Abstract
Introduction
Heightened border controls and global displacement due to the ongoing poly-crisis make access to healthcare for migrants an increasingly relevant topic for the debate. National healthcare systems worldwide continue to struggle with the tension between universal access to healthcare and exclusion. Entitlement to healthcare is shaped by nationality and legal status. Against this background, Migrant and Refugee Access to Health Systems: Challenging (Im)mobilities in Healthcare presents a multidisciplinary exploration of how mobility itself influences access to healthcare, making it a relevant and timely contribution to the field.
Edited by Luca Follis, Karolina Follis, and Nicola Burns, the anthology brings together contributors from a range of disciplines, including anthropology, geography, sociology, political science, and law. The book reveals the situations of various migrant groups (European Union (EU) citizens, asylum-seekers, undocumented migrants, seasonal workers, and so on) in Ecuador, Germany, Greece, Italy, Kuwait, Poland, Spain, Turkey, the United Kingdom, and the United States. The collection centres on the notion of ‘sedentary bias’ – the assumption of national healthcare systems that patients have a fixed address and permanent legal status (often citizenship), and that these will not change. They argue that most healthcare frameworks presuppose territorially stable, legally settled populations, thereby marginalising those whose movement or displacement disrupts these assumptions.
Throughout the book, it is demonstrated that sedimentary bias can create various barriers to accessing the right to health, disregarding the entitlements formally provided to migrants under national legislation and their medical needs. The claim is that although equality and justice in accessing healthcare are often tied to institutional and legal frameworks, the questions extend beyond these frameworks and the law. The volume situates healthcare exclusion not simply as an outcome of administrative neglect, but as a structural feature of systems designed around (im)mobility.
This review will first provide an overview of the book’s content and then offer some critical reflections. The collection is a multidisciplinary effort, not intended primarily for the legal audience, yet this review will provide an overall assessment of the book’s contribution to the field of medical law.
Structure and content
The book is divided into four sections, and the content of these sections is discussed below.
The first section, titled ‘Health Infrastructures’”, explores how physical settings, resources, and bureaucratic systems shape how mobile people and those who support them navigate healthcare. The section consists of four chapters and starts with an ethnographic exploration, where the author, Paweł Lewicki, follows a Polish migrant who lives in Germany with HIV and requires antiretroviral treatment. The chapter offers the reader a glimpse into the complexities of real-life access to rights, allowing them to imagine various stages of the journey. The chapter shows how grassroots organisations play a pivotal role in navigating bureaucratic systems.
The following chapter, chapter 3 by Jessica L. Potter and Isabel Meier, examines UK immigration policies – particularly the concept of a ‘hostile environment’ and their impact on healthcare access and the emotional experiences of NHS staff. It analyses the bureaucratic systems and institutional discourses positioning staff as both caregivers and border enforcers.
In chapter 4, Kitty Worthing investigates the reluctance of general practitioners in London to register patients. She reveals how guidance, which allows undocumented individuals to register with a general practitioner, is frequently undermined by local practices. Staff’s reluctance is shaped by broader political narratives, such as the abovementioned ‘hostile environment’ policies, and by funding structures that reward care for sedentary, easily traceable populations.
In chapter 5 by Angels Escriva, Nora Komposch, and Natalia Ribas-Mateos, the focus shifts to the province in Spain, where seasonal migrant farmworkers are recruited annually. The chapter centres on the case of a Moroccan woman who, despite suffering from cervical cancer, could not receive timely and adequate medical support. Her story reveals how language barriers, employer control, and bureaucratic exclusion make migrant workers invisible within the healthcare system.
Section II, ‘Politics and Governance of Migrant Health’, shifts to the legal and policy frameworks that govern healthcare access for migrants. It also consists of four chapters. Chapter 6, written by Danai Avgeri, investigates how health and vulnerability have become central mechanisms of control in the governance of asylum-seekers at the Greek hotspot islands. It introduces two interlinked trends: the medicalisation of borders, where health conditions are used to justify asylum and mobility rights, and the bordering of healthcare, which imposes spatial and bureaucratic barriers to accessing public health services.
