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Health Situation at EU Southern Borders: Migrant Health, Occupational Health, and Public Health

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Health Situation at EU Southern Borders: Migrant Health, Occupational Health, and Public Health ASSESSMENT REPORT: Health Situation at EU Southern borders: Migrant Health, Occupational Health, and Public Health SPAIN Field work 18–27 November 2013 The information and views set out in this report are those of the author and do not necessarily reflect an official opinion of the EC or 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 is based on desk review and field work undertaken by the International Organization for Migration (IOM), the Andalusian School of Public Health (EASP), and the Coalition for the Study of Health, Power, and Diversity (CESPYD), the Centre of Community Research and Action at the University of Seville, within the framework of the project “Equi- Health: Fostering health provision for migrants, the Roma, and other vulnerable groups.” The Equi-Health project is co-financed under the 2012 work plan, within the second programme of Community action in the field of health (2008–2013), by a direct grant awarded to IOM from the European Commission’s Directorate Generale (DG) for Health and Consumers (DG SANTE), through the Consumers, Health, and Food Executive Agency (CHAFEA). The Equi-Health project is designed and managed by the IOM Regional Office Brussels, Migration Health Division (MHD). The methodology for the field work and analysis, based on the prior “Increasing Public Health Safety Alongside the New Eastern European Border Line” (PHBLM) EC co-funded IOM project experience, was developed by IOM with support from CESPYD and the EASP. This Assessment Report was completed under IOM Migration Health Department (MHD), Regional Office (RO) Brussels guidance by Manuel García-Ramirez, Rocío Garrido, Violeta Luque-Ribelles and Marta Escobar-Ballesta, based on the initial draft report produced by EASP (Amets Suess, Olga Leralta Pinan, Ainhoa Ruiz Azarola, José Ignazio Oleaga Usategui). Due acknowledgment and thanks go to Belén Aguilera, Mª Jesús Albar, Mª Dolores López, Zaira Morales, Lucas Olmedo, Virginia Paloma and Noelia Pelícano. Giuliana Urso, Mariya Samuilova, Marina Rota, Roumyana Petrova-Benedict and Isabelle Beauclercq (IOM MHD) also peer- reviewed and edited the report. We thank Isabel de la Mata, Principal Advisor with Special Interest on Health, Health and Food Safety European Commission for her valuable input and DJ Krastev for his copy-editing, proofreading, and general editing assistance. IOM is grateful to project and local implementing partners involved during the field visit, as well as to the National Consultative Committee (NCC) – comprised by representatives of various stakeholders, including CSO – for their personal and technical support. In particular, we thank the staff and representatives of: (a) Tarifa/Algeciras: Red Cross, Algeciras Acoge, Fundación Cruz Blanca, Colectivo Lacalle; Junta de Andalucía, University of Cadiz, University of Seville, Nursing School, Guardia Civil, Hospital Punta Europa, CIE Isla de las Palomas, Ports of Tarifa and Algeciras, Centre managed by Red Cross, Shelter Parroquia de Pescadores; (b) Madrid: CEAR, SJM, Comillas, Pueblos Unidos, ACCEM, ACOGE Madrid, Salud entreculturas NGO, Hospital Ramón y Cajal, CIE Aluche-Carabanchel, Médicos sin Fronteras, Médicos del Mundo, CAR Vallecas, Centro de Acogida Red Cross; and (c) Melilla: Red Cross, SJM, Melilla Acoge, CEAR, Guardia Civil, El Telégrafo de Melilla, PRODEIN, Hospital Comarcal de Melilla, CETI Melilla, Port of Melilla. IOM would also like to convey its appreciation to the Spanish Ministry of Internal Affairs for providing access to the different centres mentioned in this document. A particular vote of thanks is due to national and international team members who carried out the field visits with great enthusiasm and professionalism, and who provided valuable insights in the process: Alberto Rodríguez García – Spanish Ministry of Interior (MoI); Carmen Cosentino – Italian MoI; María Ochoa Llido and Markus Jaeger from the Council of Europe, Ileana Andrea 2 Niculiu from Frontex, the researchers Amets Suess, Olga Leralta Pinan, Ainhoa Ruiz Azarola and Bibiana Navarro from EASP, the researcher Soorej Jose Puthoopparambil, and Magdalena Bjerneld from Uppsala University, and the IOM team Roumyana Petrova-Benedict, Giuliana Urso and Marjolein Devos (MHD, RO Brussels), Teresa Botella and Olivia Rodríguez (IOM Spain). 