Authors: Zoe Schuler

Nearly seven million Ukrainian refugees have left their homes since Russia invaded their country in 20221. For many, the hardest part – finding safety, has been achieved – primarily in European countries outside Ukraine. However, figuring out how to see a doctor once they get there has proved to be a challenge.

A study2 published in April examined barriers to healthcare access and continuity of care among Ukrainian war refugees in Europe. The findings revealed that the barriers refugees face abroad mirror the barriers rural and underserved Americans face every day. It’s not just about language, it’s about health literacy and navigation.

Early in their resettlement, Ukrainian refugees primarily focused on urgent health issues, like injuries and infections caused by war and displacement. But as time passed, managing chronic conditions became a growing priority.

Among the host countries studied (Lithuania, Poland, Sweden), Poland reported the longest wait times and highest healthcare costs for Ukrainian refugees, an expected yet concerning reality for a nation shouldering one of the heaviest refugee burdens in Europe. The study also shows that even after 17+ months in host countries, refugees often: Don’t know what benefits they’re entitled to, don’t know how to access care (especially for chronic diseases, mental health, and dental care), and miss out on preventive services, despite being eligible. Language barriers are only part of the problem. Even with translations and interpreters, the system itself is hard to navigate. Refugees found limited access to information about the local healthcare systems, especially in the Ukrainian language.

In rural America, the issue isn’t usually language; instead, it’s health literacy and system complexity. Many eligible families don’t enroll in Medicaid, WIC, or SNAP3 or don’t take advantage of free preventive screenings. Health and medical terminology is its own language. Even native English speakers may not know what a “primary care provider” is, how to schedule a colonoscopy, or that they qualify for free vaccines – and the convoluted insurance system further complicates this.

While many health systems track success through indicators like the number of clinics, hospital beds4, or services offered, these metrics don’t always reflect how easily patients can navigate or utilize care. Many European health systems provide extensive healthcare infrastructure and universal coverage, yet availability doesn’t always translate into accessibility, especially for displaced populations. If people don’t know how or when to seek care, the system fails in its mission, no matter how many resources exist. Refugees who cannot navigate their host country’s healthcare system are more likely to go untreated for chronic diseases such as hypertension or diabetes, leading to complications that are more costly and harder to manage later.

The same pattern holds true in the United States. Missed preventive care in rural and underserved communities leads to late-stage cancers, uncontrolled heart disease, and preventable hospitalizations. When people fall through these cracks, it doesn’t just affect individual patients, it strains emergency departments, increases healthcare costs, and widens existing inequities.

Safety is more than shelter – it’s knowing where to turn when you’re sick. Whether in Warsaw or West Virginia, too many people live just outside the walls of healthcare systems designed to serve them. Access without awareness is no access at all.

References

  1. USA for UNHCR. (2025). Ukraine emergency: Aid, statistics and news. https://www.unrefugees.org/emergencies/ukraine/
  2. Kardas P, Mogilevkina I, Aksoy N, Ágh T, Garuoliene K, Lomnytska M, Istomina N, Urbanaviče R, Wettermark B and Khanyk N (2025) Barriers to healthcare access and continuity of care among Ukrainian war refugees in Europe: findings from the RefuHealthAccess study. Front. Public Health 13:1516161. doi: 10.3389/fpubh.2025.1516161
  3. Neuberger, Z., Nuñez, L., & Sallack, L. (2025). WIC’s Critical Benefits Reach Only About Half of Those Eligible: States Miss Out on Opportunity to Improve Pregnancy-Related, Child Health. Center on Budget and Policy Priorities. http://www.jstor.org/stable/resrep70158
  4. Fleming P, O’Donoghue C, Almirall-Sanchez A, Mockler D, Keegan C, Cylus J, Sagan A, Thomas S. Metrics and indicators used to assess health system resilience in response to shocks to health systems in high income countries-A systematic review. Health Policy. 2022 Dec;126(12):1195-1205. doi: 10.1016/j.healthpol.2022.10.001. Epub 2022 Oct 13. PMID: 36257867; PMCID: PMC9556803.

This post is written in celebration of the AMWA Global Health Committee’s October focus: Global Health in Ukraine.