BRIDGING BORDERS
Report on a project to provide sheltered accommodation and psychosocial support to vulnerable asylum seekers to whom such services are not otherwise available
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The challenge of social integration is not an easy one. Among other things, it requires a new frame of mind, a new way of thinking. If the receiving society does not understand that integration is the responsibility of everybody, it ends up establishing an invisible border between social groups: between those it considers nationals and those it considers foreigners, aliens, outsiders... We need to propose bridges that overcome the unjust interior borders established by society. Overcoming Borders Jesuit Migrant Service Spain (SJM-EspaĂąa), April 2011
Acknowledgments This publication is part of the JRS Malta Project to provide sheltered accommodation and psychosocial support to vulnerable asylum seekers to whom such services are not otherwise available, funded by ERF 2010, Istrina 2010, Voices and other local benefactors. The views expressed in this publication are those of JRS Malta and do not necessarily represent the opinion or position of any of the project funders or of the organizations and individuals involved in the Core Team. Their contribution is acknowledged with gratitude as it would not have been possible to implement this project without their support. Date of publication: June 2012 Authors: Katrine Camilleri and Kristina Zammit Publisher: Jesuit Refugee Service Malta Design: Alison Vella Contact details: Jesuit Refugee Service (JRS) Malta SAC Sports Complex 50 Triq ix-Xorrox B’Kara Malta +356 21 442751 info@jrsmalta.org www.jrsmalta.org
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Table of Contents 4 5 6
Preface I. INTRODUCTION Key concepts and terminology used in this report 8 II. ABOUT THIS REPORT: AIMS, OBJECTIVES AND LIMITATIONS 9 9 9 11 12
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III. CONTEXT AND BACKGROUND Immigration to Malta – recent patterns and trends Law and policy regulating the treatment of asylum seekers and irregular migrants Life after reception: the challenges of integration Particular arrangements for vulnerable persons IV. THE JRS MALTA PROJECT TO PROVIDE SHELTERED ACCOMMO- DATION AND PSYCHOSOCIAL SUPPORT TO VULNERABLE ASYLUM SEEKERS: ACTIVITIES UNDERTAKEN AND RESULTS ACHIEVED 1. Project Outline 2. Project Implementation 2.1 Networking and coordination 2.2 Service provision 2.2.1 Service provision: characteristics of population served 2.2.2 Service provision: project results by numbers 2.2.3 Service provision: description of services provided 2.3 Training and capacity building 2.4 Advocacy
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V. LESSONS LEARNT 1. Overall findings 1.1 Factors creating vulnerability – need to shift our understanding of the concept of vulnerability from ‘vulnerable persons’ to ‘people in a vulnerable situation’ 33 1.2 Insufficient support for migrants with mental health problems and chronic illness 33 1.3 Importance of taking asylum seekers’ perspective into account when planning services 33 2. Findings relating to the reception system 33 2.1 Limited scope of the vulnerability assessment procedure 34 2.2 Detention of migrants in a particularly vulnerable situation 34 2.3 Quality of care for persons released on grounds of vulnerability and others in a particularly vulnerable situation 35 2.4 Mainstreaming: the pros and cons 35 3. Findings relating to access to mainstream services 36 3.1 Obstacles relating to the particular situation of migrants themselves or their legal status 36 3.2 Obstacles to access relating to service-providers 39 3.3 Obstacles relating to the legal and policy framework for integration 41
VI. RECOMMENDATIONS
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References 3
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PREFACE Between July 2011 and June 2012 JRS Malta implemented a project, funded by the European Refugee Fund 2010, local charities Istrina 2010 and Voices, and other benefactors. The project aimed to provide sheltered accommodation and psychosocial support to vulnerable asylum seekers to whom such services are not readily available. Initially we were concerned that this project, with its broad focus on asylum seekers in detention and in the community and its emphasis on promoting access to mainstream services, marked a shift away from what, until then, had been our primary focus – providing services and support to migrants and asylum seekers in detention. Reflecting on the project, we came to the realisation that although, to some extent, it drew us away from the legal and physical borders of our country, it brought us into contact with other borders which prevent asylum seekers, beneficiaries of international protection and other migrants living among us from fully enjoying their rights and obtaining the care and services they require. These borders, though possibly less visible, are no less real. They include linguistic and cultural differences, limitations in the legal and policy framework regulating access to services, shortage of resources and lack of skills and knowledge required to meet the needs of an ethnically and culturally diverse population. The diversity and complexity of these obstacles makes the challenge of identifying, addressing and overcoming them even greater. Perhaps the case that best illustrates just how serious the possible consequences of a lack of access to services could be is that of Suleiman Samake. The hitherto unknown Malian acquired national notoriety in April 2011, after he was involved in an incident with police officers who tried to remove him from the cave where he was staying. During the incident Suleiman, who was shot and injured in the stomach, allegedly ran towards the police officers wielding a large knife. Shortly after he was arraigned in Court and charged with attempted murder of four police officers.
gravity of his condition went largely unnoticed1. After his release he was placed in a large Open Centre, where he found the living conditions very difficult; without the care and support he needed, either from the system (which includes government and NGOs) or from his community, Suleiman became increasingly withdrawn and took to staying in a cave where he could be alone. His condition degenerated but it was only after the events described above that he was placed in Mount Carmel where he remains till today, pending the outcome of the trial, to receive the treatment he needs. Although possibly unusual, in terms of the gravity of the consequences and the publicity it received, Suleiman’s case is unfortunately not unique and it would be a mistake to dismiss its significance. This case highlights, more clearly than ever before, the gaps in our capacity to identify and provide care and support to asylum seekers and migrants in a particularly vulnerable situation. It also brings into sharp relief the possible consequences of failure to address these gaps and to ensure that asylum seekers, beneficiaries of protection and other migrants are able to access the care and protection they need. For us this project was extremely valuable, as it helped us to understand the nature and extent of the obstacles faced by asylum seekers, beneficiaries of protection and other migrants in need of care and services, at various levels and at different stages of their stay in Malta. By sharing the lessons learnt, we hope to stimulate debate regarding how to ensure that they receive appropriate and timely care and support and to contribute to the development of effective policies and services to this end. JRS Malta June 2012
According to public accounts, Suleiman struggled with mental health problems, even receiving in-patient care at the psychiatric hospital, while in detention however the
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I. INTRODUCTION The JRS Malta project to provide sheltered accommodation and psychosocial support to vulnerable asylum seekers to whom such services are not readily available was created primarily in response to the increased demand for services from the JRS social work team. The JRS social work service was set up in 2003 to provide services and support to vulnerable asylum seekers in detention. Then, as now, the vast majority of migrants and asylum seekers in detention were boat arrivals – that is, migrants who had arrived in Malta by boat, usually from Libya, having travelled in an irregular manner. From 2007 the number of requests for services from migrants in the community started to increase, as more and more people who JRS was supporting in detention were released to live in the community. Many of the people referred for service suffered from long-standing mental health problems, chronic illness, such as diabetes or HIV/AIDS, or other serious illness. A number required intensive follow-up, stretching our very limited service to the limit. The primary aim of the project was to increase JRS’ capacity to respond to the growing number of requests for assistance and to consolidate the services being provided both by the organization and by other stakeholders, with a view to maximising available resources and ensuring that all who need support and services are able to obtain them. Through the project we were able to recruit a social worker, an outreach worker and two cultural mediators and to contract the services of three psychologists, who worked with us on a part-time basis, to deal with the increased demand for services.
Our work in this area brought home the reality that mainstream health and social welfare services are often inaccessible to migrants and asylum seekers, in spite of the good intentions of many of the professionals working within these structures. Throughout the project, staff worked to facilitate asylum seekers’ access to mainstream services, by assisting beneficiaries to obtain services and by providing information, assistance and support to mainstream service providers who were encountering difficulties when working with asylum seekers. The project also sought to enhance the capacity of mainstream services to work effectively with asylum seekers through the provision of training and to improve collaboration between the different agencies providing services to this category of migrants. This report outlines the lessons learnt through this project, and makes recommendations based on our own direct experience and that of the professionals we worked with during the project. After defining key terms and concepts, the report describes the methodology used and the national context within which the project was implemented. It then goes on to outline the activities implemented during the lifetime of the project, the results achieved and the main lessons learnt, both regarding provision of services and support to vulnerable asylum seekers as well as regarding asylum seekers’ access to mainstream services. It concludes with recommendations for action.
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Key concepts and terminology used in this report: An asylum seeker is a third country national or stateless person who has made an application for international protection in respect of which a final decision has not yet been taken by the competent national authorities. A rejected asylum seeker is a third country national or stateless person whose application for international protection has been examined and rejected by a final decision of the competent authorities. European and national law define international protection as refugee status or subsidiary protection. The granting of international protection across the EU is regulated by the Qualification Directive; this Directive establishes a set of uniform standards regulating who qualifies for protection and lays down the minimum rights of holders, which are applicable in all Member States of the Union including Malta. The provisions of the Qualification Directive were transposed into Maltese law through the Procedural Standards in Examining Applications for Refugee Status Regulations (L.N. 243 of 2008, S.L. 420.07). National protection refers to forms of protection granted by national authorities in terms of national law or policy. These types of protection are known as non-harmonised forms of protection, as they are particular to the country where they are granted and not regulated by uniform standards across the EU. In Malta there is one form of national protection known as Temporary Humanitarian Protection or Temporary Humanitarian Protection New (THP/THPN). According to the 1951 Convention and Maltese law a refugee is a person who, owing to a well-founded fear of persecution for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside his country of origin and is unable or, owing to such fear is unwilling, to return to it. Refugee status is the status given by a country to a person who has been recognised as a refugee. Subsidiary protection is a form of international protection given to those whose application for refugee status has been dismissed but who, it has been shown, will face a real risk of serious harm if returned to their country of origin. ‘Serious harm’ is defined by law as: death penalty or execution; torture or inhuman and degrading treatment or punishment; threats to life by indiscriminate violence in international or internal armed conflicts. Temporary Humanitarian Protection (THP)/Temporary Humanitarian Protection New (THPN) is a form of national
protection granted in terms of national policy. THP/N is granted on the recommendation of the Refugee Commissioner to asylum seekers whose application for international protection has been rejected. The Refugee Commissioner may recommend the granting of THP: where the applicant is a minor; where he considers that the applicant should not be returned to his country of origin on medical grounds; where he considers that the applicant should not be returned to his country of origin on other humanitarian grounds. THPN used to be granted to rejected asylum seekers who had been in Malta for a number of years and had not been removed due to no fault of their own; today the granting of THPN is suspended. The term tolerated stay is used to refer to the situation of migrants against whom a Removal Order has been issued, who are then issued with a temporary permit to stay as immediate removal is not possible due to logistical difficulties or other legal or practical obstacles. It is not a formal status established by law, but rather an administrative response to a practical reality. As their presence is acknowledged by the immigration authorities and they are granted a permit to stay, temporarily these migrants cannot be considered to be in an irregular or illegal situation. Rejected asylum seekers released from detention in line with government policy are one such category of migrants. In this report the term migrant/s is used when reference is being made to more than one category of third country nationals present in Malta, as opposed to one specific category e.g. asylum seekers, beneficiaries of international and/or national protection and rejected asylum seekers. Both European and national law make reference to vulnerable persons, however neither provides a clear or exhaustive definition of the term, providing instead inclusive lists of categories of persons who would be considered vulnerable due to a physical or psychological condition or the impact of traumatic personal experiences. The Procedural Standards in Examining Applications for Refugee Status Regulations (L.N. 243 of 2008, S.L. 420.07) state that “vulnerable persons” include pregnant women, persons with disabilities, persons who have undergone torture, rape or other serious forms of psychological, physical or sexual violence, or minors who have been victims of any form of abuse, neglect, exploitation, torture, cruel, inhuman or degrading treatment or who have suffered from armed conflict. Both within the context of the project and for the purposes of this report, we wanted to steer clear of the debate on what constitutes ‘vulnerability’ and what exactly we mean when we talk about ‘vulnerable’ asylum seekers, a complex discussion that, in the local context, has been both coloured and further complicated by the fact that identification as vulnerable is explicitly linked to release from detention. We decided at the outset that, within the context of this project:
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hh the issue of whether or not an individual would qualify for release on grounds of vulnerability in terms of national policy was only of marginal relevance; and hh vulnerability would be determined by assessing particular needs for services, care and support, rather than focusing on whether or not individuals fell into a particular category of persons recognised as vulnerable in terms of policy. Throughout the project, staff provided services to individuals considered ‘vulnerable’ due to their need for care, services and/ or support, which were not otherwise available to them (see Methodology section for further details). The findings in this report are based on our work with this population. The term reception system is usually used to refer to the measures in place to provide material and social support to asylum seekers throughout the asylum procedure. Within the context of this report the phrase ‘reception’ is given a wider meaning; it refers to the system in place for the reception and accommodation of boat arrivals and other migrants in both closed and open centres, and covers the period from arrival to the moment when an asylum seeker or beneficiary of protection leaves the Open Centre and moves into independent accommodation. This period often extends far beyond the formal end of the asylum procedure. The Agency for the Welfare of Asylum Seekers (AWAS) was formally established in July 2009 by the Agency for the Welfare of Asylum Seekers Regulations (SL 217.11, LN 205 of 2009). It is formally responsible for the implementation of national legislation and policy concerning the welfare of refugees, persons enjoying international protection and asylum seekers. It is mandated by law to implement various tasks including: overseeing the daily management of accommodation facilities; providing particular services to categories of persons identified as vulnerable according to current policies; providing information programmes to its clients in the areas of employment, housing, education, health and welfare services offered under national schemes; acting as facilitator with all public entities responsible for providing services to ensure that national obligations to refugees and asylum seekers are accessible; advising the Minister on new developments in its field of operation and propose policy or legislation required to improve the service given and fulfil any legal obligations in respect of its service users; encouraging networking with local voluntary organisations and other public stakeholders. The term mainstream services is used to refer to services provided by either government or non-government agencies which are available to the general population, e.g. the services provided by Appogg or the government health service, as opposed to those which are available only to a limited category of people, e.g. the services provided by the Agency for the Welfare of Asylum Seekers (AWAS) which are available only to particular categories of migrants. The mainstream services
encountered through the project are mostly public healthcare and social welfare providers. The role of the cultural mediator is understood differently across Europe. For the purposes of this project, we adopted the description used by Martín and Phelan2, which essentially states that cultural mediators help service providers to understand and be aware of cultural practices which might have a bearing on the way users approach the service. They are also a resource to inform clients/patients of their entitlements and the way the system works and how it should be accessed. In addition, they play an important role in empowering clients/patients, by informing them and encouraging them to voice their needs and concerns. Cultural mediators can help service providers to monitor the progress of their patients/clients and ensure that there is appropriate follow-up. When several services are involved, they can also act as a point of contact and a link between service providers and their client/patient. It is the responsibility of cultural mediators to create a space of dialogue in which service providers and service users can establish an effective and respectful relationship. The role of a cultural mediator is different from that of an interpreter, whose role is to bridge the language barrier, by attempting to understand the intention of the utterance and portraying it as faithfully as possible in the other language3. In fact cultural mediators can be necessary and useful even where service users speak the same language but come from a totally different cultural background which impedes them from understanding the way the system works and hampers their access to services. On many occasions, the cultural mediators working on the project also provided interpretation services. A detention centre is a facility where persons held in terms of the Immigration Act (Chapter 217 of the Laws of Malta) are accommodated; detention implies complete deprivation of liberty as opposed to mere restrictions on movement. There are 4 detention facilities currently in use: three in Safi Barracks (Warehouse 1, Warehouse 2 and B Block) and one in Lyster Barracks in Hal Far (Hermes Block). An open centre is a collective accommodation facility where migrants released from detention are accommodated; other migrants, such as asylum seekers returned to Malta in terms of the Dublin Regulations could also be accommodated there. Open Centre residents are not subject to any restrictions on their liberty and they may leave the centre whenever they choose. There are 8 Open Centres currently in use: Hal Far Immigration Reception Centre, Hangar Open Centre, Hal Far Tent Village, Hal Far Open Centre, Marsa Open Centre, Balzan Open Centre, Dar Liedna and Dar is-Sliem. Most Open Centres are administered by AWAS; Marsa and Balzan Open Centres are administered by NGOs. There are also a number of smaller accommodation facilities run by NGOs.
