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ABSTRACT
This article discusses the issue of the right to health care for irregularised migrants in Sweden, from a human rights perspective. An extended right to health care for irregularised migrants came into effect through a legislative amendment in 2013. By exploring the legislative process before the new Act on Health Care to Some Foreigners Who Reside In Sweden Without the Necessary Permits in 2013, we show how the Act uses ‘deportability’ as a legal category and basis for health care and why this is problematic. Our study reveals a variety of practices that reproduce inconsistencies entrenched in rights-mobilisation for non-citizens: separate legislations for different categories of persons, vague accounts of treaty-obligations, absence of discussions on liability, and shifting the responsibility of extending health care to the local government.
Acknowledgements
We would like to thank our colleague in Malmö, Dr Michael Strange, for constructive comments on this work.
Notes
1 Regeringens proposition 1997/98:16, ‘Sverige, framtiden och mångfalden – från invandrarpolitik till integrationspolitik’ Prop 1997/98:16 [Government bill: ‘Sweden, the future and diversity: from immigration politics to integration politics'].
2 See Grete Brochmann and Anniken Hagelund, Immigration Policy and the Scandinavian Welfare State 1945–2010 (Palgrave Macmillan 2012); Karin Borevi, Välfärdsstaten i det mångkulturella samhället (Acta Universitatis Upsaliensis 2002); Diane Sainsbury, Welfare States and Immigrant Rights: The Politics of Inclusion and Exclusion (OUP 2012).
3 Lag (1994:137) om mottagande av asylsökande m.fl.
4 Lag (2013:407) om hälso- och sjukvård till vissa utlänningar som vistas i Sverige utan nödvändiga tillstånd [Act on Health Care to Some Foreigners Who Reside In Sweden Without the Necessary Permits] (2013 Act).
5 By using the term irregularised migrants rather than the more commonly used term ‘undocumented migrants' we stress the construction of undocumentedness, as well as the long-term excluded form of residency that people experience when they are not granted authorisation to stay in the country. Other notions used in discussions about irregular migration are irregular migrants, undocumented persons, and ‘papperslösa’ – from the French sans-papier. A common denominator for all discussions around the position of irregularised is the ever-present risk of deportation: see Nicholas De Genova ‘Migrant “Illegality” and Deportability in Everyday Life’ [2002] Annual Rev of Anthropology 419.
6 Deportability was not used as legal basis for rights in legislation of the control of infectious diseases, which is covered by the Infectious Diseases Act from 2004: Smittskyddslagen (2004:168) [Infectious Diseases Act] <www.riksdagen.se/sv/dokument-lagar/dokument/svensk-forfattningssamling/smittskyddslag-2004168_sfs-2004-168> accessed 24 June 2016.
7 Nicholas De Genova and Nathalie Peutz (eds), The Deportation Regime: Sovereignty, Space, and the Freedom of Movement (Duke University Press 2010). Deportability, from our understanding, can be understood both as a legal position and in terms of everyday experiences of living as a rejected asylum seeker or visa over-stayer in Sweden. People who have been categorised as deportable in Sweden are subject to threat of expulsion at any time and everywhere on state territory. For a recent publication on this and related matters, see Maja Sager, Helena Holgersson, and Klara Öberg, Irreguljär migration i Sverige. Rättigheter, vardagserfarenheter, motstånd och statliga kategoriseringar (Daidalos 2016).
8 Gregor Noll, ‘Why Human Rights Fail to Protect Undocumented Migrants' (2010) 12(2) Eur J of Migration and Law 247.
9 See more about our work here: ‘Human Rights, Migration and Undocumentedness' a blog by Jacob Lind, Anna Lundberg, Mikael Spång, Michael Strange and Emma Söderman <https://blogg.mah.se/undocumentedmigrants/> accessed 16 January 2017.
10 Linda Bosniak, ‘Being Here: Ethical Territoriality and the Rights of Immigrants’ (2007) 8(2) Theoretical Inquiries in Law 389.
11 Often referring to Eastern European citizens, usually belonging to a Roma minority, who are migrating due to poverty.
12 Vårdombudsmannen [The Care Ombudsman], ‘Vittnesmål från papperslösa’, testimony of “Rafiq”, <http://vardombudsmannen.se/?page_id=134#sthash.cefAwZop.dpuf> accessed 21 November 2016 (author translation).
