Ukrainian families’ transnational living and perception of Germany’s health care system in times of war

Key findings from this study

This research indicates that:

• Ukrainian parents' prior experiences with authoritarian medical communication and rapid clinic access shaped expectations poorly aligned with German bureaucratic health system structures.
• Families responded to German pediatric care barriers by returning to Ukraine for treatment despite ongoing conflict, indicating insufficient pull factors in German access pathways.
• Unintended discrimination occurred when German health staff did not recognize or accommodate culturally-rooted differences in self-treatment practices and infection management.
• High-quality chronic disease management in German pediatric settings represented the primary advantage motivating some families to remain in Germany despite access and communication difficulties.
• Intercultural staff training and systemic changes to appointment wait times and referral processes are necessary to improve care engagement among Ukrainian refugee families.

Overview

This qualitative study examined expectations and perceptions of Ukrainian parents with children receiving pediatric care in Germany following displacement by war. Eight narrative interviews and one focus group were conducted at a German university hospital. Medical anthropology frameworks guided thematic analysis of how Ukrainian families' prior health care experiences shaped their interactions with German pediatric services.

Methods and approach

The research employed a qualitative, participatory approach. Eight narrative interviews and one focus group discussion occurred at the Children's and Adolescents' University Hospital of Leipzig. Thematic analysis occurred within a medical anthropology framework.

Results

Ukrainian parents' expectations reflected differences in medical culture between their origin country and Germany. Ukrainian health systems emphasized authoritarian clinician-patient communication and aggressive treatment of infectious diseases. Rapid appointment access in Ukraine contrasted sharply with extended waiting times and bureaucratic barriers in German pediatric care. The financial structure in Ukrainian medicine, where clinicians' income depended on patient volume, differed fundamentally from German practice models.

Parents reported frustration with German care pathways and responded by returning to Ukraine for medical appointments despite active conflict. Self-treatment practices for infections reflected Ukrainian medical norms and diverged from German clinical standards. Families experienced unintended discrimination when cultural differences in health behaviors were not recognized or accommodated by German health staff.

Long-term chronic illness management in German pediatric settings emerged as a significant factor influencing some families' decisions to remain in Germany, indicating that high-quality specialized care offered pull-factor appeal despite communication and access barriers.

Implications

German pediatric institutions require structured intercultural training for staff to recognize and address cultural differences in health expectations and medical decision-making. Training should address both explicit communication styles and implicit assumptions about appropriate medical treatment. Staff education must extend beyond symptom recognition to encompass cultural competency in interactions with displaced populations.

Systemic changes in German health care access mechanisms could improve outcomes for refugee populations. Reducing appointment wait times and streamlining referral processes would lower barriers to care engagement. Integrating bilingual or culturally-informed health staff into pediatric wards could facilitate more effective communication and reduce unintended discrimination.

Future refugee health policy should examine whether fee-for-service or productivity-based compensation models create incentives misaligned with refugee population needs. Decoupling clinician income from patient volume could enable more patient-centered rather than throughput-focused care approaches.

Scope and limitations

This summary is based on the study abstract and available metadata. It does not include a full analysis of the complete paper, supplementary materials, or underlying datasets unless explicitly stated. Findings should be interpreted in the context of the original publication.