Treatment of chronically ill migrants remains up in air

Health Ministry suggests emergency services will attend those without papers

The decision to leave immigrants who do not have their papers in order without access to healthcare from September 1 has left many on tenterhooks. Among those experiencing the most anxiety are those immigrants suffering from chronic illnesses. Patients who need dialysis several times a week, or anti-cancer or anti-HIV drugs that need to be taken daily or in cycles still lack information about how they can continue their treatment. And neither do doctors, health centers nor associations have answers for them.

The Madrid Association for the Fight Against Kidney Diseases (Alcer) last week received a query from a Guinean citizen whose residence permit expires this month and fears being left without his dialysis treatment. What’s more, he could also lose his place on the transplant waiting list. A spokesman for the association admitted that after listening to him he couldn’t offer any solutions. Simply put, it doesn’t know what is going to happen.

Fifty-six-year-old Chilean Carmen Avellano, who undergoes dialysis at home, has the same worry. “Will I have to give back the machine? If I don’t do my dialysis, I will get even more ill and die," she says.

Then there are the cases of people such as Manuel (not his real name), a Venezuelan immigrant who suffers from HIV and has already had his health card withdrawn by the Madrid region, leaving him without medication. He was later given an extension until August 31 and he started receiving it again. “They told me in the hospital that this is the last time they will give it to me,” he says.

The AIDS Study Group (Gesida) warned two weeks ago that between 2,700 and 4,600 people with HIV could be left without treatment.

The Health Ministry continues with the same response to such cases. “No patient who needs it is going to be left without attention,” says a Ministry spokeswoman, adding, “the medical criteria surrounding emergency situations is the one that determines the attention. It is important to remember that it is not down to the doctor who treats a patient to verify their legal situation, but rather to determine the attention they need to receive.”

The problem is that in the emergency rooms they don’t know how to tackle the issue. “There has not been any instruction about what to do,” says the president of the Spanish Society of Emergency Medicine (Semes), Tómas Toranzo. “The emergency rooms are for what they are, and in these cases we can only pass the hot potato on to other services.”

He says the only situation in which they could intervene would be if “a person who, due to a kidney failure, needed an emergency dialysis. And the hospital does have that service.” For everything else, though, nothing: no chemotherapy programs, no providing medication that can only be obtained in a hospital.

Neither do outpatient departments nor other health services know what is going to happen with those suffering from chronic illnesses. Health centers and hospitals have received no information about how to attend to illegal immigrants after their health cards are revoked on September 1. “We have asked and they didn’t even answer us,” says one primary care physician.

“Not one piece of information, nor a circular… nothing,” say management sources at one big hospital in Madrid.

Adding to the confusion on Thursday was the director-general of the Basic Portfolio of National Health and Pharmacy Services, Agustín Rivero, who in an interview with RNE Spanish state radio said chronically ill migrants without papers would be treated and that the bill would be passed to their countries of origin. “When we go to other countries we have to pay for medical care or our Social Security has to finance it,” he argued.

According to Rivero, there already exist “quite a lot of” bilateral collaboration agreements with other countries.” However, he did not clarify what would happen in the case of countries where treatment received in Spain is not covered by their public health systems.


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