13 Göran Bodegård ‘Att ha rätt till vård och att få tillgång till vård. Vård av asylsökande barn med uppgivenhetssymtom’ in Adrián Groglopo and Beth Maina Ahlberg (eds), Hälsa, vård och strukturell diskriminering (Fritzes 2006) 171–229; Carin Björngren Cuadra, ‘Right of Access to Health Care for Undocumented Migrants in EU: A Comparative Study of National Policies’ (2012) 22(2) The Eur J of Public Health 267; Anna Lundberg and Emma Söderman, ‘Reflections on the Right to Health’ in Erica Righard, Magnus Johansson and Tapio Salonen (eds), Social Transformations in Scandinavian Cities: Nordic Perspectives on Urban Marginalisation and Social Sustainability (Nordic Academic Press 2015) 251–264; Shahram Khosravi, ‘Territorialiserad mänsklighet: irreguljära immigranter och det nakna livet’ in government report SOU 2006:37 Om välfärdens gränser och det villkorade medborgarskapet pp 283–310; Shahram Khosravi, ‘Detention and Deportation of Asylum Seekers in Sweden’ (2009) 50 Race & Class 38; Platform for International Cooperation on Undocumented Migrants (PICUM), Access to Health Care for Undocumented Migrants in Europe (PICUM 2007) <http://picum.org/picum.org/uploads/file_/Access_to_Health_Care_for_Undocumented_Migrants.pdf> accessed 15 July 2016.
14 See Migrationsverket [The Migration Agency] ‘The Riksdag has decided to temporarily restrict the possibility of being granted a residence permit in Sweden’ Press release 1 July 2016. <www.migrationsverket.se/English/About-the-Migration-Agency/News-archive/News-archive-2016/2016-07-01-The-Riksdag-the-Swedish-Parliament-has-decided-to-temporarily-restrict-the-possibility-of-being-granted-a-residence-permit-in-Sweden.html> accessed 23 August 2016. For more about estimated numbers of people in Sweden who are staying as undocumented (about 10,000–50,000 persons) see Socialstyrelsen [the National Board of Health and Welfare], Social Rapport 2010 (Socialstyrelsen 2010) p 268.
15 Regeringens proposition 2015/16:174, ‘Tillfälliga begränsningar av möjligheten att få uppehållstillstånd i Sverige’ [Government bill: Temporary restrictions of the possibility to obtain a residence permit in Sweden].
16 Maja Sager, Everyday Clandestinity: Experiences on the Margins of Citizenship and Migration Policies (Lund University 2011) <http://www.diva-portal.org/smash/get/diva2:896265/FULLTEXT01.pdf> accessed 20 November 2016.
17 De Genova (n 5), see also Maja Sager ‘Constructions of Deportability in Sweden. Refused Asylum Seekers’ Experiences in Relation to Gender, Family Life, and Reproduction’ (2016) 24(1) NORA: Nordic J of Feminist and Gender Research 30; Sager and others (n 7).
18 Joseph H Carens, ‘The Rights of Irregular Migrants’ (2008) 22(2) Ethics & International Affairs 163.
19 Shannon Alexander, ‘Humanitarian Bottom League? Sweden and the Right to Health for Undocumented Migrants’ (2010) 12(2) Eur J of Migration and Law 215.
20 Henry Ascher, Anders Björkman, Lars Kjellström and Tor Lindberg, ‘Diskriminering av papperslösa i vården leder till lidande och död’ [‘Discrimination of undocumented migrants leads to suffering and death’] (2008) 105(8) Läkartidningen 538. For a European perspective, see Roman Romero-Ortuno, ‘Access to Health Care for Illegal Immigrants in the EU: Should We Be Concerned?’ (2004) 11(3) Eur J of Health Law 245.
21 See Henrik Emilsson, ‘Sweden’ in Anna Triandafyllidou and Ruby Gropas (eds), European Immigration: A Sourcebook (Ashgate 2014); Isabel Schoultz, ‘Seeking Asylum and Residence Permits in Sweden: Denial, Acknowledgement, and Bureaucratic Legitimacy’ (2013) 22(2) Critical Criminology 219.
22 Grete Brochmann, ‘Nation-Building in the Scandinavian Welfare State: The Immigration Challenge’ (2015) 10(2) Nordicum-Mediterraneum A2 [1670-6242] (Conference paper) <http://nome.unak.is/nm-marzo-2012/vol-10-no-2-2015/81-conference-paper/526-nation-building-in-the-scandinavian-welfare-state-the-immigration-challenge> accessed 22 June 2016, 13.
23 Rebecca Stern, ‘“Our Refugee Policy is Generous”: Reflections on the Importance of a State’s Self-Image’ (2014) 33(1) Refugee Survey Q 25.
