Methodological paths of research on the socio-sanitary repercussions of COVID-19 among international migrants in Brazil

Abstract

This experience report presents the process of building and maintaining a multicenter, transdisciplinary network of researchers in transnational migration and health in COVID-19. We describe the challenges in the process, the organization of methodological strategies, the work processes, the contributions of the actors, and the limits and potential. In the multisite research in six states, we identified problems with health and illness, access to health services, and social protection for international migrants and refugees during the pandemic. This report on the planning and execution process highlights the complexity of design from a theoretical-methodological perspective, provoking reflection and unique decisions. The collective experience seeks to contribute to qualitative, multicenter, and interdisciplinary research on international migration from the Social Sciences in Public Health.

Keywords
Methods; Interdisciplinary placement; Multicenter study; Migrants; Public Health

Resumo

Este relato de experiência apresenta o processo de construção e manutenção de uma rede multicêntrica e transdisciplinar de pesquisadores no campo das migrações transnacionais e da saúde no contexto da Covid-19. Descrevemos os desafios no processo, a organização das estratégias metodológicas, os processos de trabalho, as contribuições dos atores, bem como os limites e as potencialidades. Na pesquisa multissituada em seis estados no Brasil, identificamos problemáticas em saúde e no adoecimento no acesso aos serviços de saúde e proteção social por migrantes internacionais e refugiados durante a pandemia. Nesse relato sobre o processo de planejamento e execução, evidencia-se a complexidade do design na perspectiva teórico-metodológica provocando reflexões e decisões singulares. Com a experiência coletiva busca-se contribuir para a pesquisa qualitativa, multicêntrica e interdisciplinar com foco nas migrações internacionais por meio das Ciências Sociais em Saúde na Saúde Coletiva.

Palavras-chave
Métodos; Práticas interdisciplinares; Estudo multicêntrico; Migrantes; Saúde Coletiva

Resumen

Este relato de experiencia presenta el proceso de construcción y mantenimiento de una red multicéntrica y transdisciplinar de investigadores en el campo de las migraciones internacionales y la salud, en el contexto de la pandemia de COVID-19. Describimos los desafíos en el proceso, la organización de las estrategias metodológicas, las contribuciones de los actores, así como los límites y las potencialidades. Durante la investigación multisituada realizada en seis estados de Brasil, identificamos problemáticas de salud y enfermedad, y en el acceso a los servicios de salud y de protección social, por parte de migrantes internacionales y refugiados en el contexto de la pandemia. Mediante la experiencia colectiva, evidenciamos la complejidad del diseño de la perspectiva teórico-metodológica, buscando contribuir a la investigación cualitativa, multicéntrica e interdisciplinar focalizada en las migraciones internacionales, a partir de las Ciencias Sociales y la Salud Colectiva.

Palabras clave
Métodos; Prácticas interdisciplinarias; Estudio multicéntrico; Migrantes; Salud Colectiva

Introduction

The challenges to elaborate a research methodology that integrates the humanities and social and health sciences are diverse. In general, the results depend on a design resulting from extensive reflection on the research objectives and the means to achieve them. These challenges become more complex when the experience involves researchers from different Brazilian states and nationalities, in a post-pandemic context, who study a population whose main characteristic is international mobility.

Multicenter studies are not exactly a novelty in the field of collective health¹-⁴. The development of qualitative research of this nature has specificities enhanced in interdisciplinary and multicentric investigations. The field in different locations, both geographically and from a sociocultural and economic perspective, makes it necessary to consider the dimensions and peculiarities of the territorial contexts where migratory processes develop and reproduce, as well as the necessary understanding of the scalar issue of cities and migrations⁵.

Based on the research “Access to health and vulnerabilities of international migrants in the context of the spread of COVID-19: an interinstitutional research in a collaborative network”, this report highlights the process of building and maintaining a multicenter and interdisciplinary network of researchers in the field of transnational migration and health. The research identified health and illness processes, access to health and social protection services for international migrants and refugees in the context of the COVID-19 pandemic, between 2022 and 2024, in six states: Amazonas, Mato Grosso, Minas Gerais, Paraná, Santa Catarina, and São Paulo.

The research articulates a national and international network of researchers with diverse backgrounds and experiences in the field of Public Health. Guided by dialogue and reflexivity as fundamental to its establishment, the network made efforts to elaborate methodological paths and addresses global and regional dimensions of transnational migration processes with a focus on health.

