Access to healthcare for undocumented migrants in Germany-ascoping review

The objective of this scoping review was to identify what is known about the impact of COVID-19 on the physical and mental well-being of refugees, asylum seekers, undocumented migrants, and internally displaced persons. The aim was also to identify barriers influencing access to treatment or prevention. The search was conducted using PubMed/Medline, CINAHL, Scopus, and ScienceDirect. A mixed methods appraisal tool was used to assess methodological rigor. The study findings were synthesized using a thematic analysis approach. This review comprised 24 studies and were conducted utilizing a mixed method approach incorporating both quantitative and qualitative methodologies. Two major themes were identified related to the impact of COVID-19 on the health and wellbeing of refugees, asylum seekers, undocumented migrants, and internally displaced persons and the key barriers influencing access to treatment or prevention of COVID-19. They often have barriers to accessing healthcare due to their legal status, language barriers, and limited resources. The pandemic has further strained already limited health resources, making it even more challenging for these populations to receive healthcare. This review reveals that refugees and asylum seekers in receiving facilities face a higher risk of COVID-19 infection than the general population due to their less favorable living conditions. The various health impacts stem from a lack of access to accurate information about the pandemic, misinformation, and the exacerbation of pre-existing mental health issues caused by heightened stress, anxiety, and uncertainty, fear of deportation among undocumented migrants, and overcrowding camps and detention facilities that increase exposure risk. Social distancing measures are difficult to implement in these settings, and inadequate sanitation, hygiene, and a lack of personal protective equipment further compound the problem. Moreover, the pandemic has had significant economic consequences for these populations. Many of them rely on informal or precarious employment, which has been disproportionately affected by the pandemic. Job losses and reduced working hours, and limited access to social protection can lead to increased poverty, and food insecurity. Children faced specific challenges, such as disruptions to education, additionally, interruptions in support services for pregnant women. Some pregnant women have avoided seeking maternity care due to fears of contracting COVID-19, resulting in increased home births and delays in accessing healthcare services. Factors that play a role in vaccination reluctance include uncertainty of undocumented migrants' inclusion in vaccination programs, furthermore, a growing vaccine hesitancy in the population; skepticism about the safety of vaccines, inadequate knowledge/education, a variety of access barriers such as language barriers, and logistical challenges including remote locations, and inaccurate information. This review highlights that the physical health of refugees, asylum seekers, undocumented migrants, and internally displaced persons has been significantly impacted by various barriers to healthcare access during the pandemic. These barriers include legal and administrative challenges, such as a lack of documentation. Additionally, the shift to digital tools has introduced new obstacles, not only due to language barriers or limited technical knowledge but also because of structural barriers, such as the requirement of a bank ID that is often inaccessible to these groups. Other factors contributing to limited healthcare access include financial constraints, language barriers, and discrimination. Additionally, limited access to accurate information about health services, prevention measures, and available resources may hinder them from seeking care or following public health guidelines. Misinformation and lack of trust in healthcare systems can also contribute to a reluctance to access care or vaccination programs. There is concerning evidence regarding vaccine hesitancy that needs to be addressed to reduce any future pandemic outbreak, in addition there is a need to explore the factors that play a role in vaccination reluctance among children in these populations.