24 Khosravi, ‘Detention and Deportation’ (n 13).
25 Brochman (n 22) 6.
26 Markus Gunneflo and Niklas Selberg, ‘Discourse or Merely Noise? Regarding the Disagreement on Undocumented Migrants’ (2010) 12(2) Eur J of Migration and Law 173.
27 Ann Quennerstedt, ‘Children's Rights Research Moving into the Future: Challenges on the Way Forward’ (2013) 21(2) The Intl J of Children's Rights 233.
28 Noll (n 8) 248.
29 2013 Act (n 4); Government Offices of Sweden, Directive 2010:7 ‘Hälso- och sjukvård åt asylsökande, personer som håller sig undan verkställighet av ett beslut om avvisning eller utvisning samt personer som befinner sig i Sverige utan att ha ansökt om nödvändiga tillstånd för att vistas i landet’ [Health care for asylum seekers, people who are avoiding enforcement of a decision on the expulsion, as well as people who are in Sweden without having applied for the necessary permits to stay in the country]; Government Offices of Sweden, Directive 2012:36; ‘Vård efter behov och på lika villkor – en mänsklig rättighet’ [Care to needs and on equal terms: a human right]; Socialdepartementet, Government inquiry SOU 2011:48, Vård efter behov och på lika villkor – en mänsklig rättighet [Care according to needs and on equal terms: a human right], <http://www.regeringen.se/rattsdokument/statens-offentliga-utredningar/2011/05/sou-201148/> accessed 21 June 2016; Lagrådsremiss [Draft ratification bill] ‘Hälso- och sjukvård till personer som vistas i Sverige utan tillstånd’ (14 February 2013) [Health care for people staying in Sweden without permission]; Regeringens proposition 2012/13:109, ‘Hälso- och sjukvård till personer som vistas i Sverige utan tillstånd’ Prop 2012/13:109 [Government bill: Health care for people staying in Sweden without permission]
30 At the time of writing she is the Director General of the Swedish Work Environment Authority <https://www.av.se/en/> accessed 29 November 2016.
31 Government inquiry SOU 2011:48 (n 29) 70–71.
32 Paul Hunt was UN Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health between August 2002 and July 2008.
33 OHCHR, Paul Hunt, ‘Report of the Special Rapporteur on the Right of Everyone to the Enjoyment of the Highest Attainable Standard of Physical and Mental Health: Mission to Sweden’ (28 February 2007) UN Doc A/HRC/4/28/Add.2, pp 2, 19–33.
34 Jack Donnelly, International Human Rights (Westview Press 2013) ch 2.
35 Dan Biswas, Brigit Toebes, Anders Hjern, Henry Ascher and Marie Nörredam, ‘Access to Health Care for Undocumented Migrants from a Human Rights Perspective: A Comparative Study of Denmark, Sweden and the Netherlands’ (2012) 14(2) Health and Human Rights 49.
36 Platform for International Cooperation on Undocumented Migrants (PICUM), ‘PICUM Newsletter January 2010’ (January 2010) <http://picum.org/picum.org/uploads/archives/PICUM-Newsletter-January-2011.pdf> accessed 1 December 2016; PICUM, ‘PICUM Bulletin December 2011’ (December 2011) <http://picum.org/en/news/bulletins/31263/#news_31235>; Svenska Röda Korset,‘Alla har rätt till vård - bakgrund’ (28 June 2013) <www.redcross.se/vart-arbete/p/papperslosa/alla-har-ratt-till-vard---bakgrund> accessed 24 June 2016.
37 ‘Rätt till vård för asylsökande och papperslösa: Gemensamt ställningstagande från vårdprofessionerna’ (Stockholm August 2009) <http://www.snabber.se/files/vardforpapperslosa/stallningstagande-vardprofessionerna.pdf> accessed 12 June 2016.
38 The Government Offices of Sweden, ‘Ramöverenskommelse mellan regeringen och Miljöpartiet de gröna om migrationspolitik’ (2011-03-03) [Framework agreement between the government and the Green Party on migration policy] <http://www.regeringen.se/contentassets/f3ece2268a5a49f88722e4d66f9e8aaa/ramoverenskommelse-mellan-regeringen-och-miljopartiet-de-grona-om-migrationspolitik> accessed 12 June 2016.
39 Prop 2012/13:109 (n 29) 11.
40 Directive 2010:7 (n 29).
41 For a recent discussion on these categorisations see Sager and others (n 7).
42 Lag (2008:344) om hälso- och sjukvård åt asylsökande m.fl.
43 Smittskyddslag (2004:168) (n 6).
44 In Swedish: vård som inte kan anstå.
45 Government inquiry SOU 2011:48 (n 29) 32.
46 ibid 40.
