Barriers and facilitators to healthcare access for migrants in Morocco: A narrative review

Abstract

Background

International migration has increased significantly in recent decades, creating major challenges for health systems, particularly in transit and destination countries such as Morocco. Migrants, often living in precarious socio-economic conditions, face multiple obstacles to healthcare access, which heightens their vulnerability. This narrative review aims to identify the main barriers and facilitators to healthcare access for migrants in Morocco, using Levesque's conceptual framework.

Methods

A literature search was conducted in PubMed, Web of Science, Scopus and Google Scholar, as well as in institutional sources (WHO, IOM, UNHCR, HCP). Relevant publications published between 2013 and 2025 in French or English were critically reviewed. The analysis was structured according to the five dimensions of Levesque's framework: accessibility, acceptability, availability, affordability and appropriateness.

Results

Twenty-two publications were included. Findings reveal that migrants in Morocco face economic, geographical, linguistic, sociocultural, administrative and structural barriers. Financial constraints, lack of health coverage, and regional disparities are among the most significant obstacles. However, several facilitators were also identified, including NGO initiatives, community-based support, and inclusive public policies.

Conclusion

Migrant access to healthcare in Morocco remains shaped by complex and multidimensional challenges. Despite notable progress, greater coordination, sustainability, and cultural sensitivity are required to ensure equitable and universal access to healthcare for all migrants, regardless of legal or economic status.

Introduction

Currently, nearly one billion people worldwide are migrants, representing approximately one in eight people [1]. In 2022, according to the World Health Organisation (WHO), this included 281 million international migrants and 82.4 million forcibly displaced people: 48 million internally displaced persons, 26.4 million refugees and 4.1 million asylum seekers [2], [3]. In addition, according to the United Nations High Commissioner for Refugees (UNHCR), it is estimated that at least 4.4 million people in 95 countries are stateless or without defined nationality [4]. This growing migration poses unique challenges to health systems, particularly in countries that serve as both transit points and destinations.

Migrants often come from difficult social, political and economic backgrounds [5]. In addition, this population is subject to a number of human rights violations, health and welfare issues, and economic difficulties during the migration process or in the host country [5]. Refugees and migrants are among the most vulnerable people in society, often facing xenophobia, discrimination, poor living conditions with limited access to housing and work, and inadequate access to health services, despite frequent physical and mental health problems [1]. The North African coastline has become a gateway of hope for thousands of migrants, often fleeing poverty or conflict. These migrants dream of a better life in Europe and do not hesitate to risk their lives by crossing two major routes: the central Mediterranean route (mainly from Libya and Tunisia to Italy) and the western Mediterranean route (mainly from Morocco and Algeria to Spain) [6].

Morocco is the African country closest to Europe, located in the Strait of Gibraltar. Thanks to this strategic geographical position, it has become an important migration corridor in the Mediterranean, as well as a transit and destination country for a growing number of migrants, particularly those from countries in the southern hemisphere [7]. On the margins of society, irregular migrants are particularly vulnerable, living in fear of arrest, violence, exploitation and deportation [8]. In 2021, the High Commission for Planning (HCP) conducted a survey on migration and estimated that 8.3% of migrants were not participating in professional activities due to health problems [9]. In addition, 27% of them were living with chronic illnesses, while 31.9% of these migrant women were able to access sexual and reproductive healthcare during the COVID-19 pandemic [9].

In 2013, the Ministry of Health, in collaboration with the International Organisation for Migration (IOM), developed the National Strategic Plan for Health and Immigration (PSNSI). This plan serves as a reference framework for all actors involved in improving access to health promotion services and medical care for vulnerable immigrants, ensuring that their human rights are respected [10]. This policy also highlighted key objectives such as guaranteeing education, access to healthcare and the integration of migrants into the labour market [11]. It has promoted the creation of new laws aimed at improving the integration of migrants into Moroccan society and providing them with better access to public services. For example, hospital regulations stipulate that: (Art. 57) « Non-Moroccan patients or injured persons shall be admitted, regardless of their status, under the same conditions as nationals. The terms and conditions for billing for services provided to them must be the same, except in cases where there are healthcare agreements between Morocco and the country of which the patient is a national » [12]. As a result, migrants, whether they are in a regular or irregular situation, have free access to services offered by a vast network of 2700 primary health care facilities, including 751 in urban areas and 1938 in rural areas [11]. Migrants also benefit from national health programmes implemented by the Ministry of Health, such as family planning, maternal and child health, and reproductive health care [13].