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II. ABOUT THIS REPORT: AIMS, OBJECTIVES AND LIMITATIONS
This report presents the lessons learnt through the JRS Malta project to provide sheltered accommodation and psychosocial support to vulnerable asylum seekers to whom such services are not readily available. It does not purport to be a scientific study, but rather: hh to document and analyse the project results, and hh to present our observations and recommendations for the strengthening of existing structures for the identification, care and support of vulnerable asylum seekers, and improved access to mainstream services for this category of migrants. The sample on which our conclusions are based was not scientifically selected. Most beneficiaries were identified by JRS staff through our outreach in detention or through the weekly drop-in service at the JRS office (see section 2.2. on Service Provision for a description of these services). A small minority were referred by other agencies. Project beneficiaries were selected on the basis of an assessment of their needs, conducted by JRS staff following a request or referral for service. The assessment conducted was aimed at identifying individual needs for in-depth psychosocial services and support and determining whether or not they were in fact available, e.g. from the Open Centre where they were accommodated. In all a total of 230 individuals were identified as being in a particularly vulnerable situation and in need of one or more of the services provided by the project, however only 187 qualified for services within the project; 43 persons were excluded on account of their legal status. Due to the parameters of the fund, the project focused on asylum seekers and beneficiaries of international protection. Rejected asylum seekers and beneficiaries of national protection were excluded, unless they started receiving a service while they were still asylum seekers, in which case the service was not withdrawn when their application was rejected. In practice this restriction created a number of problems as a significant number of persons referred for service (18%) were rejected asylum seekers and beneficiaries of national protection.
international protection, it also touches upon the situation of other categories of migrants in a particularly vulnerable situation. There are a number of reasons for this, not least the fact that beneficiaries of national protection, like beneficiaries of international protection, are entitled to stay in Malta for the duration of their protection. Also, given that THP may be granted on humanitarian or medical grounds, it is likely that a number of persons with this form of protection would require additional services and support. Through this project we became more acutely aware of the significant needs of this population and of the additional obstacles they face when seeking to access services, including our own, because of their particular legal status, or lack of it, as well as because of the lack of clarity regarding their entitlements. We believe it is fundamental to ensure that, for as long as they are in Malta, all migrants in a particularly vulnerable situation because of medical or mental health problems are able to access the medical or psycho-social support they require to be able to live with dignity. It is therefore important that the needs of all categories of migrants, as well as the particular obstacles they face when seeking to access mainstream services, are taken into account when developing policies and planning services. Our observations in this report are based primarily on our experience providing services within this project. To prepare this report, JRS also held meetings with a number of mainstream service providers in order to gain a deeper understanding of the challenges they face when providing services to migrants and asylum seekers with a view to incorporating their feedback within this report. Where possible the feedback and recommendations from the participants at the various activities organised as part of this project, particularly the Final Conference, are also included in this report.
Although, like the project, the report focuses primarily on the situation of asylum seekers and beneficiaries of 8
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III. CONTEXT AND BACKGROUND
Immigration to Malta: Recent patterns and trends Malta experienced an unprecedented increase in the number of undocumented migrants arriving by boat from Libya from 20024. Most of the migrants arriving through this route are from Sub-Saharan Africa: out of a total of 14774 arrivals between 2002 and 2011, 4764 (by far the largest national group at 32%) were Somali, 2073 (14%) Eritrean, 920 (6%) Nigerian, 786 (5.3%) Sudanese and 605 (4%) Ethiopian. Commonly described as ‘mixed flows’, the migrants arriving have different reasons for wanting to reach Europe and have very diverse and complex needs. Although most are adult men, annual arrivals typically include a smaller number of adult women and children, who may be accompanied or unaccompanied 5. Many have experienced war or serious violations of their human rights, not only in their countries of origin, but also in the countries through which they transited 6. There is also evidence that, in addition to being a smuggling route, the route to Europe through Libya is used by traffickers transporting women, particularly from Nigeria, into Europe7. Some of the arrivals, such as unaccompanied minors, families with children, victims of trauma and torture, victims of trafficking, persons with disabilities, mental health problems and medical conditions, are in a particularly vulnerable situation. Their vulnerability could be evident on arrival or else become apparent/develop later. All are detained on arrival in terms of the Immigration Act, which stipulates that migrants who have been issued with a removal order or refused admission to national territory shall be detained until removal can be effected 8. The vast majority of the migrants who arrive in Malta by boat apply for international protection in the days following their arrival; this effectively means that they cannot be removed until their asylum application is decided – however, they remain in detention. Since 2002, boat arrivals represent the vast majority of the asylum seeking population in Malta. Refugee Commission
statistics for 2011 show that out of 1855 asylum seekers, 1579 (85%) came by boat and 276 (15%) were non-boat arrivals 9. Some 56% of the migrants who arrived in Malta by boat were granted international protection10.
Law and policy regulating the treatment of asylum seekers and irregular migrants Initial reception: detention The reception of asylum seekers is regulated by the Refugees Act (Chapter 420 of the Laws of Malta) and the Reception of Asylum Seekers (Minimum Standards) Regulations (S.L. 420.06). The treatment of irregular or ‘prohibited’ immigrants and persons refused admission into Malta is governed by the Immigration Act (Chapter 217 of the Laws of Malta) and related subsidiary legislation. In practice, both the reception of asylum seekers arriving by boat and the length of their detention are governed by a complex mix of law and policy, which developed over time in a somewhat piecemeal manner in response to particular situations that arose as the local authorities struggled to deal with the challenge of receiving and providing for the arrivals. Detention is regulated by the Immigration Act, which until March 2011 did not place a time limit on detention 11. In the case of asylum seekers granted some form of protection, detention always lasted as long as it took for their asylum application to be determined. As for rejected asylum seekers, until the government introduced a policy placing an 18-month time limit on detention in 2003, they would remain in detention indefinitely pending removal. The onset of relatively large numbers of Sub-Saharan African asylum seekers arriving by boat from Libya in 2002 changed the demographics and composition of the detainee population completely. From a population made 9
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up almost exclusively of single males, suddenly there were large numbers of women and children in detention. The fact that many had their asylum applications rejected combined with the fact that removal was very difficult, as most were undocumented and there was little or no cooperation from the authorities in their country of origin, meant that most of the first arrivals remained in detention for prolonged periods of time. Due to the sharp increase in arrivals, a number of army barracks started being used as detention centres. Conditions in these facilities were always cause for concern, and they repeatedly came under fire from human rights monitoring bodies12, as few of the facilities used were intended to house that number of people for any length of time. From December 2003 the government started releasing groups of detainees who had been in detention for more or less 18 months. In January 2005 the government formalized this policy in a document entitled Irregular Immigration, Refugees and Asylum Seekers. Some months later, following the transposition of the Directive on minimum standards for the reception of asylum seekers in November 2005, a 12-month time limit on the detention of asylum seekers was introduced: this effectively meant that where an asylum application was still pending after 12 months the asylum seeker concerned would be released to live in the community pending the final outcome of his/ her application. The only persons who benefit from an exception to these general rules are those considered vulnerable, who are released from detention in terms of government policy, once they are identified and their vulnerability recognized by AWAS, the state agency responsible for the welfare of asylum seekers. The rules on detention have remained more or less unchanged till today, in spite of the transposition of the Returns Directive in March 2011.
Accommodation in the community: Open Centres The release of large numbers of migrants from detention meant that arrangements needed to be made for their accommodation in the community. The first Open Centres were set up in 2003, as existing accommodation facilities were insufficient to cope with the new increased demand for accommodation. Today Open Centres are an integral part of the reception system; upon release from detention, all are offered accommodation in an Open Centre regardless of their legal status. Asylum seekers who are never detained, i.e.
those who arrive in Malta legally or who apply for asylum before they have been apprehended for illegal entry or stay, would also be accommodated in an Open Centre if they do not have alternative accommodation. The population of these centres is therefore often very diverse, and at any given time could include beneficiaries of both national and international protection, asylum seekers, and rejected asylum seekers. The Open Centre system is administered by AWAS; however, some centres are run by NGOs. Initially residents were provided only with a pre-cooked meal in addition to accommodation, but after some time the government started providing a per diem allowance to cover food and transport. The daily amount provided depends on legal status, with beneficiaries of subsidiary protection and asylum seekers receiving €4.66 per day, rejected asylum seekers €3.49 per day and Dublin returnees €2.91 per day13. Migrants released from detention receive the allowance automatically; whether or not other categories of residents, e.g. asylum seekers who arrived in Malta legally and are never detained, will receive a per diem allowance is determined after an assessment of their individual circumstances. Beyond the provision of this basic financial support, which is not regulated by law, the rights of Open Centre residents to access employment or basic services, such as healthcare or education, are dependent on their legal status. In terms of the Reception of Asylum Seekers (Minimum Standards) Regulations (S.L. 420.06), which transposed the Reception Directive into national law, asylum seekers are entitled to ‘material reception conditions’, which include: “housing, food and clothing, provided in kind, or as financial allowances or in vouchers, and a daily expenses allowance.” They are also entitled to free state medical care14 and education up to the compulsory school age limit and to be allowed access to the labour market if a decision on their application has not been taken within 12 months. With the exception of the introduction of the 12-month time limit on detention mentioned above, the transposition of the Directive in November 2005 had little or no impact on the practical arrangements in place for the reception of asylum seekers. In practice asylum seekers who are not in detention are provided with accommodation in an open centre and the per diem allowance. They are also issued with a renewable work permit, which is valid for 6 months if they find work. The rights of beneficiaries of international protection are regulated by the Procedural Standards in Examining Applications for Refugee Status Regulations (S.L.
