Relevant peer-reviewed studies published between 11 March 2010 and 10 March 2025 were identified in PubMed and Web of Science. The search string consisted of four blocks around the following themes: (i) refugee; (ii) healthcare; (iii) discrimination; and (iv) LMICs. The search string was tailored to the specific features of the two databases, with Medical Subject Headings (MeSH) terms applied in PubMed to expand the search (the complete search strings for the individual databases are provided in the review protocol in Supplementary Material 1 – Scoping Literature Review Protocol and Methods). Three previously identified studies on the topic were used to validate and adapt the search terminology [20–22]. All hits with an English abstract were included, irrespective of the language of the full text. LMICs were defined according to the World Bank (“World Bank Country and Lending Groups”, March 2025 [23]).

Titles and abstracts were screened in parallel by K.G. and P.K. using EndNote (version 21.5, Clarivate Analytics, United States) for data management and Covidence (2025 Covidence, Veritas Health Innovation, Australia) to identify relevant studies. After screening the first 100 studies, the inclusion and exclusion criteria were refined through discussion with input from M.S.W. and subsequently applied consistently. Disagreements were resolved by consensus between K.G. and P.K., with unresolved cases discussed with M.S.W. Duplicates were removed automatically by Covidence and additionally through manual checking. Full-text screening was conducted by K.G., with final inclusion decision discussed with P.K. Studies were considered eligible if they (i) included data on discrimination in medical settings as perceived by forcibly displaced people in LMICs; (ii) aimed to investigate discrimination in healthcare or barriers to healthcare access; and (iii) had full text available in English within the University of Basel’s access rights. All forcibly displaced people, regardless of age, were considered. Studies were excluded if populations were not clearly defined as forcibly displaced, if results were not reported separately from other migrant or non-migrant groups, if discrimination was reported by non-migrants (e.g., healthcare worker’s perspectives), or if conducted in HICs. All peer-reviewed studies with primary data were included, irrespective of methodology, author’s origin, or data time frame studied. Table 1 summarizes in- and exclusion criteria.

Data from studies included in the full-text was extracted by K.G, using a data charting form developed in Microsoft Excel (version 16.98, Microsoft Corporation, United States) with input from M.S.W. Extracted variables included: title, first author, host countries studied, journal of publication, year of publication, study population, number of participants, age of population, type of study and methods (used for analysis of discrimination), aim of the study, main findings, conclusion and main recommendations. Data analysis and the generation of tables and figures were conducted in Excel. The PRISMA flow diagram was generated using Covidence. A descriptive approach was used to summarize studies by publication year, geographical scope, study population, methodology and objectives. Key findings and recommendations were grouped into subthemes using inductive coding. Detailed study characteristics and results are presented in Supplementary Material 2 – Table of Included Studies (Objectives and Methods) and Supplementary Material 3 – Table of Included Studies (Findings and Recommendations). The manuscript was written by K.G. using Microsoft Word (version 16.102.1, Microsoft Corporation, United States). ChatGPT (version GPT-4o-mini, OpenAI, United States) was used solely to summarize or shorten text and not for data analysis or manuscript writing.

Since a systematic review does not involve human subjects, human tissues or animal participants, no ethics committee approval was required.

Through the initial search in PubMed and Web of Science a total of 2463 papers were identified. After removing 455 duplicates, 2008 studies were screened by title and abstract, of which 1875 were excluded. Full texts of 133 studies were assessed, leading to the exclusion of 103 papers due to incorrect outcomes (n = 47), study population (n = 36), objectives (n = 11), or host country (n = 3); one study lacked primary data. Two studies could not be retrieved in full text and three were excluded due to non-English full texts. This left 30 studies for inclusion. One additional study was identified through reference screening, bringing the total to 31 studies included in this scoping literature review (Figure 1).

Four themes emerged from the literature on improving healthcare access and reducing discrimination against displaced people in medical settings.

