Making a difference – providing healthcare to undocumented immigrants

Washington and Oberdorfer published a case report entitled, "A 5-year old boy with miliary and osteoarticular tuberculosis," in BMJ Case Reports. The case was can important reminder of a clinical lesson, and a good outcome. "Seven months after discharge, the patient had persistent limited ROM, but was otherwise asymptomatic…. [F]amily agreement to surgery was still pending." However, on presentation, "[The patient] was febrile, tachycardic, tachypnoeic… and [had] a weight of 12 kg (<5%)…. [The patient] was in moderate distress, with bilateral lung ronchi, mild subcostal retractions, severe low back lordosis, right hip tenderness and limited and painful active and passive ROM of the right hip…. He was unable to stand without assistance." The patient was from Myanmar and "had moved to Thailand without documentation to live with his father approximately 2 months prior to presentation." This is mentioned by the authors only because, "[T]he patient revealed having received unknown evaluation and treatment in Myanmar and… The healthcare system in Myanmar… is among the world's poorest performing."

This is important to mention because Thailand is, "the only country in the world where migrants there illegally have the same healthcare rights as nationals."^[1] Migrants make up about 6% of the Thai population, and the only barrier to healthcare access is whether they can buy into a plan, costing about $58 USD. While a few European countries with universal health care (UHC) allow undocumented migrants to access health care in the same way as citizens, they have additional requirements including residence for at least three months.

In the United States, "Undocumented immigrants with routine health needs who are not covered through family members' insurance currently obtain care from a patchwork of Federally Qualified Health Centers, private charities, and hospital emergency departments, or go without." ^[2] This issue is further complicated by the fact that, even when undocumented immigrants are eligible for government-sponsored health care, many delay seeking healthcare for fear of immigration repercussions…. Policies that discourage undocumented immigrants from obtaining healthcare… can both increase costs and have serious public health effects."

In the EU there is, "no clear EU provision for undocumented migrants' right to healthcare or to other basic social needs and that Member States… are increasingly using it as a tool to discourage the entry of new migrants." These barriers can include the requirement of health care providers to report undocumented immigrants to the immigration authority, language problems, difficulties in continuity of care, lack of knowledge about the health care system and other barriers.^[3]

In this case, it is obvious that the patient was better served by being an undocumented immigrant in Thailand than he would have been in the United States or European Union. The need to provide care for undocumented immigrants is obvious from a standpoint of human rights and public health. As described by the authors in their "learning points," "International borders do not stop infectious diseases." Health care professionals have an obligation to care for the health of the patients that present to them, not merely those who possess adequate documentation.

 

BMJ Case Reports invites authors to submit global health case reports that describe the complexities of caring for immigrants in diverse situations. These cases could focus on:

-How healthcare policies affect individual patients
-Successful interventions for providing access to undocumented immigrants
-Challenges to providing healthcare for undocumented immigrants

Manuscripts may be submitted by students, physicians, nurses and allied health professionals to BMJ Case Reports at casereports.bmj.com. For more information, review our guidance on how to write a global health case report and look through our online collection.

 

To read more about undocumented immigrants and migrant health at BMJ Case Reports, please review:

–Illegal immigration: the puzzling role of several risk factors for rhabdomyolysis
–A Rohingya refugee's journey in Australia and the barriers to accessing healthcare
–Atopic dermatitis complicated by severe impetigo in a Syrian refugee infant

 

To read more about undocumented immigrant healthcare from other sources, please review:

^[1] Yan W. Only one country offers universal health care to all migrants. NPR. 2016 Mar 31.
^[2] Fernandez A, Rodriguez RA, 2017. Undocumented immigrants and access to health care. Jama Internal Medicine. 2017 Apr 1;177(4):536-7
^[3] Brady H, Humphris R, Newall D, Phillmore J. Public health aspects of migrant health: a review of the evidence on health status for refugees and asylum seekers in the European Region. 2015.

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