Healthcare needs among refugees from Ukraine arriving in Norway during 2022
This study has measured self-reported health and healthcare needs among adult refugees from Ukraine arriving in Norway during 2022. Further, we have assessed received information about, and access to, health services in Norway.
This study has measured self-reported health and healthcare needs among adult refugees from Ukraine arriving in Norway during 2022. Further, we have assessed received information about, and access to, health services in Norway. Following the full-scale invasion of Ukraine, more than 35 000 Ukrainian refugees applied for protection in Norway in 2022. Most of the arrivals are women and children, and there is a lack of systematic information about the health and healthcare needs of the group, which may differ significantly from that of other refugees. Although almost half of the study participants rated their overall health as good or very good, the Ukrainian refugees rated their health poorer in several areas, when compared to the Norwegian population. The main findings show:
- The refugees reported their health as poorer overall, with more long-term illnesses or health problems.
- The refugees reported poorer mental health with more symptoms of psychological distress during the last week.
- The refugees reported considerably poorer self-rated dental health.
- Most of the refugees had received information about health services in Norway in a way they either fully or to some extent understood. The more recently arrived refugees were less likely to report having received understandable information about health services. Further, the more newly arrived were less likely to report knowing how to contact health services, or to have received the health care they felt they had needed in Norway.
These findings may contribute to planning and ensuring appropriate health services for this group. Follow-up and continuity of treatment for long-term illnesses or health problems, as well as support for psychological distress and mental health care, represent important healthcare needs. Further, dental health services may also be a considerable need among the refugees. The findings suggest that information about health services in Norway can be improved, especially among the newly arrived.
The full-scale invasion in Ukraine has led to a sharp increase in the number of refugees coming to Norway, however there is a lack of systematic information about the health and healthcare needs of the group, which may differ significantly from that of other refugee groups. There are still few studies on the healthcare needs among the refugees, and to allow for better planning and scaling of health services for refugees from Ukraine in Norway, more systematic knowledge is needed.
This study aimed to measure self-reported health and healthcare needs in a sample of adult refugees from Ukraine, compared to the Norwegian population. A secondary aim was to assess received information about, and access to, health services in Norway.
Recruitment and survey design
The target population was adult refugees from Ukraine and who arrived in Norway during 2022. Data were collected via an online, digital questionnaire (UKR-R survey) in a cross-sectional study design between 28th October 2022 – 31st January 2023. Several survey items were taken from existing Norwegian public health surveys, including a short version of the Hopkins Symptom Checklist (HSCL-5) measuring psychological distress. Data from five Norwegian County Public Health Surveys between 2020-2022 (NOR surveys, n=256 920) were used as a comparison group. The UKR-R survey further contained questions on usual healthcare needs and information about, and access to, healthcare services in Norway.
Participants in UKR-R survey were recruited via several potential physical and social media contact points, including asylum reception centres, municipalities, non-profit organisations, and Facebook groups for refugees in Norway. Survey respondents accessed the questionnaire by scanning a QR code or via a link on posters and flyers or via social media posts.
Statistical analyses and weighting
Results for outcome measures were weighted by age and sex against all Ukrainian refugees registered with collective protection in Norway. Data from NOR surveys were also weighted against the target population to assess whether UKR-R survey respondents had different healthcare needs than that of an equivalent Norwegian population.
The UKR-R survey participants
Respondents to UKR-R survey (n=731) were 83% female, most aged 30-39 years (36%) and 40-49 years (29%), 69% with higher education, and 53% with responsibility for at least one child under the age of 18 years in Norway. Ninety-five percent had, or intended to, apply for collective protection and 79% of these were already resettled in a municipality. Most respondents (93%) reported that they had been screened for tuberculosis, but more recent arrivals were less likely to have been screened.
Forty-eight percent of UKR-R survey respondents rated their overall health as good or very good, compared to 73% of respondents in NOR surveys (p<0.001). Thirty-one percent in UKR-R survey rated their dental health as good or very good, compared to 74% of the respondents in NOR surveys (p<0.001). Older persons tended to rate their overall health and dental health as poorer compared to the younger age groups.
UKR-R respondents had a mean HSCL-5 score of 2.24 (95% CI: 2.18, 2.29), compared to 1.60 (95% CI: 1.595, 1.601) in NOR surveys, where mean scores over 2 can indicate psychological distress. More respondents in UKR-R survey than in NOR surveys reported having been extremely or quite a bit bothered during the last week by nervousness or shakiness inside, feeling fearful, feeling hopeless about the future, feeling blue or sad, and by worrying too much about things.
