As noted in a 21 November 2024 letter of the active Director-General of Migration and Home Affairs to competent Greek Ministers,1503 “the new provisions of the law on the AMKA activation set additional requirements (e.g., having an employment contract) for beneficiaries of international protection and legally residing third-country nationals in comparison to Greek citizens. This provision hinders the effective access to the healthcare system by beneficiaries of international protection and legally residing third country nationals, and is particularly worrying for persons with disabilities who are unable to work.” Lastly, clarifications offered by the Ministry of Health via Circular 48556/2025 in November 2025 on access to public health facilities for the beneficiaries foreseen under Article 33 of L. 4368/2016, have further hindered access of uninsured BIPs to healthcare. Although the Circular clarifies that BIPs can enjoy these rights without an active AMKA, thus potentially providing for a means to resolve the aforementioned barriers to its activation, it substitutes the need for active AMKA with the need to submit a written confirmation of the decision to postpone their removal pursuant to the provisions of paragraph 4 of Article 24 of L. 3907/2011. Given BIPs have a regularised stay in Greece, and thus are not subject to either removal measures or their postponement, this is a practical impossibility, and in case the Hellenic Police, which would be the competent authority for issuing such as postponement decision, does not issue such decisions in cases of BIPs. These systemic barriers have also been flagged in a recent (February 2026) case supported by RSA before the ECtHR regarding a young refugee woman from Syria facing a serious health condition and in need of vital medication, which she could not acquire on account of the impossibility of activating her AMKA. The Court ordered the Greek authorities to ensure the continuation of urgent medication and treatment necessary for her survival. 1504 Nevertheless, despite this binding decision, the administration failed to comply, leaving the applicant at imminent risk for more than 20 days after the Strasbourg ruling.1505Regarding beneficiaries of subsidiary protection, it should also be noted that they receive national passports from the Embassies/Consulates of their country of origin in Greece. However, there are cases where they are neither provided with a national passport nor with a certificate of objective impossibility to issue one, so that a travel document can be issued by the Greek authorities. Therefore, these beneficiaries of subsidiary protection are excluded from access to public health care, as the AMKA cannot be activated as described above.1506 Furthermore, according to the aforementioned JMD, the issuance of AMKA is conditional upon possession of a “valid residence title in the country with labour market access”. 1507 The requirement of a “valid” residence permit creates substantial obstacles, given that AMKA is deactivated upon (a) interruption of lawful residence in the country; or (b) interruption of access to the labour market; or (c) interruption of actual residence in the country, except for minor beneficiaries; or (d) deactivation of A.M.K.A. of the directly insured person, in the case of indirectly insured persons adults or minors 1508. “Specifically as regards deactivation due to non-legal residence in the country, [deactivation] shall automatically take 1503 1504 1505 1506 1507 1508 DG HOME, Implementation of new law on AMKA and its repercussion on Beneficiairies of International Protection and legally residing third-country nationals, 21 November 2024, Ref. Ares (2024)8316809 22/11/2024. The document was made available following a request for access to information made by RSA. RSA, “ECtHR interim measures secure access to medication for recognised refugee with serious health condition and inactive AMKA in Greece”, 2 February 2026, available at: https://rsaegean.org/en/ecthrinterim-measures-amka-refugee-greece/. RSA, “BREAKING: EFKA ignores binding ECtHR interim measures decision”, 26 February 2026, available at: https://rsaegean.org/en/breaking-efka-ignores-binding-ecthr-interim-measures-decision/. Intervention by 20 civil society organizations of the national Legal Working Group to the Minister and Vice Minister of the Ministry of Migration and Asylum and the Minister of Citizen Protection, Beneficiaries of International Protection, prot. no. β/139/24.10.2024. The same issues regarding AMKA have already been raised in the intervention No. 385/17-07-2024 addressed to the Ministry of Migration and Asylum and to all competent Authorities by 22 civil society organizations, without, however, receiving any response to date. Article 3(a) of JMD Φ80320/109864/14.12.2023. See RSA and Stiftung Pro Asyl, Beneficiaries of international protection in Greece, Access to documents and socio-economic rights, March 2024, available at: https://bit.ly/3KT41TT, p. 20. Article 7(1) JMD Φ80320/109864/2023. 291