Health, society

Summary of the opinion

For decades, France has been a country of immigration, whether for political, economic or cultural reasons. Today, the term "migrant" refers to a moment in the lives of men and women who have decided to leave their country. They stay on French soil for very different lengths of time and, in any case, their access to health care is precarious. For the most part, these people make themselves invisible in order to avoid deportation and put their health problems second to their migration plans, raising unresolved public health issues. This raises unresolved public health issues. The structures that provide care (especially hospitals) are poorly organised to reach these people, which is done by humanitarian associations without any apparent support from the state.

It is currently difficult to measure both the number of migrants and the flows of migrants in and out of France, but everything seems to indicate that their numbers do not exceed 0.5% of the general population in France. They pose no threat to either the healthcare system or our social organisation. At the same time, we all need to be aware that geopolitical developments (climate, etc.) will amplify migratory phenomena, so we need to think ahead. This means putting in place permanent official structures to shelter new arrivals in decent conditions, but also means of integrating those who may qualify for asylum or refugee status. In any case, we cannot accept that the lack of basic hygiene care for these men, women and children (who are often isolated) is an instrument for regulating their flows.

Notwithstanding the reality of the violence and major mental and psychological trauma suffered during migration, the physical health of the people cared for in this way, to varying degrees, cannot be described as poor overall.However, this assessment of "good physical health" cannot hide difficult realities, particularly in the areas of mental health and violence against women and unaccompanied minors, including in France.

The French Constitution, laws and regulations take into account the ethical imperatives concerning people exposed to the vicissitudes of migration; these texts respect international conventions. From an administrative point of view, the instruments are in place to welcome migrants with dignity. On the other hand, political rhetoric and public resources lead to inadequate implementation of these provisions, as recent repeated warnings by undisputed authorities have shown.

Although the reception of migrants in reception and orientation centres (CAO) was apparently satisfactory, this stage was preceded or followed (for those who left them) by prolonged living conditions in which the most basic rules of hygiene were not sufficiently respected. Women and unaccompanied minors in particular may have been at risk. For too long, the only initiatives taken in such situations have been by national or local associations and individual officials. There was no coherence between their efforts and those of the CAOs.

As far as the traditional health system is concerned, there are certain situations of conflict between the reception of migrants and the normal operation of the system: hostile reactions from patients who are treated alongside "migrants", a choice in certain departments, given the resources available, between the usual patient base and an influx of people from abroad for various reasons, sometimes competing with the normal activity of hospital departments. In addition, there is no real monitoring of the health of migrants, who often have difficulty communicating with medical professionals.

There is no harmonised policy for the health care access offices (PASS), which consequently fulfil their legal obligations very irregularly.

Finally, the implementation of state medical aid (AME), which represents only a minimal burden on the health budget, poses a number of problems linked to unrealistic and inefficient procedural constraints.

These observations lead us to set out a number of ethical requirements.

1. The CCNE has deliberately chosen to give priority to respect for human dignity, which is measured by the concrete way in which the material life of each person is guaranteed.
2. It is up to the healthcare system (particularly hospitals) to inspire confidence and to deal with people who put the need to hide before the need to care.
3. The "one-to-one" conversation between doctor and patient must be facilitated by an exchange that is understandable in terms of both language and cultural context.
4. Health professionals must be prepared to prioritise actions to ensure the well-being of migrants.
5. Equity, i.e. equal treatment in access to care and access to physical, mental and social well-being.
6. Solidarity, which is essential and which is expressed here in the form of fraternity and hospitality, is a condition and at the same time the achievement of all this, since everyone must feel responsible for welcoming migrants.

In addressing the issue of migrant health, the CCNE did not wish to take sides in the political dimension of the issue. However, it notes that the situation is complex and that the solutions implemented by all public actors are not equal to the challenges of today and tomorrow. On the basis of current data, the CCNE believes that there are no insurmountable difficulties in providing honourable and dignified care for migrants. What is needed, however, is a credible discourse, firstly of truth, and secondly of trust and encouragement, as a consequence of a better adaptation of public instruments. The CCNE clearly states that, in the case of migrants, as in the case of any person in need, health, as defined by the WHO, must never be used as an instrument, in particular by maintaining poor sanitary conditions as a means of refoulement. In choosing to give priority to respect for the dignity of the individual, the CCNE recalls the ethical requirement of solidarity, which is expressed in fraternity, in particular with people welcomed on French soil, and in the duty of hospitality towards them