Die Aspekte unser Arbeit sind vielfältig. Als unsere Hauptaufgabe sehen wir die Vermittlung von kranken Menschen ins staatliche Gesundheitssytem. Daneben ist unser Ziel auch die Aufklärung über die politischen und gesellschaftlichen Umstände, die diese Arbeit erst notwendig machen.
The most recent reliable estimate was that between 180,000 and 520,000 people were living illegally in Germany in 2014. After more than 1 million migrants entered Europe in 2015, an increase in the number of people living illegally is likely. The reasons for living illegally are as diverse as the migration backgrounds.
Some came as students and stayed after their visa expired, some were persecuted in their countries of origin, others were joined by family members already living here. Many have been living in Germany for several years and cannot or do not want to return to their countries of origin, others are just passing through or commuting. Some children who were born in Germany and have spent their entire lives here are illegalized if their parents do not have a residence permit. However, two aspects apply to all of them: they want to determine their own life and place of residence, and they are criminalized for doing so.
Illegalized people work in almost all sectors of the economy, and in some industries, such as construction, agriculture, and the hotel and restaurant industry, they are an essential part of the workforce. Although they have long been part of our society, their existence is largely ignored by the state. Illegalization puts people in a living situation in which they are denied numerous rights and demanding even basic human rights is associated with the risk of being deported.
Legally, people without legal residence status are assigned to the Asylum Seekers’ Benefits Act (AsylLG) and are thus entitled to medical care for acute or painful illnesses (§ 4) or to benefits that are essential for maintaining health (§ 6). However, the minimal treatment stipulated in the AsylLG is not only completely inadequate health care, it also violates the human right to health (UN Social Covenant Art. 12), which provides for equal access to medical care. The disregard of this treaty ratified by Germany has already been criticized by the Economic and Social Council of the UN , but the discrimination in the AsylLG persists.
In order to be able to assert their entitlement to medical care at all, undocumented persons must contact the social welfare office. Like all public agencies, the social welfare office is legally obligated to report to the immigration authorities (§ 87 AufenthaltG). The right to health is effectively denied to undocumented migrants because any contact with the social welfare office is associated with the threat of deportation. As a result, illnesses that are actually treatable are postponed or become chronic.
Emergency care is an exception, for which the hospital can subsequently request reimbursement from the social welfare office (SGB XII, §25). Since September 2009, an administrative regulation of the Federal Ministry of the Interior has been in effect, according to which the social welfare office is subject to “extended protection of secrecy” in this case . However, the practical implementation has major shortcomings. Hospitals are often left sitting on the costs and therefore many hospitals demand down payments from illegalized persons, who often cannot afford them, or turn them away.
From the founding of Medinetz in 2009 until the establishment of our sister association CABL e.V. in the fall of 2019, the practical mediation of medical assistance represented a core part of our work. We offered a weekly consultation hour where people without health insurance could turn to us. We then referred them to doctors who had agreed to cooperate with us. Necessary medical treatments took place on a voluntary basis or were financed by the association through donations.
Since the foundation of CABL e.V., this work is no longer necessary on our part. With the help of an anonymous treatment certificate, people without health insurance can visit doctors of their choice and the treatments can be paid through the budget of the association. Medinetz supports CABL e.V. with the experience that the volunteers have gained in many years of working with patients.
If the clients wish to have a closer supervision, this can be taken over by the active members of the Medinetz. For example, we can assist in arranging medical appointments and, if desired, accompany the client to these appointments.
CABL
Since the foundation of Medinetz in 2009, we were aware that our system could not remain a long-term solution for the medical care of people without residence status.
The care of an entire population group must not be shifted to voluntary actors. In order to return this responsibility to state hands, we have been working since the founding of Medinetz at the local and state level towards the introduction of a so-called Anonymous Treatment Certificate.
