Since 2022, Belgium has faced a worsening reception crisis for asylum seekers. In January 2025, access to governmental accommodation required an average wait of about four months. Single men were especially affected, with frequent disruptions in access to medical assistance.A three-phase study aimed to synthesise available health data on unaccommodated asylum seekers. This abstract reports findings from Phase 1, which gathered the perspectives of those concerned, exploring lived experiences and perceived health needs.We used an ethnographic design with four weeks of field observation and 20 on-site interviews across reception and care settings. Participants were selected to reflect diverse ages and nationalities. Field notes and interviews were analysed using thematic content analysis.Findings showed fragmented care pathways shaped by street survival strategies. Access to care was hindered by multiple barriers, notably limited and unclear information provided to this population. Reported health problems were closely linked to the precariousness of street conditions, including psychological distress, hygiene challenges, chronic pain, fatigue, and poor diet. Priority needs centred on housing and safety, viewed as prerequisites for health.The ethnographic approach enabled the direct involvement of those affected, who are experiencing an unprecedented situation in the current context. Barriers to health are closely linked to the conditions of non-reception and to the fragmentation of initiatives implemented in an emergency, without the possibility of a long-term vision or continuity of care.The care pathways and health problems of unaccommodated asylum seekers are specific to this population. Harmonisation and continuity of care across the various structures involved, along with consideration of their particular needs, are necessary to improve access to care for these individuals.

Refugees with experiences of trauma commonly present to primary care with complex mental health needs. The concept of moral injury has increasingly been applied to refugee populations to explain forms of distress that may not fit diagnostic criteria for post-traumatic stress disorder. However, moral injury originated within Western military psychiatry and may not adequately capture the cultural and ethical frameworks through which refugees understand their experiences.To explore how Iranian refugee torture survivors living in the UK conceptualise moral and ethical distress in relation to trauma and mental health, and to assess the relevance and limitations of the concept of moral injury in this population.This qualitative study involved in-depth semi-structured interviews with 11 Iranian refugee torture survivors and three focus groups with 13 mental health professionals working with refugee populations. Data explored experiences of imprisonment, torture, resettlement, and associated moral and ethical meanings. Analysis was conducted using a hermeneutic phenomenological approach combined with thematic analysis.Participants rarely described their distress as an “injury” to moral beliefs. Instead, narratives centred on Ensāniat, a culturally embedded ethical concept encompassing human dignity, moral agency, and relational humanity. Ensāniat enabled participants to articulate experiences of suffering, endurance, and ethical disruption without positioning themselves as moral transgressors. Applying standard moral injury frameworks risked conflating the standpoint of perpetrators with that of victims and obscuring survivors’ lived moral realities.These findings highlight limitations in the uncritical application of moral injury to refugee mental health. The dominance of Western psychiatric constructs may contribute to epistemic injustice and constrain culturally responsive care in both primary care and specialist mental health settings.Recognising culturally grounded ethical frameworks such as Ensāniat may help GPs better understand and respond to the mental health needs of traumatised refugees. Culturally attuned concepts can support more equitable, humanistic, and trauma-informed primary healthcare. Suggested MeSH Keywords: Refugees, Trauma, Mental Health, Moral Injury, Cultural Competency

Although everyone has the right to basic healthcare, access remains difficult for mobile populations living in vulnerable circumstances, such as undocumented migrants (UDMs), asylum seekers, and EU-labour migrants. Because they frequently move between locations and healthcare providers (HCPs), medical information is often lost, reducing continuity of care and increasing costs through duplicated procedures. To address this, we developed a phone-based Electronic Personal Health Record (EPHR) called HealthEmove, designed together with mobile populations and the HCPs who work with them.A prototype was developed and iteratively evaluated by (un)documented migrants, HCPs and volunteers experienced with mobile populations. Their feedback informed iterative revisions until the first version was released. This version was tested by 15 (un)documented participants using a mixed- method qualitative design. Participants completed a baseline interview with usability testing and a follow-up interview after four to eight weeks. Guided by the Technology Acceptance Model (TAM) and content validity testing, we assessed ease-of-use, comprehensibility, perceived usefulness, attitude towards using, behavioural intention to use, and actual system useEngaging end-users and HCPs throughout the design process improved ease-of-use and relevance while considering diverse levels of (digital) literacy, cultural differences, and barriers to accessing healthcare. This input led to features such as the simplified adding and sharing of medical documents, creating family accounts, appointment reminders, and a support page for navigating GP and hospital access. Additionally, findings showed the importance of secure data storage due to varying levels of trust in digital solutions and institutional distrust among UDMs.With this case study of HealthEmove we would like to discuss the barriers and facilitators in this process by interacting with the groupAs global mobility rises, the importance of technically functional and culturally responsive EPHRs grows. The case of HealthEmove shows that co-creation with stakeholders supports the development of equitable, user-friendly digital health tools that improve continuity and quality of care.