Since 2013, Morocco has implemented several policy reforms aimed at improving migrants' access to healthcare. Following the publication of the National Human Rights Council (CNDH) report on migration and human rights and the subsequent Royal Cabinet endorsement [14], [15], migrants' right to health has been formally recognized. Since 2015, partnerships between key governmental ministries have sought to extend basic medical coverage to regularised migrants and refugees, aligning access to healthcare services with schemes for economically disadvantaged populations and reinforcing the National Immigration and Asylum Strategy (SNIA) [10]. In this context, primary healthcare, education, and social and humanitarian assistance are considered fundamental rights accessible to migrants regardless of legal status [10]. The National Strategic Plan for Health and Immigration (PSNSI 2021–2025), developed by the Ministry of Health and Social Protection, provides a national framework to coordinate actions addressing migrants' health and social protection needs and to reduce vulnerability [10].

Despite these efforts, migrants in Morocco still face difficulties accessing health services [16]. Available evidence indicates that these barriers are particularly pronounced in the area of sexual and reproductive health, especially among migrant women. Limited access to family planning, maternal health services, and care related to gender-based violence has been documented, mainly due to financial constraints, lack of information, sociocultural norms, stigma, and administrative barriers [17]. These challenges were further exacerbated during the COVID-19 pandemic, which disproportionately affected migrants' access to essential sexual and reproductive health services [1].

Accordingly, this review examines access to healthcare services among migrants in Morocco in a comprehensive manner, while placing particular emphasis on sexual and reproductive health, as this domain consistently emerges in the literature as an area where barriers are most pronounced.

Materials and methods

This narrative review was chosen because it allows for a contextual, thematic, and integrative synthesis of heterogeneous sources, including both scientific articles and institutional reports, which are particularly important in the Moroccan context. It is based on a critical and interpretative analysis of scientific and institutional literature dealing with access to healthcare for migrants in Morocco. The objective is to identify the main barriers and facilitators reported in recent literature, favouring a thematic and contextual approach.

A literature review was conducted in several major electronic databases (PubMed, Web of Science, Scopus, Google Scholar) and complemented with institutional sources (HCP, WHO, IOM, UNHCR). Keywords and Boolean operators combined terms such as “migrants”, “refugees”, “access to healthcare”, “health equity”, “Morocco”, and their equivalents in French.

The selection of sources focused on publications that appeared between 2013 and 2025, in English and French. This period was chosen to cover more than a decade marked by:

• -The rise in migration flows in North Africa;
• -Changes in Moroccan public policy on immigration and asylum, particularly following the implementation of the National Immigration and Asylum Strategy in 2013;
• -The specific impacts of recent crises, such as the COVID-19 pandemic, on migrants' access to healthcare.

The studies were selected based on their thematic relevance, in order to illustrate the specific issues surrounding access to healthcare in the Moroccan context. The types of studies selected included quantitative surveys, qualitative studies, mixed analyses, review articles, institutional reports and dissertations. Comments, editorials, and documents without full text were excluded. These studies provide additional insights into the economic, administrative, sociocultural, geographical, and structural determinants of access to healthcare services.

The term “methodological plurality” refers to the inclusion of quantitative, qualitative, mixed-methods studies, and institutional reports within the narrative synthesis. Statistical patterns were identified through the synthesis of quantitative findings reported in surveys and analytical studies, such as prevalence estimates, utilization rates, and documented associations related to healthcare access. Lived experiences were captured through qualitative studies describing migrants' perceptions, practices, and interactions with healthcare services. Rather than aggregating data, this secondary synthesis integrated these complementary forms of evidence to provide a multidimensional interpretation of access to healthcare in the Moroccan migrant context.

