Unseen struggles, unmet needs: A qualitative study of housing and health disparities among newly arrived migrants and refugees in Greater Western Sydney, Australia.

Housing is a fundamental social determinant of health and wellbeing for migrant and refugee populations and serves as a critical pathway through which health disparities emerge and persist over time. However, evidence on how housing disparities shape health outcomes among newly arrived migrants and refugees remains limited, particularly evidence attentive to how these experiences vary by visa and migration pathway. This qualitative study aimed to gain an in-depth understanding of the housing and health disparities faced by newly arrived migrants and refugees in Greater Western Sydney, Australia, and how these disparities converge and diverge across visa pathways. A sample of 30 participants, comprising international students, temporary graduate and skilled visa holders, a recently naturalised citizen, and holders of refugee and humanitarian visas, completed the semi-structured interviews, and an inductive approach to thematic analysis informed by a critical realist perspective and the social determinants of health framework was undertaken to identify contextual patterns and themes. Three overarching themes emerged: (1) Structural determinants shaping access to housing among newly arrived migrants and refugees; (2) Precarious living conditions as intermediary determinants contributing to health disparities; and (3) Intersection of housing instability and financial hardship as interconnected pathways in shaping health inequities. A lack of local rental history, discriminatory rental practices based on visa status and ethnicity, and limited access to formal lease agreements and tenant rights were reported as structural barriers to securing housing across the sample. However, the resources available to offset them diverged by visa pathway, with international students and other temporary visa holders navigating these barriers without access to income support or priority social housing, which collectively heightened housing insecurity. Participants also described how precarious living conditions, such as overcrowding, substandard housing quality, and conflicts in shared accommodation, contributed to health disparities. Moreover, the intersection of housing instability and financial hardship was identified as a key driver of health inequities, with frequent relocations causing housing instability, high rental costs contributing to financial vulnerability, and cumulative stress leading to long-term health consequences. These findings underscore the need for policy interventions, including pathway-specific settlement and institutional support and stronger tenancy protections, to address systemic housing inequities and mitigate the health disparities experienced by newly arrived migrants and refugees.