Healthcare beyond borders: what do we need to address health needs of migrants and displaced populations?

To date, more than 1 billion people are on the move or displaced, driven by a range of factors, from the search for a better life for themselves and their families, to crises and resource scarcity. Many are among the most vulnerable, fleeing war, persecution, or natural disasters, which increase risks to physical and mental health and limit their access to healthcare.

In their article, published in The Lancet Public Health, the authors highlight that current health financing arrangements fall short in addressing the unique health needs of migrants and displaced populations, in particular, undocumented migrants.

Researchers highlight that ensuring migrants and refugees have access to affordable and quality health care not only upholds human rights, but also strengthens public health, however, migration is too often framed as a threat. Health systems are increasingly being tasked with enforcing national borders, such as by verifying a person’s legal status before providing care with the aim of reducing costs for host countries. Furthermore, levels of official development assistance are volatile and insufficient to meet migrant and refugee healthcare needs. They are also not always targeted at countries with the greatest need. 

“In a world increasingly shaped by climate change, conflict, and economic instability, everyone is, potentially, a migrant,” says IIASA researcher Josephine Borghi, who co-authored the article. “Responsibility for — and conceptions of — UHC must therefore extend beyond national borders, to address transnational challenges and sustain progress towards UHC everywhere.”

As part of their study, the authors highlight several examples of country initiatives to integrate migrants and refugees in domestic health financing arrangements. For example, Uganda provides refugees with entitlement to the same healthcare access as nationals, and is transferring ownership of non-governmental organization facilities providing services to refugees to the government, with funding from district budgets. As a result, many countries have shown improved health indicators, including expanded vaccine coverage, reduced maternal mortality, and strengthened public health infrastructure for refugees and migrants.

Nevertheless, multiple challenges persist. Undocumented migrants and refugees are sometimes excluded from health insurance coverage, and premium affordability and other barriers limit enrolment among those eligible for cover. Furthermore, the increasing reliance on host-country funding creates disproportionate responsibilities for financing migrant and refugee healthcare, which, in the case of low-income and middle-income countries, can risk undermining UHC progress. To address the outlined challenges, the authors advocate for a UHC framework based on cosmopolitan principles, whereby the UHC perspective shifts from a national to a global scale.

The authors outline four key pillars underpinning a cosmopolitan approach to UHC. These include:

1. Global solidarity mechanisms: countries contribute to financing migrant and refugee healthcare based on their ability to pay, with resources pooled at the supranational level to maximize efficiency and redistribution. Resources are allocated to host countries based on need, covering a universal essential package of healthcare services for migrant populations.
2. Integrated health networks: cross-border healthcare cooperation to ensure continuity of care for mobile and displaced populations.
3. Universal access policies: harmonized legal frameworks guaranteeing health coverage for migrants and refugees across jurisdictions.
4. Long-term investments: resources allocated to preventive care, mental health services, and infrastructure addressing immediate and structural health needs. 

Reference:

Severoni, S., Marotta, C., Borghi, J. (2025). Universal health coverage in the context of migration and displacement: a cosmopolitan perspective. The Lancet Public Health. 10.1016/S2468-2667(25)00117-3