Crafting a space in the field of research for an advancement in human health is a gallant step in leaving no one behind. Magnifying the usual and common movement of people through a humanitarian lens showcased a necessary spot for global health engagement. Thus, sculpting a giant step towards softening the hard, crusty grounds of a million ages in neglect to merit the ardent attention of world health advocates in order to shift the culture from research to research and innovation (25). Migration health has provoked an interest in varied geographical distributions, so that scientific research and the segregation of migrant groups for an understanding of their distinct health needs demand appropriate interventions to drive the agenda for accurate service delivery in different migrant populations. Research scholars and other significant stakeholders have solicited quality research works on migration health on both the domestic and international fronts to propel SDG-3 into realisation (26). International students in Hungary were captured in a study together with domestic students with respect to the statistics and economic gains made within definite time periods, in which Vincze and Bács (27) made an important observation on international students in institutions of higher learning in Hungary. Their study hoisted the flag of Hungary for its booming non-alcoholic beverage industry that introduced some vibrancy into the nation’s economy following the high demand for cocoa and coffee in breakfast and snack packs in its higher learning institutions, but bemoaned the steep decline in the number of native students in their various institutions with each passing year (27). Other researchers have attributed the challenges of international students in Hungary to acculturation stress. One of such cross-sectional studies on foreign students in their new environment blew the whistle on the failing mental and general health among international students due to poor adjustment strategies. The authors believed foreign students could free themselves from all social entanglements if they allowed themselves to be immersed in the Hungarian culture (28). Onosu (29) supported and validated that finding after measuring the impact of cultural immersion experience on the identity transformation process by resonating its significance on the formation, creation, and development of an individual’s persona.

A cross-sectional design was adopted for an online survey. The authors conducted the study to gather data and identify issues affecting the health and general wellbeing of international students in Hungary using a standardised questionnaire.

Universities in Hungary offer a supportive and affordable environment for international students, characterised by low tuition costs, a range of English-taught programmes, readily available dormitories, and vibrant student life. The country provides a safe and welcoming environment with opportunities for integration and support, such as demonstrated in the Stipendium Hungaricum scholarship and mentor programmes. Housing, safety, and modernity are prioritised. Investments in higher education have resulted in strong academic programmes and a globally recognised educational system. The country, in general, is known for its historical setting, safe environment, and diverse student life. Universities in Hungary provide a vibrant student life with accessible cinemas, bars, restaurants, and shopping options. Students also engage in sports and participate in exchange programmes. Most universities in the country are bio-friendly and have been recognised by world bodies for their green environment. The country boasts of a rich history and culture, with architectural landmarks and cultural events, including the UNESCO World Heritage site.

Our approach to maintaining methodological clarity focused on a clear questionnaire design, rigorous validation, and appropriate participant selection. A careful question construction, pre-testing using established scales, and the employment of statistical analysis for validation were stages observed. Appropriate participant selection criteria, e.g. representativeness of the sample and efforts at addressing potential biases were of prime concern.

In designing the questionnaire, questions were crafted in clear, unambiguous language and without jargons or technical words for respondents to easily understand. With the use of multiple-choice questions and the Likert scale, responses were formatted to align with the research questions and allow respondents to express their opinions accurately. Questions were logically stringed from simple to progressively more difficult and complex ones. They were also from general knowledge to specific knowledge, ensuring a smooth flow.

The questionnaire was pre-tested with a few people to identify any ambiguities or technical issues. Reverse-worded items were used to detect inconsistencies in responses and to assess the validity of the questionnaire. Validation of established scales (Likert, numerical, descriptive, and verbal scales) from existing research was carried out to ensure reliability and validity. The validation process continued into pilot testing our questionnaire to refine the questionnaire and identify potential issues before the main study. With Cronbach’s alpha, we were able to assess the internal consistency of the questionnaire and factor analysis to examine the underlying structure of the questionnaire and its validity. We triangulated the survey results with other data sources (qualitative and quantitative) for insights to confirm the validity of the findings. Different theoretical frameworks were used to analyse the survey data.

International students who were active at the time of data collection were included. An active student is the student who has registered for the semester and is actively participating in lectures and other curricular activities.