Chapter 7 by Souad Osseiran examines the tensions between healthcare provision and migration control in Turkey through the lens of Migrant Health Centres. The chapter highlights how healthcare initiatives, even when framed as inclusive, are vulnerable to securitisation and policy shifts that prioritise containment over care.
Chapter 8 by Carlo Botrugno spotlights the ‘ferry quarantine’ policy implemented during the COVID-19 pandemic. The author argues that migrants are increasingly treated as ‘infection risks’, not only in epidemiological terms but also within a broader exclusionary logic. Despite evidence that migrants pose minimal public health threats, policies continue to stigmatise and isolate them. The ferry quarantine exemplifies how health emergencies are used to legitimise repressive border practices.
Chapter 9 by Gwyneth Lonergan explores the intersection of mobility justice and reproductive justice through the experiences of pregnant migrants in England. The chapter critiques the assumptions underpinning the 2016 National Maternity Review, Better Births, which promotes personalised care based on informed choice. Lonergan argues that this model presumes a mobile, autonomous subject, one able to travel freely and access services, while ignoring the constraints imposed by immigration policies.
Section III, titled ‘Technologies of Resistance and Surveillance’, interrogates these phenomena and comprises three chapters. In chapter 10, Monika Ewa Kaminska examines the reproductive health challenges faced by Ukrainian refugees in Poland, particularly in accessing abortion care. Poland’s highly restrictive abortion laws and systemic barriers have rendered safe abortion virtually inaccessible, even for survivors of war-related sexual violence. Kaminska highlights how the failure to provide reproductive healthcare has been met with a robust response from NGOs, volunteers, and activist networks. These groups have mobilised digital platforms and cross-border collaborations to facilitate access to medical abortion and travel for surgical procedures.
Chapter 11 by Fu-Yu Chang offers an ethnographic account of Ecuador’s COVID-19 data infrastructure from the perspective of a rural frontline physician. Chang questions how digital platforms designed to track and manage the pandemic often hinder rather than help patient care. The chapter highlights the disconnect between national data systems and local realities, noting that bureaucratic demands and fragmented digital tools consume healthcare workers’ time and divert attention away from patients.
Chapter 12, by Sajida Z. Ally, investigates public health measures during the COVID-19 pandemic in Kuwait, disproportionately affecting migrant populations, particularly Sri Lankan workers. Through a mobility and health justice lens, Ally examines how cordons sanitaires, lockdowns, and border closures immobilised migrants and restricted their access to healthcare.
The final section of the book – Section IV: Mobile Health Futures – looks forward, offering models and strategies for more inclusive and mobile healthcare systems. The section contains three substantive chapters and an afterword for the book. In chapter 13, Corinna A. Di Stefano examines the intersection of mobility, homelessness, and healthcare access in Frankfurt am Main, with a focus on Romanian and Bulgarian citizens who live unsheltered and uninsured. The chapter highlights that public spaces and transportation become hubs of immobility, offering temporary refuge but also exposing individuals to surveillance and displacement. Humanitarian healthcare networks, including mobile medical units and outreach buses, play a crucial role in bridging the gap left by exclusionary national systems.
Chapter 14, by Piyush Pushkar and Louise Tomkow, focuses on the shift in the concept of citizenship from a universalising medium to a mechanism of exclusion in the United Kingdom. The chapter contrasts individual strategies of inclusion with collective activist efforts to dismantle eligibility boundaries, arguing that solidarity, not charity, offers a more expansive and ethical basis for healthcare rights.
In chapter 15, Jessica Beresford and Stephanie Sodero research the intersection of climate justice and migrant healthcare. The authors argue that within the UK’s NHS bordering practices, such as charging migrants for care and sharing data with immigration authorities, not only harm vulnerable populations but also undermine the net-zero climate goals. Delayed access to primary care leads to more carbon-intensive emergency treatments. The chapter emphasises the importance of migrant-inclusive healthcare in developing a climate-resilient health system.
Chapter 16, written by Anthony C. Gatrell as an afterword, reflects on the broader themes of the volume through the lens of a health geographer. He critiques the persistent sedentarist bias as a threat to public services and emphasises the emotional, physical, and systemic burdens faced by mobile patients.
