Immigrants in Estonia: whether the different cultural background is a basis of existing key barriers to medical and social services

The article is devoted to the migrants’ barriers to accessing and adhering to care, including stigma, and fear of discrimination at health services. The article specifically states that existed barriers should be considered in the provision of services. The authors’ purpose was to show the existing problems in the unequal access of migrants (especially Ukrainian) to services, as well as their possible connection with cultural and linguistic differences with the local population. The article presents results of the analysis of data obtained using twenty-two in-depth semi-structured interviews with representatives of different subgroups of migrants and three interviews with specialists working with migrants. The focus was on newly arrived migrants (in the last three years) to study how people are adapting in Estonia in the context of public health. Different groups of migrants were targeted for recruitment, including vulnerable populations (illegally working people, men having sex with men (MSM), people living with HIV). It has been also demonstrated that other migrants, non-governmental diaspora organizations and family members both in Estonia and abroad were mentioned to be the most important sources of support. Also, we show that regarding access to health services, several misconceptions and lack of information about what was available and who could access the services emerged as problematic issues. The article states, that main barriers for accessing health care was related to the status – illegal migrants and people with no residency permit had no access. Illegal migrants were also afraid of the consequences and loss of confidentiality in case of asking any medical help. Participants also reported similar problems with health care services as general Estonian population – long waiting lists, high prices (especially dental care), not attentive medical personnel. Language and cultural issues were mentioned several times – even in capital, Tallinn, had been difficult to find a doctor who was used to communicate with people with other cultural backgrounds. In conclusion, newcomers to Estonia highlighted the gaps in the Estonian health care system with which also local population is not satisfied with. But they also experienced unique issues related to their status. Education and information for the specialists working with migrants and asylum seekers in a variety of organizations should be provided. Information and educational programs for the migrants should be culturally appropriate and tailored to their needs. Reduction of stigma and enforcing human rights is essential to meet the needs of people. From public health perspective, it is necessary to provide basic health services to illegal undocumented migrants, including ensuring that they receive care for communicable diseases as early as possible.