France. URMED is organizing to make it illegal to deport people who are gravely ill

By Djouher Ould Méziane (URMED Solidarité, France)

Sick and tired but fighting

Across Europe, many AIDS organizations, many communities, see the urgent need for putting the health care of the so-called "illegals" on the political agenda, but are at best unsure of how to take on this fight, at worst unwilling to defend publicly the health rights of those most in need of them. URMED Solidarité has tirelessly taken up individual cases while building long-term support for a collective, political solution : a new law to protect from deportation people who are gravely ill.

In France, a person who is no longer legally resident in the country (situation irrégulière) must be taken in by a hospital. The right to health care is recognized for anyone who is sick, and a public hospital has an obligation by law and because of medical ethics to take in sick people.

Article 186 of the Family and Social Aid Law guarantees access to what is called free medical aid (aide médicale gratuite hospitalière) in the hospital. Any person who can prove they have lived in metropolitan France for at least three years can also benefit from medical aid at home (aide médicale à domiçile) which means they can see a doctor outside of the hospital and go to a chemist to buy medicine.

This legal framework may appear to be sufficient to guarantee the right to health care of undocumented immigrants in France. After all, it means that French law, on paper, places the right to health care above any immigration restrictions.

From the vantage point of other countries which do not even have this basic recognition of the right to health of "illegals", this may appear to be satisfactory. Unfortunately, the real problem is that there is no legal protection from deportation for foreigners who are undocumented and who are affected by serious illness. Illness is not mentioned in the existing legally-defined categories of those protected from deportation.

French social security law defines a list of 30 serious illnesses (pathologies graves). URMED’s case work and organizing encompass all of these, not only HIV/AIDS.

Any restriction today of immigrant rights may tomorrow become a violation of the rights of others : gays, drug users, delinquents, prisoners, homeless, those who are too sick or too old.

In Europe, the consequences of applying the business model to health care has already restricted the right to health, as has happened most clearly in the UK.

French society faces the choice of either maintaining an egalitarian system based on collective solidarity - the only model which can sustain public health - or to slide into a two-tiered health system which privileges the wealthy - French or not - and neglects the poor.

Deportations most often send sick people to Third World countries which do not have the infrastructure, the medical personnel, or the medicine of the rich countries. It is politically incoherent and ethically injustifiable to deport sick people to poor countries while at the same time proclaiming publicly the need to support development and humanitarian aid to these countries.

Deportation has very grave consequences for the person deported. In fact, in many cases it is the equivalent of a death sentence, often in cruel and inhumane conditions of solitude, for example in the cases of young people who have grown up in France and whose family and social ties are in France. It is clear that the course of any grave illness is closely tied to the psychological and emotional conditions of the person who is sick.

Deportation of someone who is already gravely ill or who will become sick constitutes a failure to assist someone whose life is in danger. It is a clear violation of article three of the European Convention of Human Rights which states that "no one should undergo torture, nor should they suffer from inhuman or degrading treatment." The UN Convention on the Rights of Children also states that signatory Members States must ensure that children are not separated from their parents against their will.

Minors, who are protected from deportation by law, end up separated from their parents and become wards of the State (Some have used this to argue in favor of removing legal protection to allow deportation of children along with their parents!). Partners with French nationality or with legal residency find themselves separated from their companion.

Today in France, when an undocumented foreigner is gravely ill but is not deported, they are usually granted temporary leave to remain in order to obtain care (the APS, or autorisation provisoire de séjour, is an administrative status with no backing by international law). Often they are placed under house arrest. On the average, leave to remain lasts for three months before it must be renewed. In most cases no work permit is granted, which also means that the person has no right to social security. It is a real paradox to grant three-month permits for grave illnesses like cancer or AIDS, as a serious pathology is by definition one which has no cure.

In addition to the precarious nature of temporary leave, it often takes several months until a decision is made concerning a specific case, and there is no certainty about the outcome of the request for regularization of status.

This situation is intolerable for the immigrant solidarity and aid organizations, for they find themselves with very few answers to the distress of sick, undocumented foreigners in France.

Obtaining free medical aid is a veritable obstacle course, with administrative barriers at every turn. The right to this medical aid is very often denied or trampled upon. URMED has to intervene regularly for this right to be respected.

Delivery of temporary leave to remain is no solution, even if gives people who obtain it a little breathing room. Deprived of their rights, the living conditions of undocumented foreigners who are suffering from a serious illness are both inhuman and degrading : poor housing, malnutrition, coercion, fear of identity checks in the streets...

In addition to these living conditions, as they cannot even assert the few rights they do have, they are at the mercy of swindlers and other "torturers" of all kinds, as the stories told by some of the people attest. For example :

• L., a young Moroccan woman, is HIV positive and undocumented. Her partner, who is French, battered her regularly.
• S., a young woman from Burkina Faso, is HIV positive. She was raped repeatedly by the same group of men.
• M, an Algerian man living with AIDS worked 14 hours a day for 2000 Francs a month. He was exploited by an unscrupulous boss obviously unconcerned about his health.

