Vulnerability of migrant women during disasters: a scoping review of the literature

A literature search was systematically conducted on December 15th, 2021 on PubMed, Scopus, and Web of Science databases. The search strings (see Additional file 1) combined three different sets of terms, namely migrant-related, woman-related, and disaster-related ones. No restrictions or filters were applied to the research. The search covered all years from the origin of the databases until December 15th, 2021. After removal of duplicates, titles and abstracts of the remaining articles were manually screened by one investigator (MT) and those not complying with the inclusion criteria were excluded. All the full-text articles eligible for inclusion were reviewed independently by two reviewers (MT, ER) and discrepancies were resolved after discussion with the whole group. When articles’ full text was not available, the corresponding authors of the studies were contacted (n = 2). The references of the selected articles were also screened to identify any other relevant study to be included.

The study selection process relied on the following inclusion criteria: (a) the study deals with the vulnerability of migrant women during a disaster as reported by migrant women or by providers who served them during the disaster; (b) the study is an original one, using either qualitative or quantitative methodology. Exclusion criteria were: (a) the study deals with the vulnerability of migrants, without a specific focus on women; (b) the study deals with the vulnerability of women, without a specific focus on migrants; (c) the study considers female gender as one of many variables associated with mortality/morbidity without exploring the reasons for migrant women’s vulnerability; (d) the study is not an original one (e.g. review, letter to the editor). Studies dealing with HIV were not included in this review as per the definition of disaster adopted in this study. No studies were excluded because written in languages unknown by the authors; if potentially relevant articles had been found in languages unknown by the authors, external collaborators would have been contacted.

A Google sheet was developed to extract relevant information from the included studies (see Additional file 2). The collected data included information on the article’s main characteristics and the study design, information about migrant women and their migration experience, information about the type of disaster that was experienced, migrant women’s vulnerability factors and the negative outcomes resulting from the disaster. A qualitative synthesis of study findings was supported by a phenomenological approach [42, 43] and an inductive analysis [44] focusing on experiences of migrant women during the disaster. Main themes reflecting several vulnerability pathways for migrant women during disasters have been identified.

All the studies included focus on the COVID-19 pandemic and therefore were conducted and published between 2020 and 2021.

All the 14 studies were qualitative. The most used methodology was interviews: in some cases, details about the type of interviews, namely in-depth [51, 52] or semi-structured [48, 50, 53], were included. Two studies used an ethnographic approach [45, 47], and in one study focus group discussions (FGDs) were also conducted [50]. In two studies a questionnaire was administered [49, 55] (Table 1).

The main focus of the studies, as reported by the authors, revolved around six main themes: the relationship between migrant women and the host community [45, 47, 48, 57], the exacerbation of GBV and insecurities during the pandemic [46, 54, 56], mental health issues as a consequence of COVID-19 or the containment measures [49, 50, 58], the impact of the pandemic on migrant women’s working life [51, 55, 57], maternal care [52, 53], and perceptions and attitudes towards COVID-19 [47].

In 13 out of 14 articles the study population was composed of migrant women. In one article [53], the impact of the pandemic on migrant women was explored exclusively through interviews with maternity care clinicians. In other five articles [45, 46, 50, 52, 56], professionals such as social or health workers, service providers, and community representatives were involved. In two articles migrant men were also included [46, 47] (Table 1).

An overview of demographic characteristics of migrant women is presented in Table 2. However, in some of the reviewed studies, the demographic information was vaguely described or not reported. The type of migrant, as reported by authors, was forced migrant [46], landed immigrant [51], refugee [45, 47, 48, 50, 52, 54, 55], skilled migrant [55, 58], applicant for refugee status [49], migrant carrying a passport with humanitarian visa [49], migrant with temporary permit to stay [49], and asylum seeker [47]. The legal status of migrant women was not specified in three studies [53, 56, 57] and another study only reported their ethnicity [56].

Age of migrant women was not indicated in six articles [45, 49, 51‐53, 55], while, in other cases, it was reported in a non-standardized way, and did not include data about the entire group of participants.

The home and host country of migrants are presented in Fig. 2. It should be noticed that one study mentioned the country of origin of a limited number of participants [55] and, in another study [46] it was not clear if this information was provided for all participants.

The length of stay in the host country was mentioned in six studies ranging from one to 15 years [45, 47, 50, 55, 57, 58]. In eight cases, this data was not reported [46, 48, 49, 51‐54, 56], while in other two cases the information was provided only for a limited number of participants [47, 50] or was vague [55].