Critical reflections
The volume’s central concept – sedentary bias – is an original analytical lens that reveals how healthcare systems are structurally designed to serve settled populations. The book convincingly argues that mobility itself becomes a barrier to care, even when legal entitlements exist. One of the volume’s most striking contributions is its attention to infrastructural violence – how systems of care are weaponised to exclude. Several chapters illustrate how bureaucratic procedures, data infrastructures, and moral economies produce exclusion even in systems that formally guarantee access. These analyses are particularly relevant to medical law, which sometimes fails to address the gap between legal entitlement and practical access.
As to more critical remarks, the book’s multidisciplinary approach is both a strength and a challenge. The diversity of perspectives – ranging from anthropology to law – enriches the analysis and enables a nuanced understanding of healthcare exclusion. While the volume is a multidisciplinary effort, it is difficult to classify it as truly interdisciplinary. Most chapters are case-based and self-contained, offering rich insights into ethnography and sociology, which makes the book an emotional and touching read. However, this typically situational structure, while valuable for illustrating lived experiences, may limit the book’s utility for policymakers, who often require a clearer sense of systemic patterns and transferable frameworks. From the medical lawyer’s perspective, it would also be desirable to have a more even and in-depth analysis of the law in the chapters, considering its role not only as a perceived or actual barrier, but also as to when and how it can be used as an instrument for empowerment. For a legal audience, the book may require additional interpretive work to connect empirical findings to legal debates. However, this reflection needs to be read in light of the fact that the editors, most of the authors, and the reviewer belong to different disciplinary domains.
The volume encompasses a diverse range of migrant categories, including EU citizens, asylum seekers, undocumented migrants, and seasonal workers. This diversity reflects the complexity of migration-related healthcare exclusion, allowing the book to explore how different legal statuses intersect with healthcare systems in varied ways. It also helps to deconstruct simplistic binaries between ‘deserving’ and ‘undeserving’ migrants, showing how exclusion operates across legal categories. However, this breadth also presents challenges. The chapters do not always explicitly explain how legal status influences healthcare access, and the absence of a consistent framework for comparing these categories across jurisdictions can make it challenging for readers to identify patterns or draw generalisable conclusions. Considering the breadth of migration statuses and the focus on sedimentary bias, a case study on internally displaced persons, given their growing relevance in climate- and conflict-related displacement, would also be desirable.
The book covers a wide geographical range, including Europe, the Middle East, Latin America, and the United States; some countries appear disproportionately represented, particularly the United Kingdom. Meanwhile, other regions with significant migration-related healthcare challenges are underrepresented in the book. For readers seeking comparative insights or global policy relevance, the lack of editorial explanation for the selection criteria can be challenging.
Despite some unevenness in geographical representation, the editors deserve credit for including case studies from both countries with universal healthcare systems and those with limited or fragmented access. This allows the volume to highlight how exclusionary dynamics are not confined to resource-poor settings or overtly restrictive regimes. Instead, it shows that even in systems formally committed to universality, structural and procedural barriers can undermine access to the right to health. This comparative framing enriches the analysis and underscores the need for legal and policy scrutiny across diverse healthcare models.
Despite these limitations, the editors succeed in assembling a cohesive, engaging, and empirically rich anthology. The writing is both accessible and conceptually sophisticated, striking a balance between theoretical reflection and vivid case studies. The inclusion of both practitioners and academics ensures the book resonates across disciplines.
Conclusions
Migrant and Refugee Access to Health Systems is a timely and thought-provoking book that challenges the structural assumptions of healthcare systems. Its central thesis on sedentary bias, along with its engagement with mobility justice, offers significant contributions to medical law. It will be of interest to legal scholars, policymakers, healthcare professionals, and activists seeking to understand and address the barriers faced by migrants and refugees.
The book is a sobering yet necessary read for those working on the intersection of international human rights and health. It reminds us that the struggle for migrants’ healthcare rights does not end with formal guarantees of access. Bureaucratic, infrastructural, and political barriers persist, often invisibly, and continue to undermine the principle of universality. The role of legal professionals, healthcare workers, and policymakers in dismantling these barriers remains unclear and under-theorised. The anthology does not offer a singular solution. Still, it does suggest that meaningful change requires cross-sectoral collaboration, critical engagement with mobility justice, and a willingness to challenge the structural norms of healthcare systems. In this sense, the volume is not only an academic contribution but also a call to action.