In this report, we describe the challenges faced in this process, highlighting the organization of the theoretical and methodological strategies of the research, the work processes, the contributions of the various research actors, consultants, and scholarship holders, as well as the limits and potential of this endeavor. It is an original and unique project. The description and registration of this collective experience seek to contribute to multicenter and interdisciplinary qualitative research based on Health Social Sciences in Collective Health, focusing on transnational migration processes.

We present the processes that involved the elaboration and the choices necessary for a multicenter and transdisciplinary qualitative research⁶,⁷, in a collaborative network, simultaneously operating in different research centers across six Brazilian states, highlighting its potential, challenges, and limitations. The report highlights the intellectual craftsmanship, to resume the Mill’s⁸ classic formulation, in which researchers, with a long career in research on the interfaces between health and migration, contributed with their perspectives and their life experiences to fine-tune the methodological tools of the study. This is a complex methodological proposal, which brought reflections and unique decision-making in the specificities of the research, in the post-pandemic context. It is a shared experience because of its originality and the need to contribute to the large area of Public Health, detailing the challenges related to how this project is run.

Brazil in the scenario of forced migration and health

According to the Global Trends report⁹, by the end of 2023, 117.3 million people worldwide have been displaced as a result of persecution, conflict, violence, human rights violations, or events that seriously disrupt public order. According to estimates, there was an increase of 8.8 million (8%) people displaced compared to 2022. Brazil is the choice of many migrants due to two important legal pillars based on Human Rights: the Refuge Law (Law No. 9.474, of July 22, 1997) and the Migration Law (Law No. 13.445, of May 24, 2017). These laws allow access to document regularization such as refuge, residence, work visa, permanent residency, among others, also, including them as subjects of rights. Brazil has been a reference in humanitarian reception, and, more recently, because of the Venezuelan displacement. It is also a route or destination for many forced immigrants, mainly from South and Central American countries (Bolivia, Peru, Haiti) and African countries (Congo, Senegal, among others). The National Migration System (SISMIGRA), of the Federal Ministry of Justice-Federal Police, registered from 2011 to 2022 the increase and capillarity of 1.5 million migrants, also adding the records of asylum seekers¹⁰. In 2022, there was an increase of almost 90% in the issuance of entry visas (total of 94,525 visas). Venezuelans and Bolivians were the nationalities that most requested residence in 2022¹⁰.

Health stands out as an essential right in the context of migrant integration¹¹-¹³. In Brazil, there is no specific regulation for access to health by immigrants and refugees, but the normative principles of the Brazilian Federal Constitution and the Organic Law of the Brazilian National Health System (SUS) do not prohibit universal and free access to health services in the SUS, regardless of the regularized state¹⁴. Several studies have shown the experiences of immigrants with the health system in Brazil¹³,¹⁵,¹⁶.

Researching migrant populations and COVID-19

The exposure of the population to COVID-19 has accentuated existing social inequalities, enhancing the vulnerabilities that can unequally affect populations in displacement¹²,¹⁷. In different ways and intensities, international migrants and millions of Brazilians share suffering originated or aggravated by the spread of the virus and illness. Economic policies that consider social inequality as a positive value have contributed to an exacerbated and avoidable number of deaths as a result of COVID-19¹⁸,¹⁹. In the COVID-19 pandemic, international and Brazilian human mobility was severely affected¹². The closing of borders, restrictive contact measures, and the visa-granting policy¹² caused the interruption or postponement of migratory projects.

Thus, the research was designed to identify the problems related to health and illness, access to health and social protection services for international migrants and refugees in the context of the COVID-19 pandemic, in places with an important presence of these groups in Brazil.

The field of research was developed from 2022 to 2024 with the following general objectives: 1. To identify the problems related to access to health and social protection of international migrants and refugees; 2. To contribute to public policies in relation to the needs of this population in the context of the COVID-19 pandemic. The study design is a qualitative, multicenter, nationally multisite research²⁰ and articulated with a national and international network of researchers.

<b>The constitution of the network of researchers</b>

A research network is not established by chance. It is the result of meetings at events, thesis and dissertation supervision, participation as committee members, joint publications, and the creation of work bonds permeated by affectional bonds. The presence of excellent researchers in the team is not enough to develop high-quality scientific work. Teamwork requires people with the skills and abilities to work together.