Migrant women were negatively affected by the COVID-19 pandemic. Together with the containment measures put in place to limit the spread of the virus, the pandemic triggered numerous drivers, which increased migrant women’s levels of exposure and vulnerability, thus resulting in greater impact. In this section, the pathways that generated from a condition of vulnerability and resulted in a negative impact for migrant women are reported.

Overall, six vulnerability factors have been identified: legal status, poverty conditions, pre-existing health conditions, limited agency, gender inequality, and language and cultural barriers. These resulted in nine impacts: worsening of mental health status, poor access to care, worsening of physical health conditions, fraud, exacerbation of poverty, GBV, jeopardization of educational path, and unfulfillment of religious needs (Fig. 3). A graphical representation depicting the pathways in a more detailed way can be found in the Additional file 3.

One of the vulnerability factors that affects migrant women the most is their legal status, as it compromises their job opportunities, access to care, and living conditions [45‐47, 50, 52, 54‐57]. The study of Lusambili [52] reported that in Kenya government policies such as Linda mama mtoto (short for Linda Afya ya mama na Mtoto), which allows pregnant women and infants to access affordable maternity care, turned out to be discriminatory against refugees, in particular during COVID-19. Discriminatory policies, especially when combined with migrant women’s poverty conditions, were exasperated by the shortage of medical staff during the COVID-19 pandemic, the lockdown measures, and the fear of contracting the virus, which ultimately led to an increase in home deliveries and lower utilization of reproductive, maternal, newborn and child health services, posing serious risks to both mothers and their babies (e.g., vaccinations missed) [52].

Moderator: So, the migrants don’t qualify for the Linda mama mtoto?

Respondent [Community Health Volunteer]: They qualify, but the program through NHIF [National Health Insurance Fund] refunds for deliveries for hosts [Kenyans] only, but for the migrants there is no refund. So, the facility normally says that they are doing a useless job. That is what they say. Just last week, we had like four migrants from Uganda. They delivered while I was there present, but they were saying that they are doing a useless job. (Lusambili, p. 5) (Host country: Kenya).

Racist and discriminatory attitudes from healthcare professionals, the police and the general population towards migrant women were exasperated during the COVID-19 pandemic, thus negatively impacting their mental health status [45, 49‐55, 57]. Lightman [51] reported how being a healthcare assistant was perceived as an “immigrant job” and, with the start of the pandemic, Asian healthcare assistants employed in long-term care (LTC) facilities in Canada were blamed by the residents for bringing in the virus. Discrimination was also impacted by employment competition, aggravated by COVID-19 pandemic [48, 49]. In the United States of America (USA) migrant women feared for their own safety due to the political climate related to immigrants and the increase in gun purchase for self-protection during the containment measures in the general population [56]. On a positive note, some of the participants in one study received financial support from their neighbors while others expressed positive feelings towards their host country, in relation to hygiene, safety, and social services [48].

The closure of government facilities during the lockdown caused delays in the issuance of new or renewed visa and residence permits, increasing migrant women’s sense of uncertainty [46, 47, 54, 56]. When undocumented, migrant women feared being deported [46, 56] and for this reason they experienced anxiety and distress when seeking medical help [46]. They were also worried they would not have been a priority if a ventilator was needed, and that mortality rates in the migrant population would not have been reported by the authorities, making them invisible [46].

During the pandemic, the job and income of migrant women was often compromised and because of their legal status and their holding a temporary visa, or due to the fact they were employed in informal jobs, they were unable to access state benefits and were excluded from the safety net implemented for the general population [46, 54‐56]. The extreme marginalization in which migrant women found themselves made them more vulnerable when fraudulent organizations tried to lure them [54].

