How Africa’s internal migrants remain invisible to health systems

When Grace Nakato* (name changed) crossed from Uganda into Kenya two years ago, she was following a job lead in Nairobi’s wholesale district. She arrived with her young son, who had been treated for asthma at a clinic in Kampala. The clinic had his records, but she did not think to ask for a copy.

Within months of arriving, the boy had an attack and Grace took him to a nearby public facility. But when staff asked for documentation, she did not have any. 

‘Nobody told me to carry the records,’ she told FairPlanet. ‘When we moved, I packed clothes and the things we needed. I did not think about medical files.’

She had no local health record and no registration that health workers could access. The boy was stabilised, but the treatment plan his Kampala clinic had started was never resumed.

Grace spoke to FairPlanet in Nairobi. Her experience reflects what health workers in many parts of Africa describe as a pattern.

Eric Tuisenge, a Burundian living in Naivasha in Kenya’s Rift Valley, told FairPlanet he has no formal documents but has managed to access care at local health facilities. Each visit, however, starts from scratch. ‘There is nothing about me in any system,’ he said. 

A Continent That Moves

Despite persistent assumptions about where Africans migrate, approximately 80 per cent of African international migrants remain within the continent. Many move to neighbouring countries, often leaving behind medical records and treatment histories that are difficult to retrieve.

Kenya’s Ministry of Health had not responded to questions sent by FairPlanet on access to healthcare for migrants, continuity of care across borders, and services for undocumented patients at the time of filing.

In 2024 alone, sub-Saharan Africa recorded 19.3 million new internal displacements. This counts displacement events, not individuals, so one person forced to move twice is counted twice. That figure does not include the much larger number of people who move voluntarily for work, family, or education, many of whom face similar barriers when seeking healthcare. 

Sudanese refugees in Chad received just 14 per cent of the resources needed in 2024, notes Think Global Health, a shortfall that has deepened as the United States and other donors pull back.

A commentary published in the Journal of Public Health in Africa in February 2026 by researchers at Boston University and the Stellenbosch Institute for Advanced Study described public health challenges along migration corridors, including interrupted chronic disease treatment and difficulties accessing healthcare in transit and destination countries. The authors called for new approaches to how migrants are counted and served. A companion piece published in The Lancet Regional Health – Africa in March 2026 argued that addressing these issues would improve migrant health while strengthening preparedness in host countries as mobility patterns continue to change.

Invisible on Arrival

At Kakuma in Kenya’s Turkana County, which borders South Sudan to the north, Ethiopia to the northeast, and Uganda to the west, community health promoter (CHP) Kelvin Benard works daily with populations whose legal status can determine whether they access healthcare. A CHP is a trained frontline health worker who conducts household visits, provides basic health education and helps connect vulnerable populations to healthcare services.

‘I have seen the challenge myself,’ he told FairPlanet. ‘For most of the people I serve, they are usually new in the area and unfamiliar with the systems. Access to health becomes difficult particularly for new people.’

Benard noted that the documentation barrier is often the first obstacle. ‘Without the relevant documents and if the person has not been formally registered, the person cannot access health services,’ he said.

New arrivals in Turkana move frequently along regional migration routes, often before formal registration processes are completed.

What Researchers are Calling It

The research frames these barriers as extending beyond administrative delays. Prof Adams Bodomo, Chair of African Linguistics and Literatures at the University of Vienna, has coined the term ‘medico-Afrophobia’ – a form of exclusion rooted in structural and social barriers that he argues resembles discrimination faced by African migrants elsewhere.

‘These barriers include discrimination against migrants within national healthcare systems based on nationality, language barriers, and the fear among undocumented migrants of being identified and harassed by authorities and xenophobic members of the host population,’ he explained to FairPlanet.

Bodomo argues that community action can help address some of these barriers.

‘Migrant community leaders and local advocacy groups should undertake sustained initiatives to encourage governments to extend healthcare access to both documented and undocumented migrants within host countries. Diseases know no boundaries and can only be contained through healthcare policies that eschew medico-Afrophobia and promote equal access to healthcare for both citizens and migrants.’

The Economic Trap

The challenges are also felt by migrants who have moved in search of work. Prof Mary Boatemaa Setrana, Professor of Migration and Social Change and Director of the Centre for Migration Studies at the University of Ghana, notes that healthcare services are often organised around facilities that many migrants struggle to visit during working hours.

‘Restricting healthcare delivery primarily to clinics and hospitals places some internal migrants – many of whom have migrated for economic reasons and are focused on earning a livelihood – at a disadvantage,’ she said.

Setrana points to two practical remedies: scheduled outreach in places where migrants work and live, and subsidised healthcare costs. 

‘A useful example can be drawn from Ghana’s National Health Insurance Scheme, which helps reduce out-of-pocket medical expenses and can improve access to formal healthcare services.’

What an Ideal Fix Would Look Like

The Lancet paper identifies the lack of interoperable health records as another challenge. The authors argue that continuity of care across migration corridors requires communication between providers at the local, district, national, and regional levels. The paper cites the integration of UNHCR’s Refugee Health Information System into Uganda’s national health management information system as one example that could inform similar efforts elsewhere.

On the ground, Kelvin Benard’s work highlights the role of community outreach.

‘The solution is to go to where these people are,’ he said. ‘Before they come to the facility, we go to them.’

That approach has limits, however, as it depends on available resources and sustained support. Community outreach can help people access care, but the broader policy issues identified in the research would still need to be addressed. For Setrana, the solution must start with better data. ‘Addressing this challenge requires migration-sensitive healthcare policies, improved data on mobile people, and adequate investment in community-based outreach services that bring healthcare closer to where migrants live and work,’ she said.