'Count Us In': Towards realizing health rights among undocumented people

Examining undocumented people’s access to healthcare in Rotterdam and the Hague

  • Why are significant numbers of undocumented people not accessing healthcare services which they have a right to under Dutch law?
  • What are the experiences of people who don’t access healthcare?

This three-year research project explored the puzzling question as to why uptake of healthcare by undocumented people in the Netherlands is low despite them having relatively good formal legal rights to healthcare, compared to their European neighbours. The Dutch Health Insurance Act 2009 allows healthcare providers to claim up to 80% of the costs related to treating people who are not eligible for insurance.

Dr Helen Hintjens, Dr Karin Astrid Siegmann and Professor Richard Staring from Erasmus School of Law were interested in exploring this issue from the perspective of, and together with, undocumented people in The Hague and Rotterdam.

  • Why might people choose to self-exclude?
  • What barriers might they may face or fears might they have about accessing the healthcare services?

Using Participatory Ethnographic and Evaluation Research (PEER) methodology, the researchers trained a team of people who themselves were, or had been, in an irregular situation in the Netherlands to carry out the research. Data was collected from around 50 interviews.  

Findings

Although based on a relatively small sample, the research team was able to gain insights into the experiences faced by undocumented people.

Undocumented people prefer to stay 'under the radar' unless facing a medical emergency

Findings suggested that the lack of access is not because of lack of legal right, but more to do with undocumented people’s anxiety about being ‘detected’ and their lack of trust in healthcare providers not sharing information about their whereabouts. In some cases there was also evidence that health providers were unaware of the ability to claim costs and that negative attitudes of healthcare providers discouraged people from seeking help.

Based on the evidence gathered from these fifty interviews, undocumented people do not exercise their right to healthcare mainly out of fear and prefer to stay ‘below the radar’ unless there is a medical emergency. This is likely to have longer terms negative effects both on their physical and mental health.

The full findings are published in Social Science and Medicine.

Why is this research relevant?

Although previous research has looked at access to healthcare by undocumented people from the perspective of the service providers, or within specific settings such as detention centres, relatively little is known about how most undocumented people experience accessing services.

The research can provide policy-makers, NGOs, other researchers and interested healthcare providers with insights into how better to reach this marginalized group. This is in the interests of both the undocumented people and the government’s public healthcare agenda.

Now, in the time of COVID-19, it is more important than ever that undocumented people are also able to access healthcare services easily.

Collaborations

The project was funded through the Rotterdam Global Health Initiative and brought together researchers from ISS and Erasmus School of Law.

It would not have been possible without the dedicated team of PEER trained researchers and the participants in the research.

The researchers collaborated closely with Rotterdams Ongedocumenteerden Steunpunt (ROS).