Migrant women live in a condition of vulnerability because of poverty [46‐48, 50‐52, 54], and this was exacerbated during the COVID-19 pandemic. Due to their legal status, migrant women face precarious employment situations, are forced into informal jobs such as working as childminders, hair-dressers, street vendors, cleaners, car guards, domestic assistants [49, 54], or unfavorable contracts (e.g., the zero-hour contracts in the United Kingdom (UK)) [46]. The difficulty in getting a permanent or full-time job was reported. Consequently, to get to the end of the month migrant women had to work at more than one job site or extra shifts [51]. In other cases, they worked illegally and without any protection and safeguards [46], or did not work at all and had to depend either on other household members (e.g., the husband) or on welfare or charity (e.g., Non Governmental Organizations (NGOs)) [46, 48]. One study reported that migrant women received help from churches, however this didn’t resolve their financial difficulties [54]. This situation was exacerbated by migrant women having children and sometimes being single parents [46, 54, 55]. Due to the containment measures that were implemented by government states, the COVID-19 pandemic negatively impacted migrant women’s working life and economic situations, often exacerbating their pre-existing precarious socio-economic status [46, 48, 50, 51, 54‐56], also because their working conditions prevented them from saving money [46, 54]. High numbers of job lay-offs or downturning were reported, particularly among informal workers [50, 54‐56].

I was working at this factory where we were packing plastics. For us it was already difficult because we had gone for 3 months without working and we were not being paid and when they said lockdown that was it, they never paid us. (Mutambara, p. 708) (Home country: Rwanda; host country: South Africa)

For people like us who are self-employed and into buying and selling goods it was difficult because we could no longer sell our products because everyone was now locked in their houses. (Mutambara, p. 707-708). (Home country: Burundi; host country: South Africa)

The single site working policy introduced by the Alberta government in Canada in April 2020 as a strategy to limit cross-contamination of the virus across multiple LTC facilities significantly impacted migrant women’s finances since they had been working at more than one job site to get through the month [51]. The study of Nardon involving skilled migrant women, reports that they suffered a delayed start of their career, a reverse career trajectory, or its interruption [55]. Because of their migrant status or informal job, migrant women were often ineligible for labor welfare and emergency government support, as opposed to the rest of the population [45, 46, 51, 55].

I don’t have any benefits. I cannot go to the dentist. I cannot go to a massage. I cannot go to take my daughter to psychology, psychiatry, whatever, because she has some anxiety problem since this Covid started. I cannot take her because it costs money. (Lightman, p. 6) (Home country: Romania; host country: Canada)

Due to the economic crisis that was experienced, migrant women suffered food shortage, hunger, and dehumanization [46, 54, 56]. They were unable to pay the rent and sometimes were evicted or were threatened to be evicted [46, 50, 51, 54, 56]. All these elements seriously impacted migrant women’s mental health by causing them distress and anxiety.

[The landlord] wanted his money and he came, and he cut our water and electricity, so we were really suffering. I was sleeping in the dark with my child. (Mutambara, p. 710) (Home country: Burundi; host country: South Africa)

When unprovided with bank accounts, migrant women were excluded from online bill payments or using public transport, which during the pandemic shifted to only accepting card payments. This exacerbated their immobility and hindered their possibility to rely on cheaper resources [46].

Many of the migrant women are also affected by digital poverty, with no or limited access to internet, television, and phones [45, 46, 48]. Due to the containment measures, learning opportunities, support groups, and meetings with social workers transitioned online and migrant women were often excluded with impacts on their mental well-being and jeopardization of their educational path [46, 48, 50].

Because they were seriously in need of help, migrant women were induced to trust unnamed NGOs that took advantage of the most vulnerable by fraudulently claiming COVID-19 relief measures.

There is this Non-Profit organization, I don’t recall their name. I contacted them seeking help and they took my details and whatnot, my asylum and all and only for me to realize that they never helped me with anything. And when I tried to WhatsApp them, I realized that they had blocked me on their number, and I went and looked for their social media page and they had also blocked me. (Mutambara, p. 717) (Home country: Democratic Republic of the Congo; host country: South Africa)

Migrant women are often forced to live in inadequate spaces due to their poverty and legal status. Many participants of the study conducted by Phillimore [40] in the UK, Tunisia, and Türkiye were living in shelters, shared accommodations, and overcrowded housing with shared kitchens and toilets. One Syrian woman living in Beirut compared her house to a prison, since it was very small and she lived there together with her four children [50]. This situation turned out to be particularly tough during the COVID-19 pandemic because the risk of contagion was much higher in overcrowded houses or migration reception systems. Because of the great amount of time spent at home during the lockdown, tensions among members of the family were also common [50, 54].

Poverty conditions prevented women from accessing healthcare. Firstly, migrant women feared unaffordable charges [46, 52]. The study of Lusambili describes the situation of women who were forced to deliver at home, since there was a lack of affordable hospitals offering maternity services and government maternity services were unavailable [52].

