Migrants’ social determinants of health: living conditions, violence exposure, access to healthcare

Abstract

Background: WHO and some other authors consider migration as a social determinant of health. MdM identifies it being composed of different factors such as living conditions, exposure to violence and access to healthcare. Methods: We analysed a comparative quali-quantitative survey in 4 locations, in Niger, Morocco and Tunisia, based on questionnaires and focus groups, with basic statistical tests and a complementary qualitative analysis. Results: 461 migrants were interviewed, 59% women, median age 28 year, 98.5% sub-Saharan African origin, 63% with no legal documents. 46% travelled for more than 6 months, 47% stayed in the country of interview more than 12 months, even if most of them wanted to go on. 83.8% faced violence during their life, 61% during migration. 58% of violence was psychological in nature, confiscation of money and/or documents, or violence by police or army. The types of violence's vary according to gender and localization. Only 39% did not face barriers to access to healthcare. The 3 main barriers are financial, lack of understanding of the health system and discrimination. 50% of migrants considered their health status as medium, bad or very bad, what is insufficient for such a young population. Conclusions: Some events are always part of migration: long duration, violence, barriers to access healthcare, with an overall negative impact on health. Recommendations: Authorities should address the structural factors of violence against migrants. The health needs of migrants should be taken into account in policies at all levels. Health services should always consider migrants' needs: determinants of health, mental health,