Authored By: Dorottya Viktoria Várkonyi
Technological University of the Shannon
Does Irelands legal framework provide asylum seekers with meaningful access to healthcare, or do the practical barriers undermine these rights.
This article argues that although Ireland does provide significant legal protections for asylum seekers, and healthcare entitlements, but on the other hand practical obstacles (such as waiting times, accommodation conditions, language barriers) often prevent these mentioned rights from being fully used.
Healthcare is a widely recognised basic human right.
In the European Union the EU Charter of Fundamental Human Rights mentions the access to healthcare, under Title IV-which was named Solidarity. [1]This article is based on the AC Treaty, or in other names called the Treaty of Rome, in 1957.
Ireland has been a part of the European Union since 1973.
In Ireland asylum seekers are entitled to access the healthcare services, even while their application is being processed. However, the legal entitlement does not always guarantee the practical access.
Reports from advocacy groups, healthcare organisations, and international organisations have highlighted the concerns in relation to the access of healthcare in Ireland, especially with the groups of asylum seekers.
This article examines whether Irelands legal framework provides asylum seekers with the meaningful accesses to healthcare in practice. This article argues, that while Ireland has established a system, that does recognise the importance of healthcare, it does have significant practical barriers, especially relating to the minority group of asylum seekers, and these barriers continue to limit the effectiveness of the protection.
This article outlines the relevant legal frameworks first, before examining healthcare elements, then evaluates the practical challenges.
International human rights are universal rights, which translate to, that all human beings are entitled to them, regardless of their race, colour, political views, nationality, sex, language.
The right to health care is one of the universal rights recognised across the globe. The right of healthcare was first articulated in the 1946 Constitution of the World Health Organisation’s (WHO) Constitution. [2] As part of a person’s rights the 1948 Universal Declaration of Human Rights also mentions healthcare. Since the first pieces of legislations considering healthcare as a human right more treaties have recognised it as an important topic, and nowadays an increasing attention has been paid to these rights. [3]These international treaties also shape how states (like Ireland) approach healthcare rights.
Since Ireland is a member of the European Union, the state is required to comply with the legal obligations passed by the European Parliament. The EU Charter of Fundamental Human Rights mentions healthcare as a basic human right. These Acts of the EU provide an important legal foundation for asylum seekers residing in within any of the EU member states. There are currently 27 member states in the European Union, including Ireland.
Legal provisions containing references to health or health care are present in 67.5% of worldwide constitutional provisions.[4] The Irish constitution is not one of them.
The human rights based approach requires the acceptance of fundamental human rights, in all the WHO (World Health Organisation) member states. It includes non-discrimination, and equality, accountability, and the members states must participate in empowering health service users.[5]
The current Irish Constitution (Bunreacht nHa Éireann) was enacted in 1937. In the Irish constitution there is no specific article that guarantees the constitutional right to healthcare.
Article 40 to 44 of the Constitution protects the fundamental human and civil rights in Ireland. [6]Many of the rights mentioned in these articles also apply to non-Irish citizens.
The personal rights in the Constitution set out are some of the followings: right to life, right to fair procedures, bodily integrity, religious rights.[7]
Together with the international human rights, the European Union law, and the Irish domestic law can create a framework, which is intended to protect the access to healthcare for asylum seekers. [8]However, the existence of legal protection does not guarantee effective access in practice.
Healthcare entitlements available for asylum seekers
Asylum means if a person (a refugee) is afraid to return to their country of origin, or to their previous residence because they are in danger of serious harm. In that case that person is entitled to apply for asylum.[9] A person who claims asylum is seeking international protection.
In Ireland the International protection office (IPO) is responsible for receiving and examining the asylum applications. In 2024, 28% of asylum seekers were children. The main countries of origin were Nigeria, Somalia, Pakistan, Bangladesh, and Jordan.[10]
Asylum seekers residing in Ireland are entitled to access a range of healthcare services, even while their application is being reviewed.
The application can be made at seaport, or airport, or at the International Protection Office, residing in the capital of Ireland-Dublin. The applicants are allowed to stay in the country for the whole time while their application is being processed.
The entitlements are made to ensure that all applicants shall receive necessary medical support if needed, regardless of their nationality, or immigrant status.
Asylum seekers are generally entitled to obtain a medical card. This card allows its owner to receive certain health services free of charge. It is issued by the Health Service Executive (HSE). The HSE has a list of doctors that accept medical card patients. This card allows access to general practitioner’s services (GP), some prescribed medicines, and some treatments for free of charge. It is very important for asylum seekers who may arrive with an existing medical condition, or who require ongoing medical support. [11]
A free medical screening is available for all asylum seekers. The service is confidential, and includes screenings for diseases like tuberculosis, and HIV.
In addition to these primary healthcare services asylum seekers are also eligible to access public hospitals. Such as emergency treatments, maternity services. The public health service provided the expecting women free maternity services for the whole duration of the pregnancy, and the free care is ongoing 6 weeks after the birth. After the baby is born, it is also entitled to get free vaccinations.[12]
Although Ireland does provide asylum seekers with access to healthcare services, but some barriers do still exist, which limits the effectiveness of the rights in practice.
The first significantly existing barrier is the language barrier. Many asylum seekers arrive to Ireland with a limited English language knowledge, and the official language in Ireland is English. With the already limited English knowledge, the understanding of the medical advice, devices, problems become more difficult.