3 CONTENTS ACRONYMS ________________________________________________________________ 6 EXECUTIVE SUMMARY _______________________________________________________ 7 1. INTRODUCTION __________________________________________________________ 15 2. BACKGROUND INFORMATION ______________________________________________ 16 3. METHODOLOGY _________________________________________________________ 21 3.1. Overview of data collection _______________________________________________ 20 3.2. Limitations ____________________________________________________________ 24 4. FIELD WORK ____________________________________________________________ 25 I. POLICY AND LEGAL FRAMEWORK ____________________________________________ 25 I.I EU, national and regional legal framework: interception, sea rescue and “green border” ________________________________________________________________ 25 I.II Legal and financial framework of open and closed centres _____________________ 27 I.III Entitlement to health care and provision of services __________________________ 30 I.IV Discussion Section - I ___________________________________________________ 32 II. PARTNERSHIPS, NETWORKS, AND MULTI-COUNTRY FRAMEWORKS _______________ 34 II.I Description of the reception process and coordination ________________________ 34 II.II Public Health in Border Communities ______________________________________ 53 II.III Discussion Section - II __________________________________________________ 54 III. MONITORING MIGRANT HEALTH ___________________________________________ 56 III.I Migrant Health ________________________________________________________ 56 III.II Provision of Health-care Services and Social Assistance ______________________ 57 III.III Data Collection _______________________________________________________ 64 III.IV Discussion Section - III _________________________________________________ 66 IV. MIGRANT-SENSITIVE HEALTH SYSTEM _______________________________________ 68 IV.I Infrastructure and Physical Conditions _____________________________________ 68 IV.II Occupational Health of Staff ____________________________________________ 76 IV.III Health Knowledge, Attitudes and Practices ________________________________ 82 IV.IV. Discussion Section - IV ________________________________________________ 85 5. CONCLUSION AND RECOMMENDATIONS _____________________________________ 88 V.I Conclusions ____________________________________________________________ 88 4 V.II. Recommendations _____________________________________________________ 90 REFERENCES ______________________________________________________________ 98 ANNEXES ________________________________________________________________ 107 ANNEX I. Laws, Decrees and Regulations ______________________________________ 107 ANNEX II. Equi-Health topics covered under the assessment, out of Conceptual Framework IOM/WHO/Spanish EU Presidency, 2010 ______________________________________ 117 ANNEX III. List of participants to the NCC Spain, Seville 23 October 2014_____________ 118 5 ACRONYMS CAR Refugee Assistance Centres (Centro de Ayuda al Refugiado) CETI Centres for Temporary Stay of Migrants (Centros de Estancia Temporal de Inmigrantes) CIE Migrant Detention Centres (Centros de Internamiento de Extranjeros) CEAR Spanish Refugee Assistance Commission (Comisión Española de Ayuda al Refugiado) COS Operation Centre of the GC Headquarter in Melilla (Central de Operaciones de la Comandancia de la Guardia Civil de Melilla) CSOs Civil Society Organizations DG Directorate General DG SANCO European Commission’s Directorate General for Health and Consumers EC European Commission EDATI Immigrant Support Team (Equipo de Atención al Inmigrante de la Guardia Civil) EU European Union EWG Expert Working Group GC Guardia Civil GEAS Special Group of Underwater Operations of the GC (Grupo Especial de Actividades Subacuáticas de la Guardia Civil) HIV Human Immunodeficiency Virus HR Human Rights HSP Health/Social-care Providers IHR International Health Regulations IOM International Organization for Migration IS Information Service of the GC (Servicio de Información de la Guardia Civil) LO Ley Orgánica LEO Law Enforcement Officers MH SEUB Equi-Health project Southern EU Border component MRS Maritime Rescue Service NCC National Consultative Committee NGOs Non-Governmental Organizations PHS Public Health System PRL Occupational Risk Prevention Office of the GC (Servicio de Prevención de Riesgos Laborales) RC Red Cross (Cruz Roja) SAS Andalusian Health-care System (Servicio Andaluz de Salud) RDL Royal Decree-Law (Real Decreto Ley) SIRIA Integrated and Collection Capacity Information System (Sistema Integrado y Recolección de Información de Aforos) SIVE Integrated Exterior Surveillance System TB Tuberculosis UNHCR United Nations High Commissioner for Refugees USC Citizen Safety Unit (Unidad de Seguridad Ciudadana) WHO World Health Organization 6 EXECUTIVE SUMMARY Spain has been transformed from being traditionally an emigration country to becoming one of the most important European centres for immigration in the last few decades.1 In 2013, out of a total population
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