Published: 29 Nov 2018
Cost and fears about how they will be treated, or consequences for their immigration status, are preventing people seeking or refused asylum from using health services, a new report from the Equality and Human Rights Commission has found, prompting a call for greater separation of the immigration and healthcare systems.
Our new research, published today, explores the experiences of people who are or have been in the asylum process in Britain, as well as engaging with healthcare professionals and analysing existing research.
The project found some positive practices, such as medical staff showing empathy and compassion, individuals being referred to counselling services and charities acting as a lifeline for those trying to navigate the asylum and healthcare systems. However, it also identified a number of problems with the current system, many of which particularly affected people who need regular access to healthcare services, such as pregnant women and disabled people.
Rebecca Hilsenrath, Chief Executive of the Equality and Human Rights Commission, said:
'Everyone should have access to good quality healthcare, regardless of who they are and where they come from. People seeking and refused asylum are likely to have particular health needs because of past distressing experiences and the traumatic effects of fleeing to a different country. It’s therefore crucial that they are able to fully and easily access healthcare and that their rights are protected by keeping healthcare separate from immigration enforcement. This is just about common humanity.
'We encourage the UK Government and healthcare providers to review this new research and take action on our recommendations to ensure health services are culturally appropriate, accessible to everyone and that staff are trained to recognise and respond to the specific needs of marginalised patients.'
Consistent barriers to healthcare identified by the research included:
Many asylum seekers are unable to afford costs associated with healthcare such as travel and prescriptions. For example, a pregnant asylum seeker who needed frequent hospital check-ups faced travel costs nearing £20, whilst another individual spoke of only being able to afford food or prescription costs: 'My husband often didn’t take his medication. Because he didn’t want to swap it for food. I think a lot of his conditions now are in a really bad state.'
NHS charging policy
The NHS charging policy in England has made healthcare unaffordable for many people refused asylum and caused confusion about whether individuals are eligible for free healthcare or not. A woman in London who had been refused asylum said: ‘I never received any maternity care, nor any other care in general during my pregnancy. I was so scared I didn’t ask about pregnancy care. Being part of the system would enable charges to be brought against me’
Data sharing with the Home Office
Asylum seekers were concerned that they may be arrested, detained or deported as a result of their data being shared with the Home Office. One individual spoke of her and her husband’s fear that their information would be shared not only with the Home Office but potentially also with authorities in their home country who had been responsible for her husband’s torture: 'My husband was having blackouts, and had a problem with his heart, but we were really afraid to go to the hospitals. We didn’t know what would happen if we went there and they checked our application status. So there were times we decided to stay at home and not go.'
Most asylum seekers are allocated accommodation by the Home Office and can be moved without choice, which disrupts continuity of healthcare and social networks they rely on. One individual was relocated shortly after having extensive heart surgery, despite objections from her cardiologist.
Lack of knowledge
Some health professionals lacked knowledge on the entitlements and eligibility of asylum seekers to healthcare. For example, one individual who tried to register with a GP was told “We don’t accept refugees and asylum seekers that is our policy". This is in fact unlawful.
Some were worried that their health conditions, particularly those considered stigmatising such as HIV or mental health conditions, would be taken into consideration in the asylum process
People who had traumatic pre-migratory experiences found it difficult to build trust in health professionals. One said that she avoids health services after being refused registration for an urgent appointment by a receptionist who said: “Why do you worry? The Home Office gave you a house, and money for eating”.
Information provided to asylum seekers was not always accurate or in a language or format they understand, and often interpreters weren’t provided, meaning many were unaware of their rights or how to assert them. One individual who had undergone female genital mutilation as a child experienced challenges in understanding the complexities of her pregnancy and the specific healthcare she would need.
We have made a number of recommendations to the Government, including ending data sharing between healthcare providers and the Home Office and exempting all those that have been in the asylum process from NHS charging in England, in line with Scotland and Wales. We also want the Home Office to ensure health needs are taken into account when providing accommodation, particularly for disabled people and pregnant women.
The report also makes practical recommendations for healthcare providers across England, Scotland and Wales, including ensuring clear, accessible information about the rights of people seeking and refused asylum, providing professional interpreters and increasing staff knowledge of people’s entitlements.
Dr Katherine Taylor, a GP and health advisor for Doctors of the World, said:
'People seeking asylum have fled war, conflict or persecution. Many will have experienced loss of or separation from family and loved ones, and some have gone for long periods without any healthcare. When they arrive in the UK looking for protection, it’s essential that they are able to get the healthcare they need.
'Everybody within society needs to have access to healthcare. It’s not just a matter of human rights and dignity, it’s basic common sense. Pregnant women need to see a midwife, children need vaccinations and people with chronic conditions need a GP. We know that for the NHS it is cheaper and less resource intensive to see patients early on, to provide preventative healthcare and treat chronic diseases before people develop complications. Policies that prevent people from accessing NHS services just cause more problems in the long term.'
We will shortly be publishing a practical guide to asylum seekers’ entitlements to healthcare at each stage of the asylum process, as well as suggestions for improving practice in line with human rights principles for healthcare providers and providers of asylum accommodation and support.
Notes to editors
The research was conducted by Doctors of the World and Imperial College London, in collaboration with the Equality and Human Rights Commission.
Read more about our work on refugees, asylum and immigration.