The IPO provides interpreters to support the asylum seekers during their application.[13] Also the asylum seekers have an option, to be on call with an interpreter if they were unable to get one in person.
While these interpreter services may be available in some circumstances, the access to these services is not always immediate, or consistent.
The geographical location can also create a barrier while accessing healthcare services. Many asylum applicants live in the IPAS centres, which are sometimes located outside the major urban areas. The International Protection Accommodation Services (IPAS) is a system, that provides accommodation for individuals seeking international protection in Ireland, while their application is being processed.
Applicants are accommodated in these centres through the whole country. The residents may spend months, or in difficult cases sometimes years in these accommodations, while waiting for the final decision, as the application can become a lengthy process. These centres become their primary residences.
The purpose of this system is that to ensure that applicants are having a safe place to reside during their process. [14]
Centres are located all over Ireland, often far from hospitals. As a result, the access to hospitals, or even the general practitioners require a significant travel, and this way residents face additional challenges.
The limited public transport options in Ireland can further increase these difficulties.
The long waiting times in irish healthcare also represent another big challenge. The waiting lists in Ireland are not unique only to the asylum seekers, as it does affect many individuals. However, the impact may be particularly significant for individuals who are unfamiliar with the Irish healthcare system, or who require additional support when accessing these services. The delays in obtaining the specialist appointments may also reduce the practical values.
Accommodation conditions may also impact the healthcare outcomes for the asylum seeker patients. While living in shared accommodations, with the anxiety and uncertainty of their application outcome can also contribute to stress.
The mental health support represents a particularly important issue. Many asylum seekers may have experienced war, trauma, displacement, losing family members, or family separation before even arriving to Ireland. These experiences can increase the need for psychological and psychiatrical support. However, the demand for these mental health services has frequently exceeded the available resources, resulting in delays and limited accesses to specialists.
Legal aid is available for asylum seekers residing in Ireland. The Irish Refugee Advisory Board is a refugee led group, that ensures that the voices of refugees are hard. [15]
Are legal rights meaningful without effective access?
The existence of legal rights does not automatically guarantee that those rights can be effectively exercised in practice.
Through this article it has been shown that Ireland does provide asylum seekers with significant healthcare entitlements through international obligations, and through European Law, and through domestic legislation.
On paper asylum seekers does have access to a wide range of healthcare services, like hospital access, and primary care, maternity services, mental health supports.
However the practical barriers, such as the language barriers, their geographical isolation, the long waiting lists may reduce the effectiveness of these mentioned legal protections. While a person may be entitled to access the services, the service is very difficult to obtain.
This raises an important question: should the effectiveness of a right be measured by its existence, or by the individual’s ability to exercise that right?
This issue does extend beyond healthcare, as many areas of law could be applied.
The purely legal approach does suggest that Ireland has fulfilled its obligations by providing the healthcare entitlements to the asylum seekers. Rights are often described as protections, which are guaranteed by the legal systems.
However a more practical approach may argue that these rights should be assessed accordingly to whether individuals can genuinely benefit from them.
A person may possess a legal entitlement to treatment, and still encounter barriers that delay, or prevent that service.
For asylum seekers the distinction between theoretical and practical rights are very important. Many applicants arrive to Ireland without an established support network, and they rely heavily on state-provided services.
Legal rights and practical access are closely connected.
A healthcare system might offer extensive protections in theory, but those protections have limited value, if obstacles prevent vulnerable individuals from accessing them. Ensuring effective access is just as important as recognising the right itself.
While Ireland has made considerable efforts to provide healthcare access to asylum seekers, this paper identified that further improvements may be necessary to ensure that the legal rights can be obtained not only in theory, but in practice.
Recommendations
I would suggest greater investments in interpretation, and translation services. These would improve the communication between the healthcare professionals, and asylum seekers. The access to interpretations with a wider range of languages would be helpful.
Secondly, transport assistance should be considered for asylum seekers residing in the IPAS Centres, especially for the people residing in rural areas.
Improved transport links would help to reduce barriers to attend medical appointments.
Thirdly, additional services such as mental health services should be added. Many asylum seekers might have experienced trauma, conflicts, family displacement, separation, armed conflicts, violence, and also to prolonged periods of uncertainty. In addition the asylum application process can also be stressful, due to the concerns regarding their status. Expanding access to psychologists who specialise in these topics could help address the complex healthcare needs of the asylum seekers.
Conclusion
Healthcare is recognised as a fundamental human right. Throughout this article it has been demonstrated that Ireland does provide asylum seekers with a range of healthcare services, and these protections reflect Irelands commitment, to ensuring that vulnerable individuals are not denied essential healthcare.
This article has identified a number of barriers that may limit the effectiveness of these rights.
In conclusion Ireland has made a big progress in providing healthcare access for asylum seekers.
Reference(S):
[1] EU Charter-Fundamental Human Rights
[2] WHO
[3] WHO
[4] Kinney and Clark 2004
[5] WHO Human Rights
[6] Irish Constitutuion
[7] Irish Constitution
[8] Digital Solutions for Migrant Refugee Health-Stephen A. Matlin
[9] UNHCR
[10] AIDA country report on Ireland
[11] Citzens Informations
[12] Citizens Informations
[13] Doras.org
[14] Citizens Informations
[15] Irish Refugee Advisory Board