[Migrant women] do not have money and cannot afford to go to private hospitals as they are very expensive. … Some of the refugee women who were expectant would even deliver alongside the road because they did not have money. They went through difficulties. (Community health worker, Lusambili, p. 5) (Host country: Kenya)

Secondly, migrant women’s housings are often in peripheral areas, with hospitals far to reach. With reference to the study of Lusambili, the distance from hospitals is described as one of the reasons that often force migrant women to home birth [52]. Beyond all the risks it entails, delivering at home may result in difficulties in getting a child’s birth certificate, forcing families to pay in order to receive it, thus aggravating even more their already precarious situation.

Respondent: Yes, I got some mothers post-natally [post natal] that wanted me to guide them on how to get birth certificates. You know when you deliver at home it gets hard to get a notification. I got quite a number whom I had to guide on the process of getting birth certificates. They had to report to the chief.

Moderator: That is a long process.

Respondent: You know a sub-chief had to be paid. Everything is money here in Kenya.

(Community health worker, Lusambili, p. 4) (Host country: Kenya)

Migrant women’s pre-existing poor health conditions were reported in six studies [47‐50, 52, 58]. In two articles [47, 52] some of the women were said to be HIV positive. In other cases, they suffered from kidney failure, hypertension, allergies, or diabetes [50, 53, 54]. In other instances, their health-related vulnerability factor was pregnancy [52, 53].

During the pandemic, fear of COVID-19 prevented migrant women with chronic health issues from accessing healthcare facilities, causing them to stop attending their check-ups and inhibiting them from receiving the necessary treatments [54].

It brings fear, this Corona affected us with fear, there is a fear to even go and get medication for blood pressure at the hospital because I will be thinking that maybe if I go there and get into contact with one person who has Corona then I will die. (Mutambara, p. 714) (Home country: Burundi; host country: South Africa)

The priority given to patients affected by COVID-19 at the expense of non-COVID-19 ones resulted in the failure to receive care for chronic conditions [52, 54]. For example, the rearrangement of hospital activities implemented in order to cope with the health emergency resulted in the disruption of antenatal classes [53]. The study of Lusambili reported that viral load taking for HIV positive mothers was postponed and that because of the curfew women in labor could not access the hospital after 7 p.m., meaning that they had to deliver at home [52]. Açıkalın reports testimonies from migrant women who could access care only to get their children vaccinated and to get cancer treatment [48]. The fact that migrant women were sent away from hospitals because they were not considered a priority, sometimes resulting from and into medical xenophobia, ultimately led them to the use of do-it-yourself remedies [54].

I had a very sharp stomach pain and I went to the clinic but the way the nurses received me. They said they cannot help me because they only have to treat people for Coronavirus. They never attended to me and I was just sitting there in deep pain and then had to go back home. Since then, I have been sick, I was having flu. I never went back to the hospital and then I used lemon, ginger and garlic, that is what I used. I never went back to the hospital because I was scared of how the nurses would treat me because the last time, they were even rude to me. (Mutambara, p. 714-715) (Home country: Burundi; host country: South Africa).

Testimonies of migrant women who portrayed their experience of accessing healthcare services in a positive way were also found [48].

Another sphere of vulnerability is connected with migrant women’s mental health, as reported in four articles [47, 49, 50, 58]. For example, Syrian women who have been living in Lebanon after fleeing war suffer from anxiety and are constantly stressed and scared, having nightmares, difficulty in performing regular activities and experiencing hair loss [50]. In addition, in the Arab region mental health is considered a taboo issue and therefore migrant women might be discouraged from seeking help [50]. Stigma around this topic was also mentioned in Sabri [56]. The COVID-19 pandemic and the lockdowns triggered memories of migrant women’s traumatizing events [45‐48, 50, 53, 55, 57, 58], hence increasing risk of self-harm and suicidal thoughts [46]. In the study of Marabello, when social workers proposed to a woman to visit a psychologist, she reacted with distress, refusing that and claiming her condition was a result of witchcraft [47].

The lockdowns intensified migrant women’s social isolation and loneliness resulting in the worsening of their mental well-being [45, 47, 48, 50, 52, 53, 55, 57, 58]. The situation was particularly hard also for those women that moved to a new country just before the COVID-19 pandemic, or those who had not yet developed their social capital. This had repercussions on migrant women’s psychological adjustment, since they were frustrated about the integration process and had the feeling of being stuck and not creating new opportunities for the future [55]. The positive experience of receiving support by other refugees’ families was described in one study [48].

