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Background The COVID-19 syndemic reveals social and health inequalities, putting marginalized groups such as migrants at greater risk. Yet health systems fail to routinely monitor the health of migrants, refugees, and internally displaced persons. Our systematic review provides an up-to-date synthesis of the empirical evidence on COVID-19 infection risk, transmission, outcome of disease and risk of severe course of disease among migrant populations. It further aims to compile extant evidence on COVID-19 vaccination coverage among these groups, and on the effects of pandemic control measures on their health. Methods Following PRISMA guidelines, we registered a review protocol, searched 14 scientific databases and 4 pre-print servers using the WHO database of global literature on COVID-19, and hand-searched relevant websites for grey literature. The search period covers the time from 12/2019 to 11/30/2021. Articles in English, German and Spanish and all study designs were included. Results A total of 6966 references were identified for title and abstract screening. 518 records were screened in full-text, out of which 204 articles were included so far (conflict solving at full-text stage and data extraction are ongoing). Our review presents a broad landscape of different study designs, migrant populations and COVID-19 outcomes. Based on previous work, we expect to find a higher risk of infection in migrants and their disproportionate share among COVID-19 cases, and consolidate the (mental) health impacts of pandemic control measures. Our preliminary findings indicate a vast knowledge gap on vaccination coverage among migrant groups. Conclusions Two years into the syndemic, this review summarizes the global empirical evidence on the impact of the COVID-19 syndemic on migrant populations. With health systems often lacking related data, the review provides an important evidence base for the consideration of migrants in future pandemic preparedness policies. Key messages • The systematic review provides an up-to-date synthesis of the empirical evidence on COVID-19 among diverse migrant populations globally. • Knowledge on vaccination coverage in migrants remains patchy.

BackgroundAsylum seekers and refugees (ASR) in Germany are dispersed quasi-randomly to state-provided, collective accommodation centres. We aimed to analyse contextual effects of post-migration housing environment on their mental health.MethodsWe drew a balanced random sample of 54 from 1 938 accommodation centres with 70 634 ASR in Germany’s 3rd largest federal state. Individual-level data on depression (PHQ2) and anxiety (GAD2) symptoms as well as sociodemographic- and asylum-related covariates, was collected and linked to contextual geo-referenced data on housing environment (‘Small-area Housing Environment Deterioration’ index, number of residents, remoteness, urbanity and German Index of Multiple Deprivation). We fitted two-level random-intercept models to exploratively estimate adjusted contextual effects.ResultsOf 411 surveyed participants, 45.53% and 44.83%, respectively, reported symptoms of depression or anxiety. 52.8% lived in centres with highest deterioration, 46.2% in centres with >=50 residents, 76.9% in urban, and 56% in deprived districts. 7.4% of centres were remote. The accommodation-level median odds ratio for GAD2 was 2.10 with contextual-level variance of 16%.For odds of reporting GAD2 / PHQ2, the highest degree of deterioration (OR 2.22; 95% CI 0.52-9.59 / 1.99;0.55-7.18), large accommodation size (1.34;0.59-3.06. / 1.12;0.56-2.26), remoteness (2.16;0.32-14.79 / 3.79;0.62-23.18) and district urbanity (3.05;0.98-9.49 / 1.14;0.46-2.79) showed higher, but statistically not significant, point-estimates. District deprivation demonstrated higher odds for GAD2 (1.21;0.51-2.88) and, inversely, lower odds for PHQ2 (0.88;0.41-1.89).ConclusionWe found tendencies for, but no significant, contextual effects of housing environment on ASR mental health in accommodation centres. Confirmatory analyses with prior power calculations are needed to complement these exploratory estimates.Research in contextWhat is already known on this subjectResearch on mental health of asylum seekers and refugees (ASR) has focused on pre- and peri-migratory factors, and increasingly recognizes post-migratory factors and their importance in restoring, sustaining, and protecting health to enable societal integration and participation. Research on the small-area housing environment, and its potential health effects is still scarce, and often limited by high-levels of aggregation of contextual factors, crude or not-standardised measurements on housing characteristics, and risk of compositional bias due to selective migration into housing environments.What this study addsWe make use of the quasi-random allocation of ASR to state-provided, collective accommodation centres, and link individual-level data on health and socio-demographic variables with small-area measures of contextual housing environment at accommodation-level to explore potential effects while minimising the risk of compositional bias. Accommodation-level factors contribute considerably to mental health variance. A tendency towards higher odds of reporting symptoms of generalized anxiety could be observed for housing deterioration, higher numbers of residents, remoteness as well as district urbanity and deprivation. Similar tendencies were estimated for reporting symptoms of depression except for deprivation potentially functioning protectively. Confirmatory research with appropriate sample size calculations as well as mediation and structural equation analysis are needed. Results may guide policy makers in design and planning of needs-based health services and housing infrastructure.

Additional file 1.

