As a result, in most European Union (EU) countries, foreigners (especially undocumented migrants’) access to health care is much more restricted than it is for nationals. In some countries, they have access only to vital emergency health care; in others, even if access to health care is in the law, its effectiveness is limited by complex procedures [1]

However, several current public health issues (bird flu, communicable infectious diseases, etc.) show the need not to let these people fall through the health net as, because of their mobility and the social conditions in which they live (or have lived), they are more particularly fragile and exposed.

On the other hand, on an economical point of view, the health policies which delays or restricts access to prevention and primary health care for part of the population living in the country often end up by paying for expensive hospitalisation and treatments that are required by this same population. Those health care service and treatments at hospital come to be more expensive than prevention and primary health care.

In front of those stakes, MdM’s 11 European associations [2] have decided to develop a 3-year project aimed at promoting effective access to health care in the EU for asylum seekers and undocumented migrants. This 3 years advocacy project, called ‘Averroès’, will be run in 19 EU member states [3]. out of the 27 EUmembers. It should encourage binding community restrictive laws to be passed concerning the health and protection of seriously ill foreigners.

I) Context

 The EU Commission, who counts approximately 25 million non-nationals in the EU (just under 5.5% of its total population) , estimates a presence of 4.5 to 8 million undocumented migrants. In addition the EU recorded 187,223 asylum seekers, in 2005. It is a large immigration region.

 Alongside settled immigration, European countries are experiencing a more and more mobile immigration, especially in the East and South. This second shape of immigration can be a migration of neighbouring populations, or population movements caused by a globalisation of flows [4]

 In the EU, the health status of undocumented immigrants and asylum seekers is generally more precarious than that of nationals because of various reasons: heavy pathologies (tropical and infectious diseases), a complex personal itinerary that often leads to traumatising crisis situations (situation that generated the leaving and the trip conditions), and especially because of very precarious living conditions. And, as the WHO stresses, “it is the poorest who generally have the worst health”.

 With respect to access to health care in the EU, we have to say that in law and in practice of the states members, undocumented migrants and asylum seekers are globally excluded from health care. Recent amendments to national and European provisions contribute to stress this exclusion. The most deprived are likened to fraudsters. Policies towards this population tend towards less health access, more control and therefore stress the fact of more stigmatisation.

Finally, the protection of seriously ill foreigners against deportation to countries where they cannot access to required health care is not guaranteed and assured by all the EU states members.

II) What is at stake?

As far as MdM is concerned, undocumented migrants’ and asylum seekers’ access to health care in the EU represents three stakes that must be taken into account:

In ethical terms : Considering values, humanist tradition and commitments of the EU in European and international texts, and taking into account the fact that a lack of access to health care can have very serious (even fatal) consequences, it is an important ethic goal to guarantee access to the health system for all people living in the EU.

In terms of public health: In a world where people regularly travel between countries and continents, denying access to prevention and health care to a part of the population living in the EU represents a significant public health risk. This risk is even of major importance since those without access to health care are the undocumented immigrants and asylum seekers who are the most deprived and exposed to illness . Actually, this lack of access to health care tends to considerably reduce the capacity to screen for and control communicable diseases and risks of epidemics (such as tuberculosis, HIV…).

In economic terms: In a concern to rationalise and reduce public health costs, member states generally emphasise prevention and the use of primary health care structure. However, undocumented immigrants and asylum seekers have no or insufficient access to prevention, early screening and primary healthcare, but they almost always have access to emergency healthcare [5] When they are taken care of, the diseases’ complications of some of the patients usually require longer and more costly treatments.

III) The objectives of the Averroès project

General objective: To improve the health status of undocumented migrants and asylum seekers in the EU.

Specific objective: To improve, within 3 years, asylum seekers’ and undocumented migrants’ access to health care in the EU, as well as the protection of seriously ill foreigners against deportation to countries where they cannot access health care, by encouraging the elaboration and implementation of binding community regulations.

IV) The strategy of the Averroès project

The Averroès project proposes to create a network of NGOs covering 19 member states of the EU. This network will lead campaigns over a five-year period for recognition and adoption by the EU of:
  a right of identical access for illegal immigrants and asylum seekers as the ones enjoyed by member state nationals;
  a right to protection against deportation for seriously ill foreigners.

The Averroes project has 3 main components:

1) To increase the commitment, knowledge, analytical and networking capacity and efficiency of European NGOs to advocate for asylum seekers’ and undocumented migrants’ access to health care in the EU

 An NGO advocacy network will be established to defend asylum seekers’ and/or undocumented migrants’ access to health care. This network will include all the MdM organisations operating in 11 EU member states as well as counterparts NGOs in 8 EU member states where MdM has no presence. The network members will share the same objectives and activities and will seek to establish solid, long-term collaborations;

 The work initiated by the MdM European Observatory on Access to Health Care will be continued and reinforced. All the Averroes network members will join the Observatory‘s survey on the health status and access to health care of asylum seekers and undocumented immigrants. They will take part in the activities set up to promote the protection of seriously ill foreigners against deportation, in the EU. This survey will be published and broadly distributed.

 In addition, the network will carry out and publish a comparative study on the EU and member states major political trends and legislation.

2) To mobilise the public opinion

 During the project period, national and European sensitization and mobilisation campaigns will be conducted.

3) To convince national and European public authorities

 An advocacy officer based in Brussels will dialogue with the relevant European institutions. The Averroes network members will establish a dialogue with all the national institutions that are directly concerned by health and migration issues, in the 19 EU member states.

Averroès (Abú al-Walìd ibn Ruchd)

Born in Spain, Averroès was a twelfth-century Arab doctor, jurist and philosopher. He symbolises intercultural dialogue and tolerance and his philosophical doctrine rests on the alliance of spirituality and rationalism. Religious authorities considered this philosophy with great hostility and Averroès was condemned by both Islam (being obliged to flee to Marrakesh where he lived in exile and misery) and twice posthumously by the Church.