Current representations of large movements of migrants and asylum seekers have become part of the global consciousness. Media viewers are bombarded with images of people from the global south riding atop of trains, holding on to dinghies, arriving at refugee camps, crawling beneath wire fences or being rescued after being stranded in the ocean or the desert for days. Images of gruesome scenes of death in the Mediterranean or the Arizona or Sahara deserts reveal the inherent risks of irregular migration, as bodies are pulled out of the water or corpses are recovered, bagged, and disposed of, their identities remaining forever unknown. Together, these images communicate a powerful, unbearable feeling of despair and crisis. Around the world, many of these tragedies are attributed to the actions of migrant smugglers, who are almost monolithically depicted as men from the Global South organized in webs of organized criminals whose transnational reach allows them to prey on migrants and asylum seekers' vulnerabilities. Smugglers are described as callous, greedy, and violent. Reports on efforts to contain their influence and strength are also abundant in official narratives of border and migration control. The risks inherent to clandestine journeys and the violence people face during these transits must not be denied. Many smugglers do take advantage of the naivetέ and helplessness of migrants, refugees, and asylum seekers, stripping them of their valuables and abandoning them to their fate during their journeys. Yet, as those working directly with migrants and asylum seekers in transit can attest, the relationships that emerge between smugglers and those who rely on their services are much more complex, and quite often, significantly less heinous than what media and law enforcement suggest. The visibility of contemporary, large migration movements has driven much research on migrants' clandestine journeys and their human rights implications. However, the social contexts that shape said journeys and their facilitation have not been much explored by researchers (Achilli 2015). In other words, the efforts carried out by migrants, asylum seekers, and their families and friends to access safe passage have hardly been the target of scholarly analysis, and are often obscured by the more graphic narratives of victimization and crime. In short, knowledge on the ways migrants, asylum seekers, and their communities conceive, define, and mobilize mechanisms for irregular or clandestine migration is limited at best. The dichotomist script of smugglers as predators and migrants and asylum seekers as victims that dominates narratives of clandestine migration has often obscured the perspectives of those who rely on smugglers for their mobility. This has not only silenced migrants and asylum seekers' efforts to reach safety, but also the collective knowledge their communities use to secure their mobility amid increased border militarization and migration controls. This paper provides an overview of contemporary, empirical scholarship on clandestine migration facilitation. It then argues that the processes leading to clandestine or irregular migration are not merely the domain of criminal groups. Rather, they also involve a series of complex mechanisms of protection crafted within migrant and refugee communities as attempts to reduce the vulnerabilities known to be inherent to clandestine journeys. Both criminal and less nefarious efforts are shaped by and in response to enforcement measures worldwide on the part of nation-states to control migration flows. Devised within migrant and refugee communities, and mobilized formally and informally among their members, strategies to facilitate clandestine or irregular migration constitute a system of human security rooted in generations-long, historical notions of solidarity, tradition, reciprocity, and affect (Khosravi 2010). Yet amid concerns over national and border security, and the reemergence of nationalism, said strategies have become increasingly stigmatized, traveling clandestinely being perceived as an inherently — and uniquely — criminal activity. This contribution constitutes an attempt to critically rethink the framework present in everyday narratives of irregular migration facilitation. It is a call to incorporate into current protection dialogs the perceptions of those who rely on criminalized migration mechanisms to fulfill mobility goals, and in so doing, articulate and inform solutions towards promoting safe and dignifying journeys for all migrants and asylum seekers in transit.

