Germany

General information and legal support within Germany

Legal status and visa requirements for those who were forced to leave Ukraine

  • Since 2017, Ukrainian nationals with biometric passports have been able to enter the EU without a visa for short-term stays in accordance with EU law. Ukrainian nationals who do not have a biometric passport are also exempt from the requirement of a residence title (visa) for entry and stay in the Federal territory;
  • Refugees from Ukraine do not have to go through an asylum procedure. They can work, have health insurance, and send their children to school. This regulation is initially limited until 31 August 2022. This may be prolonged. Permission for a further subsequent stay of no more than 90 days can generally be obtained from the foreigners authority in Germany (§ 40 Residence Ordinance). As a rule, the foreigners authority of the city in which you have your habitual residence is responsible.

Refugee status/ asylum seeker status/ temporary protection status

  • In order to receive benefits (medical, social), registration is required, e.g. at reception centres or aliens’ registration offices. Once registration has taken place, a certificate (proof of arrival, start-up certificate, fictitious certificate or other confirmation) is issued which can be presented to the relevant benefit authority;
  • The registration as asylum seeker can be performed, but this process takes longer and is currently not recommended because asylum applicants are obliged to live in an initial reception centre. This means that the person may have to move to another city in Germany and cannot choose which initial reception centre and city he/she will live in. Social benefits according to the AsylbLG (Закон про отримання політичного притулку), i.e. food, accommodation, heating, clothing, health care, household items as well as other personal needs and free medical care for acute illnesses and pain are also then available free of charge.
  • The procedure of registration might take up to few days and is divided into four steps:
  1. Initial registration. The appointment for registration can be made online, however, the registration is only possible offline in the reception center.
  2. Distribution to a place of residence (in case of social benefit recipients).
  3. Registration of the residential address at the place of destination.
  4. Application for a residence permit.

Access to the healthcare services

Fees

Basic medical care is free of charge for Ukrainian refugees.

Except in emergencies, the diagnosis and subsequent treatment of an illness is usually carried out by doctors who work in their own practice or in a group practice with other colleagues. The patient will only be treated in hospital if treatment by a registered doctor is not sufficient. Only visiting a hospital without consultation in an emergency.

Where can the Ukrainians who were forced to leave Ukraine go for the following healthcare services?

The general information on medical care for Ukrainian refugees from the Federal Ministry of Health is available on the website: www.bundesgesundheitsministerium.de

 

Acute treatment

Acute emergencies at medical on-call services in hospitals or emergency outpatient departments or emergency doctors there.

The services can be found on the map (www.kbv.de) or via the phone consultations: 116 117 (non-emergency calls number).

Chronic/long-term treatment

The Ukrainians who were forced to leave Ukraine can get such a treatment via registered doctors (for OAT, addiction support facilities with associated substitution outpatient clinics can also be requested; for ART and OAT, specialised doctors should be consulted).

Visiting family doctors

Registration is not necessary to visit the family doctor, but an appointment must first be made with all registered doctors. To book an appointment the person should contact 116 117. Many doctors’ surgeries also offer open consultation hours at certain times

Only the registration with the (local) foreigners’ authority is required to use such services.

Other services

  • Preventive medical examinations: via registered doctors;
  • tests: HIV, HEP at registered doctors or local health offices – COVID tests also at private testing stations (fee required);
  • vaccinations can be conducted at health offices or registered doctors.

Services for People Living with HIV​

HIV-testing

  • Testing is free of charge at local health offices and general practitioners throughout the country.
  • Check the HIV doctors list and their availability here: www.dagnae.de
  • If tested positive, counselling for further support and, if necessary, therapy is provided by health authorities and doctors (tests are usually coupled with counselling). The preconditions for receiving ART must be clarified individually via local health offices, AIDS help centres and, if necessary, addiction counselling centres.

The information can be obtained by phone (116 117) or via the website: www.aidshilfe.de (German, English)

Antiretroviral treatment (ART)

  • People on ART can bring their own medication into the country together with their doctor’s prescription.
  • Those seeking help can contact the practices directly. It is often easiest to contact a local AIDS support (AIDS-Hilfe) centre , which can help with referrals.
  • All HIV-infected persons who inject drugs, can receive ART in Germany. Anamnesis and therapy planning should be clarified via addiction support facilities, AIDS help centres and local health offices as well as via specialised doctors.

How can minors get treatment

Minors can get tested and get ART. However, parental permission is required and individual cases must be agreed on with the attending physician.

Pre-exposure prophylaxis (PrEP)

People from the age of 16 with a substantial HIV risk (MSM and trans* persons, partners of HIV-infected persons etc.) can get PrEP (Pre-exposure prophylaxis) for free, covered by the statutory health insurance. However, it must be indicated/prescribed by specialised doctors and all the details such as eligibility, duration etc. to be clarified individually with a specialised doctor.

