Subjective health of undocumented migrants in Germany – a mixed methods approach

Abstract

BackgroundHealth of migrants is known to be above-average in the beginning of the migration trajectory. At the same time reports from non-government organisations (NGOs) suggest that undocumented migrants in Germany tend to present late and in poor health at healthcare facilities. In this paper, we explore the health status of undocumented migrants with a mixed method approach including complementary qualitative and quantitative datasets.MethodsUndocumented migrants attending a NGO based in Hamburg, Germany, were asked to fill in the SF-12v2, a standardized questionnaire measuring health-related quality of life (HRQOL). The SF-12v2 was analyzed in comparison to the U.S. American norm sample and a representative German sample. Differences in mean scores for HRQOL were evaluated with a t-test and with a generalized linear model analyzing the impact of living without legal status on HRQOL. The quantitative research was complemented by a qualitative ethnographic study on undocumented migration and health in Berlin, Germany. The study included semi-structured interviews, informal conversations and participant observation with Latin American migrants over the course of three years. The study focused on subjective experiences of illness and health and the impact of illegality on migrants’ health and access to health care.ResultsHRQOL was significantly worse in the sample of undocumented migrants (n = 96) as compared to the U.S. American sample (p < 0.005). Living without legal status displayed a significant negative effect on subjective mental and physical health (p ≤ 0.003) in the generalized linear model when adjusted for age and gender compared to the representative German population sample. The ethnographic study, which included 35 migrants, identified socio-economic conditions, the subjective experiences of criminalization, and late presentation at healthcare-facilities as the three main factors impacting on health from migrant perspective.DiscussionThe present research suggests a high morbidity and mortality in this comparatively young population. The ethnographic research confirms negative impacts on health of social determinants in general and stressassociated with living without legal status in particular, both are further aggravated by exclusion from health care services. In addition to the provision of health care it appears to be important to structurally tackle the underlying social conditions which affect undocumented migrants’ health.ConclusionsLiving without legal status has a negative impact on health and well-being. Limited access to care may further exacerbate physical and mental illness. Possibilities to claim basic rights and protection as well as access to care without legal status appear to be important measures to improve health and well-being.

‘Managing scarcity’– a qualitative study on volunteer-based healthcare for chronically ill, uninsured migrants in Berlin, Germany

“…Based on literature research,7 13 15 16 a semi-structured interview guideline was developed (CL, FH, CH), pre-tested and finalised after revision. Issues addressed included status quo of medical care, reasons for consultation, treatment options and barriers, influence of legal status and solution strategies (table 1).…”

“…In Germany, the number of migrants without legal residence permit was estimated in 2014 to be between 180 000 and 520 000 people,5 with an upward tendency 6. Having no legal status often leads to precarious working and living conditions, aggravated by fear of detection and deportation 7. Officially, healthcare for undocumented migrants is ascertained by German asylum-seekers law, granting access to treatment for acute or painful diseases 8.…”

“…This situation is considered especially deleterious for chronically ill people: with financial and language issues constituting further access barriers,15 these particularly vulnerable patients may wait until there is no other option before consulting any healthcare services at all 7 16. The term ‘chronic illness’ is used very differently in the literature 17.…”

Exclusion through statistical invisibility. An exploration on what can be known through publicly available datasets on irregular migration and the health status of this population in Germany

“…Hamburg providing healthcare for irregular migrants. The sample consisted of 96 persons who approached the organisation for treatment, and data have been analysed by Kuehne et al (2015). The study shows that due to the avoidance of accessing healthcare, when irregular migrants finally search for help, their health status tends to be rather poor (Kuehne et al 2015).…”

“…A variety of studies further illustrate these findings: For example, Susann Hutschke (2009), who described the experiences of irregular Latin American women in Berlin when they become sick, and Sandra Schmidt (2009) who studied access to healthcare among irregular migrants in Bremen. Local experiences in dealing with health needs of irregular migrants (for example, the cases of Berlin: Misbach et al 2009, andBremen: Lotze 2009) and the health status of undocumented migrants in Hamburg (Kuehne et al 2015) have also been an object of study. Analyses on assessments of doctors related to the provision of healthcare for irregular migrants and the experience of non-governmental actors providing care in major German cities also point to an overall situation of poor access to health services and its consequences on individuals' health status (German Institute for Human Rights 2008;Mylius et al 2011).…”