As migration to Europe continues to grow and global temperatures keep rising, two powerful forces are converging in doctors’ consulting rooms and emergency departments across the continent.

Together, they create an immediate clinical challenge. Patients arriving from different geographic regions bring distinct baseline risks for infectious, genetic, renal, cardiovascular, and mental health conditions. At the same time, Europe’s hotter summers, more frequent heatwaves, and more volatile weather can worsen some of those conditions or create new risks after people arrive. The situation is exposing blind spots in healthcare systems built around historically local disease patterns.

The scale makes those blind spots difficult to ignore. Almost 50 million people were born outside the EU. “We’re talking about massive numbers, mostly of people from low- and middle-income settings,” Santino Severoni, MD, head of the Special Initiative on Health and Migration at the World Health Organization (WHO) in Geneva, Switzerland, told Medscape News Europe. Beyond their clinical needs, many also face significant barriers to accessing care. Healthcare workers need to build the essential knowledge to treat them effectively, Severoni said.

The story is no longer about migration or climate change in isolation. It is about what happens when the two intersect. For European healthcare professionals, it is a present-day challenge sitting in the waiting room.

Clinical Challenges in a Changing Climate

Increased migration brings a higher prevalence of conditions that are rare in host populations, explains Anita Rijneveld, MD, PhD, a hematologist and head of the Erasmus MC Center of Expertise for Sickle Cell and Thalassemia in Rotterdam, Netherlands.

She told Medscape News Europe that in major Dutch cities like Amsterdam and Rotterdam, up to 50% of inhabitants are now migrants or children of migrants. This has led to an increase in the prevalence of hemoglobinopathies in these urban centers, requiring specialized expert teams to manage the hundreds of patients now requiring care, she said.

For example, Rijneveld said she has noticed a steady rise in sickle cell disease (SCD) cases arriving from abroad, including students, refugees, and migrants fleeing environmental disasters and conflicts.

In Netherlands, all newborns have been screened for SCD and thalassemia since 2022, allowing for early intervention and increased life expectancy. But migrants are often not screened in their countries of origin, making it difficult for European doctors to recognize the disease when a patient presents with symptoms later in life, Rijneveld said.

Without the diagnostic history, clinicians can mistake vaso-occlusive events (VOEs) in people with SCD for a common infection. VOEs are the most common, painful, and sometimes life-threatening complication of SCD and result from sickle cells blocking blood vessels and depriving tissues of oxygen. Symptoms such as abdominal pain, bone pain, and fever can be misdiagnosed if the doctor is unaware of the patient’s underlying condition.

This is where climate change enters the clinical picture directly. Environmental factors play a critical role in SCD management, and Europe’s shifting climate is altering that risk landscape. Heat is a significant concern: patients with SCD frequently have impaired kidney concentration capacity, meaning they produce more urine and lose fluids faster than others. “They need to drink a minimum of 3 liters of fluid a day. Always,” Rijneveld said, a requirement that becomes critical during heatwaves to prevent a VOE. Cold, however, is often the most acute trigger, because vasoconstriction promotes cell adhesion to vessel walls and subsequent occlusion.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is similarly increasing in prevalence in European clinics — and similarly prone to going unrecognized. Found in approximately 1 in 10 people of African descent, this genetic disorder causes a shortage of the G6PD enzyme that protects red blood cells, leading to hemolytic anemia when triggered by infections, certain medications, or foods like fava beans. The condition is frequently hidden because a patient may appear entirely healthy without these triggers.

In nephrology, a parallel challenge is taking shape. In many European clinics, chronic kidney disease (CKD) is typically associated with aging, diabetes, and hypertension. But that diagnostic framework can miss CKD of unknown etiology (CKDu), which often present in younger people without any of these comorbidities. “There is a potential blind spot,” said Eranga Wijewickrama, MD, PhD, a nephrologist and professor at the University of Colombo, Colombo, Sri Lanka.