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420.07). In terms of this law, refugees and beneficiaries of subsidiary protection have a number of rights: rights related to their entitlement to stay in Malta and that of their family, rights related to the possibility travel and socioeconomic entitlements, such as employment, education, healthcare and social welfare. Both in law and in practice there are a number of differences between the entitlements of these two categories of migrants. Both are entitled to remain in Malta with freedom of movement and to be granted personal documents and a residence permit; in the case of refugees the permit is valid for 3 years, in the case of persons with SP for one. Dependent members of their family who are in Malta with them when they apply for asylum are granted the same rights, but only recognised refugees have the right to family re-unification – i.e. to bring dependent members of their family to Malta after they have been granted protection. Both categories of migrants may obtain a permit to work in Malta and both are entitled to access state education and medical care. Although all beneficiaries of international protection are entitled to some degree of social welfare support, there are significant differences in the level of entitlement of the two categories, as will be highlighted later. Moreover, in terms of current policy they cannot receive these benefits for as long as they are resident in an Open Centre. According to the relevant policy15, people with temporary humanitarian protection or temporary humanitarian protection new (THP/N) “shall have the same rights as those granted to beneficiaries of subsidiary protection under Article 14 of the Procedural Standards in Examining Applications for Refugee Status Regulations�. However, while in practice it would appear that migrants with THP/N enjoy similar benefits to those enjoyed by persons with SP in certain areas, such as access to the labour market and medical care16, there is huge disparity in others, such as access to social welfare support.
is greater. The conditions of residence in Open Centres are regulated by a Service Agreement between centre management and resident. Breach of the Open Centre rules could result in termination of the Service Agreement, which could mean either that the service user is asked to find his/her own accommodation or that s/he is asked to move to another centre, depending on the particular circumstances of the case. Service Agreements usually last for a maximum of one year, after which time residents are expected to be ready to move into independent accommodation; it is not unusual for residents to be allowed to remain in the centres longer. As a rule, once residents leave the Open Centre they are no longer entitled to receive the per diem allowance. Whether or not they are entitled to receive other benefits will depend on their legal status, as outlined below.
Life after reception: the challenges of integration Although accommodation in Open Centres was never meant to be permanent, many migrants, including asylum seekers and beneficiaries of international protection, find it very difficult to move out of these centres into independent accommodation and even harder to integrate into Maltese society.
Rejected asylum seekers released from detention do not have any formal legal rights, although in practice they do enjoy a number of benefits. They are granted a temporary permit to stay until they can be removed, and provided with health care17, education and the possibility to obtain a renewable employment licence valid for 3 months if they find employment.
The Report on a pilot study on destitution amongst the migrant community in Malta18 highlights a number of possible reasons for this. One is the fact that, although most categories of Open Centre residents would be able to get the required permission to work legally19, stable employment is particularly difficult to secure. This, combined with the fact that payment of the per diem allowance is linked to residence in an Open Centre and re-admission into the Open Centre system is only allowed in exceptional circumstances, discourages self-sufficiency particularly in those who are not entitled to any form of mainstream social welfare benefits.
The quality of accommodation in the different Open Centres varies considerably, ranging from large centres where conditions are extremely basic and the staff to resident ratio is very low to smaller centres, targeting mostly families with children and unaccompanied minors, where conditions are far better and the support provided
AWAS has consistently argued that the Open Centre system is intended only to provide for the initial reception of asylum seekers and migrants released from detention, and not to act as a safety-net by providing support in case of unemployment or other adverse circumstances once residents have moved into the community. This is the role 11
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of mainstream services, and beneficiaries of international protection and migrants living in the community should be encouraged to access such services. While this position makes perfect sense in principle, in practice, where migrants are unable to access mainstream benefits and services for whatever reason, it could result in situations where people are denied the support and/or assistance they require. In terms of law, only recognised refugees are entitled to the full range of social welfare benefits available to Maltese nationals. Beneficiaries of subsidiary protection are entitled to ‘core welfare benefits’; this term is not defined in national law, in spite of the fact that Recital 34 of the Qualification Directive states that: “With regard to social assistance and healthcare, the modalities and detail of the provision of core benefits to beneficiaries of subsidiary protection should be determined by national law.” The same provision also stipulates that: “The possibility of limiting the benefits for beneficiaries of subsidiary protection status to core benefits is to be understood in the sense that this notion covers at least minimum income support, assistance in case of illness, pregnancy and parental assistance, in so far as they are granted to nationals according to the legislation of the Member State concerned”. According to current policy, core welfare benefits include only the following non-contributory benefits: Social Assistance20 and Unemployment Assistance. As highlighted above, these benefits are not granted to Open Centre residents, who would normally be in receipt of a per diem allowance to cover food and transport. In practice, as beneficiaries of subsidiary protection are precluded from registration on Part 1 of the Employment Register, they unable to access those benefits requiring registration as a pre-condition for entitlement, even if they are contributory benefits and the individuals concerned have paid a sufficient number of contributions. Such benefits include: Unemployment and Special Unemployment Benefit and Unemployment Assistance. Although on paper people with temporary humanitarian protection or temporary humanitarian protection new (THP/N) “have the same rights as those granted to beneficiaries of subsidiary protection”, the exact scope of these entitlements, if any, has not been determined and, to our knowledge, to date no beneficiaries of this form of protection have been granted social benefits.
contributory benefits to which they would otherwise be entitled in terms of national law as they are excluded from registration on Part 1 of the Employment Register, a precondition for obtaining such benefits in terms of national law. Malta lacks a clear and comprehensive national policy to facilitate the integration of migrants and beneficiaries of international protection into Maltese society21. The Refugees Act and related subsidiary legislation provide for basic rights for beneficiaries of international protection, but there is no state agency or institution officially mandated to promote integration or to coordinate the efforts of the various governmental and non-governmental actors working on this issue. It was initially presumed by many that AWAS, originally called Organization for the Integration and Welfare of Asylum Seekers (OIWAS), would have this role. However with time its mandate, and its name, was narrowed to focus primarily on reception of asylum seekers. Over the years since it was set up, in spite of the limited resources with which it has had to work, the organization has developed basic structures for the reception of asylum seekers, but in most cases is hard pressed to provide anything more than limited care and support during the reception phase. This lack of a national strategy on integration has significantly impacted on migrants’ ability to integrate in Maltese society. As things stand, given the lack of institutional support, the success or otherwise of integration is almost exclusively dependent on the capacity and determination of the individual. Moreover, the lack of a central authority with responsibility to coordinate integration effectively means that legal and policy questions take much longer to be addressed and are rarely dealt with in a holistic and coordinated manner. One such issue is the definition of the term “core welfare benefits” in national law, which to date has not been thoroughly addressed, although it is a fundamental question about the extent of the rights of beneficiaries of subsidiary protection in national law.
Rejected asylum seekers living outside the open centre system are not entitled to any form of financial support. They are not entitled to non-contributory benefits and, like beneficiaries of SP, they are unable to access the 12
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Particular arrangements for vulnerable persons Both European and national law make clear that states have legal responsibilities towards vulnerable asylum seekers/persons granted international protection, directing them to take their specific needs into account. In terms of national policy, all irregular migrants in a particularly vulnerable situation are exempt from detention; the policy states that: “Irregular migrants who, by virtue of their age and/or physical condition, are considered to be vulnerable are exempt from detention and are accommodated in alternative centres” 22. In order to implement this policy, AWAS operates two assessment procedures: one for unaccompanied minors, focused mainly on assessing claims to minor age, coordinated by the Age Assessment Team (AAT) and another, for vulnerable adults, coordinated by the Vulnerable Adults Assessment Team (VAAT). Neither assessment procedure is regulated by law or by publicly available rules. Both teams receive referrals from various sources and assess cases with a view to determining whether or not the individual concerned should benefit from early release in terms of government policy. The structures and procedures in place for the identification and referral of vulnerable migrants are somewhat basic. Migrants who are identified by the immigration authorities as being in a particularly vulnerable situation upon arrival, e.g. heavily pregnant women, children or persons with disability, are immediately referred to AWAS for assessment with a view to release on grounds of vulnerability. However, apart from this initial screening, once the migrants are transferred to detention, identification and referral takes place on a purely ad hoc basis and depends largely on NGO personnel or detention centre staff. Referrals to the VAAT may take place at any point during an individual’s detention and there is the ongoing possibility of review in case of deterioration in the individual’s condition or the availability of new information. In practice, the state provides little more than basic care and services by way of reception conditions in detention. Conditions in detention are particularly difficult for detainees in a vulnerable situation. The time taken to conclude vulnerability assessment procedures varies, with some cases where the individual’s vulnerability is obvious being concluded within days, and others where more in-depth assessment is required taking a considerable length of time23. During this time vulnerable individuals
are detained with other immigrants, with very little by way of support and extremely limited access to professional services, e.g. psychological support and social work services, as detention centres are managed and manned exclusively be security personnel. Once they are released from detention, certain categories of vulnerable asylum seekers, such as unaccompanied minors and pregnant women/families with minor children are provided with accommodation in centres specifically set up to cater for their needs which provide considerable support. Other categories, such as persons suffering from mental health problems, chronic illness or serious medical problems, such as HIV/AIDS or cancer, persons with physical disabilities and victims of trauma and torture, are usually placed in open centres providing for the general migrant population. Some of these centres are very large and, as a result, staff is in a position to provide little by way of support or services, due to limitations of resources. Migrants who move out of open centres into independent accommodation, who either have a pre-existing vulnerability or who become vulnerable, either due to the onset of physical or mental health problems or to other factors, are often totally isolated and bereft of all support, apart from that of their friends, if they have any they can rely on. Access to mainstream services is extremely limited. Moreover few of the professionals/ service providers who come in contact with vulnerable asylum seekers are adequately trained and often lack the resources required, such as trained translators or cultural mediators, to be able to respond to their specific needs. This lack of required support, both in detention and in the community, often has an adverse effect the physical and mental health of vulnerable people, leading to degeneration in their condition and the need for repeated hospitalisation. It also significantly impacts on their ability to achieve a measure of self-sufficiency and to move out of open centres, i.e. sheltered accommodation, into more independent accommodation. The situation is obviously far worse if the individuals concerned are not granted some form of protection or legal status in Malta, as their access to services and social support is even more limited.
13
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IV. The JRS Malta project to provide sheltered accommodation
and psychosocial support to vulnerable asylum seekers24:
ACTIVITIES UNDERTAKEN AND RESULTS ACHIEVED
1. Project Outline The JRS Malta Psychosocial Project was developed with a view to ensuring that as many vulnerable persons as possible are identified and receive the protection, assistance and/or service they require in a timely manner, in detention and throughout their stay in Malta.
Activities The objectives outlined above were to be achieved through the following activities: Service provision
Objectives
hh Working with asylum seekers from the moment of their arrival, to identify vulnerable asylum seekers requiring care and support;
The main objective of the project was to consolidate and further develop the services currently being offered, in order to ensure that, a far as possible, vulnerable asylum seekers benefit from:
hh Making the necessary referrals and providing the care and support of a multi-disciplinary team of professionals, pending the outcome of the assessment and following release from detention to an open centre;
hh The services of a multi-disciplinary team of professionals, whether they live in independent accommodation or centres run by other agencies, after an in-depth assessment of their specific needs, according to availability of resources
hh Establishing partnerships with other agencies already offering specialised services for people with disabilities and physical or mental health problems to provide a small number of placements for vulnerable asylum seekers within their facilities;
hh Accomodation in an existing mainstream residential facility staffed by trained personnel, offering supported living for those persons who require extensive support, and who would not qualify for placement in an existing AWAS open centre for vulnerable persons, where necessary and possible.
hh Identifying, in collaboration with other professionals, those individuals who require placement in supported accommodation;
The project also sought to: hh Enhance collaboration between other actors providing a service in this field, in order to ensure that as many people as possible receive the service they need and that the services provided are coordinated;
hh Providing the necessary support, through the services of a social worker, throughout their stay in the said facility, with a view to working towards independence. Capacity-building hh Providing training for project staff and others working in direct contact with vulnerable asylum seekers. Networking and coordination
hh Provide training and capacity building for persons working with vulnerable asylum seekers, e.g. nurses, staff of social welfare agencies, and open centre staff, at various levels, in order to ensure that the needs of vulnerable persons are recognised and met;
hh Networking with other organisations working in the field and providing other services to project beneficiaries, in order to ensure a coordinated service.
hh Explore existing possibilities of long-term solutions and advocate for greater access to mainstream services for those who need them.
hh Advocating, together with all other interested parties, for greater access to mainstream services.