Post-exposure prophylaxis (PEP)

PEP is recommended immediately after a possible/probable infection e.g. if a partner is HIV+ (without therapy) and the condom breaks or in case of an accident, a puncture wound, contaminated syringes etc.. It is free of charge (covered by health insurance) and there is no minimum age for receiving post-exposure prophylaxis.

However, prior to this, it is reasonable to get tested first. Search for the testing center here: www.aidshilfe.de/PEP

IMPORTANT: PEP must be started as soon as possible after the HIV risk incident occurred. Preferably within two hours, otherwise preferably within 24 hours, at the latest before 48 hours. Whether PEP can still be useful up to 72 hours (three days) after the exposure is controversial.

As a rule, the drug is taken for 4 weeks.

Services for People Living with Hepatitis B or C

Hepatitis B or C testing, hepatitis B vaccination, and hepatitis B or C treatment availability

All the services are available free of charge for all registered Ukrainians. The health insurance covers the cost for vaccination – and for therapy if a diagnosis has been made.   

  • If vaccination documents are available, they should be used to check whether vaccinations are missing. If vaccination documents are not available, vaccinations that are not documented should be considered as not having been carried out for pragmatic reasons (recommendation by The Standing Commission on Vaccination (StIKO).
  • Verbal account of vaccination is accepted if the person can clearly remember or describe the vaccination.
  • Vaccination information is also available at the refugee shelters and from doctors.
  • To get information on vaccination, it is required to contact a local AIDS center or drug counselling center, which can help with referrals.
  • Lock-in vaccinations to control outbreaks of vaccine-preventable diseases should be administered as a priority and possibly combined with other necessary vaccinations. This includes hepatitis B vaccine (HBV).
  • With direct regards for Ukrainians, StIKO recommends HBV vaccination for children between 2 months and 5 years if prior proof of vaccination cannot be established.
  • For adults, the general rules apply i.e. StIKO recommends vaccination for at risk groups i.e. HCV positive, HIV positive, PWID, people with sexual behaviour that puts them at risk, those have contact with HBV positive person, dialysis patients, pregnant women, employees who work in high exposure e.g. healthcare workers and people working in shelters or nursing homes.
Ukrainians forced to leave their country who stay in Germany, should clarify with the health provider found via the source HIVandmore.de  if they:
  • Need hepatitis B or C testing or vaccination as well as hepatitis B or C treatment.
  • Cannot provide medical history of hepatitis B vaccination or hepatitis B or C treatment. This is crucial to renew vaccination or a new diagnosis and counselling regarding further therapy. The doctors for consultations can be found here.
Treatment options available for hepatitis related liver diseases

Hepatocellular carcinoma (HCC) treatment is covered by health insurance; however, the procedure is quite expensive, therefore, a diagnosis needs to be made first by a specialist (click to find a doctor)  and therapy agreed with the health insurance by the doctor (and sometimes the patient).

More information (in German) is available via the link: www.leberhilfe.org

Support systems (harm reduction/safer use, social support, or psychosocial support) available for the Ukrainians undergoing therapy for hepatitis C or related liver diseases

In most places in Germany, there are addiction support facilities that also offer syringe exchange, condoms, and psycho-social support. People living with hepatitis can also find counselling for further help there.

Helpful links:

  • Addiction help centres can be found via phone number 116 117 or within the link: www.dhs.de  (first field: enter postcode or town; select radius: kilometres; select topic: “illegal drugs”).
  • Locations of syringe dispensing machines can be found here: www.spritzenautomaten.de  (postcode, name of city). In drug consumption rooms you can inject under hygienic conditions. The addresses can be found here: www.drogenkonsumraum.net    (postcode, name of city).
  • Brochure of the German Centre for Addiction Issues e. V. (also in Russian) here: www.migration-gesundheit.bund.de

Services for People Living with Tuberculosis

If the person has TB symptoms:
  • TB screening is voluntary upon arrival. There may be offers for screening at/through the refugee registration sites. Also, a local health office can be contacted for counselling.
  • If a Ukrainian who was forced to leave Ukraine has symptoms of TB (e.g. cough, fever, weight loss), they should refer to the local health department, chosen online in advance. This also applies to those who have TB infection and receive preventive treatment.
  • The same applies to children. Counselling and referral to specialised doctors is available via the online tool 
  • If a Ukrainian does not have TB symptoms , but has been in contact with someone with TB, they should get screened for TB infection via the local health office: tools.rki.de/plztool
If TB was already diagnosed in Ukraine and the person needs to continue treatment:
  • Any information and support is provided via local healthcare offices; tools.rki.de/plztool or on the German Central Committee to Combat Tuberculosis (DZK) website (in German, English, Ukrainian). 
  • All the above-mentioned services are relevant as well for:
    • those who are on directly observed treatment (DOT)/ video directly observed treatment (VDOT), or
    • those who started the TB treatment for multidrug-resistant TB in Ukraine and need to continue in Germany.
Non-medical support

The various types of support, like food, shelter, and psychological support are available via treating hospitals; information is available in German  or in Ukrainian.