Students who had a passive status in the active semester of data collection and were absent from lectures and other curricular activities were excluded.

Respondents in this survey were international students in universities in Hungary. Using an online survey, everyone who received the questionnaire had a chance of being selected at random. Steps to mitigating potential biases of any form were considered. An email invitation to participate in the survey was sent to international students through the university’s portal, Neptun. The email sought the consent of international students and their interest in responding to the questionnaire.

A purposeful empirical survey was carried out in Hungary between May and August 2021. An anonymous online survey questionnaire was sent to the international students’ community by email from the University of Pécs portal, Neptun. A total of 476 responses were received at the end of data collection, but 440 were finally analysed after data purification. The difference of 36 was excluded from the analysis of some variables due to reasons related to incomplete questionnaire responses and visible evidence of illogical responses.

Data were collected from several international students, including Stipendium Hungaricum scholarship beneficiaries. An anonymous online survey questionnaire was sent to students in Hungarian universities in no specific order or preference, with responses from predominantly 4 universities. There were 63 questions in total for the questionnaire, two of which were open-ended and the rest, closed-ended. There were questions pinned to the Likert scale to allow respondents to indicate their opinions, attitudes, or feelings about their general and mental health wellbeing since arriving in Hungary for academic purposes. The questions were in three main categories seeking information on their basic demographics, self-assessed health status, health habits and health-seeking behaviors, and expectations on healthcare in Hungary. Each closed-ended question had options from which respondents could choose, depending on their reality or choice of preference. There was also available among these, the option to withhold themselves from answering a particular question. Some areas that questions covered included their self-assessed health status, health service availability, accessibility, affordability, acceptability, and quality.

Descriptive statistics (e.g., response frequencies, percentages, and proportions) were used to summarise variables. Chi-square goodness of fit test for independence was used to investigate the significant differences among the studied parameters and socio-demographic variables. The chi-square analysis in this study was conducted as a goodness-of-fit test, comparing observed frequencies to expected frequencies based on a hypothesised distribution. This involved categorical data, not continuous variables.

To enhance interpretability, we included proportions alongside p-values to highlight practical significance. A significant result (p < 0.05) indicates a meaningful difference between at least the smallest and largest observed frequencies. The degrees of freedom, however, have been added to all tables.

CART algorithms were employed to assess the relationship between some responses and the socio-demographic variables of participants. Misclassification cost was used to select the most appropriate tree. Finally, p-values less than 0.05 (significance at 95% CI level) were considered statistically significant. Data were analysed using SPSS software (Windows version 26).

We used Classification and Regression Tree (CART) models instead of traditional regression methods for several important reasons.

With approximately 436 student responses, the sample size was sufficient for tree-based modeling. CART does not require very large datasets to generate reliable splits, especially when the goal is to identify patterns and segment populations rather than estimate population-level coefficients.

CART is well-suited for capturing complex, non-linear relationships between variables without requiring pre-specification. In contrast, traditional regression assumes linear relationships and requires explicit modeling of interaction terms, which may lead to model misspecification if relationships are complex.

CART models produce intuitive decision trees that are easy to interpret and communicate, especially for applied audiences. This is particularly beneficial in survey research where stakeholder understanding is important.

The dataset included a combination of categorical and continuous variables. CART naturally handles both types of data without requiring transformation or dummy coding, unlike traditional regression.

We have included a visual representation of the CART tree (Figures 1–8) to aid in interpretation and to demonstrate the model’s segmentation logic. The figure highlights the key predictors and decision paths that best explain the variation in survey responses.

The study was conducted in accordance with the Helsinki Declaration and was approved by the Institutional Scientific Research Committee of the University of Pecs (approval no: PTE/61924/2021) and the Hungarian Medical Research Council (ethical approval no: BM/26490-1). Protection of data privacy and confidentiality, as required in ethical considerations for scientific research, was followed by granting anonymity in reporting findings as well as limiting access to survey data to only relevant public health specialists and statisticians. Clear and transparent information about the purpose of the research and how the data will be used was given in the mail that disseminated the questionnaire. In conclusion, we adhered to all relevant ethical guidelines and regulations for conducting online surveys.