Advocacy
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2. Project Implementation This section outlines the various activities undertaken as part of this project. The results are divided according to the different strands outlined above; greatest emphasis is placed on the activities undertaken as part of the service provision component of the project as these are most relevant for the purposes of this report.
2.1 Networking and coordination The project Core Team One of the first activities of the project was to set up a Core Team [CT]. The CT was made up of the Project Manager, one representative from each of the three organizations providing accommodation as part of this project (YMCA, Richmond Foundation and Suret il-Bniedem), representatives of the 3 International Organisations working with migrants and asylum seekers in Malta (UNHCR, IOM and Malta Red Cross), one member from the government agency responsible for the welfare of asylum seekers (AWAS) and two external advisors, Ms Nadya Abdilla, Clinical Psychologist, and Dr Marceline Naudi, Senior Lecturer within the Dept. of Social Policy and Social Work at the University of Malta. This team met 5 times throughout the year and worked on: hh Developing a coordinated service, by drawing up guidelines for service provision and the selection of beneficiaries; hh Advising on the selection of staff for the project and assisting with the training of project staff where necessary; hh Monitoring the development of the service throughout the lifetime of the project and conducting ongoing evaluation in order to ensure that the best possible service is provided and that service develops in a truly coordinated manner; hh Ensuring sustainability of the service beyond the lifetime of the project in collaboration with other partners/ organisations in the field; hh Contributing to the planning and implementation of the different training activities organised throughout the year. The contribution of the CT was key to the cohesive development of the project and to furthering collaboration and coordination between the different organizations providing services or support to vulnerable asylum
seekers. AWAS’ involvement was particularly valuable as it ensured that the services provided through the project complemented those provided by the agency.
Informal collaboration and networking The project provided numerous opportunities to network with professionals providing services to vulnerable asylum seekers, both in relation to specific cases and at activities organized as part of the project which brought together large numbers of professionals from different agencies and mainstream services. Examples of the latter are the two training events organised as part of the project and the Final Conference, which brought together some 160 professionals from various backgrounds.
2.2 Service Provision This component of the project was by far the largest, and was the main focus for most of the staff working on the project. Through the project we provided two levels of service: hh Information, advice, basic material support and limited assistance, mostly through our outreach in detention and weekly drop-in service at the JRS office; hh More in-depth services, such as social work services, psychological support, nursing support and assistance to access medical care, including through the provision of cultural mediation and interpretation services, to persons identified as being in a particularly vulnerable situation. Individuals requiring in-depth services and support were identified mostly through our outreach and drop-in services. Most project beneficiaries required more than one service. Criteria for the selection of beneficiaries Beneficiaries for in-depth services were selected according to criteria established at the outset and approved by the Core Team. In terms of the rules regulating project funded by the European Refugee Fund only asylum seekers and beneficiaries of international protection could qualify for services from the project. Persons with Temporary Humanitarian Protection, a form of national (as opposed to international) protection, and rejected asylum seekers were excluded. In terms of the project guidelines for the selection of 15
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beneficiaries, project staff provided services to asylum seekers and beneficiaries of international protection who were in a particularly vulnerable situation, as a result of physical or mental health problems or because of the circumstances in which they found themselves. Services were provided only if they were not already receiving or otherwise able to receive the service from another agency or organization.
which through this project was expanded to include: the Service Manager, a second full-time social worker, an outreach worker, two cultural mediators, and three psychologists, who worked with the team on a part-time basis. In addition the team benefitted from the services of two professionals with training in nursing: a nurse released from government service to work with JRS, and a Jesuit priest from Tanzania who trained as a psychiatric nurse.
Whether or not an individual was in a particularly vulnerable situation was determined by project staff following an individual assessment. A determination by AWAS that a person was vulnerable was not required for an individual to benefit from the services provided as part of this project; the determining factor was that the individual or family unit had needs that could be met by this project. Similarly, a decision that an individual should receive services through this project did not mean that the said individual/s would automatically be considered vulnerable within the scope and context of the AWAS assessment procedure. Project staff did not conduct assessment with a view to release as per government policy, but simply with a view to determining whether the individual/s concerned qualified for services within this project.
The psychosocial team worked primarily in detention, where they focused on identification, referral and support of vulnerable asylum seekers. We believe this aspect of our work is crucial as a significant number of adults released from detention on grounds of vulnerability were identified, referred and followed up by JRS staff. Project staff also offered services to asylum seekers and beneficiaries of protection living outside detention centres; of these, a significant number sought our services in the period immediately following their release from detention, while others sought our services as a result of difficulties encountered after they had been living in Malta for some time.
JRS psychosocial team
What follows is a description of the population served, as well as a detailed outline of the activities conducted and services provided to project beneficiaries.
Services were provided by the JRS psychosocial team,
2.2.1 Service provision: characteristics of population served 230 individuals (169 cases) identified as being in need of in-depth services
19%
187 individuals (136 cases) received one or more indepth services through this project 43 individuals (33 cases) ineligible for services from the project due to legal status
81% Eligible Ineligible due to legal status
16
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BENEFICIARIES Beneficiaries by nationality:
Breakdown by detention/community: 40% of project beneficiaries (75 individuals, 68 cases) referred from detention 60% (112 individuals, 68 cases) were referred when they were already living in the community (open centres or independent accommodation)
40% 60%
Detention Community
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Accommodation in the community: 35% of project beneficiaries from the community were living in independent accommodation Some 48% were living in one of the larger Open Centres
Independent accommodation
Sheltered accommodation
HTV HOC MOC
Balzan Open Centre
Other MEC accommodation
7 10
24
1 4 17
5
Breakdown of beneficiaries [individuals] by age:
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Breakdown of adult beneficiaries [individuals] by gender:
Family composition [cases]:
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INELIGIBLE CASES: Breakdown by detention/community:
Community: 32 individuals (22 cases)
Detention: 11 individuals (11 cases)
11
32
Accommodation in the community: Of those in the community 59% lived outside the Open Centres – 50% in independent accommodation
Independent accommodation
Other hostel accommodation
HTV MOC
Balzan Open Centre
Other MEC accommodation
4 1 1
11 3 2
Breakdown of ineligible referrals [individuals] by age:
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Breakdown of ineligible referrals [adult individuals] by gender:
Family composition – ineligible referrals [cases]:
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2.2.2 Service provision: project results by numbers PSYCHOSOCIAL SUPPORT IN DETENTION 68 cases (75 individuals) received services from the project – all were referred to AWAS for assessment with a view to release on grounds of vulnerability
Presenting problem/reason for referral: Some 51% of referrals were made on grounds of mental health – a further 31% presented with both physical and mental health issues.
Mental Health
Physical and Mental Health
Physical Health (disablity and mental illness)
Family Reunification
16%
3%
50% 31%
Status of referral to AWAS at project end: By the end of the project 57% of those referred had been released on grounds of vulnerability.
Released on grounds of vulnerability
Awaiting decision
Deemed not to qualify for release
Deported while awaiting AWAS decision
Released with protection while awaiting AWAS decision
7
1
6 3 12
39
Deceased
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Services provided while in detention:
Ineligible cases: An additional 10 rejected asylum seekers, who were receiving in-patient treatment at MCH, were monitored and followed up by the JRS nurse on a regular basis and provided with ongoing support; they could not receive the full service as they were not project beneficiaries.
PSYCHO-EDUCATIONAL GROUP SESSIONS In addition to the specialised services provided to vulnerable individuals, 116 asylum seekers in detention benefitted from psycho-educational group therapy
17%
Women Men
83%
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PSYCHOSOCIAL SUPPORT TO VULNERABLE ASYLUM SEEKERS UPON RELEASE FROM DETENTION Continued support in 37 cases referred for vulnerability assessment following release from detention Most were released from detention on grounds of vulnerability following assessment by AWAS; a number were released with protection before the AWAS assessment was concluded. Services provided upon release from detention:
Social work support
Medical follow-up
Social work and medical follow-up
Social work and accommodation
Social work, medical follow-up and individual psychological sessions
Individual psychological sessions
13%
3%
3%
35%
27%
19%
PSYCHOSOCIAL SUPPORT TO MIGRANTS LIVING IN THE COMMUNITY (OPEN CENTRES AND INDEPENDENT ACCOMMODATION) 68 cases – 112 individuals living in the community (open centres or independent accommodation) Reasons for referral/Presenting problem:
Mental health
Disability
Chronic illness
26%
37%
Medical
1%
General social work support
18%
18%
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Of the 25 cases requiring general social work support, 68% were new releases, Dublin returnees or asylum seekers who did not arrive in Malta by boat
New releases
Returnees/asylum seekers who did not arrive by boat
32%
Other
48% 20%
Services provided:
Social work support
Medical follow-up
Social work and medical follow-up
4% 2%
3%
2% 2%
27%
Social work and individual psychological sessions
Social work and accommodation
Social work, medical follow-up, and individual psychological sessions
31%
Social work, medical follow-up and accommodation
29%
Social work, medical follow-up, individual psychological sessions and accommodation
Ineligible cases: A further 22 individuals were provided with basic medical and basic support by the JRS team; however they could not benefit from the full services provided by the project because of their legal status. Reasons for referral/Presenting problems – ineligible cases:
General social work support
Domestic violence
Mental health
General medical support
Chronic illness
14%
18%
18% 14% 36%
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INDIVIDUAL PSYCHOLOGICAL SUPPORT 13 persons provided with individual psychological support 4 detention 9 community
PROVISION OF MEDICATION Purchase of prescribed medication not provided for free by the government health services: 9 persons in the community (2 more than once) 130 persons in detention (40 more than once)
Most were for relatively minor complaints; in detention, a significant number were in some way linked to the conditions of detention – e.g. the prevalence of haemorrhoids and constipation is largely linked to the diet provided; the prevalence of minor infections is linked to the crowding. On a few occasions we had to provide medication for more serious conditions, such as diabetes.
Diabetes Gynaecological conditions or pregnancy Hormonal problems Mouth infections Constipation Eye problems Worms (Vermox) Skin conditions Pain relief Haemarrhoids Colds, flu, coughs and hay fever
ACCOMMODATION Through the project 19 individuals were provided with accommodation.
Single male
Single female
Family units
3
3
1
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2.2.3 Service provision: description of services provided Psychosocial support in detention Throughout the duration of the project, the psychosocial team visited the detention centres on a weekly basis, to get to know the new arrivals individually, in order to be in a position to identify those in need of in-depth services and refer those in a vulnerable situation for assessment and eventual release from detention in terms of government policy. The reasons for referral in the vast majority of cases could be categorised under the broad heading of ‘mental health issues’, which would include various forms and degrees of mental health problems, varying from depression and PTSD to suicide attempts. Though a number were initially referred on grounds of physical ill-health, we observed that, over time, a number of them also developed mental health problems such as depression and suicidal ideations. Project staff closely followed and supported all 68 referees by attending appointments and visits at Mater Dei Hospital, regularly attending ward rounds at Mount Carmel Hospital, liaising with healthcare professionals, providing the services of cultural mediators, providing individual psychological therapy, as well as updating AWAS and other social work services. Social Work Support Under this heading we include various forms of support, ranging from seeing to clients’ basic needs, to facilitating their access to mainstream services and liaising with other social work agencies regarding issues such as domestic violence, child protection and health issues. Most of the clients we were following, whether in detention or in the community, required some form of social work intervention, often in addition to some other service (see pie charts above). Asylum seekers and beneficiaries of protection living in the community who were approached us for assistance could be classified in two main categories: hh Asylum seekers and beneficiaries of protection who request our services and support in the days following their release from detention. Throughout the project some 20 to 30 individuals and families on average came to the JRS office every Monday to request information and basic material support.
