The Netherlands doesn’t provide proper medical care for illegal immigrants. This is the conclusion of the organisation Doctors of the World, which campaigns for good health care for people without residence permits. What is going on in the sector that only this week was named as the most customer-friendly health service in Europe?

One in three people living illegally in the Netherlands has at some time been turned away by a GP or hospital. And more than half of them don’t seek treatment when they need it. The figures emerge from a survey among 110 people without residence permits.

There are between 75,000 and 185,000 such people living in the Netherlands, the vast majority of them from outside Europe. Since 1997, illegal immigrants are no longer able to obtain health insurance. But there is no alternative to the regular health service if they are in need of treatment, and to access it you have to show proof of insurance.

Margreet Kroesen, coordinator at Doctors of the World Amsterdam, mediates between illegal immigrants and health care providers.

“For illegal immigrants in the Netherlands it’s extremely difficult to get access to health care. The Netherlands has a relatively high number of refusals, not so much by GPs but especially in hospitals, because there the bills involved are large. Often illegal immigrants are asked to pay at the hospital reception desk before they are given treatment, even if they have a letter of referral from a GP. They don’t have the money because they aren’t allowed to work, so they go back home again sick.”

Fund
Since the beginning of 2009 there has been a special government fund to pay for medical care for illegal immigrants. Certain hospitals are able to claim back the costs of providing treatment to such immigrants – problem solved, one might think.

What’s more, the hospitals that don’t have access to the fund turn a blind eye in an emergency. Take the Sint Lucas Andreas Hospital in Amsterdam. Fee Willenborg is head of Accident and Emergency.

“We always deal with emergencies and women giving birth – we have to by law in the Netherlands. Non-urgent cases we send on to a hospital that can claim from the fund. We do ask people who come to accident and emergency for a contribution of 250 euros, but if they don’t it we help them anyway, money or no money.”

Tough line
In theory then, medical care for people without residence permits would appear to be well organised. But the practice is erratic, says Rian Ederveen who works for a support centre for illegal immigrants. Hospital workers often take an extremely tough line, even at accident and emergency departments, where hospitals are obliged to provide treatment by law.

“Recently a child without papers came to accident and emergency with a broken leg. The hospital staff demanded that money had to be paid first, otherwise the child wouldn’t be treated. The A&E department threatened to send the child with a broken leg away, and kept this up for so long that eventually the person who had witnessed the accident put up the money, and only then was the child treated.”

Fear
An equally serious problem is that illegal immigrants hardly dare to go to the doctor. They are prevented by shame, and fear of deportation, says Margreet Kroesen of Doctors of the World.

“The group waits much longer before seeking treatment than the average Dutch person. The don’t know their rights, are often traumatised, are ashamed that they can only pay part of the bill, are very scared of being reported – they don’t know that doctors are bound by confidentiality. These people are purely occupied with survival and only go to the doctor when their symptoms are extremely serious.”

A young Turkish woman in the waiting room at Doctors of the World underlines the problem. She is holding a stack of invoices.

“I’m 27 and come from Turkey. I’ve lived here for seven years. My son got cancer and after mediation he was given an operation. Now I have to pay the bills, which run to 33,000 euros. I’ve got no money, no job, I don’t know what to do.”

So the much-vaunted customer-friendly Dutch health system doesn’t always provide a haven for people without papers. Health care workers are not always aware of the existing provisions. Sometimes they drive a hard bargain with immigrants in need of treatment, who are too vulnerable to be able to stand up for themselves. And there is no solution on the horizon.