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For decades, France has been host to immigration for political, economic or cultural
reasons. Today, the word “migrants” has come to refer to a moment in time in the lives of men and women who have decided to leave their country of origin. They reside on French soil for very diverse periods of time but their situation is unfailingly precarious as regards access to health care. Most of them prefer to keep out of sight to avoid being escorted back to the frontier and therefore choose to give pride of place to their plans for migrating over any health problems they may be suffering from, which is the cause of a number of unsolved public health problems. The healthcare institutions (hospitals in particular), unlike humanitarian organisations, are not organised to offer their services to migrants without visible government support.
At this point, it is difficult to estimate the number of people already present in this country and the numbers of migrants entering and leaving, but there is every indication that altogether they do not exceed 0.5 % of the population of France. They do not in any way constitute a threat either to our healthcare system or to our social fabric. However, we must all be well aware that geopolitical developments (climate, etc.) are bound to augment migrational flows so that forward planning is required involving the creation of official and durable structures to shelter new arrivals in acceptable conditions. There is also a need to organise the integration of those who may be entitled to claim rights of asylum or refugee status. In any event, it is unacceptable to consider that not providing elementary hygiene for these men, women and (often unaccompanied) children is an instrument of choice to regulate migrant flows.
Despite the factual reality of violence and the major assaults on their mental and psychological health during migration, the physical health of these people who have received varying degrees of care cannot, on the whole, be described as poor. The “good physical health” assessment, however, cannot conceal some cases where circumstances are not optimal, in particular as regards mental health and the trauma inflicted — in France itself also — on women and unaccompanied juveniles.
The French constitution, laws and regulations take into account the ethical imperatives applying to people undergoing the vicissitudes of migration; these rules comply with international agreements. Administratively speaking, the instruments for giving migrants a decent welcome already exist. But political utterances and public resources are such that these instruments are lacking in effectiveness, as indisputable authorities on such matters have recently warned us of, time and time again.
Although the welcome given migrants in the “centres d’accueil et d’orientation (CAO)” (reception and guidance centres) seems to be satisfactory, this phase is either preceded or followed (for those who have left the centres) by long periods of time during which the most elementary rules of hygiene are not adequately complied with. Women and unaccompanied juveniles, in particular, may be exposed to danger. In such circumstances, for far too long, the sole measures taken were those initiated by local or national associations and public agents acting individually. There was no coherence between their efforts and those of the CAOs.
As regards the general public health system, there are a number of conflictual situations surrounding the welcome given to migrants and the everyday running of the health institutions: hostile reactions to migrants from patients also waiting to receive care and, in some hospital departments, selective choices that need to be made because their resources are limited between the usual patient population and an inflow of people from abroad whose needs for healthcare enter into competition with the day-to-day running of the hospital’s services. There is also no effective follow-up of migrant health and they frequently experience difficulty in communicating with care providers.
There is no policy for harmonising the operations of the walk-in health care clinics (Permanence d’accès aux soins de santé - PASS) so that they differ greatly in the way they discharge their legal duties.
Finally, the implementation of the State aided medical assistance (aide médicale d’Etat - AME), which only represents a minute portion of the total French healthcare budget, raises a number of issues due to unrealistic and inefficient procedural constraints.
These findings inspired the following list of ethical imperatives.
(1) CCNE has deliberately chosen to give priority to respect for human dignity, which
is measured in concrete terms by the way in which each individual’s material life
is provided for.
(2) It is the healthcare system's responsibility (hospitals in particular) to be capable
of acting with understanding and enlist the trust of people whose priority is the
need for concealment rather than the need to obtain medical help.
(3) There is a need to enable “one-to-one communication” between doctor and patient
by dialogue made comprehensible in both linguistic and cultural terms.
(4) Members of the medical professions must be willing to prioritise actions
specifically intended to ensure migrant wellbeing.
(5) Equity, i.e. equality of access to healthcare and to physical, mental and social
(6) Solidarity, an essential consideration, expressed here in terms of fraternity and
hospitality, is a condition and also the outcome of all that is described above;
everyone must feel individually responsible for the welcome extended to migrants.
In addressing the subject of migrants’ health, CCNE had no wish to take sides in the political dimensions of the issue. The Committee noted, however, that we were facing a complex situation for which the solutions implemented by public agencies were not, on the whole, responding adequately to today's and tomorrow's challenges. CCNE considers that, as matters stands at present, there is no insurmountable reason why migrants' healthcare needs cannot be met honourably and decently. One prerequisite, however, would be to make convincingly truthful, trustworthy and, later, encouraging public statements on the subject, as a corollary of more fit-for-purpose public policies. CCNE states categorically that, as regards migrants, as is true of any person in distress, health in the meaning defined by WHO, cannot ever be instrumentalised, in particular by perpetuating insanitary conditions as an instrument of rejection. In choosing to give prominence to respect for human dignity, CCNE emphasises that the ethical imperative of solidarity is expressed by a spirit of fraternity, in particular as it is extended to those entering French territory and in the duty of hospitality which is owed to them.