Sofia is out of breath, again.
Breathing freely is never easy for the 60-year-old grandmother – she relies on inhalers to manage her chronic lung disease – but lately even a gentle walk has been causing her to wheeze. Earlier this year, Sofia was found dazed in the bathroom having coughed up blood. She spent several days in hospital on a ventilator before the diagnosis arrived. Lung cancer.
For Sofia*, a Covid vaccine could be the difference between life and death. But she has been told by the authorities in Galicia, northern Spain, that she is not eligible.
“They’ve said I can’t get vaccinated because I don’t have a health card,” Sofia says, pressing a tissue to her cheek. “But I think that I’m at risk. One of the nurses told me it’s because of bureaucracy.”
Sixteen years ago Sofia fled persecution in Venezuela, a nation with 5.4 million refugees and displaced migrants around the world, and is now among Spain’s many personas sin papeles, or undocumented migrants: she lives in the country but lacks vital paperwork.
To be eligible for vaccination, people in Galicia must show a health card, which in turn requires proof of residence. Other autonomous regions in Spain have their own requirements, such as the presentation of a national identity number or a passport. While 74% of Spain’s official population of 47 million has received at least one dose of a Covid-19 vaccine, the country’s undocumented migrants – estimated to be as many as 470,000 people in 2019 – are being left behind.
Even a first dose would give Sofia enormous relief. But without the right paperwork, the jab remains out of reach.
Sofia’s story is not uncommon. The Bureau of Investigative Journalism can reveal that administrative barriers in at least 10 European countries are blocking access to Covid-19 vaccines for nearly 4 million undocumented migrants.
Countries including Germany, Spain, Norway and Bulgaria require some form of ID, health card or a residency permit. In Hungary, Belgium, Slovakia and Greece, vaccinations are officially available only to people with a social security number.
At the start of its vaccination campaign, the Netherlands only offered jabs to people with a registered address and a government-issued invitation letter. In Italy, a basic technical error has hindered vaccine access for 500,000-700,000 non-EU migrants without official paperwork. Despite each having been issued with a number to access essential healthcare, there is nowhere on the online registration form for them to enter it. The few regions that attempted to address the problem have had mixed results: in Lombardy, for instance, it can take several attempts before the system recognises the code, and even when it does, people often do not receive the expected text message with the time and place of their vaccination.
The UK is home to an estimated 1.2 million undocumented people. Anyone is allowed to get a Covid-19 vaccine as long as they have an NHS number or are registered with a GP, which does not require any specific paperwork. However, a recent investigation by Bureau Local found that less than a quarter of city GP surgeries surveyed across England, Scotland and Wales would register someone without proof of address, proof of ID or legal immigration status.
Vaccines are available in the above countries – almost all have fully vaccinated at least 40% of their populations. But while their national inoculation plans often say that migrants are entitled to the vaccine, the reality has been a story of frustration, fear and red tape.
In June, the EU agency that oversees Europe’s defences against infectious disease urged governments to recognise that undocumented migrants “face barriers to European health and vaccination systems on arrival or are excluded due to a lack of entitlement to free healthcare”.
Members of migrant communities tend to be especially likely to contract coronavirus, often because they live in crowded, poorly ventilated conditions and work in jobs that cannot be done remotely. Without general access to basic medical care, it is common for undocumented migrants to develop underlying conditions that go untreated and could leave them more vulnerable to infections. It is unsurprising, then, that migrants are disproportionately likely to die from Covid-19.
In Germany, jabs are technically available only to those with a residency permit. A joint committee of the six major welfare organisations in Germany has criticised the German government for offering undocumented migrants insufficient access to Covid-19 vaccines.
Without a health card – obtained via official papers – undocumented migrants will be turned away from most GP surgeries and hospitals. They may be told to try the benefits office, which supplies vouchers to reimburse medical costs in exchange for personal information. But their details will be logged and sent to immigration authorities and border control – who will likely deport them.
This absence of a “firewall” between the health service and immigration authorities compounds an already difficult situation for Germany’s undocumented migrants – of whom there are up to 1.2 million – who maintain a fraught relationship with wider society.
A firewall is essential in preserving the very different goals of the health service and immigration forces, said Jacqueline Weekers, the director of migration health at the International Organization for Migration. “Public health authorities must take into account years of widespread discrimination and criminalising policies that may have eroded the trust of migrants in irregular situations, leading them to avoid seeking healthcare for fear – and actual risk – of arrest or deportation.”
“What we have in Germany – the opposite of a firewall, basically – is implemented to find people who are hiding,” said Christoph Krieger, a sociologist and head of a refugee camp in the northern state of Schleswig-Holstein. “The distrust between the authorities and migrants is huge.”
Krieger also volunteers at Medibüro in Kiel, northern Germany, one of about 40 NGOs across the country working to ensure equitable healthcare access for undocumented communities and people without health insurance. Their network of health workers, regional authorities and migrant communities is largely held together by what he calls “a system of trust”.
“I doubt that every undocumented migrant [will find] a way to a coronavirus vaccination. That’s nearly impossible, because it’s so complicated and you need to find someone you can trust, someone who will help you,” Krieger said. “In many places, you’re lost if you don’t have anyone who pays for you or gives you the treatment of [an NGO].”
In Belgium, Lily Caldwell is working with four NGOs to vaccinate 5,000 homeless undocumented migrants in Brussels. So far, her team has given 1,400 one-dose vaccines. One of them was to a man living in a Metro station who was afraid to stray too far in case the police took away his mattress and bags. Caldwell vaccinated him next to a car while a colleague watched over his belongings.