Faced with such situations, immigrant and immigrant aid associations, came together with AIDS and other health organizations to brainstorm possible solutions in the early 1990s. A group gathered under the auspices of the AIDS section of the Direction générale de la Santé (health ministry). From these initial discussions was born the collective ADMEF, the Action for the Rights of Sick Foreigners in France.

ADMEF, composed of 35 organizations, was a six-month project launched in June 1994. Its objective was to obtain a modification in the law granting protection from deportation to any foreigner who is gravely ill - regardless of residency status. ADMEF’s demand was for those individuals to receive a 10-year residency permit.

ADMEF also centralized, for the few months of its existence, the case work. In six months, the group filed over 400 requests for "regularization" of the legal situation of gravely ill immigrants. Strong networking and immediate response to individual cases allowed ADMEF to stop many sick people from being taken by the police to the border for deportation.

During that period, ADMEF also lobbied the government and the media.

This action ended in December 1994, when ADMEF was scuttled by the majority of its member organizations. Five organizations which sat on the ADMEF’s working committee decided to continue the work initiated by ADMEF, this time in a new collective. After all, the objectives of ADMEF were still far from being achieved.

In January 1995, AIDES, Cimade, the Comité national contre la Double Peine, the MRAP, and Sida Info Service founded URMED Solidarité.

URMED Solidarité set no time limits for achieving its objectives of pursuing the campaign begun by ADMEF. In almost two years of work, URMED has unrelentingly taken up individual cases while at the same time doing the research and the political work necessary to draft a proposed law meeting its objectives.

URMED has published a detailed report documenting all of the known cases taken up by ADMEF, URMED, or other organizations. The report outlines the main arguments in favor of a law to protect foreigners who are gravely ill from deportation, and responds to underlying questions such as : Is it possible to adopt new legislation to protect foreigners who are gravely ill from deportation and to grant them leave to remain to obtain health care, without encouraging a new wave of immigration ?

To this question, URMED points out that new arrivals are improbable at best, given the overal political climate which has tighly shut France’s - and Europe’s - borders through draconian visa restrictions, dissuassion by OFPRA (France’s refugee office) by massively rejecting asylum claims, hardened border controls against illegal immigration, multiplication of identity checks, and the Schengen acords which reinforce controls at the Schengen borders and have put in place the Schengen Information System.

Speaking directly to such issues, URMED decided, was indispensable in order to be able to defend URMED’s demand of an important modification of existing law.

As for the case work, URMED has vigorously sustained efforts to file applications for leave to remain and to make sure that individuals have access to the health and other benefits which they are entitled to. URMED’s interventions have proven effective in stopping deportation, but the results are still far from satisfactory and demonstrate the importance of a collective solution set by law.

The coordination between the different organizations involved in URMED has allowed collective action to mobilize rapidly around specific cases to effectively to stop deportations.

URMED’s organizers, of very different backgrounds, have learned to share their experiences and to bring together diverse skills for both the case work and the political objectives. Close collaboration and solidarity between member organizations has made it possible for URMED to broaden and strengthen the response to the specific problems of individuals seeking support.

URMED’s work began in and around Paris, but work also needed to be taken up outside of the capital. Also, the issues needed to be addressed publicly at the national level, as lobbying had to include politicians and journalists at the local level throughout France. Today, the first regional URMED collective is being launched in the PACA (Provence Alpes Côte d’Azur) region of southern France.

If we were to take stock of URMED’s experience today, we would say that it has been very important - and remains so - to continue to make visible the situation of gravely ill immigrants who are undocumented in France, to inform and to sensitize the public about the distress of these people.

URMED has allowed many health and social workers to benefit from its research and its skills. It has provided in-depth information which was sorely lacking and whose absence considerably slowed individual demands from being acted on.

URMED’s case work makes it clear that legislative change is necessary. The reality is that no long-term solution has been found for any of the individual cases taken up. This is just as clear as the fact that the only chance undocumented people have of obtaining decent health care is to have their case taken up publicly and politically.

Many undocumented immigrants, despite being seriously ill, are still deported, often without the knowledge of the immigrant aid organizations. Although it is clear that support from organizations improves the chance of finding a solution, having one’s case taken up does not by any means guarantee protection from deportation.

It is essential to demand tirelessly a modification of existing legislation by the government. This is the only alternative to a case-by-case approach whose arbitrary nature can cause grave injustice and create two categories of undocumented, gravely ill immigrants. For example, the people who are sick but who have served a prison sentence would still be deported (this is the Double Penalty) to what is, according to their papers, their "country of origin" but where, very often, they have never been to, were not born in, and do not speak the language of. Disease does not discriminate. M

Photo : Double Peine. On 1 February 1992, AIDS and Double Penalty activists took to the streets to protest all deportations. (photo : agence IM’média)