The sociodemographic information of respondents is summarised in Table 1. The proportion of women (53.4%) in the study exceeded men (46.6%). Most respondents, comprising 42.5%, fell within the age group of 21–25 years, while only 5.2% were above 35 years old. The highest proportion of international students came from the Northern Africa and Western Asia region, accounting for 23.9% of respondents. Following closely were students from Eastern and Southeastern Asia, constituting 19.3%. In contrast, Latin America and the Caribbean, as well as Sub-Saharan Africa, had the lowest representation, with proportions of 5.2 and 8.9%, respectively. While Muslims dominated the study with a count of 124 respondents representing 28.2%, Jews were the least represented with a count of just 4, which was less than 1% of the total number of respondents. There were 36.6, 26.4, and 23.6% students with high school, bachelor’s, and master’s qualifications, respectively. Only 6.6% of the respondents had attained their PhD qualification. As a result, the majority of the students surveyed were currently pursuing their bachelor’s, master’s, or PhD degrees with respective proportions of 39.8, 26.6, and 29.3%.

International students studying in Hungary were asked to self-assess their health status, and the result is presented in Table 2. Before leaving their home countries, most of the students claimed their health status was very good, with a proportion of 56.6%. This was significantly higher than (p < 0.05) those students who had bad health (0.7%) before moving to Hungary. A similar observation was made when the students first arrived in Hungary, where the significant majority (47.5%) again indicated a very good health status, with only 2.5% indicating a poor health upon arrival. When they were asked to rate their health status in the recent period, the proportion of students with very good health status reduced to 36.2%, whereas those with poor health increased to 3%. This led 28.3% of respondents to admit that their health status has slightly deteriorated since they arrived in Hungary. In contrast, a significant 43.7% indicated that their health status had not changed since they arrived in Hungary. Coronavirus infection and mental health problems were the top health problems respondents were worried about at the time of this study. While 44.9% were concerned about coronavirus infections, 41.4% worried about mental health issues. These proportions were significantly higher (p < 0.05) than those of respondents who were concerned about acute infectious diseases (6.3%), chronic infectious diseases (3.7%), chronic non-infectious diseases (8.8%), or sexual and reproductive problems (7.7%). The majority of respondents (67.4%) had no known emerging health problems. Conversely, 22.5% had mental health problems as their emerging health problem of concern. Chronic health problems were not of concern to most of the respondents, as 75.5% said they do not have any chronic health problems. Accordingly, 83.8% of respondents do not have to take any medications regularly. For those 13.7% who responded that they take medications regularly, 20.3% had stopped taking their medications because they claim they have finished and are no more being prescribed in Hungary. A significant 33.8% of respondents attributed their decision to stop their medication to other reasons aside from their personal decision to stop taking the medication (9.4%), the medication not being available in Hungary (9.4%), or no specialist found yet in Hungary (27.0%). Dental problems were of no concern for international students in Hungary, as the significant majority (81.5%) responded ‘no’ when asked if they had this health issue.

Respondents were asked about how difficult it is to access healthcare in Hungary, and their responses are summarised in Table 3. The majority indicated that they will trust health professionals from their home countries more than those from Hungary. While 36.7% rated their trust in health professionals from their home country as ‘very much’, only 20.6% gave a similar rating to health professionals in Hungary. The significant (p < 0.05) majority (36.3%), however, stated that they somewhat trust health professionals in Hungary. When the need for health services arises, most of the respondents said they would rather contact their primary care providers, with a significant (p < 0.05) proportion of 56.1% rather than contacting their religious community for advice (0.9%) or contacting a traditional healer (1.8%). Surprisingly, 63% of respondents did not have any information about the healthcare system in Hungary before their arrival. This proportion significantly exceeded the 12.9% who claimed they had such information before they arrived in Hungary.