According to the clinicians interviewed in the study of Melov, in Australia the lack of family support from overseas was one of the biggest challenges for pregnant and newly mothers migrant women, since in South Asia and China they are used to including their whole family in the childbearing process and in the postpartum period [53].

Due to the disruption of the social services determined by the containment measures, migrant women could not attend support groups and meet social workers or other professionals [46, 50]. On a positive note, one study reported that telehealth appointments with multilingual psychiatrists and sharing videos with advice on mental health were put in place [45].

COVID-19 containment measures further limited women’s autonomy and decision-making capacities [47, 48, 52, 54, 58]. For example, in the study of Marabello a woman expressed her desire to leave her child with a friend of hers while she was not at home, but her request was denied by social workers because, following the government guidelines for limiting the spread of the virus, she had to rely only on flat mates living in the same reception system [47]. A woman living in Australia said that through the indefinite shutting of Australian borders the government “abruptly took away [her] agency and freedom of movement, so hard won, leaving [her] feeling trapped, helpless, and angry” [58] and this feeling was shared by some of the participants to Phillimore’s study [46].

The educational path of migrant women as well as their religious needs suffered from the lockdowns [46, 48] and provoked a reduction or a nullification of their decision-making capacities. On the one hand women had to delay or interrupt their educational efforts, which may have helped them improving their integration within their host communities, for example learning a new language, or developing skills helpful in finding a job. On the other hand, their decision to practice a religion together with other devotees was obstructed, limiting the way they could express their freedom of faith and their belonging to a community [48].

The lockdown and the closures of support programs for GBV survivors [46, 50] represented another obstacle in their path towards empowerment and the reestablishment of their decision-making capacities. In particular, the inability to leave the relationship for some of the survivors was connected with pre-existing vulnerability factors, such as their legal status and poverty conditions, and with drivers such as the disruption of social services, which hindered them also from reporting abuses [56].

Moreover, the pre-existing limited agency prepared the ground for the victimization provoked by fraudulent initiatives of NGOs who pretended to try and help the women [54]. The limited agency endured by migrant women, aggravated by the disruption of social services, negatively influenced their mental well-being [48, 58].

During the COVID-19 pandemic school closures and the lack of non-parental childcare options together with remote work challenges have exacerbated the disproportionate gendered division of housework and childcare in the home [48, 55, 56], increasing even more the household burden of migrant women. As a consequence, their mental health conditions worsened due to stress and anxiety [46].

Another negative outcome for migrant women found in the included literature was the increase in frequency and intensity of occurrences of GBV, in particular sexual and intimate partner violence (IPV), as a consequence of the enforcement of stay-at-home orders [46, 48, 50, 54, 56]. These amplified stalking and monitoring behaviors, as well as other forms of control, namely financial, trying to get survivors pregnant or threats to infect them with COVID-19 [56].

The man is just drinking beer all the time. If you ask where did you get money to buy beer when we do not even have money for food, it will be trouble, they just want to drink beer and the other thing is that because they are not working and they are having pressure, all the pressure they direct at us – the women. So, we as women, we are suffering. (Mutambara, p. 712) (Home country: Burundi; host country: South Africa)

If you are in the same house with an abusive partner, anything could be a trigger. If you can’t get out, then don’t get into any compromising situation. Try to stay quiet, to be as nice as you can. (Sabri, p. 1304) (Host country: United States)

Sometimes migrant women were concerned for the well-being of their children, who were also subjected to violence [46, 54, 56]. One study described how community babysitting, that is members of the woman’s social circle volunteering to take care of her children while at the same time protecting her from the abuser, was dismantled during the COVID-19 pandemic due to the containment measures [56].

The economic crisis provoked by the pandemic heavily aggravated migrant women’s dependency on their perpetrators, preventing them from leaving a threatening domestic environment [46, 54, 56]. In other instances they were sexually and financially exploited by their partners, as reported in one study describing girls being forced into prostitution [46].

Migrant women who experienced GBV could not attend support groups, meetings with social workers or other professionals and empowerment programs in person [46, 50] and when these activities moved online, they were often excluded because of the lack of access to the internet [46, 50]. The probability of being caught in the act when using virtual support services, and the associated risk for increased violence, was also reported [50, 56]. This situation further aggravated their poor mental health conditions, exacerbated by the fact that some of the women were left to fend for themselves [54, 56].

