Access to health care for asylum seekers is guaranteed in law under the same conditions as for Polish nationals who have health insurance.[1] Health care for asylum seekers is publicly funded. If an asylum seeker is deprived of material reception conditions or they are limited, they are still entitled to health care.[2]
Basic health care is organised in medical offices within each of the reception centres. The Office for Foreigners informed that in 2022 the GP in the centres had 6 duty hours per 120 asylum seekers, while the nurse had 20 hours for the same number of possible patients. Both had 3 hours a week extra for every additional 50 asylum seekers. They were present in the centres at least three times a week. Additionally, in every centre, the duty hours of a paediatrician were organised at least for 4 hours a week per 50 children, with extra 2 hours of duty for every additional 20 children. A paediatrician was present in the centres at least 2 days a week.[3]
Health care for asylum seekers includes treatment for persons suffering from mental health problems. In 2022, psychologists worked in all centres for at least 4 hours a week for every 120 asylum seekers. This was extended to 1 hour for every additional 50 asylum seekers.[4] Asylum seekers can also be directed to a psychiatrist or a psychiatric hospital. In 2022, according to the Office for Foreigners, psychological support was provided by an NGO – Fundacja Polskie Forum Migracyjne.[5]
The psychological assistance in the reception centres is limited to basic consultations.[6] Some asylum seekers consider psychologists working in the centre as not neutral enough as they are employed (indirectly) by the Office for Foreigners.[7] Furthermore, according to some experts and many NGOs, specialised treatment for victims of torture or traumatised asylum seekers is not available in practice.[8] NGOs still point to the lack of proper treatment of persons with PTSD. The available psychological assistance is considered an intervention, not a regular therapy. There is a shortage of psychologists prepared to work with vulnerable and traumatized asylum seekers.[9] Moreover, there are not enough specialised NGOs that provide psychological consultations and treatment to asylum seekers.[10]
Medical assistance is provided by the private contractor Petra Medica, with whom the Office for Foreigners has signed an agreement to coordinate medical care for asylum seekers. The Office for Foreigners monitors the application of this agreement. The quality of medical assistance provided under this agreement has triggered wide criticism.[11] In particular, access to specialised medical care worsened[12] and some asylum seekers are refused access to more costly treatments. Sometimes, only after NGOs’ interventions and months of fighting for access to proper medical treatment, asylum seekers were able to receive it. Several cases of refusals of medical treatment, drawing from the SIP’s yearly reports, have been described in the previous AIDA reports.[13] The above-mentioned issues were also reported in 2022.
One of the biggest obstacles in accessing health care that asylum seekers face is the lack of intercultural competence and knowledge of foreign languages among doctors and nurses.[14] Petra Medica which is responsible for the provision of medical assistance to asylum seekers is also obliged to ensure interpretation during the medical and psychological consultations, if it is needed. However, NGOs have been expressing concerns regarding the availability and quality of the interpretation provided to asylum seekers in connection with medical consultations. In particular, it is reported that asylum seekers who are not speaking Polish, English or Russian face great difficulties with being provided with medical assistance (they cannot make the needed appointments as the helpline is available only in English and Russian, and they cannot understand a doctor during the appointment, etc.).[15]
Another challenge is the fact that some clinics and hospitals providing medical assistance to asylum seekers are located far away from the reception centres, so an asylum seeker cannot be assisted by the closest medical facility, except for emergencies. The Office for Foreigners noticed that for those asylum seekers living outside the reception centres health care is provided in voivodeship cities in Poland and that coordination of visits is conducted by the Petra Medica helpline, where the asylum seeker can learn about the time of the visit and ways to get the prescription.
In 2022, 26 complaints about medical assistance were registered (including a couple of complaints repeatedly submitted by the same asylum seekers).[16] They concerned inter alia:
- Long waiting times for the specialist consultation,
- Problems with the hospital treatment coverage (wrongly filled hospital invoices),
- Doctors and nurses providing medical assistance.
