Barriers and facilitators to healthcare access among asylum seekers: a systematic review

Background

Access to healthcare is a fundamental human right. This systematic review aimed to synthesise evidence on the barriers and facilitators influencing asylum seekers’ access to healthcare services in host countries.

Methods

The review focused on primary qualitative, quantitative and mixed-methods studies published in English involving adult asylum seekers. Studies were excluded when they did not analysed asylum seekers, or health outcomes without addressing access or use. Because of variation in study designs, settings and healthcare domains, findings were synthesised narratively.

Results

Twenty-four primary studies were identified. The evidence showed a consistent gap between formal entitlement and actual access to healthcare. Barriers operated across several levels. At policy level, restrictive or unclear entitlements, insurance exclusions, voucher systems, and administrative gatekeeping limited access. At service level, barriers included fragmented pathways, long waiting times, poor continuity, limited primary care, inadequate interpretation and lack of provider awareness of asylum seekers’ rights. At interpersonal level, barriers included mistrust, discrimination, dismissive encounters, poor communication and limited cultural safety. At individual and social level, barriers included limited knowledge of the health system, language difficulties, poverty, unstable housing, social isolation, trauma and psychosocial distress. Facilitators included clear entitlement information, simplified access mechanisms, trusted providers, trained interpreters and cultural mediators, continuity of care, community and NGO navigation support, and trauma-informed services.

Conclusions

Asylum seekers’ healthcare access is shaped by more than formal eligibility. Equitable access requires health systems that actively remove administrative barriers, provide clear information, support communication, and connect healthcare with social and community-based support.

Key messages

• Healthcare rights alone are not enough; asylum seekers need clear information, navigation support, interpreters and culturally safe care.

• Healthcare systems must move beyond eligibility rules and actively support asylum seekers through clear pathways, trained staff, interpreters and community navigation.