Migrant & Refugee Health

Skip anything

Every question is optional. No one has to retell painful events, name a diagnosis, or choose a religion or identity to begin.

Pause or stop

Stop at any point. Nothing is sent anywhere, and nothing is shared unless the person chooses it in the sharing review.

Whose words

Record who said each thing: the person, a caregiver or surrogate, or a professional. A caregiver's needs get their own field.

Support to take part

Extra time, a quieter place, pictures, an interpreter or a trusted person can help someone say what matters. Ask what helps.

Barriers are not preferences

Cost, travel, work, housing, caring for others and digital access are written down as barriers, not as what the person wants.

Meaning, religious or not

Hope, purpose, faith, relationships and identity can be part of the conversation if the person wants. None is assumed.

• Doctor or nurse: Care, medicines and what happens next, explained at the person's pace.
• Interpreter or communication specialist: Language and communication support so the person's own words come through.
• Community health worker or cultural mediator: A bridge to services and the community, where such roles exist.
• Social worker or caseworker: Costs, entitlements and practical support. Rules differ by place.
• Psychologist or counselor: Support after hard experiences, at the person's pace.
• Chaplain or spiritual-care provider: Meaning, distress, hope and relationships, for people of any faith or none.
• People the person chooses: Family, friends, or a community or faith contact, only if the person wants them. Never assumed safe, available or wanted.

Roles, titles and training differ by country and service. Not every role exists everywhere.

A purposive sample chosen for contrast, not a ranking or a representative survey: Global, United Kingdom, United States, Chile, South Africa, Jordan, Bangladesh, Malaysia, Australia. Each example states what its source establishes and what it does not. Policy on paper is not proof that a service is available.

• Global · Guidance · 2024

  WHO's global action plan on refugee and migrant health lists, as an option when Member States request it, supporting cross-border dialogue and collaboration to improve continuity and quality of care for refugees and migrants.

  What others could learn: Continuity of care can be treated as a cross-border question, not only a clinic one. The same option names uniform protocols for continuity of care and patient tracking to reduce loss to follow-up when people move. A care conversation could note which records, medicines and contacts a person carries with them.

  Conditions, limits and source

  Conditions that matter:

  Depends on Member State requests, national contexts and legal frameworks, and on collaboration with the International Labour Organization, the International Organization for Migration, UNHCR and other partners. The plan states that access to vaccination and continuity of care is more difficult for people on the move.

  Cannot be inferred:

  Does not show that any cross-border protocol exists or works. Does not describe entitlements in any country. Does not say what any individual refugee or migrant needs or prefers.

  Limits:

  A strategic framework, not an evaluation of any service. Paragraph 31 lists options for the WHO Secretariat in response to requests by Member States, not duties of countries. The World Health Assembly noted the plan in 2019 (decision WHA72(14)) and extended its time frame to 2030 in 2023. It does not describe how continuity works in any border setting.

  Source: World Health Organization, WHO global action plan on promoting the health of refugees and migrants, 2019-2030 (Priority 2, paragraph 31(b), printed p. 10 (PDF p. 16); paragraph 15 on continuity of care for people on the move, printed p. 3; Preface on decision WHA72(14) and the 2023 extension to 2030). Where: Global. Population: Refugees and migrants, across all phases of migration and displacement. Published 2024-07-15; retrieved 2026-10-12.

• United Kingdom · Reported experience · 2023

  A systematic review of 10 studies published 2014 to 2021 found limited evidence suggesting that fears of NHS charging and data sharing can deter some migrants in England from accessing healthcare.

  What others could learn: Fear can persist even when a person is exempt. The review reports that fears persisted among some migrants who were exempt from charging, and that patients and professionals often lacked knowledge of the rules. Clear information on charges and on what is shared may matter as much as the rule itself.

