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.

Introduction: LGBTQI + refugees and asylum seekers experience enormous distress during their lifespan. Ill-effects of socio-cultural stigma, systemic violence, and forced migration due to sexual orientation, gender identity or expressions, and sex characteristics (SOGIESC) are not their only challenge. The cumbersome asylum process in host countries negatively affects their mental health and well-being. The objective of this systematic review was to retrieve, critically evaluate and synthesize the evidence from qualitative data relating to mental health conditions of LGBTQI + forced migrants before, during, and after resettlement. Methods: Seven Databases (Web of Science, PubMed, Taylor, and Francis online as well as MEDLINE, PSYNDEX, PsycINFO, and PsycArticles via EBSCO) were queried with relevant search terms between January and April 2020. To be included in the analysis, studies had to be qualitative and published in peer-reviewed journals between 2002 and 2020. Of 410 records, 23 of them met the inclusion criteria. Two low-score records were removed after critical evaluation with the CASP (Critical Appraisal Skills Program). Data from 21 studies were extracted. Qualitative meta-aggregation was implemented as the data synthesis strategy. Results: Four emerged themes were linked to distress: Violence/discrimination, mental healthcare access barriers, asylum system challenges, and unaddressed mental health difficulties. Coping strategies and support resources were two other relevant themes across and within the data. Conclusions: Experiencing violence and deprivation of equitable mental health services in countries of origin due to SOGIESC status, difficulties in the asylum process, limited care in detention centers, cultural and financial barriers in host countries, and finally, discrimination based on multiple marginalized identities explain how the mental health condition of LGBTQI + forced migrants is inextricably intertwined with structural discrimination. Policy Implications: Host countries need to ensure migrant and local communities are aware of state equality and LGBTQI + anti-discrimination policies. Service providers in both asylum and health systems need to be trained for affirmative, culturally sensitive, and intersectional approaches in their practice and avoid treating queer clients against their expectations and stereotypes. Also, they should address the authentic accounts of resilience and resistance of LGBTQI + forced migrants.

Schools are relevant settings for supporting refugee adolescents' mental health. As education and migration are important social determinants of health, we aim to integrate the qualitative findings of our mixed-methods study into a broader discussion regarding the role of schools and the potential effects on refugee adolescents' lives and mental health, as well as the impact of the COVID-19 pandemic. In this article, we present the findings of school-based actors' (i.e., teachers and school psychologists) perception of refugee adolescents' access to mental health care. The interviews highlight the importance of schools and social activities as main stabilizers and sources of support for refugee adolescents’ mental health and the role trusting school-parent relationships play in mental health care help-seeking. Our data indicate that schools lack the resources to properly address these needs. However, these structural gaps are rooted into historical segregation and discrimination in the German educational system and left unaddressed, can increase stigma and intergenerational social inequalities, especially in connection to the COVID-19 pandemic. We conclude our article with a set of recommendations that could be relevant and implemented across different contexts to strengthen the role of the school setting in promoting the mental health and well-being of refugee adolescents.

Despite racism and its impact on health inequities being increasingly studied in health care settings, racism in public health services has so far been neglected in public health research. Studying racism in public health services provides many opportunities to explore the relationship between racism and health protection. We identify several research themes to be explored on (1) non-stigmatizing and community-driven risk communication, (2) surveillance by public health authorities of racialized minority groups, (3) racism experiences in everyday interactions with public health authorities, (4) legal consequences of encounters with public health authorities and (5) public health infrastructure, structural racism and the intersectionality of marginalization. Tackling these research themes will help to start building an evidence base on how racism interferes with equitable health protection and how to dismantle it.

How can Schools of Public Health Actively Promote Peace?