On a positive note, one study mentioned strategies used to help survivors of GBV, from providing technology, financial assistance, referral to safe shelters and mental health services to suggesting safe ways to cope with the abuser or to signal abuses [56]. Another study reported more apparent gender equality in providing support during pregnancy, parenting and division of household tasks within migrant couples during the pandemic [53].

Language and cultural barriers could prevent migrant women from accessing services as well as from integrating in their host community [45, 46, 48, 53]. For example, Açıkalın explains how in Türkiye this issue represents an obstacle to migrant women’s interaction with the Turkish people, in finding a job and in accessing services available to them, including healthcare, and how this was further exacerbated in the context of the COVID-19 pandemic, with possible repercussions on their psychological well-being [48].

During the pandemic, because of language barriers, migrant women faced challenges in acquiring information about COVID-19 – from how to protect themselves to how to access services and resources – both on the government websites and in the media. Women had instead to rely on information provided by NGOs who made it available in different languages [45, 46]. However, when this service was present, it required time and, since the guidelines changed quickly, this made it impossible for migrant women to keep up with them through translation [45].

This scoping review has a few important strengths. First, it was conducted following a systematic process, with a rigorous and transparent approach to data retrieval, screening, and analysis. Second, to the best of our knowledge, this is the first literature review exploring the pathways leading from a condition of vulnerability to negative impacts during disasters for migrant women. Third, the in-depth inductive analysis allowed us to unravel a complex multi-layered phenomenon and to be able to report the study findings in the form of pathways, which can be easily accessible to the scientific community, policymakers and the wider public. This review also has some limitations. First, not all the studies reported data systematically, and this might have affected a fuller understanding of their findings. Second, the findings of this review are limited to the COVID-19 pandemic global disaster, as studies dealing with the vulnerability of migrant women in other disasters have not been retrieved. Third, no gray literature was included in the searching process. Fourth, studies focusing on internal migrants were not included, because we decided to analyze the spectrum of barriers migrant women experience when confronted with a system that is different from the one they have in their home country. Fifth, we recognize that each host country is different from the other, also in terms of gross domestic product (GDP), and that their reception policies and integration strategies vary widely. However, in our review we decided to include studies conducted in different countries to identify common patterns in the experiences of migrant women living in a host country in the event of a disaster. Finally, migrant women are a heterogeneous group and for this reason the vulnerability factors that apply to some of them might not be relevant for others. In this regard, it was our concern to specify the type of migrant, when possible, and the study context. We also reported specific examples and quotations from original studies to facilitate the understanding of how the context can influence and shape the unique experience of each migrant woman.

Literature dealing with migrant women in the context of disaster is scant. In order to strengthen disaster risk reduction (DRR) strategies, more evidence about the impact of disasters on migrant women needs to be collected. Both qualitative and quantitative research is needed, and an intersectional approach should be adopted [72]. At the same time, research should investigate coping and resilience strategies implemented by vulnerable groups, including migrant women, in order to identify examples of best practices and areas where a proper intervention is required.

We encourage authors studying vulnerable populations, including migrant women, to report disaggregated data (e.g., age, home country, legal status, lenght of stay in the host country, socioeconomic indicators) in a clear, precise, and standardized way, to allow the identification of various sub-groups collectively referred to as “migrant women”.

As pointed out by the Sendai Framework for DRR 2015–2030, there has to be a broader and a more people-centered preventive approach to disaster risk management [73]. On the same line, the H-EDRM framework called for a “whole-of-society approach” [3]. DRR should be gender-sensitive, and strategies aiming at gender equality such as gender mainstreaming [74] should be followed in line with the United Nations’ 2030 Sustainable Development Goals, in particular number five – Gender Equality [75]. Policymakers and key stakeholders should ensure that disaster risk information and health promotion strategies reach all segments of the population, paying particular attention to the most marginalized categories like migrants and refugees. Language and cultural barriers need to be overcome, primarily by relying on experts such as interpreters, cultural mediators, and anthropologists.

Health equity is realized when everyone can attain their full potential for health and well-being [76]. The COVID-19 pandemic demonstrated that the achievement of this goal is still far to reach [77]. The post-COVID-19 era should build upon the lessons learned during the pandemic and constitutes the momentum for thoroughly identifying and addressing the SDH that perpetuate inequalities and penalize the most vulnerable and marginalized groups [78].