Emergency medical services utilization among refugees on the Eastern Mediterranean Migration route

Understanding refugee emergency medical services (EMS) utilization patterns is critical for forecasting demand, optimizing triage, and planning route-adapted surge capacity in border regions. Van Province is Turkey's border gateway on the Eastern Mediterranean migration route.

This study aimed to quantitatively characterize refugee EMS utilization patterns and compare them with same-day randomly sampled citizen encounters along this migration route.

A retrospective, observational cohort study of adult EMS encounters in Van Province was conducted for the years 2018-2024, using 1 : 1 same-day random sampling to select citizen controls. Refugee status referred to noncitizen patients presenting without official identification, corresponding to undocumented irregular migrants in the EMS registry.

Primary outcomes were the distributions of mutually exclusive prehospital presentation categories derived from EMS-assigned International Classification of Diseases 10 th Revision codes and clinical narratives. Associations with refugee status were assessed using logistic regression adjusted for age and sex.

The analytic sample comprised 4924 encounters (refugees n  = 2462 and citizens n  = 2462). Refugees were younger (median 27 vs. 42 years) and more often male (63.6 vs. 39.5%). Rural scenes were more frequent (39.0 vs. 28.2%). Refugees had a greater trauma burden: traffic accidents [12.9 vs. 3.5%; adjusted odds ratio (aOR): 2.24, 95% confidence interval (CI): 1.71-2.94], other physical trauma (16.1 vs. 6.5%; aOR: 2.02, 95% CI: 1.62-2.51), cold-related emergencies (4.0 vs. 0.3%; aOR: 7.15, 95% CI: 3.21-15.90), and gunshot injuries (2.6 vs. 0.1%; aOR: 10.14, 95% CI: 3.05-33.63). Chronic presentations were lower: respiratory (5.3 vs. 14.1%; aOR: 0.58, 95% CI: 0.45-0.73) and cardiovascular (3.7 vs. 12.7%; aOR: 0.55, 95% CI: 0.42-0.72). Medico-legal cases were more common among refugees (22.0 vs. 5.0%; P  < 0.001). Simple Triage and Rapid Treatment (START) triage distributions showed fewer green (57.6 vs. 62.9%) and more yellow (35.8 vs. 31.3%) among refugees; red was similar (5.1 vs. 5.2%), while black was higher (1.5 vs. 0.6%).

Along this migration route, refugee EMS utilization showed a distinctly trauma-dominant pattern, marked by transport injuries, violence-related events, cold-exposure emergencies, and a higher burden of medico-legal presentations compared with citizens.