The Dominican Republic has among the lowest levels of public investment in health in Latin America and the Caribbean. But instead of strengthening its system, the government has blamed the population perceived as Haitian and has introduced a protocol in public hospitals that ties care to migratory status and puts these people at risk of being arrested and deported, Amnesty International warned today in the report Health without stigma: How the Dominican Republic’s migration policies affect the right to health.
“This protocol is a smokescreen used by President Luis Abinader to try to hide the fact that his administration and the ones before it have not invested enough to guarantee the right to health”, said Ana Piquer, Americas Director at Amnesty International. “Dominican hospitals should be places of care and protection, not spaces of fear and surveillance. The government must invest sufficient resources in health and immediately roll back all measures that scare people away from getting medical care because of their nationality or migratory status“, she added.
This protocol is a smokescreen used by President Luis Abinader to try to hide the fact that his administration and the ones before it have not invested enough to guarantee the right to health
Ana Piquer, Americas Director at Amnesty International.
On 6 April 2025, President Luis Abinader implemented a set of migration-related measures, including the “Procedure for the management of health services for foreign patients.” This protocol requires foreigners to present identification, a passport with a valid visa, a work card issued by the Directorate of Migration, and proof of home address as requirements for hospital admission. Foreigners who do not present these documents face being arrested and deported after receiving care. According to the president, these measures aim to “control the surge of patients in public hospitals” and guarantee the rights of Dominicans.
Amnesty International has analysed this issue using data from Dominican National Health Service facilities and household surveys, as well as from interviews with experts and health service users. According to the information the organization examined, health care access and availability issues in the country are not caused by Haitian refugees overwhelming the services. Rather, they can be explained by the state’s gradual failure to invest in health, in spite of its international obligations to use the maximum available resources possible to guarantee the right to health.
Amnesty International also finds that implementing the protocol impedes Haitians’ right to health, increasing inequality in access to health and limiting public health efforts for the country’s entire population.
The public health system has deteriorated because of the limited availability of health services
In February 2025, President Luis Abinader announced that his administration would prioritize investing in the health system to benefit Dominican nationals. However, historically the underlying problems in access to public health have not been related to the demand for health services by Haitians living in the country, but to insufficient funding and low availability of resources. According to the World Health Organization (WHO), the Dominican Republic has the second lowest public spending on health as a percentage of its GDP in the region, allocating less than half (2.7% of GDP) of the WHO recommendation (6%). Although the budget for health spending has grown by 5% from 2022 to 2024, these increases are not substantial or sufficient to reach the internationally established target.
The number of beds and nurses available in the Dominican Republic’s health system is also below the regional average, according to data from the WHO and the Pan American Health Organization.
The Dominican health system is not overburdened by Haitians
Amnesty International’s research and official data show that Haitians make up only a small fraction of public health service users nationwide. Based on secondary care figures from the Dominican National Health Service up to the first quarter of 2025, Haitians only accounted for 7.9% of all consultations and 14.8% of all hospitalizations. Although the share of Haitian patients is higher and exceeds 30% in some provinces – such as Independencia, Elías Piña, Pedernales and Seibo – the total patients in these areas only represented 2% of the countrywide total in 2025.
Amnesty International’s statistical analysis of Dominican National Health Service data reveals that bed occupancy and overcrowding in critical contexts is not caused by increases in hospitalizations, emergencies or surgeries for Haitian patients, but by an overall increase in demand for health services.
The health services are not being overwhelmed by Haitian women giving birth
Authorities, national media and public figures say that an increasing proportion of deliveries are by Haitian women, drawing a racist and misogynistic connection to what they call an “invasion of wombs” in the country. However, Amnesty International’s research and official data show that, between 2023 and 2025, the proportions in registered births remained constant, while the number of births registered in the National Health Service – to both Haitian and Dominican women – has gone down. With seasonally adjusted figures, the percentage of births to Haitian mothers went from 36% in the first quarter of 2023 to 37% in the first quarter of 2025.
The increased share of births to Haitian women is explained by a marked decrease in births among Dominican women, not by a higher number of Haitian women giving birth. Consequently, this change in composition does not put additional pressure on hospital capacity or compromise the availability of health services in the country.
But it is true that the protocol and the practices it leads to, such as identifying, arresting and deporting pregnant women after they are treated in hospitals, do endanger the lives and health of women and newborns. Fear of deportation deters women from using public health services.