Following study selection, a narrative synthesis was conducted to integrate findings across heterogeneous sources. The synthesis followed an iterative process consisting of: (1) familiarization with the included studies; (2) identification of recurrent barriers and facilitators related to healthcare access; (3) thematic grouping of findings using Levesque's conceptual framework as an analytical guide; and (4) interpretive comparison of patterns and divergences across study types, populations, and contexts. This approach allowed the authors to generate an integrated and context-sensitive interpretation of the literature, while acknowledging the descriptive and non-quantitative nature of a narrative review.

In this review, the term “migrants” is used as a broad category encompassing diverse populations, including labour migrants, undocumented migrants, and asylum seekers, depending on the definitions adopted in the included studies. The term “refugees” refers specifically to individuals formally recognized under international or national protection frameworks, as defined by the respective sources. Several studies explicitly addressed legal and administrative status, highlighting that irregular or undocumented status constitutes a key determinant of healthcare access, particularly through its interaction with administrative barriers, fear of exclusion, and reliance on non-governmental organizations. However, not all studies systematically disaggregated findings by legal status, which limits direct comparison across populations.

To structure and guide the analysis, the review draws on the conceptual framework developed by Levesque et al. (2013) (See Fig. 1) [18], [19], which conceptualizes access to healthcare through five interrelated dimensions: approachability, acceptability, availability and accommodation, affordability, and appropriateness. This framework was used as an analytical grid to organize and interpret the barriers and facilitators to healthcare access reported in the included studies. Table 1 and Fig. 1 consistently apply these five dimensions throughout the analysis.

Fig. 1.

Lévesque's conceptual framework for access to healthcare (2013) [18].

The framework illustrates five dimensions of accessibility (approachability, acceptability, availability and accommodation, affordability, appropriateness) and the corresponding abilities of patients (to perceive, to seek, to reach, to pay, and to engage).

Table 1.

The five dimensions of Lévesque's conceptual framework.

Dimension	Definition	Considerations
Approachability	Availability of contactable services	Adequate provision of services, goods and facilities, including types of services and sufficient qualified human resources
Acceptability	Cultural and social acceptance of services	Ethical standards and the appropriateness of services, goods and facilities to address cultural and gender differences and life cycle requirements; improve outcomes; and ensure confidentiality, effective communication and enabling attitudes.
Availability and accommodation	Obtaining services on time	Proximity, transport options and journey times
Affordability	Financial capacity required to use the services	Direct and indirect costs of accessing healthcare
Appropriateness	Matching between services needed and services received	Organisation of services, including the quality of facilities and the satisfaction of user expectations

We have identified five key dimensions of service accessibility, illustrated in the upper part of Fig. 1 approachability, acceptability, availability and accommodation, affordability, and appropriateness. These dimensions interact with five individual capacities that determine access: the capacity to perceive, seek, reach, pay, and engage [20].

To operationalize the conceptual framework proposed by Levesque et al., the five dimensions of access to healthcare, approachability, acceptability, availability and accommodation, affordability, and appropriateness were used as an analytical grid throughout the narrative synthesis. During data extraction and analysis, barriers and facilitators reported in the included studies were systematically mapped onto these dimensions. This process allowed for a structured and comparable interpretation of heterogeneous evidence derived from quantitative studies, qualitative research, institutional reports, and reviews. The distribution of findings across the five dimensions was examined to identify which aspects of access were most frequently addressed in the literature and which were less consistently documented.

This approach allows for a contextual and thematic interpretation of the main trends identified in the literature.

Results

Following the screening of publications identified from multiple electronic databases and institutional sources, and after application of the inclusion and exclusion criteria, a total of twenty-two publications published between 2013 and 2025 were retained for the final analysis. These studies are characterised by methodological diversity, reflecting the growing interest in access to healthcare for migrants in Morocco. The corpus includes:

• -Five quantitative surveys, including cross-sectional and analytical studies (n = 5) [21], [22], [23], [24], [25];
• -Nine qualitative studies exploring migrants' perceptions, practices and experiences (n = 9) [26], [27], [28], [29], [30], [31], [32], [33], [34];
• -Three mixed approaches combining qualitative and quantitative methods (n = 3) [35], [36], [37];
• -Three institutional reports (HCP, national surveys, Covid-19 surveys) (n = 3) [35], [38], [39];
• -One review article (including a narrative review) (n = 1) [40];
• -One academic thesis (master's thesis) (n = 1) [16].

