ABSTRACT
Under the ICESCR, states must ensure the right to health, which extends beyond their citizens to everyone within their territory, irrespective of migration status; and beyond policies and practices within the sphere of health to those that affect health. In the majority of European countries, the right to health is conditioned on the right to reside. This has significant costs for the health of undocumented residents who have very restricted entitlements to primary and secondary care in most member states. Studies show that it is financially more costly to exclude people from health care based on residence status than to grant them fuller access to health services, including preventive care. Categorical exclusions from care also compromise public health goals, and the ethical obligations of health providers asked to participate in immigration control at the expense of patients’ best interest, undermining trust and deterring health-seeking behaviour. Other health costs for irregular migrants relate to policies and practices outside the health sector. For instance, undocumented workers in most European countries cannot safely report workplace violations. The result is greater exposure to exploitation, poverty, injury, and death, with limited recourse to the justice or health care system. There are also health-related consequences for policies intended to deter irregular migration, such as the widespread use of immigration detention, which is a well-known cause of diminished physical and mental health, and a place where access to adequate health care is generally limited. The result is a double blow to the health of people in detention, particularly those with special needs, such as pregnant women, and children, with potential lifelong consequences. To mitigate these costs, policies regulating migration – and mobility – must begin to systematically integrate social as well as labour rights and protections, and to address the damaging effects of linking social rights to residence status. There must also be recognition of, and efforts to address, the health-related harms of existing immigration control policies. The UN global compact on migration represents a critical opportunity to address migration in a way that integrates the perspective of people who migrate for a diversity of reasons, to ensure that health-related costs of irregular migration are recognized and concretely addressed in a manner that is anchored in human rights and dignity.