  Conditions, limits and source

  Conditions that matter:

  As described in the review, NHS trusts recover costs from overseas visitors at 150% of the service tariff for most secondary and tertiary care, with exemptions for some groups and for urgent and immediately necessary treatment. The authors support training and communication about the regulations for patients and professionals.

  Cannot be inferred:

  Does not measure how many migrants delayed or avoided care. Does not show health outcomes. Does not describe the rules in force today, or in settings with different charging or data-sharing rules.

  Limits:

  The authors call the evidence lacking, and seven of the 10 studies were rated low quality. Most included studies are qualitative or grey literature, so the review shows that fears were reported, not how often care was avoided. Studies date from 2014 to 2021; current charging rules were not checked here. Two authors declared campaigning with the group Docs not Cops.

  Source: BMC Public Health (Rassa N, McCarthy M, Casalotti S, Zhang C, Wurie F, Brown C, Campos-Matos I), The impact of NHS charging regulations on healthcare access and utilisation among migrants in England: a systematic review. (Abstract, Results (BMC Public Health 2023;23(1):403); Results on fear of charging and data sharing; quality appraisal (Appendix C)). Where: United Kingdom (England). Population: Migrants in England affected by NHS charging regulations, including people seeking asylum and pregnant migrant women, across 10 included studies. Published 2023-02-28; retrieved 2026-10-12.

• United States · Measured outcome · 2023

  In a 2018 to 2019 California survey of 1,681 Asian and Latinx immigrants, almost all individual enforcement experiences, and each additional cumulative experience, were associated with delaying care in both groups.

  What others could learn: Direct encounters with enforcement, not only general fear, were linked with delayed care. A care conversation can make room for worries about safety and about who sees health information, without asking about a person's status.

  Conditions, limits and source

  Conditions that matter:

  The survey ran in English, Spanish, Chinese (Mandarin and Cantonese), Vietnamese and Korean, with sample weights. Enforcement policy at federal, state and local levels shapes exposure; the authors point to changes in health and immigration policy to protect access to care.

  Cannot be inferred:

  Does not show that enforcement caused delays. Does not describe immigrants outside California, or immigrant groups beyond the Asian and Latinx respondents surveyed. Says nothing about any individual's legal status. Does not show health outcomes of delayed care.

  Limits:

  Cross-sectional and self-reported; the authors say the design precludes causal conclusions, and the survey did not record when experiences happened. There were no associations with having a usual source of care. The analysis could not separate respondents by legal status. Of eligible participants, 42.5% in 2018 and 31.4% in 2019 completed the survey.

  Source: Medical Care (Young MT, Tafolla S, Saadi A, Sudhinaraset M, Chen L, Pourat N), Beyond "Chilling Effects": Latinx and Asian Immigrants' Experiences With Enforcement and Barriers to Health Care. (Abstract, Results (Med Care 2023;61(5):306-313); Methods and Limitations in the PMC author manuscript). Where: United States (California). Population: Asian and Latinx immigrant adults in California (n=1681). Published 2023-03-20; retrieved 2026-10-12.

• Chile · Reported experience · 2020

  In 18 interviews in two communes of Chile's Metropolitan Region, key actors linked the intercultural facilitator role in care for Haitian migrants to translation, interpretation, health-system education, intercultural mediation and administrative tasks.

  What others could learn: One role can combine language support, explaining how the health system works and cultural mediation. The authors say participants' view of the role matched current health policy, and that it could be replicated in countries facing similar challenges.

  Conditions, limits and source

  Conditions that matter:

  Facilitators based in family health centers and hospitals, with health policy support for the role. The abstract does not describe facilitator numbers, training, pay or languages covered.

  Cannot be inferred:

  Does not show that facilitators improve access or health outcomes. Not representative of Chile, of other communes, or of all Haitian migrants. Does not describe how many centers employ facilitators.

  Limits:

  Abstract only; the article is in Spanish and the publisher site and doi.org were unreachable. One qualitative case study with a small sample (18 participants) in two communes. The abstract does not say how many participants were migrants or facilitators, or when interviews took place. Perceptions of a role, not measured effects on care.

