Europe’s Newest Patients: Why Women Need Specialized Healthcare

报告

women talking

Imagine a woman. She is in her early 30s. She is married, and a mother. She knows what she needs: an annual gynecological exam and effective contraception. She can easily get those things for free at a doctor’s office near her home, and she has for all of her adult life.

She lives in Syria.

When that same woman leaves her country because bombing as a consequence of civil war has destroyed most of her town, she discovers that the basic healthcare she counted on at home is far from standard around the world.

In Greece, she is sexually assaulted by a trafficker, and worries that she’ll be deported if she seeks medical care.

In Italy, a doctor tells her that his religious views prohibit him from prescribing birth control.

And in France, she discovers that there are no interpreters available to help her explain to a doctor what she needs.

These are real stories told to health advocates by real women who leave their homes to seek safety in Europe. In some cases, a woman might experience just one of two of these scenarios. But often, she experiences all three – and many more. For many people on the move, the journey away from home to seek asylum means leaving a place of relative stability – however impoverished or changed by violence – to enter a volatile process fraught with uncertainty and, often, trauma.

Basic healthcare, once a routine part of life, becomes a luxury.

“The priority is to find where to sleep, how to give food to your children,” says Adeline Grippon, who manages a health and social services center with Médecins du Monde (in English, Doctors of the World) in Seine Saint Denis, a Paris suburb.

There are no free handouts for people seeking asylum. Even housing and food, once all but guaranteed for asylum seekers, is hard to come by. It can take months for a family to be matched with a single hotel room, Grippon says. People are always on the move, often landing for a few nights at a time in informal encampments that are routinely cleared by police.

Grippon was a health advocate in multiple African countries for years before she returned to France.

Still, she’s startled by what she sees in her own home country.

“In Africa, we had better follow-up of our pregnant women that we do here with women who live near Paris,” she says.

The 4-Women Project

woman smiling
Photo: A.Finistre/H. Lucas

Médecins du Monde operates in more than 70 countries, providing emergency and ongoing medical care for people who would otherwise struggle to find it. In more than 40 years, the organization has sent health professionals of all kinds into some of the world’s most tense situations.

Teams of doctors rotated in and out of Afghanistan in the early 1980s, when a Soviet invasion sparked widespread instability. For indigenous people in Brazil that same decade, contact with settlers and loggers brought serious health problems, so Médecins du Monde responded with an emergency vaccination program. It supported anti-apartheid medical workers in South Africa, HIV/AIDS care in Romania, mental healthcare in Rwanda shortly after a genocide ended there and post-typhoon emergency care in the Philippines.

These and many other projects were supported by administrators in France, where Médecins du Monde is headquartered.

But over time, the nexus of global crises shifted. Patterns of human migration expanded. Rickety boats overcrowded with people have always navigated waterways in certain regions, but suddenly, such boats set out into the Mediterranean Sea like never before, as numerous as the waves that lap against the coastlines of Greece and Italy.

Fewer than 10,000 people categorized as refugees or migrants arrived in Europe by sea in 2010, according to data collected by UNHCR, the United Nations’ refugee resettlement agency. In 2015, land and sea arrivals topped 1 million.

Aid agencies worked quickly to respond to this ever-changing crisis. Médecins du Monde launched healthcare programs at first in Italy and Greece, then expanded to multiple European countries as people traveling from Afghanistan, Bangladesh, and many other places pushed northward.

Legally, newly-arrived people in most European countries are entitled to medical services. In Italy, for example, a registration process that includes access to a doctor is supposed to happen immediately. But in reality, that process can take up to nine months, says Eve Derriennic, a Paris-based desk officer with Médecins du Monde who has worked extensively with people recently arrived in Europe.

In every case, women on this northward journey are in the minority. On average, they’re outnumbered by men two to one by the time they formally seek asylum. In many cases, they account for fewer than 10 percent of the people in need of services.

“In an emergency situation, most of the activities target the 90 percent,” Derriennic says.

Most donors who fund work like that of Médecins du Monde want to target the largest number of people as possible. It’s difficult to find the money for specialists who focus on women, such as obstetricians, Derriennic says.

Médecins du Monde’s goal isn’t to replace a local health system, but even the women who are able to register for health services in Italy are often unable to get the care they need. It’s not unusual for a woman to be pregnant, as a result of rape, by the time she lands in Europe, Derriennic says.

In Greece, Derriennic says, women who were accustomed to easily-available contraception in their home countries often couldn’t find it at all.

“We knew this was a gap in our intervention, but we never had enough time or enough resources to develop a real answer to their specific needs,” Derriennic says.