When they were asked about getting any information on their entitlements to health services in Hungary, 35.9, 32.9 and 31.3%, respectively, responded yes, no, and partly. These proportions were not statistically different (p > 0.05). For those respondents who had information, the Tempus Public Foundation/ Stipendium Hungaricum website and the university administration website were the leading online websites that provided respondents with such information. While 45.7% resorted to the Tempus Public Foundation/ Stipendium Hungaricum website for their information, 41.8% depended on the University administration website. These were closely followed by those respondents who relied on their friends and family for information (39.9%), and onsite at the university administration office (22.1%). A little over half (50.6%) of the respondents said they could have full access to free public health services in Hungary. A relatively lower proportion of 4.6% of the respondents also stated that they had to pay for all public health services, while 41% of the international students surveyed have not had any health problems that required medical attention. On the contrary, 54.1% of respondents also indicated that they have been faced with health problems that required attention since they arrived in Hungary. Of the 54.1, 27% always received the needed healthcare, 25.7% received healthcare in most cases, 11.1% in some cases, and 14.6% said they never received the healthcare services they required. Preliminary health check/aptitude test upon arrival at the university, primary care/GP services with acute problems, and visiting a dentist were the major medical care services respondents claimed had received since their arrival in Hungary, with respective proportions of 38.1, 32.8, and 23.6%. Exactly 3.7% indicated they have had life-threatening conditions and had to receive emergency care. This proportion, however, was significantly (p < 0.05) lower than the three topmost medical care services received by international students in Hungary.

Although 44.2% of respondents indicated they felt the need for mental health counselling, 47.7% also contended that they do not need any mental health counselling in Hungary. Of the 44.2% who felt the need for mental health counselling, 31.2% did not get access to such services, whereas 19.3% did get access. Consequently, only 10.6% of the respondents got the necessary mental health counselling, while 33.2% did not get it. In general, the proportion of international students in Hungary who are likely to face difficulties in accessing healthcare and those who are likely not to face any difficulties was not significant (p > 0.05). While 41.7% indicated they were likely to face difficulties in accessing healthcare in Hungary, 47.4% stated otherwise.

Respondents were asked to rate some difficulties that may impede healthcare access in Hungary. The result is summarised in Table 4. For language barriers and lack of qualified interpreters, respondents rated this difficulty as very likely to impede healthcare access in Hungary for international students, with a significant proportion of 39.7% agreeing to this. While cultural barriers and misunderstandings are somewhat (30.6%) likely to impede healthcare access, religious barriers are not likely to impede healthcare access, with more than half (52.8%) of the respondents attesting to this. Similarly, the majority of the respondents stated that the lack of information about entitlements and the lack of providers’ information about entitlements will neither impede nor improve (neutral) healthcare access, with respective proportions of 33.3 and 34.3%. While the majority (31.8%) agreed that the lack of translated informational materials is somewhat likely to impede healthcare access, the lack of vaccination documents will not at all impede healthcare access, with the significant (p < 0.05) majority, 40.2% agreeing to this.

The administrative problems with health insurance, the lack of translated (previous) documents, personal financial problems, the unavailability of previously prescribed medications, the non-availability of mental health services, and discrimination from healthcare providers were all not likely to impede healthcare access for international students in Hungary. The proportion of respondents who were like-minded to this rating was 33.0, 34.6, 36.2, 42.0, 34.5, and 33.6%, respectively, for administrative problems with health insurance, the lack of translated (previous) documents, personal financial problems, the unavailability of previously prescribed medications, the non-availability of mental health services, and discrimination from healthcare providers. On the other hand, the lack of social services for immigrants will have a neutral effect on healthcare access for international students in Hungary, with 28.7% being the significant majority.

Generally, men had their health status significantly or slightly improved than women upon arrival in Hungary, as presented in Supplementary Table 1. As a result, the health of women deteriorated more than compared with men upon arrival in Hungary. Those respondents in the age category of 21–25 years had their health status improved (significantly and slightly) than any other age group. When respondents’ regions based on UN SDG regions were considered, those coming from Central and Southern Asia were the significant (p < 0.05) majority who claimed their health status significantly improved upon arrival in Hungary. Those coming from Europe and North America, on the other hand, were the significant majority (p < 0.05) who said their health status either significantly or slightly deteriorated. The respondents’ regions based on UN SDG regions had significant (p < 0.05) associations with respondents’ health status rating upon arrival in Hungary. The religious background and educational level of respondents also showed significant (p < 0.05) associations with their health status rating. For religion, the significant majority who claimed an improvement (both significant or slight improvements) in their health status upon arrival in Hungary were Muslims. In contrast, non-believers were the major group whose health status deteriorated significantly or slightly upon arrival in Hungary. When their level of education was considered, those with a high school graduation certificate or equivalent had their significantly deteriorated health status compared to any other educational level. On the other hand, the significant value (p < 0.05) majority of respondents with a bachelor’s degree or equivalent had their health status significantly improved upon arrival in Hungary, than any other educational level.

