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

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