Health system considerations related to voluntary and forced displacement in the Eastern Mediterranean Region: a critical analysis of the available literature

Abstract

Background: The WHO Region for the Eastern Mediterranean has had a history of complex migration patterns, with high levels of migration to, from and within the Region, overlaid by massive recent forced displacement. Relatively little is known about the health system response to this large-scale mobility. Aims: To review the literature on the Region critically, identify gaps and suggest areas needing research and policy attention. Method: A search of the published literature using MEDLINE and POPLINE was conducted on health and migration focusing on the WHO health system building blocks with no date or language limitations. Results: Out of 4679 retrieved articles published between 1964 and January 2019, 140 met our inclusion criteria; 45 additional articles were included in a December 2020 update. Most publications focused on refugees and on the delivery of services. Conclusions: Few studies explored the responsiveness of health system to refugees and migrants compared with those for host communities, or assessed the quality of services or refugees’/migrants’ perceptions of available health services. Few suggested new approaches to financing health care access for these populations or new governance arrangements.