Addressing Refugee Healthcare Barriers in the U.S.

As of June 2024, 122.6 million people were forcibly displaced from their homes due to persecution, violence, and human rights violations. Out of these 122.6 million people, 43.7 million were refugees (Refugee and Migrant Mental Health, n.d.). According to an umbrella review on barriers preventing mental health services to refugees and asylum seekers, a refugee is defined as “a person who has left their country of origin because their life or personal safety is at risk” (Bilican et al., 2025). 2024 statistics demonstrate a drastic increase from 2020, when around 60 million people were forcibly displaced. Key drivers of these rises include the civil war in Sudan, instability in the Democratic Republic of Congo, violence in Gaza, anti-government protests in Syria, insecurity in Afghanistan, and war in Ukraine (Understanding Global Displacement,2026). Refugees are not just fleeing their home country, but traumatic situations such as bombings, rape, destruction of sacred sites, and discrimination.

For them, receiving necessities such as healthcare is imperative.  In the 1951 Refugee Convention, healthcare is a guaranteed right for refugees, and access to healthcare services to the same degree should be provided to refugees as with other residents (Abbas et al., 2018). Unfortunately, barriers exist such as language and cultural differences, healthcare accessibility disparities, and limited healthcare coverage. The current U.S. healthcare system is not well-equipped to address the influx of people or the vulnerability of refugees. To mitigate these barriers, interpreters must be given proper cultural training and long-term health insurance must be enacted to encourage health-seeking behaviors amongst refugees. 

Issues Surrounding Interpreters

Refugees come from diverse backgrounds, and with that comes a variety of languages they speak. This makes communication difficult between a refugee and a doctor, and often an interpreter is brought in. However, interpreters in themselves are barriers. For example, the lack of diversity among interpreters results in multiple interpreters being used to assist one patient, leading to increased patient time. A 2026 study consisting of interviews with clinical officers and nurses in the Nyumanzi Health Centre III (HCIII) in Uganda corroborates this issue, with a clinical officer claiming there may be a need for two interpreters when “patients… don’t speak the dominant language, like Dinka”. When this happens, “[they] look for someone who knows Nuer and Dinka but may not speak English well. That person interprets the patient’s communication to Dinka, then [their] interpreter interprets it into English for the doctor” (Nakanjako et al., 2026, pg.13). This interview solidifies that in some instances, there is a need for an interpreter for the patient, and an interpreter for the interpreter in order to convey the patient's words to the doctor. Not only does this use more resources, but it also increases the time spent on one patient. Furthermore, it opens the translation of the patient's words to more error, which is concerning considering that most refugees arrive without proper documentation. Therefore, the only way for healthcare professionals to obtain a medical history is by word of mouth, and inaccuracies in translation hinder this. Thus, potentially harming the refugee themselves as a comprehensive medical history is what allows for correct treatment plans. Another clinical officer from this same study argues, “[One] may have like 20 hypertensive patients to review, [planning] to spend 5 minutes on each [ and instead one] may end up spending 10 to 20 minutes or even 30 minutes [extra]” (Nakanjako et al., 2026, pg.13). This idea that the lack of clear communication between the doctor and patient may disrupt the schedule of the doctor who is already facing an intensive workload signals the need for a better arrangement of interpreters. Moreover, overworked doctors do not perform as well as those who have manageable schedules.  Especially because the increase in consultations will only harm the other refugees who are faced with increased waiting times. Refugees are already facing anxiety and stress from being in a new country, so excessive wait times will only negatively impact the satisfaction of healthcare services for them. In turn, possibly deterring them from seeking healthcare.

As previously stated, refugees flee vulnerable situations that make them susceptible to mental health challenges. However, even beyond pre-migration, the migration journey and integration in the host country also act as risk factors. Specifically in the pre-migration stage of their life, refugees lack livelihood and opportunities for development. During migration, they are exposed to life-threatening conditions. In the post-migration and integration stage, they may face stress from being separated from family members, living in immigration detention centers, unemployment, and conflict with host populations (World Health Organization, 2025). These risk factors enable refugees to be more cautious when receiving healthcare, which often results in confidentiality issues surrounding interpreters. Specifically, refugees are often concerned that their interpreters won't keep their information private, which is exacerbated when the interpreter is close to the refugee community. A nurse from the same 2026 HCIII study claims that when “patients have sensitive illnesses, for example, a problem on the vulva or penis, they find difficulty disclosing when the interpreter is there.” and “Sometimes this person may be of the opposite sex to this interpreter, and this person may be coming from the same block, and the person may fear that this interpreter may reveal their issue to the community” (Nakanjako et al., 2026, pg.10). The lack of willingness to disclose sensitive issues when an interpreter is present suggests the lack of trust some refugees have in their interpreters. Interpreters act as a channel between patients and doctors, so when an illness is not disclosed to an interpreter, it is not conveyed to the doctor either. This hinders medical treatment and accurate diagnosis, which goes back to harming the patient and their access to proper healthcare treatment.

