Asylum seekers in emergency reception centers do not receive the care they are entitled to. Their mental and physical health suffer from poor hygiene, lack of privacy, limited access to care and a hopeless stay. Care providers who work at these locations do not feel they can help residents and fear that staying in emergency shelters will make them sicker.
This is the conclusion of the Red Cross, volunteer organization Dokters van de Wereld and expertise center for health differences Pharos in a report that will be published on Tuesday. Researchers interviewed 131 residents and dozens of doctors and site managers. The organizations advocate that the government quickly clarify which minimum standards of care at crisis emergency reception locations must comply with. There is currently no such guideline.
“From politicians we keep hearing that a law will soon be introduced in which reception and care can be better arranged,” says Jasper Kuipers, director of Dokters van de Wereld. “But the reality is that today there are people in emergency shelters who need care that they are not getting. Not for months. A solution must now be found.”
Temporary facilities
Crisis emergency shelters are the locations that have been set up across the country since the summer of 2022 because Ter Apel silted up. They are not managed by the COA (Central Agency for the Reception of Asylum Seekers), but by municipalities and security regions. There are currently 7,000 asylum seekers in the emergency shelter. They were intended as temporary shelters, but asylum seekers have been staying at some locations for more than ten months. The only government guideline on the organization of crisis emergency shelters assumes a maximum duration of shelter of one week.
NRC described this spring how seconded basic doctors work at crisis emergency reception locations with minimal support. The basic doctors are poorly equipped, often just graduated, have no access to an electronic patient file and are only supervised by a telephone backup.
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“Care providers and location managers put their heart and soul into it, but they tell us that they are being thwarted by the system,” says researcher Heleen Koudijs of Pharos. Koudijs also works as a doctor at a crisis emergency reception location through secondment agency Arts en Specialist. “Learning ability is what it lacks. Hardly any experiences are shared, not even between locations within the same security region. Doctors and location managers have to keep reinventing the wheel.”
The locations themselves also make people sick. Residents live close together, sometimes with 8 people in one room, in tents or containers. There are sometimes too few toilets, or they are not clean. Infectious diseases such as scabies, diarrhea and respiratory infections are therefore common. Asylum seekers are also misinformed, the researchers saw. Residents were told that treatment was postponed until they are staying in an asylum seekers’ center or have a residence permit. That is not correct: after two months in the Netherlands, asylum seekers are entitled to the same care as everyone else in the Netherlands.
In any case, it is an illusion that the market will solve this if you, as a government, are not clear what care you are asking of them
Jasper Cooper director Doctors of the World
It is also unclear among care providers what kind of care they provide. Some saw it as GP care, others called it crisis care. Because care providers put off referring, or a patient is not referred, simple complaints get out of hand: a man with a wound on his foot was only given a bandage, but eventually ended up in hospital with blood poisoning.
Doctors who work through secondment agencies Arts & Specialist and Just4Care do not have access to electronic patient files or a General Practitioner Information System (HIS). They are forced to create files on separate sheets of paper, or send patient information via unsecured emails. That is a violation of professional secrecy, the researchers write. Secondment agency Arts & Specialist says in response that it is ‘not able’ to purchase an HIS.
“If you pretend to be able to handle this care, you must of course also be able to arrange an HIS,” says Kuipers of Dokters van de Wereld. “But it is an illusion anyway that the market will solve this if you, as a government, are not clear what care you are asking of them. That is why we insist on more direction from the national government. That is where the knowledge about purchasing care is located, not in the safety regions.”
A version of this article also appeared in the June 20, 2023 issue of the newspaper.