of Community action in the field of health (2008- 2013), by a direct grant awarded to IOM by the European Commission’s Directorate General for Health and Food Safety (SANTE), through the Consumers, Health, Agriculture, and Food Executive Agency (CHAFEA). The Equi-Health project is designed and managed by the International Organization for Migration (IOM) Regional Office Brussels, Migration Health Division (MHD). The methodology of the field work and analysis, based on the prior to PHBLM (Increasing Public Health Safety alongside the New Eastern European Border Line project) European Commission co-funded IOM project experience, was developed by IOM with additional support from the Andalusian School of Public Health (EASP). The Assessment Report was drafted under the IOM MHD Brussels Regional Office guidance by Milen Petrov from IOM MHD Sofia, and edited and revised by Mariya Samuilova. We thank DJ Krastev for his copy-editing, proofreading, and general editing assistance. IOM is grateful to local and project implementation field visit partners, to all interview respondents, and to all participants in the Refugee Crisis Coordination Mechanism chaired by the State Agency for Refugees. We particularly thank staff and representatives of: the State Agency for Refugees, the Ministry of Health, the Migration Directorate of the Ministry of Interior, the Medical Institute of the Bulgarian Ministry of Interior, the Bulgarian Red Cross, Doctors without Borders, Municipal Hospitals in Haskovo, Harmanli, and Yambol, the UNHCR and UNICEF country offices in Bulgaria, the Assistance Centre for Torture Survivors NGO, Refugees’ Friends Activist Group, and the Council of Women Refugees. IOM would also like to convey thanks to the Bulgarian Ministry of the Interior for providing access to the Elkhovo reception centre and to the closed centres in Busmanci and Lubimetc, and to the State Agency for Refugees for the authorization to visit the “Voenna rampa,” “Vrazhdebna,” “Ovcha Kupel” open reception centres in Sofia, as well as the ones in Kovachevtsi, Harmanli, and Pastrogor. We are grateful to the NGOs, local authorities, and all stakeholders consulted during the visits and national stakeholder committee meeting for their time and participation in the assessment and subsequent discussion of results. 2 CONTENTS ACRONYMS ................................................................................................................................ 5 EXECUTIVE SUMMARY ............................................................................................................... 6 1. INTRODUCTION .................................................................................................................... 10 2. BACKGROUND INFORMATION .............................................................................................. 12 2.1. Irregular migration to Bulgaria ........................................................................................... 12 2.2. Number of asylum applications and main countries of origin ............................................. 15 2.3. Media Coverage and Political Debate ................................................................................. 16 3. METHODOLOGY ................................................................................................................... 18 3.1. Overview of data collection ............................................................................................... 18 3.2. Limitations ........................................................................................................................ 20 4. FIELD WORK ......................................................................................................................... 21 I POLICY AND LEGAL FRAMEWORK ........................................................................................... 21 I.I International, EU, and national/local legislative frameworks on interception/reception /rescue at sea/green border ..................................................................................................... 21 I.II Legislative and financial frameworks of open/closed centres ............................................... 23 I.III Entitlements to health care; health service provisions ........................................................ 26 I.IV Discussion section .............................................................................................................. 29 II. PARTNERSHIPS, NETWORKS, AND MULTI-COUNTRY FRAMEWORKS ...................................... 31 II.I Description of the reception process and coordination ........................................................ 31 II.II Public health in border communities .................................................................................. 35 II.III Discussion Section - II ........................................................................................................ 36 III. MONITORING MIGRANT HEALTH ......................................................................................... 38 III.I Migrant health ................................................................................................................... 38 III.II Provision of health-care services and social assistance ....................................................... 38 III.III Data Collection ................................................................................................................. 47 III.IV Discussion Section - III ...................................................................................................... 51 IV. MIGRANT-SENSITIVE HEALTH SYSTEM ................................................................................. 53 IV.I Infrastructure and physical conditions ................................................................................ 53 IV.II Occupational health of staff .............................................................................................. 57 IV.III Health knowledge, attitude, and practices ........................................................................ 58 IV.IV Discussion Section ............................................................................................................ 60 5. CONCLUSIONS AND RECOMMENDATIONS ............................................................................ 62 3 5.1. Conclusions ....................................................................................................................... 62 5.2. Recommendations ............................................................................................................. 63 REFERENCES ............................................................................................................................. 67 ANNEXES.................................................................................................................................. 69 4 ACRONYMS BCP Border Check Point BRC Bulgarian Red Cross BGN Bulgarian Lev (national currency) CoM Council of Ministers ERF European Refugee Fund FRC First Reception Centre IBSS Integrated Border Surveillance System HP Health Professional HIV Human Immunodeficiency Virus LEO Law Enforcement Officer MoH Ministry of Health MoI Ministry of Interior NFIs Non Food Items NGO Non-Governmental Organization NHS National Health System OSF Open Society Foundation RHI Regional Health Inspectorate SAR State Agency for Refugees TCN Third-Country National UAM Unaccompanied Minor UNHCR United Nations High Commissioner for Refugees UNICEF United Nations Children's Fund 5 EXECUTIVE SUMMARY In 2013–2014, Bulgaria saw an unprecedented migration influx in as a consequence of military conflicts and sociopolitical instability in the Middle East, Afghanistan and sub-Saharan Africa. The expanding war in the Syrian Arab Republic and Iraq has forced more than 1.6 million1 refugees to escape to neighbouring Turkey, many of them seeking to continue their journey westward. At the same time, the construction of a fence along the Greek – Turkish border diverted the migration flow to the Bulgarian border with Turkey, it being the other external EU border in the region. Thus, thousands of migrants came to Bulgarian territory without proper travel documents, and while enduring dangerous travelling conditions; a large number of them have also experienced various traumatic events in their countries of origin, and/or during their journey to Europe. This report presents the results of the assessment of migrant, occupational, and public health which took place in Bulgaria between February and March 2014, and which was continuously updated within the framework of the IOM EQUI-HEALTH project until April 2015. Migrant Health
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