It is clear that the initial weeks following release from detention are particularly challenging for migrants, as they seek to adapt to their new reality and navigate a system that is largely alien to them. Common requests for support included: employment-related requests, such as help to write CV’s, apply for work permits and seek employment; requests regarding possible options of child care for their children; and requests for basic material items. These requests and the services provided are not included in the project statistics above. Most of these clients within this category requesting our services were accommodated in one of the larger open centres, where staff to resident ratio is very low and such support is not easily available. The majority would require support during this initial period and would only return to request our services if they encountered particular problems during their stay in Malta. A few individuals and families required more in-depth services and were referred to the project services; these cases are included in the project statistics. hh Asylum seekers and beneficiaries of protection who required a service as a result of particular condition, incidents or circumstances, at times occurring even after they had been residing in Malta for a considerable period of time. Some examples would include loss of stable employment, or an episode of severe mental or physical ill-health. Such circumstances often completely destabilise the individuals concerned, as they are usually accompanied by loss of income and loss of accommodation due to inability to meet rent payments. The situation is complicated further where the individual is unable to work for health reasons. Most of the clients within this category requesting our service were living outside the Open Centre system in independent accommodation. In such cases clients usually require in-depth support over a relatively prolonged period of time. In addition they often required specialised services or support from mainstream services. One cross-cutting issue noted was that in a significant number of cases, clients required assistance to access basic services as, in practice, it is often very difficult for them to access services that are relatively easily 27
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accessible to the Maltese population. One such example is the child care service provided by the State. This service is open to migrants and migrants accepted for the service are treated in the same way as all other serviceusers. However, in practice migrants find it very difficult to access the service. Getting to know about the service and collecting the application form can be an insurmountable obstacle, as the information provided is limited and is often not in a language or form they can understand. Filling the form, gathering the necessary documentation, setting an appointment with the childcare centre and communicating with the staff are all equally problematic where language is a barrier.
mental health problems, particularly where there was a language barrier.
In the past year, we supported 15 families to obtain this service. The JRS social worker assisted with the application process, completing the forms, making the necessary contacts with the child care centre and often facilitating the first meeting once the child was accepted in the service. The lack of such support could push families to find alternative, often unregulated, foster placements that could cause several problems for the foster family, the natural parents and ultimately for the child.
Several medical professionals noted that when their patients are supported, there is a higher turnout for appointments. This is mainly because we register their appointments in our diary, remind our clients prior to the appointment and many times accompany them to the visit. This service has helped both patients and professionals.
As was already noted, a number of the individuals referred to the project required specialised services or support; some examples of such cases would include clients experiencing domestic violence requiring accommodation in a safe shelter, or persons with medical or psychiatric problems requiring long term care. In such cases project staff served as a bridge between clients and professionals, attending meetings, liaising with social workers and providing information on relevant issues, such as country of origin information, the asylum procedure, and the clients’ legal status and rights. With clients receiving medical care, project staff provided cultural mediation, attended ward rounds and otherwise liaised with medical professionals to provide information and advocate for their clients’ needs. For example, it is important for a psychiatrist to know the conditions of detention before discharging a patient, or for a doctor to know why a medical certificate is being requested. Medical Follow-up The services within this heading include: accompanying clients to or otherwise following up on hospital appointments, dispensing medication and providing interpretation and/or cultural mediation during hospital visits. As a rule we offered this service only to people with serious acute or chronic medical conditions or serious
The service was developed in response to concerns raised by medical staff that many migrants failed to follow up their treatment. From our experience working with migrants we found that they are often confused by the system, particularly if they have numerous hospital appointments requiring them to go from one department to another and if they do not understand the language. When this happens they may give up and miss their hospital visits, leading to deterioration in their physical or mental health and increasing the possibility of re-admission.
Individual Psychological Sessions Throughout the project some 13 individuals benefitted from individual psychological therapy, 4 while in detention and 9 in the community. Most clients accessing individual therapy initially presented with mood management issues. What became apparent during therapy was that many individuals’ psychological difficulties were a result of the trauma experienced compounded by the high stressors of the refugee experience.
‘Although there was a delayed implementation of specialized counselling sessions to vulnerable adults, those who received the service agreed that the availability of specialized counselling has been a ‘turning point’ in their lives.’ Beatus Mauki S.J. Group therapy & psycho-educational sessions In addition to the individual psychological support provided, the team also offered psycho-educational group sessions to 116 asylum seekers in detention; in addition to providing support, these sessions helped project staff
28
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‘Psychological therapy provided these
‘Therapy in a group setting also proved to
individuals with the precious opportunity
be effective albeit in a different way. While
to work on their trauma, improving
initially diffident, following the provision
their level of functioning and possibly
of a good grounding in psychological
preventing the later emergence of further
concepts, clients appeared to catch on
psychological difficulties. Work of this
and contributed to the group effectively. In
nature was often delicate requiring time
my opinion, group therapy was particularly
for trust to be built. A number of clients
useful for this population as it allowed
took a while to engage in therapy and
them the opportunity to share similar
this was probably due to the lack of
experiences, thoughts and worries, in a
familiarity with such work, the possible
way that instilled a sense of community in
notion of stigma surrounding mental
this difficult environment. Group therapy
health services, shame surrounding some
also served to quell conflicts that arose
of their life stories and a strong element
in the individuals’ daily lives in detention
of caution ingrained in these individuals.
by providing a supportive environment
These issues sometimes created a barrier
within which they could share their
to identification of severe issues such as
disagreements and reach compromises.’
human trafficking.’
to identify individual needs with a view to making referrals and providing support. Topics addressed included understanding cultural differences, conflict resolution, dealing with and expressing emotions, positive thinking, adaptive behaviour, understanding mental health and preserving psychological health in detention. Accommodation As part of this project, we attempted to place asylum seekers and beneficiaries of protection within mainstream residential facilities. The mainstream facilities selected offered different kinds of service and varying degrees of support, ranging from highly specialised, intensive programmes such as that offered by Richmond Foundation, which agreed to provide two places within their residential programme at Villa Chelsea, to facilities offering temporary accommodation and limited social support for homeless persons, such as that offered by YMCA.
Alexia Rossi, psychologist
Placement in some facilities was very successful – through the project 11 persons were accommodated at YMCA and 8 in accommodation provided by the Jesuit Fathers – however, it proved impossible to place even one project beneficiary in the other facilities. There is no doubt that this is at least in part due to the rules for selection of project beneficiaries imposed by the funding programme and to the rules for selection of residents imposed by the facilities themselves, which naturally limit the number of people who would qualify for a service. In general it is true to say that, facilities that offer generic services, such as temporary accommodation for homeless persons, were much easier to place people in as they have far less stringent criteria for the selection of beneficiaries than specialised programmes for a particular target group. Moreover, within the context of the project, the fact that most of the project beneficiaries who needed temporary accommodation were already living outside the Open Centre system also made it far easier to place them, as they were not concerned about the possible loss of their per diem. 29
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With facilities offering services to a specific target group placement was naturally much more complicated, as a far smaller number of beneficiaries qualified. Moreover, as was highlighted earlier, the number of persons who qualified for placement or other services was further restricted by the ERF requirement that project beneficiaries be asylum seekers or beneficiaries of international protection. However, there were also other reasons for the difficulties encountered when seeking to place people in mainstream residential facilities. These included the fact that there was
2.3 Training and capacity building Survey of training needs During the initial weeks of the project a survey of training needs was conducted among organizations working in the field of reception of asylum seekers and mainstream service providers. Respondents were asked to provide information on the skills and competencies required for their staff to be able to provide services to asylum seekers.
a marked reluctance on the part of beneficiaries to move out of the Open Centre system into a facility where most of the other residents were Maltese, even if the conditions were better and they could continue to receive their per diem allowance there. The main reason for this was the fact that they felt isolated and cut off from the community support network that exists within the Open Centres. They also felt threatened by the highly regulated environment, which was totally different from anything they had experienced to date and felt completely alien.
and the challenges facing professionals providing a service to this particular client group. Speakers included a mix of local and foreign academics and practitioners. Some 110 professionals attended. The following is a breakdown of the participants according to background: Psychologists/Counsellors
Social Workers
Two training seminars were planned on the basis of the survey results. The following is an outline of the topics tackled during the training and a profile of the attendees.
Nurses
2.3.1 Seminar 1: How the system works and working within the system
Doctors/Psychiatrists
Cultural mediators
The aim of this first training seminar held on January 19 and 20, 2012 was to provide participants with a basic understanding of the legal and policy framework regulating the treatment of migrants and asylum seekers in Malta.
Project partners
NGOs and IOs
Govt officials
Participants were introduced to the various stakeholders in the field, including government agencies, international organizations and NGOs working in the field of immigration and asylum, in order to get a better idea of the roles and functions of the different agencies involved in the reception of asylum seekers. In all some 65 participants attended this training.
JRS staff
2.3.2 Seminar 2: Understanding the other: the challenge of providing culturally competent care The second training event, held on April 26 and 27, 2012, which focused mostly on mental and psychological health, discussed the complex issues impacting the psychological well-being of migrants, migrants’ perception of their own situation and that of the professionals providing a service,
Midwives
4%
6%
9%
21%
7% 3% 4% 2% 14%
30%
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2.4 Advocacy
‘… the first conference for me … was an eye opener. I always felt that I did not know enough about the situation of asylum seekers in Malta and this was the main reason why I made sure to attend this conference. I was not disappointed at all as throughout it delivered the kind of knowledge I needed, both with regards to understanding the situation as it is in Malta and also in understanding what these people go through and why they decide to flee their country. It was important for me to learn about the
Through the various activities conducted as part of this project, project staff documented and sought to better understand the obstacles faced by asylum seekers and beneficiaries of protection seeking to access mainstream services. The lessons learnt through this exercise are included in the next part of this report. The closing conference of the project, held on June 25, 2012, focused specifically on this issue. Participants discussed the needs of especially vulnerable asylum seekers, and their access to health and social services. The conference brought together some 70 people from different backgrounds: social workers, healthcare professionals and personnel from other government agencies and services, as well as NGO staff, reception centre personnel, UNHCR and other professionals working within the reception system. The recommendations made by participants for the care of asylum seekers in a particularly vulnerable situation and their improved access to health and social services are included in this report.
type of benefits different categories of people receive… The second conference also met my expectations fully. I was eager to learn more from the experiences of our foreign speakers. As expected this conference was another eye opener especially when I learnt more about the trafficking of individuals- and how Malta could be used both as a transit country and also as a destination for some individuals. I felt very grateful towards the woman who went through such an ordeal and who shared her experience with us.’ Charmaine Attard Bezzina, social worker
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V. LESSONS LEARNT
This section outlines the lessons learnt through this project. Findings are grouped under three main headings: overall findings; findings relating to the identification and care of vulnerable asylum seekers and beneficiaries of protection within the reception system; and findings relating to access to mainstream services. Although these findings are based mostly on our own experience and observations throughout this project, we also incorporate feedback from professionals working within mainstream services.
1. Overall Findings The findings in this section are general in the sense that they do not relate to any one particular phase of the process in place to receive migrants or to any specific category of services; the issues they raise are crosscutting and should be taken into account when planning, implementing and evaluating any services.
1.1 Factors creating vulnerability – need to shift our understanding of the concept of vulnerability from ‘vulnerable persons’ to ‘people in a vulnerable situation’ As was highlighted above, within the national context, the concept of vulnerability is inextricably linked to release from detention, as persons considered vulnerable by virtue of their age or physical condition are the only category of migrants to benefit from an exception to the strict legal and policy rules on detention of irregular arrivals. The term ‘vulnerable person’, which has become something of a term of art, points to an understanding of vulnerability that is almost exclusively focused on inherent individual characteristics. This understanding of the term is, at least to some extent, reinforced by the definitions and descriptions in existing legal and policy instruments which all contain inclusive lists of categories of persons considered vulnerable because of some inherent characteristic, such as age, health or personal experience.
It is no doubt true that some individuals are in need of particular services, care and support because of an inherent characteristic, such as their age or their physical or mental health, or the psychological impact of their traumatic past experience. However, the requests for support and services that we received throughout the project indicate that while an individual’s personal condition could in itself create a need for services or support, this need is often exacerbated by contextual or social conditions. Moreover, such conditions could, of themselves, create a need for services and support even where the individual would not normally be considered particularly vulnerable. So, for example, we saw that almost all new arrivals, regardless of legal status or personal characteristics, find it difficult to understand the system and to adapt to the reality of prolonged deprivation of liberty and the harsh living conditions in detention. They therefore require intensive support during their detention. Similarly we noted that almost all migrants, regardless of legal status, require some support in the days immediately following release from detention. Individual factors, such as physical or mental health problems, or a large number of dependents, could increase the need for support. The existence of a strong social support network could help to mitigate the impact of these circumstances on the individual’s wellbeing and reduce the need for services from other sources. This understanding of vulnerability is in line with the outcomes of the DEVAS study conducted by JRS Europe among detainees in 22 countries of the EU. The study concluded that: “‘vulnerability’ can be conceptualised as a concentric circle of personal (internal), social and environment (external) factors that may strengthen or weaken an individual’s personal condition. Put differently, the presence or absence of these factors may either empower a detainee to cope with the negative effects of detention, or they may expose the detainee to further harm.” While, as we have repeatedly stated, we believe that current government policy on release of persons in a particularly vulnerable situation is a good practice, we are concerned that it may have led to a restrictive understanding of the
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factors creating and/or exacerbating vulnerability. The obvious consequence of this is that the needs of persons requiring services and support as a result of other factors may be, and as will be seen, often are, overlooked.