  Source: Revista Peruana de Medicina Experimental y Salud Pública (Sepúlveda C, Cabieses B); English abstract via PubMed, [Role of the intercultural facilitator for international migrants in chilean health centres: perspectives from four groups of key actors]. (Abstract, Results (English abstract on PubMed; Rev Peru Med Exp Salud Publica 2019;36(4):592-600)). Where: Chile (Quilicura and Santiago communes, Metropolitan Region). Population: Key actors (health authorities, health workers, intercultural facilitators and international migrants), n=18; focus on care for Haitian migrants. Published 2020-01-17; retrieved 2026-10-12.

• South Africa · Policy · 2021

  Reviewing South African law and policy as of 2020, with 18 key informant interviews, a 2021 study found the Immigration Act and the 2019 NHI Bill made migrants' legal status the most significant determinant of healthcare access.

  What others could learn: Entitlement on paper and access at the facility can differ. Key informants described insistence on identity documents before service, financial misclassification and medical xenophobia. The authors call for clear guidelines on the rights and responsibilities of providers, migrants and refugees, and on healthcare entitlements.

  Conditions, limits and source

  Conditions that matter:

  The Constitution says no one may be refused emergency medical treatment, and the National Health Act says the same of providers. According to the authors, the Immigration Act requires facility staff to determine migrants' status before providing services and to report undocumented migrants to the Department of Home Affairs. Public-sector resource constraints affect all patients.

  Cannot be inferred:

  Does not show what happens at any one facility or how often care is refused. Does not describe the law in force today. Does not describe the experience of any individual migrant or refugee, or of all migrants of one nationality.

  Limits:

  Describes law and draft policy as reviewed in 2020; later legislative changes, including what became of the NHI Bill, were not checked here. Key informant views, not patient interviews or measured access. Interviews spanned 2015 to 2019, which the authors note as a limitation. Policies vary by province in content, interpretation or implementation.

  Source: Health Policy and Planning (White JA, Rispel LC), Policy exclusion or confusion? Perspectives on universal health coverage for migrants and refugees in South Africa. (Abstract (Health Policy Plan 2021;36(8):1292-1306); Results on legislation; Discussion; Limitations). Where: South Africa. Population: Migrants and refugees in South Africa, as subjects of law and policy; 18 key informants from government, academia, civil society and a United Nations organization. Published 2021-04-13; retrieved 2026-10-12.

• Jordan · Reported experience · 2019

  In 68 interviews in 2018, Syrian refugees in central and northern Jordan described noncommunicable disease services across government, NGO and private sectors as complex, inadequate, expensive and fragmented.

  What others could learn: Cost and fragmentation shape what a person can follow through on. Participants described coping by reducing medication dosages, borrowing medicines, selling food aid and taking on debt. They also described host-community neighbors helping during health emergencies. A care conversation can ask where each medicine comes from and what it costs.

  Conditions, limits and source

  Conditions that matter:

  According to the authors, in January 2018 Jordan raised fees for Syrian refugees to the "foreigner rate", with 80% of fees paid before services; most participants then avoided government facilities because of cost. Interviews were conducted by Jordanian interviewers in Levantine Arabic.

  Cannot be inferred:

  Does not describe current fees or entitlements in Jordan. Not representative of all Syrian refugees in Jordan, including those in camps. Does not show health outcomes.

  Limits:

  Interviews took place in April 2018, shortly after a fee change; fees and entitlements for Syrian refugees in Jordan may have changed since and were not checked here. Participants were drawn from people who had not returned to two NGO clinics. Urban and semi-urban settings only. Participants' accounts, not measured access or outcomes.