Out of the countries listed at least once by UNHCR among the top 10 receiving countries of forcibly displaced people from 2010 to 2024 [60], only Colombia, Iran, Jordan, Pakistan and Türkiye had studies that could be included in this review. No studies were found that focused on Afghanistan, the Democratic Republic of Congo, Ethiopia, Iraq, Nigeria, the State of Palestine, Somalia, South Sudan, Sudan, the Syrian Arab Republic, Ukraine or Yemen, leaving those major refugee-hosting countries unrepresented (Figure 3A). Out of the countries listed at least once by UNHCR among the top 10 countries of origin with the most forcibly displaced people from 2010 to 2024 [60], some studies on discrimination in medical settings were done on people originating from Afghanistan, the Democratic Republic of Congo, Somalia, the Syrian Arab Republic and Venezuela. Only one study each included refugees from Ethiopia, Iraq, Nigeria, the State of Palestine, South Sudan and Sudan, and no studies including forcibly displaced people from the Central African Republic, Colombia, Myanmar, Pakistan, Türkiye, Ukraine or Yemen matching our inclusion criteria were found (Figure 3B). Hence, the significant underrepresentation of many of the most affected host countries and displaced populations identified in this scoping literature review calls for further investigation in future studies.

No literature on internally displaced people was identified to be included in this review. This is especially striking, given that nearly 60% of all forcibly displaced people remain within their own country [1]. It is, however, possible that some research on discrimination against internally displaced people has been conducted but was not included in this review due to the lack of differentiation of the migrant population or the rather narrow scope of the review (see Section Strengths and Limitations).

Most studies in the review applied an explorative qualitative approach, primarily investigating barriers to healthcare access without specifically focusing on discrimination. As a result, generalizable data on prevalence and context of discrimination in healthcare in LMICs among forcibly displaced is lacking. Although five of the studies used quantitative methods, none used standardized tools such as the Discrimination in Medical Settings Scale [61] to systematically assess perceived discrimination. The results of the studies in the review are therefore very heterogeneous, ranging from mere mentioning of perceived discrimination to rich descriptions of displaced people experiencing discriminating attitudes, mistreatment, verbal abuse or disrespectful behavior by healthcare providers when seeking care in the host country [20, 24, 26–28, 31, 33–35, 37–45]. Several studies reported perceived discrimination in healthcare as a barrier to accessing care. Refugees who were afraid of discrimination or were dissatisfied with the service avoided certain facilities or delayed seeking care until their health situation had reached a critical stage [20, 27, 34, 39, 40, 42, 50, 51]. Stigma and mistreatment of refugees by healthcare workers also lead to mistrust and confidentiality concerns [36, 52, 53]. Some refugees expressed feeling worthless due to exclusion, others reported increased trauma and stress or a compromise of emotional wellbeing [33, 35, 46].

The quantitative results show that 10%–44% of the refugees reported experiencing discrimination while seeking healthcare [20, 30, 31, 37]. While these numbers are comparable to findings from recent studies on discrimination in medical settings across different populations in the United States, where 21%–40% of respondents reported experiencing discrimination in healthcare [58, 59, 62], a study published in 2017 on perceived discrimination in primary healthcare across various European countries (and populations) reported slightly lower rates, with 7% (1.4%–12.8%) of the respondents indicating they had felt discriminated against [54].

Overall, the existing evidence suggests that perceived discrimination in medical settings poses a significant barrier to refugees receiving high-quality healthcare, however, the true prevalence, determinants and impacts remain insufficiently understood due to methodological limitations and the lack of standardized measurement approaches.

In the identified literature, the reasons for perceived discrimination often remain unclear. In many cases, it was not possible to distinguish whether the perceived unfair treatment was based on actual discrimination or on the perception of some other form of mistreatment unrelated to personal traits and affecting all patient populations (e.g., general bad attitude of certain health staff towards all patients, lack of commodities for all patients). Some studies in our review included perspectives from healthcare providers or key informants from refugee organizations, offering an additional viewpoint and, to some extent, possible explanations for the perceived unfair treatment of refugees by healthcare providers. These included, among others, feelings of resentment toward refugees, work overload, a general scarcity of resources, discriminatory policies and language barriers [25, 29, 37, 38, 40–42, 45, 51]. However, the study designs often did not allow direct comparison or objectification of the answers (e.g., no comparison group was used, different questions were asked, different methodologies were applied or a qualitative approach resulted in heterogeneous narratives). Although the effect on the refugee’s health outcomes and health-seeking behavior is likely to be the same, regardless of the underlying cause of the perceived discrimination or whether the discriminatory acts can be objectively verified [50, 63], understanding the underlying reasons for perceived discrimination is essential to develop effective strategies to tackle discriminatory behavior and improve healthcare for displaced people. This underscores the need for methodologically robust, comparative and mixed-method research to identify and address the underlying reasons for perceived discrimination in healthcare settings.