The populations studied were diverse: sub-Saharan migrants, refugees, migrant women, migrant children and, in some studies, healthcare professionals. This plurality of sources and perspectives provides a multidimensional and contextualised view of migrants' access to healthcare in Morocco, combining institutional, academic and community findings.

The topics covered include access to healthcare and vaccination coverage, sexual and reproductive health, gender-based violence, the impact of health crises (COVID-19), sociocultural and structural determinants, and the role of Non-Governmental Organisation (NGOs) and public policy. Some publications highlight the increased vulnerability of migrant women to gender norms and violence. Others highlight the limitations of funding and the persistence of inequalities despite inclusive policies. Finally, qualitative and participatory studies emphasise the central role of NGOs and community networks and the importance of training healthcare professionals to reduce discrimination and improve care. Table 2 summarises the publications included in this review, highlighting their methodological diversity, the contexts studied and the main results reported.

Table 2.

Overview of studies and reports included in the narrative review on healthcare access for migrants in Morocco (2013–2025).

Title	Author's name	Year of publication	Type of study/publication	Population / context	Key findings
Access to healthcare for sub-Saharan migrants in Morocco: A situation analysis in the context of the implementation of the Casablanca-Settat PSRSI	Boughnisa A.	2018	Final thesis (Master)	Sub-Saharan migrants Casablanca-Settat	Lack of institutional coordination; facilitating NGOs.
Barriers to accessing sexual and reproductive health services for migrant women in eastern Morocco	Belouali J. et al.	2025	A quantitative analytical study	Migrant women (Eastern Morocco)	Gender norms, stigmatisation; lack of information; facilitating NGOs.
Health coverage for migrants in Morocco	El Berri H.	2018	Institutional presentation / policy briefing	Migrant in Morocco	Theoretical access guaranteed, but uneven implementation; administrative barriers.
Immunization coverage and predictive factors for non-completion of immunization among migrant children under 5 years old, Casablanca – Morocco	Toirambe SE. et al.	2021	Cross-sectional study	Migrant children Casablanca	Economic, administrative and linguistic barriers; lack of parental education.
Gender norms and access to sexual and reproductive health services among women in the Marrakech-Safi region of Morocco: a qualitative study	Ouahid H. et al.	2023	Qualitative study	Migrant women	Gender norms; stigmatisation; lack of use of preventive services.
Enquête sur l'impact du Covid-19 sur la situation socio-économique et psychologique des réfugiés au Maroc	HCP	2020	Institutional report	Refugees in Morocco	Limited access to healthcare during the pandemic; worsening socioeconomic conditions.
La migration internationale au maroc: résultats de l'enquête nationale sur la migration internationale 2018–2019	HCP	2020	National population-based survey	Migrant in Morocco	Persistent inequalities in access; difficulties in regularisation.
Health and Sub-Saharan Migrants in Morocco: Recent Changes and Future Trends in Healthcare Access and Immigration Policy	Doppelt S.	2013	Qualitative policy analysis	Migrant in Morocco	Structural and policy barriers; policy recommendations.
Improving access and utilization of sexual and reproductive health services by migrant women in Morocco: A qualitative study	Amaghdour C. et al.	2025	Qualitative study	Migrant women	Stigmatisation, taboos; facilitating NGOs; increased need for support.
Interactions et transactions identitaires d'immigrés noirs dans l'espace public et les centres de santé au Maroc	Delescluse A.	2023	Qualitative study	Sub-Saharan migrants	Racial discrimination; language barriers; social isolation.
La lutte contre le sida au Maroc: opportunités et limites pour l'accès aux soins des personnes en migration	Fidelin C.	2021	Qualitative study	Migrant in Morocco)	Stigmatisation, lack of resources; major role played by associations.
Les déterminants socioculturels d'accès à la santé des personnes migrantes au Maroc	Haince MC. et al.	2021	Qualitative study	Migrant in Morocco	Language barriers, discrimination, stigmatisation; community solidarity.
Migrant healthcare access in Morocco: A narrative review	El Bouri H, Najdi A.	2025	Narrative review	Migrant in Morocco	Overall analysis; persistent inequalities; inadequate public policies.
Migrant Women in Morocco: Improving Sexual Health and Tackling Gender-based Violence	Khalis M. et al.	20,023	Mixed-methods study	Migrant women	Increased vulnerabilities; gender-based violence; facilitating
Migrants and refugees' health financing in Morocco: How much is the hidden contribution of the government through free services?	Akhnif EH. et al.	2024	Health economics analysis	Migrants and refugees	‘Hidden contribution’ via indirect expenditure; insufficient free services.
L'accès aux soins des immigrants subsahariens au Maroc: Cas de la ville de Marrakech	Lotfi R.	2025	Mixed-methods study	Sub-Saharan migrants Marrakech	Economic, administrative and cultural difficulties.
Sexual and reproductive health and gender-based violence among female migrants in Morocco: a cross sectional survey	Acharai L. et al.	2023	Cross-sectional study	Migrant women Morocco	High prevalence of GBV; financial and institutional barriers.
Sexual violence and sub-Saharan migrants in Morocco: a community-based participatory assessment using respondent driven sampling	Keygnaert I. et al.	2014	Participatory study (RDS)	Sub-Saharan migrants Morocco	Frequent sexual violence; cultural and social barriers to treatment.
Sub-Saharan Migrant Integration in Morocco: Oujda as a Case study	Bitari W.	2020	Case study	Migrants Oujda	Role of community networks; administrative difficulties.
The Current State of Migrant Health in Morocco: Pre-and Peri-COVID-19 Pandemic	Babahaji L.	2020	Mixed-methods study	Migrants Maroc	Reduced access during Covid-19; exacerbation of structural vulnerabilities.
The role of NGOs and associations in health care for migrants in North West Morocco	Koubri H. et al.	2021	Qualitative study	Migrants Nord-Ouest	NGOs offer free healthcare, cultural mediation and social support.
The role of the healthcare sector in the prevention of sexual violence against sub-Saharan transmigrants in Morocco: a study of knowledge, attitudes and practices of healthcare workers	van den Ameele S. et al.	2013	Qualitative study	Sub-Saharan migrants and healthcare professionals	Lack of staff training; need for awareness raising.

