Anuj Kapilashrami

Purpose: Migration in South Asia is shaped by diverse drivers such as economic needs, conflict, persecution, natural disasters and sociocultural factors. Migrants across typologies are vulnerable to mental health challenges. However, research in this domain remains fragmented. This scoping review aims to synthesize existing literature on migrant mental health in South Asia and map key trends, identify research gaps and draw implications for future research, policy and practice. Design/methodology/approach: A systematic search of peer-reviewed literature was conducted across databases including Scopus, Web of Science and PsycINFO. Studies using both qualitative and quantitative methods were included. Data extraction and thematic synthesis was conducted to analyse study characteristics, research methodologies, mental health outcomes and associated risk and protective factors. Findings: Eighty studies met the inclusion criteria, with nearly half published since 2020. Most were cross-sectional and concentrated in India, Bangladesh and Nepal. Commonly studied mental health issues included depression, anxiety and post-traumatic stress disorder – particularly among refugees, internally displaced persons and labour migrants. Risk factors included violence and trauma, economic hardship, social isolation and perceived discrimination; while protective factors such as family support, cultural practices and community resilience were highlighted, though resilience was often conceptualised narrowly as an individual trait. Research on queer and transgender migrants, children, older adults and help-seeking behaviours was notably absent. Originality/value: This review underscores that while the burden of poor mental health among migrants in South Asia is significant, research priorities vary based on the migrant typology. Significant research gaps persist, including limited longitudinal studies and participatory research methods. Pathways to migrant mental health and wellbeing and intersectional analyses of mental health precarity are also unexplored. Future work should consider dimensions of precarity among migrants in the region to better understand mental health vulnerabilities.

Background: Migrants living in precarious conditions often face gendered violence (GV) and poor mental health (MH). However, most of the existing GV and MH measures assume residentially stable populations, missing migration-related precarity or structural conditions shaping migrants’ experiences. As a result, the intersection of GV, poor MH and precarity across migrant populations remains unstudied, especially in low- and middle-income country (LMIC) settings, that the National Institute for Health and Care Research (NIHR)-funded research programme Gendered Violence and Poor Mental Health among Migrants in Precarious Situations (GEMMS) aims to explore. Aim: This paper describes the development of the GEMMS survey tool and presents preliminary pilot validation evidence for selected adapted and newly developed components designed to measure GV, MH and precarity associated with migration across multiple LMIC settings. Methods: GEMMS survey tool development followed a participatory process with multicountry research teams, international experts, local advisory groups and community members with lived experiences. Guided by GEMMS’ conceptual frameworks, items were drawn from validated instruments where possible and newly developed as informed by GEMMS’ ethnography and country profiling. After several rounds of expert reviews, community consultations and item-level content validation, the tool was pilot-tested in Cambodia, India and South Africa (total n=198), to improve wording, sequencing, skip logics and order. Exploratory factor analysis was done to assess internal coherence of the newly adapted items. Results: Final survey tool comprises 216 items. Exploratory factor analysis of selected adapted and de novo migration-related and psychosocial item sets in pilot analyses identified two coherent migration-related and three MH-related factors: structural harm, socio-cultural marginalisation; social exclusion, belonging/social integration and migration stress. All five factors were robust, with interpretable and meaningful loadings that aligned with the guiding theory. Conclusion: The GEMMS survey tool provides an integrated, context-responsive, structurally informed survey tool for measuring GV, MH and multidimensional precarity in migrant populations. This paper demonstrates its development process, pilot feasibility and preliminary validation evidence for selected components, while establishing a foundation for future intersectional and syndemic-informed analysis across diverse migrant populations in LMICs.

