HEALTHY

Access to the Brazilian healthcare system for immigrants

The Constitution of the Federative Republic of Brazil extends a range of fundamental rights to foreign residents in the country, including the right to life (Article 5, caput, of the CRFB/88). Although nothing is explicitly stated about social rights, including the right to healthcare (Article 6 of the CRF/88), there have been no doubts since 2017 regarding its extension to foreigners. By virtue of the principle of non-discrimination, Law 13.445/2017 (Migration Law) established in Article 4 that immigrants must be guaranteed, on equal terms with nationals, "access to public health services and social assistance and social security, in accordance with the law, without discrimination based on nationality and immigration status" (Clause VIII).

Regarding access to the Unified Health System (SUS), the Migration Law explicitly states that there should be no discrimination based on nationality and immigration status, and that access to healthcare services cannot be conditioned on migration regularization or the presentation of documents. However, it should be noted that for foreigners without legal residence in the country, access to SUS is limited to emergency and urgency care (emergency services), as Decree No. 9.199/2017, which regulates the Migration Law, establishes the requirement of a temporary visa for medical treatment, which may be granted to immigrants and their companions who can prove sufficient means of subsistence (Article 35).

On the other hand, Article 5 of Law No. 9.474/1997 (Refugee Law) unequivocally guarantees refugees the same rights and obligations as foreigners in Brazil, which suggests that access to the healthcare system should equally be ensured for this group.

However, despite Law 13.445/2017 affirming the principles and guidelines of the Brazilian migration policy, the universality, indivisibility, and interdependence of human rights, as well as humanitarian reception, the bureaucratic difficulties in implementing the right to healthcare for immigrants are not unknown.

SUS Card

The SUS Card, also known as the National Health Card, is a document issued by the Unified Health System (SUS) in Brazil. Its main objective is to facilitate citizens' access to healthcare services provided by the public system. With the SUS Card, users can schedule appointments, exams, surgeries, and receive free medication, as well as have access to emergency services. The card is valid nationwide and can be used at any healthcare facility affiliated with the SUS.

Obtaining the SUS Card is free for immigrants and refugees and can be done at municipal health departments, health centers, hospitals, or SUS service units. It is necessary to present an identification document, such as an RG (General Registry) or Birth Certificate, and proof of residence. Having the SUS Card is not mandatory to receive healthcare services, but its possession facilitates access and registration of patient information, contributing to more efficient and integrated healthcare services.

Refugees in Brazil have the right to access healthcare services from the Unified Health System (SUS) and, therefore, can also obtain the SUS Card. To do so, they must follow these steps:

• Registration in the National Registry of Refugees (CNR): Refugees should approach the Federal Police to request registration in the National Registry of Refugees. This registration is necessary to prove refugee status and obtain proper documentation.
• Personal documentation: Refugees must provide the required personal documents for issuing the SUS Card, such as the RNE (National Registry of Foreigners), passport, or Refugee Application Protocol. Additionally, other documents may be requested, such as proof of residence and CPF (Individual Taxpayer Identification).
• Visit a SUS healthcare facility: With the necessary documents in hand, the refugee should go to a SUS healthcare facility, such as a primary healthcare unit, hospital, or service center. It is important to choose a facility near their place of residence.
• Request the SUS Card: At the facility, the refugee should inform that they wish to obtain the SUS Card. They will need to fill out a form with personal information and provide the required documents. The attendant will guide them through the specific procedures for card issuance at that facility.

After the application process, the SUS Card will be issued and delivered to the refugee. With the card in hand, they can use healthcare services provided by the SUS, such as consultations, exams, medication, and emergency care.

It is important to note that the process of obtaining the SUS Card may vary depending on the location and specific policies of each municipality. Therefore, it is recommended to contact the municipal health department in the region where the refugee is residing to obtain accurate information about the procedures and required documents.