Public health aspects of migrant health: a review of the evidence on health status for undocumented migrants in the European Region

The issue Migration is considered a major social, political and public health challenge for the WHO European Region, with Europe currently having the second largest number of international migrants per year. While all migrants may have issues with accessing health care, undocumented migrants are vulnerable to certain risks and diseases and may encounter several barriers to accessing health care because of their irregular status and economic and social marginalization. The synthesis question The objective of this report is to synthesize research findings from a systematic review of available academic and grey literature to address the following question: What policies and interventions work to improve health care access and delivery for undocumented migrants in the European Region? Types of evidence The evidence comes from peer-reviewed literature and grey literature of a study population of people not having the legal right to be/remain in a country within the WHO European Region. This review considered a total of 122 publications in English, with full text available, up to 28 February 2015. Results Inconsistency and uncertainty in demographic and health data specifically concerning undocumented migrants are common across the WHO European Region. • Most reports consider a specific issue, such as infectious diseases, chronic illnesses, mental disorders, or mother–child health, rather than general health access. • Undocumented migrants mostly only have access to emergency care across the Region. • Even in the countries where undocumented migrants are fully entitled to care, formal and informal barriers hinder access.Informal barriers include language and communication problems, lack of social network, and lack of knowledge about the health care system and about networks of health care professionals. • Health care providers often see barriers to provision of health care, such as cultural and language barriers. The few available examples of policies and best practices are focused on overcoming such barriers. Policy considerations In order to support policy-makers in strengthening or introducing specific and coherent policies regarding undocumented migrants’ entitlement to health, guaranteeing fair health care access and ensuring confidentiality and protection for all parties involved, the following policy options are identified: • reconsider entitlement to health care for undocumented migrants with respect for human rights, national legal frameworks, organization of the health system and public health issues; • increase public awareness by advocating on the issues facing undocumented migrants; • plan systems to disseminate information to both undocumented migrants and health providers about the right to health care, how to access it and legal protection; • promote an intersectoral approach and cross-border cooperation, as well as service planning oriented to universal health coverage; • support health care providers by making available or improving communication services (i.e. cultural mediators, interpreters) in order to promote an inclusive and culturally sensitive health system; • collect data on undocumented migrants’ health status routinely and make these available for the scientific community and policy-makers; • define indicators and tools to monitor and assess the impact of policies; • plan specific training programmes on migrant health for health care professionals, encouraging the inclusion of this into educational health programmes; and • foster research to improve knowledge of the health needs of undocumented migrants and how these compare with those of other migrant groups.