Foreign caregivers experience significant psychological burden, intensified during armed conflict, reducing their capacity to cope with daily demands and stressors. Clinical assessment is frequently limited by linguistic and cultural gaps. In many Asian caregiving communities, distress may be described through physical or functional complaints rather than explicit emotional terms, reducing the effectiveness of standard screening questions. Open-source large language models (LLMs) may help bridge these communication gaps by providing culturally attuned explanations.A 46-year-old female caregiver from the Philippines presented with insomnia, tearfulness, irritability, and stress-related overeating during a period of regional instability. Initial assessment was limited by language and cultural framing. To overcome this barrier, an open-source LLM was used as a real-time multilingual communication mediator. The LLM reshaped explanations and questions into accessible, culturally familiar language that matched the patient’s way of describing her difficulties. This enabled her to discuss effects of missile alerts, family separation, and workplace pressures with greater clarity. Using this mediated dialogue, PHQ-9 and GAD-7 (validated screening tools for depression and anxiety) were administered in a culturally sensitive manner, aligning functional and physical descriptions with the emotional and cognitive domains required for standardized scoring. These insights enabled the family physician to develop a care plan including weekly supportive encounters, sleep-hygiene strategies, and low-dose SSRI. In the following weeks, the patient reported better sleep and improved coping with daily stressors.Culturally adapted LLM-supported communication may enhance early detection of depression and anxiety among foreign caregivers, particularly in crisis settings. Future practice may integrate similar tools to help reduce inequities in mental health access and support greater patient engagement.The LLM improved interpretability of somatic complaints and supported more accurate clinical assessment, while all diagnostic reasoning and treatment decisions remained physician-led.LLM-assisted, culturally adapted communication can strengthen mental-health care for foreign caregivers by improving access, diagnostic clarity, and patient participation in primary care.

Recently arrived asylum-seeking women face a markedly increased risk of sexual violence (SV) during the first months in host countries, while simultaneously encountering major barriers to accessing healthcare. PREVISEDA is a national programme aiming to implement an early, coordinated, primary-care–based intervention for the prevention, detection, and management of SV among asylum-seeking women in France. We report preliminary observational results from the first implementation site.To evaluate the impact of a primary-care protocol for systematic SV screening and multidisciplinary management among recently arrived asylum seeking womenRetrospective observational study of all adult migrant women included in the PREVISEDA protocol at a participatory primary-care centre (May 2022–December 2023). SV history was classified as previously known or newly disclosed through screening. We analysed follow-up intensity, referrals, mental-health indicators, and psychotropic prescriptions. Visits were weighted per month of follow-up.Among 121 women (mean age 33 years; 48.8% from West Africa), 53.7% had experienced SV. Only 19.8% had a known history; screening newly identified SV in 42.3% of the 97 women without prior documentation, frequently during the first consultation (62.3%). Survivors required significantly more follow-up (2.6 vs 1.7 visits/month, p=0.02) and more mental-health-related consultations and psychotropic prescriptions. Multidisciplinary referrals were frequent (64.5%), but psychological care remained difficult to access despite referrals.These preliminary data demonstrate that proactive SV screening integrated into primary care substantially increases identification of previously unrecognised trauma and improves care engagement. The intensity and nature of follow-up highlight unmet medical, psychological, and social needs in this population. These  findings informed the design of PREVISEDA, a national, Ministry-of-Health–funded programme that now aims to prospectively and comparatively evaluate this model across 6 French regions. In parallel, preparatory work is underway to examine the feasibility of a European extension in collaboration with academic and community partners.This pilot work shows the feasibility and clinical relevance of an early, structured primary-care model for SV screening and management among migrant women. It provided the empirical basis for the multicentre PREVISEDA trial and contributes to shaping future national and European strategies to promote safety, equity, and mental-health support for recently arrived women.

Migration is a defining feature of modern society, with displacement often accompanied by profound medical and psychological needs. In Ireland, asylum seekers are housed in “direct provision” centres, frequently facing barriers to healthcare. By the end of 2018, over 6,000 people seeking international protection were accommodated in such centres.During my placement as a GP registrar, a direct provision centre opened locally, housing approximately 90 asylum seekers. Initial healthcare planning was absent. My first encounters with patients in an out of hours setting highlighted critical gaps: a pregnant woman with suspected ectopic pregnancy, a man left without antihypertensives for weeks, and a young woman with diabetes and neurological symptoms but no GP care. In response, our practice invited 30 patients, including 10 children, into care, offering extended initial assessments. Challenges included absence of medical cards, language and cultural barriers, disrupted continuity due to relocations, and lack of transport or childcare. Clinical issues ranged from vitamin D deficiency and chronic disease management to maternity care and complex psychological trauma. Strengths of our approach included rapid team response and provision of holistic GP-led care; limitations lay in overstretched resources and reliance on voluntary goodwill.The experience underlined how systemic barriers—lack of GP registration, poor screening processes, limited psychological supports—compound vulnerability. Inclusion within general practice not only improved health outcomes but fostered community integration, with patients later volunteering locally. Future care requires structural change: guaranteed GP access, streamlined medical card provision, dedicated mental health supports, and policies respecting cultural preferences.This case reflects the conference themes: Liberty—the freedom to provide equitable care despite system constraints; Equality—addressing barriers to access; and Fraternity—building solidarity between practitioners, patients, and communities.The experience highlights how general practice can embody humanism, offering “Céad Míle Fáilte”—a hundred thousand welcomes—through healthcare.