Effectively addressing discrimination in healthcare will require a coordinated, evidence-informed and context-sensitive approach that recognizes the complexity of migration, discrimination and health systems [64]. Based on the studies in our review, several general recommendations can be drawn to reduce discrimination in healthcare. Firstly, enhancing intercultural competencies among healthcare providers through training on migrants’ legal rights, cultural diversity and anti-discrimination, as well as integrating migrants into the healthcare workforce, is needed [20, 24, 27, 28, 33, 35, 41, 43–47, 49, 50, 65]. Secondly, strengthening health systems is essential, including ensuring adequate staffing, supplies and infrastructure, as well as employing professional interpreters to support the delivery of high-quality care for all [20, 26, 28, 29, 32, 36, 38, 40]. Thirdly, to protect migrants from violence and deportation and to reduce xenophobia in healthcare, inclusive policies must be developed and promoted and international guidelines and initiatives should be adapted to national contexts [24, 26, 27, 30, 33, 38, 39, 41–44, 47, 48, 50–53]. Finally, further research is needed to understand healthcare providers’ justifications for behaviors perceived as discriminatory, to explore specific barriers to healthcare access faced by migrant populations and to examine the underlying causes of marginalization and structural violence [24, 25, 32, 34, 37].

However, as pointed out by several authors in the Lancet Series on Racism, Xenophobia, Discrimination and Health, it should not be forgotten that healthcare is just one of the institutions in which discrimination has an impact on health outcomes of migrants and other minorities [4, 65, 66]. Therefore, it will not be sufficient to merely try to “cure” the causes of discrimination in healthcare by improving access to services and enhancing cultural sensitivity among healthcare providers alone. Ultimately, it will be necessary to address discrimination as a fundamental social determinant of health and tackle the underlying systems of categorization, marginalization and oppression, the overall root causes of discrimination, racism and xenophobia [4, 65, 66].

Drawing on this literature review, the following recommendations aim to strengthen future research on discrimination against forcibly displaced populations in healthcare. Studies should use validated measures of self-reported discrimination, clearly define study populations and migrant subgroups, and include appropriate control groups to enable comparative analysis. Incorporating multiple perspectives, including those of healthcare workers and third-party informants such as representatives of refugee organizations, can improve contextual understanding. Research should assess the prevalence, settings, forms, and drivers of discrimination by examining where, when, why, and against whom it occurs, as well as who perpetrates it. Related data analyses should control for key confounders, including demographic, legal, socioeconomic and health-related factors. These findings should be interpreted within relevant historical, political and policy contexts. Publishing results, particularly from multi-setting or cross-country studies, will strengthen the global comparative evidence base.

The scoping review followed the frameworks of Arksey and O’Malley, Levac et al., and the PRISMA-ScR guidelines to ensure a systematic and transparent process [17–19]. PubMed and Web of Science were used, with MeSH terms applied in PubMed to expand the search; the absence of these terms in Web of Science may have limited the number of retrieved studies. Inclusion and exclusion criteria were defined, refined after screening the first 100 studies, and consistently applied. Two authors independently screened titles and abstracts, resolving disagreements through discussion to minimize selection bias. Only English, peer-reviewed primary studies published between March 2010 and March 2025 were included. This may have excluded earlier research, grey literature, non-English studies, and English reviews covering non-English work. The language restriction may have introduced a geographical and cultural bias into the findings. However, we expect only a small percentage of the literature to be unavailable in English. Studies had to clearly define migrant populations and provide results specific to forcibly displaced people, which may have excluded research where refugees or internally displaced persons were not distinguished from voluntary migrants. Focusing solely on discrimination or barriers to healthcare access may have omitted broader studies of migrant experiences. As is standard in scoping reviews, no formal quality assessment was conducted; however, limiting inclusion to peer-reviewed studies ensured a baseline level of methodological quality.

Overall, this review highlights the scarcity of robust, comparable and context-specific data on healthcare discrimination as perceived by displaced populations in LMICs. Many of the most affected host countries are underrepresented, as are their populations. Nevertheless, it provides valuable insights into the existing evidence, suggesting that perceived discrimination in medical settings poses a significant barrier to refugees receiving high-quality healthcare. This evidence can be used to generate hypotheses for future studies and allows authors to take on a mixed-method approach to examine the prevalence, circumstances and impacts of discrimination on health outcomes and health seeking behavior. To improve access to and the quality of care for migrants, future research findings should be incorporated in national policies, guidelines and intervention programs that promote inclusion and equality in healthcare. Meanwhile, efforts should focus on strengthening health systems, enhancing intercultural competencies and advancing inclusive policies that ensure respectful, high-quality care for forcibly displaced populations and other migrants.