Changes to immigration law mean sick could be deported
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French doctors are worried that changes to the French immigration law will stop foreigners receiving vital medical treatment. On Wednesday a key committee is discussing the law, which would scrap a provision that since 1998 has allowed immigrants temporary residency for medical treatment in France.
Louise (not her real name), a 42-year-old Nigerian woman, is sitting in a hospital room in Argenteuil, a northern Paris suburb. She's been here for several days.
Doctors have figured out that she has a stomach infection, but they are running more tests because she is HIV-positive.
Louise came to France in 2008, because she says she had problems with the Nigerian government. Even though her request for political asylum from France was turned down, she is still living here legally, because of her medical condition.
She says she had no idea she had the disease until doctors performed medical tests when she arrived in France.
"I had to do blood tests, urine tests," she explains. "The nurse then asked me to come see her. She said 'I'm very sorry your result is no good'. I say 'what happened?' She said, 'you are HIV-positive'. I started crying."
When she talks about being HIV-positive, Louise becomes very quiet and her eyes tear up. She says she has had to have psychological treatment, because she was considering suicide when she found out.
"When I came to France I was a normal person. If someone had told me four or five years ago that I have this illness, I would have slapped that person," she says.
Her situation is not unusual. Dr Pascal Revault of the Comede, a group that helps immigrants obtain medical care France, says most immigrants who have HIV or hepatitis don't realize they are ill until after they arrive.
"Ninety per cent of them discover their status here in France," he explains. "This means that less than ten per cent know they are infected, and they did not come here to get their HIV or hepatitis treated."
In other words, people come to France for other reasons; often, like Louise, they are asylum seekers. It is only once they discover they are sick that they apply for a residency permit for medical reasons.
Some 6,000 people do so each year, most for post traumatic stress syndrome (PTSD), according to Dr Revault. Others have hepatitis, HIV/Aids or other, non-transmittable problems like hypertension, diabetes and asthma.
Authorities determine whether or not someone should get a residency permit by asking a doctor for a certificate that answers three questions: Is the person suffering from a disease? Is the disease life-threatening? And is the treatment accessible in the home country?
This third question is key, according to Revault. The law as it currently stands refers to the accessibility of the treatment in the home country, which is determined by looking at country reports from institutions like UNaids, the WHO and the EU.
The modified law would change the wording slightly: instead of asking if the treatment is accessible, it would ask if it exists.
This is a subtle word change, but one that Revault says makes all the difference.
"Accessibility is a precise, public health expression," he says. It has a specific meaning, unlike existence.
"Existence is something either very broad or very narrow, and it depends really on the people who will be interpreting it. Existence could mean that the drug appears on a list in the country. But this of course has nothing to do with availability, affordability and accessibility. It could not be in the country because of problems with the organisation of the health system, because the drugs are not stored properly."
He worries that in a climate of budget cuts and rising anti-immigrant sentiments in France, the mere existence of a drug in a country will mean more foreigners will be denied the health care they need.
This, he says is not just bad for people who are sick, but detrimental for French taxpayers as well. If sick people are not treated, they will end up in hospital emergency rooms.
"The less they will treat themselves, the more they will come to emergency services, and the more it will cost," he says. "We think this is very dangerous for the health system in France."
It will also cost more, he says, because more cases will end up in court on appeal.
Regardless of the cost, though, for Revault, the issue is an ethical one.
"The way you treat the foreign people is the way you will treat the people who are not foreign," he says. "The way I treat my human counterpart is the way I will be treated also. So what is my future?"
The French Senate and Parliament are at loggerheads over the ammendment. On Wednesday a reconciliation committee meets to find a compromise.
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