Barriers to accessing healthcare

Economic barriers appear to be the most consistent obstacle. Several institutional surveys and research studies confirm that the lack of social security coverage, the high cost of medical consultations, medicines and additional tests, as well as indirect costs related to transport, are major obstacles [21], [22], [38], [39]. Evidence indicates that, despite the theoretical free nature of certain public health services, migrants bear a “hidden contribution” due to uncovered expenses, particularly for medicines or specialised care [22]. Research on childhood vaccination [21] also highlights that economic constraints and a lack of educational resources among parents explain incomplete vaccination coverage among migrant children. Similarly, studies on sexual and reproductive health [23], [24], [26], [34], [36] emphasise that financial insecurity leads to a failure to use preventive services and delays in gynaecological and obstetric follow-up.

Administrative and legal barriers constitute a second major obstacle. Irregular status, lack of documentation, and complex administrative procedures continue to limit effective access to care [16], [27], [29], [38]. Although Morocco has established an inclusive legal framework through the SNIA and the PSNSI, the literature shows that the implementation of these policies remains uneven. In some institutions, migrants without residence permits still encounter implicit refusals of access to healthcare, despite regulations that guarantee theoretical equality [40].

Structural and geographical barriers reinforce these inequalities. The concentration of healthcare infrastructure in large cities, the shortage of human resources in rural areas, and geographical distance constitute additional obstacles [25], [33], [35], [37], [41]. Several case studies illustrate that migrants living in Oujda or Marrakech often have to travel long distances to access healthcare facilities, leading to delays in diagnosis and treatment [25], [35]. Furthermore, structural challenges are frequently compounded by limited coordination between local institutions and actors, which reduces the effectiveness of existing mechanisms [33], [41].