  Source: Conflict and Health (McNatt ZZ, Freels PE, Chandler H, Fawad M, Qarmout S, Al-Oraibi AS, Boothby N), "What's happening in Syria even affects the rocks": a qualitative study of the Syrian refugee experience accessing noncommunicable disease services in Jordan. (Abstract, Results, theme 2 (Confl Health 2019;13:26); Background on the January 2018 fee change; Results and Discussion on cost and coping). Where: Jordan (urban and semi-urban areas, central and northern Jordan). Population: Adult Syrian refugees with diabetes, hypertension or asthma who had sought care at one of two NGO clinics in 2016 and did not return (n=68). Published 2019-06-13; retrieved 2026-10-12.

• Bangladesh · Service in operation · 2022

  A 2020 quality improvement project at three primary health facilities in Bangladesh's Rohingya refugee camps used Rohingya community health workers, who already visited homes regularly, to encourage people with hypertension to return for follow-up.

  What others could learn: Community health workers who already visit homes can link people to follow-up and health education for a long-term condition. The authors say national staff, local champions and refugee volunteers were involved from the outset, and the clinic was still running over two years after it began.

  Conditions, limits and source

  Conditions that matter:

  An existing system of Rohingya community health workers visiting each home; a dedicated clinic within primary care; pharmacist training and stable medicine supply; NGO operation. During COVID-19 the project gave longer prescriptions to keep people in care.

  Cannot be inferred:

  Does not show that community health worker visits alone changed return rates or blood pressure. Not representative of all services in the camps. Does not report what Rohingya patients themselves said about the service.

  Limits:

  Brief report written by the project team about a single project at three facilities run by one NGO partnership. Of 554 patients seen in 2020, 358 (64.6%) returned for follow-up at least once. The report does not separate the effect of community health worker follow-up from other changes, and has no comparison group.

  Source: BMJ Open Quality (Hamilton D, Sultana M, Ho LL, Arai M, Businge E, Lukwata R, Maina AGK, Khadka M, Wright J), Managing hypertension in a Rohingya refugee camp: a brief report. (Design and strategy (second plan-do-study-act cycle); Results; Discussion (BMJ Open Qual 2022;11(4):e001846)). Where: Bangladesh (Rohingya refugee camps, Cox's Bazar District). Population: Rohingya refugees seen for hypertension in a noncommunicable disease service (554 patients in 2020). Published 2022-12-08; retrieved 2026-10-12.

• Malaysia · Reported experience · 2020

  Stakeholders interviewed in Malaysia in 2018 to 2019 reported that health workers used Google Translate and hand gestures to communicate, and migrant patients were encouraged to bring friends as informal interpreters.

  What others could learn: Where no formal interpreter system exists, communication falls to apps, gestures and companions. The authors report that language barriers complicated communication about complex conditions, including mental health, and obtaining informed consent. In the same study, public facilities in Thailand could hire Migrant Health Workers as formal interpreters.

  Conditions, limits and source

  Conditions that matter:

  The authors link limited policy support for cultural competency in Malaysia partly to domestic concerns about overuse of services by non-citizens, and ask who should pay for language interventions: employers, the government or migrants themselves.

  Cannot be inferred:

  Does not measure how often informal interpreters are used or their effect on care. Does not describe all migrants or refugees in Malaysia, or those of any one nationality.

  Limits:

  Stakeholder perceptions, mostly from professionals and organizations rather than migrants themselves. Purposive and snowball sampling, which the authors say may add selection bias. Describes 2018 to 2019, when Malaysia had not formalized an interpreter system; later changes were not checked.

  Source: PLoS One (Pocock NS, Chan Z, Loganathan T, Suphanchaimat R, Kosiyaporn H, Allotey P, Chan WK, Tan D), Moving towards culturally competent health systems for migrants? Applying systems thinking in a qualitative study in Malaysia and Thailand. (Abstract, Results (PLoS One 2020;15(4):e0231154); Methods for interview dates; Discussion for limitations). Where: Malaysia. Population: Policy, civil society, industry stakeholders and health workers in Malaysia (37 interviews, 44 participants); the study's separate Thailand sample is not used for this claim. Published 2020-04-06; retrieved 2026-10-12.

