Background: Accessing and using health care in European countries pose major challenges for asylum seekers and refugees due to legal, linguistic, administrative, and knowledge barriers. This scoping review will systematically describe the literature regarding health care for asylum seekers and refugees in high-income European countries, and the experiences that they have in accessing and using health care. Methods: Three databases in the field of public health were systematically searched, from which 1665 studies were selected for title and abstract screening, and 69 full texts were screened for eligibility by the main author. Of these studies, 44 were included in this systematic review. A narrative synthesis was undertaken. Results: Barriers in access to health care are highly prevalent in refugee populations, and can lead to underusage, misuse of health care, and higher costs. The qualitative results suggest that too little attention is paid to the living situations of refugees. This is especially true in access to care, and in the doctor-patient interaction. This can lead to a gap between needs and care. Conclusions: Although the problems refugees and asylum seekers face in accessing health care in high-income European countries have long been documented, little has changed over time. Living conditions are a key determinant for accessing health care.

Background: Refugees and asylum seekers have a high prevalence of psychiatric disorders such as post-traumatic stress disorder (PTSD), anxiety, and depression. The postmigration context inheres different risk and protective factors for mental health of refugees and asylum seekers in host countries. We conducted a systematic review to update knowledge on the association between characteristics of the postmigration living situation (PMLS) and mental health outcomes in Europe since 2015. Methods: We searched in five databases according to the PRISMA statement. From a total of 5,579 relevant studies published in 2015–22, 3,839 were included for title and abstract screening, and 70 full texts screened for eligibility. Out of these, 19 studies on refugees and asylum seekers conducted in European countries after 2014 were included in this systematic review. The quality of studies was assessed by using the Mixed Methods Appraisal Tool (MMAT) – version 2018. We performed a narrative synthesis using the four layers of the social determinants of health framework. Results: A wide range of risk and protective factors for mental health in the PMLS were identified as exposure measures, which included individual factors (e.g., language skills), social and community networks (e.g., family concerns, loneliness and social support, discrimination), living and working conditions (e.g., legal status, duration of residence, unemployment and financial hardship, housing) as well as general socio-economic, cultural and environmental factors (e.g., social status, acculturation). We found postmigration stressors are positively associated with symptoms of depression, anxiety, and PTSD, albeit not consistently so. Especially, the general socio-economic, cultural and environmental factors showed weak associations with mental health. Conclusions: Heterogenous study characteristics likely explain the inconsistent associations between characteristics of the PMLS and mental health outcomes. However, broken down in its component layers, most risk and protective factors of the PMLS were significantly associated with symptoms of mental disorders showing the same direction of association across the included studies, while the association between some stressors or resources of the PMLS and mental health turns out to be less homogeneous than expected. Characteristics of the PMLS contribute to the high prevalence of mental diseases of refugees and asylum seekers. Disadvantages in general socio-economic conditions, living and working conditions, in access to social and community networks need to be redressed, in addition to better access to health care.

Zusammenfassung: Hintergrund: Menschen mit Fluchtgeschichte sind mit einer Vielzahl von rechtlichen, strukturellen, administrativen, kulturellen und sprachlichen Barrieren im Zugang zur Gesundheitsversorgung konfrontiert. Derzeit liegen jedoch wenig Daten zu gesundheitlichen Bedarfen und Bedürfnissen von Geflüchteten vor. Insbesondere ihre subjektiven Erfahrungen im Zugang zur Gesundheitsversorgung sind bisher wenig berücksichtigt worden. Ziel der Arbeit: In diesem Beitrag sollen die subjektiven Erfahrungen von Menschen mit Fluchtgeschichte beim Zugang zur Gesundheitsversorgung und bei deren Nutzung beschrieben werden. Strategien bei der Bewältigung von Herausforderungen werden dargestellt. Methoden: Die Rekrutierung der InterviewpartnerInnen erfolgte anhand von quantitativen Querschnittsdaten, die im Rahmen einer Studie zur Gesundheit von Geflüchteten (FlüGe-Gesundheitsstudie) erhoben wurden. Personen, die einer erneuten Kontaktaufnahme zugestimmt hatten, wurden telefonisch kontaktiert. Es wurde eine im Hinblick auf Alter, Geschlecht, Nationalität, Gesundheitszustand und Inanspruchnahmeverhalten heterogene Teilstichprobe (n = 18) mittels dolmetschergestützter problemzentrierter Interviews nachbefragt. Die Datenauswertung erfolgte in einem deduktiv-induktiven Prozess. Ergebnisse und Diskussion: Die wenig migrationssensible Gesundheitsversorgung von Menschen mit Fluchtgeschichte ist geprägt durch Sprachbarrieren, Orientierungslosigkeit, Ablehnungserfahrungen, Fehlbehandlungen und strukturelle Barrieren. Fremdheitserfahrungen in und mit dem Gesundheitssystem können dazu führen, dass die Versorgung nicht (mehr) oder nur verzögert in Anspruch genommen wird. Gleichzeitig werden individuelle Strategien von Geflüchteten und VersorgerInnen angewendet, um den genannten Herausforderungen zu begegnen.

Objectives: The study aims to investigate the significance of legal status for well-being and access to and use of needs-based health care by asylum seekers and refugees in Germany.Methods: Using a mixed-method-design, we first conducted a cross-sectional study to explore access to health care and unmet needs of refugees and asylum seekers and legal status. Data were analysed using descriptive statistics. For the qualitative study a heterogeneous sample was recruited from the quantitative data. Interviews were analysed using a deductive-inductive approach.Results: Quantitative results showed that health care utilisation was associated with an unsecure legal status but not with unmet care needs. The in-depth qualitative study revealed that the legal status determines experiences of structural violence that can negatively affect well-being and associated access to health care.Conclusion: An insecure legal status can affect access to health care for refugees and asylum seekers. In order to improve health, changes in living conditions and the removal of access barriers are necessary.

Background: Armed conflict and war are public health disasters. Public health action has a crucial role in conflict-related emergencies and rehabilitation but also in war prevention and peace promotion. Translating this into public health training and competencies has just started to emerge, especially in Europe. Methods: We conducted a Scoping Review to map and identify the role of public health education and training of public health workforce relating to the prevention of war and promoting peace, as reflected in the scientific literature. We searched in PubMed, CINAHL, PsycINFO, Embase, Web of Science Core Collections as well as the reference list of included material in English, German and Polish. Focusing initially on the European region, we later expanded the search outside of Europe. Results: We included 7 publications from opinion pieces to an empirical assessment of curricula and training. The educational programs were predominantly short-term and extra-curricular in postgraduate courses addressing both public health professionals in conflict-affected countries as well as countries not directly affected by war. Publications focused on public health action in times of war, without specifying the context and type of war or armed conflict. Competencies taught focused on emergency response and multi-disciplinary collaboration during emergencies, frequently drawing on experience and examples from natural disaster and disease outbreak management. Conclusions: The scientific discourse on competences in public health education for times of war and for the promotion of peace, predominately focuses on immediate emergency response actions. The prevention of war and the promotion of peace are missing foci, that need to feature more prominently in public health training. Public Health Education and training should ensure that war prevention and peace promotion, as well as public health action in times of war, are included in their competencies for public health professionals.