Barriers to health care access among refugee asylum seekers

J Health Care Poor Underserved. 2011 May;22(2):506-22. doi: 10.1353/hpu.2011.0047.


Objective: Asylum seekers have poor access to health care. Qualitative data portraying their experience is lacking.

Methods: We conducted focus groups and comprehensive interviews with 35 asylum seekers and 15 expert providers/advocacy organization representatives. Purposive sampling was used to recruit subgroups. Interviews were recorded, coded, and analyzed.

Participants: 85% male, mostly from African countries. Major barriers: a) Internal, including mental illness, fatalism, mistrust, and perceived discrimination; b) Structural, including affordability, limited services, inadequate interpretation, resettlement challenges such as shelter, food, and employment insecurity; health care for urgent care only; and poor cultural competency; c) Barriers in social assimilation, including difficulty navigating a complex system and inadequate community support.

Conclusion: Significant inter-related barriers exist at the individual, provider, and system levels. Strategies to improve access include targeting social programs and mental health services, expanding Medicaid eligibility/enrollment, promoting community-based organizations, enforcing the use of trained medical interpreters, and improving cultural competency.

MeSH terms

  • Adult
  • Africa / ethnology
  • Attitude to Health*
  • Female
  • Focus Groups
  • Health Services Accessibility*
  • Humans
  • Male
  • Mental Disorders
  • New York City
  • Qualitative Research
  • Refugees / psychology*
  • Social Support
  • Socioeconomic Factors