• Australia · Reported experience · 2024

  Seven Karen women of refugee background who recently gave birth in Melbourne said they may not experience trauma- and violence-informed maternity care without access to an interpreter, or if their relationship with the interpreter is unsafe.

  What others could learn: Interpreting can be part of trauma-informed care rather than an add-on. Women also named care design and accessibility, and choice and control, and still preferred female interpreters for discussing women's health. The authors suggest continuity of trauma-informed interpreting may support communication.

  Conditions, limits and source

  Conditions that matter:

  Access to professional interpreters, including female interpreters, and time in appointments. The lead researcher is a Karen-Australian woman with lived refugee experience, and a Community Advisory Group shaped the study.

  Cannot be inferred:

  Not representative of Karen women, of women of refugee background, or of people from Myanmar generally. Does not test any trauma-informed intervention. Does not show how the findings apply outside pregnancy care.

  Limits:

  Very small sample (seven women) from one community in one area of Melbourne, recruited through community networks. The authors chose a modest sample for feasibility and participant safety. Reported experience, not a measured effect of any interpreting practice.

  Source: International Journal of Environmental Research and Public Health (Toke S, Correa-Velez I, Riggs E), Exploring Trauma- and Violence-Informed Pregnancy Care for Karen Women of Refugee Background: A Community-Based Participatory Study. (Abstract (Int J Environ Res Public Health 2024;21(3):254); Results 3.3 and Discussion 4.3 'Trauma-Informed Interpreting'). Where: Australia (Western metropolitan Melbourne, Victoria). Population: Karen women of refugee background who had recently had a baby (n=7). Published 2024-02-22; retrieved 2026-10-12.

• Australia · Measured outcome · 2021

  In the OPTIMISE trial in 31 Australian general practices, more practices used the government-funded interpreting service after facilitation, but family members and friends still interpreted, with GPs reporting patients preferred this.

  What others could learn: Recording each person's preferred language and interpreter needs where all staff can see it was a gap even in practices with procedures. The authors suggest training all staff on when and how to work with interpreters, and discussing patient concerns about interpreting services.

  Conditions, limits and source

  Conditions that matter:

  Australia's government-funded Translating and Interpreting Service; reception staff who assess and record language needs; GP time and administrative burden, since the extra time to arrange interpreters remained a major barrier. In 71% of practices at least one GP spoke a language spoken by recent humanitarian entrants.

  Cannot be inferred:

  Does not show patients' own reasons for using family members. Does not show health outcomes of interpreter use. Not representative of rural practices or of all patients from refugee backgrounds.

  Limits:

  Patient preference is as reported by GPs and practice staff, not by patients. The authors note that patients often bring family for interpreting and support, which may lead to a misconception that family interpreting is their preference. Uses a subset of trial measures at baseline and 6 months, in urban practices only.

  Source: BMC Health Services Research (Saito S, Harris MF, Long KM, Lewis V, Casey S, Hogg W, Cheng IH, Advocat J, Marsh G, Gunatillaka N, Russell G), Response to language barriers with patients from refugee background in general practice in Australia: findings from the OPTIMISE study. (Abstract, Results (BMC Health Serv Res 2021;21(1):921); Results on family members and friends as interpreters; Discussion). Where: Australia (three urban regions with high refugee settlement). Population: 31 general practices and 55 general practitioners serving patients from refugee backgrounds. Published 2021-09-06; retrieved 2026-10-12.

• The sourced examples include guidance, reported experience, measured outcome, policy, service in operation. Each quote was matched to the source text; that is not independent expert review.
• The prompts and fictional case are original. They have not been tested with patients, caregivers or clinicians.
• Whether this workflow helps anyone is an open research question.
• Content is in English. Interface translations are not reviewed for this topic.