ASSESSMENT REPORT Health Situation at EU’s Southern Borders - Migrant, Occupational, and Public Health CROATIA Field work 7–14 April 2014 The information and views set out in this report are those of the author and do not necessarily reflect an official opinion of either 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. This document presents the findings from the Assessment undertaken by the International Organization for Migration (IOM) within the framework of the “Fostering health provision for migrants, the Roma and other vulnerable groups” (Equi-Health) project, co-financed under the 2012 work plan, within the 2nd programme of community action in the field of health (2008–2013), by a direct grant awarded to IOM from the European Commission’s DG for Health and Consumers (SANTE), through the Consumers, Health and Food Executive Agency (CHAFEA). The EQUI-HEALTH project is designed and managed by IOM Regional Office Brussels, Migration Health Division (MHD). The methodology for the fieldwork and analysis is based on the Increasing Public Health Safety alongside the New Eastern Border Line project (PHBLM) EC co-funded IOM project experience and was developed by IOM with the support of the Andalusian School of Public Health (EASP). The Assessment Report was drafted under the overall guidance of IOM MHD RO Brussels by Tea Vidovic and Mitre Georgiev, further revised and elaborated by Milen Petrov, Mariya Samuilova, Marina Rota and Isabelle Beauclercq. We thank DJ Krastev for his copy-editing, proofreading, and general editing assistance. IOM is grateful to all national and local stakeholders who took the time to meet with the team in Zagreb, Vinkovci, and Dubrovnik: Ministry of Health, Ministry of Interior, Administration of the Detention Centre for Foreigners (Jezevo), Administration of Reception Centre for Asylum- Seekers (Zagreb), Border Police, Border Sanitary Inspection, Ministry of Defense, Coast Guard authorities, Maritime Affairs, Customs Directorate, Croatian Health Insurance Fund, Croatian Occupational Health Institute, Croatia Institute of Emergency Medicine, Croatian Public Health Institute, Zagreb County Public Health Institute, City of Zagreb Public Health Institute, Caritas, Croatian Red Cross, Croatian Law Centre, Institution for Education of Children and Juveniles (Zagreb), NGO Zagreb Pride, NGO Centre for Peace Studies, Vinkovci general hospital, Vinkovci Municipality, Vukovar-Srijem County, Vukovar-Srijem Police Directorate, Vukovar River Port Authority, Dubrovnik Municipality, Dubrovnik-Neretva County Public Health Institute, Dubrovnik-Neretva County Institute of Emergency, Dubrovnik-Neretva Police Directorate, Port of Gruz, Gruda Police Precinct Management, Karasovici border check point administration, representatives of the UNHCR. IOM would like to thank the Croatian Ministry of Interior for authorizing access to the Detention Centre for Foreigners (Jezevo) and to the Administration of Reception Centre for Asylum-Seekers (Zagreb), as well as to the Croatian Ministry of Health for providing authorization to interview health professionals working with migrants. IOM is also grateful to the NGOs, local authorities, and stakeholders consulted during our field visits for their time and support. IOM would also like to thank the international team members who enthusiastically carried out the field work and provided valuable input – our national experts Tea Vidovic and Mitre Georgiev, Dr. Andreas Foteineas from National Health Operatons Centre (MoH), Greece, Matteo Dembech from WHO EURO, Andreea Niculiu from FRONTEX, Lana Vucinic from the Croatian MoI, Jasminka Bubas from the Croatian and Dr. Tihomira Ivanda from the Croatian MoH, and the IOM MHD team – Mariya Samuilova and Milen Petrov. This assessment would not have been possible without the support and efforts of IOM Zagreb and especially Tatjana 2 Radosevic and Ivan Pitesa, who took care of all the logistical details surrounding the field visit and the organization of multiple meetings in Croatia. 3 CONTENTS ACRONYMS....................................................................................................................... 6 ADDENDUM TO THE ASSESSMENT REPORT HEALTH SITUATION AT EU’S SOUTHERN BORDERS - MIGRANT, OCCUPATIONAL, AND PUBLIC HEALTH - CROATIA, JUNE 2015 ......... 7 EXECUTIVE SUMMARY ...................................................................................................... 8 1. INTRODUCTION ........................................................................................................ 14 2. BACKGROUND INFORMATION ON MIGRATION ........................................................ 15 2.1. Irregular migration to Croatia .................................................................................... 17 2.2. Number of asylum applications and main countries of origin .................................. 17 2.3. Migration discourse in national media ...................................................................... 18 3. METHODOLOGY ....................................................................................................... 19 4. FIELD WORK ............................................................................................................. 24 I. POLICY AND LEGAL FRAMEWORK ................................................................................. 24 I.I. EU and national/local legislative framework on interception/reception/rescue at sea/green borders .................................................................................................... 24 I.II. Legislative and financial framework of open/closed centres ............................... 27 I.III. Entitlements to and health care service provisions ............................................ 30 I.IV. International Health Regulation (IHR)/ Early Warning Response System (EWRS) 34 I.V. Discussion Section - I .......................................................................................... 35 II. PARTNERSHIPS, NETWORKS, AND MULTI-COUNTRY FRAMEWORKS ............................ 37 II.I Description of the reception process and coordination ........................................ 40 II.II. Public health in border communities ................................................................. 47 II.III Discussion Section - II ........................................................................................ 49 III. MONITORING MIGRANT HEALTH................................................................................ 50 III.I. Migrant health .................................................................................................. 50 III.I.I. Physical aspects of migrants' health ................................................................ 50 III.I.II. Mental well-being of migrants ........................................................................ 52 III.I.III. Social aspects of migrants' health .................................................................. 53 III.II. Provision of health care .................................................................................... 55 III.III. Data collection ................................................................................................ 56 III.IV. Discussion Section - III ..................................................................................... 57 4 IV. MIGRANT-SENSITIVE HEALTH SYSTEMS ...................................................................... 59 IV.I. Infrastructure and physical conditions ............................................................... 59 IV.II. Occupational health of staff ............................................................................. 63 IV.III. Health knowledge, attitudes, and practices ..................................................... 64 IV.IV. Discussion Section - IV .................................................................................... 64 5. CONCLUSIONS AND RECOMMENDATIONS ................................................................ 68 REFERENCES ................................................................................................................... 73 ANNEXES ........................................................................................................................ 76 ANNEX I. Equi-Health topics covered under the assessment, out of Conceptual Framework IOM / WHO / Spanish EU Presidency, 2010 ..................................................................... 76 ANNEX II. Open/closed centre checklist .......................................................................... 78 ANNEX III. Table: Legal Documents used for the report elaboration ................................. 87 5 ACRONYMS AA Asylum Act BCP Border Checkpoint CARDS Community Assistance for Reconstruction, Development, and Stabilisation CRC Croatian Red Cross CSO Civil Society Organization DC Detention Centre EBF External Borders Fund EC European Commission EEA European Economic Area EMN European Migration Network EU European Union FRONTEX European Agency for the Management of Operational Cooperation at the External Borders of the Member States of the European Union HIV Human Immunodeficiency Virus HRK Hrvatska kuna (Croatian kuna – national currency) IBM Integrated Border Management IECJ Institution for Education of Children and Juvenile IHR International Health Regulations IOM International Organization