The research team, led by Fabian Link, Zeliha Öcek, and Michaela Coenen of LMU Munich together with Apostolos Veizis of INTERSOS Hellas in Athens, interviewed fifteen staff members of civil society organizations between March and May 2024. Participants were recruited through purposive and snowball sampling, a technique in which initial contacts recommend further interviewees, allowing the researchers to reach workers embedded in local, national, and international organizations across the full length of the route. Semi-structured, in-depth interviews covered healthcare access, service gaps, the roles organizations play, the challenges they face, and their relations with institutions. The transcripts were then analyzed using qualitative content analysis, a method that systematically codes textual data into categories and themes. Ethical approval was obtained from the Ethics Committee of the Faculty of Medicine at LMU Munich, and all participants gave written informed consent.

The analytical engine of the study produced four main categories that structure the findings: the structural and sociopolitical context, the situation of people on the move themselves, national healthcare systems, and civil society organizations. This framework matters because it reframes migrant health not as an individual medical problem but as the output of an interacting system. Whether a person with an infected wound or a chronic illness receives care depends on migration governance, the capacity and willingness of national health services, and the presence or absence of an NGO clinic within walking distance of an informal settlement or a police station.

Participants described a landscape of fragmented migration governance in which responsibility for people in transit is dispersed across states, European Union agencies, and international bodies without any single actor owning the outcome. The Balkan Route is not a single road but a shifting mosaic of border crossings, transit camps, informal settlements, and pushback zones, and the legal status of a person can change overnight as they move from one jurisdiction to another. In this environment, the interviewees reported, legal barriers and discrimination operate as determinants of health in their own right. A person without registration may be formally entitled to emergency care yet practically unable to access it, turned away at reception desks, unable to communicate their symptoms, or afraid to present at a facility that they believe may report them to authorities.

The health risks experienced by people on the move are cumulative rather than episodic, according to the accounts gathered in the study. Exhaustion from weeks of walking, injuries sustained during border crossings, exposure to cold and unsanitary conditions, untreated chronic diseases, and the psychological burden of uncertainty and violence compound one another. Structural, administrative, and communication barriers then stack on top of these vulnerabilities. Language interpretation is often unavailable; paperwork requirements assume a fixed address; and the constant threat of removal discourages people from seeking care at all. The result is a population whose medical needs intensify precisely as their access to formal services diminishes.

Against this backdrop, the study’s central finding is the mediating role of civil society organizations. Although participants consistently viewed states as the actors primarily responsible for healthcare provision, they reported that CSOs fill critical gaps in three distinct ways. First, they deliver health-related services directly, from basic medical care and hygiene support to referrals for specialist treatment. Second, they facilitate access through mediation, accompanying individuals to hospitals, translating, navigating bureaucracy, and vouching for patients who would otherwise fall through the cracks. Third, they advocate for more equitable healthcare, pressing authorities and international agencies to recognize and close the gaps they observe on the ground. This triple function, service provision, brokerage, and advocacy, makes CSOs the connective tissue between a mobile population and health systems that were never designed to receive it.

Yet the study is equally clear that this role is constrained from multiple directions. Unstable funding keeps organizations in a permanent state of short-term planning, with projects that can end when donor priorities shift. Workforce shortages mean that a handful of coordinators, nurses, and cultural mediators must cover enormous geographic and caseload spans. Political pressures add another layer: organizations operating in countries where migration is a charged political issue face suspicion, obstruction, and in some contexts the risk of being accused of facilitating irregular movement. Perhaps most corrosive are the ethical tensions participants described regarding the substitution of state responsibilities. When an NGO clinic becomes the de facto primary care provider for a transit population, it relieves the state of pressure to fulfill its own obligations, and it does so without the mandate, resources, or accountability of a public health system. Workers described the discomfort of propping up a parallel structure they know should not need to exist.

What emerges as the decisive variable separating effective support from failure is trust. The interviewees emphasized that collaboration between civil society organizations, healthcare providers, public authorities, local communities, and people on the move themselves is essential for healthcare to reach those who need it. Trust operates at every interface: a hospital that trusts an NGO’s referral accepts its patients; a local community that trusts a organization tolerates its presence; a person in transit who trusts a cultural mediator discloses symptoms that would otherwise remain hidden. Where these relationships exist, the machinery of care functions despite the structural obstacles. Where they do not, even well-funded interventions stall.

