Introduction to the health of refugees and asylum seekers in Europe

In 2015 over one million people arrived in Europe by sea, mostly originating from Syria. In the same year 3,771 people went missing or died attempting to reach safety in Europe. In 2016 people continue to make the hazardous journey across the sea and at the beginning of February 67,072 people made it across, while 357 were reported dead or missing.[1]

Many of those who do reach Europe, across the sea or otherwise, continue to face threats to their health and security. In their attempt to reach countries of asylum, they are forced to endure inadequate shelter and sanitation, and lengthy multi-day walks and waits at borders in adverse weather conditions.

While some of them suffer from chronic medical conditions that go unattended, others are pregnant without access to prenatal care. Many of the refugees and asylum seekers are children, some with respiratory infections. Others suffer from mental trauma related to the conflict and persecution they are fleeing from. The fear of repatriation or detention and bureaucratic hurdles makes them potentially wary of seeking healthcare. The London School of Hygiene and Tropical Medicine published on their website the article titled “On the move: the race to keep forced migrants healthy”, that looks at some of the health consequences for refugees and asylum seekers of being on the move.

Those refugees and asylum seekers who do access some kind of healthcare present medical staff in Europe with several challenges. Whilst some of these challenges are not related to their medical conditions, such as language barriers and cultural differences, others are medical or public health related and, if possible, should be attended to with an evidence-based approach.

The information and collection of evidence within this resource aims to provide those addressing the health of refugees and asylum seekers with some guidance. The collection of evidence is divided between the sources mentioned on this page and a Cochrane Library Special Collection, housed in the Cochrane Library. Both collections of evidence focus on some of the most relevant medical conditions as perceived by experts who have been involved either in guideline development or on the frontline, directly addressing the needs of refugees and asylum seekers. In the first instance, the collaboration (see below) decided on the following priority conditions to address in the Special Collection:

  • Common Mental Health Disorders (including PTSD and depression)
  • Vaccine Preventable Diseases
  • Skin conditions (including Impetigo, Scabies and Cellulitis)
  • Tuberculosis
  • Sexual and Physical Violence

Latterly, in 2018, Oral Health was added to this list as a priority area.

This Evidence Aid resource will link to each Special Collection, but also identify non-Cochrane systematic reviews. The Cochrane Evidence Aid Special Collection – Health of refugees and asylum seekers in Europe includes only Cochrane Reviews, although these are also listed below. (The Cochrane Evidence Aid Special Collection is also available in Spanish: La salud de los refugiados y solicitantes de asilo en Europa, hosted by Cochrane Iberoamérica.)

This initiative is a collaboration between Cochrane, Wiley, Kevin Pottie, Leo Ho and Evidence Aid and incorporates the suggestions and contributions of many others. The pictures were provided by Denis Bosnic and were all taken in Italy (contact details or link to site).

Please contact us with suggestions and comments, so we can improve this page. We will add to this page whenever we find other relevant materials, so please return to this page if you are interested.

*All of the summaries of the reviews and guidelines have also been translated into Spanish [ES] and French [FR]. We are very grateful to volunteers at Translators Without Borders who help us with this important work.

If you would like to use an appraisal framework when considering the relevance and quality of the full reviews that Evidence Aid links to, a few useful tools are: AMSTARCASP and ROBIS. Guidance is also available on reporting reviews: PRISMA.

1 (last accessed on 2 February 2016).