Gender differences of participants showed traits of resilience in withstanding migration fatigue in favour of males. As shown in Supplementary Table 1, female participants who suffered health breakdowns were more than their male counterparts. This finding reverberates with the work of Trapollini and Giudici (30), who lent credence to the observation that migrants grow weaker in health after staying in a foreign country for a long period of time. Aside from that, health status differences between migrants and non-migrants are marginally more distinct among women than they are among men (31). This led them to posit that there are factors responsible for the unique trajectories travelled by migrants depending on their gender. Another study, which corroborated our findings, asserts that the disadvantage suffered by women was due to insufficient attention to preventive and screening measures for morbid medical conditions such as metabolic diseases, obesity, and perinatal problems (32). Further confirmation solidified that apart from ailments common to both genders, such as infectious diseases, female migrants may encounter additional difficulties in accessing healthcare because they are mostly relegated to the background for socio-cultural reasons (33). Moreover, women, by their vulnerable status as migrants, become exposed to numerous health risks, of which physical abuse and sexual violence are but a few (34). Narrowing down to the health problems that were of concern to students, as shown in Table 2, 33 of them, representing 7.7%, pointed to sexual and reproductive health issues. Of this figure, 19 (4.4%) were men, and 14 (3.3%) were women. Reasons were not given for the concerns, as this was a closed-ended question. However, existing literature explains that male international students are more sexually active than their female counterparts, hence stand a higher risk of exposure to sexually transmitted infections (35). For obvious reasons, these behaviors are common and may possibly occur without the use of sheaths or condoms to protect them from the infectious body fluids of their sexual partners. This evidence inevitably accounts for the differences in gender susceptibility to poor health as documented in this study (36).

Female international students may be vulnerable to violations of their feminine rights in exercising their rights to negotiate and participate in safe sexual activities. More disturbing is the fear of being stigmatised after falling victim to indiscriminate sexual violence due to socio-cultural norms that frown on women being openly expressive in their sexual exploits (37). Again, they most likely will not patronise sexual and reproductive health services despite the availability of such services to them because they do not want to be part of the statistics. These observations prompted some researchers to advocate putting the life course into view as an important factor in understanding the aging process of migrants (38). Their finding was supported in the recommendations made in a separate study that suggested a conscious effort at nurturing health throughout the course of life, believing it will favour its operationalisation and optimise population health (39). If an underserved community of international students is to benefit from more strategic interventions, timely support programmes, and basic to the development of optimal health will be necessary. By paying particular attention to those emerging trajectories and processes that are most significant to prevalent adult patterns of illness and developing effective ways to address them, researchers can use life course interventions to propel health trajectories on their right track and further optimise them (40) through integrated multifaceted approaches (41). In doing so, the gaps created by inadequate supplies in the face of increased demands of international students, specifically those in Hungary, will reduce the inequalities recorded in this study (42).

Regarding participants’ region of origin, our findings showed that those from Central and Southern Asia experienced an improvement in health while in Hungary. Regrettably, the ones from Europe and North America reported deteriorated health after relocating to Hungary. Eastern Europe, of which Hungary belongs, is reported to have the highest odds ratio of poor health concerning nativity. The perception that long stay abroad impacts migrant’s health negatively was confirmed by Lanari and Bussini (43), and was evident in the number of semesters participants had spent in Hungary and its related consequences on their health. Some other reasons for this outcome could be a result of the variations in how UHC is perceived and implemented in these destinations. Almost every country in Western Europe is said to have universal health coverage, and so is Hungary (44). The disparities with the region of origin could be partly due to differences in the culture of the people (45).