SIP informs that it regularly receives complaints about the Petra Medica’s functioning and in practice, many asylum seekers give up their right to medical assistance during asylum proceedings due to the problems they had with accessing health care designed for them.[17]
The COVID-19 pandemic impacted significantly the medical assistance for asylum seekers in the years 2020-2021. Asylum seekers had access to testing and vaccinations, albeit some difficulties were also reported in this regard.[18]
Polish-Belarusian border
The humanitarian crisis at the Polish-Belarusian border that started in August 2021 and continued throughout 2022 left many prospective asylum seekers without access to material reception conditions, including medical assistance (see Access to the territory and push backs). In those circumstances, medical assistance was mostly provided by NGOs, activists and groups of doctors. However, its scope and effectiveness were greatly limited after the introduction of the emergency state and afterwards other measures that excluded access of NGOs, activists and medical staff to some areas near the Polish-Belarusian border. On 1 July 2022, after 301 days, the scope of the prohibition of mobility in the near-border area was changed – the area affected is since then much smaller (only 200 m from the border, instead of 3 km). It allowed persons providing medical assistance to have access to more ill and injured persons that crossed the Polish-Belarusian border. In 2023, the closed near-border area was limited to 15 m from the border.[19]
Foreigners crossing the Polish-Belarusian border often required medical assistance, in particular in winter. They were starved, dehydrated, freezing (some with hypothermia), suffering from food poisoning, beaten up by – according to their accounts – Polish or Belarusian officers, and with other injuries, inter alia foot and leg injuries resulting walking barefoot or climbing through a wired fence.[20]
In 2022, a special fence was built at the Polish-Belarusian border. It is 5.5 m high and it is topped with razor wire.[21] The new fence did not stop third-country nationals from crossing this border but contributed greatly to their increased suffering.[22] As reported by Grupa Granica, many persons suffered injuries while climbing and coming off the fence, including fractures of the bones. Crossing the border through swamps, wetlands and rivers (paths that are now used more despite the risk due to the construction of the fence) increased the risk of drownings, injuries, hypothermia and – in consequence – death. At least 6 persons drowned at the Polish-Belarusian border.[23] The ambulances were rarely called for by Grupa Granica since the Border Guard has been known to take third-country nationals from hospitals and push them back to Belarus.[24] In consequence, in the second part of the year, an increasing number of interventions of Grupa Granica required providing professional medical assistance.[25]
One blood-curdling example of the dangers that the fence created and of the indifference of the Polish authorities is the case of a man stuck on the wall in October 2022. His leg got tangled up in the wire and he was hanging head-down 5 meters above the ground. The Polish army watched and mocked the person but did not offer the man any assistance. They only photographed and recorded the event. Eventually, the man fell down. [26] His fate afterwards is unknown.