The technical significance of the study lies in its transnational scope and its grounding in the operational perspective of frontline staff rather than in policy documents or patient surveys alone. By sampling across eleven countries and across organizational scales, from small local groups to international humanitarian agencies, the researchers captured the heterogeneity of the route rather than a single national snapshot. Qualitative content analysis allowed them to move from individual anecdotes to system-level categories, showing how the same structural forces, fragmented governance, limited health system capacity, discrimination, and legal exclusion, reproduce themselves at every point along the corridor. The consistency of these themes across such different political contexts is itself a finding: the barriers to healthcare for people on the move are not local anomalies but features of the European migration architecture.

The authors’ conclusions point toward a specific reform agenda rather than a vague call for improvement. Strengthening trust-based collaboration, they argue, must go hand in hand with preserving the independence of civil society organizations and maintaining state accountability for healthcare provision. In other words, the goal is not to formalize the substitution of NGOs for the state but to use their mediating capacity to pull states back into their proper role. As migration pressures persist and the Balkan Route continues to shift with border politics, the study suggests that the health of people in transit will depend less on any single clinic or program than on whether the fragile web of trust connecting volunteers, doctors, officials, and migrants can be strengthened before it frays. For now, along the forests and border towns of southeastern Europe, it is civil society that keeps the promise of healthcare alive, one mediated referral at a time.

Subject of Research: Civil society organizations' roles and obstacles in providing healthcare access to people on the move along the Balkan migration route

Article Title: Health support for people on the move: a qualitative exploration of civil society organizations’ roles and obstacles along the Balkan route

Article References: Link, F., Öcek, Z., Veizis, A., & Coenen, M. (2026). Health support for people on the move: a qualitative exploration of civil society organizations’ roles and obstacles along the Balkan route. International Journal for Equity in Health. https://doi.org/10.1186/s12939-026-03048-x

Image Credits: AI Generated

DOI: 10.1186/s12939-026-03048-x

Keywords: Balkan Route, migration health, civil society organizations, healthcare access, qualitative research, refugees, migrants, health equity, humanitarian aid, public health, Europe, health systems

The study’s methodology reflects a careful attempt to identify a population that is frequently invisible in electronic health record data. Because many medical records do not reliably capture country of birth, the researchers used preferred language as a proxy for foreign-born status, then confirmed immigrant status through a complete review of the electronic medical record carried out by a trained clinical team. This two-step verification matters, because language barriers themselves are a known driver of health care underuse, and conflating language with birthplace without verification could have distorted the findings. The chart review covered the period from June to December 2021 and assessed screening status for five cancer types: cervical, breast, colon, lung, and hepatocellular cancer.

The headline numbers tell a story of uneven protection. Among eligible women, 63.0 percent were up to date on cervical cancer screening and 71.4 percent on breast cancer screening. Colon cancer screening fared worse, with only 52.4 percent of eligible patients current. The steepest shortfalls appeared in the screening programs that depend on specific risk profiles: just 23.1 percent of patients eligible for lung cancer screening and 25.0 percent of those eligible for hepatocellular cancer screening were up to date with recommended guidelines. For lung cancer, eligibility typically hinges on age and a documented smoking history, while hepatocellular surveillance is generally reserved for patients with cirrhosis or chronic hepatitis B infection, making accurate risk documentation a prerequisite for any screening at all.

Why do these particular screens lag so far behind? The technical requirements of risk-based screening offer one explanation. Unlike population-wide tests such as mammography or colonoscopy, lung and liver cancer screening depend on clinicians first identifying who qualifies. That identification step can fail at multiple points for patients who arrived as refugees or immigrants: smoking histories may never be documented in a patient’s preferred language, hepatitis B status acquired in endemic regions may go untested, and conversations about eligibility may never happen if interpretation services are inconsistent. A screening program that begins with an unasked question effectively ends before it starts, and the Syracuse data suggest exactly that pattern.