In terms of education, respondents with high school certificates also experienced poor health relative to respondents at other educational levels. These findings were backed by a study that found graduate students usually exhibit greater levels of resilience than undergraduates. In the context of religion, the health of Muslims improved while that of non-believers deteriorated. Religious beliefs may not be empirically proven. Nevertheless, they have an impact on those who practice them. According to Karl Marx, religion is “a fantasy that allowed people to blame their degraded lives.” In an elaborate expression, Marx stated, “Religion is the sigh of the oppressed creature, the heart of a heartless world, and the soul of soulless conditions. It is the opium of the people” (46). Strangely, religion rather moulds the beliefs and behaviors of practitioners and has been confirmed that religiously practising its doctrines improves the impact of health interventions (47, 48). Non-believers, on the other hand, hang on to no supreme force as backup for encouragement, hence their inability to resist stress, hence the deterioration of their health as reported in this study (49). The Islamic faith, to a large extent, incorporates concepts of health beliefs, health tips, and social care into practice (50, 51) and even promotes mental health after traumatic experiences, as observed in the outcome (52).

The study also revealed there was a significant relationship between differences in gender, origin, educational and religious backgrounds, and participants’ health status after migrating to Hungary. This could be a result of their physical and psychological make-up manifesting in their adaptability in their new environment. In the context of existing literature, sociologists have explained that associations between demographic characteristics, sociocultural adjustment, and psychological wellbeing accounted for changes in different sociocultural spheres of growth along the life course and were the most precarious for the psychological wellbeing of immigrants. In the absence of apparent factors such as discrimination, predictions of depression can be made from participants’ responses. Consolidating our findings is the conclusion drawn by Counted (53) that sociodemographic factors remain important variables for discussing the sense of place after they investigated the sociodemographic associated with attitudes toward specific geographic settings of migrants in general.

Considering the kind of medical services sought by students as captured in Table 3, visits to the GP were mainly because of infections (132, 32.8%) and chronic illnesses (60, 14.9%). Juxtaposing these proportions to the total number of participants, approximately 50% of international students had health issues after settling in Hungary, an outcome synonymous with existing literature (54). Proponents of migration health have long advocated interventions for persons in motion over long distances with limited access to healthcare services. They further buttressed their stance not only in line with philosophies underpinning anthropological reasoning but also with empirical evidence of changes occurring in the human body during migration. Unfortunately, the gap between health promotion and disease prevention activities remains wide among vulnerable populations such as foreign students (55). Reasons accounting for the high numbers of infections can be attributed to the COVID-19 pandemic. Suffice it to say that the baseline data of international students were established at the time they arrived in Hungary. The adequacy of how much personal space each student had to themselves in their various dormitories or apartments of residence, lecture rooms, or theatres may have also provided the vehicle that worsened the already volatile, contagious situation. Conditions might have also been compounded by the unexpected influx of a marauding crowd spilling over from the Russian–Ukrainian war when Hungary, in that trail-blazing humanitarian gesture, gave room to the masses fleeing an acquisitive pandemonium (56). Records even confirm that Ukraine has lower SARS-CoV-2 vaccination rates than Hungary, hence a greater possibility that some spread must have resulted from that emergency infiltration (57).

Migrant students in Hungary living with chronic diseases are often disadvantaged, as chronic illnesses require a lifetime of medical treatment management for optimal health. Therefore, delays in accessing timely care are a way of silently courting complications; thus, the fear of the unknown may pose a mental problem to some participants in the study (58). The situation as it stands paints a gloomy picture of the health needs of international students. This finding complements the observation of Mucci et al. (59), who, after their systematic review on the psychological health of migrant workers, uncovered that disorders emerging chiefly from the research were low concentration at work, depressive moods, and anxiety. These were conditions arising from marginalisation, amongst others, for which commitment to occupational medicine would be a wholesome remedy in vanquishing those occupational triggers.

