By Kadija Bouyzourn

In public health, language is often treated as a technical issue. Translate the leaflet, subtitle the video, tick the compliance box, job done. But my research shows that language barriers are rarely just about language. They are deeply intersectional, shaped by who people are, where they come from, and what the system expects of them.

During my PhD, I studied multilingual health communication in Brussels, with a focus on Moroccan-background communities, particularly speakers of Darija and Amazigh. What I found is that language exclusion is layered, not linear. It intersects with literacy, gender, digital access, trust, and colonial legacies. These barriers don’t exist in isolation. They compound.

A translated leaflet doesn’t guarantee access 

Let’s take a simple example: a translated COVID-19 leaflet. If it’s in Modern Standard Arabic, it may be unreadable for someone who speaks only Darija, a spoken Moroccan Arabic variety that differs in grammar, vocabulary, and register. Even if it were in Darija, what if the person can’t read Arabic script? What if they don’t have a smartphone or aren’t literate in any language? 

These are not rare scenarios. Many older migrants from Morocco arrived in Belgium in the 1960s and 70s with little or no formal schooling, particularly those from rural Amazigh-speaking areas. They navigate public health systems shaped around written French or Dutch, often relying on their children or neighbours to interpret. These are not individual deficits, but the result of historical and structural exclusion, both in Morocco and Belgium.

The daughter as interpreter: role reversal and emotional strain

One image from my interviews stays with me: a teenage girl translating a doctor’s words to her mother in a crowded clinic. The medical Dutch is fast, abstract. The mother doesn’t speak it. The daughter tries to interpret, from French into Amazigh, a language without direct equivalents for most medical terms. She’s unsure. She later tells me: “It felt like I was carrying my mum’s health in my hands.”

This kind of intergenerational mediation is common… and risky. Children become de facto interpreters, negotiating complex medical information, privacy boundaries, and adult decisions they are not equipped to handle. It’s not just about words. It’s about power, care, and emotional labour.

Intersectionality isn’t just a buzzword, it’s reality 

We often talk about “hard-to-reach” groups in public health. But who’s really being hard to reach?

When language exclusion intersects with:

• Low literacy (not reading or writing in any script)

• Gendered roles (women with limited social mobility)

• Digital inequality (no digital literacy)

• Legal precarity (fear of accessing services)

• Cultural mismatch (modernist assumptions about family roles)

…we get a complex web of barriers that translation alone can’t solve. That’s what I call intersectional language barriers: they’re not just about missing a word, but about missing the whole context of someone’s life.