Individual and structural barriers to Latin American refugees and asylum seekers' access to primary and mental healthcare in Chile: A qualitative study

Abstract

Background Since 2010 there has been a growing population of refugees and asylum seekers in Latin America. This study sought to investigate the perceived experiences and healthcare needs of refugees and asylum seekers of Latin American origin in Chile in order to identify main barriers to healthcare and provide guidance on allied challenges for the public healthcare system. Methods Descriptive qualitative case study with semi-structured interviews applied to refugees and asylum seekers (n = 8), healthcare workers (n = 4), and members of Non-Governmental Organizations and religious foundations focused on working with refugees and asylum seekers in Chile (n = 2). Results Although Chilean law guarantees access to all levels of healthcare for the international migrant population, the specific healthcare needs of refugees and asylum seekers were not adequately covered. Primary care and mental healthcare were the most required types of service for participants, yet they appeared to be the most difficult to access. Difficulties in social integration -including access to healthcare, housing, and education- upon arrival and lengthy waiting times for legal status of refugees also presented great barriers to effective healthcare provision and wellbeing. Healthcare workers and members of organizations indicated the need for more information about refugee and asylum-seeking populations, their rights and conditions, as well as more effective and tailored healthcare interventions for them, especially for emergency mental healthcare situations. Conclusions All participants perceived that there was disinformation among institutional actors regarding the healthcare needs of refugees and asylum seekers in Chile. They also perceived that there were barriers to access to primary care and mental healthcare, which might lead to overuse of emergency services. This study highlights a sense of urgency to protect the social and healthcare needs of refugees and asylum seekers in Latin America.

Experiences of Providers and Immigrants/Refugees with Health Care: A Meta-Synthesis of the Latin American Context

“…"I was very worried about the idea that girls [daughters] could get sick […] a plan of attention was very clear (W1, refugee woman) (Calderón et al, 2020).…”

“…In addition, there is lack of formal health policies aimed at caring for immigrants/refugees (Aizenberg et al, 2015), adequate infrastructure, inputs, and human resources for care (Barbosa et al, 2020;Duden & Martins-Borges, 2021), and health services that are more articulated and less bureaucratic (Carneiro-Junior et al, 2018;Carneiro-Junior et al, 2022;Motizuki et al, 2019;Ojeda et al, 2020). As a consequence, immigrants/ refugees face difficulties accessing health services (Aizenberg et al, 2015;Arcos et al, 2018;Calderón et al, 2020;Giraldo et al, 2021;Ramírez-Santana et al, 2019), especially primary care services (Pedrozo et al, 2021;Pinto et al, 2019), compelling them, especially undocumented ones, to extensivily use emergency units as a gateway (Agudelo-Suárez et al, 2022;Barreto et al, 2019;Giraldo et al, 2021;Pedrozo et al, 2021).…”

“…They said she wasn't registered or the document was expired. I did not understand well, but they did not meet her (M1, refugee, man) (Calderón et al, 2020).…”

“…Another prominent situation identified by providers is related to immigrants/refugees' lack of knowledge of the host country's health system, which leads to vulnerability by delaying the search for care and hindering access to health services (Barreto et al, 2019;Calderón et al, 2020;Ramírez-Santana et al, 2019).…”

“…Providers Unpreparedness. Providers do not feel prepared and secure to meet the health demands of immigrants/refugees (Barreto et al, 2019;Bernales et al, 2017;Calderón et al, 2020;Delamuta et al, 2020;Motizuki et al, 2019;Ramírez-Santana et al, 2019), recognizing the lack of experience and cultural skills to work with this population (Duden & Martins-Borges, 2021;Ojeda et al, 2020) and establish a welcoming acceptance (Duden & Martins-Borges, 2021;Motizuki et al, 2019), based on an effective communication process (Barreto et al, 2019;Duden & Martins-Borges, 2021).…”