As shown in Table 4, respondents’ estimation of cultural barriers and misunderstandings becoming an impediment to healthcare access in Hungary was tipped for “very much” at 12.5% and somewhat at 30.6%, altogether 43.1%. This figure is greater than the stakes for “neutral”, “not really”, and “not at all” (17, 5.9 and 5% respectively). The expression of international students’ opinion regarding this outcome simply communicates their desire to see and benefit from a multi-culturally oriented health service. Hitherto, they had indicated by popular affirmation that they trust care professionals in their home country more than they do for caregivers in Hungary; a clue for Hungary to run with in allaying the fears of foreign students by birthing its success of an enviable multiethnic health hub within the EU that will draw not only the patronage of international students but the broader community of Europeans within its sub region. But the situation confronting international students in Hungary may not be an isolated case. There is diversity and a lack of integration regarding healthcare provision across Europe due to policy differences between healthcare systems and social services, leading to poorly coordinated outcomes (60). Migrants in general are susceptible to chronic physical health conditions and mental health (61). For this reason, the WHO charges all countries to build robust and resilient healthcare system of sound quality that responds to the needs of all members in their population, including those who are vulnerable, e.g., refugees and migrants (62). Healthcare that is comprehensively and equitably reachable must be provided for these student migrants in national contexts and respond to intricate and emerging individual needs (63). The commitment towards actualising this goal is the heartbeat of the World Health Organisation in the European region, even to the point of demanding the inclusion of undocumented migrants in an integrated healthcare plan for the entire population (64). Lack of funds and of a trained and stable workforce, organisational shortfalls, and poor synchronisation of activities across the different horizons of management hinder the provision of healthcare for migrants (31). Reflecting on the high numbers of international students in dire need of healthcare amid such rich and caring continental provision, more will have to be done for the population of foreign students by the Hungarian institutions as a matter of duty and global prospect.

The findings in Table 3 echo a void in the target of having every member within the international student community satisfied with the freedom to access healthcare at their own will when deemed right by them. While some got it always and others had it in most cases, there were those who never had a chance. Factually worrying is the realisation that a staggering 14.6% of these students never got the services they required, an outright contradiction to the WHO’s fight of leaving no one behind as far as universal health coverage is concerned (5). By design, several factors have been implicated as common hitches that buffet international students. Our finding is supported by a study conducted in Hungary to compare the prevalence of acute infection and seropositivity of SARS-CoV-2 among healthcare workers (HCWs) and medical students. A total of 1832 students recruited in a study (53%) were international students, while 682 (20%), Hungarian students had a lower prevalence of seropositivity. High prevalence was recorded among international students (65). By the proportions, an assumption can be made that more international students would need a doctor’s attention than domestic students would. In effect, seeking medical attention is the fulcrum around which recovery evolves (66). Unfortunately, it appeared that affected students encountered some obstacles in reaching out for these services. A simple prediction of the underlying cause may be alluding to bureaucratic and management issues rather than geographical or infrastructural causes (67). Deprivation suffered by the overwhelming numbers may have unleashed a greater burden of the contagious respiratory infection on the population. Even so, though bureaucratic demands were necessary, in some jurisdictions, a call was made to suspend bureaucracy in the provision of essential services during the pandemic because of its time-consuming demands as part of global efforts to nip the spread of infection in the bud (68). Possibilities of racial and ethnic discrimination cannot be ruled out in interrogating the reasons why those concerned were not given the chance, if the results are anything to go by. Authors have remarked that although instilling moral values in students is appropriate, strategic investment for the futuristic goals of a healthy population is necessary to sustain multiracial student communities (69). The need for primary prevention in mental health should be examined closely by policymakers worldwide (70), with a focus on both individuals and groups, since peculiarities in challenges may exist, as an international student may not be directly affected but may be a member of a group severely underserved (71). Formidable in confirming this outcome is the unbiased, unpolarised, and dispassionate follow-up exploratory study of Atiku and Adofo (72) that unearthed the difficulties international students encountered in their various attempts at accessing healthcare services in Hungary. Their findings were also corroborated to a large extent by Lannert and Derenyi, who recorded similar findings for which they recommended a shift of focus from mobility to quality (73).

