Europe is living through a moment that is, by any historical measure, extraordinary. Between 2015 and 2023, close to seven million people lodged a first-time asylum application somewhere in the European Union, with 2023 alone accounting for over a million of them. Alongside this, more than four million Ukrainians registered for Temporary Protection after Russia’s invasion — a status the Council has now extended to March 2027. In May 2024, the EU responded with the Pact on Migration and Asylum, the most significant overhaul of European migration governance in a generation, asking Member States to act in solidarity at a scale never previously attempted.
Ambition on that scale needs evidence to match it. And that is precisely where Europe’s systems are falling short.
A health crisis hiding in plain sight
Start with a single, sobering statistic. Across 2014–2023, migrants accounted for nearly 46% of all HIV diagnoses in the EU and European Economic Area, even though they make up a much smaller share of the overall population. The most recent surveillance data, published in late 2025 by the European Centre for Disease Prevention and Control and WHO Europe, shows that in 2024 migrants accounted for more than half of all new HIV diagnoses in the region. Roughly half of those diagnoses came late — well past the point where treatment is most effective — meaning the EU’s own target of fewer than 20% late diagnoses by 2025 was missed by a wide margin.
What makes this picture particularly urgent is that a meaningful share of these infections are not “imported.” A growing body of evidence from multiple Member States shows that many migrants acquire HIV after they arrive in Europe, not before. In other words, this is not a story about where people came from. It is a story about what happens — or fails to happen — once they are here: whether they are offered a test, whether they know where to get one, whether they feel safe enough to ask.
These figures do not exist in isolation. They are symptoms of a deeper structural problem: migrants across the EU consistently report not knowing the health system well enough to use it. In Sweden, for example, almost a quarter of migrant youth who avoided seeking sexual and reproductive healthcare said the reason was simple — they did not know the system existed or how to access it. Among migrant women living with HIV surveyed across nine EU countries, six in ten were diagnosed late despite having used health services before. The barrier, in other words, usually is not a lack of healthcare. It is a lack of navigable, trustworthy access to the healthcare that already exists.
One person, many overlapping barriers
Anyone who has worked in migrant support services will recognise a pattern that population-level statistics often miss: vulnerabilities rarely travel alone. A woman with insecure residence status may also lack access to interpretation, live in temporary housing with no privacy, fear that visiting a clinic could trigger an immigration check, and worry about her children’s school place all at the same time. She does not experience these as five separate problems to be solved by five separate services. She experiences them as one compounding, mutually reinforcing situation.
Researchers call this lens “intersectionality” — the recognition that age, gender, legal status, disability, and economic position do not simply add up, but interact to produce outcomes that none of them would produce alone. It is not a new idea in academic terms, but it remains strikingly absent from how European institutions actually collect data and design policy. Health systems track health. Housing authorities track housing. Labour ministries track employment. Almost nobody is set up to see the whole person, and the gaps between these systems are exactly where people fall through.
The same fragmentation appears at the level of national data. EU countries currently define “migrant,” collect health data, and measure outcomes in incompatible ways. This is not a minor technical inconvenience — it means nobody can currently say, with EU-wide confidence, which interventions for migrant health and integration actually work, for whom, and under what conditions. Policymakers are being asked to act at a continental scale on the strength of evidence that barely holds together at the national one.
Integration is not a checkbox
The same problem reappears in how Europe measures integration more broadly. Most national and EU evaluation frameworks track easily countable outcomes: whether someone found a job within two years, whether a language course was completed, whether a family was housed. These numbers matter, but they capture administrative tidiness, not lived reality.
Integration researchers have long argued — and recent EU-wide benchmarking confirms — that integration is a long, uneven, biographical process, not a milestone to be ticked off. The quality of someone’s very first weeks in a new country — whether their qualifications were recognised, whether they were treated as a contributor or a burden, whether they were met with patience or suspicion — appears to leave a durable mark on how their life unfolds for years afterward. Yet almost none of Europe’s current monitoring captures this. The most recent cross-national integration index, covering all 27 Member States, puts the EU average policy score at just 54 out of 100, with persistent and in places widening gaps between the strongest and weakest performing countries. Mental health and psychosocial wellbeing — despite mounting evidence of how central they are to whether someone truly settles — remain among the least monitored dimensions of integration anywhere in the EU.
Cross-border comparisons make the unevenness starker still. A 2024 review of services for women fleeing Ukraine found dramatic variation in access to emergency contraception, STI care, abortion services, interpreters, and mental health support — even though every one of these women held the identical legal status of Temporary Protection. Legal entitlement, in practice, is not the same thing as actual access. What a person can get in the Netherlands, they may simply not be able to get in Cyprus, Romania, or Hungary — not because the law says so, but because the systems behind the law were never built to deliver it equally.
Why this matters for Europe specifically
It would be easy to read all of this as a set of national problems that happen to be occurring inside the same political union. It is not. Migration, by its nature, crosses borders — and so do its consequences. A health data gap in one Member State limits what every other Member State can learn. An integration failure in one country produces ripple effects across EU labour markets, social cohesion, and the credibility of the Union’s own commitments to solidarity.
The EU has, in fact, just built much of the legal architecture this evidence gap needs to fill. The European Health Data Space Regulation, in force since March 2025, creates for the first time a common EU framework for sharing health data safely and consistently across borders. The Pact on Migration and Asylum’s own implementation plan explicitly calls for “tailored policy recommendations that uphold human rights and enhance practical implementation” — an admission, in effect, that good intentions are not self-executing. The EU’s own mid-term review of its Action Plan on Integration and Inclusion, published in mid-2025, concluded plainly that progress remains uneven and the evidence base too thin, particularly when it comes to health outcomes and the long-term impact of local integration services.
In other words, the legal and political will increasingly exists. What is missing is the comparative, cross-country, intersectional evidence that would let that will translate into services that actually reach the people they are meant to serve — consistently, regardless of which Member State someone happens to have arrived in.
Why this matters to us
This is the gap that STANDOutEdu, together with partners across the European research and civil society landscape, is working to help close. Understanding how migration, health, and integration interact — not as three separate fields but as one lived reality — sits at the heart of our long-standing engagement with EU-funded research and capacity-building. The questions are not abstract. They concern whether a woman with insecure legal status feels safe enough to get tested for a treatable condition; whether a young person’s school years are shaped by inclusion or invisibility; whether the systems built in Brussels actually function the same way in Nicosia as they do in Amsterdam.
Europe does not lack the ambition to build a fairer migration and integration system. What it has lacked, until now, is the evidence base sturdy enough to carry that ambition across all 27 Member States, for all the people the Pact is meant to serve. Building that evidence — rigorously, comparatively, and with migrants themselves as partners rather than subjects — is some of the most consequential work European research can do right now.
References
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Menalaos Lambis
Proposal Writing Coordinator