Background. The Immunization Agenda 2030 (IA2030) tracks new and underused vaccine introduction as an access metric, and its mid-term review calls for stronger country ownership, prioritisation, data use and tailored support in conflict-affected and resource-constrained settings; however, national launch status does not measure recurrent financing, implementation, safety or equity. We examined how recent vaccine-introduction activity was distributed across the WHO African Region. Methods. We conducted a descriptive country-level ecological analysis of all 47 Member States from January 2023 to June 2026. The country was the unit of analysis and contributed one cumulative, unweighted count of nationally endorsed vaccine-introduction and programme-change events. Counts were linked to Gavi eligibility, World Bank FY26 conflict-affected status, broader fragile and conflict-affected situation status in sensitivity analysis, and concurrent system-performance indicators, and modelled with Poisson regression using HC1 robust standard errors. Two Expanded Programme on Immunization (EPI) manager survey waves were summarised at country level. Reporting followed STROBE and RECORD. Results. Seventy-two events were recorded across 38 of 47 Member States: 48 new-antigen introductions, 20 dose or schedule expansions and four combination-vaccine introductions; malaria vaccines accounted for 21. Gavi-eligible conflict-affected countries averaged 2.50 events per country versus 1.27 in both comparison groups. Gavi-eligible conflict-affected status was associated with a higher count (incidence rate ratio [IRR] 1.97, 95% confidence interval [CI] 1.38-2.81; p<0.001), whereas non-Gavi status was not (IRR 1.00, 95% CI 0.54-1.87). The association was strongest for new-antigen introductions (IRR 2.36, 95% CI 1.43-3.91), attenuated but persisted after excluding malaria-vaccine events (IRR 1.77, 95% CI 1.06-2.97), and was robust to baseline introduction-opportunity adjustment (IRR 2.00). Surveys reported constraints in prioritisation, financing, 2026 preparation and post-introduction evaluation. Conclusions. Recent vaccine-introduction activity concentrated where Gavi eligibility, conflict-affected status and weaker concurrent system performance intersected. The association attenuated after excluding malaria-vaccine events, suggesting that the observed financing-conflict gradient was not solely driven by malaria vaccine rollout. However, the ecological design supports no causal inference. Monitoring should pair launch status with financing, implementation, safety and equity indicators to distinguish policy adoption from sustained protection.

There is growing evidence that people-centred, community-driven primary healthcare (PHC) is ‛the most cost-effective, equitable and accessible route to extending health services to unreached populations’ [1]. PHC, distinct from primary level care, adopts a ‘whole-of-society’ approach with communities at its heart [2,3]. This approach brings centre stage a focus on empowerment of communities and their […]

Mental health conditions are emerging concerns that were worsened by Covid-19, especially in developing countries. The pandemic instigated an increase in household stress particularly among migrant women living in urban slums due to overcrowding, increased caregiving burden, and intimate partner violence, resulting in deteriorating mental health. This study assessed the prevalence of mental health conditions and intimate partner violence during Covid-19 and also explored the pathways between pandemic-related household stress and mental health outcomes with the mediating role of crowding and intimate partner violence in the Bangladeshi urban slums. The cross-sectional survey was conducted among internal migrant women from five slums of Urban Health and Demographic Surveillance Systems operated by International Centre for Diarrhoeal Disease Research, Bangladesh. Face-to-face interviews were conducted from August to October 2022 using a semi-structured questionnaire that had three validated screening tools to measure depression, anxiety and intimate partner violence. A path analysis using structural equation modelling with maximum likelihood methods was performed to understand the objectives. Among the total 405 participants, the majority of women (68.40%) were housewives and their husbands (46.43%), were engaged as daily wagers. A large portion of the women (38.77%) had only primary education and one-third of the surveyed women (36.5%) reported increased household stress due to Covid-19. About 71% of women experienced an event of intimate partner violence with reports of emotional (57.3%), physical (49.4%), and sexual violence (39.0%). The prevalence of anxiety and depression were 73.8% and 65.2%, respectively. The structural equation modelling path analysis revealed that household stress increased the likelihood of anxiety and depression. Moreover, household stress has a direct effect on anxiety, while it has an indirect effect on both anxiety and depression with these effects mediated by intimate partner violence. These novel baseline findings may support the relevant stakeholders to design further research and programmes to strengthen emergency preparedness for the women living in informal settlements of Urban Bangladesh. A rights-based approach, as has been shown effective elsewhere, may offer a strategy to enhance the overall well-being.

