Modern migration has a significant impact on the public health sector. The movement of people from different countries and regions can contribute to the spread of infectious diseases, especially if there is insufficient medical supervision. Therefore, one of the key elements of migration policy is the mandatory medical examination that foreigners undergo when applying for a residence permit.

The Fourth Meeting of the Migration Policy Dialogue Platform was dedicated to health care and epidemiological security, where national approaches to ensuring sanitary security in the context of immigration were discussed, as well as possible ways to improve existing practices.

Medicine for foreigners: Rules, exceptions

As informed by Nora Pahlevanyan, Head of the Outpatient Medical Care Policy Division of the Medical Care Policy Department of the Ministry of Health of Armenia, according to the government resolution “On Free Medical Care and Services Guaranteed by the State,” persons applying for asylum and their family members are put on the list of socially vulnerable and certain groups of the population and have the right to receive free and preferential medical care and services guaranteed by the state; in particular, free of charge: upon medical indication, inpatient medical care, special and expensive laboratory and instrumental diagnostic tests, as well as medical services provided using the latest technology.

As for persons with refugee status, refugees and their family members are not put on the list of socially vulnerable and separate (special) groups and do not benefit from the privileges of receiving free inpatient medical care. But according to an order of the minister of health of Armenia, in case of medical indication, a referral for free inpatient medical care or free difficult-to-access, expensive laboratory diagnostic tests is provided by the professional commission of the Ministry of Health, where their application is discussed. If the application is approved, they will also be able to benefit from the relevant privileges. But this privilege can be used only once a year, according to the order of the minister of health of Armenia.

By decision of the government of Armenia, forcibly displaced persons from Nagorno-Karabakh are also put on the list of socially vulnerable and separate groups of the population and have the right to receive free and preferential medical care and services guaranteed by the state. Until 2025, these benefits were provided to all those who had arrived in Armenia as victims of military operations. But with the latest amendments to the government's decision, only those who arrived in Armenia after September 23, 2023 have retained their right to them. Thus, the majority of this group is still included in the preferential medical care program.

Foreign citizens in Armenia are provided with medical assistance within the framework of international agreements and national law. It should be noted that in Armenia, in case of sudden acute conditions and illnesses, accidents, poisonings, injuries that threaten the life or health of others, medical institutions provide urgent and non-deferrable medical assistance to foreigners free of charge and in full, regardless of their organizational and legal forms, departmental affiliation, and forms of ownership. After the risk to the life of the patient or the health of others has been eliminated, further provision of medical assistance is carried out on a paid basis.

By the decision of the government, the list of diseases posing a risk to others has been approved, in the presence of which persons, regardless of citizenship, have the right to free and preferential medical care and services guaranteed by the state. Infectious diseases; in particular, tuberculosis (all types), HIV infection, viral hepatitis, diphtheria, anthrax, coronavirus infection, etc. are on this list. It should be noted that in Armenia, if there is an HIV infection and tuberculosis, medical care, including planned treatment and provision of medication, is provided free of charge and in full. This is due to public health priorities and is aimed at preventing the spread of infections. “Armenia is, by all accounts, the only country where tuberculosis treatment is completely free for everyone, regardless of citizenship. The same applies to HIV treatment as well,” emphasized a representative of the Ministry of Health.

According to Section 6 of Article 11 of the Law on Psychiatric Care, non-deferrable medical psychiatric care is also provided free of charge to foreigners in Armenia.

Diseases and borders: How medical supervision of immigrants is regulated in Armenia

Migration expert Tatevik Bezhanyan noted that in many countries there is a list of diseases, the presence of which among foreigners can serve as a basis for depriving them of the right to stay in, not granting a residence permit in, and deportation from the country.

"For example, in Russia, foreigners, including citizens of Armenia, must undergo a medical examination within 30 days of arrival in Russia in order to be able to work [there]. When applying for a residence permit, applicants undergo a medical examination also. If HIV, leprosy, syphilis, and tuberculosis, as well as drugs, are detected in their body, the person is registered in the registry of monitored persons, and then deported from the country, and the issuance of a residence permit is denied.