The anonymous treatment voucher is an approach to health care for people without residence status that has been discussed again and again for almost twenty years. Similar to the way in which the care of asylum seekers is currently organized in many federal states, a specialized office is to issue treatment vouchers to illegalized migrants, with which the treating doctors can settle the costs of the treatment. In this way, the legal right to health care, which people without residence status also have according to AsylbLG, is to be fulfilled (AsylbLG §1 Abs 1 Nr. 5). Due to the obligation of municipal offices to report according to §87 AufenthG, the allocation of treatment vouchers should take place in an independent institution, for example attached to a social counseling center. This center has a budget available through which the treatment costs can be settled. The vouchers issued are given a pseudonym, so that no personal data of the patients need to be disclosed at any point in the billing process. However, not only people without residential status, but all people without health insurance can make use of anonymous treatment vouchers.
As early as 2001, the working group “Poverty and Health” called on the federal government to examine the possibility of anonymously guaranteeing health care services for illegalized migrants and potential financing options. However, this proposal was rejected by the Federal Ministry of Labor and Social Affairs (Beauftragte der Bundesregierung für Ausländerfragen. 2002. Report of the Federal Government Commissioner for Foreigners’ Affairs on the Situation of Foreigners in the Federal Republic of Germany. Berlin and Bonn p.245). In the meantime, however, several German cities and states have succeeded in launching projects to issue the anonymous health insurance voucher. In Thuringia, for example, the association Anonymer Krankenschein Thüringen e.V. was founded in 2017 and has since been issuing anonymous sick certificates throughout the state.
In Leipzig, after intensive political work, a budget of €100,000 per year was approved in the budget for 2019/2020 at the request of the Green Party in the city council for the establishment of a clearinghouse for medical care for undocumented people
(https://static.leipzig.de/fileadmin/mediendatenbank/leipzig-de/Stadt/02.1_Dez1_Allgemeine_Verwaltung/18_Ref_Migration_und_Integration/Gesamtkonzept_zur_Integration/Broschure_VIELFALT_LEBEN.pdf – P. 36)
In cooperation with the health and social welfare departments, the association CABL e.V. (Clearingstelle und Anonymer Behandlungsschein Leipzig e.V.) was founded, which started its work in November 2019.
Since the beginning of its work, CABL e.V. has offered social counseling with the aim of integrating its clients* into standard medical care, and at the same time, anonymous treatment vouchers are issued in the consultation hours to finance outpatient medical treatment. Due to the low financial means, inpatient treatments can currently only be covered in individual cases and after prior consultation.
The aim of the association is now to stabilize the offer and to establish the anonymous treatment voucher as a means of settlement in Leipzig practices and pharmacies.
SABS
An Anonymous Treatment Voucher in Leipzig is already a great success, but many people who need medical support are not covered by the project. The establishment of CABL e.V. in Leipzig has created an inequality of treatment for people within Saxony that is not justifiable.
In 2020, an initiative of Medinetze Dresden, Leipzig and Jena as well as Medibüro Chemnitz has therefore been formed, which, following the example of AKST in Thuringia, demands a Saxon Anonymous Treatment Certificate (SABS) with a clearing offer, funded by the state. Especially in rural regions, support structures and networks, such as the Medinetze, are much weaker. This puts marginalized groups at an additional disadvantage. It is therefore urgently necessary to create nationwide services. As has been shown in Thuringia, such a project is practicable, promising and feasible.
Other political work
Even after the establishment of the anonymous treatment certificate in Leipzig, our political work is not over. On the one hand, the funding of CABL e.V. is not secured in the long term, on the other hand, the care that CABL e.V. is able to provide for people without health insurance is only an interim solution. For example, the association’s budget is far from sufficient to provide comprehensive care for its clients. In addition, anonymous treatment vouchers are significantly more costly and barrier-increasing than standard medical care in Germany. In the long term, the German healthcare system must be open to all people, regardless of passport or residence status.
We will continue to advocate for this politically, both at local, state and federal level. Concrete goals include the abolition or amendment of the obligation to notify public bodies (§87 AufenthG), to which the organization Doctors of the World has also committed itself (https://www.bundestag.de/resource/blob/816306/4b6f8e5608bd56520e8f498d1bb25bc0/19_14_0265-3-_Aerzte-der-Welt_Gesundsversorgung-data.pdf).