47 Prop 2012/13:109 (n 29).
48 Anders Bolling ‘MSB avfärdar “systemkollaps”’ Dagens Nyheter (15 December 2015) <http://www.dn.se/nyheter/sverige/msb-avfardar-systemkollaps/> accessed 13 June 2016.
49 Among other things temporary residence permits became the general rule and the regulation about family reunification were severaly restrictied: see Flyktinggruppernas Riksråd, ‘What Does the Temporary Asylum Law Mean For Those Seeking Asylum?’ (22 August 2016) <http://www.farr.se/en/att-soeka-asyl/the-temporary-law> accessed 22 November 2016.
50 Hälso- och sjukvårdslag (1982:763).
51 See Regjeringens proposition ‘Om hälso- sjukvård’, Prop 1981/82: 97 [Bill: On Health Care Legislation] p 120; Regjeringens proposition ‘Med förslag till tandvårdslag’, Prop 1984/85:79 [Bill: Suggestions for Legislation on Dental Care] p 64. It should be noted that non-citizens do not have a right to stay in Sweden without proper permits. Only citizens have an unconditional right to do so. According to the Aliens Act, non-citizens who stay for longer than three months should hold a residence permit unless valid visa has been granted, or the person may have a right to stay because of protection needs (see Aliens Act 2006:716 ch 4).
52 The Migration Board changed its name to the Migration Agency in the spring of 2016.
53 See Allmänna råd från Socialstyrelsen 1954:4 Hälso- och sjukvård för asylsökande och flyktingar [General advice from The National Board of Health and Welfare Healthcare for asylum seekers and refugees] <http://www5.ltkronoberg.se/upload/Dokument/Halsa_och_vard/For_vardgivare/asyl_allmannarad_socialstyr.pdf> accessed 2 December 2016.
54 These are among the organisations arguing for equal access to health care: Akademikerförbundet SSR, Amnesty International, Caritas/Katolska kyrkan, Deltastiftelsen, Ersta Diakoni, Flyktinggruppernas och asylkommittéernas riksråd, Förbundet Sveriges Arbetsterapeuter, Föreningen Läkare mot Aids, Hiv-Sverige, HMR, IFMSA-Sweden, LO, Läkare i Världen, Läkare Utan Gränser, Papperslösa Stockholm, Rosengrenska kliniken för gömda flyktingar, Rädda Barnen, Röda Korset, Svenska barnläkarföreningen, Svenska barnmorskeförbundet, Svenska Logopedförbundet, Svensk sjuksköterskeföreningen, Sveriges kristna råd, Sveriges läkarförbund, Sveriges Psykologförbund, TCO och Vårdförbundet. Utöver dessa stöds initiativet av Psykiatriska Riksföreningen, Riksföreningen för skolsköterskor, Riksföreningen för sjuksköterskor inom urologi (RSU), Svenska Helsingforskommittén för mänskliga rättigheter, Riksförbundet för sexuell upplysning (RFSU), Förbundet för Kristen Humanism och Samhällssyn (KHS), Antirasistiska Akademin (ArA), UNICEF Sverige, Immigranternas Riksförbund, Sveriges Tandläkarförbund, Legitimerade Sjukgymnasters Riksförbund, White Ribbon Alliance for Safe Motherhoood Sweden, Tinnerökliniken, Liljegrenska frivillignätverk i Varberg och Röda Korsets Ungdomsförbund. See Government inquiry SOU 2011:48 (n 29) 269 fn 7; the Infectious Diseases Act (n 6).
55 Government proposal (n 40) 37.
56 See among others Association of health professionals, review of government proposition, 12 November 2012 <https://www.vardforbundet.se/engagemang-och-paverkan/sa-paverkar-vardforbundet/remissyttranden/2012/halso--och-sjukvard-till-personer-som-vistas-i-sverige-utan-tillstand-ds-201236/>; Swedish Pediatric Society for Children, review of government proposition, 11 November 2012 <http://www.snabber.se/files/vardforpapperslosa/svenska_barnlakarforeningen.pdf> accessed 9 December 2016.
57 Lag (2008:344) (n 42) ss 5 and 6.
58 This is governed by the 2008 law about asylum seekers, the Communicable Diseases Act, s 4 of the Health and Medical Services Act and s 6 of the Dental Care Act [in Swedish: Tandvårdslag].