Geflüchtete Menschen werden in Gesundheitssurveys in Deutschland bisher unzureichend berücksichtigt. Ziel von RESPOND (Improving regional health system responses to the challenges of forced migration) war die Erhebung valider epidemiologischer Daten zu Gesundheitszustand und Versorgung bei geflüchteten Menschen. Kernelemente waren ein bevölkerungsbezogenes Stichprobenverfahren in Baden-Württemberg, mehrsprachige Fragebögen und ein persönlicher Ansatz zur Rekrutierung und Datenerhebung in Sammelunterkünften mit mehrsprachigen Feldteams. Zudem wurden Daten zur Lage und baulichen Qualität der Unterkünfte ermittelt. Die Ergebnisse weisen auf eine hohe allgemeine gesundheitliche Belastung hin. Die Prävalenz von Depressions- (44,3 %) und Angstsymptomatik (43,0 %) war hoch. Gleichzeitig wird ein ausgeprägter Verzicht auf primär- (30,5 %) sowie fachärztliche (30,9 %) Versorgung berichtet. Zwar sind primärärztliche Angebote gut zu erreichen. Häufige ambulant-sensitive, das heißt durch ambulante Versorgung potenziell vermeidbare Hospitalisierungen (25,3 %) sowie erlebte Defizite in der Versorgungsqualität weisen jedoch auf Zugangsbarrieren hin. Fast die Hälfte aller geflüchteten Menschen (45,3 %) wohnen in Unterkünften mit niedriger baulicher Qualität. Die Erhebung valider Daten zur gesundheitlichen Lage geflüchteter Menschen ist durch eine Kombination aus gezieltem Sampling, mehrsprachigen Rekrutierungs- und Erhebungsinstrumenten sowie persönlichem Kontakt gut möglich. Der Ansatz kann etablierte Verfahren der Durchführung von Gesundheitssurveys ergänzen und auf andere Bundesländer ausgeweitet werden.

To date, the integration of refugees in German health surveys is insufficient. The survey RESPOND (Improving regional health system responses to the challenges of forced migration) aimed to collect valid epidemiological data on refugee health status and healthcare provision. The core elements of the survey consisted of a population-based sampling procedure in Baden-Württemberg, multilingual questionnaires and a face-to-face approach of recruitment and data collection in collective accommodation centres with multilingual field teams. In addition, data on the geographical locations of accommodation centres and their structural quality were obtained. The results indicate a high overall health burden. The prevalence of depression (44.3%) and anxiety symptoms (43.0%) was high. At the same time, high unmet needs were reported for primary (30.5%) and specialist (30.9%) care. Despite sufficient geographical accessibility of primary care services, frequent ambulatory care sensitive hospitalisations, i.e. hospitalisations that could potentially have been avoided through primary care (25.3%), as well as subjective deficits in the quality of care, suggest barriers to accessing healthcare services. Almost half of all refugees (45.3%) live in accommodation facilities of poor structural quality. Collecting valid data on the health situation of refugees is possible through a combination of targeted sampling, multilingual recruitment and survey instruments as well as personal recruitment. The presented approach could complement established procedures for conducting health surveys and be extended to other federal states.

Background: Accurate data on the health status, health behaviour and access to health care of asylum seekers is essential, but such data is lacking in many European countries. We hence aimed to: (a) develop and pilot-test an instrument that can be used to compare and benchmark the country health information systems (HIS) with respect to the ability to assess the health status and health care situation of asylum seekers and (b) present the results of that pilot for The Netherlands (NL) and Germany (DE). Materials and Methods: Reviewing and adapting existing tools, we developed a Health Information Assessment Tool on Asylum Seekers (HIATUS) with 50 items to assess HIS performance across three dimensions: (1) availability and detail of data across potential data sources; (2) HIS resources and monitoring capacity; (3) general coverage and timeliness of publications on selected indicators. We piloted HIATUS by applying the tool to the HIS in DE and NL. Two raters per country independently assessed the performance of country HIS and the inter-rater reliability was analysed by Pearson’s rho and the intra-class correlation (ICC). We then applied a consensus-based group rating to obtain the final ratings which were transformed into a weighted summary score (range: 0–97). We assessed HIS performance by calculating total and domain-specific HIATUS scores by country as well as absolute and relative gaps in scores within and between countries. Results: In the independent rating, Pearson’s rho was 0.14 (NL) and 0.30 (DE), the ICC yielded an estimated reliability of 0.29 (NL) and 0.83 (DE) respectively. In the final consensus-based rating, the total HIATUS score was 47 in NL and 15 in DE, translating into a relative gap in HIS capacity of 52% (NL) and 85% (DE) respectively. Shortfalls in HIS capacity in both countries relate to the areas of HIS coordination, planning and policies, and to limited coverage of specific indicators such as self-reported health, mental health, socio-economic status and health behaviour. The relative gap in the HIATUS component “data sources and availability” was much higher in Germany (92%) than in NL (28%). Conclusions: The standardised tool (HIATUS) proved useful for assessment of country HIS performance in two countries by consensus-based rating. HIATUS revealed substantial limitations in HIS capacity to assess the health situation of asylum seekers in both countries. The tool allowed for between-country comparisons, revealing that capacities were lower in DE relative to NL. Monitoring and benchmarking gaps in HIS capacity in further European countries can help to strengthen HIS in the future.

Hintergrund: Die Themen Fehler in der Medizin und Patientensicherheit rückten spätestens durch die 2000 vom Institute of Medicine veröffentlichte Studie "To err is human“ zunehmend in den Fokus des öffentlichen und wissenschaftlichen Interesses. Ein Bereich, in dem das[for full text, please go to the a.m. URL], Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA)