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. 2025 Jun 30;22(7):1042.
doi: 10.3390/ijerph22071042.

Upholding the Right to Health in Contexts of Displacement: A Whole-of-Route Policy Analysis in South Africa, Kenya, Somalia, and the Democratic Republic of Congo

Rebecca Walker  1 , Jo Vearey  1   2 , Ahmed Said Bile  3 , Genèse Lobukulu Lolimo  4
Affiliations

Upholding the Right to Health in Contexts of Displacement: A Whole-of-Route Policy Analysis in South Africa, Kenya, Somalia, and the Democratic Republic of Congo

Rebecca Walker et al. Int J Environ Res Public Health. .

Abstract

The Sustainable Development Goals commit states to Universal Health Coverage (UHC) for all; yet displaced populations-including asylum seekers, refugees, internally displaced persons (IDPs), and undocumented migrants-remain systematically excluded from national health systems across southern and eastern Africa. This paper applies a whole-of-route, rights-based framework to examine how legal status, policy implementation, and structural governance shape healthcare access for displaced populations across South Africa, Kenya, Somalia, and the Democratic Republic of Congo (DRC). Drawing on 70 key informant interviews and policy analysis conducted between 2020 and 2025, the study finds that despite formal commitments to health equity, access remains constrained by restrictive legal regimes, administrative discretion, and fragmented service delivery models. Critical gaps persist in migration-sensitive planning, gender-responsive care, and mental health integration. The findings highlight the limitations of rights-based rhetoric in the absence of legal coherence, intersectoral coordination, and political will. To realise UHC in displacement contexts, health systems must move beyond citizen-centric models and embed migration-aware, inclusive, and sustainable approaches across all stages of displacement. Without such structural reforms, displaced populations will remain at the margins of national health agendas-and the promise of health for all will remain unmet.

Keywords: Democratic Republic of Congo (DRC); Kenya; Somalia; gender-aware; healthcare; internally displaced people (IDPs); legislative frameworks South Africa; mental health; universal health coverage (UHC).

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Conflict of interest statement

Ahmed Said Bile is affiliated with the SIDRA Institute. The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Movements of displaced people from the DRC and Somalia often follow an established migratory pathway connecting Kenya and South Africa.
Figure 2
Figure 2
Select key migration and health frameworks: global, continental, and regional levels.
Figure 3
Figure 3
Migration and health policy assessment framework.
Figure 4
Figure 4
Cross-comparison of migration and health policy and planning in the DRC, Somalia, Kenya, and South Africa.
See this image and copyright information in PMC

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