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The health status of refugees and asylum seekers varies significantly across the European region. Differences are attributed to the political nature of the legal categories of “asylum seeker” and “refugee”; the wide disparities in national health services; and the diversity in individual characteristics of this population including age, gender, socioeconomic background, country of origin, ethnicity, language proficiency, migration trajectory, and legal status. Refugees are considered to be at risk of being or becoming relatively “unhealthy migrants” compared to those migrating on the basis of economic motives, who are characterized by the “healthy migrant effect.” Refugees and asylum seekers are at risk to the drivers of declining health associated with settlement such as poor diet and housing. Restricted access to health care whether from legal, economic, cultural, or language barriers is another likely cause of declining health status. There is also evidence to suggest that the “embodiment” of the experience of exclusion and marginalization that refugee and asylum seekers face in countries of resettlement significantly drives decrements in the health status of this population.

Irregular migrants belong to the most vulnerable migrant groups. Health threats associated with an irregular status are high, and access to health services is severely restricted globally. Concerning migration aspects, a common public narrative for Europe and Africa is that Africa is sending thousands of migrants to embark on an irregular life-threatening journey of migration to Europe every year. Although this is a well documented reality, it is by far not the most important migration pattern in terms of numbers and health threats when looking at Africa. It can be argued that, on the contrary, Africa is mainly characterized by south-to-south migration both for economic and humanitarian reasons, with African nation-states like Uganda being among the top three nations worldwide hosting refugees. In addition, main migration routes from Africa do not target Europe but rather other regions like the Gulf countries. Existing dialogue between Europe and Africa has great potential to fast track and develop joint policies and strategies for meaningful, affordable legal migration patterns and access to the human right to health for irregular migrants. First, a change of the rhetoric around irregular migration from Africa mainly directed toward Europe is needed. Second, existing policies and strategies regarding the health of irregular migrants need to be examined and evaluated. Within all the huge differences concerning public health systems and capacities in Europe and Africa, a common strategy to discourage irregular migration seems to be restricting the access of irregular migrants to their human right to health through national regulations. This has paradoxically created a simultaneous inclusion on grounds of human rights regulations and exclusion on grounds of national restrictions, with “functional ignorance” (health care organizations and personnel ignore the lack of residence permits and its legal implications) and “structural compensation” (facilities run by nongovernmental organizations take over public health responsibilities and health care provision) as key features. Such strategies put a lot of strain on health care providers and irregular migrants and should not be considered as a sustainable solution. Instead, action should be taken to overcome the paradox of contradictory migration and health policies by means of firewalls and structural mechanisms. An important step in this direction can be to rethink cooperation between Europe and Africa in this domain, starting with the development of a joint evidence base relevant for Europe and Africa in an interdisciplinary approach and with European and African scholars that can support proactive policy and strategy development to safeguard the human right to health for irregular migrants together with good migration governance.