Healthcare access and utilisation under liminal legality: Sudanese forced migrants in Israel

This study examines how legal status shapes healthcare access and utilisation among Sudanese forced migrants living in Israel under prolonged legal precarity. Drawing on the frameworks of liminal legality and legal violence, we explore how structural barriers and institutional exclusion influence health-seeking behaviours. We employed a mixed-methods design that combined a survey of 130 male Sudanese asylum seekers and refugees with focus groups, in-depth interviews, and ethnographic fieldwork. Quantitative data revealed significant disparities in healthcare eligibility and utilisation by legal status: refugees with temporary residency accessed state health insurance and relied heavily on mainstream services, while asylum seekers, whose access depended on employer-purchased private insurance, exhibited fragmented care-seeking patterns and frequent reliance on volunteer clinics and emergency departments. Qualitative findings identified multiple barriers, including bureaucratic complexity, language difficulties, discrimination, and mistrust of healthcare institutions, which compounded asylum seekers' exclusion. We introduce the concept of healthcare self-exclusion to describe how precarious legal status fosters the internalisation of exclusion, leading individuals to avoid care even when technically eligible. These findings underscore the role of legal status as a determinant of health and highlight how restrictive immigration and healthcare policies perpetuate health inequities. Policy reforms that decouple health coverage from employment status and ensure equitable access to preventive and primary care are urgently needed.