In Paris’ chic île de la Cité area, a long queue awaits at the entrance of one of the PASS centers located at the Hotel-Dieu hospital. Twenty-something people are gathered in front of the main door,  which remains shut at 7:30 am in the morning. It is an extremely hot Parisian morning and most of the people in the queue are from Ivory Coast.

The doors opened around 8:30am. Mory took a numbered ticket and sat in the waiting room. The air was damp inside. It is his second visit to PASS, “I suffer from an allergy in my eyes. They scratch me a lot”, Mory said. “It’s been four years I moved to France after a friend advised me to do so”, he added.

PASS are healthcare centers located in public hospitals, for people without any health coverage or are facing difficult situations. In the waiting room, you can find migrants, asylum seekers, homeless and poor people.

"Over here we deliver healthcare just like anywhere else, but the setting is different. We have to deal with people who are more concerned about finding food to eat and a place to sleep at night than with their own health. The doctor-patient relationship is different, it is more complex," doctor Helene, coordinator of the PASS at the Hotel-Dieu hospital, said.

Every morning, before the start of the consultation sessions, the team of doctors at Champs-Lége check on the patients received the day before. Crowds of interns and other senior doctors gather in Doctor Helene’s office that serves as a meeting room for the team.

"Do I apply for a 'residency permit for healthcare' for my patient?" Asks one intern. "We have to consider the patient that is more than three months pregnant. She is a more pressing case. She sleeps at a friend's house, but might end up back on the streets soon," says another.

That morning, and for an hour, the medical team reviewed cases of many migrants. “We do receive people with health coverage, who for various reasons might’ve faced difficulties in accessing the health system," doctor Helene said.

90% of consultations are without appointment

The PASS center at the Hotel-Dieu hospital receives around 50 patients per day, although the majority does not have an appointment. "Many of our patients have a hard time finding their way here. To give a date is something very abstract, and generally speaking, appointments aren’t respected here,” she said.

Doctors do not receive emergencies at PASS centers. They treat lighter cases, similar to patients visiting a general doctor. For instance, they treat dermatological problems (scabies, itching, bites ...), infectious problems (tonsillitis, influenza, tuberculosis ...) and bone problems.

"Many patients come with old bone fractures, probably caused by the difficult conditions they passed through in order to get to France. However, thanks to PASS, they have access to radiology and scanners, in addition to the pharmacy at the hospital,” Helene said.

Patients received at PASS centers are often referred by the local NGOs. "About 30% of the patients received hear about us through word of mouth," Helene added. For example, Daouda, sitting across Mory in the waiting room, knew about PASS through Médecins sans Frontières (MSF).

"When you come here, you have to tell yourself that you're here for the day, you have to wait for hours, and it’s slow!" Mory murmured. He had walked in earlier today suffering from intestinal pain.

Consultations at PASS takes time. "On average, I see 5 patients in the morning here, while I see 5 patients in an hour in other places," Dr. Helen said. Unlike conventional one-on-one doctor appointments, PASS consultations combine diagnosis and interviews. Doctors seek to know the migratory route a patient took, their accommodation and the food they ate. "To make a correct diagnosis, we must know everything," the doctor jokes. "We ask them if they remember possible vaccinations they took, blood tests ..."

The language barrier often plays a role in extending the duration of the medical consultation. Some patients do not speak a word of French. "We work with what we have. We can try to communicate through Google translate on our phones, or we ask if someone in the waiting room can help interpret, of course after getting the patient's agreement. If we have no other option, we call for a paid interpreter," Helene added. On average, 60% of the consultations pass smoothly.

A gateway towards reintegration

PASS centers also function as a gateway towards reintegration. "When a patient with no documents is received here, we do not allow them to simply walk away. We redirect them towards social workers to take care of their cases,” Barbara Bertini, coordinator of PASS in Ile de France, said.

Unfortunately, many patients do not know their rights. "For example, asylum seekers can benefit from the services of PUMA , or people in an irregular situation can benefit from that of AME . The idea is to leave place to marginalized people in dire situations,” Bertini added.

Claire is one of the patients helped by PASS during her administrative procedures. The Ivorian 32 years old arrived in March 2018 and for more than 4 months, she slept in the street. Her appointments at PASS also helped her better understand her rights. "The social workers at the hospital told me about the process to request accommodation. I have to go back and talk about it with them. It takes time," she explains very timidly. Claire also wants to apply for asylum eventually and PASS will surely be of valuable support to her.

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Useful information:

PASS centers are open from Monday to Friday, starting 9am.

Consultations take place according to the order of registration. They are open to everyone.

PASS centers are distributed around Paris, in the suburbs and in France. Here are a few addresses:

-PASS de l'Hôtel-Dieu AP-HP

1, place du Parvis Notre-Dame – Paris 4e

-PASS des Hôpitaux Lariboisière et Fernand-Widal AP-HP Consultation Arc-en-ciel 2, rue Ambroise-Paré – Paris 10e

-PASS de l'hôpital Pitié-Salpêtrière AP-HP 83, boulevard Pitié-Salpêtrière - Paris 13e

-PASS de l'hôpital Corentin-Celton AP-HP 4, parvis Corentin-Celton - Issy-les-Moulineaux (92)

-PASS de l'hôpital Saint-Antoine AP-HP 184, rue du Faubourg Saint-Antoine – Paris 12e (consultations for patients 16 years old and above)

For children and minors:

-PASS de l'hôpital Ambroise-Paré AP-HP 9, avenue Charles-de-Gaulle – Boulogne-Billancourt 92

-PASS de l’hôpital Jean-Verdier AP-HP Avenue du 14 Juillet – Bondy 93