The broader context makes these numbers more alarming. Cancer screening rates in refugee and immigrant populations across the United States are consistently lower than those of the U.S.-born population, a disparity rooted in a tangle of barriers: limited English proficiency, unfamiliarity with the preventive care model, competing settlement priorities, insurance gaps, transportation challenges, cultural attitudes toward cancer and its disclosure, and prior negative experiences with health systems both abroad and in the United States. Refugees often arrive after years of displacement and may have missed screening opportunities entirely during the intervals when guidelines would have applied. The Syracuse study provides baseline data from a non-English-speaking refugee and immigrant primary care population at an academic medical institution, a measurement step the authors describe as essential before interventions can be designed.

Baseline data of this kind serve a specific technical purpose in health equity research. Without knowing where screening rates stand, clinics cannot set targets, allocate resources, or evaluate whether an intervention works. The Syracuse team frames its findings as an opportunity: identifying the gaps in cancer screening provides a chance to design meaningful clinic-based and community-based interventions for providers and health systems to improve health equity. In practice, such interventions might include reminder systems in patients’ preferred languages, dedicated navigation staff who shepherd patients from eligibility determination to completed screening, integrated interpretation services, and community partnerships that build trust and health literacy around cancer prevention.

The study also illustrates the value of academic primary care clinics as windows into underserved populations. SUNY Upstate’s adult medicine clinic serves a substantial refugee and immigrant patient base, reflecting Syracuse’s long history as a resettlement city. Chart review of this kind, approved by the institution’s Institutional Review Board with consent waived, allows researchers to measure real-world care delivery rather than relying on self-reported screening, which is known to be imprecise. The trade-off is that a single-clinic, single-city sample cannot be generalized wholesale to other settings, but it offers something national datasets often cannot: a granular, verified picture of one clinic’s performance against national guidelines for a specific, identifiable population.

The five cancer types examined span the major evidence-based screening programs in American medicine. Cervical cancer screening via cytology and HPV testing, breast cancer screening via mammography, and colorectal cancer screening via stool-based tests or colonoscopy are recommended for broad age-eligible populations. Lung cancer screening with low-dose computed tomography is targeted at high-risk current and former smokers, and hepatocellular surveillance with ultrasound, with or without alpha-fetoprotein testing, targets patients with cirrhosis or chronic hepatitis B. The divergence in the Syracuse data between the broad-population screens and the risk-stratified screens points to a structural insight: disparities are not uniform across preventive services but concentrate where screening depends on upstream risk assessment and patient-clinician communication.

Timing also deserves attention. The chart review window of June to December 2021 fell during the COVID-19 pandemic, when routine preventive care was disrupted nationwide as clinics suspended non-urgent services and patients deferred visits. Screening rates measured in that period may reflect pandemic-era backlogs that have since partially recovered, a caveat that underscores why the authors position this as baseline data rather than a definitive portrait. Still, the scale of the shortfalls in lung and liver cancer screening, at roughly one in four or fewer patients current, exceeds what pandemic disruption alone would plausibly explain, and aligns with the persistent disparities documented in refugee and immigrant health research.

What happens next will determine whether this study becomes a turning point or another data point. The authors’ stated purpose, to present baseline data that enables the design of clinic and community interventions, implies a research-to-practice pipeline: targeted outreach, risk documentation improvements, language-concordant education, and system-level tracking of screening completion. For the patients behind the 1,083 charts, the stakes are concrete. Cancers detected through screening are typically found earlier and carry better prognoses than symptomatic cancers, and every percentage point of screening completion represents lives potentially extended. The Syracuse findings transform an abstract inequity into a measurable, addressable checklist, and in doing so they offer health systems elsewhere a template for asking the same question of their own records: who among our most vulnerable patients is being missed, and by which screens?

Subject of Research: Cancer screening disparities among refugee and immigrant primary care patients in Syracuse, New York

Article Title: Cancer screening gaps among refugees and immigrants in Syracuse New York

Article References: Thompson, C. A., Sous, W., Ahmed, A., Rogner, J., Chee, S., Arafa, F., Searles, M., Purdy, A., & Shaw, A. V. (2026). Cancer screening gaps among refugees and immigrants in Syracuse New York. Discover Social Science and Health. https://doi.org/10.1007/s44155-026-00466-8

Image Credits: AI Generated

DOI: 10.1007/s44155-026-00466-8

Keywords: cancer screening, refugees, immigrants, health equity, primary care, SUNY Upstate, Syracuse, lung cancer, hepatocellular carcinoma, cervical cancer, chart review, health disparities