Flüchtlingsrat Leipzig
fluechtlingsrat-lpz.org
fr@fluechtlingsrat-lpz.org
menschen-wuerdig – Kampagne für menschenwürdiges Leben & Wohnen auch für Asylsuchende
http://www.menschen-wuerdig.org/
- Background
The most recent reliable estimate was that between 180,000 and 520,000 people were living illegally in Germany in 2014. After more than 1 million migrants entered Europe in 2015, an increase in the number of people living illegally is likely. The reasons for living illegally are as diverse as the migration backgrounds.
Some came as students and stayed after their visa expired, some were persecuted in their countries of origin, others were joined by family members already living here. Many have been living in Germany for several years and cannot or do not want to return to their countries of origin, others are just passing through or commuting. Some children who were born in Germany and have spent their entire lives here are illegalized if their parents do not have a residence permit. However, two aspects apply to all of them: they want to determine their own life and place of residence, and they are criminalized for doing so.
Illegalized people work in almost all sectors of the economy, and in some industries, such as construction, agriculture, and the hotel and restaurant industry, they are an essential part of the workforce. Although they have long been part of our society, their existence is largely ignored by the state. Illegalization puts people in a living situation in which they are denied numerous rights and demanding even basic human rights is associated with the risk of being deported.
Legally, people without legal residence status are assigned to the Asylum Seekers’ Benefits Act (AsylLG) and are thus entitled to medical care for acute or painful illnesses (§ 4) or to benefits that are essential for maintaining health (§ 6). However, the minimal treatment stipulated in the AsylLG is not only completely inadequate health care, it also violates the human right to health (UN Social Covenant Art. 12), which provides for equal access to medical care. The disregard of this treaty ratified by Germany has already been criticized by the Economic and Social Council of the UN , but the discrimination in the AsylLG persists.
In order to be able to assert their entitlement to medical care at all, undocumented persons must contact the social welfare office. Like all public agencies, the social welfare office is legally obligated to report to the immigration authorities (§ 87 AufenthaltG). The right to health is effectively denied to undocumented migrants because any contact with the social welfare office is associated with the threat of deportation. As a result, illnesses that are actually treatable are postponed or become chronic.
Emergency care is an exception, for which the hospital can subsequently request reimbursement from the social welfare office (SGB XII, §25). Since September 2009, an administrative regulation of the Federal Ministry of the Interior has been in effect, according to which the social welfare office is subject to “extended protection of secrecy” in this case . However, the practical implementation has major shortcomings. Hospitals are often left sitting on the costs and therefore many hospitals demand down payments from illegalized persons, who often cannot afford them, or turn them away.
- Practical Help
From the founding of Medinetz in 2009 until the establishment of our sister association CABL e.V. in the fall of 2019, the practical mediation of medical assistance represented a core part of our work. We offered a weekly consultation hour where people without health insurance could turn to us. We then referred them to doctors who had agreed to cooperate with us. Necessary medical treatments took place on a voluntary basis or were financed by the association through donations.
Since the foundation of CABL e.V., this work is no longer necessary on our part. With the help of an anonymous treatment certificate, people without health insurance can visit doctors of their choice and the treatments can be paid through the budget of the association. Medinetz supports CABL e.V. with the experience that the volunteers have gained in many years of working with patients.
If the clients wish to have a closer supervision, this can be taken over by the active members of the Medinetz. For example, we can assist in arranging medical appointments and, if desired, accompany the client to these appointments. - Political Initiative
CABL
Since the foundation of Medinetz in 2009, we were aware that our system could not remain a long-term solution for the medical care of people without residence status.
The care of an entire population group must not be shifted to voluntary actors. In order to return this responsibility to state hands, we have been working since the founding of Medinetz at the local and state level towards the introduction of a so-called Anonymous Treatment Certificate.
The anonymous treatment voucher is an approach to health care for people without residence status that has been discussed again and again for almost twenty years. Similar to the way in which the care of asylum seekers is currently organized in many federal states, a specialized office is to issue treatment vouchers to illegalized migrants, with which the treating doctors can settle the costs of the treatment. In this way, the legal right to health care, which people without residence status also have according to AsylbLG, is to be fulfilled (AsylbLG §1 Abs 1 Nr. 5). Due to the obligation of municipal offices to report according to §87 AufenthG, the allocation of treatment vouchers should take place in an independent institution, for example attached to a social counseling center. This center has a budget available through which the treatment costs can be settled. The vouchers issued are given a pseudonym, so that no personal data of the patients need to be disclosed at any point in the billing process. However, not only people without residential status, but all people without health insurance can make use of anonymous treatment vouchers.
