Inclusion of Refugees Into National Health Systems: Enablers, Barriers and Lessons From Six Country Case Studies
8 affiliations
- 1Institute for Global Health and Development Queen Margaret University Edinburgh UK
- 2Department of Community Health Sciences Aga Khan University Karachi Pakistan
- 3Strathmore University Nairobi Kenya
- 4Independent researcher Duhok Iraq
- 5School of Oriental and African Studies (SOAS) London UK
- 6Independent researcher Lima Peru
- 7Department of Economics University of Zambia Lusaka Zambia
- 8Liverpool School of Tropical Medicine Liverpool UK
Abstract
The global refugee population has nearly doubled in the last decade, and many of these populations face chronic displacement, often in neighbouring countries with limited resources. Emergency, short‐term responses are being transitioned to longer term approaches, including a focus on inclusion through coverage in national health systems. However, analysis of empirical and comparative evidence on how to enact these approaches has been limited. In this article, we analyse the inclusion of refugees in six low and middle‐income country (LMIC) health systems (Kenya, Kurdistan Region of Iraq (KRI), Mauritania, Pakistan, Peru and Zambia). Using a shared framework and tools, we collected data over 2023 to 2025, using document reviews, key informant interviews, focus group discussions and participatory workshops. Analysis was carried out separately for each setting, validated locally, and later compared for synthesis. We focus on key health system domains—governance, health financing, service delivery (including the health workforce) and health information systems—outlining the attributes of refugee inclusion and system integration in each, identifying patterns across the case studies and barriers and enablers. We identify leverage points for improving integration but highlight that inclusion of refugees into national health systems is complex and does not guarantee improved outcomes, especially when refugees previously benefited from a higher level of resources and are being included in strained host health systems. However, committed government leadership, coordinated international support, and multi‐year investments in strengthening key components of the local health system, including enabling refugee health staff to engage effectively in it, can make the transition to an integrated system a beneficial one for both refugee and host communities.
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BibTeX
@article{witter2026inclusion,
title = {{Inclusion of Refugees Into National Health Systems: Enablers, Barriers and Lessons From Six Country Case Studies}},
author = {Sophie Witter and Alastair Ager and Karin Diaconu and Zahid Ali Memon and Ben Ngoye and Natasha Palmer and Marcia Vera‐Espinoza and Amina Olabi and Hussam Rekani and Hassan Ould Moctar and Ricardo Chuquimia and Chitalu Miriam Chama‐Chiliba and Ibrahim Bou‐Orm and Maria Paola Bertone},
journal = {The International Journal of Health Planning and Management},
year = {2026},
month = jul,
doi = {10.1002/hpm.70109},
url = {https://doi.org/10.1002/hpm.70109},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Inclusion of Refugees Into National Health Systems: Enablers, Barriers and Lessons From Six Country Case Studies
AU - Sophie Witter
AU - Alastair Ager
AU - Karin Diaconu
AU - Zahid Ali Memon
AU - Ben Ngoye
AU - Natasha Palmer
AU - Marcia Vera‐Espinoza
AU - Amina Olabi
AU - Hussam Rekani
AU - Hassan Ould Moctar
AU - Ricardo Chuquimia
AU - Chitalu Miriam Chama‐Chiliba
AU - Ibrahim Bou‐Orm
AU - Maria Paola Bertone
PY - 2026
DA - 2026/07/23
JO - The International Journal of Health Planning and Management
DO - 10.1002/hpm.70109
UR - https://doi.org/10.1002/hpm.70109
AB - The global refugee population has nearly doubled in the last decade, and many of these populations face chronic displacement, often in neighbouring countries with limited resources. Emergency, short‐term responses are being transitioned to longer term approaches, including a focus on inclusion through coverage in national health systems. However, analysis of empirical and comparative evidence on how to enact these approaches has been limited. In this article, we analyse the inclusion of refugees in six low and middle‐income country (LMIC) health systems (Kenya, Kurdistan Region of Iraq (KRI), Mauritania, Pakistan, Peru and Zambia). Using a shared framework and tools, we collected data over 2023 to 2025, using document reviews, key informant interviews, focus group discussions and participatory workshops. Analysis was carried out separately for each setting, validated locally, and later compared for synthesis. We focus on key health system domains—governance, health financing, service delivery (including the health workforce) and health information systems—outlining the attributes of refugee inclusion and system integration in each, identifying patterns across the case studies and barriers and enablers. We identify leverage points for improving integration but highlight that inclusion of refugees into national health systems is complex and does not guarantee improved outcomes, especially when refugees previously benefited from a higher level of resources and are being included in strained host health systems. However, committed government leadership, coordinated international support, and multi‐year investments in strengthening key components of the local health system, including enabling refugee health staff to engage effectively in it, can make the transition to an integrated system a beneficial one for both refugee and host communities.
SN - 0749-6753
SN - 1099-1751
ER -