1.2 Insufficient support for migrants with mental health problems and chronic illness If the number and type of requests for assistance received are taken to be an indication of the needs on the ground, the project results would seem to affirm that there is insufficient support for some categories of vulnerable asylum seekers, particularly people with mental health problems and chronic illness. A significant proportion of individuals referred for services from the project fell within these categories. Some 42% of all the referrals received overall (71 out of 169 cases) concerned issues of mental health; 27% of these requests/referrals (19 cases) were ineligible for support from the project due to issues of legal status. A further 25% of all referrals received concerned physical health needs; 17% of these requests/referrals (7 cases) were ineligible for support from the project due to legal status. While the proportion of referrals on grounds of physical or mental health needs is much higher in detention, accounting for some 98% of all requests received, in the community the proportion is still quite high (64% of all requests received). Of the latter, in 15 cases (17%) the issue was chronic illness, in 26 cases (29%) the issue was mental health, while 16 cases (18%) presented with general medical needs. In our view this clearly indicates that there was a need for services and support among this population that was not being met by existing services. From our observations this is true for all categories of migrants, whether they are still within the reception system (i.e. the detention centres and the open centres) or have moved out of the Open Centres and are living independently in the community. In our experience, the individuals with greatest need for social work services and other forms of support are those who do not enjoy a strong community/social support network, e.g. family or supportive friends.
1.3 Importance of taking asylum seekers’ perspective into account when planning services The project also highlighted the importance of adopting a listen and learn approach in our work with asylum seekers
and other migrants; a need to work with the refugees not as one who is bringing something to them, but as one who has first of all to learn what I should bring25. The only way to achieve this is by listening to asylum seekers’ views and perceptions of their needs and involving service users when developing policies and planning services, rather than simply using our own pre-conceived ideas to decide what is needed, as what we think is best for people may not, in fact, be what they need. Our experience with the accommodation component of the project showed that failing to do this would mean that we risk creating services that do not meet/respond to asylum seekers’ needs and therefore fail to achieve their stated aims.
2. Findings relating to the reception system The findings in this section relate to the structures in place to identify and provide services and support to vulnerable individuals at reception stage – that is, from the moment of their arrival in Malta to the moment when they leave a closed or open centre to move into independent accommodation. Although project beneficiaries were asylum seekers or beneficiaries of international protection, the project findings relate to factors that are unrelated to legal status, such as the systems and structures in place to identify individual needs, and therefore apply to all migrants residing in closed and open centres.
2.1 Limited scope of the vulnerability assessment procedure In practice, the Vulnerable Adults Assessment Procedure set up and administered by AWAS is almost exclusively focused on determining whether or not an individual should qualify for early release from detention in terms of government policy. The limited scope of the assessment procedure has a number of practical implications both in terms of access to care as well as in terms of the quality of care and support received by persons recognised as vulnerable. First and foremost, this means that only detainees are assessed by the VAAT; vulnerable adults living in Open Centres and in independent accommodation would not be referred for assessment. Moreover, as the assessment was set up primarily to implement government policy on release of vulnerable migrants, the primary focus of the 33
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assessment is to examine whether or not the individual concerned should be referred for early release rather than on identifying needs with a view to ensuring that they are met through the provision of the necessary support and services. The situation of those who find themselves in a particularly vulnerable situation, due to the onset of illness or the aggravation of a previously existing condition, when they are living outside of a detention centre, i.e. in an Open Centre or in the community, is particularly problematic, not only in terms of guaranteeing access to follow up care, but also, and perhaps even more, in terms of identification of new needs and referral for assessment and care. It is no doubt positive that Malta not only acknowledges in principle that asylum seekers and migrants who are vulnerable, due to age, physical or mental health problems or other particular circumstances, should not be detained, but has also set up a mechanism to ensure that this policy is implemented in practice. However, this project has confirmed that this is far from sufficient to ensure that the needs of vulnerable asylum seekers are taken into account in the provision of even basic services.
2.2 Detention of migrants in a particularly vulnerable situation While awaiting the outcome of the Vulnerability Assessment Procedure, which may take months, particularly in cases where vulnerability is not obvious, asylum seekers remain in detention. This is problematic first and foremost as prolonged deprivation of liberty is known to exacerbate existing vulnerability26. Moreover, in detention they are not provided with special care or support; in fact it is true to say that, as a rule, like other detainees, they are not provided with anything other than basic medical care by way of essential services. Detention centres are staffed almost exclusively by retired security personnel, who are neither competent nor trained to cater for the welfare of the people in their custody. Moreover, detainees’ access to psychological support and social work services is extremely limited, as none of the centres employs a social worker or other caring professional on a permanent basis. We believe that there is an urgent need to recruit professional staff within detention centres to provide psychosocial care and support to detainees and offering specialised services to detainees identified as being in a particularly vulnerable situation and who are awaiting the
outcome of vulnerability assessment procedures. Detainees requiring in-patient treatment for mental health problems are held in the Asylum Seekers’ Unit (also known as Ward M8B). The physical conditions in this facility were severely criticised by the Committee for the Prevention of Torture (CPT) in the report on their 2008 visit, but little has changed since.27 In this ward, which also accommodates female prisoners, there is a great emphasis on security and detainees are held in their cells for some 23 hours each day. Furthermore, on more than one occasion during the project deportations were carried out from within this ward, further exacerbating detainees sense of uncertainty and isolation.
2.3 Quality of care for persons released on grounds of vulnerability and others in a particularly vulnerable situation Once persons are formally identified as vulnerable and released from detention, they are usually placed in an Open Centre. As was indicated earlier, some categories of vulnerable persons, such as families with minor children or unaccompanied minors, are placed in one of the smaller centres, where conditions are good and the support provided adequate. As a rule, other categories of vulnerable persons, such as persons suffering from mental health problems or chronic illness, would be placed in one of the larger centres upon release. This is particularly problematic, as within most of these centres the level of care provided is minimal and conditions are far from ideal. From our experience, migrants with mental health problems or chronic illness requiring ongoing and consistent follow-up, need considerable support not only to be able to access the necessary medical care but also to keep up to date with their follow-up treatment and care after discharge. This need for support is exacerbated where the condition is significantly debilitating and where the individuals concerned lack a social support network. As was highlighted in section IV above, through this project we provided various kinds of support to Open Centre residents to enable them to access medical care. Many of the medical professionals interviewed in the preparation of this report highlighted the importance of this support, particularly in assisting the hospital authorities to maintain contact with patients, guaranteeing that patients attend hospital appointments, dispensing medication where necessary and facilitating communication through the services of an interpreter/cultural mediator, all of
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which are key to ensuring proper follow up care. They also indicated that there is a higher rate of failure to follow up with treatment upon discharge where support is not available, however the findings on this are purely anecdotal and would need to be studied further in order to draw firm conclusions.
as previously stated, even where placement was possible, it often proved difficult to persuade beneficiaries to leave the Open Centre, and the community support provided there, to move into a mainstream facility, even if the conditions were better and they could continue to receive their per diem allowance there.
In spite of the lack of empirical evidence, there are very strong indications that, residents in a particularly vulnerable situation, due to mental or physical health problems, require ongoing care and support, which the larger Open Centres are currently not in a position to provide due to lack of resources.
One cannot exclude that their perception was influenced at least to some extent by their particular psychological state, as the individuals concerned had some degree of mental health problems. However, this too needs to be taken into account if we are looking at ways of better meeting the needs of this category of persons.
Although it is clear that some persons, particularly those suffering from serious mental or physical health conditions that make them unable to function independently, will always require more support than can be provided in an Open Centre, it is equally clear that not all migrants requiring some level of support will be able to find accommodation in a mainstream residential facility, at least in the short or medium-term.
Although it is acknowledged that the sample we are assessing is very small, we believe that these migrants’ preference for Open Centre accommodation, primarily because of the support provided by the migrant community there, should not be dismissed. Persons in a particularly vulnerable situation could benefit considerably from the support of a community network and, unless they require highly specialised care due to the gravity of their condition, an Open Centre setting would possibly be the best place to ensure that they enjoy the support of a community.
In addition, as was highlighted earlier, the project results show that not only people formally recognised as vulnerable require care and support. Most open centre residents require support and services at some point or another and our experience with this project would seem to indicate that certain circumstances, such as the transfer from a closed to an open centre or the transition to independent accommodation, usually create particular needs for services and support. It is therefore fundamental that the capacity of the Open Centres to provide the individual follow up and support required is strengthened, through the recruitment of trained staff within the centres to provide residents in a particularly vulnerable situation with the services and support they require.
2.4
Mainstreaming: the pros and cons
In addition to questions raised above regarding the availability of mainstream residential placements, our experience within this project also raises questions regarding whether or not mainstream placements are necessarily the ideal solution in all cases. As already highlighted above, this component of the project proved particularly challenging. Placement was difficult, not least because of the combined impact of the specialised nature of some of the facilities and the restrictive criteria of the ERF, which excluded persons who would otherwise have qualified for the service. However,
In our view this is one other reason that militates in favour of strengthening the structures at Open Centre level to provide adequate support to residents in a particularly vulnerable situation.
3. Findings relating to access to mainstream services: We were aware from the outset that, while on paper most mainstream services are open to migrants, in practice their access to these services is hindered by a number of factors, in fact the project was developed with a view to facilitating and advocating for improved access to such services. Our own direct experience working with project beneficiaries and our contact with mainstream service providers throughout the project helped us to better understand the obstacles to access. It is acknowledged that, due to resource limitations, access to particular services, especially those provided free of charge by the State, e.g. childcare and psychological services, could be difficult even for Maltese. Here we 35
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are not looking at those obstacles that affect all who need a service equally, but rather at those obstacles that specifically impact the access of migrants who would otherwise be able to benefit from the service, all things being equal. They are described hereunder and grouped under three headings for ease of reference: those relating to the particular situation of the migrants themselves or their legal status; those relating to the services and/or service providers and those relating to the legal and policy framework for integration. We acknowledge however that there is an amount of overlap between the different categories.
3.1 Obstacles relating to the particular situation of migrants themselves or their legal status This category includes the particular difficulties faced by migrants when seeking to access mainstream services. It is clear that some of these difficulties are also a result of the fact that mainstream services were not developed with a view to guaranteeing accessibility for people from different ethnic and linguistic backgrounds. However, all are intrinsically linked to the fact that the individuals seeking to access the service are migrants and stem from their particular needs and experiences. The following are some of the obstacles to access that were highlighted both by project beneficiaries and by professionals:
3.1.1 Difficulties in communication These difficulties are usually directly attributable to the fact that many migrants are unable to understand and/or speak Maltese or English. In such situations, where migrants are not provided with the services of an interpreter they are unable to communicate effectively with the service provider concerned so they are obviously unable to obtain the services they require28. Through the project we provided the service of interpreters to mainstream services, particularly healthcare providers, on a regular basis as no other services were available. The frequency with which our support in this area was requested brought home the reality of just how unavailable this indispensible service can be in practice. The use of interpreters raises a whole host of other issues, which could impact the effective flow of communication between clients and service provider almost as much as the lack of an interpreter. Some such issues include: the
fact that many interpreters are not trained and they do not fully understand the parameters of their role within the therapeutic relationship; issues relating to confidentiality, a situation which is further complicated by the fact that many interpreters are an integral part of the migrant community; and difficulties finding interpreters that speak a good level of English and have a clear understanding of the often complex language used in particular contexts, e.g. in the provision of medical or psychiatric services. These issues can be addressed by using trained interpreters rather than fellow detainees or friends who happen to be accompanying the individual concerned.
3.1.2 Lack of trust in the system Many migrants and asylum seekers have a deep-seated mistrust in the ‘system’; this creates an expectation or fear that they will experience discrimination or receive inadequate treatment because of their ‘outsider’ status29. The roots of this perception are complex and varied. They stem in part from the migrants’ own experience of reception in Malta, which often involves multiple rejections from various sources and the experience of a number of real or perceived injustices, including, in some cases, the longterm deprivation of liberty in difficult circumstances. Their experiences in their country of origin and the countries through which they transited, where they suffered at the hands of institutions and their agents that were at best indifferent and at worst totally corrupt and repressive, also play a part in shaping their perceptions, as they do little to instil confidence in institutions of the state or their agents30. The fact that very often mainstream service providers can only provide limited assistance, for the reasons highlighted in section 3.2 below and due to limitations of resources leading to long waiting lists31, which affect Maltese and migrants alike, only serves to reinforce this perception. Such a negative perception acts as an invisible barrier, preventing migrants from approaching the services they require, often until it is too late. We found the contribution of the cultural mediators on the project to be indispensible in identifying and addressing misconceptions, concerns and unrealistic expectations. Their presence and timely intervention was key to facilitating access to service.
