Accessing Universal Public Health Insurance: an essential service for migrants in Iran

Tehran – To discover that your child is suffering from a rare and chronic pathology is a nightmare for every parent, and struggling to access health support due to administrative obstacles can make the situation even more challenging. 

This was the condition of Halima*, 32, and Amin Ahmadi* 33, two Afghan nationals living in Iran and parents of two daughters. Both born in Iran, their younger kid, Mahtab*, was diagnosed with cystic fibrosis (CF) when she was just three months old. 

CF is a genetic and chronic condition that damages the lungs, digestive tract and other organs. There is no definitive cure for cystic fibrosis, but the symptoms can be managed with the right treatments. 

Unfortunately, Mahtab was hospitalized two years ago due to Covid-19, and, since then, her situation had been rapidly deteriorating. To keep her condition from worsening, she relied on multiple and expensive medications every day. 

Normally, in Iran, the cost of Mahtab’s medicine would be covered by Universal Public Health Insurance (UPHI). UPHI is a comprehensive insurance package developed by the Islamic Republic of Iran which allows refugees and migrants to access the vast majority of health services, including hospitalization, doctor’s visits, lab tests and medication costs. Iran is one of the few countries in the world that cover refugees and migrants under a public health scheme, similar to the one accessible to Iranians themselves. 

Yet, the status of the couple made it difficult for them to access the insurance coverage. 

Halima used to hold an Amayesh card, a document which allows migrants in Iran and their families to access UPHI’s services.  However, due to bureaucratic difficulties in renewing the certificate, the family lost their access to these services. As a consequence, they had to pay around 10 million Iranian Rials (ca. 234 dollars) monthly for Mahtab’s medication. Amin did not have a stable income and earned no more than 6 million IRR (around 142 dollars) per month, while the medical expenses were becoming harder and harder to meet. 

It was in such a dire situation that Alima had to make difficult choices to afford the medicines, and many people were encouraging her not to spend so much on treatments, given that the disease has no definitive cure. “But I am a mother”, she said, “and I can’t see my child suffering every minute in front of my eyes.” 

As soon as the family reached out to the provincial BAFIA (Bureau for Aliens and Foreign Immigrants Affairs) Authorities, IOM and Government caseworkers started working together to help them collect and submit all the necessary documentsto obtain UPHI for Mahtab. The official procedures were lengthy, but with constant follow-ups, the family was finally able to benefit from the insurance. 

“Having insurance has greatly reduced the medication costs”, said Alima, explaining that it is now much easier for them to manage the household’s expenses and that they now have fewer concerns in life. “I will always remember your kindness and support. I don’t know what I could have done if I had not met IOM to support my daughter.”

Mahtab’s case is just one of the many examples of IOM’s interventions in Iran to support migrants in accessing healthcare services: in May 2023, IOM assisted 600 migrants in their enrolment in the Iranian national health insurance scheme by covering the costs of the insurance premium fees and supporting them throughout the registration procedures. 

“Accessing health insurance has a profound and beneficial effect on the lives of migrants”, says Negar, Senior Project Assistant at IOM Iran. “IOM is committed to fostering the physical, mental and social well-being of migrants, regardless of their origin and status.”

In addition to UPHI enrollment support, IOM is working with the national health sector by providing essential health equipment and enhancing the infrastructure of healthcare facilities, both in migrants and refugees’ settlements and in border areas, where the Organization also intends to implement programmes to prevent, respond and control the spread of diseases connected to the high volume of population movements. 

“The global community should acknowledge the efforts made by the Government of Iran towards the people of Afghanistan, especially in the health and education sectors,” indicates IOM Iran Chief of Mission, Lalini Veerassamy. “We ought to do more to support Iran in bearing the weight of such a large Afghans influx with mixed vulnerabilities and needs.” 

*Names have been changed to protect their identity