For migrants arriving from endemic regions such as South Asia and Central America, the concern is specific: they may already have kidney damage before they arrive. CKDu is linked primarily to environmental toxin exposure, but heat stress and chronic dehydration from years of outdoor manual labor are significant aggravating factors. A patient who has spent years working in extreme heat in their country of origin may present in a European clinic with raised serum creatinine and no obvious explanation; because no one has thought to ask about their occupational history.

That history, Wijewickrama said, is essential. Clinicians should routinely assess the type of work a patient has done, the duration and intensity of heat exposure, their hydration practices, and access to rest and cooling; particularly in younger patients presenting with kidney stones. “Such history is highly relevant not only for stone disease but also for identifying individuals at risk of recurrent kidney injury,” he said. Guidance on screening people based on occupational exposure or geographic origin remains limited, he added. “In my view, there is a need for greater flexibility in clinical assessment — particularly incorporating occupational and environmental risk factors into screening decisions.”

And there is a broader concern that extends beyond migrant populations. As heatwaves become more frequent and intense across Europe, the continent’s own outdoor workers face growing exposure to the same heat stress and dehydration conditions that have driven CKDu epidemics elsewhere. “It is plausible that we may see an increase in CKD related to heat stress in Europe, particularly among vulnerable occupational groups such as agricultural and construction workers,” Wijewickrama said. Whether this will lead to a CKDu epidemic on the scale seen in Central America or Sri Lanka remains uncertain. But the trajectory warrants clinical attention.

Addressing the Evolving Health Needs of Migrant Populations 

The public health narrative surrounding migration and health has often been dominated by a focus on infectious disease. Severoni argues this is a clinical bias that obscures a more pressing reality. Communicable diseases pose a significant societal risk mainly during active epidemics. The more persistent and far less visible burden is noncommunicable disease. Hypertension, diabetes, and cardiovascular conditions are highly prevalent within migrant populations; the product of different baseline risk profiles and the physical toll of migration and the resulting interrupted care.

Settling in dense, urban environments compounds the picture, where overcrowded housing and poor ventilation drive additional risks for chronic lung diseases and mental health conditions.

Accessing care is itself a major obstacle. Legal status is the primary gatekeeper: asylum seekers and undocumented people frequently find themselves excluded from national health systems. Even when legal access exists, language barriers, lack of insurance, and the challenge of navigating an unfamiliar system deter many from seeking preventive care.

The Need for Long-Term Integration

The barriers patients face are compounded by gaps on the provider side. Without cultural mediation or professional interpretation, the risk for misdiagnosis or poor treatment adherence increases significantly. Many systems also fail to account for the psychosocial needs of those fleeing conflict or trauma, leaving a gap in essential mental health and psychosocial support at the point when it is most needed.

Closing those gaps requires training. The WHO’s Global Competency Standards for health professionals working with migrants and refugees provide a framework of clinical, cultural, and communication skills designed to help providers deliver equitable care to diverse patient populations. Intended for integration into medical and nursing curricula, the standards have recently been embedded into Estonia’s medical training as a referenced elective e-course. Kadri Suija, MD, PhD, a general practitioner and associate professor at the University of Tartu, Tartu, Estonia, told Medscape News Europe that there’s a growing case for making such training. The training equips physicians to navigate insurance complexities and language barriers while delivering culturally informed care. “It gives you more confidence in what we are doing and releases that uncertainty,” Suija said.

For Severoni, training is not the only thing that is needed. Health systems remain trapped in what he describes as a reactive cycle of “short-term crisis management” — providing emergency food, water, and vaccinations when refugees arrive but then reverting to business as usual. Long-term structural integration is essential, he said. And that means dismantling parallel systems: rather than setting up separate migrant clinics, migrants’ health needs should be folded into national health systems. It also requires a whole-of-government approach that recognizes health as inseparable from housing, labor law, and legal status — a reminder, Severoni said, that “social determinants affect a person’s health more than any virus.”

Severoni, Rijneveld, Wijewickrama, and Suija reported having no relevant financial relationships.

Manuela Callari is a freelance science journalist specializing in human and planetary health. Her work has been published in The Medical Republic, Rare Disease Advisor, New Scientist, The Guardian, MIT Technology Review, and others.