Telling people that they will probably have to sleep on the streets tonight is always difficult

Vluchtelingen wachten voor poorten Klein Kasteeltje

This week the crisis continued. Every day we met more people who were denied accommodation and left to sleep on the streets. One of the hardest things about our job has thus become telling people that we cannot find them accommodation.

I find myself half-heartedly telling people about other organisations trying to give them information but at the same time warning them that these organisations are experiencing extreme pressure at the minute and that their chance of getting a place is slim. I sometimes wonder how many people actually get through to the emergency numbers as any time I have tried to call on behalf of somebody else, I’ve failed.

After listening the repetitive la-la-la of their hold tone for several minutes, three or four times, I have concluded that it was not possible and told the person they would have to call again later. I’ve also wondered what people do if they call for the first time and do not speak French – do they know to stay on hold – do they understand that they should call back several times due to the ‘large volume of calls currently being received?’

Telling people that they will probably have to sleep on the street tonight is always difficult. They know looking at me that I do not really understand the gravity of my words even if I mean good. Nonetheless, this situation is even more challenging when the person we talk to is clearly a vulnerable case. We had two such cases this week, neither of whom we were able to help on the day we met them.

"Telling people that they will probably have to sleep on the street tonight is always difficult"

The first such case that we met was that of a Palestinian who had already undergone several surgeries before fleeing. The scars that ran across his forehead and skull, clearly mapped out his surgeries, each one a tribute to the lack of supplies and spontaneous power cuts experienced by Palestinian health care system. His scars were neither thin nor straight. It was clear that for one reason or another his surgeon was not able to stitch him up in the way we would expect a European surgeon to do in the age of microsurgery and grafting. Despite the fact that his vulnerability was clearly visible and that he had brought with him several documents attesting to his numerous health issues, this man was sent outside with a slip of paper telling him to send an email to Fedasil to join a waiting list.

Our team really tried to advocate on this man’s behalf but ultimately, it was too late in the afternoon. He had no choice but to come back the following day. I’m happy to say he was allocated a centre the next day but, ultimately, this was not good enough. The question of whether or not he will be able to get the surgeries he needs in Belgium is also not answered. As this man talked to my colleague, I learned that he had considered applying for asylum elsewhere in the European Union but had decided to come to Belgium after discovering that his surgery would not be covered there and that it would cost €60,000. An astronomical amount that most middle-class Belgian families would struggle to pay never mind somebody fleeing conflict who is currently living in the State without a source of income.

A few days later we met another man, this time from Afghanistan, in a similar situation. The entire right side of his body had been damaged in an accident. He walked with a severe limp and could not lift his right arm. After failing to get him a place to sleep, he tried to shake my hand to say thank you. To do this he had to lean against a wall for balance and use his left hand to lift up and rotate his right hand into position. He then used his left hand to gently rock his right hand up and down. After our handshake, he let go of his right hand and it fell suddenly by his side, swaying gently at first before falling limp. He could not walk easily with his small carry-on suitcase so one of our volunteers had to escort him to the train station. I am not sure how anybody expected this man to be able to write an email and then spend weeks, maybe even months, in precarious living conditions waiting for a centre.

This man’s vulnerability was so evident that even the security guards at the gate of Klein Kasteeltje, tried to advocate on his behalf. One of the security guards was so frustrated by the situation that he told the man to come back in the morning and that he personally would advocate to his colleagues on behalf of the man. This was a security guard who has seen countless people being turned away from the gate, including women and children and remained calm, yet, he was shocked by the injustice of this man’s case. He told us that sometimes he can have a ‘cold heart’ but that this man was a ‘cripple’ so he had to try do something to help him.

"He told us that sometimes he can have a ‘cold heart’ but that this man was a ‘cripple’ so he had to try do something to help him"

Both of these men needed access to medical assistance and denying them access to the reception system makes accessing the care they need more complicated, even if they are still entitled to free healthcare, assuming it is necessary.

Under the European Social Charter, everybody in the European Union, including people living without papers, has access to urgent medical care, but most countries do not define urgent meaning the right to healthcare for non-nationals can often be complicated and subjective. In Belgium, applicants for international protection are granted access to the health care system though Articles 23, 25, 30 of the 2007 Reception Law. This law works in conjunction with The Royal Decree of 19 April 2007 which classifies medical treatments into two lists – the plus list and the minus list. If a treatment is included on the plus list, it is considered medically necessary, and as such, it will be fully reimbursed and the applicant for international protection will not have to pay anything out of pocket. However, if a treatment features on the minus list than the opposite is true. It is not considered necessary and it will not be reimbursed, leaving the applicant for international protection liable for the entire cost.

Moreover, applicants for international protection are not integrated in the compulsory national health insurance scheme for Belgian citizens. This often results in differences in the quality of healthcare provided to applicants. This can be particularly disruptive if an applicant is moved from a reception centre in one region to another or if the applicant chooses to move to a different region after being granted international protection.

Understanding this system and the differences between the plus and minus lists can be quite complicated for newcomers particularly if they do not have access to the internet or speak one of the official languages of the State. Access to healthcare is therefore more straight forward for those living in a reception centre. This makes the fact that vulnerable men are being sent to sleep on streets even worse. In reception centres, the medical service team coordinate medical services. There are often salaried nurses working for the medical service team and external practitioners and psychologists consult the centres regularly. The medical service team can also refer applicants to external services if they consider it to be necessary.

"This makes the fact that vulnerable men are being sent to sleep on streets even worse"

In contrast, applicants with a code 207 ‘No Show’, i.e. those applicants who are not staying in a reception centre, must organise their own healthcare. They must also fill out a form in order to get a payment guarantee from the medial unit at Fedasil before visiting a medical professional. In the case of surgeries, the medical unit has the right to request a medical report and cost estimate to determine whether or not the surgery is necessary and can be covered. If an applicant does not get a payment guarantee from Fedasil, then they must get a certificate from their healthcare professional stating that the procedure was necessary, otherwise, they will be held liable for all costs.

This ultimately means that applicants, who are denied a centre, face additional administrative obstacles in order to access healthcare. The fact that they are living on the street and may not have access to Wi-Fi to send emails to Fedasil and may not have the linguistic skills to access important information about the procedure, such as the need to get a payment guarantee in advance, should not be overlooked.

The other side, is that if vulnerable cases are forced to sleep on the streets, then the probability of their medical vulnerabilities increasing is extremely high, particularly given how cold and wet it is, in Brussels, at the minute.