Health and access to care for undocumented migrants living in the European Union: a scoping review

Abstract

Background Literature on health and access to care of undocumented migrants in the European Union (EU) is limited and heterogeneous in focus and quality. Authors conducted a scoping review to identify the extent, nature and distribution of existing primary research (1990–2012), thus clarifying what is known, key gaps, and potential next steps.Methods Authors used Arksey and O’Malley’s six-stage scoping framework, with Levac, Colquhoun and O’Brien’s revisions, to review identified sources. Findings were summarized thematically: (i) physical, mental and social health issues, (ii) access and barriers to care, (iii) vulnerable groups and (iv) policy and rights.Results Fifty-four sources were included of 598 identified, with 93% (50/54) published during 2005–2012. EU member states from Eastern Europe were under-represented, particularly in single-country studies. Most study designs (52%) were qualitative. Sampling descriptions were generally poor, and sampling purposeful, with only four studies using any randomization. Demographic descriptions were far from uniform and only two studies focused on undocumented children and youth. Most (80%) included findings on health-care access, with obstacles reported at primary, secondary and tertiary levels. Major access barriers included fear, lack of awareness of rights, socioeconomics. Mental disorders appeared widespread, while obstetric needs and injuries were key reasons for seeking care. Pregnant women, children and detainees appeared most vulnerable. While EU policy supports health-care access for undocumented migrants, practices remain haphazard, with studies reporting differing interpretation and implementation of rights at regional, institutional and individual levels.Conclusions This scoping review is an initial attempt to describe available primary evidence on health and access to care for undocumented migrants in the European Union. It underlines the need for more and better-quality research, increased co-operation between gatekeepers, providers, researchers and policy makers, and reduced ambiguities in health-care rights and obligations for undocumented migrants.

Compassionate care provision: an immense need during the refugee crisis: lessons learned from a European capacity-building project

“…A lack of access to and a lack of information about health systems and treatment possibilities are perhaps the most significant barriers for the vulnerable subgroups of these populations, including women, the elderly, the very young and children, as well as those previously suffering from ill health [5,6].…”

National Health Service Principles as Experienced by Vulnerable London Migrants in "Austerity Britain": A Qualitative Study of Rights, Entitlements, and Civil-Society Advocacy

“…27 While many services are legally available to undocumented migrants in Britain, persistent practical barriers may prevent vulnerable migrants from accessing the care to which they are entitled. 40 NHS reforms affect access to free secondary and tertiary treatment for failed asylum-seekers, undocumented migrants (ie, non-EEA nationals without immigration permission to be in the United Kingdom), visitors (ie, individuals of any nationality who temporarily visit the United Kingdom), and British expatriates. 28 Rules and regulation of entitlements are unclear, leading to confusion among providers and service-users.…”

“…28 Rules and regulation of entitlements are unclear, leading to confusion among providers and service-users. 38,[40][41][42][43] Asylum-seekers and undocumented migrants may fear that if they use health services, they will be reported to authorities. Such reluctance to use health services may result in the delayed treatment of infections that endanger wider population health, inappropriate use of costly emergency services, barriers in registering with general practitioners (GPs), and lack of engagement with or awareness of vital health promotion activities.…”

“…29,32,41,62 Results were consistent with studies by Mladovsky and others that migrants are confused about host country health systems and entitlements. 29,40,62 Several issues warrant improvement, including accessibility, communication, and clarity on migrant entitlements and GP responsibilities. 18,58,63 Concerns have been raised about potential public health impacts 25 and the human impact of changes to NHS entitlements and charging policy (eg, consequences of forcing health-workers to 'police' access, the extent changes may violate patient confidentiality or human rights).…”

New times for migrants' health in Europe

“…Health and health needs of migrants may differ from those of the general European population [3][4][5] . Upon arrival, migrants' health status might be better than the general host population due to "the healthy migrant effect", but depending on the policies and practices of the host country, migrants may experience discrimination and drop in their socio-economic status post migration 3 .…”