The political asylum system in Western Europe is under strain. High numbers of people are applying for political asylum as the only possibility of living legally in Western countries, while governments are trying to prevent access to their territories and to discourage applicants. It is very difficult to foresee an equitable and timely solution of the root causes of many displacements, either extreme poverty or human rights abuse. In the meanwhile, many of those who are genuinely persecuted are rejected before their cases can even be considered.The entitlements to health care of different categories of refugees and asylum seekers have been reviewed. While convention refugees and de facto refugees have the same right to health care than the citizens of the country of asylum, asylum seekers and persons who are offered temporary protection tend to have restricted access to health care, although there is a great variability across countries. The available reports on the health status of asylum seekers in Western European countries document a quite difficult psychological and social adjustment. It is unclear whether this situation, which is caused by the stress of leaving their own country and family, by uncertainty over the future, and by possible exposure to violence is intensified by restriction to work, unsuitable organization of day to day life in asylum centers, and limited access to health care. A major effort is urgently needed to evaluate the health needs of asylum seekers, and to improve standards of reception and care in European countries.