Language, sociocultural and gender barriers are particularly pronounced in qualitative studies. Lack of proficiency in Arabic or French makes communication with healthcare providers difficult, hinders understanding of medical prescriptions and complicates navigation of the healthcare system [27], [28], [29]. Racial discrimination and persistent stigmatisation are reported in several surveys, reinforcing migrants' mistrust of public institutions [27], [28]. Migrant women face additional obstacles, particularly in terms of sexual and reproductive health. Qualitative evidence indicates that shame, cultural taboos, and fear of moral judgment constitute major barriers to the use of gynaecological services [34]. Moreover, gender norms and social inequalities have been shown to limit the utilization of reproductive health services, particularly in eastern Morocco [23]. Finally, several studies highlight that sexual violence, fear of hostile reception, and lack of appropriate care further exacerbate the vulnerabilities of migrant women [26], [30].

Facilitators of access to healthcare

Despite these numerous barriers, several studies highlight factors that facilitate access to healthcare. NGOs and associations play a crucial role by offering free or subsidized healthcare, providing cultural mediation and interpreting services, and conducting awareness campaigns [28], [31], [35]. In some regions, these actors extend their support beyond medical care by assisting migrants with administrative procedures and social services [31]. In addition, community-based organizations involved in HIV prevention have been shown to provide safe and trusted spaces for migrants who are excluded from the public health system [28].

Public policies are also a facilitating factor. The SNIA (2013) and the PSNSI (2021–2025) have enabled migrants to be formally integrated into national health programmes [16], [38], [39], [40]. Nevertheless, the literature indicates that their implementation remains uneven across regions, and their overall impact is constrained by persistent structural limitations and social representations.

Finally, community networks play an important role. Some qualitative studies reveal that solidarity among migrants promotes information sharing, referral to structures considered more welcoming, and assistance with administrative procedures [25], [27], [29]. These networks, which are often informal, are an essential resource for overcoming a lack of knowledge about the Moroccan healthcare system.

All 22 studies converge on a clear conclusion: migrants' access to healthcare in Morocco remains limited by a range of interconnected obstacles, among which economic, administrative, structural, linguistic and socio-cultural constraints play a central role. Migrant women appear to be particularly vulnerable in the area of sexual and reproductive health, due to economic, cultural and gender-related barriers. NGO initiatives, inclusive public policies and community dynamics are important levers, but their scope remains limited in the face of persistent inequalities. A more integrated, coordinated and sensitive approach to the realities experienced by migrants is needed to move towards equitable and effective access to healthcare in Morocco.

Discussion

The findings of this narrative review highlight the persistence of multifaceted barriers that hinder equitable access to healthcare for migrants in Morocco, despite policies and initiatives intended to promote inclusion. The 22 publications included, covering the period from 2013 to 2025, converge on the idea that migrants face economic, administrative, structural, sociocultural and gender-related challenges that reduce their ability to access, utilize and benefit from healthcare services. These barriers echo the Levesque conceptual framework on access to healthcare, which emphasizes the interaction between health system characteristics and individuals' abilities to seek, reach and engage with care [20].

When analyzed using Levesque's framework, the reviewed literature shows that the five dimensions of access were not equally represented. Affordability, availability and accommodation, and acceptability were the most prominent dimensions, largely reflecting financial constraints, geographical barriers, and sociocultural factors such as stigma and gender norms, particularly in studies addressing sexual and reproductive health. By contrast, approachability and appropriateness were less explicitly examined and were often addressed indirectly through discussions on information, trust, or perceived quality of care. This uneven distribution reflects the thematic and methodological focus of the existing literature and highlights important gaps for future research.

Economic constraints emerged as a major limitation to healthcare access. Several studies reported that, even when services are officially free of charge in public facilities, “hidden costs” related to medicines, diagnostic tests or transportation represent a substantial burden for migrants with precarious incomes [21], [22]. These findings are consistent with evidence from sub-Saharan Africa, where low levels of health insurance coverage are associated with reduced utilization of antenatal, delivery, and postnatal services, and where out-of-pocket expenditure often results in delayed healthcare seeking and lower adherence to treatment [42]. The absence of formal health coverage for most migrants in Morocco therefore exacerbates socioeconomic inequalities and contributes to health inequities.

