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Background The NHS Charges to Overseas Visitors Regulations 2015 outline when healthcare costs should be recuperated from overseas visitors in England. National and global stakeholders have expressed concerns that charging may exacerbate health inequalities and undermine public health efforts especially among vulnerable migrant groups. This review aims to systematically describe the evidence regarding the impact of NHS charging regulations on healthcare access and utilisation and health outcomes for migrants in England. Methods A systematic search of scientific databases and grey literature sources was performed. Quantitative and qualitative studies, case studies and grey literature published between 1 January 2014 and 1 April 2021 were included. Screening, data extraction and quality appraisal were carried out in accordance with PRISMA guidelines. Results From the 1,459 identified studies, 10 were selected for inclusion. 6 were qualitative, 3 were mixed methods and 1 was quantitative. The evidence is lacking but suggests that fears of charging and data sharing can deter some migrants from accessing healthcare. There is also evidence to suggest a lack of knowledge of the charging regulations among patients and healthcare professionals is contributing to this deterrence. Conclusions Further independent research supported by strengthening of data collection is required to better understand the effects of charging on healthcare and health outcomes among vulnerable migrants. Our findings support improved training and communication about NHS Charging Regulations for patients and professionals.

Afghans who have fought to bring health and justice to the country in their roles as officials, health professionals, non-governmental workers, activists, artists, and journalists are being persecuted once again through the Taliban's door-to-door and social media searches.1 Afghan civilians continue to be direct and targeted victims of the armed conflict as violence soars2 and there are substantial health, humanitarian, and protection needs in the country, which field reports from WHO highlight are increasing in areas where people have been seeking safety and shelter.3 Humanitarian and health organisations report large internal displacement of people in Afghanistan, with more than 500 000 people displaced in total4—250 000 of these since May, 2021—and 80 000 children displaced in the past 2 months alone;4,5 decreased access to health care;6 interruption to essential health services; and increased health needs directly generated by the conflict, which the UNHCR emphasised must not be forgotten.7 These effects are felt disproportionately by the most vulnerable groups in Afghan communities, such as pregnant women, children, individuals with disabilities, and those belonging to other marginalised communities. Over the coming months, there is a significant risk that the collective efforts invested by successive ministers and others, including Afghanistan's Ministry of Public Health, provincial authorities, health-care providers, international donors, and NGOs, in humanitarian aid, service delivery, and strengthening of the health system in Afghanistan will be lost. Before August, 2021, mental health services in Afghanistan were limited in availability, under-resourced, and under-staffed, especially for mental disorders related to gender-based violence.19 The psychological trauma experienced will need to be addressed using culturally appropriate services20 to prevent long-term mental health disorders and further psychological wounds of war.