The national network^(h) was established by reaching out to researchers with expertise in transnational migration and health, as well as in studies in the field. They conducted relevant scientific studies, research with migrant groups and health services, as well as university extension projects. In their paths, they have graduated in Anthropology, Sociology, Psychology, Physiotherapy, Medicine, Nursing, Nutrition, Social Work, and History, and all have experience in qualitative methodologies with different theoretical approaches. The three consultants are researchers in international centers in Argentina, the United States, Spain, and Portugal. The initial team consisted of ten researchers, a coordinator, a deputy coordinator and three consultants. There are nine women, including the coordinator, two self-declared migrants, a black female researcher and internal migrants. The network is now larger, with 32 people, and has researchers from each state: either Scientific Initiation students, Master’s, Doctorate, and Postdoctoral fellows, and professors, including two technicians.

Our interlocutors are international migrants, people in situations of refuge, representatives of associations and organizations (confessional or secular; reception or health care) of civil society that work with international migrants, health service workers, and public managers (local and regional) in the health sector.

Tensions and mediations of teamwork

We present three fundamental aspects to develop network research: organization and working mode; theoretical-methodological processes that guided the choices and heterogeneity of migrant groups.

Planning and document production required virtual and remote work strategies, e-mail communications, message exchange and synchronous videoconferencing, supported by a virtual library, research protocol, and process records and training materials.

We decided that we would prioritize the participation of migrants in the survey. However, it was necessary to define which nationalities would be included, whether an inclusion criterion would be the time they were in Brazil and whether we would make any division by gender, age, and education. Despite the presence of diversity of nationalities in each state, we defined interviewing migrants with a greater local presence, justified by historical, demographic, economic, and social criteria. Gender was one of the division criteria because the impacts of the pandemic could be different. The argument was based on the repercussions of the impact of restrictions, such as: children not attending school, partners with altered income and work dynamics, changes in domestic organization and resources, and, in short, in how women’s reproductive work was affected²¹. In the workplace, women suffered the greatest impacts during the COVID-19 pandemic¹²,²¹. Many also faced violence at work or in the domestic environment²².

Field research took place in two stages. In the first stage, along with the production of data and materials from different sources, 84 international migrants (with and without refugee status) from Venezuela, Haiti, Syria, Colombia, Bolivia and Angola were interviewed in the six states. In the second phase, we conducted in-depth interviews with 36 different actors (healthcare professionals, public managers and representatives of Non-Governmental Organizations). For each group, a specific roadmap of guide questions was produced.

In total, 120 in-depth interviews were carried out, in addition to the contextualization of each research location, sociodemographic characterization of the participants and contextualization of the situation of each interview. Sociodemographic data on municipalities and contamination by COVID-19; epidemiological characteristics of migrant populations; photos, Google Maps images, graphs, official and unofficial information; nationalities and history of migratory flows, as well as economic activities and insertion of migrants and public policies, were also aggregated.

The appropriation of the project topics, objectives, and methodological procedures were reviewed based on local experiences and adapted for the development of field research. The project was outlined under the theoretical and methodological axis of Anthropology, from the perspective of transnational migration¹¹,²³,²⁴.

The academic context of the participants and their research projects revealed differences throughout the meetings, expressed in questions and concerns. While performing the tasks, the interaction of the diversities of qualifications, lines of research and different contexts of migratory flows was constant. The challenge was to recognize the differences (in the various plans described) and foster bridges and identities. This process, present in all decisions, from bureaucratic to theoretical-conceptual, had several developments, shown below.

In addition to the diversity of academic training in the composition of the group, an important aspect is the context in which the participating universities are inserted and how the research projects on migration and health are developed. We discovered these differences throughout the meetings and in the questions and concerns that arose.

In São Paulo, for example, migratory flows have a specific dynamic related to potential labor market opportunities and public policies at the municipal level that promote the social integration of migrants. Many civil society organizations focus on migrants²⁵. The group of researchers has training focused on Social Sciences and Humanities. In the case of Minas Gerais, the researchers have expertise in occupational health, with a degree in Physiotherapy and a doctorate in Public Health. Migrant worker health is a strong line of research.