Apart from distrust, translating medical terms is strenuous in general, and this problem is heightened since refugees face low health literacy rates, which leads to confusion in navigating social networks and obtaining information (Coumans & Wark, 2024).  In a 2018 study of refugee resettlement case managers, interpreters, and pharmacists in Milwaukee, Wisconsin, a participant could not translate the word “MRI”. Instead, they explained it as a “big machine that you go in, and they take your picture.” The lack of an accurate word to translate certain medical terms suggests that refugees may not get a complete picture of the care they are receiving. Furthermore, if there is no accurate translation, it is up to the interpreter to communicate a definition they think is adequate, which may deviate from the accepted definition. In sum, with refugees already facing low health literacy rates, incomplete definitions may exacerbate their surface-level understanding of the healthcare system. This is an issue because if vague and unclear definitions are given, refugees may feel like they are not receiving sufficient care, or that the treatment is too complex. This, in turn, could deter them from seeking healthcare.

Cultural Differences

Aside from barriers that are present from interpreters, the fact that refugees may be perceived as outsiders in their host country contributes to tensions between them and healthcare providers, which discourages health-seeking behavior. In a 2024 meta-analysis regarding health services for refugees, six out of 22 sources noted a lack of appropriate cultural awareness in programs and interactions between healthcare providers (Coumans & Wark, 2024). Specifically, healthcare providers did not seem to be aware of their patients' culture, gender, religion, social status, ethnicity, or trauma, which manifested in the refugees feeling their healthcare provider demonstrated cultural superiority. In turn, the refugees felt low self-esteem, which has been shown to correlate with low health-seeking behavior. This is corroborated by a study of refugees in New Zealand, where a Bhutanese refugee was told to eat lamb for her low iron levels by her doctor despite being uncomfortable with the food, claiming “They should consider this and recommend alternative foods” (Shrestha-Ranhit et al., 2020).

The lack of consideration of the refugees' opinion may make the patient feel like the doctors' cultural perception is superior and that their culture was disrespected; furthermore, if the patient does not comply with the doctors' orders, the patient may feel that the blame for this is being placed on their culture (Shaburdin et al., 2020). Already navigating a new country, this pressures refugees into assimilation, which alienates them further. The disregard for the patient’s values also reinforces a stereotypical relationship where the refugees are perceived as a uniform group of people who do not know anything, while doctors are all-knowing teachers. This, in turn, decreases the chances of refugees continuing to go to their healthcare provider or may even hinder a refugee from seeking out healthcare because they do not want to talk to a “stranger”.

Essentially, cultural differences may hinder a personal patient-doctor relationship from forming, which is essential to refugees who are vulnerable and in need of compassionate care.

 Legislative Barriers

In 1980, President Jimmy Carter signed the Refugee Act of 1980 into law, which standardized the process of admitting refugees into the country and created the Office of Refugee Resettlement, which provides refugees with medical and social services, English training, and employment assistance to help integrate them into society. However, in January of 2025, Trump placed a pause on the U.S. Refugee Admissions program, despite genocides taking place in Gaza and Sudan. This pause impacts refugees’ applications for green card status, naturalization, work documents, and immigration benefits. Furthermore, the 2025 tax and budget law limits permanent healthcare coverage for non-citizens, including refugees. It reserves eligibility for Medicaid, CHIP, ACA Marketplace coverage, Medicare, and SNAP for Lawful Permanent Residents (LPRs). Refugees are not initially LPRs, but can apply one year after living in the U.S. However, with the halt in the U.S. Refugee Admissions program, there are severe delays in this process. Although some states have elected to still allow refugees to be eligible for these programs when they expanded Medicaid, Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming still remain unexpanded (Pillai & Artiga, 2025).

Despite refugees in certain states losing access to permanent healthcare opportunities starting October 1st, 2026, the Refugee Medical Assistance (RMA) program still offers temporary assistance.  RMA provides temporary health care coverage for refugees who are not eligible for Medicaid or CHIP and fit the RMA eligibility requirements, which vary from state to state (Norris, 2025). Previously, individuals were eligible for 12 months of RMA benefits, but after a March 2025 announcement by the Office of Refugee Resettlement (ORR), this period has been shortened to four months. The ORR claims that since funding for refugee programs has dropped by more than 35% and around 109,800 refugees/humanantarian entrants have arrived since October 2024, providing 12 months of assistance was simply not financially possible (Office of Refugee Resettlement, 2025).

These policy changes are disappointing. While Medicaid-expanded states still offer healthcare to refugees, the 40% of refugees residing in non-expansion states must rely on temporary assistance, for now only four months (Lukens & Harker, 2025). After these four months are up, refugees must rely on safety net care like affordable care clinics, which are severely overworked and underfunded–creating the possibility of intensifying the barriers discussed prior. Thus, rather than being guaranteed healthcare, it is treated like a privilege, severely contradicting the precedent made in the 1951 Refugee Convention. Furthermore, the issue of interpreters and cultural and regional differences still persists. Moreover, non-expansion states are overwhelmingly rural in their geographical makeup, which has the possibility of exacerbating rural vs. urban discrepancies (Chatlani, 2024).

