Dr Marie Claire Van Hout is Professor of Public Health Policy and Practice at the Liverpool John Moore’s University, United Kingdom. She is a regular UN and WHO expert consultant, in the areas of drugs and crime, gender-based violence, prison health and HIV. Her ethos is ‘leaving no one behind’ and her work focuses on health equity, human rights law and the inclusion health of key populations such as people who use drugs, men who have sex with men, women affected by violence, Roma and Travellers, migrants and prisoners. Since September 2020, Marie Claire has been working with ENS to conduct research assessing the impact of statelessness on the right to health in Europe, including in relation to COVID-19.
Your work has largely focused on advocating for and informing public health policy on the health rights of socially excluded and marginalised populations. What made you want to turn your attention to statelessness through this project and how does it relate to your wider work?
My work over the past 20 years has been focused on health equity, addressing health disparities, and the health of marginalised groups. It is underpinned by the sustainable development ethos of leaving no one behind, which I feel is very applicable to the situation of stateless people. When I saw the research proposal, I thought to myself, “what is statelessness?”. It wasn’t something I knew a lot about, but I have done some research on the situation of migrants in immigration detention in Europe and did a lot of research on Irish travellers and Roma, through which I became aware of Roma statelessness. So, I was very interested in the project and felt I had something to offer based on my research background and previous work for UN agencies.
In April, we will launch our research report assessing the situation of statelessness, health and COVID-19 in Europe. What does the research tell us about the challenges stateless people in Europe face in accessing healthcare, including in the COVID-19 context?
The research shows us that the right to health for stateless people has been further compromised during the COVID-19 pandemic, when their access to healthcare was already restricted beforehand, and has created vast health disparity and inequity. In many cases, stateless people’s access to health services is very restricted due to lack of documentation and hinges on their residence status in the country, meaning that many only have the right to access emergency care. There were also reports in some cases of health services turning away those who were stateless and showing symptoms of the virus.
A strong theme in the research was fear among stateless people of accessing medical services in case their data was shared with immigration services. This has huge impacts on a country’s ability to implement testing, tracing and isolation measures. If you think about the COVID vaccination rollout, where there is an existing lack of institutional trust, and people who have been excluded in COVID response public health measures are now expected to step up and be vaccinated by the State that excluded them, that’s a very complex situation. Some countries have, positively, taken the step of creating a firewall preventing data sharing between immigration and registration services.
The environmental determinants of health for stateless people were already poor for many, with some living in poor and congested living conditions, and facing a lack of clean running water and access to soap and hand sanitiser. This compromises their health immunity and in the context of COVID-19, the ability to socially distance, making their ability to protect themselves from this virus extremely difficult. There were also reports of stateless people not being able to receive state aid because they are not entitled. Many stateless people work in the informal employment sector, so when informal employment has dried up due to government restrictions in response to the pandemic, it has left some stateless people in a very precarious situation. In response to this situation, NGOs across Europe are stepping up to try and save and maintain lives.
Much of the public health guidance and information provided by governments has not been specifically tailored to stateless people, however some has been tailored to groups that stateless people may be part of such as Roma and migrant populations. Again, NGOs are the ones stepping up to reach stateless people and provide them with clear information. Access to information has also been impeded for stateless people because governments have switched to using digital technology, excluding those without access to the internet and laptops. This was also the case for legal procedures, where a lot of governments switched to online booking systems to continue with asylum, statelessness determination and other procedures. There have been some reported delays and backlogs in legal procedures during the pandemic and it has also impacted on stateless people’s access to legal representation.
Civil society has emphasised the need for an inclusive human rights and public health response during the COVID-19 health emergency. What action is needed to ensure the health rights of all, including stateless people, both during and after COVID-19?
It will be very important to regularise stateless people’s status and ensure that there is no sharing of data between health and immigration officials. In the longer term, States need to introduce mechanisms to identify statelessness and statelessness determination procedures in law, where they haven’t already done so. The right to health and access to testing, treatment and vaccinations needs to be guaranteed for everyone on an equal basis, without excluding anyone in practice because of their residence status, lack of nationality or legal proof of their identity. It is not enough for governments to say that vaccinations are for all, they need to make sure this is done in practice, and manage the logistics needed to make that happen. If stateless people are not vaccinated, it will not only be harmful for them, but also the wider population. This will also require steps to address the racism, hate speech, xenophobia and antigypsyism that has increased during responses to the pandemic.
Norms of due process in immigration, nationality, international protection, and civil registration procedures need to be upheld, and extending residence permits during the pandemic will help to avoid discrimination in access to healthcare. Where delays are unavoidable, nobody should be penalised or disadvantaged as a result. Civil registration procedures should be registered as essential services in order to reduce the risk of statelessness resulting from a lack of legal proof of identity or nationality.
Governments will need to work together with UN agencies such as UNHCR and UNICEF, and NGOs and community-led organisations who have trust within stateless communities to facilitate public health responses, including vaccination efforts, and to make sure that stateless people are included in public health information campaigns. It is also essential that stateless people who have lost their incomes and residence status because of COVID-19 restrictions are able to access social security, providing them with a minimum essential level of support, again regardless of their residence or documentation status. The invisibility of statelessness needs to be addressed through improving available data, including anonymised health monitoring data to help generate evidence-based policies. This must go hand in hand with the adoption of firewalls between health and other government departments, including immigration officials.
The impact of statelessness on the right to health, as well as COVID-19 on stateless people in Europe is relatively under researched and understood. How can this research help raise awareness among key stakeholders and galvanise action to protect the right to health for stateless people?
The information from the report can help to generate advocacy tools, including country specific tools drawing on the research data from individual countries. This will support advocacy at national level by providing evidence of the issues faced by stateless people in accessing the right to health and presenting key action points for governments to implement. There is a real opportunity in the current moment, as governments know that they need to vaccinate over a certain percentage of the population in order to control the virus, so by missing populations such as stateless people, they understand that there will be risks. With that in mind, the report can be used to try to leverage policy change and better resource allocation to improve access to healthcare for stateless people, and to support community-led organisations and other NGOs who have really stepped up during this time of crisis to support stateless people.
This research is an important step towards better understanding the nexus between statelessness and health. In your view, why is further research and investment on this topic needed and what should it focus on?
Doing this research was a real eye opener for me in terms of realising just how hidden and marginalised stateless people are in health research. There were real difficulties in finding out the specific situation of stateless people as opposed to wider communities or groups they might belong to, such as refugee and migrant communities and minority groups including Roma, which exposes how little data and research is available on the nexus between statelessness and health. We spent a lot of time trying to find legal cases relating to statelessness and the right to health, and it was really shocking to me that there is such a lack of jurisprudence on this issue, and I worry that we may see cases in the future where stateless persons have been excluded from vaccination campaigns. There needs to be a lot more research done on stateless people not only in relation to their access to health, but also in relation to other rights such as the right to education and to work. Having more evidence can help us to answer crucial questions such as how to assure the rights of stateless people in crises like this, and how we can best protect their lives and those of their families.