When Jaakko Kivisaari, a public healthcare centre physician, reached retirement four years ago, he decided to continue using his professional skills by working as a volunteer in Turku at Global Clinic, an organization that provides free healthcare services to undocumented migrants.
The number of undocumented migrants in Finland is expected to double this year, increasing pressure to provide public health services beyond they emergency care to which they are entitled
"My thought was that undocumented migrants are the kind of people who are otherwise treated badly by society. So, let's at least try to offer them some humanity," Kivisaari explains.
In addition to Turku, Global Clinic operates in Helsinki, Tampere, Oulu, Joensuu and Lahti. All of its workers are volunteers, healthcare professionals who work free-of-charge for their time and effort.
Limited right to care
Most undocumented migrants in Finland are asylum seekers whose applications for asylum or residence were rejected, but who have decided to stay anyway.
Some are students, workers, or travellers who have overstayed their visas. One significant group are also members of the Roma community from Eastern Europe.
The Finnish constitution guarantees everyone the right to health and well-being. For undocumented migrants, however, these are limited rights. Generally, they are provided only emergency care by public healthcare services. This means treatment for conditions that are life-threatening or imperil long-term well-being.
Some cities have, though, decided to provide more than emergency healthcare services to undocumented migrants. The City of Helsinki has gone the furthest. In November 2017, Helsinki expanded offerings to include services such as inoculations and care for chronic conditions.
Helsinki, Espoo, Vantaa and Turku also offer more than just basic services to minors and expectant mothers.
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Jaakko Kivisaari would like to see undocumented migrants guaranteed a significantly broader range of health services, and to see this right written into law.
"I believe that there would be less incentive to radicalization if society would show some neighbourly love to these people in such desperate straits. It should be shown that this is not a cold, hard society," says Jaakko Kivisaari.
The other side of the coin is that research has shown that providing expanded healthcare services to these groups of people cost society less in the long run than making only emergency services available.
"It would be both a sensible and cost-effective health policy. Providing treatment in time is cost-efficient," points out Meri Korniloff, a coordinator for the group Physicians for Social Responsibility.
Twice as many this year
According to a University of Turku study, there are an estimated 2,000 - 4,000 undocumented migrants living in 42 different towns and cities in Finland. Most live in Helsinki and its immediate surroundings, and in Turku.
Katri Gadd, a Ph.D. project researcher at the University of Turku estimates that the number of undocumented migrants will double this year as large numbers of asylum seekers who arrived in Finland in 2015 get final rejections of their asylum applications.
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"Undocumented immigration has become a permanent phenomenon in Finland. It has not been possible to eliminate it from any democratic country, anywhere," says Gadd.
According to Katri Gadd, there is uncertainty in Finland about how to deal with undocumented migrants. For example, municipalities would like to see some sort of guidance from the central government.
Jaakko Kivisaari agrees.
"The situation would be clearer if there were national legislation. Right now, there is a lot of uncertainty among municipal healthcare personnel about what the rights of undocumented immigrants are," notes Kivisaari.
Finland came close to passing a law on arranging healthcare services for undocumented migrants three years ago.
In 2014, the National Institute for Health and Welfare THL issued a detailed report on how these services should be organized and expanded.
Under the draft bill that followed, undocumented immigrants would have been eligible for the same healthcare services as are asylum seekers.
Before the bill could be brought to parliament for debate, it was tabled and in effect killed at the initiative of SDP member Kari Rajamäki.
Rajamäki came in for sharp criticism from his own party and from within government ranks. He defended the move by arguing that it had been in the national interest because improved healthcare services would have lead to "health tourism".
"There is no scientific evidence that a law on health services for undocumented immigrants would have spurred any kind of immigration flow here or widespread [undocumented] residence in Finland," says Katri Gadd of the University of Turku.
Psychiatric problems on the rise
Turku's Global Clinic is open once a week for a few hours at a time. On busy days, staff sees some ten or so patients. Its operations are entirely funded by donations.
According to the Helsinki Global Clinic, the average age of its clients is 34 and they suffer especially from musculoskeletal and digestive disorders.
Above all, Jaakko Kivisaari sees a growing problem with mental health.
"With so many asylum rejections, a lot of patients come to us that are under psychological pressure," he explains.
Katri Gadd hopes that a law on providing expanded services will come about.
"I think it's a bad thing that, for example, people have to reach a crisis with mental health problems before they can get help. In terms of security in society, this is in no one's interest."