Administrative and legal status issues also represent recurrent barriers. Evidence shows that undocumented migrants often face implicit restrictions when attempting to access healthcare services, despite Morocco's commitments under the SNIA adopted in 2013 [38], [40]. Similar findings have been reported in other regions, including the European Union, where health policies are theoretically inclusive but inconsistently implemented in practice, leaving undocumented migrants facing significant barriers to healthcare access [43]. This gap between policy and practice undermines migrants' trust in the health system and reinforces their reliance on parallel structures, notably NGOs.

Geographical and structural factors further aggravate inequalities. The concentration of healthcare facilities in large urban centers, combined with shortages of qualified health professionals in peripheral regions, has been repeatedly highlighted [35], [41]. This uneven distribution generates regional disparities that particularly disadvantage migrants living in border cities or rural settings. Comparable findings have been reported in sub-Saharan Africa, where refugees and migrants in remote areas face increased risks of exclusion from essential healthcare [1].

Sociocultural and gender-related barriers deepen inequalities even further. Qualitative studies have shown that language difficulties, racial discrimination and stigma strongly reduce migrants' willingness to seek healthcare [27], [28]. These findings are consistent with studies in Europe and the Middle East, where migrants often cite discriminatory attitudes from healthcare providers as a major deterrent to access [44]. Migrant women appear particularly vulnerable, as several Moroccan studies focusing on sexual and reproductive health demonstrate [23], [24], [34]. Gender norms, cultural taboos and fear of moral judgment discourage women from attending reproductive health services, leading to delayed or foregone care. Moreover, sexual and gender-based violence is disproportionately prevalent among migrant women, further exacerbating their health vulnerabilities [26], [30].

This review also identifies several facilitators of access to healthcare. Civil society organizations, particularly NGOs, are recognized as essential actors in providing free or subsidized services, cultural mediation, psychosocial support and advocacy [31], [36]. These findings are consistent with international evidence showing that NGOs often bridge gaps in migrant healthcare where formal systems fall short [45]. Community solidarity networks also play an important role in orienting migrants, sharing information and facilitating navigation within the health system [25], [29]. At the institutional level, the SNIA and the more recent PSNSI represent important steps towards inclusivity, although their implementation remains uneven and their impact limited [16], [38], [40].

When examined through Levesque's conceptual framework, these facilitators primarily strengthen acceptability, affordability, and approachability. Through cultural mediation, psychosocial support, advocacy, and the provision of free or subsidized services, NGOs reduce sociocultural and financial barriers to healthcare access. These interventions are particularly evident in sexual and reproductive health, maternal care, HIV services, and support for survivors of gender-based violence, where they also enhance trust, information, and engagement with health services [31], [36].

Community-based networks complement formal health institutions by facilitating referrals to perceived accessible services, supporting administrative navigation, and disseminating information on available care. Through informal accompaniment, peer support, and trust-building; particularly for newly arrived migrants and women seeking sexual and reproductive health services; these networks help bridge gaps left by formal health systems and enhance migrants' ability to seek and reach care [25], [29].

While migration and health policies have formally improved migrant inclusion, their implementation remains uneven and highly dependent on local contexts, resulting in regionally variable access to healthcare. Although policy reforms between 2015 and 2018 temporarily enhanced access and visibility of migrant health issues, limited monitoring and follow-up have constrained the sustainability of these gains, highlighting the dual role of policy as both a facilitator and a barrier [16], [38], [40]. The strength of this review lies in its integration of diverse qualitative and quantitative sources, allowing a nuanced and contextual interpretation of migrant healthcare access in Morocco.

Beyond migrant-specific barriers, the reviewed literature points to broader structural dynamics that shape healthcare access in Morocco. Psychosocial strain among healthcare workers, particularly in peripheral or under-resourced settings, along with limited resources and high workloads, may affect the quality and continuity of care for both migrants and host populations. In addition, migrants' engagement with formal health services is influenced by pre-existing health-seeking practices, such as reliance on traditional or spiritual mediators, as well as by precarious living and working conditions and collective community experiences. Importantly, several constraints identified in this review, including geographical distance, service shortages, and administrative complexity, also affect Moroccan populations in rural or border areas, suggesting that many barriers are systemic rather than exclusively migration-related.

