Photo: DFID – UK Department for International Development via Wikimedia Commons
A new qualitative study published in BMC Medicine looks at how migrant and refugee populations from sub-Saharan Africa access the Tunisian healthcare system, identifying the main obstacles and facilitators they encounter. The research is part of the “MENA Migrant Health” project, coordinated by ISGlobal together with institutions in Tunisia, Morocco, Egypt and Sudan, and with the participation of the National Office for Family and Population (ONFP), the Faculty of Medicine of Sousse and Médecins du Monde Belgium.
In recent decades, Tunisia has become a country of origin, transit and destination for migrants from sub-Saharan Africa. In 2021, an estimated 59,000 migrants had been living in the country for more than six months, with nationals of Côte d’Ivoire and the Democratic Republic of Congo forming the largest groups. At the same time, more than 15,600 refugees and asylum seekers were registered in 2024. This migration context, shaped by complex trajectories and frequent mobility, increases the risk of health problems and makes continuity of care more difficult.
Between May and December 2023, researchers conducted 33 individual interviews and 16 focus-group discussions in four urban areas with a high migrant presence: Tunis, Medenine, Sousse and Sfax. A total of 120 migrants and 43 NGO professionals participated. The thematic analysis, guided by an adaptation of Levesque’s conceptual framework, helped identify structural, social and administrative barriers affecting these populations’ ability to perceive, seek and receive healthcare.
The study describes a set of interconnected obstacles:
- Language and bureaucratic barriers. The predominance of Arabic and the complexity of the healthcare system lead to misunderstandings, repeated referrals and delays.
- Discrimination and unequal treatment. Migrants report longer waits, discriminatory behavior and denial of services, which erodes trust in the system.
- Limited information and guidance. Many rely on informal networks which, although helpful, may spread incomplete information and further fragment care pathways.
- Legal status and documentation. Lack of residence permits or identification limits access to public facilities and creates fear of being reported or deported.
- Economic costs. The absence of insurance, out-of-pocket payments and the price of tests and medications make access difficult, especially for those working in the informal economy.
- Mobility and lack of follow-up. Frequent changes of residence or phone number hinder clinical follow-up, especially for chronic diseases or psychological support.
- Limited knowledge of specific pathologies. Some migrants perceive that the system has limited capacity to diagnose diseases endemic to their countries of origin, such as malaria.
“Despite these challenges, NGOs play a crucial role in helping migrants navigate the health system. Through guidance, care coordination, and referrals—especially for undocumented migrants—they reduce fragmentation and improve continuity of care” states Anissa Ouachi, author of the study and PhD researcher at ISGlobal .
The study emphasizes the need for policy reforms that prioritize culturally sensitive approaches, multilingual resources, simplified administrative procedures, and broader financial coverage. Training healthcare professionals in cultural competence and migrants’ rights, combined with stronger collaboration between NGOs, health providers, and policymakers, could help ensure equitable access to care.
Taha Maatoug, co-author of the study and also PhD researcher at ISGlobal, concludes: “Strengthening partnerships between healthcare providers and NGOs, while addressing legal, financial, and cultural barriers, is essential if we want migrants in Tunisia to truly access the care they need and deserve.”
Reference
Maatoug, T., Ouahchi, A., Seedat, F. et al. Healthcare access among sub-Saharan migrants and refugees in Tunisia: an interpretative qualitative study. BMC Med 23, 547 (2025). https://doi.org/10.1186/s12916-025-04383-6
