Access to healthcare is one of our basic rights and has implications that stretch beyond addressing physical problems. Having secure, reliable access to healthcare for issues ranging from trivial to serious profoundly impacts our well-being and concept of stability.
Understanding the Challenges of Migration
When refugees flee their homes, face sudden displacement, or move throughout Europe, access to healthcare services is routinely disrupted. Refugees may not be able to visit healthcare providers or access medicines and supplies due to: distance, safety concerns, linguistics, policy, or financial barriers. Even when access to a humanitarian healthcare service is available, such services are usually compromised and complicated by a lack of resources and shortages of medicine to meet the demand.
Refugees are particularly vulnerable to the effects of disrupted healthcare systems, as they often come from communities affected by war, conflict, natural disasters, environmental degradation, or economic crises. Migration itself involves long, physically, and mentally exhausting journeys where access to food, water, sanitation, and healthcare services is infrequent and limited. The health concerns for refugees and migrants can therefore be complex and compounded by their migration journeys in multiple ways:
Due to a lack of access to healthcare services, refugees facing sudden displacement or those moving throughout Europe may not be fully vaccinated against a variety of vaccine-preventable diseases. This puts refugee populations at increased risk of contracting diseases such as measles, polio, viral hepatitis, diphtheria, and whooping cough.
Particularly when residing in overcrowded camps, refugees are often at a higher risk of communicable diseases.
Children are particularly at a high risk of contracting vaccine-preventable diseases due to a lack of immunisation throughout displacement: refugee children are at a very high risk of being “zero-dose” i.e. without any immunisation, or under-immunised. Currently, UNICEF, WHO, UNRWA, and their partners have launched a rapid response to deliver 960 thousand doses of vaccines to protect as many adults and children in the Gaza Strip as possible.
A fear of stigma, a lack of treatment options, and limited screening programmes for infectious diseases compound to affect individuals with untreated diseases such as HIV.
For individuals with non-communicable diseases (NCDs), such as heart diseases, cancers, diabetes, chronic illnesses, and mental health conditions, a lack of access to treatment affects an individual at every stage from diagnosis to treatment.
Maternity care is impacted by displacement and is complicated by late presentation, malnutrition, poverty, and stress
Due to a lack of access to treatment, refugees often present with higher instances of poorly controlled chronic conditions, such as hypertension, diabetes, epilepsy, incorrectly healed injuries, and a lack of medication.
Owing to stressful and traumatic experiences associated with migration, refugees are at a higher risk of poor mental health; support services should aim to provide support in areas related to depression, isolation, and sexual and gender-based violence.
Due to the increased vulnerability to infectious diseases, limited access to essential treatments, and amplified mental and physical health concerns, it is crucial that refugees have access to comprehensive and intensive medical support.
However, there are critical gaps in the healthcare system that currently do not address the myriad of challenges faced by refugees during displacement.
The Global Health System: how refugees are left behind
Fundamentally, the right to health exists for all people and therefore encompasses refugees and displaced persons. According to the 1951 UNHCR Convention relating to the Status of Refugees, refugees should have access to the same or similar healthcare services provided to host populations.
Health policies are dependent upon national legislation, meaning the reality of host countries’ obligation to provide healthcare services for refugees may differ significantly among European countries. In some countries, refugees can access national healthcare services under the same conditions as nationals and have costs subsidised, reduced, or provided for free. In others, refugees are given the same access as foreigners rather than nationals, and so can only access health services at a higher cost.
Yet in reality, there are many barriers to public health services for refugees, and services may fall short in their provision of support even when refugees are entitled to services. In particular, the World Health Organisation has found that refugees and migrants often face worse health outcomes in countries of transit and destination due to: institutional discrimination, restricted use of health services, and language and cultural barriers.
As an example, in the UK, refugees and asylum seekers with active applications are fully entitled to free NHS care. However, even when access is available, the Refugee Council has documented multiple instances in the UK where refugees have been routinely and unfairly refused access to the healthcare they are entitled to:
Refugees have been refused access to services such as GP registration or refused interpretation services by GPs, dentists, and hospital staff.
Digital exclusion, whether through a lack of internet access or possession of mobile phones, can prevent refugees from accessing information about healthcare services.
Refugees have been incorrectly refused secondary healthcare or asked to pay upfront costs for treatments that are not urgently required.
A lack of clarity about rights has also left some refugees and asylum seekers unsure of the access they are entitled to. The Refugee Council talked to numerous pregnant refugees who were fearful of being detained, charged, or deported if they engaged with health services: this prevented many child-bearing refugees from accessing antenatal care, choosing instead to only attend hospital services for the delivery.
As this example shows, although the right to health extends to refugees and displaced persons globally, the realisation of this right varies considerably across European countries due to national legislative disparities, discrimination in medical processes and systemic flaws in access rights. Despite legal entitlements, refugees often encounter formidable barriers to accessing public health services. Addressing such challenges requires not only legal frameworks that affirm equal healthcare rights for refugees, but also concerted efforts to eliminate discriminatory practices and enhance accessibility, ensuring that the right to health is a reality for all.
There is an urgent need for health services across the world to be better equipped to respond to migration-specific challenges, whilst supporting and empowering refugee populations. Cooperation between humanitarian organisations, health professionals, and relevant government departments is crucial to ensure gaps in the system are addressed, and no one is left behind.
In our next blog post, we will explore how Indigo’s volunteers are showing up for refugees, and are directly making a difference. To discover how you can join our volunteers in addressing healthcare concerns , explore and apply to be a volunteer.
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