Saving Us From Them

The influx of undocumented migrants and asylum seekers into Lithuania, particularly during the COVID-19 pandemic, presents unique public health challenges. This study employs the Social Determinants of Health framework to explore the healthcare and social needs of this vulnerable population. In May 2022, we carried out a qualitative study through semi-structured interviews with asylum seekers across four centers in Lithuania. Employing both purposive and snowball sampling techniques, we selected participants for our investigation. The study comprised 21 interviews-19 conducted in Arabic and 2 in English-with durations ranging between 20 and 40 min each. We audio-recorded all interviews, transcribed them verbatim, and subsequently performed a thematic analysis using Atlas.ti software. This process of design and analysis strictly followed the principles of thematic analysis as outlined by Braun and Clarke, guaranteeing methodological precision and rigor. 21 interviews revealed critical insights into the healthcare access challenges, mental health issues, and social integration barriers faced by the participants. Key themes included 'Healthcare Needs and the Impact of the COVID-19 Pandemic 'and 'Social needs and Aspirations Amidst Pandemic-Induced Uncertainty '. The findings highlight the multifaceted healthcare and social needs of asylum seekers, juxtaposed against significant barriers they face. Access to medical services is hindered by long waiting times and financial constraints, especially for specialized care such as dental services. Communication issues during medical appointments due to language barriers and the lack of gender-specific healthcare, such as access to gynecological services, further exacerbate the challenges. Additionally, the COVID-19 pandemic introduces hurdles such as limited testing, isolation measures, language-specific information barriers, and insufficient social distancing practices. Mental health has emerged as a critical concern, with asylum seekers reporting significant stress and emotional exhaustion due to uncertainty and restrictive living conditions. Social needs extend to delayed asylum application processes, inconsistent language education opportunities, inadequate clothing, and nutrition that lacks cultural sensitivity, and living conditions characterized by overcrowding and insufficient facilities. The restricted freedom of movement within asylum seeking centres severely impacts their psychological well-being, underscoring a deep longing for autonomy and a better life despite the myriad of challenges faced. The study illustrates the complex interplay between migration, health, and social factors in the context of a global pandemic. It highlights the need for culturally sensitive healthcare services, mental health support, and structured language education programs. Offering educational avenues alongside language courses for children and adults is essential for fostering social inclusion and securing economic prosperity. Addressing the challenge of language barriers is of utmost importance, as these barriers significantly impede undocumented migrants' and asylum seekers employment opportunities and their access to crucial services. The findings emphasized immigration as a health determinant and underscored the importance of inclusive health policies and advocacy for undocumented migrants and asylum seekers' rights and needs. There is an urgent need for comprehensive policies and practices that are grounded in the principles of equity, compassion, and human rights. Additionally, advocating for practice adaptations that are culturally sensitive, linguistically inclusive, and responsive to the unique challenges faced by undocumented migrants and asylum seekers. As global migration continues to rise, these findings are crucial for informing public health strategies and social services that cater to the diverse needs of this vulnerable population.

OP 17: Refugees and Asylum Seekers 1, B210 (FCSH), September 4, 2025, 13:30 - 14:30AimThe UN Sustainable Development Goals (SDGs) call for equitable Universal Health Coverage (UHC) for all, including undocumented migrants. In the WHO European region, undocumented migrants face significant barriers to UHC. This project aimed to conduct a rapid literature review to map healthcare and social welfare access for undocumented migrants in the European region, summarise their health status, and create a call for action for UHC for all migrants by 2030.MethodsA rapid literature review was conducted using PubMed, Google Scholar, and grey literature from 2018-2023. Studies included both qualitative and quantitative research. The search used the terms “undocumented migrants AND health access AND Europe,” yielding 178 results, of which 48 were included. A series of roundtable meetings were conducted to craft the call for action based on the review findings, and healthcare access and health status was mapped based on the literature.ResultsSwitzerland and France provided the highest level of free access to UHC for undocumented migrants, but most countries in Eastern Europe offered no healthcare or welfare support. There were many instances of non-governmental organisations bridging the gap in UHC for undocumented migrants across the region, but this was unsustainable. Small-scale studies indicated that many undocumented migrants in the region experience poor health, but comprehensive data were lacking. There were many examples of poor access to healthcare due to unfamiliarity with the host country healthcare system, lack of interpreters, and high out-of-pocket costs. Key recommendations include extending legal entitlements to UHC, improving secure migration health data, policies addressing wider determinants of health, and participatory approaches in UHC initiatives.ConclusionWith the 2030 SDGs approaching, achieving UHC for all remains an urgent task. The treatment of undocumented migrants in the European region and beyond reflects broader human rights and dignity, and the time for action is now.

BackgroundAlthough migrants constitute an important proportion of the European population, little is known about migrant sexual health. Existing research mainly focuses on migrants’ sexual health risks and accessibility issues while recommendations on adequate sexual health promotion are rarely provided. Hence, this paper explores how refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands define sexual health, search for sexual health information and perceive sexual health determinants.MethodsApplying Community-based Participatory Research as the overarching research approach, we conducted 223 in-depth interviews with refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. The Framework Analysis Technique was used to analyse qualitative data. We checked the extensiveness of the qualitative data and analysed the quantitative socio-demographic data with SPSS.ResultsOur results indicate that gender and age do not appear to be decisive determinants. However, incorporated cultural norms and education attainment are important to consider in desirable sexual health promotion in refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. Furthermore, our results demonstrate that these migrants have a predominant internal health locus of control. Yet, most of them feel that this personal attitude is hugely challenged by the Belgian and Dutch asylum system and migration laws which force them into a structural dependent situation inducing sexual ill-health.ConclusionRefugees, asylum seekers and undocumented migrants in Belgium and the Netherlands are at risk of sexual ill-health. Incorporated cultural norms and attained education are important determinants to address in desirable sexual health promotion. Yet, as their legal status demonstrates to be the key determinant, the prime concern is to alter organizational and societal factors linked to the Belgian and Dutch asylum system. Refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands should be granted the same opportunity as Belgian and Dutch citizens have, to become equally in control of their sexual health and sexuality.

