Migration and Health in Nowhereland The publication of this book and the underlying research project “NowHerecare – Health Care in NowHereland – Improving Services for Undocumented Migrants in the EU” were co-funded by: The European Commission, The Austrian Federal The Fund for a Healthy DG SANCO through the Ministry for Science and Austria Public Health Executive Agency Research Bibliographic information of the Deutsche Nationalbibliothek (German National Library): The German National Library lists this publication in the German National Bibliography; detailed bibliographic data can be found on the Internet website: http://dnb.d-nb.de. ISBN 978-3-99031-000-7 This work is protected by copyright. All rights derived from the copyright, in particular, the right of translation, reproduction, extraction of illustrations, radio broadcast, photomechanical or similar reproduction, reproduction on the Internet and storage on data processing equipments shall be reserved, even for partial exploitation thereof. This book was prepared with the greatest possible care. With complex materials, however, changes, abridgements and errors can never be ruled out. For this reason, all information is without guarantee. The publisher and publish- ing house expressly disclaim any liability. © 2012 omninum KG, 2540 Bad Vöslau, Austria Further information and updates to the book: www.omninum.com www.migration-integration.com Editing/Proofreading: Magdalena Burghardt, Brian Dorsey Typesetting: Stefan Schmutterer, Christian Bendl, Anne Saskia Mrasek Cover Design: Florian Schiller Production: Theiss GmbH, 9431 St. Stefan im Lavanttal All rights reserved. Gudrun Biffl, Friedrich Altenburg (Eds.) Migration and Health in Nowhereland Access of Undocumented Migrants to Work and Health Care in Europe Health – Work – Family – Housing – Policy – Transnationalism omninum 2012 Table of Contents Acknowledgements ..................................................... 7 Executive Summary..................................................... 9 Introduction ......................................................... 13 Undocumented Migrants Migration in Europe and Undocumented Migrants............................ 19 Gudrun Biffl Definitions and Methods of Estimation of Undocumented Migrants .............. 25 Gudrun Biffl Sources of Irregularity: The Social Construction of Irregular Migration............. 39 Gudrun Biffl Health and Migration in Europe Access to Health Care in the European Union................................ 77 Gudrun Biffl Health Services for Undocumented Migrants in Europe: An Overview ............. 99 Friedrich Altenburg Policy towards Undocumented Migrants of the EU27 ........................ 109 Carin Björngren-Cuadra Landscapes of Nowhereland Situation of Undocumented Migrants in Selected EU Member States ............. 133 Friedrich Altenburg | 5 TABLE OF CONteNts Good Practice Examples Good Practice Examples of Health Care Provision for UDMs................... 149 Friedrich Altenburg, Gudrun Biffl Voices of Undocumented Migrants The Voices of Undocumented Migrants ................................... 177 Friedrich Altenburg, Gudrun Biffl Conclusions and Recommendations ...................................... 203 Gudrun Biffl, Friedrich Altenburg List of Authors ...................................................... 215 6 | Acknowledgements This book is the result of a joint effort of many people, as well as of a research project im- plemented in the years 2008 to 2010. Therefore, we want to take this opportunity to give credit and thanks to those people and institutions who put us into the position to write, edit and publish this book. So, first of all we would like to thank the funding agencies not only for their financial support, but also their understanding and cooperation during the implementation and in the finalisation of the project. We are grateful for this personal and institutional support, namely to • the European Commission, DG Health and Consumer Protection and the Public Health Executive Agency • the Austrian Federal Ministry for Science and Research • the Fund for a Healthy Austria. This book would not have been possible without the contributions from the research institutions and partners who formed the Nowhereland Project. We would like to thank all of them for their partnership, professionalism and for their many contributions to this project, which was implemented under the lead of the Danube University Krems, together with Azienda Unità Sanitaria Locale di Reggio Emilia (Italy), the University of Brighton (UK), the Malmö Institute for Studies of Migration (Sweden), the Platform for International Cooperation on Undocumented Migrants – PICUM (Belgium), the Centre for Research and Studies in Sociology (Portugal) and with the International Centre for Migration Policy Development – ICMPD (Austria). We owe a lot to those people who let us participate in their lives and working conditions, both migrants themselves and those working with and for them. Their stories were an inspi- ration and motivation for us to write and edit this book. Our special thanks go to our esteemed co-author, Carin Björngren-Cuadra, who was in charge of the chapter on health policies towards this specific group of undocumented migrants. This is also the place to thank Anna Triandafyllidou and Albert Kraler for their kind permission to work with the materials of the “Clandestino” project, enabling us to give extensive insight into the intricate issue of undocumented migrants. We are extremely grateful to have omninum as our publisher and their great team of editors and experts. Without their efforts up to the last minute, this book would not have happened. Gudrun Biffl and Friedrich Altenburg Danube University Krems | 7 Executive Summary Undocumented migrants are receiving increasing attention in the public media and in scholarly research. The tendency in these discussions is to focus on specific issues, be they the legal framework, the sources of irregularity or the human rights aspects concerning undocumented migrants. While these studies are important, as they provide deeper insight into some of the most complex legal and political issues of today, we go beyond the scope of these issues and deal comprehensively with irregular migration. We draw attention to the role of informal labour markets in attracting migrants, the role of welfare models and social protection sys- tems in determining their socio-economic status, their problems of access to health services and the impact on their health condition. We also focus on the role of migration and the various migrant groups for enabling irregular migration, and on the different access rights of the various groups of migrants to work and to health services. Our aim is to raise awareness of the complexity of the issues involved in this subject and of the fact that legal and institutional frameworks are slow to change, while rapid economic, technological and social change impact immediately on the lives of those at the forefront of change. These developments bring about winners and losers, raising inequalities in societies and between societies. They may also change the life course of migrants, dragging some into irregularity while others, mainly natives, may profit from the availability of a group of persons with reduced access rights to work. We provide arguments in favour of actions to ensure access to health care, thereby preserving human dignity, because, as Martin Luther King, Jr. said: “…of all of the forms of inequality, injustice in health is the most shocking and the most inhumane”. In this book we do not only wish to draw attention to the need of improving health protection for irregular migrants for their own sake, but also for the sake of the public health of the community in general. Thus, the aim of the book is to inform policymakers, practitioners and researchers about the multi-faceted state of undocumented migrants in order to speed up appropriate legislative and institutional reforms to deal with their needs. Currently, some 32 million foreign citizens reside in the European Union, of whom some 1.9 to 3.8 million are undocumented migrants. The most important pull factors are prospects of work, family reunion and chain migration. This explains the increasing difficulty for EU-MS to control migration flows, as human rights regulations protect the right to family. In addition, the right to refuge continues to be a strong element justifying immigration to Europe. The countries of origin of irregular migrants tend to be the same as those of regular migrants; they also tend to follow the same routes, using transnational community networks. Moreover, the changing pattern of origin countries of asylum seekers increases the ethnic and cultural diversity of this group of migrants. We also draw attention to the increasing inequality in health outcomes, measured by life expectancy, mortality, morbidity and self-assessed health in the European Union. This is not the consequence of a deterioration in the performance of health systems generally, but rather of the increasing disparity in socio-economic status and the widening of the social hierarchy in the various EU Member States. In general, people – especially males – in Central and Eastern Europe live shorter lives and spend more years of their lives in ill health. Southern European countries tend to have large health inequalities by educational attainment level, | 9 EXecutiVE SummARY while countries like France, Germany and Austria tend to have the smallest