Between August 2021 and March 2023, at least 40 persons died at the border.[27] The total number of deaths is surely higher. Third-country nationals who were interviewed by HFHR and Grupa Granica said that there were bodies lying in the woods on the both sides of the Polish-Belarusian border.[28] One of the interviewees stated that she witnessed one man dying after falling into a swamp. When she was apprehended, she tried to inform the Border Guard about the location of the body, but they did not listen. The body was found approx. one week later by a local inhabitant.[29] In January 2023, a body of a doctor from Yemen was found in the woods near the Polish-Belarusian border. The third-country nationals that were accompanying the ill Yemeni national informed the Border Guard about his location and very bad condition. Their appeals for sending medical assistance were ignored; they were pushed back to Belarus. The Yemeni national was found only when another patrol was informed about his grave condition; however, then, he was already dead.[30] The death of an Ethiopian woman raised particular concerns as reportedly Polish Police and Border Guard were informed by other third-country nationals about her bad medical condition, but – instead of transporting her to the hospital – they pushed her back to Belarus. The Human Rights Commissioner is investigating this case; however, the Border Guard and Police seem to be unwilling to cooperate.[31]
In an increasing number of judgments issued in 2022 courts condemned pushbacks at the Polish-Belarusian border, also in cases concerning pushbacks from Polish hospitals. In judgment no. IV SA/Wa 615/22, the Provincial Administrative Court in Warsaw considered a case of a Syrian national who was pushed back to Belarus in November 2021 after a short stay in a Polish hospital and in spite of his pleadings for asylum. In Belarus, he was subject to violence from the Belarusian authorities forcing him to go back to Poland. A decision ordering his immediate removal was issued and challenged by the Helsinki Foundation for Human Rights’ lawyer. The court annulled the decision, explaining that the Border Guard did not rigorously assess the factual situation of the foreigner, in particular, the circumstances of his arrival to Poland and his situation upon return. The court highlighted that the principle of non-refoulement still applies at the Polish-Belarusian border.[32] A case concerning a pushback from a hospital was also communicated to the Polish government by the ECtHR in June 2022.[33]
Information about persons providing medical assistance at the Polish-Belarusian border has been misrepresented by the Border Guard. For example, in January 2023, on its social media, the Border Guard accused activists of refusing to reveal the location of three Afghan nationals needing medical assistance. They were dehydrated, in hypothermia, losing consciousness. According to the NGO Stowarzyszenie Egala, the information about their location was given to relevant authorities twice. Moreover, activists personally showed the firemen the way to the ill foreigners.[34]
Some persons who had aided ill or injured foreigners at the Polish-Belarusian border were prosecuted in 2021 and 2022. In July 2022, one of the activists who had transported an ill third-country national to a hospital was acquitted. The court highlighted that providing humanitarian aid is not illegal.[35] Another activist was found guilty of insulting a policeman during the rescue action of three drowning Syrians. She showed the firemen where the foreigners were located when she saw that the authorities were looking in the wrong place. According to the activist, she was told by the firemen that the Syrian nationals were rescued in time thanks to her intervention. One of them was in hypothermia and unconscious. When the police appeared at the scene, one of the policemen felt insulted by the words of the activist. She was subsequently prosecuted and convicted with a fine (lowered on appeal).[36] In another case, persons seeking a Syrian national in hypothermia in the border area were arrested by the Polish army and their phones and rescue equipment were seized. The court found those actions generally legal, albeit identified some procedural violations.[37]
[1] Article 73(1) Law on Protection.
[2] Articles 76(1) and 70(1) Law on Protection.
[3] Information provided by the Office for Foreigners, 3 February 2023.
[4] ibid.
[5] Information provided by the Office for Foreigners, 3 February 2023. See the PFM website: Polskie Forum Migracyjne.
[6] See Pachocka, M. and Sobczak-Szelc K., ‘Refugee Protection Poland – Country Report’, Multilevel Governance of Mass Migration in Europe and Beyond Project (Horizon2020), January 2020, available at: https://bit.ly/2U1A9uL, 70. The Office for Foreigners claims that those psychologists’ assistance concentrates on psychological support and counselling and also on diagnosis of mental disorders, including PTSD.
[7] M. Pachocka, K. Pędziwiatr, K. Sobczak-Szelc, J. Szałańska, ‘Reception Policies, Practices and Responses: Poland Country Report’, 2020, RESPOND Working Papers 2020/45, available at: http://bit.ly/3jLCvsV, 71.
[8] See e.g. M. Szczepanik, Right to healthcare and access to medical services for asylum seekers and beneficiaries of international protection in Poland, May 2017, available at: http://bit.ly/2CxXokd. See also Małgorzata Jaźwińska and Magdalena Sadowska, ‘Osoby, które doświadczyły przemocy’, in SIP, Prawa cudzoziemców w Polsce w 2019 roku. Raport, 2020, available in Polish at: https://bit.ly/3jT7weM, 13-14, pointing out that persons who were subject to violence are not properly identified.