More respondents to UKR-R survey reported having long-term illnesses or health problems compared to NOR surveys (58% vs. 44%, p<0.001). In both surveys, 73% of respondents reported that their long-term illnesses or health problems affected their daily lives to some or a great extent (p=0.11). Both the proportion reporting long-term illnesses, and the degree to which their daily lives were affected by them, increased with age.
A similar proportion in both UKR-R surveys and NOR surveys reported having disabilities or problems due to injury (19% vs. 22%, p=0.06), but more in UKR-R survey reported them affecting their daily life to some or a great extent (77% vs. 73%, p<0.001). Both the proportion reporting disabilities, and the degree to which their daily lives were affected by them, increased with age.
Self-assessed healthcare needs, information about, and access to health services in Norway
Most respondents to UKR-R survey reported needing health services 2-4 times per year for long-term illnesses, health problems or disabilities. Seventy percent had needed to see a see a doctor, psychologist, or other health professional during the last 12 months, and 81% of these had had a consultation. Older respondents generally reported a greater need for health services compared to younger respondents. Eighty-six percent of respondents reported that they had needed health care in Norway. Of these, 32% responded that they had received the health care they felt they needed, 42% answered ‘To some extent’, and 26% answered that they had not.
Thirty-nine percent of respondents reported that they had received information about the health services in Norway in a way that they could understand, while 49% answered ‘To some extent’. Most reported that they knew how to contact a doctor or other health professional if they needed help, either fully (49%) or to some extent (43%). The more recent arrivals were less likely to report having received understandable information about health services, to know how to contact health services, and to report having received the health care they felt they had needed in Norway.
This survey has provided more systematic information on the health and healthcare needs of refugees from Ukraine in Norway. Respondents rated their overall health and dental health as poorer than in the Norwegian population. Respondents on average reported more symptoms of psychological distress, and higher proportions reported having long-term illnesses, health problems or disabilities compared to in NOR surveys. At the same time, ratings of overall health among UKR-R survey respondents were higher compared to the population average in Ukraine, but lower compared to other refugee and immigrant groups in Norway. The observed higher levels of psychological distress symptoms among the refugees may be expected and is in keeping with existing knowledge. Reports from Ukraine also suggest a degree of undertreatment for mental health problems and barriers to health care including stigma. The relatively high proportions of cardiovascular risk factors and chronic respiratory diseases is also in keeping with public health reports from Ukraine.
Relative to other refugee groups, a shorter geographical distance and fewer practical and legal hindrances would make it easier for Ukrainians with some form of health challenge to seek refuge in Norway. Ensuring follow-up and continuity of treatment for long-term illnesses or health problems among the refugees, as well as support for psychological distress and mental health care, represent important healthcare needs. Further, dental health may also be a considerable healthcare need among the refugees. The expected large numbers of refugees through 2023, and high share of children and women in reproductive age, should also be considered when planning and scaling of health services for this group of refugees.
Although most respondents who had needed health care had had a consultation, this was not the case for all, and there were still indications of some unmet health needs. This may be seen in relation to respondents’ knowledge of the health system in Norway. Findings from this survey suggest that especially among the more recently arrived, information about, and access to, health services in Norway could be improved.
The survey relied on self-selection, and a digital questionnaire, which has likely affected who has responded. As in other existing surveys among refugees from Ukraine, respondents were predominately highly educated females. Weighting by age and sex partly compensates for non-responsiveness, however we have not been able to adjust for potential differences in education level. Results may not be fully representative and may underestimate the overall health and healthcare needs among refugees from Ukraine. Survey items were largely based on existing public health surveys in Norway, which has allowed comparison with a sample from the general population, but at the cost of a more tailored questionnaire to the healthcare needs of refugees.
The survey found that refugees from Ukraine arriving during 2022, compared to an equivalent Norwegian population, rated their overall health and dental health as poorer, a higher proportion reported having long-term illnesses or health problems, and more symptoms of psychological distress. There were indications of unmet or only partially met healthcare and information needs, especially among more recently arrived persons, and indicates an area for improvement. Health status and healthcare needs are not static and may change over time, however the findings may help to inform planning of health services and information to refugees from Ukraine, especially in municipalities and areas that receive large numbers of refugees. Future surveys should be better tailored for refugee populations and be extended to include other refugee groups than from Ukraine. Other research methods such as register-based studies and qualitative interviews may complement and build on the current findings.