Determinants of health among Ukrainian refugees in Germany: comparison with other refugee groups

Abstract Background 6.5 million Ukrainian refugees have been displaced globally since 2022, with 1 million seeking asylum in Germany. Little is known about the health determinants for this group, limiting the evidence base for policy intervention. Methods We use a nationally representative survey of adult Ukrainian refugees in Germany (IAB-BiB/FReDA-BAMF-SOEP study; n = 5943), conducted in 2023, to analyse the effect of sociodemographic, pre-migration (experienced war intensity, traumatic experiences) and post-migration factors (time since arrival, accommodation, social networks) on self-rated health using multiple logistic regression. We contrast these findings with estimates of identical models obtained from a subset of the IAB-BAMF-SOEP-sample of non-Ukrainian refugees within one year of arrival (n = 1195). Results In the Ukrainian sample, post-migration factors are particularly critical for health, with those experiencing discrimination (OR 1.83; 95%CI: 1.51,2.21) and social isolation (OR: 2.70; 95%CI: 2.23, 3.28) affected by ill health, while those with high German proficiency (OR 0.34; 95%CI: 0.18, 0.64) and contact with Germans (OR: 0.66; 95%CI: 0.53,0.83) are protected. Pre-migration factors do not affect self-rated health. Among refugees from other countries of origin, post-migration factors are not associated with health within the first year of arrival, with exception of social isolation (OR: 2.03; 95%CI: 1.32,3.13). Discussion Despite the EU Temporary Protection Directive, the health of Ukrainian refugees in Germany is shaped by adverse post-migration circumstances. While other refugee groups may have had riskier escape journeys and worse arrival conditions, this is unrelated to self-rated health in the first year. This underscores the importance of considering pre-migration contexts when evaluating subjective health. Outreach services, communication campaigns and the expansion of medical interpreting services are needed to ensure access to the health system. Key messages • Despite the EU Temporary Protection Directive, the health of Ukrainian refugees in Germany is shaped by adverse post-migration circumstances. • Outreach services, communication campaigns and the expansion of medical interpreting services are needed to ensure access to the health system.