France

The CASOs/CAOA provide their services to the public unconditionally and offer free consultations, mostly without any need for an appointment. People can see a range of different healthcare professionals for a medical consultation or assessment before being referred wherever possible to suitable mainstream healthcare facilities. They can also be supported through the process of accessing their rights.

In 2019, the CASO in Marseille introduced a City Pass (Pass de ville) with the aim that it would be transferred to mainstream healthcare. The original one-off initiative has been continued and enables people who don’t have health insurance to receive healthcare without being billed for it. People are treated by local doctors and can undergo a full course of treatment (including pharmacy, laboratory and radiology services) without having to pay while they wait to obtain health insurance. The initiative will be transferred to a dedicated facility in 2022.

In 2020, the CASOs adapted their services to the different phases of the Covid-19 pandemic and / or set up outreach services for communities excluded or isolated from the healthcare system. Covid-19 is now part of routine activities and there are no longer special, dedicated programmes.

Adopting a community approach that involves the people affected means that some programmes offer community sessions and activities around health promotion, focusing on selected topics. In particular, a programme in Nantes is using a health promotion approach to improve the access to and quality of SRHR services for people living in inadequate, unhealthy, substandard and / or informal housing in the Pays de la Loire region.

We are continuing to train our teams to implement a ‘gender-based’ approach to certain healthcare issues, such as screening for gender-based violence. The programmes are also committed to screening for gynaecological cancers, providing information about contraception and antenatal care.

• In 2015, a programme was set up which was specifically aimed at unaccompanied minors.
• In Paris – support with procedures (this ended in 2022).
• In Nantes – a similar programme came to an end during 2016.
• Two other programmes for unaccompanied minors were developed in Normandy.
• In Caen – the programme was set to be transferred during 2022 and replaced by a health mediation programme for young migrants.
• In Rouen – dedicated activities ended in 2018. The teams support unaccompanied minors, providing sympathetic listening in spaces where they can go for respite, access to healthcare and help to exercise their rights.

Programmes are also involved in working in squats and slums to offer people access to healthcare and support with exercising their rights. These programmes also refer them to healthcare facilities, with a particular focus on women’s and children’s health. Health mediators work with partner organisations and mainstream services to improve care and treatment for people living in slum conditions and to empower them to access healthcare and rights independently.

In 2020, a number of regional offices took action to seek to improve the living conditions of people living in squats and slums. The hazards of living in inadequate housing were exacerbated by the Covid crisis – lack of access to water and sanitation made it difficult for people to implement preventive measures.

The Lotus Bus is a programme run by Médecins du Monde focusing on harm reduction in sex work and promoting access to healthcare and rights.

In response to the risks associated with drug use, in late 2021 Médecins du Monde decided to resume its work to address the worsening situation of people who use drugs in public spaces in north-east Paris. Everyone working in this area was reporting a critical situation with an absence of support from the public authorities and a desperate lack of resources. Tensions with local residents were significantly exacerbated by the Covid crisis and the associated restrictions. Media coverage of the situation reinforced political positions taken for electoral purposes and this has contributed to a climate that is particularly hostile and harmful to the health of these very vulnerable people. The project was redefined during 2022 and is scheduled to last for 5 years.

In 2020 and 2021, the Combrailles programme transferred its activities to local healthcare facilities. In Haute Vallée de l’Aude, Médecins du Monde is supporting vulnerable people to access healthcare. The team is responding to the healthcare crisis by providing accessible medical and social services open to all, as well as mobile facilities for people who live a long way from services.

A programme to promote access to healthcare and rights in sensitive urban areas was established in Lille in 2015. It uses an outreach approach to help people whose healthcare has been disrupted. The programme provides support to tackle the main obstacles collaboratively and is working actively with mainstream and third-sector organisations to build individual and collective capacity.

In 2020, the programme continued its outreach activities and adapted them in light of the public health crisis. This involved organising welfare and healthcare outreach to maintain contact and ensure continuity of services and to provide people with information about Covid-19. The programme ended in April 2021.

In 2020, Médecins du Monde ran an exploratory humanitarian mission on the island of Réunion to look at the impact of poor housing on health. The results highlight the fact that vulnerable people who are living in inadequate housing and / or are geographically isolated have poorer health overall compared to the general population. This is due to being unable to access adequate healthcare because of their living conditions and / or where they live. Based on these results, since November 2021 the Médecins du Monde team in Réunion has been running a project which aims to encourage people to seek healthcare and to help isolated people in poor housing in the south and west of Réunion to register with mainstream services. The project is also helping to develop tailored health mediation to meet the specific needs of these communities. Based on the model adopted in mainland France, it prioritises interactions between the health sector and the diverse population of Réunion to bring them closer together.

In French Guiana, 2021 was marked by the ongoing crisis concerning the reception of asylum seekers and the social tensions around migration. In addition, in response to the continuing Covid-19 health crisis the Médecins du Monde team increased its health mediation work through ‘mobile health teams’ and visits to informal settlements to provide information and prevention measures adapted to the local health context.

In 2021 the Pass de Ville project was resumed after having been postponed because of the health crisis and reforms to AME (the State Medical Aid system). The team worked on the preparation phase to ensure a successful operational launch and the first patient registrations in early 2022.