Social determinants of health and migrant access to public healthcare in Brazil during the COVID-19 pandemic

BACKGROUND: In recent decades, Brazil has emerged as a significant destination for migrants and refugees, contributing to a Global South-South migration trend. This trend is particularly notable for its influx from South and Central American countries, as well as African countries. Healthcare access in Brazil is universal through the Brazilian Health System (SUS). Although the existence of a social protection system is relevant, there are challenges to the law’s actual applicability in the country. Given the profound social and territorial inequalities existing in Brazil, the consequences of the pandemic have been particularly severe. The critical situations of social vulnerability have been intensified during the COVID-19 pandemic, posing a significant threat to the most impoverished populations, including international migrants. This article investigates how social determinants of health (SDH) shaped the experiences of international migrants in Brazil during the COVID-19 pandemic, particularly regarding access to the public health system. METHODS: Drawing on qualitative, multi-sited fieldwork conducted in six Brazilian states between 2022 and 2023, the study analyzes in-depth interviews with 84 migrants from Venezuela, Haiti, Bolivia, Angola, Colombia, and Syria. RESULTS: The research highlights significant vulnerabilities linked to employment status, housing, and racialized exclusion, while also documenting widespread access to Brazil’s Unified Health System (SUS) for COVID-19 testing, vaccination, and care. Despite systemic barriers—including xenophobia, documentation requirements, and language barriers—the findings underscore SUS’s role as a vital mechanism for inclusion. CONCLUSION: The study argues that an SDH framework is essential for understanding the intersectional inequalities affecting migrant health and for developing coordinated, rights-based, and transnational public health responses to global crises.