Literature review report

Literature review report

There is increasing interest and concern about migration to Europe from non-European countries and its impact on the European social healthcare systems. It is therefore important to look at the evidence available on provision and access to health care for migrants and refugees. This report provides a review of existing evidence on migrant & refugee access to health care and discusses main health issues among migrants/refugees.

The aim of this report is to provide an overview of evidence made available by academic articles and grey literature on the topic of health care and migration in the 10 European countries involved in the project. The specific research questions were:

  • What is known about the physical and mental health status of migrants and refugees in the EU member states?
  • What is known about the health care needs of migrants and refugees in the EU member states?
  • What health care and social services are available for migrants and refugees?

Results: Despite the aspiration to ensure equal access and provision of healthcare, there is evidence of inequalities between migrants and non-migrants in healthcare. Different countries tend to focus on different aspects of migrants’ health, hence comparison and generalization across countries is difficult. Most of the existing evidence is fragmented and scattered. However, it seems that there is an unmet need especially when it comes to mental and dental health. Legal barriers exist in equal access to health care, as well as language issues, discrimination, overuse of emergency services and underuse of primary health care.

Please watch this space for the full report and relevant publications

Scenarios - prediction model

Scenarios - prediction model

Mig-HealthCare research (literature review, focus groups, survey, mapping of services and best practice) will be used to design a prediction model – scenarios to predict the health care services needed to address and respond to the needs of different groups of vulnerable migrants and refugees. Different scenarios will be discussed regarding the demands of EU health care and social services in the coming years. Visualizing future trends based on the current situation is a powerful tool to prepare services for future problems.

Please watch this space for the full report and relevant publications

Survey and interview findings

Survey and interview findings

This report discusses the results of the participatory research conducted within the Mig-HealthCare consortium to explore the physical and mental health of migrants and refugees in the consortium countries which include Greece, France, Malta, Germany, Austria, Italy, Cyprus, Spain, Sweden and Bulgaria.

This research aims to cover the gaps concerning less explored health issues (mental health, dental health, gynecological issues, dermatological issues etc) as well as needs and expectations of health care providers.

More specifically the following questions are addressed:

  • What is the physical and mental health status and the main physical and mental health problems of migrants/refugees in the EU? Some areas are widely unknown. For example we will explore mental health, dental health, obstetrics and gynecology issues among migrants/refugees
  • Which differences are observed between different groups (migrants living in the community, migrants/refugees living in organized facilities, irregular migrants/refugees, vulnerable groups such as women and children) and why?
  • What are the differences among countries in Europe and where are the challenges more marked?
  • What are the needs, facilitators and barriers, as viewed from the providers who offer health care and social services to migrants/refugees in Europe?

Original research included:

  1. Focus group discussions and interviews with health care providers in each of the countries of the consortium. In total between November 2017 and April 2018, 20 focus group discussions and 19 individual interviews were conducted with health care providers, policy makers and representatives from NGOs, including volunteer workers in the 10 countries of the consortium.
  2. A survey using a purpose made questionnaire answered by migrants/refugees in all participating countries. In total, 1,325 questionnaires from 10 member states were collected.

Identifying and addressing common misconceptions

Through focus groups conducted in local communities we identified misconceptions about migrants/refugees. These mainly have to do with health issues. Common misconceptions are that migrants carry infectious diseases and that they overload the national welfare systems- Read below to find out how we address these misconceptions.


Q: "Migrants carry infectious diseases?"

A: (According to research) It was demonstrated that migrants and refugees are likely to have good general health, but they can be at risk of falling sick in transition or whilst staying in receiving countries due to poor living conditions or adjustments in their lifestyle.

This is the main conclusion of the first “Report on the health of refugees and migrants” in the WHO European Region, released by WHO/Europe in 2018. The report summarizes the latest available evidence on the health of refugees and migrants– from a review of more than 13 000 documents – as well as the progress made by countries to promote their health. It was developed in partnership with the Italian National Institute for Health, Migration and Poverty (INMP).