That changed when Fondation CHANEL began funding Médecins du Monde in 2016 to create the 4-Women Project, which supports services specifically for women who lack any form of legal residency in Croatia, Italy, Greece and France. In just one example, a Médecins du Monde site in Greece used Fondation CHANEL funding to bring on a gynecologist and a midwife. In other areas, Médecins du Monde brought on cultural and health mediators.

In addition to funding site-specific programs, Fondation CHANEL support also enables Médecins du Monde staff to visit one another’s sites in order to create a globally-cohesive strategy of care for vulnerable women. Health and social workers who are skilled at counseling women who are considering abortion can now provide training on that topic to colleagues around the world. Emergency response protocols for domestic violence might require special considerations depending on where a woman is from. Now, Médecins du Monde team members can implement best practices in multiple countries.

“We’re able to focus on the women’s specific needs,” Derriennic says. “That’s the real added value of the CHANEL grant, because no other donor has that focus.”

 

 

 

 

Women Matter: The Impact of Gender-Specific Care

women and child
Photo: A.Finistre/H. Lucas

The COVID crisis was still in full force one morning in early April of 2021 when Adeline Grippon opened the doors of CASO, a Médecins du Monde-run social services and health clinic in the Seine Saint Denis suburb of Paris. (In French, CASO is an acronym for Centres d’Accueil de Soins et D’Orientation. In English, that’s Reception, Care and Orientation Center).

Outside, she found about 40 people waiting for her. Some had minor medical issues that needed attention. One pregnant woman, accompanied by her toddler, asked about prenatal care. Five or six of the people in line wanted help establishing a postal address to receive mail – a key step in establishing a formal asylum case.

Among the people in line that day was a government official, bearing a hospital bill for 4,500 Euros, addressed to Médecins du Monde’s CASO. A woman who had received some services at CASO gave birth in a local hospital, even though she wasn’t yet a recipient of France’s social service programs.

“This guy came to announce that there’s a legal case in process against this woman,” Grippon says. The next step in the process was for the woman’s wages to be garnished.

“But the people we work with don’t have a salary, or even a house,” Grippon says.

If the woman had brought her bill to CASO shortly after the childbirth, Grippon says, CASO’s social workers would likely have been able to get the hospital to classify the woman as someone in limbo: still in line to get the free medical care to which she’s entitled under French law. The bill would have disappeared, Grippon says.

Once that bill is in the hands of the state, though, it’s nearly impossible to get rid of it. And there are long-term, sometimes crushing consequences. If the woman applies for asylum, she might be rejected purely because she has a bill on record that she didn’t pay.

“Treating people is one thing,” Grippon says. “But the hardest thing is to explain their rights and help them get them.”

Fondation CHANEL’s funding means that Médecins du Monde can have experts on staff at CASO who work specifically with women, like the one with the hospital bill. There is a social worker, a health mediator and a field coordinator, as well as Grippon herself. Those staff members coordinate the 80-odd volunteers, most of whom are doctors and nurses, including mental health professionals, gynecologists, midwives and more.

CASO provides services for roughly 6,000 people every year, Grippon says. She estimates that number could easily balloon to 9,000 people every year, if there were more space in the center.

 By the time many of the people who need help find it at CASO, they’ve experienced significant trauma, says Dr. Alain Benet, a retired general physician who has volunteered at the center for the past decade. A person from Mali, for example, likely has crossed the Sahara Desert before being imprisoned in Libya and then shunted onto an overcrowded boat for a dicey trip across the Mediterranean Sea. Humane treatment, for most people in that scenario, beyond expectation – and women often bear the worst of it.

“The number of women who experience sexual abuse is well over 50 percent,” he says through an interpreter.   

Most people Benet sees at CASO hope to get a basic medical check. They’re highly motivated, he says, full of energy and eager to be strong and healthy so they can work hard and find success.

Some, though, have serious medical conditions – cancer, heart disease or chronic illnesses – that require ongoing care. For those people, Benet does what he can to help them secure a temporary immigration status in order to get the medical treatment they need.

That’s often a long shot, he says, but the effort sometimes pays off.

As a young doctor, Benet dreamed of working in clinics and hospitals in Africa. Now, especially as a volunteer for Médecins du Monde, he’s fulfilling that dream in an unexpected way.

“I wanted to work in Africa, but instead the Africans came to me,” he says.

Benet continues to treat patients at CASO even as the number of volunteers has dwindled due to the COVID-19 pandemic. At the same time the number of emergency requests from people newly-arrived in Europe for food and shelter has shot way up. These days, Grippon says, about half of the people who come to CASO, many with families in tow, are looking for a place to sleep. Médecins du Monde doesn’t operate any shelters.

“We can give them a place to rest for a while, we can help explain the process for seeking asylum,” she says. “We can’t help them fill out the documents, but we can explain how it works.”

From there, she says, the family must head out again, to continue its search for home.

 

K. Karch
Reporter for Fondation CHANEL