[9] Pachocka, M. and Sobczak-Szelc K., ‘Refugee Protection Poland – Country Report’, Multilevel Governance of Mass Migration in Europe and Beyond Project (Horizon2020), January 2020, available at: https://bit.ly/2U1A9uL, 71.
[10] M. Szczepanik, Right to healthcare and access to medical services for asylum seekers and beneficiaries of international protection in Poland, May 2017, available at: http://bit.ly/2CxXokd
[11] See e.g. HFHR, Input to the EUAA’s Asylum Report, February 2023, available in English here: https://bit.ly/3VgXwOZ, 9.
[12] M. Pachocka, K. Pędziwiatr, K. Sobczak-Szelc, J. Szałańska, ‘Reception Policies, Practices and Responses: Poland Country Report’, 2020, RESPOND Working Papers 2020/45, available at: http://bit.ly/3jLCvsV, 70.
[13] See AIDA, Country Report Poland – 2021 Update, May 2022, available at: https://bit.ly/3ZydJ2R.
[14] M. Koss-Goryszewska, ‘Służba zdrowia’ in A. Górska, M. Koss-Goryszewska, J. Kucharczyk (eds), W stronę krajowego machanizmu ewaluacji integracji: Diagnoza sytuacji beneficjentów ochrony międzynarodowej w Polsce, Instytut Spraw Publicznych 2019, 43.
[15] A. Chrzanowska, ‘Dostęp do leczenia osób ubiegających się o ochronę międzynarodową’ in SIP, Prawa cudzoziemców w Polsce w 2020 roku. Raport, 2021, available in Polish at: https://bit.ly/3sGmlXS, 74-75. See also HFHR, Input to the EUAA’s Asylum Report, February 2023, available in English here: https://bit.ly/44EE82F, 9.
[16] Information provided by the Office for Foreigners, 3 February 2023.
[17] A. Chrzanowska, ‘Dostęp do leczenia osób ubiegających się o ochronę międzynarodową’ in SIP, Prawa cudzoziemców w Polsce w 2020 roku. Raport, 2021, available in Polish at: https://bit.ly/3sGmlXS, 74.
[18] For more information see AIDA, Country Report Poland – 2021 Update, May 2022, available at: https://bit.ly/3ZydJ2R.
[19] ECRE, Seeking Refuge in Poland: A Fact-Finding Report on Access to Asylum and Reception Conditions for Asylum Seekers, April 2023, available here: https://bit.ly/41hGgdJ, 14.
[20] See e.g. M.J. Pietrusińska, N. Gebert, ‘Leczymy uchodźców. Raport oparty na relacjach pracowników przygranicznych placówek służby zdrowia’, December 2021, available in Polish at: https://bit.ly/3sFrOhQ, 15.
[21] Maciej Chołodowski, ‘5,5 m wysokości, 170 km długości, 50 tys. ton stali. Stanął mur na granicy polsko-białoruskiej’, Wyborcza.pl, 30 June 2022, available here: http://bit.ly/3lUsyPs.
[22] SIP, EUAA Asylum Report CSO Input, 6 February 2023, available here: http://bit.ly/3ZAnGga.
[23] C. Ciobanu, B. T. Wieliński, Mur nie zatrzyma ludzi. Wolontariuszka o sytuacji na granicy z Białorusią, 7 April 2023, Wyborcza.pl.
[24] K. Czarnota and M. Górczyńska, The Lawless Zone: Polish-Belarusian Border Monitoring, HFHR, June 2022, available here: https://bit.ly/3K206Dp, 16; Grupa Granica, ‘Situation on the Polish-Belarusian border July – October 2022’, available here: http://bit.ly/3U26AXA, 4; Fundacja Ocalenie, ‘Przemoc państwa i działania oddolne’, May 2022, available here: https://bit.ly/3JZCdwj, 41-42; Stowarzyszenie EGALA, ‘Relacja pełnomocniczki wywiezionego obywatela Syrii’, 13 October 2022, avilable in Polish here: http://bit.ly/3G5RrOY. For more detailed information, see also AIDA, Country Report Poland – 2021 Update, May 2022, available at: https://bit.ly/3ZydJ2R.