This policy also feeds into the reproductive violence that Haitian women had already been experiencing at public facilities. Haitians and Dominicans of Haitian descent interviewed by Amnesty International reported being rejected by hospitals or enduring racist remarks when seeking prenatal or emergency care. Several reported having no choice but to give birth in their homes without adequate medical assistance or in informal spaces for fear of being arrested, despite serious risks to their health, their pregnancies, and their babies.
The government’s decisions are discriminatory and deepen inequality in access to health for Haitians
The migration protocol in public hospitals disproportionately affects Haitians and people of Haitian descent. It is implemented in a context of racial profiling and xenophobia against people of Haitian origin, aggravating racial discrimination and perpetuating an official discourse that associates being Haitian with illness, poverty or illegal status. The measure hinders access to health and violates international human rights obligations – including the rights to health, equality and non-discrimination – guaranteed in the International Covenant on Economic, Social and Cultural Rights and the International Convention on the Elimination of All Forms of Racial Discrimination.
Statistics from a UNICEF survey reviewed by Amnesty International show that Haitians have less access to drinking water, proper sanitation and water inside the home – all determinants of health in their households. Additionally, health insurance and vaccination coverage for children under five is very low, and Haitian children have higher levels of malnutrition. Similarly, pregnant Haitian women have higher neonatal mortality rates, less access to health insurance and less access to follow-up consultations.
The health protocol threatens the health of everyone in the Dominican Republic
Under the international human rights framework, Amnesty International finds that the migration protocol in public hospitalscould affect prevention and health care actions in the Dominican Republic. General Recommendation 37 of the International Convention on the Elimination of All Forms of Racial Discrimination states that “racial discrimination … produces and exacerbates health inequities, leading to, or increasing the incidence of, cases of preventable disease and death.”
Public health and international cooperation experts consulted by Amnesty International say the protocol may undermine the broader public health response, potentially putting the health of everyone in the country at risk. They indicated that the barriers to health care access created by the protocol, which push Haitians living in the country away from health services, could increase maternal mortality and weaken the national response to HIV and other infectious diseases such as tuberculosis.
According to the experts interviewed, many Haitians were previously receiving HIV treatment through programmes supported by international aid, which has been greatly reduced or cut back. However, since the health protocol took effect, many Haitians could be left without access to life-saving treatments because of fear, mistrust, and even the legal risk of being deported. This in turn affects HIV prevention efforts nationwide. Amnesty International concludes that the migration protocol in public hospitals has a discriminatory and racist effect on access to health care for Haitians and Black people, and, more generally, undermines public health.
Appeals to the Dominican government
The authorities argue that registering “foreigners” in hospitals and notifying the authorities of their immigration status is a “security” and “law enforcement” measure. However, forcing health personnel to report their patients creates an environment of fear that discourages people from seeking medical care, including for chronic health conditions. It increases unassisted births and preventable deaths.
“The migration protocol in public hospitals is not built on evidence or respect for human rights.It puts up obstacles for Haitians trying to get health services and institutionalizes discriminatory treatment against Haitians and Dominicans of Haitian descent. But it also jeopardizes the health of everyone living in the country,” said Diego Vázquez, researcher at Amnesty International. “The Dominican government must ensure that all people have access to acceptable and quality health care without discrimination.”
The migration protocol in public hospitals is not built on evidence or respect for human rights.It puts up obstacles for Haitians trying to get health services and institutionalizes discriminatory treatment against Haitians and Dominicans of Haitian descent. But it also jeopardizes the health of everyone living in the country”.
Diego Vázquez, researcher at Amnesty International.
Amnesty International urges President Luis Abinader and all Dominican authorities to guarantee the right to health of Haitians and Dominicans of Haitian descent, to stop deporting these people when they go to hospitals and to immediately revoke the migratory protocol that forces public hospitals to register and report the migratory status of those it treats. It calls on the administration to take all possible administrative, political and legal measures to guarantee the right to health in the Dominican Republic without discrimination based on race, gender, national origin, migratory status or any other aspect.
Background
Since October 2024, the Dominican authorities have deported over 300,000 Haitians, including pregnant women and children, despite the grave humanitarian and security crisis in Haiti and in spite of UNHCR’s urging since 2022 to stop forcible returns. The findings are part of Amnesty International’s #AntiracistDR campaign, which documents structural racial discrimination in the Dominican Republic’s migration and nationality policies. The campaign calls on people to demand that Luis Abinader, President of the Dominican Republic, end the collective expulsions and racial discrimination of Haitians and Dominicans of Haitian descent, guarantee access to health without discrimination and respect and protect those who defend equality and non-discrimination, racial justice and the rights of migrants.
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