Throughout the development of the tasks provided for in the project, we had the constant provocation to deal with different academic and theoretical qualifications, lines of research, places and contexts of different migratory flows.

The debate on field research was permeated by differences and similarities. At the beginning of the process, a virtual file was created in which each Center described the socioeconomic and cultural context of the research site. Meetings were held to define a base field in which the research would be carried out.

Although the researchers knew the anthropological perspective of the project, they did not necessarily have training in this area. We seek an approximation with the qualitative field experiences of the various local coordinators, respecting the original training. The techniques were chosen because they are as close as possible to a contextualization of the field close to an anthropological approach, with contributions from previous experiences of researchers in studies with international migrants.

As an example, we cite the in-depth interview script with migrants. Faced with the need to review local and general analysis, a committee of researchers from each state prepared the script later improved by the network, based on interdisciplinarity, local contexts, and migratory flows, and the renunciation of strictly local objectives.

Field research techniques included in-depth interviews with a semi-structured script, contextualization of the field, and the interview situation.

In general, the project development structure was organized into permanent but not strict committees, which allowed for: (1) optimize standardize, and monitor the processes and ensure the quality of the work, (2) ensure compliance with the internal schedule and that of the funding agencies, (3) produce instruments and documents (scripts, ICFs, field reports, etc.), and (4) hold knowledge-sharing events. Under the leadership of the management group, researchers were assigned to committees for report production, accountability, interview scripts, event organization, and discussion of results. In the periodic meetings, planning, production and knowledge transfer were articulated. Each Working Group consisted of the staff of a state, and the Committees were not geographically delimited. With the development of the field and the dimensions reached by the team, each group assumed the conduction and quality verification of the research, decentralizing the responsibilities and, at the same time, respecting local differences.

The development of field research with migrants coincided with the political scenario of presidential elections in the country in 2022. In most states, interviews were conducted within the planned schedule. Some delays occurred because of xenophobic discourse and fear of migrants positioning themselves in the scenario of political polarization. There was difficulty in contacting participants and in having them agree to participate in the research, which is evidenced by the distrust and avoidance of some migrants. Also, their poor labor conditions made it difficult to carry out some interviews. The schedule was restructured without compromising the overall development of the project, which was approved by the Research Ethics Committee of the Federal University of São Paulo 0424/2022 opinion No. 5.452.965, Amendment 5.939.048.

It is important to highlight that the research produced narratives of the recent past of international migrants and other actors²⁶. Likewise, the socio-political and historical context, briefly described here, is fundamental to understand some difficulties of the research and consider these issues in the analyses.

The World Health Organization (WHO) published a statement declaring COVID-19 was no longer a Public Health Emergency of International Concern on May 5, 2023 (PHEIC), when Brazil reached 37,519,960 confirmed cases and 700,494 cumulative deaths from the disease (as of May 6, 2023)²⁷.

The Brazilian Ministry of Health published Ordinance No. 913 on April 22, 2022, declaring the end of the ESPIN (Public Health Emergency of National Importance) caused by Covid-19²⁸. This occurred more than a year before the WHO, showing the mismatch between the measures taken nationally and what was recommended by the WHO during the pandemic.

The literature shows that the Brazilian government’s response to the pandemic were disastrous. Studies show that there was a strategy to spread Covid-19, promoted systematically at the federal level²⁹-³². Ventura et al.²⁹ present a timeline of the federal strategy for spreading the disease, highlighting the intentionality of spreading the virus in the country. Ortega and Orsini³³ also highlight the lack of coordinated national policies to contain the spread of the virus, the dissemination of fake news about the vaccine, the delay in decision-making at the federal level, as well as the denial of science in the impact on this result³³. Consequently, fatalities were concentrated in vulnerable populations³⁴.

The socioeconomic, historical-geographic, political and cultural context of each research location has its own dynamics. Although the same nationalities are present in different places, it is essential not to generalize migrant groups and their particularities. For example, before the COVID-19 pandemic, the flow of people from Venezuela to Brazil had been intensifying and, between 2015 and 2017, it was increased by 922%, when 609,049 Venezuelans were welcomed, of which 345,574 left the country³⁵. Although there is a presence of these people in the various fields of research, the analysis of similarities and differences occurred in the analyses.