"In addition, if in the case of syphilis and tuberculosis, a second entry is allowed with a document confirming successful treatment, in other cases the entry ban is set indefinitely," the expert explained. According to him, drugs were found in the blood of 80% of the Armenian citizens who contacted her from temporary detention centers and were subject to deportation in connection with the above-mentioned issues.

Armenia also has approved a list of diseases, in the presence of which foreigners may be denied entry to the country. Tropical malaria, plague, active tuberculosis of the respiratory organs, atypical pneumonia, bird flu, cholera, and HIV are on this list. But as a representative of the Ministry of Health notes, according to available data, these criteria are not applied in practice. No cases of deportation on the basis of a disease have been recorded, and the level of monitoring of the health of those entering the country raises doubts.

"The Ministry of Health does not conduct monitoring of compliance with the entry ban for medical reasons. During the COVID-19 pandemic, this was within the jurisdiction of the Health and Labor Inspectorate. We do not have data on whether or not this monitoring is being implemented in practice.

In practice, it is virtually absent. And this applies to also Armenia’s citizens returning from countries with high epidemiological risks—in particular, India or Mozambique—who also are not checked. Recently enhanced monitoring measures have been taken for citizens of India, Egypt, and Iraq. They are required to have medical insurance to enter Armenia,” noted the representative of the Ministry of Health.

Bezhanyan added that in order to obtain a residence permit in Armenia, foreigners are required to submit a medical certificate by undergoing a medical examination at the country’s healthcare institutions. But according to the expert, there is a need to improve the quality of these examinations. Often, these procedures are a formality or fictitious. Moreover, labor immigrants, as a rule, are exempted from the obligation to provide a general certificate, which was of concern to the participants in the aforesaid meeting and was criticized by them.

This is perceived particularly acutely given the fact that in Armenia, expensive treatment for diseases such as HIV and tuberculosis is provided at the expense of the state and is provided to all those in need, regardless of citizenship. Many participants in the meeting believe that such an approach requires systematic monitoring of external and internal migration, both in the interests of public health and for the sake of the stability of the healthcare system.

Migration risks, research, future of deportation system

Deputy Minister of Internal Affairs of Armenia Armen Ghazaryan considers mandatory medical examinations when applying for a residence permit ineffective, and notes that they need to be canceled. According to him, such measures do not lead to real results, but instead create a high risk of corruption.

“The problem needs to be solved not at the phase of issuing a residence permit, but much earlier, when entering the country. Risk management in the context of migration policy should be carried out for preventive purposes, and not just be a reaction to what has already happened,” he noted.

In Ghazaryan’s conviction, one of the possible solutions could be the introduction of insurance mechanisms. It is also not ruled that citizens of a number of countries will be required to submit a medical certificate issued by a specialized medical institution in order to obtain an entry permit.

Some of the participants in the meeting expressed the opinion that in the event of dangerous infectious diseases among immigrants, deportation measures should be applied, as provided for by the current law. But Armen Ghazaryan clarified that the Ministry of Internal Affairs of Armenia continues to demonstrate a more restrained approach and is committed to a balanced migration policy.

In this context, Nelli Davtyan, Head of the Migration and Citizenship Service of the Ministry of Internal Affairs of Armenia, proposed introducing a mechanism for mass medical examination of immigrants in cooperation with the Ministry of Health of Armenia.

Also, Davtyan noted that Armenia has been a country of emigration for years, and active work is currently underway to develop the necessary mechanisms to respond to growing migration.

According to her, a new temporary detention center for immigrants is being built in Abovyan city. It is planned to be used to accommodate asylum seekers. In addition, a design for a building to hold illegal immigrants subject to deportation has already been approved.

This article was produced within the “Reinforcement of the Migration Management System in the Republic of Armenia” project implemented by People in Need. The project is co-funded by the European Union through the Migration Partnership Facility (MPF) implemented by the International Centre for Migration Policy Development (ICMPD).