[25] Grupa Granica, ‘Situation on the Polish-Belarusian border July – October 2022’, available here: http://bit.ly/3U26AXA, 4; and ‘Situation on the Polish-Belarusian border October-November 2022. Another winter brings a threat of an increase in the number of fatalities and missing persons on the Polish-Belarusian border’, 13.12.2022, available here: http://bit.ly/40wBA4b, 5-6.
[26] SIP, EUAA Asylum Report CSO Input, 6 February 2023, available here: http://bit.ly/3ZAnGga; Grupa Granica, ‘Situation on the Polish-Belarusian border July – October 2022’, available here: http://bit.ly/3U26AXA, 4.
[27] Grupa Granica, Periodic report of Grupa Granica on the situation at the Polish-Belarusian border. December 2022-January 2023, 10; Stowarzyszenie Egala, W piątek 24 marca odnalezione zostało ciało 40. ofiary śmiertelnej na pograniczu polsko-białoruskim – STOWARZYSZENIE EGALA..
[28] Grupa Granica, Periodic report of Grupa Granica on the situation at the Polish-Belarusian border. December 2022-January 2023, 3; K. Czarnota and M. Górczyńska, The Lawless Zone: Polish-Belarusian Border Monitoring, HFHR, June 2022, available here https://bit.ly/3K206Dp, 18-19.
[29] K. Czarnota and M. Górczyńska, The Lawless Zone: Polish-Belarusian Border Monitoring, HFHR, June 2022, available here https://bit.ly/3K206Dp, 18-19.
[30] Stowarzyszenie EGALA, ‘Kolejna śmierć’, 14 January 2023, available in Polish here: http://bit.ly/3Kk0MnV.
[31] Human Rights Commissioner, Śmierć młodej kobiety z Etiopii w lesie na granicy. RPO prosi o wyjaśnienia Policję i Straż Graniczną (brpo.gov.pl) and Śmierć obywatelki Etiopii przy granicy. RPO pyta policję, co zrobiła w celu jej odnalezienia i pomocy. Kolejne pismo (brpo.gov.pl).
[32] HFHR, ‘Wojewódzki Sąd Administracyjny w Warszawie uchylił decyzję Straży Granicznej o zawróceniu obywatela Syrii do granicy z Białorusią’, 10 June 2022, available in Polish here: http://bit.ly/3TVLkm9.
[33] Applications nos. 52405/21 and 53402/21 K.A. and M.A. and Others against Poland.
[34] Stowarzyszenie EGALA, ‘Niezgodne z prawdą zarzuty SG’, 10 January 2023, available in Polish here: http://bit.ly/437V94P.
[35] Stowarzyszenie EGALA, ‘Sąd uniwinnił aktywistę’, 20 July 2022, available in Polish here: http://bit.ly/42SE2Uj.
[36] A. Jędrzejczyk, ‘Na bagnie umierali ludzie, a policjant poczuł się znieważony. Proces Elżbiety Podleśnej we Włodawie’ 8 lipca 2022, OKO.press, available in Polish here: http://bit.ly/3nBW11f; and Egala, Aktywistka winna. Wyrok w sprawie Elżbiety Podleśnej, 16 September 2022, available in Polish here: http://bit.ly/3M6k2Ys; Stowarzyszenie Egala, ‘Saga sądowa Elżbiety Podleśnej trwa’, 16 February 2023, https://bit.ly/3LSn1C3.
[37] SIP, EUAA Asylum Report CSO Input, 6 February 2023, available here: http://bit.ly/3ZAnGga.