With over 360,000 migrants, refugees and asylum-seekers arriving into the European Union by sea in 2016, health service and public health provision for new arrivals remains critical. Non-EU migrants are a vulnerable group and have traditionally faced considerable barriers in accessing healthcare. These barriers include national legal frameworks which restrict their entitlement to free or affordable care, difficulties in integrating socially (for example due to language and administrative barriers), culture-specific issues (for example, due to cultural and religious norms or beliefs, like gender preference for doctors) as well as lack of information on available services and rights.
The act of migration is itself considered a social determinant of health. The health status of a migrating individual upon arrival in a destination country is defined by their pre-existing health status, their socio-economic status in their country of origin as well as the access and quality of health services in their country of origin. Their situation is further influenced by the route and distance of the migration path which can include frequent exposure to poor basic resources, violence and conflict in intermediate locations (like the refugee camps or detention centers), and the access to health services in intermediate and destination countries.
Unaccompanied minors are met with additional health challenges, including specific psychological trauma as a result of their migratory experiences. Specialised care and responses to specific needs for these children are not frequently provided, as psychiatric interventions offered are not readily distinguished from mental health care provided to adults, often rendering psychiatric care age-inappropriate. In many cases, incomplete or non-existent vaccination in the country of origin or intermediate locations put all newly-arrived migrant children, including unaccompanied minors, at greater risk of contracting communicable diseases.
Undocumented migrants also face specific challenges when accessing healthcare within the EU. While emergency care is available to non-EU migrants at no cost in some EU Member States, a fee for emergency care is requested out-of-pocket in others. Most significantly, across the EU, undocumented migrants often have very limited or no entitlement to cost-free preventative healthcare - despite the often quoted cost-effectiveness of preventative versus emergency treatment . Many harbour a fear of seeking treatment and engaging with primary care services, primarily due to their irregular legal status and mandatory police reporting in some EU countries. For those suffering from chronic diseases, a general lack of information and knowledge may lead to cases of disruptive treatment schemes which lead to more costly emergency services or aggravated medical status.
There have been numerous proposals to provide more intersectoral and interdisciplinary support to uphold the rights of migrants in the EU. These include last year’s Action Plan on the integration of third country nationals as well as the call for The protection of children in migration, which encourages Member States to extend increased support to migrant children including unaccompanied minors. The recent unveiling of the European Pillar of Social Rights, which EuroHealthNet welcomed following an invited consultation, may potentially offer increased opportunity for newly-arrived migrants to be better integrated into European society - particularly by way of its ‘Social Protection and Inclusion’ principles - which could, in turn, impact their ability to access public services, including healthcare. The proposed enhanced ‘right to health’ potentially extends to all people in, not just originally from, Europe.
There is a responsibility at both EU and Member State level for the provision of adequate, accessible and affordable health services for non-EU migrants, as well as the reception of these individuals more broadly. While healthcare provision for migrants does currently differ across the EU, various regions and cities have increased their efforts beyond the national laws provisions to fill the gaps in access to health care; policy-makers, service designers and health care professionals have played a crucial role in allocating the necessary resources and ensuring health care services in local contexts.
Yet, improved coordination, evidence-based and intersectoral approaches are needed in the EU in order to make sure that tangible and effective action is being taken in all Member States to minimise migration-related health inequalities, which are primarily a result of inappropriate legal frameworks and social exclusion. In return, these health inequalities create more poverty, unemployment and disability, pushing children into the cycle of disadvantage and impeding on social integration and contribution to the economy and societal development of the host country.
EuroHealthNet’s Policy Précis on ‘Migration, Refugees and Health Needs’ is available to view here.
 UNHCR (2017) Mediterranean Situation http://data2.unhcr.org/en/situations/mediterranean
 IOM(2006) Migration: A Social Determinant of the Health of Migrants https://ec.europa.eu/migrant-integration/index.cfm?action=media.download&uuid=2AA986F7-DBA1-D96C-9028652AF54FC2C1
Hebebrand et al. (2016) A first assessment of the needs of young refugees arriving in Europe: what mental health professionals need to know https://link.springer.com/article/10.1007/s00787-015-0807-0
 European Union Agency for Fundamental Rights (FRA) (2015) Cost of exclusion from healthcare – The case of migrants in an irregular situation http://fra.europa.eu/en/publication/2015/cost-exclusion-healthcare-case-migrants-irregular-situation
 European Commission (2016) Action Plan on the integration of third country nationals http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=COM:2016:0377:FIN
 European Commission (2017) The protection of children in migration https://ec.europa.eu/home-affairs/sites/homeaffairs/files/what-we-do/pol...
 European Commission (2017) European Pillar of Social Rights https://ec.europa.eu/commission/priorities/deeper-and-fairer-economic-an...
 PICUM (2017) Cities of Rights: Ensuring health care for undocumented residents http://picum.org/picum.org/uploads/publication/CityOfRights_FINAL_WEB_EN...