Homelessness as structural vulnerability: Precarious citizenship and migrant health in a Nordic welfare state

Housing is a key social determinant of health, yet little is known about how homelessness shapes migrants' health in Nordic welfare states where legal status, labour market attachment and welfare entitlements are unevenly distributed. This article examines how homelessness affects the physical and mental health of migrants, and how structural barriers limit their capacity to navigate access to health care.

Exploratory mixed-methods study combining registry data on shelter use in Oslo (2019-2023) and interviews with ten frontline health and social care staff at a long-term, NGO-run shelter. Analyses were informed by precarious citizenship and structural vulnerability.

Homeless migrants represented a heterogeneous group in terms of citizenship status and health problems. Migrants' region of origin influenced their resident status, the uncertainty of their situation, and the duration of their stay. Homelessness interacted with migrants' pre-existing vulnerabilities, such as precarious legal and economic status, language barriers, limited access to public services, and untreated chronic disease, to accelerate health decline. Precarious citizenship can be enacted through gendered arenas of exploitation, with consequences for safety, access to care and possibilities for recovery.

Homelessness among migrants reflects structural vulnerability and contributes to cumulative disadvantage. Homelessness is not simply a backdrop to migrant ill-health; it is an active health risk that exacerbates disease, disrupts treatment, and limits recovery. Shelters and low-threshold services play a crucial bridging role by enabling access to treatment and rehabilitation. Addressing migrant health inequities requires rights-based approaches and integrated policies linking housing stability and health care access.