Deepening the data on refugees’ health needs: WHO in Poland pioneers a methodology with far-reaching potential

One in 8 people on the planet is on the move. Some migrate for economic reasons, and others are forcibly displaced by one of the many conflicts raging around the world. More than ever before, climate change and natural disasters are forcing populations to move within and across country borders. These refugees and migrants often lack adequate access to health care, and so may experience worse health outcomes than the rest of the population.

Unfortunately, global evidence and data on the health of refugees and migrants is mostly fragmented, often limited to migration flows and some demographic characteristics. Yet access to comprehensive, representative and systematically collected data is of paramount importance for evidence‐informed policy-making. It is also needed to create targeted interventions that make a difference in population health, and to uphold the basic human right to health - including for the billion people who are on the move.

To fill this gap, Statistics Poland and WHO have teamed up to explore ways to tackle data limitations in the context of the Ukrainian refugee crisis. In 2022 they conducted the first study to cover a representative sample of Ukrainian refugees in Poland, using mixed methods to unveil not just the numbers but also the human narratives behind the refugee crisis.

The methodology was then applied to a second round of mixed-method surveys conducted in 2023, which also integrated big data and administrative records.

Understanding the health needs of mobile populations

After 2 years, hostilities are ongoing in Ukraine and many of the refugees who fled to safety in Poland are unable to return to their homes. To understand their needs and experiences of accessing and using health services, the report's authors used a quantitative survey to collect data from 4800 refugees in households and temporary accommodation establishments, and data at the Polish-Ukrainian border.

To better understand the experiences the refugees have had with health-care services, they also undertook qualitative behavioural insights research, carrying out 30 in-depth interviews with a selected group of questionnaire respondents to elicit further information about health service needs and access.

Big data and administrative records were integrated alongside the survey results. The big data included geospatial data obtained from mobile network operators for locating populations on the move, and payment card operator data, which provided insights into patterns of health-care expenditure by Ukrainian refugees.

A methodology with global potential

At the report's launch in Warsaw, Poland, on 26 June, WHO/Europe's Representative in Poland and Special Envoy for Refugee Receiving Countries Dr Nino Berdzuli was one of several speakers to highlight how this data-integration approach could be applied by other countries.

"This integration of quantitative and qualitative surveys with administrative and big data to develop robust estimates on the health of refugees and migrants will narrow the gap in real-time data availability, and the gap between knowledge and action to develop evidence-informed health policies and practices," she said.

"I hope that this event will serve as a catalyst to refresh collaborative approaches on health and statistics and will solidify planning for future joint efforts to improve data-driven health responses and advance equity in European and global health systems."

Dr Dominik Rozkrut, President of Statistics Poland and President of the International Association for Official Statistics, stated, "Our groundbreaking integration of diverse data sources, including big data, illuminates the nuanced landscape of refugee health in Poland. By analysing both expenditures and movements, we gain invaluable insights that empower policy-makers to make informed decisions for targeted and timely health-care interventions."

At the event, indicating the huge appetite for better data on refugees and migrants, several other countries presented their information needs and their experiences of increasing the robustness of estimates and filling data gaps.

Dr Gundo Weiler, Director of WHO/Europe's Division of Country Support and Partnerships and acting Regional Emergency Director, emphasized, "Refugees and migrants are particularly vulnerable. To understand their health needs, innovative approaches are urgently needed. I applaud this successful collaboration between the health sector and a national statistical office."

He added, "The methodology deployed not only holds potential for generating robust health estimates for refugees and migrants in Poland; it also holds the possibility to provide a global model for countries who host, send or are transit countries for refugees and migrants."

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