3.1.3 Lack of understanding of the way the system works For many migrants the structures in place to provide services such as healthcare or social welfare services,
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which tend to be large and somewhat impersonal, are difficult to understand and navigate32. It is also difficult for them to understand why they are being asked for certain information, what it will be used for, and the extent to which the various state institutions from which they are receiving a service do, or do not, communicate and share information. This is in part due to the lack of information provided, however it is also at least in part due to the fact that their own personal experience of contact with the local institutions dealing with different aspects of their situation gives mixed messages, as some of their personal information is clearly shared by some institutions. So, for example, if they move from one Open Centre to another and the transfer is authorised by the state agency responsible for managing Open Centres, it is not immediately obvious to all of them that they need to inform the other agencies of the state dealing with other aspects of their situation, e.g. the hospital, of their change of address. Once again, in this area the contribution of cultural mediators proved to be essential in improving migrants’ understanding of the system and facilitating access to services.
3.1.4 Lack of clarity regarding legal entitlements Access to services is often hindered by issues relating to legal entitlement to the said service or benefit itself or to the entitlement to receive the service free of charge33. These issues are particularly prominent in the case of rejected asylum seekers with tolerated stay or migrants with THP/N, as the precise legal scope of their entitlement to various services, including even the most basic services such as healthcare, is unclear. However, this is also an issue for asylum seekers and beneficiaries of subsidiary protection as the scope of their entitlements is not clearly defined in national law and therefore gives rise to a number of questions in practice. During the project we came across more than one case where asylum seekers, who are legally entitled to ‘free state medical care’ were billed for medical care received at a public hospital or refused healthcare on the grounds they were not entitled to healthcare. We even came across one case where a recognised refugee was billed for services provided.
3.1.5 Migrants’ living conditions For many migrants living in Open Centres or in independent
accommodation, daily life is often a struggle for survival. The situation is worse for those in a particularly vulnerable situation; in fact, many of the migrants we served through this project had particular problems due to physical or mental health conditions, so they had difficulty finding and keeping a job. Unemployed residents in Open Centres only receive a small per diem allowance, which is nowhere near enough to provide for the basic necessities of life34. Beneficiaries of international protection living in independent accommodation who are unemployed would, as a rule, be entitled to social welfare benefits, but other categories of migrants, such as asylum seekers, migrants with THP/N and rejected asylum seekers would not be entitled to any form of income support. Even when they are employed, most migrants have relatively high-labour but low-paid jobs, so for them paying rent and basic living expenses is always a challenge. Where they have special needs, such as dietary or medical requirements (because of a particular medical condition or because they are taking certain medication), life becomes immeasurably more difficult. In the circumstances we observed, it is often hard for migrants even to afford the bus fare to go to hospital for their appointments35 or to buy the food and other items they need. Furthermore, if they are in employment it is difficult for them to take time off to keep their appointments36 and if they are placed in a position where they have to choose between their livelihood and their medical care they would most likely choose the former.
3.1.6 Individual factors In addition to the above, there could also be factors specific to the individual case, such as mental health issues or a low level of education, which serve to further obscure and complicate matters. Such factors could exacerbate mistrust and widen the distance between migrants and the services they need.
3.2 Obstacles to access relating to services providers This section outlines those obstacles posed by the way in which mainstream service providers operate or the rules regulating selection of beneficiaries, which make it difficult or impossible for migrants to access these services. From our observations these difficulties are primarily due to the fact that little or no effort was made to adapt the services to the particular needs of migrants, even the 37
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most obvious ones like communication difficulties due to language, or to train staff to understand the particular situation of migrants. It is clear that this could be due to a lack of resources, which is a real challenge in a world where policy makers and service providers alike are constantly struggling to meet ever-increasing and extremely diverse and complex needs. However, it is equally clear that some effort needs to be made to tailor the services provided to meet migrants’ needs, otherwise there is a very real risk that all but a few will be virtually excluded. Some examples of the obstacles encountered include: 3.2.1 Restrictive criteria While we did not come across a single service that explicitly excludes migrants, sometimes services adopt criteria for selection of beneficiaries that in practice automatically exclude many migrants, such as requirements that service users speak English or Maltese in order to be accepted. We encountered such criteria both within the public and the voluntary sector and, from what we could see, as a rule they are imposed due to limited resources and lack of availability of interpreters or cultural mediators, rather than to an intention to discriminate or to exclude migrants from the service. In fact, these same service providers offered services to large numbers of migrants who fit the criteria for selection. 37
However, it is clear that the use of restrictive criteria, even if based on apparently legitimate grounds, could effectively exclude many migrants from accessing a particular service. 3.2.2 Lack of availability of trained interpreters or cultural mediators Few mainstream service providers employ trained interpreters or cultural mediators and this seriously hampers their ability to provide services to migrants in a timely and effective manner. The one exception is the Migrant Health Unit within the Department of Health, which provides cultural mediators to assist patients receiving treatment at Mater Dei Hospital. Although the service provided is insufficient to meet the demand, it is one example of good practice within the public service which has significantly improved migrants’ access to medical care. In the absence of a proper service, migrants and service
providers alike rely on the assistance of NGOs, where this is available, or on the assistance of friends or fellowdetainees. All of these are problematic, at least to some extent, as NGO services are very limited and using friends or fellow-detainees raises a host of questions relating to adequacy of translation and confidentiality, highlighted above. 3.2.3 Questions entitlements
regarding
legal
status
and
Many mainstream service providers we encountered had limited or no knowledge of the laws, policies and practices regulating the treatment of asylum seekers and beneficiaries of protection and determining the scope and extent of their entitlements to basic services and benefits. The fact that the relevant legal and policy provisions are vague at best and spread out in a number of legislative instruments and policy documents or decisions, many of which are not publicly available, only serves to complicate matters further. As a result many service providers had questions regarding whether or not particular individuals were in fact entitled to a service. In practice this led to situations where even persons with an acknowledged legal right to free medical care were either billed for services provided or refused access to healthcare, as highlighted earlier in this report. 3.2.4 Lack of knowledge regarding the roles of the various agencies dealing with immigration and asylum In addition to lack of knowledge regarding the applicable laws and policies, service providers we encountered were also confused about the roles and responsibilities of the various governmental and non-governmental agencies working in the field of immigration and asylum. This is not surprising as over the past ten years there have been a number of changes, not only at legislative and policy level but also at operational level, with a number of new government agencies, such as the Detention Service and AWAS, being set up to deal with particular aspects of the reception of boat arrivals. Moreover, in recent years, the responsibility for various aspects of immigration management, previously dealt with by the Immigration Department of the Malta Police Force, such as the issuing of visas and residence permits, has been passed on to other new or existing government departments. There are also a number of non-governmental stakeholders, including both voluntary and international organizations,
38
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providing different services to migrants and asylum seekers. Some service providers complained about the lack of coordination between the different agencies and departments dealing with immigration issues, which compounds their sense of confusion. 3.2.5 Lack of cultural competence among staff working within mainstream service providers Professional staff working within mainstream services often complained that they felt unprepared to deal with people from diverse cultural, ethnic, linguistic and religious backgrounds. This is hardly surprising as having to provide services to migrants on a daily basis is a relatively new experience for staff within local mainstream services. In view of this few, if any, were trained to deal with this reality as until recently it was not deemed necessary to provide professionals in training with the skills or knowledge needed to serve such a diverse client-group. In fact, it has been noted that the training provided by local institutions, particularly in the area of psychology and mental health, is largely grounded in Euro-American theories of helping, which, in turn determined the type of care and assistance provided.38 We tried to address this issue through the project, by providing training for professionals working within mainstream services, however this is obviously insufficient to address the existing knowledge and skills gap and more work needs to be undertaken in this area. 3.2.6 Prejudice or hostility towards migrants Through our contact with staff working within mainstream services we were able to observe that some individual members of staff do harbour prejudices against migrants and asylum seekers. This is often reflected in stereotypical views and generalisations regarding particular categories of migrants or particular national groups (for example assumptions that migrants abuse the services provided or that more often than not detainees feign mental illness to prevent deportation or obtain release from detention), in questions regarding the extent of professional responsibility towards particular categories of persons with ‘irregular’ or ‘illegal’ migration status, or in attempts to justify the application of different standards to immigrants, even if on paper they have the same entitlements to the benefit or service as Maltese nationals.
Such attitudes and prejudices are dangerous as they could lead to migrants being denied the benefit, treatment, care or service they require. They could also lead to an unacceptable lowering of the standard of care provided in certain cases.
3.3 Obstacles relating to the legal and policy framework for integration Mainstream service providers stressed that they are often in a position where they cannot provide meaningful assistance to migrant clients referred to them, due to the fact that the clients’ access to other, basic services or benefits is extremely limited or non-existent. At times this limited or restricted access is due to the factors listed above, but at times it is also due to lack of entitlement or lack of clarity regarding the exact scope of legal entitlements, which has been mentioned several times throughout this report. This is particularly true of migrants in an irregular situation, those who enjoy tolerated stay after their asylum application has been rejected, and those with THP/N or other national forms of protection, as people in these situations enjoy very limited legal rights and in many cases the extent of their entitlement, even to basic services such as free healthcare beyond emergency care, is unclear. However, it is also true of asylum seekers – that is, those awaiting a final decision on their asylum application – and beneficiaries of subsidiary protection, as neither the exact content of “free state medical care”, “material reception conditions” nor that of “core welfare benefits” is clarified in national law. One issue that emerged as a significant hurdle is the restricted access to financial benefits for some beneficiaries of protection. The following are some examples, which highlight the scope and nature of the difficulties faced: Social work intervention aimed at supporting persons with subsidiary protection living in Open Centres to move out of the centres into independent accommodation is severely hampered by their lack of access to social benefits while living in the centres. Beneficiaries of international protection living in Open Centres are deemed not to be entitled to social benefits, as they are living in a state-run facility However, the per diem food and transport allowance 39
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provided to Open Centre residents is minimal and far from sufficient to allow residents to meet their basic needs, which go beyond food and transport. Yet residents are expected to work on moving out of the centre within 12 months. The lack of financial support makes it practically impossible for some people, particularly those who cannot work, either because of their physical or mental health problems or because they have children for whom they are wholly responsible, to ever move out of the Open Centres. For the latter category the situation is compounded by the lack of affordable childcare.
if they are unable to obtain financial support they will very probably lose their accommodation, as they cannot pay for rent or other basic services, like water and electricity. This is particularly problematic as migrants who have moved out of the Open Centres are unable to move back into the centres. Without any extended family network in Malta and only very limited availability of placements in homeless shelters, many beneficiaries of protection in a situation of prolonged unemployment, experience extreme financial and material hardship and often survive only thanks to the support of friends.
Perhaps the most intractable problems are faced by people with THP and rejected asylum seekers with tolerated stay, particularly where the individuals concerned cannot work due to serious physical or mental health problems. Holders of THP have no access to any form of mainstream social benefit, including the non-contributory social assistance, in spite of the fact that in terms of government policy they are entitled to the same benefits as beneficiaries of SP. Rejected asylum seekers too have no right to social welfare benefits. In practice this has meant that it is virtually impossible for them to move out of the Open Centres as the few options available in practice, such as supported living, require a minimum income equivalent to social assistance. Assisting people outside the Open Centre system who have found themselves without work, is often even more problematic as, with the exception of recognised refugees, beneficiaries of protection (whether national or international) are not entitled to unemployment assistance since they are excluded from registration on Part I of the national employment register. This same restriction also affects other categories of migrants who would be entitled to unemployment benefit (a contributory benefit) by virtue of the number of contributions paid, but are excluded from this benefit because of the inability to register on the national employment register. For beneficiaries of SP the situation has been partially remedied by a discretionary extension of social assistance where access unemployment assistance is precluded. However, the situation is far from ideal and the real problem, that is, the exclusion of certain categories of people from registration in the national employment register, needs to be addressed. Where beneficiaries of SP find themselves without a job, 40
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1. Make the promotion of integration of migrants in Malta a national priority. 2. Clarify legal and policy rules on reception of asylum seekers, in line with our obligations under relevant international and regional legal instruments.
competent care, with a specific focus on working with asylum seekers and refugees; b. Disseminating information on the legal entitlements of different categories of migrants; c. Providing the services of trained interpreters and cultural mediators to all departments needing them.
3. Specify the content of national and international protection, particularly beneficiaries’ right to basic services such as education, healthcare, employment, social welfare services and social benefits, in national law.
14. Set up ‘one-stop shop’ migrant support centres on the Portuguese model1, to facilitate access to basic services and to provide the necessary guidance to access mainstream services.