If a person has a Ukrainian prescription for TB treatment medication 

The prerequisite for dispensing a medicinal product on a foreign prescription is that the pharmacy is satisfied with of the validity and authenticity of the prescription. If there are doubts or ambiguities, dispensing will be refused and the person referred to a resident doctor. Therefore, anyone on TB medication or with TB infection should go to their local health office as soon as possible to ensure that they get a valid prescription for the pharmacy. 

The local health offices to contact can be found here.

Bacille Calmette-Guérin (BCG) vaccination for children

BCG vaccination is not recommended in Germany. Questions about this issue should be discussed with a doctor.

Please note: Local health offices are government centres and private practitioners are also available. Treatment is available in hospitals (government, private or NGO run) and psychosocial care for patients is sometimes also offered. 

Useful links to browse more on TB treatment within Germany for Ukrainians:

Opioid agonist treatment (OAT) services

Medication rules

1. People entering Germany (including Ukrainians) are only allowed to bring their take-home OAT  oral medication for a maximum of 30 days and only for personal use (no transporting for friends ). They need to have proof of prescription from at least  the prescribing doctor or,  better still,  from an official body, which is stated by the German Health Ministry:  

  •  In the case of narcotics, importation (taking along) and subsequent re-exportation (taking along) without a permit or authorisation is possible according to section 4 paragraph 1 number 4 of the Narcotics Act in conjunction with section 15 of the Narcotics Foreign Trade Ordinance (BtMAHV) under the following conditions:
  • The narcotics are brought in reasonable quantities by a doctor travelling with the patient for the purpose of permissible medical practice or first aid, or
  • By the patients themselves in quantities appropriate to the duration of the journey on the basis of a medical prescription or certificate for their own use.

In order to avoid difficulties when crossing the border, (…) patients should carry with them original or certified copies of medical prescriptions or certificates which, on the basis of the instructions for use contained therein with details of the individual and daily doses, make it possible to estimate the appropriateness of the quantities of narcotics carried.

2. It is important that Ukrainian OAT patients bring their doctor’s prescription, and, If possible, they should also bring the international certificate (click to download).

According to Bundesopiumstelle at BFarm, a signed and stamped prescription from a doctor or certificate issued by OAT centre should be enough (and at best be translated into English or German) if the Ukrainian MoH cannot issue the certificate or people don’t have time to wait for it.   

3. To get the dosage, the best option is to contact a local addiction counselling centre. However, it is suggested to see a doctor or special counselling service before they can receive OAT. To make an appointment, please search for a specialist via the website Deutsche Hauptstelle für Suchtfragen e.V: www.dhs.de

Please note, that the person needs to be registered in the country to have access OAT prescriptions.  

What OAT drugs are available in the country?

Methadone, levomethadon, buprenorphin. See details at the website.

OAT treatment fees

To get the free of charge OAT medication, patients should contact counselling services (addiction support facilities) to find a doctor who will consult on the current patient limits in doctors’ practices and outpatient clinics, and free slots availability for Ukrainian citizens.

Search for local addiction support facilities here:

Take-home dosages availability

According to the legal guideline (Section 5, paragraph 9 of the BtMVV), as a rule, substitution treatment is carried out on site. Under certain conditions, the substitution substance may exceptionally also be prescribed to be taken on the patient’s own responsibility if:

  1. The continuity of the substitution treatment of the patient cannot be guaranteed otherwise
  2. The course of treatment permits this 
  3. Risks of danger to self or others are excluded as far as possible, and
  4. The safety and control of narcotics traffic are not impaired. (§ 5 para. 8 BtMVV).

The prescription is subject to the decision and responsibility of the attending physician; the patient has no right to it.

Minimum age for people who use drugs to receive OAT

There is no minimum age  so minors can also receive OAT; but they usually need their parents’ permission. Individual cases must be clarified with substituting doctors.

According to the law, adolescents as well as those who have been using opioids for a shorter period of time are not generally excluded from substitution treatment.

Useful links to follow on OAT

Sources

General requirements and access to healthcare

HIV

Hepatitis B/C

TB

OAT