3.8 million refugees and immigrants arrived in the EU in 2014. The migratory flow is expected to stay at 1.5 million people/year until 2036.
Besides language and cultural barriers, the migrant population suffers from social isolation, therefore their first health contact tends to be urgent care.
The physician-patient communication is an essential element in ensuring adequate healthcare, both to make diagnosis and initiation of treatment. If the patient does not understand the doctor’s language, the adherence to treatment, preventive measures will fail, and as a consequence results are not obtained. It has been shown that people with lack of knowledge of the dominant language receive less and poorer healthcare, than those who know the local language.
[alert type=blue ]Authors: Iñigo Jaca and Xabier Zarandona. They are both medical doctors in public hospitals and members of ICEC EH. [/alert]
In some European territories, where the States did not impose the requirement on the medical officers to know the co-official languages, patients have also suffered from the effects of language barriers (Basque Country, Catalonia, etc.). Communication is not just oral, it is also about gestures and also offers the interpretation of the silences. The lack of knowledge of a language poses an insurmountable barrier to indulge in a relationship guided by emotions, affections, and information, which hardly can be replaced by a non-professional translator or a family member.
European Legal Framework on health
Articles 114 and 168 TFEU, underlying the health standards, stipulate that the EU must “ensure a high level of protection of human health”. Article 35 of the EU Charter of Fundamental Rights recognizes the right of access to preventive health care and the right to benefit from medical treatment under the conditions established by national laws and practices, always ensuring the high level of protection as stated in TFEU. Article 53 of the European Directive 2005/36/EC on the recognition of Professional Qualifications provides that the doctors shall have a knowledge of languages necessary for practising the profession in the host Member State. The European Council’s Convention on Human Rights and Bio-medicine of 1997 ratified by the EU member states establishes the right of patients to seek information, informed consent and privacy of the individuals health information.
Effects on health caused due to lack of the local language
People with lack of knowledge of the dominant language of the land have more difficulties in gaining access to health care, less information about their health problem, reduced treatment adherence, reduced use of preventive medicine, are more at risk to suffer medical errors and the results of medical care are worse.
In a study conducted at US six hospitals, data were collected on adverse events with a result of physical damage. 46.8% of adverse events in patients with lack of knowledge of English, suffered from temporary to moderate damages and even death, and only 24.4% was recorded in English-speaking patients. Adverse events in patients with lack of knowledge of English were more due to communication errors (52.4%) than in the English-speaking patients (35.9%).
Health care access for immigrants and refugees in the EU is influenced by financial difficulties. Non-governmental and humanitarian agencies support communication and healthcare access of refugees and immigrants, but their capacity is limited. Spending cuts in healthcare in the EU countries, seriously affect the care of these groups.
A study carried out by the European Union Agency for Fundamental Rights, entitled «Inequalities and multiple discrimination in access to and quality of healthcare», reveals that there are barriers in access to healthcare and a different quality of care is given. The communication and language barriers affect many groups protected by the anti-discrimination legislation and also as set forth in the statement “ensure a high level of protection of human health” of TFEU. Due to spending cuts, the face-to-face hospital translation services have shifted to over-the-telephone, posing more risk to the patient’s safety. Judge Knapman in the UK ruled as medical malpractice the damages caused due to medical errors or unjustified delays in the provision of care owing to difficulty in communication due to insufficient knowledge of the language.
We filed Petition 0521/2014 with the European Parliament’s Committee on Petitions to cease the breach of the European standards in an area north of Navarre, where healthcare practitioners with no knowledge of the Basque language were positioned to attend to elderly patients. Cecilia Wikström, Chairman of the Commission, dismissed the petition not paying attention to the violation of the right to health caused by language barriers in healthcare.
One of the problems that the EU is facing in the current scenario of spending cuts, is the lack of effectiveness of its healthcare standards and recommendations, its right seems more a declaration of principles instead of being statutory law in the various States that host migrants. The Court of Justice should have more powers to judge behaviours against the protection of human health.
The Directorate General for Health and Food Safety of the EU has drawn up a Protocol and a Manual for health examinations of migrants and exiles based on the experience of the International Organization for Migration (IOM). The Protocol aims to serve refugees and immigrants on a voluntary basis in order to know their background, vaccination status, physical examination, brief assessment of their mental health, indication of the need for follow-up or treatment.