"What is striking," said MSF head of mission for Belgium, Laurent Vanhorebeke "is that the failures of the system are avoidable. Across Belgium there are numerous practical solutions that work, but the will is not there to put them in place. In the meantime, the cost, but human and financial, is enormous."

MSF is disturbed to see the number of consultations increase in its health centres in Brussels, Liège and Antwerp. This reality demonstrates the lack of access to healthcare for a whole segment of people living in Belgium. Illustrated by the 10 000 medical consultations carried out in MSF clinics in 2003, these new findings from MSF healthcare projects in three locations across Belgium have reveal a healthcare system hampered by complexity, incoherence and compounded by a lack of will to reform.

Legal grey areas and a lack of coordination concerning medical care for illegal immigrants among Public Centres for Social Assistance (Publique d’Aide Sociale- CPAS) have created a disparate and unpredictable system. Processes for obtaining medical care differs from commune to commune and quality varies from effective to Kafkaesque. For example, one regular practice in some communes requires a patient to visit a doctor to prove he is ill in order to be allowed to see a doctor to be treated.

"The failures of the system have severe consequences for those most in need of help- mainly immigrants, but also poor Belgians," explains MSF head of mission for Belgium, Laurent Vanhorebeke.

"While the Belgian healthcare system should provide for everyone, illegal or otherwise, the reality is that red tape and in some cases, total incoherence, threaten the health of thousands of people".

The system not only has implications for the physical and mental health of patients, but also for increasingly saturated medical facilities and practitioners who face a maze of bureaucracy when dealing with patients without papers. The financial cost is also significant as patients unable to see a doctor risk developing complications forcing them to seek more expensive emergency care in hospitals.

"What is striking," concludes Vanhorebeke, "is that the failures of the system are avoidable. Across Belgium there are numerous practical solutions that work, but the will is not there to put them in place. In the meantime, the cost, but human and financial, is enormous."