Adjusting health financing for people fleeing conflict: WHO releases new guidance for countries in Europe

WHO has released new guidance on how host countries can adjust health financing to meet the needs of people fleeing conflict.

Since the Russian military offensive in Ukraine began on 24 February 2022, over 4.5 million people have fled Ukraine to seek safe havens in neighbouring countries. Although these countries have responded quickly, the sudden arrival of a large number of people has put enormous pressure on their health systems, which were already pushed to the brink by the ongoing COVID-19 pandemic.

New policy guidelines developed by the WHO Barcelona Office for Health Systems Financing now outline health financing actions for countries to ensure that incoming refugees can access a full range of health services quickly and without financial or administrative barriers.

When people flee conflict and other humanitarian disasters, they need access to a spectrum of health services and medicines. There are several ways in which host countries can ensure that these services are provided to all.

The new WHO guidance encourages countries to remove all administrative and communication barriers for incoming refugees.

Reception centres that offer compulsory or voluntary health checks are often the first places where new arrivals can get information on local health systems and secure access to health services. Many countries in the WHO European Region, including Austria, Czechia, Estonia, Finland, Hungary, Italy, Lithuania, Norway, the Republic of Moldova and Romania, are performing health checks in reception centres.

However, many people fleeing war in Ukraine are staying in private shelters or homes. WHO/Europe encourages countries to set up helplines to support people in all possible settings as they seek health information and advice.

Financial and administrative barriers can often be a burden to incoming refugees. WHO/Europe encourages countries to eliminate or simplify administrative rules so that refugees can quickly access all health services, including medicines. This includes taking necessary measures to prevent informal payments.

Several countries in Europe provide only limited entitlement to publicly financed health services to refugees and asylum seekers. Countries should consider extending entitlements to people fleeing conflict and ensure that the process of obtaining and maintaining coverage is simple and rapid.

Income support can also be considered for refugees to ensure they can cover the cost of meeting their basic needs and the indirect costs of seeking health care, such as transportation.

Some countries’ health benefits packages might not include all the services necessary to meet the health needs of people fleeing conflict, which include an increased need for specific mental health services and language and communication support.

In these cases, adjustments should be rapidly introduced, including the addition of services such as free COVID-19 vaccination, care for cancer patients, counselling or psychological support, interpretation services, and essential dental care.

WHO/Europe recognizes that providing health care for refugees will have a significant impact on host countries’ health budgets.

Allocating additional public funds to address increased health needs can help relieve this pressure. Increased external funding, especially for middle-income countries and those hosting larger numbers of refugees, would allow support to be delivered more effectively. Quickly establishing ways to monitor and report on health spending for people fleeing conflict can help measure the impact on health budgets.

Although the new WHO guidance was swiftly developed in response to the current Ukraine crisis, the policy tools apply to all countries in Europe and central Asia who receive refugees fleeing conflict – regardless of country of origin.

When people are forced to flee their homes because of violence, their health needs move with them. WHO/Europe encourages all countries to continue providing the full range of health services to all people crossing their borders, whether they are applying for temporary protection, seeking asylum or being registered as refugees.

WHO/Europe will continue to provide technical support to countries to respond to health emergencies and minimize disruptions to the delivery of critical health-care services.

For more on WHO’s response to the Ukraine humanitarian emergency, visit the Ukraine Emergency section of the WHO/Europe website.