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In 2015, more than 890,000 asylum seekers were registered in Germany. The provision of medical and psychosocial care for asylum seekers is facing numerous obstacles. Access to health care is mostly insufficient, particularly in initial reception centres. The present article describes the development and implementation of an interdisciplinary outpatient clinic for asylum seekers at the main registration authority in the state of Baden-Wuerttemberg operated by physicians of the University Hospital of Heidelberg and the local Medical Association in Heidelberg. A steering committee was appointed to plan and implement the interdisciplinary outpatient clinic. Semi-structured interviews with nine steering committee members were conducted to elucidate perceived barriers during the planning and implementation phase. The steering committee's strong personal commitment and the health authorities' impartial management were cited as the main contributing factors to the success of the implementation process. Significant barriers were seen in the funding of personnel, equipment, and language mediation as well as in legal liability and billing-related aspects. Results are discussed with a focus on financing, administrative and legal framework as well as language mediation, documentation and further matters that are essential to ensure high-quality care.

In 2015 Germany received more than 476 600 asylum applications.1 Incoming asylum seekers are accommodated in reception centres (RCs) for up to 6 months before they are dispersed to other federal states or districts. Due to the high immigration since the end of 2014, many federal states established new RCs to expand their capacities in hosting asylum seekers. Baden Wurttemberg, for example, one of the largest federal states receiving about 13% of incoming asylum seekers, expanded its capacity from one RC up until 2014 to five RCs thereafter. Since there are no nationwide standards in place, healthcare provision in RCs is highly heterogeneously organised and fragmented.2 In Heidelberg, former barracks of the US army were reorganised as an RC in August 2015 and hosted about 6500 asylum seekers. The concentration of asylum seekers in the RC, linked with insufficient provision of primary health care, led to an unmanageable number of consultations in emergency departments of nearby hospitals. Asylum seekers have specific healthcare needs due to exposure to pre-, peri-, and postmigration health risks. These include traumatic events,3 endemic infectious diseases in the countries of origin or transit,4 and chronic conditions which may have been exacerbated during the migration process. They are also at higher risk of developing psychological distress5 and acquiring infectious diseases in the host country due to mass accommodation.6 To address both the shortcomings in primary care provision and the special needs, a walk-in clinic jointly led by the university hospital, the public health services, and the local physicians’ association was established in the RC with funds from the state government and the university hospital. The clinic provides general medicine as well as gynecological, paediatric, and psychiatric and psychosomatic health care. The aim of this article is to report challenges and solutions of …