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Including LGBTIQ+ migrants and refugees in the health system

This week, as Sydney hosted World Pride, politicians, lawyers, health professionals, and rights advocates attended a conference at the University of Western Sydney focussed on LGBTQ+ displacement and the meaning of migration and pride within our health system.

Queer Displacements is the first and only conference in the Asia Pacific which foregrounds protection and settlement challenges of lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ+) forcibly displaced people. The theme of this year’s conference is ‘Leadership, partnership and belonging’

The conference addressed some of the recent findings of a report from the Forcibly Displaced People Network which revealed high levels of discrimination, violence and exclusionary and negative experiences reported by LGBTIQA+ forcibly displaced people in Australia.

Below Dr Adele Murdolo, Executive Director of the Multicultural Centre for Women’s Health and MSI Australia’s Managing Director, Jamal Hakim, explain why and how our health systems needs to include LGBTIQ+ migrants and refugees, as both health consumers and health leaders.


Adele Murdolo and Jamal Hakim write: 

In Australia, many migrants spend years living precariously, often moving from one temporary visa to another. The average time is ten years before gaining permanent residency and before gaining Medicare access.

Everyday health discrimination is prevalent in Australia, particularly in an under-resourced health system. Displaced people in Australia face some of the most severe barriers to healthcare, which are compounded for those who are also LGBTIQ+.

The need for an LGBTIQ+ health strategy

Australia does not have an LGBTIQ+ health strategy. Trans and gender diverse people are required to fit into rigid biological models of health. Intersex people are almost invisible.

Existing policy frameworks instead integrate concepts of queerness and migration. The National Women’s Health and Men’s Health Strategies frame both LGBTIQ+ people and migrant and refugee people as ‘priority populations’.

Migrant and refugees in Australia are less likely to have access to evidence-based and culturally relevant information which will enable them to manage their own fertility, infection prevention and menstrual health. 

We need to act now if migrant and refugee LGBTIQ+ health is going to be a priority. 

Migrants and refugees face higher risks

Due to the impact of health system inequities, migrant and refugees are at higher risk of experiencing pregnancy-related conditions such as preeclampsia and gestational diabetes. They are more likely to experience perinatal mental health conditions, often linked to social isolation and socioeconomic or financial insecurity, compounded by migration-related stressors. 

They have lower levels of access to preventative health services. For example, migrant and refugee people have lower screening rates for breast and cervical screening. This is partially because their own health is often the last priority in a long list of priorities to survive.

In Australia, international students must have Overseas Student Health Cover (OSHC) for the duration of their stay. OSHC does not cover pregnancy-related conditions in the first 12 months of arrival in Australia unless the pregnancy is linked to an emergency situation. 

This means that if an international student, or the partner of an international student, experiences an unplanned pregnancy within the first 12 months of arrival, they may be faced with limited and sometimes expensive reproductive choices while simultaneously experiencing financial and settlement difficulties.

Systemic, structural and interpersonal barriers

Immigration policy, temporary and dependent visa status, visa-based exclusions in health and social policy, along with social isolation and economic insecurity from the settlement process can increase migrant and refugee people’s vulnerability to coercive practices and/or violence. The violence they endure may be more severe and prolonged and they often experience structural and interpersonal barriers to accessing support services. 

A health professional’s responses to a person’s health and wellbeing needs can vary greatly depending on their perceptions of the patient. Contexts of a precarious visa system, racism, transphobia and queerphobia are often missing in textbook descriptions of patient health care needs.

In a practical sense migrant doctors may be understanding on some issues, but it can be harder to talk about queer health issues. Likewise queer friendly doctors don’t necessarily have migrant community sensitivities.

Culturally responsive health often relies upon building the health literacy of patients or increasing the ‘cultural competency’ of health professionals. 

Thinking broader

We need to think broader. We need to move towards universal access to health.

We must extend Medicare to include all migrants irrespective of visa category. Australia should remove waiting and residency periods to health access, especially those directly linked to visa status and including those contained in the Overseas Student Health Cover deed. Alongside this we should remove prohibitive costs relating to visa processing fees, English language entry requirements and the recognition of overseas qualifications.

Extending Medicare is not an innovative solution, it is simply a necessary requirement for universal access for all people living in Australia. Anything else is creating a two-class health system.

Migrant refugee health should be a key priority in research and programs. This includes mapping information about migrant and refugee health needs, including gender, pronouns, sexuality and intersex status, preferred language, requirements for an interpreter or a bilingual worker. It requires collaborating with migrant organisations and leaders with the expertise and knowledge in this field.

Investing in workforce

We need to invest in our migrant and refugee LGBTIQ+ workforce. In Australia we need to think about how to centre health professionals of colour who are also connected within LGBTIQ+ communities. This requires ongoing investment to support and develop a bilingual, bicultural health workforce that is professionally recognised and appropriately remunerated. It also means increased support for migrant mental health services that are culturally safe and accessible.

Let’s translate our passion for international pride within our own communities, and reshape health systems that belong to all of us.

The Queer Displacements conference was held at the Western Sydney University on 22 and 23 February 2023. Queer Displacements is the first and only conference in the Asia Pacific designed to comprehensibly foreground the protection and settlement challenges of lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ+) forcibly displaced people.

Dr Adele Murdolo is the Executive Director of the Multicultural Centre for Women’s Health. She has a PhD in History and Women’s Studies and her research and publication areas include women’s health, violence against women and feminist history and activism in Australia. Adele is from an Italian migrant background. She is a passionate speaker and advocate for building the status of migrant and refugee women through research, practice and policy. For almost two decades as Executive Director of MCWH, Adele has provided strong leadership, expert advice and input into policy. You can follow Adele on Twitter.

Jamal Hakim is the Managing Director at MSI Australia. He holds two Bachelors in Commerce and Asian Studies from the ANU, and a Juris Doctor from RMIT. Jamal was born in Kuwait, and is of Lebanese heritage. He grew up in Ngunnawal country in a multicultural community, with personal experience of the impacts of health bias against people of colour. Having worked in complex environments throughout his career, Jamal aims to balance culture, commercial sustainability and mission. He currently holds several board appointments, including with Democracy in Colour and MS Health Pty Ltd. In 2020, Jamal was elected as a Councillor for the City of Melbourne. You can follow Jamal on Twitter.


See Croakey’s archive of articles on the health and wellbeing of asylum seekers and refugees

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