59 Lag (2008:344) (n 42) ss 4–6; The Communicable Diseases Act; The Health and Medical Services Act, s 4.
60 Prop 2012/13:109 (n 29) 22.
61 Government inquiry SOU 2011:48 (n 29) 32.
62 Prop 2012/13:109 (n 29) 13.
63 ibid 58.
64 See Swedish title of 2013 Act: Lag om hälso- och sjukvård till vissa utlänningar som vistas i Sverige utan nödvändiga tillstånd.
65 Prop 2012/13:109 (n 29) 58.
66 Government inquiry SOU 2011:48 (n 29) 365.
67 Convention on the Rights of the Child (adopted 20 November 1989, entered into force 2 September 1990) UNGA Res 44/25 (CRC) art 2.
68 Government inquiry SOU 2011:48 (n 29) 158; Universal Declaration of Human Rights (adopted 10 December 1948) UNGA Res 217 A(III) (UDHR).
69 Government inquiry SOU 2011:48 (n 29) 159.
70 See International Covenant on Economic, Social and Cultural Rights (adopted 16 December 1966,
entered into force 3 January 1976) UNGA Res 2200A (XXI) (ICESCR) General comment No 14 and No 20; International Convention on the Elimination of All Forms of Racial Discrimination (adopted 21 December 1965, entered into force 4 January 1969) UNGA Res 2106 (XX) (CERD) General Comment No 30.
71 Government inquiry SOU 2011:48 (n 29) 217.
72 Prop 2012/13:109 (n 29) 29.
73 In 2009, the Swedish Parliament approved Proposition 2009/10:80, ‘A Reformed Constitution’ [En reformerad grundlag], making substantial amendments to the Instrument of Government, and related acts. The amendment modernised and simplified the text in general, and strengthened several fundamental rights and freedoms. Protection against unfair discrimination was extended to include discrimination based on sexual orientation. The amendment affirmed the responsibility of public authorities to protect children's rights, and to promote the preservation and development of ethnic minorities’ culture and language, making special mention of the Sami people. It also strengthens judicial powers to make it easier to determine whether new laws contravene the constitution or the Charter of Fundamental Rights of the European Union. These amendments took effect on 1 January 2011.
74 Instrument of Government (1975), SFS 1974:152, reprinted 2003:593, ch 2 s 25; Government inquiry SOU 2011:48 (n 29) 177.
75 Government inquiry SOU 2011:48 (n 29) 175.
76 Instrument of Government (n 71) ch 1, s 2.
77 Government inquiry SOU 2011:48 (n 29) 295.
78 Lisbon Declaration 1981, quoted in Government inquiry SOU 2011:48 (n 29) 295.
79 Government inquiry SOU 2011:48 (n 29) 21, 38, 43, 351.
80 ibid 156.
81 ibid 368.
82 ibid 31.
83 See e.g. Prop 2012/13:109 (n 29) 12; Finansdepartementet, Regeringens Prop 2009/10:1, ‘Budgetpropositionen för 2010’.
84 Prop 2012/13:109 (n 29) 56.
85 The current practice in Swedish clinics and health care institutions on how to respond when the police call (to find out whether or not a person they are searching for is present in the clinic) is to refer to the doctor-patient confidentiality that prevails in Swedish health care institutions.
86 Government inquiry SOU 2011:48 (n 29) 292.
87 ibid 293.
88 Kulturdepartementet, Government inquiry SOU 2010:70 120, ‘Ny struktur för skydd av mänskliga rättigheter – Slutbetänkande av Delegationen för mänskliga rättigheter i Sverige’ [New structure for the protection of Human Rights] <http://www.regeringen.se/contentassets/3da10d176fae4352bd4ee41b4bbd971a/ny-struktur-for-skydd-av-manskliga-rattigheter-sou-201070> accessed 28 November 2016.
89 Government inquiry SOU 2011:48 (n 29) 301.
90 Prop 2012/13:109 (n 29) 45.
91 ibid.
92 ibid 46.
93 ibid 42.
94 Bosniak (n 10) 391.
95 Amanda Nielsen, Challenging Rightlessness: On Irregular Migrants and the Contestation of Welfare State Demarcation in Sweden (Linnaeus University Press 2016); doctoral thesis <http://www.diva-portal.org/smash/record.jsf?pid=diva2%3A896265&dswid=4813> accessed 1 December 2016.
96 Besides the scholars referred to above (ns 18–23), Hannah Arendt reflected on this paradox in her renowned Origins of Totalitarianism (Harcourt, Brace, Janovich 1951).
97 De Genova and Peutz (n 7).
98 Giorgio Agamben, Homo sacer: Sovereign Power and Bare Life (Stanford University Press 1998).