Health insurance solves the problem by half, covering the cost of consultation, examination, and diagnostic procedures as indicated in the Stipendium Hungaricum scholarship package for all beneficiaries. The absence of insured health simply means inaccessible healthcare (74). According to the Hungarian Central Statistical Office, 11.4% of the entire student population in institutions of higher education are international students. Out of this, 4.4% are Stipendium Hungaricum scholarship holders. This implies that a significant 7% of foreign students may either be beneficiaries of other forms of scholarship or self-funding. Secondly, self-funding students are, by regulation, under an obligation to ensure their health during the admission process. Deductively, some form of insurance coverage must have been in place for every single student. Therefore, the ‘obstructed’ access to services for international students depicted in Table 3 could be related to reasons other than health insurance coverage (75). As a minority group in a foreign country, coverage of the population concerned and the kind of services accessible to members are usually limited, as revealed in current scientific literature (76). It has also been on record that without health insurance, it is usually difficult and almost impossible for students to bear the full cost of cash and carry, the reason for which institutions arrange for affordable insurance services for their students. It is a global phenomenon that visiting a specialist and receiving some treatment could cost so many dollars in the United States, while a hospital stay of only three days could cost about 10,000 dollars. Interestingly, the average cost of healthcare in Hungary for international students is between 200–300 EUR per year. Relatively, Hungary offers an affordable alternative; nonetheless, it could be challenging for a lot of foreign students. Weighing the options available, consequences for denied access are ominous and devastating since essential services like vaccinations and management of critical conditions risk being missed and complicated (77). The TAJ card, however, covers basic ophthalmic and dentistry services such as consultation and examination fees, but not prescriptions for lenses or aesthetic procedures, thereby precipitating a limiting factor to accessing complex services (78).

The stakes were high (39.7%) on the Likert scale in estimating that language barrier and the lack of qualified interpreters are impediments to accessing healthcare in Hungary. Study participants indicated language was their most significant barrier to accessing care through the ratings of the possible options among 14 other variables in its category. It has been noted in other studies that suggest international students were not able to effectively communicate socially and academically, a situation that retarded their ability to acquire new conversational skills in their host country. Indeed, the same observation has been made in this study. This assertion was corroborated by Ibragimova and Tarasova (79), who conducted a study on language-related problems of international students in a Russian university and concluded that international students in non-English speaking countries contend with the challenges of language difficulties. The Hungarian society is mostly condensed in its local language. A significant 98.9% speak Hungarian, English 25.3%, German 12.6%, Russian 2.1%, French 1.5%, Romanian 1.4%, and other 5.1% (80). Unfortunately, the process of patient-caregiver communication is hampered by a strong language barrier. This deficit negatively impacts the quality of care that is rendered or received. There are potential risks to students’ health if their health context, language, and beliefs differ significantly from the understanding of health in the Hungarian context. Misunderstandings can occur, and delays in diagnoses pose a threat to their health and safety unless assistance is sought from people who speak both languages. Until then, the integrity of privacy and confidentiality may be seriously compromised (81). In summary, the importance of this challenge was admitted in the honest confirmation made by Lannert and Derenyi: “Half of the respondents think that insufficient foreign language competence of students, lecturers and the administrative staff is the most important obstacle to internationalization in higher education. The second most frequent mention was shortage of funds. About one in four respondents mentioned structural problems and problems with human resources” (73). Resorting to medical interpreter services for foreign students in Hungary may be a means, agreeably (82). However, to correct this cacophony, hospitals in Hungary should be making use of language translator applications that suit this digital dispensation. Introducing a mandatory language training for international students in the first 6 months of their studies, as it is with countries like Germany, is likely to improve the current situation (83). The findings of this study bear consequences for both the international students’ community and their host country, Hungary. The first point of intervention should be a step towards standardising care and introducing some flexibility in the bureaucratic processes that Lannert and Derenyi (73), described as rigidly unproductive. Improving outcomes should be achieved by phasing out old-fashioned practices that sink the efforts of well-meaning caregivers and pushing for regular research-informed interventions to redefine healthcare in a modernised and acceptable fashion. Secondly, the distinction between perceptions and perspectives will require a concentrated and coordinated commitment from an interdisciplinary health industry team (84).

Through the identification of credible associations among variables and the formulation of specific, testable hypotheses that can be evaluated in a structured or comparative design, novel research studies can be engineered from the findings of this research. Included are the following:

Descriptive studies, which will add meaning to the numbers depicting the prevalence of barriers to access in the exploratory phase, with a follow-up comparative study that examines how access differs across demographic groups or geographic regions. In essence, public health specialists can conduct intervention studies that test strategies to improve access, based on the empirical acumen benefited from this current study should be greatly considered in: