A/HRC/14/30 entry to richer Northern countries has increased the use of clandestine, unofficial and dangerous entries. For instance, vulnerable groups of migrants, such as asylum-seekers, or victims of trafficking and people-smuggling, may have been exposed to sexual and genderbased violence, greater vulnerability to ill-health and may have had a diminished ability to exercise informed choices concerning their health in countries of origin or in transit. According to the World Health Organization (WHO), the exposure to risk associated with population movements also raises migrants’ vulnerability to psychosocial disorders, drug abuse, alcoholism and violence. In addition, limited access to health care during the transit and early insertion phases of migration increases the resultant burden of untreated conditions.19 B. Challenges in accessibility 26. A considerable gulf exists between the rhetoric of the universal application of human rights and the enjoyment of these rights in practice. While the international human rights standards require that States provide essential primary health care to all individuals regardless of their nationality or immigration status,20 host States have been less willing to meet this standard, fearful that such a move will defeat migration control policies and overburden health and other social services. 27. Entitlements and access to health care for migrants and the level of such care vary enormously, depending on the State in focus as well as on immigration status.21 It may range from emergency care to expansive health coverage for all, including migrants in irregular situations. On one end of the spectrum, regular migrants satisfying certain conditions may have entitlements comparable to citizens of host States, although there may be differences between long-term and short-term migrants with regard to entitlements and access.22 On the other end, non-nationals may not be able to access life-saving medication, because facilities deny treatment on the basis of “being foreign” or not having a national identity document.23 What may exist between the two extremes is the payment for preventative and primary health care, including urgent or emergency care and free medical service on certain restricted grounds.24 Most countries, however, link access to nonemergency health care to migrants’ immigration status. 28. While States have developed different criteria for what constitutes emergency health care, this regrettably does not address the fundamental issue of not conditioning health care to a person’s immigration status. In this regard, mere commitment to emergency care is unjustified not only from a human rights perspective, but also from a public health standpoint, as a failure to receive any type of preventive and primary care can create health risks for both migrants and their host community. Experts have suggested that given the relatively small proportion of migrants in irregular situations and their underutilization of services, providing them with access to preventive and primary care rather than with 19 20 21 22 23 24 8 World Health Organization, “Health of migrants”, document A61/12, para. 17. See Committee on Economic, Social and Cultural Rights, general comment No. 3 (1990), para. 10. See Platform for International Cooperation on Undocumented Migrants (PICUM), Access to Health Care for Undocumented Migrants in Europe (Brussels, 2007). Available from www.picum.org/ article/reports. Immigrant Centre of Ireland and Independent Law Centre, submission to the Special Rapporteur on the human rights of migrants on access to economic and social rights by migrants – particularly, the enjoyment of the right to an adequate standard of living and the right to health for undocumented migrants in Ireland, January 2010. UNDP, Human Development Report 2009, p. 56. See PICUM, Access to Health Care, pp. 7–9. GE.10-12615