Remedies

 Improving the Interpretation System

Previously, it was established that refugees may not trust their interpreters, which hinders their healthcare providers from providing care efficiently. One way this can be mitigated is through cultural competency training for interpreters, which has already been a part of the medical education for healthcare providers. Expanding this for interpreters would involve interpreters being aware of the patient and their own background, adapting their services to their patients' cultural context, preventing the perpetuation of stereotypes, and respecting differences. In the context of refugee groups, a clinic in the U.S. conducted 30-minute pre- and post-therapy sessions between their therapists and interpreters, and it allowed them to learn more about their patients' culture (Kaczorowski, 2011). Broadening culture competency training to interpreters and then having healthcare providers and interpreters work together would allow for more personalized care and would prevent patients from feeling alienated. To tie it back to the cultural superiority complex discussed earlier, if interpreters and healthcare providers received the same training it would allow both professions to reflect on their cultural biases. In turn, working as a team, they can correct when either act in a culturally superior manner. Furthermore, healthcare providers often receive cultural competency training during medical school, which is often years back from when they are treating refugees. Reinforcing this training would serve as an adequate refresher. In sum, cultural competency training fosters a more personal relationship, which increases trust.

Another issue involving interpreters was the lack of linguistic diversity and difficulty translating medical terminology.  Although an emphasis on on-site interpreters should be placed to provide personalized care, telephone interpreters are useful for providing translation for niche languages. This can be done by creating a streamlined interpreting agency with interpreters available at all times for maximum convenience. Australia has the Australian Translating and Interpreting Service, which provides translation for 160 languages and is available 24 hours a day (Phillips, 2012). Creating a service such as this solves two issues: it prevents using multiple interpreters for one patient, leading to delayed waiting times, and the remote interpreters can easily look up tricky medical terminology if necessary. Although tele-interpreters are less personalized, it is better to have a less complex interpretation process. As discussed before, two interpreters open the doctors' or the patients' words to more misinterpretation, which defeats the point of having an interpreter. Furthermore, remote interpreters can still enhance the relationship between the healthcare provider and patient by potentially offering a direct and more accurate translation rather than simply communicating the gist of what one person says. This would allow the patient to understand the tone and emotions behind the healthcare provider's words.

Medicare for All

The Medicare for All Act was proposed in Congress, but never passed. It was largely advocated for by Senator Bernie Sanders and Representative Pramila Jayapal. Essentially, the act advocated for national federal insurance over a four-year period, where in the first year seniors starting from the age of 55 and children aged zero to 18 are eligible to enroll. By the fourth year, every U.S resident would gain access to universal healthcare (Office of Sen. Bernie Sanders, 2023). Since refugees fall under the category of “U.S resident,” they too would be eligible for this program, preventing them from having to navigate the RMA, Medicaid, or CHIP process. Most importantly, this guarantees permanent healthcare insurance, which is correlated with better healthcare-seeking behavior (Al- Hanawi et al., 2020). Because health insurance is associated with better health-seeking behavior, and since Medicare for All guarantees permanent healthcare insurance for refugees, it should be implemented as it is most advantageous.

Although implementing the Medicare for All Act results in the most benefits, proponents of the private healthcare insurance system may argue that Medicare for All is too expensive a program to implement. For example, they may point out that “most households with workers (82%) would see their taxes increase by more than they would save from no longer paying privately for health insurance and medical care”(Haislmaier & Hall, 2019, pg. 6). From this perspective, it seems like universal healthcare would do more economic harm than good since taxes would go up. Since there is more economic harm being done and families might have less disposable income, it might make sense to reject the Medicare for All Act. However, this perspective is ultimately too narrow and fails to acknowledge the long-term savings of the act. In a 2020 study by Yale epidemiologists, it was found that Medicare for All would reduce U.S healthcare spending by 13% and save around 68,000 lives per year (Public Citizen, 2020). Since Medicare for All leads to long-term savings despite initial tax increases, it is clear that in the end it is not only a more cost-effective plan but a more humanitarian one. The savings can be explained by households no longer having to pay premiums, and the government no longer having to work on implementing a complicated healthcare system. Instead, with one single payer, the insurance system is more streamlined and easier to manage.

Conclusion

While the number of refugees is increasing globally, healthcare systems remain fundamentally flawed, especially in the United States, which has halted the processing of refugees and has limited the insurance coverage of their healthcare. Along with these legislative hurdles, the current interpreter system utilized in healthcare settings lacks multilingualism, the ability to form trusting relationships with the patient, and poses risks for correct translation of medical terminology.  All of these impediments decrease the chances of refugees obtaining healthcare on their own. However, a comprehensive solution can be enacted, which includes improving the interpretation system through teleinterpreters and cultural competency training and pushing the Medicare for All Act through Congress. In summary, healthcare is not a privilege; it’s a human right, and a solution that encompasses this must be instituted.

Siyona Jain is a rising senior at Hopewell Valley Central High School.

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