Challenges in using healthcare services by undocumented migrants in Europe

Entitlement of undocumented migrants to European healthcare services varies between European countries, and the utilization of these services by undocumented migrants is often poorly recorded. In order to create a better understanding of the overall barriers, authors of the systematic review recently published in BMC Health Services Research examine the challenges faced by undocumented migrants when accessing healthcare services in Europe.

Migration has become an important topic of social and political debates, including in Europe. But the migrants’ perspective has seldom been considered in these debates. For instance, are migrants satisfied with their new living environment and are they given the opportunity to integrate in the hosting community? Can they access essential public services, such as education and healthcare?

It is difficult to give a clear-cut answer to such questions because migrants are not a homogenous group but individuals with diverse backgrounds, preferences and needs. The migrants’ legal status matters as well. Undocumented migrants without a permit authorizing them to reside in the host country, represent an especially vulnerable group. This includes individuals who have been unsuccessful in asylum procedures (rejected asylum-seekers), have overstayed the period specified in their visas (‘over-stayers’), or have entered the country illegally.

A recent review on healthcare utilization by undocumented migrants, which I carried out with Marjolein Winters and Lea de Jong from Maastricht University, and Bernd Rechel from the European Observatory on Health Systems and Policies, was published in BMC Health Services Research.

We found that undocumented migrants face particular challenges in using healthcare services in many European countries. Migrants without a proper registration tend to go to clinics for free primary care or directly to hospitals rather than consulting general practitioners. Fear of being deported and the limited entitlements to healthcare are usually the key explanations. For example, in Germany, Denmark and Belgium, undocumented migrants are only provided with access to emergency care or sometimes to services for specific conditions (e.g. infectious diseases) or specific needs (e.g. maternal healthcare).

But even in the case of maternal healthcare, which undocumented migrants are usually entitled to access in Europe, under-utilization and inadequate care are reported. A typical example of this is the late appearance of pregnant undocumented women in clinics. Lack of awareness of entitlements and need of care, or uncertainty and fear of consequences are likely to be contributing factors.

Source: iStock image from author

Although we focus on healthcare use, we recognize that undocumented migrants are exceptionally vulnerable, not only because they face numerous barriers in utilizing healthcare services, but also because their other basic human needs are not met. However, research evidence is still scarce due to the inherent challenges in doing research on undocumented migrants.

Nevertheless, research on this topic is especially needed in countries which provide limited rights to undocumented migrants. Research data are important to demonstrate the scope and scale of the problem, and bring the issue to the attention of decision-makers.

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