Dr. Fiona O'Reilly:

I thank the committee for welcoming us this afternoon. Safetynet Primary Care is a medical charity providing primary care and health screening to marginalised groups within society. We work to address the gaps between what vulnerable groups need healthwise and what is provided by mainstream services. The gap is a reflection of priorities in society and is ever changing.

The emphasis of our work has changed from almost exclusively providing care to people who experience homelessness to a new position whereby half of our work is being targeted at who we call the global homeless. In a globalising world, where the arbitrary borders defining countries are not proving as effective at containing destitution and persecution as they were in the past, migrants are increasingly becoming a part of Ireland’s present and future and, therefore, need to be included in our health and social service planning. However, where migrants are made vulnerable because of structural barriers imposed through systems and services designed for and by the non-migrant population they can and do suffer. In this way, we as a host country miss an opportunity to reap the economic and social gain. This is where we are at now.

The category of migrants Safetynet encounters, who have high needs and low service levels, include the Roma, protection applicants, who are asylum seekers, and those who end up in homeless services. The situation is complicated when there is no eligibility to social protection or housing, no access to GPs even with eligibility and no interpreting services are available. Pre-migration experiences can leave people with a complete distrust of authority and a lack of confidence in health systems. Navigating health services can be very difficult without literacy or digital literacy. The medical card application process is extremely labour intensive and bureaucratic. It requires people to be taken on by a GP before they can apply for a medical card. Transient addresses and people moving around and being moved around means follow-up medical care is not possible.

Our recommendations involve reversing the structural barriers. Protection applicants should have access to medical care and assessment immediately on claiming asylum. The Roma specifically are very disadvantaged. My colleague, Dr. Skuce, will speak more about them. The systems for engagement with State bodies, health and social services are outdated. They have been designed or have evolved to cater for the needs of a homogenous population born and bred in Ireland, who speak English and who are culturally similar. Access to interpreting so that engagement with State bodies is possible should be mandatory. Our systems and services require future-proofing for the multicultural society we are fast becoming. Largely, people come to Ireland to make a better life, to work and to be healthy and happy. Structural barriers make them vulnerable.