Background: Early years interventions are critical to children’s health and development and are emerging as core to public health programmes in the UK and globally. Evaluating such interventions is complex. The study reported in this article evaluates a place-based public health initiative ‘A Better Start Southend’ (ABSS) aimed at facilitating early years’ development specifically. It centres on examining the access barriers and facilitators experienced by parents and young children, as perceived by health professionals providing these services. Methods: This paper illustrates the utilisation of participatory action research (PAR) approach, employing creative methods, including spider grams, service mapping and photovoice, with health professionals delivering ABSS services. PAR methods enabled exploration of community resources that facilitate or impede early childhood development in the local context. Results: Operationalising PAR yielded critical providers’ perspectives on key challenges of delivering these programmes, and the factors that in their view impeded their uptake by families and hence effectiveness. The approach provided space for authentic knowledge production through critical reflexive enquiry, exchange, collaborative dialogue and transformation. Through the process, participants revealed the social and commercial determinants of childhood development and how these determined the reach and success of ABSS. Health professionals especially highlighted poor-quality housing, poor public transport, the cost-of-living crisis and harmful commercial marketing practices as key barriers to promoting good early childhood development. System-wide barriers were also reported and included poor resourcing of health and social care services, lack of culturally and linguistically accessible provisions, and exclusionary practices creating inequitable access to health for many families and children. Conclusion: PAR is a potentially valuable tool for healthcare evaluations with the ability to generate nuanced reflexive perspectives and considerations that go beyond identifying the outcomes and gaps in interventions. It draws participants into a reflexive process to define pathways for change. Health professionals identified social inequities as the most significant barrier to promoting early childhood development. These inequities were not addressed in the design and implementation of the early year programme under study. The study supports the need for a multi-level, multi-systems and intersectional framework for place-based public health programmes to have the desired impact and reduce inequalities in access to early years interventions.

Migration and health has emerged as an important global research and policy priority in recent years and is now framed as pivotal to achieving the Sustainable Development Goals (SDGs) 8.8 and 10. Researchers and sectoral experts have called for the inclusion of migrants in global health policies, especially in relation to Universal Health Coverage (UHC) […]

Human resource for health (HRH) is considered critical for achieving Universal Health Coverage, and the crisis surrounding HRH is now established as a global emergency. Their vital role has been central in the pandemic response. Yet, the discussions and deliberations on the recent pandemic treaty circumscribe HRH discussions to their capacities and protection, and address discrimination mainly in relation to gender. While this paper endorses the case for prioritisation of HRH in global pandemic preparedness planning, it re‐frames the HRH crisis in relation to the institutional and structural factors driving HRH shortage, maldistribution and skills‐needs misalignment. We critique the supply‐and‐demand framing of HRH crisis as one that obliviates the systematic inequalities within health systems that underpin health workforce motivations, distribution, satisfaction and performance. We propose an intersectional equity lens to redefine the HRH challenges, understand their underlying drivers and accordingly integrate in the global pandemic preparedness plans.

Lassa and colleagues’ study is a strong commentary on the biomedical hegemony and professional monopoly of medical doctors in the policy landscape of the Global Fund in Nigeria. Situating this critical dimension of professional power within wider scholarship of power and governance of global health initiatives (such as the Global Fund), in this comment, I put forth two core arguments. I call for a relational perspective of power in a dynamic policy space that the Fund characterises. I argue that a systems-view analysis of power requires a thorough examination of subsystems, how they interact, and the diverse forms of power—individual agentic, ideational, and structural—and the mechanisms through which power is wielded. The lens of governmentality allows linking individual (expertise and practices) with institutional regimes and social practices these enable; and in examining the interface of local/ sub-national, national, and global within which policy formulation and implementation occurs.

Migration patterns in South Asia are defined by temporary migration of low-wage labourers within and across national borders. The conditions in which migrants move, live and work expose them to multiple health risks that cause chronic ailments, mental health problems, and increase their susceptibility to airborne and waterborne diseases. Despite this, public policies and mainstream discourses in the region overlook migrants’ health needs or tend to pathologize them as carriers of infectious diseases. In this chapter, we take stock of the regional evidence on migrants’ health, presenting an overview of their health and the underlying social and structural determinants. In reviewing this evidence, we identify the high-risk and disempowering conditions in which they work, the transient nature of their lives and livelihoods, and the intersecting inequalities they face based on distinct aspects of their social location. Together, these conditions, identities and social locations produce distinct yet inter-related and interlocking oppressive states of insecurity, disempowerment, dispossession, exclusion and disposability, locking migrants in a continuing cycle of poverty and ill-health.