As early as 2001, the working group “Poverty and Health” called on the federal government to examine the possibility of anonymously guaranteeing health care services for illegalized migrants and potential financing options. However, this proposal was rejected by the Federal Ministry of Labor and Social Affairs (Beauftragte der Bundesregierung für Ausländerfragen. 2002. Report of the Federal Government Commissioner for Foreigners’ Affairs on the Situation of Foreigners in the Federal Republic of Germany. Berlin and Bonn p.245). In the meantime, however, several German cities and states have succeeded in launching projects to issue the anonymous health insurance voucher. In Thuringia, for example, the association Anonymer Krankenschein Thüringen e.V. was founded in 2017 and has since been issuing anonymous sick certificates throughout the state.
In Leipzig, after intensive political work, a budget of €100,000 per year was approved in the budget for 2019/2020 at the request of the Green Party in the city council for the establishment of a clearinghouse for medical care for undocumented people
(https://static.leipzig.de/fileadmin/mediendatenbank/leipzig-de/Stadt/02.1_Dez1_Allgemeine_Verwaltung/18_Ref_Migration_und_Integration/Gesamtkonzept_zur_Integration/Broschure_VIELFALT_LEBEN.pdf – P. 36)
In cooperation with the health and social welfare departments, the association CABL e.V. (Clearingstelle und Anonymer Behandlungsschein Leipzig e.V.) was founded, which started its work in November 2019.
Since the beginning of its work, CABL e.V. has offered social counseling with the aim of integrating its clients* into standard medical care, and at the same time, anonymous treatment vouchers are issued in the consultation hours to finance outpatient medical treatment. Due to the low financial means, inpatient treatments can currently only be covered in individual cases and after prior consultation.
The aim of the association is now to stabilize the offer and to establish the anonymous treatment voucher as a means of settlement in Leipzig practices and pharmacies.
SABS
An Anonymous Treatment Voucher in Leipzig is already a great success, but many people who need medical support are not covered by the project. The establishment of CABL e.V. in Leipzig has created an inequality of treatment for people within Saxony that is not justifiable.
In 2020, an initiative of Medinetze Dresden, Leipzig and Jena as well as Medibüro Chemnitz has therefore been formed, which, following the example of AKST in Thuringia, demands a Saxon Anonymous Treatment Certificate (SABS) with a clearing offer, funded by the state. Especially in rural regions, support structures and networks, such as the Medinetze, are much weaker. This puts marginalized groups at an additional disadvantage. It is therefore urgently necessary to create nationwide services. As has been shown in Thuringia, such a project is practicable, promising and feasible.
Other political work
Even after the establishment of the anonymous treatment certificate in Leipzig, our political work is not over. On the one hand, the funding of CABL e.V. is not secured in the long term, on the other hand, the care that CABL e.V. is able to provide for people without health insurance is only an interim solution. For example, the association’s budget is far from sufficient to provide comprehensive care for its clients. In addition, anonymous treatment vouchers are significantly more costly and barrier-increasing than standard medical care in Germany. In the long term, the German healthcare system must be open to all people, regardless of passport or residence status.
We will continue to advocate for this politically, both at local, state and federal level. Concrete goals include the abolition or amendment of the obligation to notify public bodies (§87 AufenthG), to which the organization Doctors of the World has also committed itself (https://www.bundestag.de/resource/blob/816306/4b6f8e5608bd56520e8f498d1bb25bc0/19_14_0265-3-_Aerzte-der-Welt_Gesundsversorgung-data.pdf).
- Links
Flüchtlingsrat Leipzig
fluechtlingsrat-lpz.org
fr@fluechtlingsrat-lpz.orgmenschen-wuerdig – Kampagne für menschenwürdiges Leben & Wohnen auch für Asylsuchende
http://www.menschen-wuerdig.org/