This narrative review has some limitations that should be acknowledged. First, despite efforts to identify a wide range of sources, the coverage of the literature remains partial and some relevant studies may not have been included. Second, as a narrative review, no systematic quality appraisal of the included studies was performed, which may limit the comparability of findings. Third, the heterogeneity of methodologies, populations and outcomes among the 22 studies introduces variability that makes generalizations cautious. Finally, the review was limited to publications in English and French, which may have led to language bias.

Despite these limitations, the implications of this review are clear. Reducing barriers to healthcare access for migrants in Morocco requires a multisectoral approach that strengthens coordination between public institutions, NGOs and community organizations. Policymakers should prioritize expanding financial protection mechanisms, ensuring that migrants are formally included in universal health coverage schemes. Efforts should also focus on reducing discrimination within health facilities by promoting cultural competence training for healthcare providers, particularly in sensitive areas such as sexual and reproductive health. Furthermore, decentralizing healthcare infrastructure and reinforcing services in peripheral and border areas would help mitigate geographical disparities.

Despite the growing body of literature on migrants' access to healthcare in Morocco, several evidence gaps remain. Future research should assess the effectiveness of cultural mediation and psychosocial support mechanisms in improving healthcare utilization, particularly in sexual and reproductive health services. Comparative studies examining access barriers among migrant and host populations in rural or border areas are also needed to distinguish migration-specific challenges from broader systemic constraints. In addition, the psychosocial well-being of healthcare workers serving migrant communities, especially in under-resourced settings, remains underexplored. Finally, longitudinal and policy-tracking studies are required to evaluate the implementation, sustainability, and outcomes of migration- and SRH-related reforms over time.

In conclusion, while progress has been made in recognizing migrants' right to health in Morocco, the persistence of economic, structural, administrative and sociocultural barriers continues to hinder equitable access. Building on the contributions of NGOs, community networks and existing inclusive policies, stronger political commitment and more consistent implementation of national strategies will be essential to move closer to universal health coverage. This review contributes to the growing body of literature emphasizing the need for context-sensitive, evidence-based policies to ensure that migrants, regardless of status, are not left behind in the pursuit of health equity.

Conclusion

This narrative review underscores the multifaceted barriers that migrants continue to face in accessing healthcare services in Morocco, particularly in the field of sexual and reproductive health. Using Levesque's conceptual framework, the findings highlight the central role of affordability, acceptability, availability, and migrants' ability to engage with the health system in shaping access to care. Persistent economic hardship, geographical inequalities, linguistic and administrative constraints, and structural limitations continue to hinder equitable healthcare access for this vulnerable population.

While civil society organizations, humanitarian associations, and inclusive national policies contribute to reducing some of these, their impact remains uneven and fragmented. Strengthening sexual and reproductive health service delivery for migrants requires concrete actions, including expanding financial protection mechanisms, integrating cultural mediation and psychosocial support within public health facilities, and improving service availability in peripheral and border areas. Enhanced intersectoral coordination between health authorities, social services, NGOs, and local actors is essential to ensure continuity of care and reduce fragmentation. In addition, sustained monitoring and evaluation mechanisms should be embedded within national health planning frameworks to track migrant inclusion and policy implementation over time. Advancing towards universal health coverage in Morocco will depend on ensuring that migrants, regardless of legal or socioeconomic status, are systematically included in long-term health system strengthening strategies.

Ethics/approval

This study is a narrative review based exclusively on published and publicly available data. Therefore, no ethics approval was required and no human participants were involved.

CRediT authorship contribution statement

Amaghdour Chaimaa: Writing – review & editing, Writing – original draft, Methodology, Conceptualization. Farhan Houssein Ali: Methodology. Belouali Radouane: Writing – review & editing, Supervision. Hassouni Kenza: Writing – review & editing, Supervision.

Funding

The funders played no role in the study design, data acquisition or interpretation, publication decisions, or writing of the manuscript.

Declaration of competing interest

The authors declare no conflict of interest.