Recent legislation mandating reporting of undocumented immigrants may instill fear of discovery when they access emergency department (ED) services. The objectives of this study were to: 1) characterize the knowledge and beliefs of undocumented Latino immigrants (UDLI) about health care workers' reporting (or nonreporting) of illegal immigrants in the ED, 2) determine whether UDLI fear discovery when presenting to the ED, and 3) determine the nature and sources of this fear. This was a cross-sectional study of UDLI and two comparison groups conducted in two California county EDs, from November 2009 to August 2010. The authors interviewed a convenience sample of adult UDLI, Latino legal residents (LLR), and non-Latino legal residents (NLLR) using a structured instrument in their native language. The main outcome was fear of discovery among UDLI and the sources of that fear. Of 1,224 patients approached, 1,007 (82.3%) were interviewed: 314 UDLI, 373 LLR, and 320 NLLR. The median age was 43 years (interquartile range [IQR] = 31 to 55 years), and 51% were male. UDLIs were less likely to speak English (14%, 95% confidence interval [CI] = 10% to 18%), have health insurance (39%, 95% CI 32% to 44%), or have a regular primary care provider (PCP; 39%, 95% CI = 34% to 45%), compared to LLR (English 56%, 95% CI = 51% to 61%; health insurance 50%, 95% CI = 45% to 55%; regular PCP 51%, 95% = CI 46% to 57%) and NLLR (English 95%, 95% CI = 92% to 97%; health insurance 49%, 95% CI = 43% to 54%; regular PCP 51%, 95% CI = 45% to 56%). Of the 16% of UDLI who stated that nurses and doctors treat undocumented immigrant patients differently than citizens, 41% (95% CI = 29% to 54%) reported less respect given to UDLI by staff. Thirty-two percent of UDLI had heard of Proposition 187, 13% believed hospital staff reported UDLI to immigration authorities, and 9% said they were asked about their citizenship status. Fear of coming to the hospital because of discovery was expressed by 12% (95% CI = 9% to 16%) of UDLI, with 42% (95% CI = 28% to 58%) citing discussions with friends/family, 32% (95% CI = 19% to 47%) citing media and 16% (95% CI = 7% to 30%) citing both as sources of this fear. One in eight of UDLI presenting to the ED express fear of discovery and consequent deportation. Belief that medical staff report UDLI and recent immigration are risk factors for this fear. Family, friends, and media are the primary sources of these concerns.

Background: Emerging evidence suggests that the COVID-19 pandemic is widening pre-pandemic health, social, and economic inequalities between refugees, migrants, and asylum seekers and the general population. This global scoping review examined the impact of the pandemic on community-based asylum seekers and undocumented migrants in high- and upper-middle-income countries. Methods: We conducted a systematic search of peer-reviewed articles in PubMed, Scopus, Web of Science, and ProQuest Central. We applied Katikireddi’s framework of understanding and addressing inequalities to examine the differential impact of the pandemic across exposure, vulnerability to infection, disease consequences, social consequences, effectiveness of control measures, and adverse consequences of control measures. Results: We included 32 articles in the review. The analysis showed that asylum seekers and undocumented migrants experienced greater exposure to the COVID-19 virus and higher infection rates. They also experienced differential social consequences in the form of job loss and lost and/or reduced work hours. The effectiveness of pandemic response measures on asylum seekers and undocumented migrants was also affected by pre-pandemic social and economic marginalisation, exclusion from pandemic-induced policy measures, lack of appropriate pandemic communication, and variable trust in governments and authority. Pandemic control measures had greater adverse consequences on asylum seekers and undocumented migrants than the general population, with the majority of studies included in this review reporting worsened mental health and social isolation conditions and reduced access to health care. Conclusions: Asylum seekers and undocumented migrants experienced a disproportionate impact of the COVID-19 pandemic across the six thematic areas of comparison. Policies that reduce exposure and vulnerability to the infection, grant equitable access to health and social care, and build capacities and resilience, are critical to enable asylum seekers and undocumented migrants to cope with and recover from pre-pandemic and pandemic-induced inequalities.

