"Your problem is still your problem": Gatekeeping, perceived exclusion, and Ukrainian refugees' (dis)engagement with...

In many European health systems, general practitioners (GPs) serve as the first point of contact and as gatekeepers to specialist services. While gatekeeping is often framed as promoting equity, less is known about how such systems are experienced by newly arrived refugees who enter with expectations shaped by different healthcare fields. This study investigates Ukrainian refugees' experiences of (dis)engagement in encounters with primary care services in the Greater Copenhagen area and how they responded to these encounters. Data were generated through one participatory workshop and 15 semi-structured interviews with adult Ukrainian refugees living in Denmark (June-October 2023). Analysis followed reflexive thematic analysis and was informed by Bourdieu's concepts of habitus and field, and relational care. Participants frequently experienced initial GP encounters as surprising, frustrating, and alienating, particularly in relation to time-limited consultations, "wait-and-see" approaches, reluctance to prescribe medication, and the need to justify health concerns. These interactions were interpreted as dismissal, indifference, or conditional inclusion in the welfare state. When care felt unresponsive, participants sought alternative pathways, including informal networks and transnational strategies such as consulting Ukrainian doctors online or traveling for tests and medicines. Over time, some adapted to the Danish system's rules, particularly following encounters where GPs offered explanations, listened, or flexibly connected concerns across domains. Participants also emphasized the importance of brokers, such as municipal staff, volunteers, and peers, who helped make the system intelligible and accessible. The study shows that universal entitlements and rapid integration into mainstream healthcare do not automatically produce equitable care. Equity depends on relational work that supports navigation, translates system logics, and enables recognition within time-pressured primary care encounters.