Statelessness has long been invisible in public health policymaking. Our new report exposes specific challenges stateless people face as a consequence of the COVID-19 pandemic and the responses needed to address them.
‘More than a health crisis, the COVID-19 pandemic has developed into a rights crisis affecting us all. Yet it does not affect all of us equally.’
These are the words of the Council of Europe Commissioner for Human Rights in the Foreword of our new report on statelessness and the right to health. Published today, our research demonstrates why regional and international institutions, States, public health officials and healthcare providers must act now to address the challenges stateless people are facing as a consequence of the global pandemic. It is not too late for mitigating action and today we are setting out what needs to happen on COVID-19 testing, treatment and vaccinations, healthcare information and access, social security, and inclusion of stateless communities.
The nexus between statelessness and health
Stateless people’s enjoyment of rights, including the right to health, varies significantly from country to country in large part because of a lack of mechanisms to identify and determine who is stateless in a particular country. For example, some stateless migrants and refugees with a residence permit or a form of international protection do have access to healthcare, but others with insecure immigration status face significant barriers. Likewise, stateless minorities who have lived in the same place for generations, such as ethnic Russians in the Baltic States may have access to healthcare in line with nationals. Others, including many Roma who lack documentary proof of their nationality, face multiple violations of their right to health.
Statelessness has long been invisible in public health policymaking. A key challenge is that stateless people are a diverse group about whom little data exists to inform policy and practice. Their experiences and identities intersect with those of other marginalised and minoritized groups, but our research shows that there are issues relating specifically to statelessness, which impact on an individual’s ability to realise their right to the highest attainable standard of health.
COVID-19 has exacerbated these issues. Discrimination, social exclusion, and deprivation were experienced by many stateless people in Europe prior to the pandemic. They faced multiple social, structural, and environmental negative determinants of health, which have worsened over the last year. These include racism, antigypsyism, and xenophobia; poor and congested living conditions; lack of sanitation and hygiene; chronic (mental and physical) ill health; overrepresentation in the informal labour market; and lack of access to healthcare and social security. During the pandemic, many have lost their sources of income, had to work whilst sick and without adequate protection, been unable to access State aid and healthcare, and children’s education has been disrupted. In our report and accompanying policy briefing, we identify eight areas in which statelessness is intersecting with other risk factors and vulnerabilities to undermine the right to health for stateless people, and recommend how these can be addressed by policy makers.
Barriers to healthcare access
Perhaps most fundamentally, stateless people report a range of barriers to accessing healthcare, which have been amplified by the pandemic as access to services became more challenging for everyone and health systems were overwhelmed. Stateless people’s lack of legal status, identity documentation and health insurance, combined with institutional mistrust, fear of data sharing with immigration authorities, experiences of discrimination, and financial, language, and other practical barriers, mean many have faced huge obstacles to accessing services. Even COVID-19 testing and treatment has been out of reach for some, with digital IDs or identity documents being required in some countries as a condition for access to testing, charges being applied, or exemptions from requirements for COVID-19-related care being poorly communicated in others.
Currently, there is an urgent question about access to vaccines. Consideration must be given to how to reach marginalised communities excluded from healthcare systems, as well as how to secure consent and ensure follow-up in communities where lack of institutional trust will hamper government efforts without careful and inclusive planning, working together with community representatives and NGOs.
Inclusion of stateless people in public health policymaking and pandemic response measures
The lack of proactive measures to ensure the inclusion of stateless people in public health information and policies has been an issue throughout the pandemic as it was before and will remain after if action is not taken now. The invisible nature of statelessness and lack of population data make it difficult to evidence and inform public health policy and target health messages to stateless communities. But it is not impossible. Information and services are often only available in a country’s main language(s) and digital exclusion further hinders access. NGO and community-led initiatives, in some cases supported by international organisations like UNHCR, have responded to this gap, operationalising public health information, translating main messages, sharing information in different formats, and setting up mobile health units. More must be done to ensure stateless people and representatives of communities affected by statelessness participate in the planning and decision-making that affects their lives so that public health information is accessible and relevant.
In relation to State-aid and socio-economic relief measures during the pandemic, here too, NGOs and trusted community organisations have stepped in to try to help fill the many gaps in government provision. Some limited good practice examples can be found of hygiene and sanitation measures being distributed in communities affected by statelessness, such as segregated Roma settlements receiving extra sanitation equipment in some countries, or pensioners and other vulnerable groups being sent free masks and sanitiser. But no examples could be found in our research of stateless people being included in financial assistance measures. In most countries, State aid has been explicitly restricted to nationals, specific vulnerable groups with residence permits, or permanent residence holders only.
Legal and civil registration procedures
COVID-19 response measures have also impacted on norms of due process in legal procedures ranging from statelessness determination and international protection procedures, residence permit and naturalisation applications, immigration detention and return proceedings, and civil registration services. All of these have impacted on stateless people, and in turn had consequent impacts on their right to health due to the link between proof of residence or identity and health rights. Delays in procedures have left people in limbo in some countries, legal representatives have faced barriers to accessing their clients, and access to vital judicial oversight of fundamental rights through the courts - including in relation to immigration detention - has been compromised.
Some examples of good practice have emerged, including in Portugal where everyone with a pending immigration or asylum application was granted a temporary residence permit for the duration of the pandemic to ensure their access to services. Such positive measures should be held out as examples and built upon when planning future responses.
Addressing discrimination, racism, and antigypsyism
The backdrop to these myriad impacts of the pandemic has been a worrying increase in xenophobia, racism and antigypsyism. Whilst not necessarily specific to stateless people, the effects of this trend have been born by migrants, refugees, Roma, people of colour, and minority groups in general. It has at times been fuelled by political rhetoric blaming specific groups for the spread of disease, and many stateless people reported increased experiences of hate speech, racism, and antigypsyism both online and on the streets of Europe’s towns and cities. More must be done to address these trends, both publicly and institutionally to eradicate politically charged xenophobia and racism, and to concretely address institutional racism and antigypsyism. People directly affected, including stateless people, must be involved in the development and implementation of such responses.
The way forward
Most importantly, it is not too late to address all these challenges. In fact, as vaccination programmes are being rolled out, and the world looks ahead not just to the fallout of COVID-19 but to the prevention and mitigation of future pandemics, now is the time to take action to ensure the inclusion of stateless people in public health planning and responses.
The last 12 months have made it tragically clear what happens when some people are left behind. Out of this tragedy must emerge progressive policies, which tackle the root causes of exclusion. Policymakers need to be thinking about pathways to regularisation for all, including statelessness determination procedures; health coverage that is truly universal; inclusive and participatory health information and health inclusion campaigns; effective measures to call out and stamp out racism and antigypsyism; and better data and evidence on statelessness and its impact on health rights and outcomes. Without concrete action to identify who it is that we are leaving behind now and how to ensure they catch-up, we will have learnt nothing from this pandemic.