4. Put in place a national policy framework and strategic action plan on integration, through consultation with all relevant stakeholders including NGOs, migrants and beneficiaries of protection.
15. Establish a focal point for integration within each department to provide guidance on laws and entitlements and to serve as contact person for collaboration with the authorities responsible for integration and with different departments and ministries on issues relating to integration.
5. Clarify the scope and extent of the mandate of AWAS, ensuring it includes all migrants within the reception system (detention and open centres) and all asylum seekers whether or not they arrived in Malta by boat, and the role of mainstream services in the provision of care to migrants in a particularly vulnerable situation. 6. Identify a single entity that will have effective responsibility for overseeing the implementation of the policy on integration, as well as for promoting dialogue and cooperation between different ministries and services, and between government and NGOs, addressing gaps in existing laws and policies, and ensuring effective access to legal entitlements to education, healthcare, social welfare and other services.
Care, support and services to asylum seekers and migrants in a particularly vulnerable situation 16. Ensure that both within and outside the reception system, care and services for migrants in a particularly vulnerable situation are provided on the basis of need rather than legal status. 17. Provide migrants with the support necessary for to access mainstream services, through the provision of social work services and the services of interpreters/ cultural mediators.
Vulnerability assessment procedure
Detention
7. Broaden the scope of the vulnerability assessment procedure beyond release from detention to an assessment of needs with a view to meeting them.
18. Ensure that detainees awaiting the outcome of vulnerability assessment procedures are adequately supported and provided with the care they require while in detention.
8. Clarify and publish the rules regulating vulnerability assessment and ensure that they provide at least basic procedural safeguards. 9. Set timelines for assessment procedures, which in any case should not go beyond one month from referral. 10. Allow for the possibility of assessment at any point during the reception phase. Reception system 11. Strengthen the capacity of open and detention centres to provide holistic and culturally-appropriate care to all residents and to identify those in a particularly vulnerable situation, through the recruitment and training of additional professional staff, including social workers, community workers, interpreters and cultural mediators. 12. Provide residents in open and detention centres with information about their rights, entitlements and obligations, as well as about available services and how to access them, in a language and form they understand. Mainstream services 13. Strengthen and equip mainstream services to take on the increased caseload and to address the particular needs of the migrant population by: a. Providing training in the provision of culturally
VI. RECOMMENDATIONS
Legal and policy framework on integration
19. Improve the conditions in which detainees receive in-patient treatment at Mount Carmel Hospital (currently ward M8B) and ensure there is less focus on security and more on care. 20. Ensure that all prescribed medication is provided to detainees, whether or not it is available for free. Open Centres 21. Create specialised residential facilities and services for migrants in a particularly vulnerable situation who have specific needs for care and support, particularly persons with chronic illness and/or mental health problems, possibly in collaboration with NGOs and other stakeholders. Community 22. Allow access to basic social welfare support to beneficiaries of national protection who have moved out of the Open Centre system yet cannot work due to their physical or mental health condition or other personal circumstances. 23. Provide rejected asylum seekers with tolerated stay at least basic financial support, either through the AWAS per diem system or through the state social welfare system, if they are unable to work for any of the reasons mentioned above.
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REFERENCES
1
See Times of Malta article on http://www.timesofmalta.com/ articles/view/20120422/local/Shot-migrant-who-lived-in-a-cavethat-society-forgot.416484
– 2010, available at http://www.unhcr.org.mt/images/stories/ UNHCR_Malta_Fact_Sheet_2002-2010.pdf; NSO, World Refugee Day 2012, News Release 118/2012.
Martin M. C. & Phelan M., Interpreters and Cultural Mediators –different but complementary roles, Translocations: Migration and Social Change 6(1), (2010), available at: http://doras.dcu. ie/16481/
Regulation 11(14) and (15) of the Common Standards for Return of Illegally Staying Third Country Nationals Regulations, which transposed the Return Directive into national law in March 2011, places a 6 month time limit on detention, which may be extended for a further 12 months up to a maximum of 18 months. It is unclear whether this time limit applies to all categories of detainees, as regulation 11(1) states that the safeguards do not apply to third country nationals who are “subject to a refusal of entry” or “who are apprehended or intercepted by the competent authorities in connection with the irregular crossing by sea or air of the external border of Malta and who have not subsequently obtained an authorisation or a right to stay in Malta”.
2
Mikkelson, H., (2008) “Controversies over the role of the court interpreter” in Crossing Borders in Community Interpreting: definitions and dilemmas, ed. ValeroGarcés, C. and Martin, A., John Benjamins Amsterdam and Philadelphia. 3
4 In 2002 some 1468 undocumented migrants arrived in Malta by boat, compared to 57 in 2001. In the intervening years, with the exception of 2003 when 586 migrants arrived in this manner, there was always an average of 1680 arrivals per annum: 1388 in 2004; 1822 in 2005; 1780 in 2006; 1694 in 2007; 2775 in 2008; 1475 in 2009, 47 in 2010 & 1579 in 2011 (National Statistics Office, World Refugee Day 2012, News Release 118/2002, 19 June 2012).
In 2011, out of 1579 migrants arriving by boat, 1178 (74.53%) were adult males, 280 (17.59%) were adult females and 121 (7.89%) were minors. Out of these 60 were unaccompanied minors, out of whom 53 were male and 7 were female. (Data compiled by the Office of the Refugee Commissioner as at 31/12/11 available at http://www.unhcr.org.mt/index. php?option=com_content&view=article&id=519&Itemid=110) 5
Jesuit Refugee Service, Malta: Do they know?: asylum seekers testify to life in Libya, December 2009, Human Rights Watch, Pushed Back, Pushed Around: Italy’s Forced Return of Boat Migrants and Asylum Seekers, Libya’s Mistreatment of Migrants and Asylum Seekers, 21 September 2009, 1-56432537-7
6
Migration, Human Smuggling and Trafficking from Nigeria to Europe, IOM Migration Research Series, No. 23 (Geneva, International Organization for Migration, 2006), available at: www.iom.int/jahia/webdav/site/myjahiasite/shared/shared/ mainsite/published_docs/serial_publications/mrs23.pdf; United Nations Office on Drugs and Crime, Transnational Trafficking and the Rule of Law in West Africa: A Threat Assessment (2009), available at: www.unodc.org/documents/data-andanalysis/Studies/West_Africa_Report_2009.pdf. 7
Immigration Act, Chapter 217 of the Laws of Malta, Article 10 and 14 8
Data compiled by the Office of the Refugee Commissioner as at 30/12/2011 available at: http://www.unhcr.org.mt/index. php?option=com_content&view=article&id=113&Itemid=110 9
Between 2002-2010, 56% of all asylum seekers were granted some form of international protection. In 2011, out of 1606 applications for international protection processed by the Office of the Refugee Commissioner, 884 (55%) were granted international protection. UNHCR Malta, Factsheet Malta 2002 10
11
See for example: Council of Europe, Report to the Maltese Government on the visit to Malta carried out by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) from 19 to 26 May 2008, 17 February 2011, available at: http://www.cpt.coe.int/ documents/mlt/2011-05-inf-eng.pdf; United Nations General Assembly, Report of the Working Group on Arbitrary Detention: Addendum-Mission to Malta (19 to 23 January 2009), 18 January 2010, A/HRC/13/30/Add.2 available at: http://www2. ohchr.org/english/issues/detention/docs/A-HRC-13-30-Add2. pdf 12
13 JRS Malta, Report on a pilot study on destitution amongst the migrant community in Malta, March 2010 at page 13. This report was part of the ANDES (Advocacy Network on Destitution) Project coordinated by JRS Europe in 2009 and 2010.
The HUMA report on Malta published in April 2011 by the HUMA Network notes that the precise extent of asylum seekers’ entitlement to healthcare is not clear – see Access to healthcare and living conditions of asylum seekers and undocumented migrants in Cyprus, Malta, Poland and Romania, which may be accessed at http://www.humanetwork.org/averroes_be/content/download/8798/83596/file/ HUMA_report.pdf, pages 65-70 for more details on the legal entitlement to healthcare of the different categories of migrants in Malta 14
15 See Annex 3 of EMN study available at http://www.mjha. gov.mt/MediaCenter/PDFs/1_MT%20EMN%20report%20nonHarmonised%20forms%20of%20protection%20(d).pdf
See HUMA report cited in [n 14] above for more information on entitlements to health care, see also page 87 of the said report 16
17
See [n 16]
18
Cited above. See [n 13]
19
Refugees and beneficiaries of subsidiary protection are given
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a permit to work in Malta, which effectively allows them to take up any job they find. Asylum seekers and rejected asylum seekers would need to find an employer willing to apply for a licence to employ them to undertake a particular job. If they wish to change job, the new employer would need to apply for a new licence. The highest rate for a single person would be €13.20 (€92.32 per week); this sum is set on the basis of an assessment of the amount required to cover basic subsistence. 20
waiting lists as a barrier to accessing healthcare – see [n 14] page 88 Here too our observations are supported by the findings of the HUMA report, cited above, which states that lack of information about where to go to obtain the necessary service was cited by 17% of respondents as a barrier to accessing healthcare - page 88 32
21
Once again, the HUMA report too indicates that lack of information regarding entitlements is an obstacle to migrants’ access to healthcare; the said report highlights lack of information on part of service users (17% overall) and on the part of service providers (3% overall) as an obstacle - page 88
22 See [n 21]. MJHA & MFSS, Irregular Immigrants, Refugees and Integration, January 2005, Page 11, Section 4 – Detention of Asylum Seekers
34 The Caritas Malta study, A Minimum Budget for a Decent Living (16 March 2012), concluded that ‘the minimum essential budget for a household of two adults and two children is estimated at €10,634, a lone parent and two children at €8,581 and for two older persons at €6,328’, maintaining that this is only a minimum acceptable standard below which a household’s income should not fall for an individual to live with dignity. Available at: http://www.caritasmalta. org/?m=news&id=44
The Today Public Policy Institute, Managing the Challenges of Irregular Immigration in Malta, November 2008, page 4, and HUMA report page 64; the national policy document, Irregular Immigrants, Refugees and Integration, published by MJHA & MFSS in January 2005, contains a brief section on integration page 26, section 18
According to JRS records, out of a total of 39 persons released on grounds of vulnerability during the project, 1 was released within 2 weeks of referral; 6 within 1 month; 13 within 2 months; 6 within 3 months; 7 within 4 months; 2 within 5 months; 1 within 7 months; and 3 within 8 months. See section 2.2.2 of this report for more information on the reasons for referral. 23
Hereinafter referred to as the JRS Malta Psychosocial Project 24
‘Waiting in Joyful Hope’, William Yeomans S.J. in Everybody’s Challenge, JRS, October 2000. 25
Becoming Vulnerable in Detention – Civil Society Report on the Detention of Vulnerable Asylum Seekers and Irregular Migrants in the EU, JRS Europe, June 2010 at page 13
33
16% of the respondents in the HUMA report cited in footnote 14 above cited lack of transport as an obstacle to their access to healthcare 35
36 7% of respondents in the HUMA report cited above mentioned the possible impact of the need to attend hospital appointments on their job as an obstacle to healthcare
For example, in order to attend certain ETC courses or Sedqa group therapy sessions to deal with problems of alcohol or drug abuse it is necessary to at least understand Maltese. 37
26
Para 170, page 57 of the CPT report on their 2008 visit to Malta which may be accessed at: http://www.cpt.coe.int/ documents/mlt/2011-05-inf-eng.pdf
Caruana S, Do you hear what I say? – How Maltese mental health professionals work multiculturally with Sub-Saharan African asylum seekers, January 2012, at page 13 38
27
39
See information on CNAI at www.acidi.gov.pt
24% of the respondents in the HUMA study also highlighted the language barrier as an obstacle to obtaining medical treatment – see [n 14] page 88 28
The HUMA report cited above also identified the following obstacles to asylum seekers’ and undocumented migrants’ access to healthcare: experience of discrimination/feeling unwelcome (32% of all respondents) and lack of faith in the treatment provided (13% of respondents) at page 88. 29
Hathaway J, The Law of Refugee Status, Butterworths (1991) pages 84-85 30
31
In the HUMA report 38% of respondents mentioned long
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Hospitality is that deeply human and Christian value that recognises the claim that someone has, not because he or she is a member of my family or my community or my race or my faith, but simply because he or she is a human being who deserves welcome and respect. … in today’s world… many are closing their borders and their hearts, in fear or resentment, to those who are different … but, perhaps, we can ask how we may, creatively, effectively and positively, influence the closed and unwelcoming values of the cultures in which we work. Letter to JRS on its 30th anniversary Fr Adolfo Nicholas S.J., Superior General of the Society of Jesus
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