Financial and administrative barriers to healthcare access for forcibly displaced persons in Armenia

Background

As a consequence of war, a 9-month blockade and subsequent military operations, Nagorno-Karabakh’s entire population was forcibly displaced during 2020-2023. Within the Community Wellbeing Project, which aims to enhance the health, wellbeing, resilience of refugees, the study examines how administrative barriers shape access to health services. While access is often framed through financial or individual-level factors, administrative constraints - such as documentation, eligibility requirements, and system navigation - shape service utilization and inequities in displacement settings.

Methods

A cross-sectional community-based survey was conducted in 2025 in two phases among refugees (n = 746). The survey captured service needs, utilization and access barriers. Descriptive analyses quantified unmet needs and identified dominant constraints affecting service access.

Results

Overall, 53.6% of respondents reported a need for healthcare services, of whom 26.7% did not receive care. Financial constraints were the most frequently cited barrier (90.0%), followed by transportation and time limitations. Respondents reporting administrative or legal service needs (6.2%) exhibited substantially higher unmet needs. This pattern suggests that reported financial barriers may function as proxies for deeper administrative exclusion linked to documentation gaps, restrictions and limited system navigability.

Conclusions

Financial barriers constitute a critical determinant of service access in displacement settings.To address financial and administrative barriers, simplifying administrative procedures and integrating legal and social support within health systems may improve access, reduce inequities, and enhance system responsiveness for displaced populations.

Key messages

• Simplifying eligibility, documentation, and navigation is essential to reduce inequities in displaced populations.

• Integrating legal and social support into health systems can improve access, equity, and responsiveness for displaced populations.