ECtHR interim measures secure access to medication for recognised refugee with serious health condition and inactive AMKA in Greece
On 19 February 2026, the European Court of Human Rights (ECtHR) issued interim measures in the case of Zakiya*, a young recognised refugee from Syria, to prevent interruption of urgent medication and treatment necessary for her survival. Zakiya* suffers from a disability and a serious chronic condition that render access to medication vital.
She has received hospitalisation and medication at an Athens hospital since the fall of 2024, following her arrival in Greece with members of her family. The impossibility to obtain an active AMKA after she obtained refugee status and a residence permit put her life at imminent risk until the Court’s recent intervention.
After Zakiya* received refugee status and a residence permit from the Greek Asylum Service, the Provisional Health Care and Insurance Number (PAAYPA) she held as an asylum seeker was deactivated, and an active Social Security Number (AMKA) was required for her to continue receiving daily medication as part of her treatment.
However, Zakiya* was unable to obtain an active AMKA, as such activation requires a work contract or recruitment certificate. Zakiya* is unable to obtain either due to her serious chronic health condition. Whereas European Union and Greek law entitle recognised refugees to equal treatment to Greek nationals as regards health care, domestic regulations on AMKA offer an active AMKA to third-country nationals – such as Zakiya* – only upon condition that they have secured employment and hold a work contract or an officially uploaded recruitment certificate from an employer. These documents are not required from Greek nationals or EU citizens. This impermissible discrimination against refugees remains in force to date, despite repeated interventions from the European Commission, the Greek Ombudsman, and civil society. In addition, measures introduced by a recent Ministry of Health circular to allow refugees to access health care without an active AMKA have not worked in practice, as it is impossible to obtain the required documents cited in the circular.
These legislative barriers have led Zakiya*, like many other refugees, to an impasse with dire consequences for her life and health. Despite having followed a maze of procedures before different services, Zakiya* only found a solution to her predicament after approaching the ECtHR. Refugee Support Aegean (RSA) is legally representing Zakiya* and undertook the necessary legal steps to secure continuation of her treatment from the outset. The Court issued a binding interim measures decision requiring the Greek authorities to guarantee Zakiya* uninterrupted prescription and access to the necessary medication for her survival.
This development is a vital safeguard for Zakiya* and a stark reminder of the chronic, systemic barriers faced by people granted protection in Greece, with direct repercussions on their health and life.
Timeline
Timeline of efforts by Zakiya* and her RSA lawyers to ensure continuation of her treatment:
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Zakiya’s* PAAYPA is deactivated upon the lapse of one month from receipt of her Greek residence permit.
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Zakiya* is informed by the hospital that there is an issue with the continuation of her treatment due to AMKA.
RSA lawyers request a “postponement of removal certificate” from the Hellenic Police, needed by Zakiya* to continue her treatment without an active AMKA according to the Ministry of Health circular.
The Hellenic Police cannot issue a “postponement of removal certificate” to Zakiya* since she is a recognised refugee lawfully residing in Greece.
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RSA lawyers ask the Ministry of Health how a recognised refugee may obtain a “postponement of removal certificate” since the Hellenic Police cannot grant it.
The Ministry of Health replies that it is not competent to issue the document in question or to give instructions on its issuance.
RSA addresses the Secretariat-General for Vulnerable Persons under the Ministry of Migration and Asylum, requesting their intervention to prevent interruption of Zakiya’s* treatment.
The Ministry of Migration and Asylum does not respond to RSA’s request.
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Zakiya* attends her scheduled appointment at the National Social Security Entity (EFKA), accompanied by her lawyer. She receives an inactive AMKA due to the fact that she is unemployed. They request activation of Zakiya’s* AMKA without a work contract or a recruitment certificate from an employer given her disability and the need for continuation of her treatment.
EFKA refuses to activate Zakiya’s* AMKA without a work contract or recruitment certificate from an employer, since these are required documents according to the AMKA regulations.
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RSA lodges a request for interim measures before the ECtHR on behalf of Zakiya*, to ensure that she can continue her treatment.
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RSA addresses the hospital social service, requesting information on the possibility for Zakiya* to continue her treatment without an active AMKA.
Upon her next scheduled appointment, Zakiya* is informed that the prescription of her medication remains impossible in the absence of an active AMKA.
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RSA submits a new request to the Secretariat-General for Vulnerable Persons and the Reception and Identification Service of the Ministry of Migration and Asylum, explaining that Zakiya* cannot activate her AMKA due to the requirement of a work contract or a recruitment certificate from an employer, nor can she obtain the “postponement of removal certificate” cited in the Ministry of Health circular.
The Ministry of Migration and Asylum does not respond to RSA’s request.
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The ECtHR grants interim measures and requests the Greek state to ensure that Zakiya* has uninterrupted prescription and access to the medication she needs.
*Name changed for reasons of safety and protection of private life.
