Abstract
BackgroundHealth of migrants is known to be above-average in the beginning of the migration trajectory. At the same time reports from non-government organisations (NGOs) suggest that undocumented migrants in Germany tend to present late and in poor health at healthcare facilities. In this paper, we explore the health status of undocumented migrants with a mixed method approach including complementary qualitative and quantitative datasets.MethodsUndocumented migrants attending a NGO based in Hamburg, Germany, were asked to fill in the SF-12v2, a standardized questionnaire measuring health-related quality of life (HRQOL). The SF-12v2 was analyzed in comparison to the U.S. American norm sample and a representative German sample. Differences in mean scores for HRQOL were evaluated with a t-test and with a generalized linear model analyzing the impact of living without legal status on HRQOL. The quantitative research was complemented by a qualitative ethnographic study on undocumented migration and health in Berlin, Germany. The study included semi-structured interviews, informal conversations and participant observation with Latin American migrants over the course of three years. The study focused on subjective experiences of illness and health and the impact of illegality on migrants’ health and access to health care.ResultsHRQOL was significantly worse in the sample of undocumented migrants (n = 96) as compared to the U.S. American sample (p < 0.005). Living without legal status displayed a significant negative effect on subjective mental and physical health (p ≤ 0.003) in the generalized linear model when adjusted for age and gender compared to the representative German population sample. The ethnographic study, which included 35 migrants, identified socio-economic conditions, the subjective experiences of criminalization, and late presentation at healthcare-facilities as the three main factors impacting on health from migrant perspective.DiscussionThe present research suggests a high morbidity and mortality in this comparatively young population. The ethnographic research confirms negative impacts on health of social determinants in general and stressassociated with living without legal status in particular, both are further aggravated by exclusion from health care services. In addition to the provision of health care it appears to be important to structurally tackle the underlying social conditions which affect undocumented migrants’ health.ConclusionsLiving without legal status has a negative impact on health and well-being. Limited access to care may further exacerbate physical and mental illness. Possibilities to claim basic rights and protection as well as access to care without legal status appear to be important measures to improve health and well-being.
Highlights
Health of migrants is known to be above-average in the beginning of the migration trajectory
Living without legal status has a negative impact on health and well-being
58.3 % originated from Latin America or the Caribbean, 17.7 % were from Africa and 16.7 % came from Southeastor East-Europe or countries formerly belonging to the Soviet Union and 7.3 % came from other regions. 98.6 % of the migrants reported to seek medical advice for a physical complaint, 1.4 % came because of a mental health problem
Summary
Health of migrants is known to be above-average in the beginning of the migration trajectory. While the population of undocumented migrants is diverse in reasons for migration as well as in terms of duration and nature of stay in Germany, the majority is reported to be young adults between 20 and 40 years of age [2, 3]. Undocumented migrants are a young and healthy population at the beginning of their migration history [4, 5], they are exposed to negative social determinants of health on a large scale [6,7,8]. In the absence of objective indices that are commonly used to measure health and provide information on the need for health care provision, health-related quality of life (HRQOL), and self-reported health and barriers to healthcare of undocumented migrants offer unique insights into the health status and challenges of a hidden population
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