Key points about communicable diseases:

  • Refugees and migrants can be more vulnerable to infectious diseases in places or origin, transit and destination because of exposure to infections, lack of access to health care, interrupted care and poor living conditions.
  • There are indications that there is a very low risk of transmitting communicable diseases from the refugee and migrant population to the host population in the WHO European Region

The studies in this report indicate that refugees and migrants living in countries with less favourable inte¬gration policies report poorer health outcomes

See link for more info:

Report on the health of refugees and migrants in the WHO European Region: no public health without refugee and migrant health (2018),
link here
link here

Q: "Migrants overload national welfare systems?"

Evidence based on European Union Agency for Fundamental Rights

The report “ Cost of exclusion from healthcare – The case of migrants in an irregular situation” published by the European Union Agency for Fundamental Rights (FRA) aims to estimate the economic cost of providing regular access to healthcare for migrants in an irregu¬lar situation, compared with the cost of providing treatment in emergency cases only. Two specific medical condi¬tions – hypertension and prenatal care – were selected as examples, and their associated costs were calculated using an economic model. This model was then applied to three EU Member States: Germany, Greece and Sweden. The testing suggests that providing access to regular preventive healthcare for migrants in an irregular situation would be cost-saving for governments. Moreover, as the model only includes costs incurred by healthcare systems, not costs incurred by the patient or society at large, it is likely that the cost savings are underestimated. This report shows that providing regular preventive care, as opposed to providing only emergency care, is cost-saving for healthcare systems. Even when using a simple model to estimate costs, the implications are clear: treating a condition only when it becomes an emergency not only endangers the health of a patient, but also results in a greater economic burden to health¬care systems.

Evidence based on countries' data

References for Italy:

The economic benefits that the migrant population brings to Italy outweigh the costs to the national health system.

References for Spain:

Migrants consume a large part of the health budget. This prejudice is linked to other similar ones as, "Many migrants take advantage of health and social resources enabled through our effort of many years", "Too many resources are devoted to the care of immigrants". The system is overloaded, and a large part of the population accuses immigrants of damaging the functioning of the system. However, recent studies show that the immigrant population represents 10% of the population, and their health expenses 0.69% of the total (2.5% of emergency care services), so this discourse is discredited (Miras, 2015; Etxeberria, Murua, Arrieta, Garmendia, & Etxeberria, 2012).

  • ETXEBERRIA, F., MURUA, H., ARRIETA, E., GARMENDIA, J., & ETXEBERRIA, J. (2012). Prejuicios, inmigración y educación. Actitudes del alumnado de secundaria. Revista Interuniversitaria de Formación del Profesorado, 97-131.
  • MIRAS, C. (2015). Prejuicios y racismo en la atención de Enfermería a población inmigrante en España (TFG). UNIVERSIDAD DE JAÉN. Facultad de Ciencias de la Salud, 38.
  • PLAZA DEL PINO, F. (2012). Prejuicios de las enfermeras hacia la población inmigrante: una mirada desde el Sur de España. Scielo, 87-96.

References for France:

  • Hippolyte d’Albis, Ekrame Boubtane and Dramane Coulibaly , Macroeconomic evidence suggests that asylum seekers are not a “burden” for Western European countries Science Advances 20 Jun 2018: Vol. 4, no. 6, eaaq0883 DOI: 10.1126/sciadv.aaq0883
  • André J.M. ; Azzedine, F. Access to healthcare for undocumented migrants in France: a critical examination of State Medical Assistance Public Health Reviews201637:5
  • Chambaud, L. Azzedine, F. La Tribune Santé des migrants: les préjugés ont la vie dure 17 décembre 2017 https://www.latribune.fr/opinions/tribunes/sante-des-migrants-les-prejuges-ont-la-vie-dure-789150.html

Evidence based on compendium of University College London (UCL) -Lancet Commission on Migration and Health.

The Commissioners have reviewed a mass of data collected by researchers from around the world. These data describe the scale and nature of migration and the many threats to the health of men and women and their families. This evidence challenges common myths and highlights the diversity, dynamics, and benefits of modern migration and how it relates to population and individual health.

The study shows that migrants generally contribute more to the wealth of host societies than they cost.

See the link: https://www.thelancet.com/commissions/migration-health

See the video Migration and health: the health of a world on the move: https://youtu.be/-efWKvVzats