Asylum seekers and their health
January 2008
The BMA is concerned at the detrimental impact of the asylum process on the health of asylum seekers and calls on the Government to allocate sufficient funding and implement effective policies to ensure that the health of this minority group does not deteriorate in the UK.
The United Nations Convention Relating to the Status of Refugees, which Britain signed in 1951, states that host countries must provide those fleeing tyranny and persecution with access to health services, housing, education and employment.
BMA concerns
The BMA reviewed the healthcare requirements of asylum seekers and examined the implications of the immigration process on health in its 2002 report 'Asylum seekers: meeting their healthcare needs'. The report concluded that the health of asylum seekers may actually get worse after entry to the UK and that we are failing vulnerable people who have often been subjected to persecution and possibly torture and rape.
From the point of entry to the UK, not enough is being done to safeguard the health of asylum seekers. Basic medical testing does not routinely take place which means that tuberculosis (TB) often goes undiagnosed, those suffering from psychological affects of torture are not always referred to specialist centres, and unaccompanied children are not given appropriate vaccinations and immunisations.
A significant number of asylum seekers are prone to particular health problems, such as a range of communicable diseases (TB, Hepatitis, HIV/Aids), the physical effects of war and torture (rape/sexual assault, landmine injuries, beatings and malnutrition) and social and psychological problems (depression, stress and anxiety, racial harassment).
There are also a number of barriers to healthcare for asylum seekers. For example:
- insufficient translation services, in particular in the area of mental health
- lack of continuity of care and
- essential documentation, such as exemption from charges forms, only being available in English and Welsh.
BMA recommendations
In its report the BMA lists the following recommendations:
- The dispersal policy should be effectively managed so that asylum seekers receive adequate accommodation and are not moved from place to place. In this way, they will be more likely to integrate into the community and access the services they require.
- Funding for asylum seekers should not be provided within existing general practitioner budgets as this will have a knock on effect on healthcare provision to the resident population. It should be new money.
- Children should be educated within the local community as this improves integration with the host community and is therefore beneficial to their general wellbeing.
- More research is needed in order to progress the debate on the impact of UK immigration controls on health – this should include basic demographic characteristics of asylum seekers, health on entry to the UK, the impact on GP practices and the cost effectiveness of the government's new proposals.
- The physical and mental health of all asylum seekers (including unaccompanied children) should be assessed and appropriate treatment and/or support given. Medical assessment should include testing for TB, Hepatitis A, B, C and HIV (with appropriate counselling), immunisation and vaccination assessment and referral to a specialist centre if there is any evidence of physical or psychological torture or maltreatment. Note: The BMA remains opposed to mandatory HIV testing for migrants. The BMA believes that testing should be offered as part of a healthcare package, but informed consent will always be necessary.
- Trained interpreters or advocates, rather than family members or friends, should be used wherever possible if language is not shared.
- Asylum seekers should not normally be held in detention. This applies especially to families, children and pregnant women. Detention can remind torture victims of their experiences and compound the psychological damage/torment that they have already suffered.
Failed asylum seekers
Of particular concern to the BMA has been the plight of those individuals whose asylum claims have been rejected but remain in the UK, often without any health or social support. Following changes to the eligibility criteria for access to free NHS secondary care, it is clear that failed asylum seekers are only entitled to emergency or 'immediately necessary' care, and that this can be a source of suffering and hardship. While GPs retain the discretion to register such individuals and to provide NHS primary care, this is not widely known. The BMA would like to see a degree of humane flexibility introduced into the system to ensure that genuine health need is met. The BMA also believes that in many instances it is not just more humane, but also more cost-effective to provide on-going support, rather than to wait until emergency treatment is required. A joint DoH and Home office review of access to the NHS by foreign nationals was due to be completed by the end of 2007 and there will be a full public consultation exercise on any proposals. This include eligibility of failed asylum seekers for free primary care.
Conclusion
The BMA believes that it is essential that new policies take account of what has gone wrong in the past and ensure that future procedures safeguard the health of asylum seekers. It is also vital that lessons are learnt from successful projects currently taking place so that good practice can be replicated. Rather than looking for scapegoats, we should be looking at ways to treat vulnerable individuals and limit the risk of transmission of all transmitted infections. In the long term, this will save the NHS money.
The BMA shares the Government’s concern about the cost of people receiving NHS care when they have no right to it. However doctors are more concerned with human suffering and how to relieve it.
It is important that any Government measures to clamp down on health tourism ensure that emergency life-threatening interventions can continue to take place. It is also vital that doctors are able to treat people who have transmissible illnesses, including TB.
See separate briefing paper on charges to overseas visitors
For further information, please contact the parliamentary unit:
E-mail: parliamentaryunit@bma.org.uk.