The pandemic also had important impacts on different migratory flows¹². The participation of migrants from Bolivia, Haiti, Syria, Venezuela, Colombia and Angola in the research allows for the visibility of these differences and similarities. Local migratory processes and flows are considered in their movements and in light of the impacts of the pandemic on ways of life, care, and social insertion.

Conceptual theoretical support in facing these challenges is fundamental, especially when faced with the need not to “naturalize” nationalities and nations, as if they were homogeneous and harmonic groups²⁴,³⁶. Additionally, people migrate at different historical, political, and economic moments. This highlights the need to move beyond cultural approaches that can perpetuate racial and ethnic differences³⁷.

These issues, among others, were present since the conception of the project, the organization of methodological strategies, the performance of field and documentary research, as well as in the analysis.

The analysis of the material referring to migrants was organized into two dimensions. The first is a local analysis, carried out in each research center. Given the differences in theoretical approach and lines of research, we decided that local researchers would straightforwardly work with the material to respond to the proposed objectives. The second is an analysis of the material collected from all groups. Three senior researchers carried out this analysis with the help of an organization and pre-analysis software for qualitative material. We chose a descriptive analysis of the material because of the size of the material, which is about 2,264 pages of interview transcripts with migrants.

The software analysis was preceded by the development of codes and based on the references to the topic under investigation, the expertise of the researchers, and the field of research. The material can be organized both by place where the interviews took place and by category (theme or code), which will allow establishing dialogue and deepening similarities and differences. As a result, we hope to get an overview of what happened in the pandemic with these migrants in various contexts.

Final considerations

The development of a qualitative research with this design presents theoretical-methodological and management challenges that are in constant negotiation. The results have presented part of the diversity and complexity of the impacts of the pandemic on the lives of these groups.

We highlight some aspects for the development and outcome of this research. The diversity of training and work mode of researchers is a stimulus to the exchange of different experiences and learning. Information technology is a tool that has made multisite research possible, even during the pandemic in 2022. We have shared practices, experiences, documents, interviews, texts produced, among others, reinforcing the relevance of shared and transparent work.

The local analysis of each nucleus and the global analysis through software offered a set of knowledge built in the course of the research. We heard the experiences, strategies, and dramatic issues experienced. Field research, as close as possible to the life experiences of migrants and other actors, allowed us to understand not only the distinct vulnerabilities of these groups in the pandemic, but the protagonism and solutions built.

The interdisciplinary perspective of this research explained epistemic differences, methodological challenges, complementarities, and divergences that show the relevance of a reflective and critical stance on the different disciplinary sensitivities³⁸.

Acknowledgements

We would like to thank the interlocutors of our research, international migrants, and professionals who work with this population, the graduate program in Collective Health of the Federal University of São Paulo, the financial support of FAPESP and CNPq and all the researchers who participated in this project.

• Martin D, Silveira C, Inoue SRV, Goldberg A, Almeida ACG, Siqueira CE, Granada D. Methodological paths of research on the socio-sanitary repercussions of COVID-19 among international migrants in Brazil. Interface (Botucatu). 2025; 29: e250653 https://doi.org/10.1590/interface.250653
• Funding
  São Paulo Research Foundation (FAPESP, process n. 2021/06792-2) and the National Council for Scientific and Technological Development (CNPq, process no. 403913/2021-7 and 305522/2022-1- PQ 2 Scholarship, Denise Martin)
• (h)
  The project’s participating institutions are: Federal University of São Paulo – Unifesp and Faculty of Medical Sciences of Santa Casa de São Paulo (SP); Federal University of Santa Catarina and State University of Santa Catarina - UDESC (SC), Federal University of Mato Grosso – UFMT (MT), Federal University of Uberlândia – UFU (MG), State University of Londrina – UEL (PR), and Fiocruz (AM). The international consultants belong to Consejo Nacional de Investigaciones Científicas y Técnicas (Conicet, Argentina) and University of Brasília – UNB, University of Massachusetts Boston (USA), and Emory University (USA).

Data Availability

The contents underlying the research text are included in the manuscript.

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Edited by

• Editor
  Rosamaria Giatti Carneiro https://orcid.org/0000-0002-1271-7645

• Associated editor
  Catarina Delaunay https://orcid.org/0000-0001-9679-0681

Publication Dates

• Publication in this collection
  27 Feb 2026
• Date of issue
  2025

History

• Received
  31 Oct 2024
• Accepted
  11 Sept 2025