Iran healthcare programme is a lifesaver for sick refugees

Despite being partially blind since birth, Ali Hashemi works as a garbage collector in this small city near the Iranian capital Tehran to provide for his wife and three children.While Ali takes his visual impairment in his stride, the significant costs of his medical treatment placed an ongoing strain on the family’s limited income. Ali sometimes waived his regular medical care in order to meet other basic needs for his children, such as transport to school and even nutritious food. “I have to go to see the doctor regularly for check-ups and to get medication, but this wasn’t always possible. My family comes first for me – it will always be my obligation as a father and a husband to provide for them,” he explains.

Ali is one of close to one million Afghan and Iraqi refugees who have been living in Iran for as long as 40 years, having fled insecurity in Afghanistan.
Unfortunately, his wife fell ill last year and was diagnosed with a thyroid disorder, requiring surgery. Medical fees faced by the family suddenly became overwhelming. These were compounded when the hearing of Ali’s eldest son began to deteriorate, which demanded complicated corrective surgery at a specialized hospital in the city of Qom, south of the capital.

Fraught with worry over how he would be able to pay for two emergency surgeries, Ali approached UNHCR, the UN Refugee Agency, for help, and learned about the Universal Public Health Insurance (UPHI) programme. The ground breaking insurance plan enables Afghan and Iraqi refugees in Iran to access and benefit from a comprehensive insurance package similar to that received by Iranian nationals.
As a result of a partnership between UNHCR and the Government of Iran since the scheme was launched in 2015, Iran’s Bureau for Aliens and Foreign Immigrants’ Affairs of the Ministry of Interior, the Ministry of Health and the Iran Health Insurance Organization are continuing their collaboration with UNHCR into 2020.

This ensures that subsidised hospital treatment such as surgeries, as well as medication and out-patient care can be offered to refugee families enrolled in UPHI across the country. All refugees in Iran can enrol in UPHI by paying a basic premium rate. But 92,000 identified as particularly vulnerable -- including refugees, with medical conditions requiring special treatment -- are excluded from paying any premium fees, as they are fully subsidised by UNHCR.

As a result, Ali and his family along with tens of thousands of other refugees across Iran have received the specialised treatment they need without having to resort to negative strategies in order to cope, such as loan-taking or pulling children out of school. Lauding this exemplary government-led initiative, UNHCR Representative in Iran, Ivo Freijsen, appeals to the international community to further recognise the government’s ongoing commitment to enhancing refugees’ access to affordable healthcare and other basic services.

“Not only has the government - as well as Iranian communities - generously hosted such a large refugee population for four decades, Iran continues to work with UNHCR to invest in and to enhance its progressive refugee-related policies under the umbrella of the regional Solutions Strategy for Afghan Refugees” said Ivo Freijsen. “It is a breakthrough initiative which continues to bring relief to thousands of refugees across the country, particularly at a time when they are facing considerable pressures”. António Guterres said he hoped other countries would follow Iran’s “exemplary initiative which is going to profoundly impact the lives of its refugees.”

Freijsen reiterated the need for sustained international support and to further expand refugees’ inclusion into national services in line with the Global Compact on Refugees, which was affirmed at the UN General Assembly in December 2018. “I call on donor countries to deliver robust support to the Government of Iran at this critical time to further acknowledge the considerable investments Iran has made in spearheading this insurance scheme, which is just one example of its inclusive policies,” he concludes.

For Ali and his family, meanwhile, being enrolled in health coverage has been absolutely vital. “I cannot describe the relief I felt when I realized that the insurance scheme would pay for the operations my wife and son needed,” he says. “I would have had no choice but to take out a loan, or to have begged for money otherwise; I don’t know what I would have done”.

Refugee insurance coverage started in 1995 but on a very small scale as it was only available for those affected by three specific diseases. The rest have had access to the free Iranian primary health services, but could not afford the costs for secondary and tertiary healthcare, especially in the difficult economic context of the recent years. In 2011, UNHCR therefore launched a much larger programme, the Health Insurance Scheme (HISE), providing cover to all refugees identified as vulnerable according to a series of pre-determined criteria.

Photo