When analyzing human rights violation incidents involving REAct project clients who are internally displaced persons (IDPs), it was established that clients from communities such as PLHIV, PLTB, PWID, and OST patients repeatedly faced violations of their rights to access medical care in their city of relocation. In this case, the perpetrators cited excuses such as lack of local registration, no general medical services contracts (Healthcare Services Declaration) entered into with family physicians, existing restrictions on services from specialized healthcare professionals, or came up with some other flimsy excuses.
Let’s look into what IDPs are actually entitled to in terms of health care rights, medical services, and assistance. Besides the Constitution, the primary regulatory framework here is established by the Law of Ukraine On Ensuring the Rights and Freedoms of Internally Displaced Persons of October 20, 2014 (No. 1706-VII). Article 9 guarantees that all internally displaced persons (IDPs) have the right to access medical care in state and municipal healthcare facilities, as well as to be provided with medication.
The law requires that local authorities organize the provision of medical care and services, implement comprehensive safety standards for public health and disease control as well as quarantine measures in the area where IDPs are actually residing. Local authorities are also obligated to ensure that healthcare facilities operate in a normal manner and provide the necessary assistance to IDPs, with due regard to the fact that they are residing in temporary accommodations in their respective areas. In state and municipal health care facilities, IDPs have the right to access diagnostic and treatment services for their health issues and concerns, basic testing and analysis procedures, palliative care, have their prescriptions filled under the Affordable Medicines program, and receive insulin, as well as undergo vaccinations in accordance with the vaccination schedule.
An internally displaced person residing within the relevant administrative-territorial unit has the right to contact the health care facility of their choice and file an application to its chief physician requesting that they be registered in the area where they are actually residing. For an internally displaced person, a certificate of registration as an IDP shall serve as documentary proof of their place of residence. If an IDP needs specialized medical care (oncologist, cardiologist, general practitioner, psychologist, pediatrician, etc.), then such a person may apply to the territorial health care facility situated in the city of relocation for referral to another medical facility that specializes in providing relevant services.
If an IDP wishes to sign a new Healthcare Services Declaration Form with a family doctor, they only need to contact the nearest outpatient care provider or primary health care center and present the following list of documents:
- Original passport or another identity document of the patient and/or their legal representative;
- Taxpayer Identification Number (original);
- If the Healthcare Services Declaration Form is intended for a child, be sure to provide the child’s birth certificate.
If an IDP wishes to receive a referral for specialized medical care services, but they have not signed a Healthcare Services Declaration Form with a family doctor based in the area where they are actually residing, they have the right to claim the referral from a family doctor working at the nearest primary health care facility that has an agreement in place with the NHSU. No new Healthcare Services Declaration needs to be released in this case! All you need to do is book an appointment and provide your data and the details of the family doctor with whom you have signed your Healthcare Services Declaration Form.
Based on the Guarantee Terms and Conditions, with the referral in hand, you can seek services from a doctor based in any region or healthcare facility that has an agreement in place with the NHSU for access to the appropriate service package. You can find the right specialist in a new area by calling the NHSU contact center at 16-77.
Please take special note: IDPs are entitled to free medicines when they are hospitalized, and the Affordable Medicines program is available for IDPs in pharmacies. Under this program, all prescription drugs for patients who need ongoing treatment can be obtained at any pharmacy free of charge. If the cost of the medications needed exceeds the price established by government regulations, they will be available at a small extra cost. For example, IDPs who require outpatient treatment for cardiovascular diseases, type I/II diabetes mellitus, diabetes insipidus, bronchial asthma, mental and behavioral disorders, or epilepsy can receive the medicines they need (that are included in the program) free of charge or at a small extra cost.
You can pick up your prescription in paper form from the doctor who provides primary health care, regardless of whether you have signed a Healthcare Services Declaration Form with them! IDPs living with HIV have the right to access ART free of charge in the area where they are actually residing. Similar regulatory guarantees are applicable to IDPs with TB in regard to accessing TB treatment. In order to receive their free medicines, an IDP is required to see the appropriate doctor (general practitioner, pediatrician, or family doctor), pick up their prescription, and then bring it to a pharmacy marked with the Affordable Medicines program participant’s logo.
If a doctor or a health care provider violates the rights of key populations with regard to access to medical care or refuses to provide medical assistance, a complaint should be filed with the head of the health care facility in question. It’s best to file a written complaint with the chief physician (medical director), i.e., the person in charge of the health care facility, about the unlawful actions of the medical practitioner or other medical staff involved (this is only the first step but it’s often sufficient and takes care of the issue at hand). However, if the violation has not been fully corrected or has been corrected only partially, the person concerned can also undertake the following steps:
- File a complaint with the local Department of Health in the relevant city or region;
- File a complaint via the Ministry of Health Hotline at 0800 60 20 19 or with the NHSU (National Health Service of Ukraine) at 16-77;
- Call in your complaint via the Government Hotline of the Cabinet of Ministers of Ukraine at 15-45.
Based on the experience of the REAct project, the above measures aimed at protecting IDPs’ rights to health care and medical assistance can be effective in eliminating human rights violations and ensuring access to proper medical care and treatment.