2.1. Studied Population

The main mission of Doctors of the World/Médecins du Monde (MdM) is to provide access to healthcare through free social and medical services for people who face barriers to the mainstream healthcare system. MdM works mainly with people confronted with multiple vulnerabilities affecting their access to healthcare, including homeless people, drug users, and destitute nationals, as well as migrant EU citizens, sex workers, undocumented migrants, asylum seekers, and Roma communities. MdM programs aim at empowerment through the active participation of user groups as a way of identifying health-related solutions and combating the stigmatisation and exclusion of these groups.

The programs which collected our data are free clinics run by MdM or its partners, which offer primary healthcare consultations as well as social support and information about the healthcare system and patients’ rights with regard to accessing healthcare. Ultimately, these programs aim to help patients reintegrate into the mainstream healthcare system, where this is legally possible. The patients seen by MdM are therefore those individuals who have found health care via MdM, which means that they were in need of care and ineligible (or so they thought) for medical care in the common law healthcare system, either because they cannot afford them or for other administrative reasons.

MdM programs are run predominately by volunteers (90% are volunteers and the remaining 10% are paid staff, of which around 90% are health professionals—including nurses, general practitioners, midwives, dentists, medical specialists, and psychologists—and 10% are social workers, support workers, mediators, and translators). The MdM International Network has developed a quantitative and qualitative information system that includes systematic patient data collection and annual statistical analysis, narrative patient testimonies, de jure and de facto legal analysis of healthcare systems, as well as identification of best practices.

For this analysis, we based our sample on the total population seen by MdM. In the end, we included 1356 adult migrants who consulted an MdM volunteer at one of the free clinics run by MdM or its partners in five countries for the first time in 2014. These free clinics are located in Munich (Germany), Alicante, Bilbao, Malaga, Seville, Tenerife, Valencia, Zaragoza (Spain), La Chaux de Fonds, Neuchâtel (Switzerland), Istanbul (Turkey), and London (United Kingdom). Unfortunately, we could not include patients seen in Greece as their asylum status and length of stay in Greece were not available.