health care services has been consistently hindered in practice by significant shortages of resources 1103 and capacity for both foreigners and the local population, as the public health sector is under extreme pressure and lacks the capacity to cover all the needs for health care services. Moreover, Article 55 IPA, subsequently replaced by Article 59 (2) Asylum Code, introduced a new Foreigner’s Temporary Insurance and Health Coverage Number (Προσωρινός Αριθμός Ασφάλισης και Υγειονομικής Περίθαλψης Αλλοδαπού, PAAYPA) replacing the AMKA for asylum seekers.1104 Article 59 (2) provides that PAAYPA is to be issued to asylum applicants together with their asylum applicant’s card.1105 With this number, asylum applicants are entitled free of charge to access the necessary health, pharmaceutical and hospital care, including the necessary psychiatric care where appropriate. The PAAYPA is deactivated if the applicant loses the right to remain on the territory.1106 An October 2022 Joint Ministerial Decision (JMD) regarding access of international protection applicants to health care services, medical and pharmaceutical care, social security, the labour market, provides further clarifications on the acquisition of a PAAYPA number.1107 For every applicant for international protection, a PAAYPA number is issued. This number is unique and corresponds to the number of the applicant’s international protection card. 1108 The competent service for the procedure of PAAYPA issuance is the Asylum Service. The latter proceeds with the issuance of the PAAYPA when registering the application for international protection and writes the PAAYPA number on the international protection applicant’s card.1109 PAAYPA holders benefit from primary and secondary health care upon presentation of their international protection applicant card. 1110 The PAAYPA number remains active as long as there is an active international protection applicant’s card and is renewed automatically with the renewal of the applicant’s card. The validity of PAAYPA is equivalent to the duration of the applicant’s card, except for pregnant women, whose number remains valid for one year. 1111 For UAM applicants for international protection, PAAYPA remains active even after the issuance or service of a decision rejecting their asylum application and its validity is extended until the execution of a return decision or until the UAM reaches adulthood.1112 Following these developments, and despite initial delays in the operationalisation of the new system, issuance of the PAAYPA seems to have been increasingly streamlined since early 2021, 1113 at least to the extent that GCR is aware. Notwithstanding, challenges do seem to persist as, indicatively, out of 61 registered asylum applicant households surveyed between 1 January 2023 and 31 December 2023 as part of an ongoing monitoring activity carried out under UNHCR in Greece, 5% of respondents still lacked a PAAYPA number.1114 As explained above (see Access to the Labour Market), a recent legislative development automatically excludes from access to public healthcare beneficiaries of international protection (when one becomes a recognised refugee a PAAYPA needs to be converted to AMKA) who are not yet working or are not able to work because of their health condition or age (e.g. the elderly). Also, the possession of an active AMKA is necessary for access to the benefits of the Agency for Welfare Benefits and Social Solidarity (OPEKA). 1103 1104 1105 1106 1107 1108 1109 1110 1111 1112 1113 1114 For the impact of the ten years of financial crisis and the austerity measures on the Greek public Health System, see Amnesty International, Greece: resuscitation required – the Greek health system after a decade of austerity, April 2020, available at: https://bit.ly/3cAKeG0. See Content of international protection. Article 59 (2) Asylum Code. Article 59 (2) Asylum Code. Ministerial Decision 605869 (Β' 5392/18.10.2022). Article 1(3) of Ministerial Decision 605869/2022. Article 2(1) of Ministerial Decision 605869/2022. Article 3 of Ministerial Decision 605869/2022. Article 6(1), (2) of Ministerial Decision 605869/2022. Article 6(6) of Ministerial Decision 605869/2022. For more, see AIDA, Country Report Greece: 2022 Update, June 2023, op.cit, pp. 191-193 and previous relevant reports. UNHCR, Inter-Agency Protection Monitoring for Refugees in Greece: Key findings, available at: https://tinyurl.com/3z6t3y9f, relevant section 2 on documentation. For the data in this paragraph, filters have been used to only include registered asylum applicant households surveyed during 2023 alone. 226