‘May I get asylum for my diabetes?’

ملتمسي اللجوء | الهجرة غير النظامية | آلية احتجاز ملتمسي اللجوء | بدائل احتجاز ملتمسي اللجوء | المهاجرين غير النظاميين | مفوضية الأمم المتحدة للاجئين | الاحتجاز للتحقيق من الهوية | الإشراف المجتمعي | الإفراج بكفالة | السيادة الإقليمية | Asylum Seeker | Illegal Immigration | Mechanism of Asylum Seekers Detention | Illegal Immigrants | UNHCR | Detention to Verify Identity | Community Supervision | Release on Bail | Regional Sovereignty

The principle of non-discrimination in Article 2 of the International Covenant on Economic, Social and Cultural Rights (ICESCR) holds that its rights are equally applicable to ‘everyone’. Nevertheless, evidence from the national context suggests that access to health care for asylum seekers and undocumented migrants depends on their legal status and in particular, preventive health care is often inaccessible to them.1 This has led to several hitherto under-investigated questions concerning the right to health in this context: Does a right to preventive health care exist at the international level? If so, what individual rights and State obligations are involved in this right? How does the principle of non-discrimination relate to this right? Does this principle offer (additional) protection to asylum seekers and undocumented migrants in terms of a possible right to preventive health care? Method: The main issue is what the principle of nondiscrimination has to offer for the preventive health care of persons without a regular residence status. Based on an analysis of the non-binding, but authoritative, General Comments of the United Nations (UN) Committee on Economic, Social and Cultural Rights (CESCR), the paper takes an exploratory style that goes beyond traditional legal analysis and investigates how the law should be interpreted in order to enhance its effectiveness and relevance. Results and Discussion: Strictly speaking, there is no explicit, binding right to preventive health care for asylum seekers or undocumented migrants in the ICESCR itself.2 Nevertheless, implications can be found in the CESCR General Comments Number 14 and 20.3 Particularly, if one takes into account how the law should be interpreted according to CESCR General Comment 14 (CESCR GC 14), there should be a right to preventive health care for asylum seekers and undocumented migrants. The exact content of such a right, however, is less clearly defined. Further, the principle of non-discrimination is not conclusive as to whether the right to health would apply equally to asylum seekers and/or undocumented migrants as it would to nationals. Conclusion: For non-discrimination to be truly unambiguous with regard to the preventive health care of asylum seekers and undocumented migrants, it would be necessary to strike out the ‘general welfare’ provision of CESCR General Comment 20 (CESCR GC 20) and to clearly state that the ‘other status’ criterion also entails ‘residence status’. In that sense, the principle of non-discrimination is, indeed, an empty promise and the right to preventive health care for asylum seekers and undocumented migrants seems to be much better protected under the CESCR GC 14’s non-discriminatory interpretation of the right to health itself.

The Principle of Non-Discrimination: An Empty Promise for the Preventive Health Care of Asylum Seekers and Undocumented Migrants?

Editorial

A critical interpretive synthesis of the constructed identities and experiences of refugees, asylum seekers, and undocumented migrants in relation to accessing primary care services in the UK

BackgroundUndocumented migrants in the UK are at high risk of food insecurity and destitution as a consequence of the No Recourse to Public Funds (NRPF) rule which prevents access to...