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Health care for
the hidden


Sweden’s generous social welfare system is the envy of many countries. But thousands of people in Sweden have little or no access to health care, a situation the Swedish Red Cross is trying to remedy.


ARE you going to give birth? Thanks, that will be 22,000 Swedish crowns (US$ 3,140). That is what people who are not covered under the Swedish social system face when seeking health care. No one knows how many people live hidden in Sweden, it could be 10,000 or it could be many more. But every day Charlotta Arwidson sees more evidence that many people in Sweden live year after year without being registered.

“Many of us aren’t aware that there is a group of people who live in the shadows of the welfare state. We think everyone fits in, but they don’t,” she says. Arwidson manages the Swedish Red Cross project, Health Care for the Hidden. It functions as a referral agency where people who don’t have the right to treatment can get help. About 50 doctors, midwives, psychologists and other professionals make up the Red Cross network.

Under Swedish law, people without a state identity number have the right to emergency care only, which in practice often means acute but unsubsidized treatment in hospital. Anything else, from treatment for an ear infection, to maternity care, to insulin for diabetes, or treatment in the early stages of cancer, is practically non-existent for these people. Because the little care they can receive is unsubsidized, a visit to the emergency room can cost 2,000 crowns (US$ 285). A study by the Platform for International Cooperation on Undocumented Migrants (PICUM) found that Sweden was among the worst countries in the European Union at providing health care to the hidden. PICUM aims to encourage respect for paperless migrants’ basic social rights throughout Europe.

“We Swedes are incredibly well organized. If you don’t have an identity number, you don’t get access to anything. There are no loopholes. I think we are proud to live in a well-organized country and that organization has many advantages. At the same time, those who don’t fit in are really excluded,” says Arwidson.

“You shouldn’t have to earn health care. It’s a human right,” she says.

Maria, 22, comes from Bolivia but has worked as a cleaner in Sweden for two years. She has never registered with the Swedish authorities and is quite typical of the group of hidden people Arwidson comes into contact with.

Recently, Maria had an ingrown toenail, a minor complaint that normally shouldn’t have caused any trouble. But because Maria was afraid to go to the doctor, she did not get medical attention. Her toe became worse and her foot began to swell and became painful. Finally, when it was inflamed and seriously infected, and Maria couldn’t walk any longer, she knew she needed help.

“I thought a lot before I went to the doctor’s that day. I thought they might ask me to show a lot of papers. Or ring the police... I was afraid. I needed to take care of my little girl,” she says, talking about her 2-month-old daughter.

Maria was lucky, although the doctor’s surgery denied her treatment, a woman on the staff tipped off Maria about the Red Cross project. Maria had never heard of the Red Cross before but she called Arwidson and quickly got help finding a doctor who would treat her at no cost.

After the initial phone contact, Arwidson, who is a nurse, always meets the people to assess their needs. She then refers them to a doctor. Patients don’t need to pay and neither does the Red Cross. The health-care workers in the network are all volunteers.

Sometimes Charlotta Arwidson is asked if her work is illegal.

“People should know that it is not illegal to help hidden people get health care. To provide free assistance is absolutely legal,” explains Arwidson.

On the other hand, denying someone health care is unethical and can have serious consequences, she says.

Maria also came into contact with the Swedish health-care system when she was pregnant. When she conceived a year ago, she had no idea there were organizations that could put her in touch with a midwife. She longed for Bolivia when she discovered she was pregnant. There she would have known how it all functioned. At the same time, she wanted to stay in Sweden with her husband, who also lives and works here. She was afraid that the midwife might alert the police and that she would be deported. It was only when she was six months pregnant that she contacted a midwife who managed to convince her to give birth in hospital. “She told me I must think of my child’s life,” says Maria.

After delivering her baby, the bill came. Now the family owes the local council 22,000 crowns.

Cases like Maria’s make Arwidson really angry. What would have happened if Maria had chosen to give birth at home out of fear of the authorities?

Many of the people who live hidden in Sweden, for one reason or another, have low incomes. Some earn as little as 30 crowns (US$ 4.30) a day and can’t insist on their rights.

Red Cross statistics show that this group of people, who are unable to pay their own health-care costs, are worse off psychologically and physically because they live outside the system.

Arwidson doesn’t believe it is the health-care workers’ job to decide who has the right to treatment and who doesn’t. Doctors and nurses should do what they do best — diagnose and treat those with medical problems.

“Sick people come to the hospital and the first thing they are asked is, ‘Do you have a personal identity number? Do you have money to pay?’ Their needs are irrelevant; the deciding factor is their legal status,” says Arwidson.

International conventions which Sweden has signed affirm that the right to health care is a human right.

Maria isn’t complaining about the Swedish state. She isn’t asking for free health care. But there is a question that worries her because it’s hard to make ends meet.

“What happens if we can’t pay the hospital bill?”


Migrants without an identity number are excluded from most health care in Sweden, says Charlotta Arwidson of the Swedish Red Cross.




Governments need to act
PICUM asks states to:

1. Acknowledge the social and economic presence of undocumented migrants.
2. Collect data on who undocumented migrants are, why they come and how they survive.
3. Involve (local) non-governmental organizations in research and policymaking.
4. Mainstream undocumented migrants; give them social services such as health care, housing, education and fair working conditions.
5. Inspect workplaces and penalize employers who exploit workers.
6. Safeguard the right to equality under law.
7. Safeguard the right to organize and unionize.
8. Regularize undocumented migrants to avoid leaving them on the margins, subject to exploitation.
9. Open up the debate on the future of the low wage sector.
10. Ratify the International Convention for the Protection of the Rights of All Migrant Workers and the Members of Their Families (1990), which guarantees various social rights to undocumented migrant workers.





The facts about Sweden’s hidden people

• The Swedish Red Cross took over Health Care for the Hidden from Médecins sans Frontières in January 2006.
• Health Care for the Hidden is responsible for 50 to 60 consultations a month; among other things, it can help with blood tests, visits to doctors and midwives.
• About two-thirds of the patients the Red Cross sees have never sought asylum in Sweden. The remainder are people who have been denied asylum and live in hiding.
• For obvious reasons there are no exact statistics on how large these groups are.
• Seventy per cent of patients are aged between 25 and 40.
• The most common medical problems are diabetes, respiratory disease and high blood pressure.
• A majority of patients are women and many of them seek help with gynaecological problems or maternity care.
The Swedish Red Cross believes the state should:
• Design a system that subsidizes health care for hidden people so local councils are reimbursed for helping these patients.
• Change the law so hidden people have the right, not just to emergency care, but also to other kinds of treatment.

Ulrika Nordin
Ulrika Nordin is a freelance journalist based in Sweden.



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