h ea lth More than 30 countries require documentation to treat a child at a health facility. In at least 20 countries, stateless children cannot be legally vaccinated. Travel restrictions, the prohibitively high medical costs levied on non-nationals and discrimination conspired to impede access to health care services by many of the stateless children and youth surveyed. This not only affected their ability to participate in preventive child-health programmes, it also prompted decisions to defer or forgo professional treatment even for serious illness or injury. The psychological toll of childhoods spent stateless also had PRATAP, 15, MALAYSIA “Why do I have to suffer this way?” serious consequences for the self-esteem and future prospects of some of the young people, even if they were able to acquire nationality during adulthood. King, 18, Thailand. daughter’s health and ability to take care of herself without State support. “While I am around I can look after her,” he says, “but I won’t be able to look after a disabled child for another 30 or 40 years.” ©UNHCR / R. ARNOLD Obstacles to treatment Many participants in the consultations said they had difficulties in accessing health care due to lack of national identity documents. In Italy, Roma parents noted that because their stateless children were not able to use public paediatric services or child health education, they had resorted to taking them to the emergency departments of public hospitals, even for basic ailments. Sandokan, the stateless Roma father of disabled Christina, says: “It’s important for parents to receive health education from a qualified paediatrician. Information on nutrition and immunization – you won’t get this from the emergency department of a hospital. But that is our only option for health care – even for a sore throat.” In Malaysia, parents and guardians of young stateless children with profound disabilities spoke of the difficulties they faced in trying to access State care and support for these children. Santosh, the father of a 14-year-old boy suffering from spina bifida, was unable to obtain a State-sponsored wheelchair, necessary for his son’s mobility. He finally managed to raise the funds through a community NGO. In Italy, Sandokan worries constantly about his disabled 12 Cost barriers The most significant barrier to accessing health care highlighted by participants in the consultations was the high cost of treatment. Although States frequently offer subsidized or even free health services to their nationals, a person who is stateless will often have to pay the higher fees imposed on foreigners. This often puts much-needed treatment out of reach. For some of the parents interviewed, the prohibitively high costs of treatment applied to non-citizens, meant that their own births and those of their children had taken place at home rather than in a hospital, making it difficult to secure birth registration documents. In a few cases, parents admitted that they would consider fraudulently using the nationality identity documents of friends and neighbours. Shanti, the mother of a stateless boy of Tamil origin in Malaysia, says: “My son is four years old, he has never been to a hospital. He was even born at home. Why? Because he does not have citizenship. If he gets very sick in the future and needs to go to hospital we will just borrow someone else’s documents.” S TAT E L E S S N E S S R E P O R T S TAT E L E S S N E S S R E P O R T 13