There are two main ways that refugees and asylum seekers come to the UK.
- The majority of asylum seekers travel independently to the UK and make an ‘in-country’ application for asylum. People who claim asylum in the UK may initially enter the country in a variety in the ways, both documented and undocumented.
- Some refugees are resettled through UK government schemes linked to the UNHCR (UN Refugee Agency). This option is only available to a limited number of people who are deemed particularly vulnerable or at risk. They usually come from refugee camps in low-resource countries.
Refugees and asylum seekers coming to the UK by any route may have experienced significant periods of deprivation with little or no access to healthcare.
This can be in their own country, other countries they have passed through or in refugee camps. Refugee camps, including in Europe, can be over-crowded with living conditions that contribute to poor physical and mental health.
Understanding your patient’s journey, the risks they may have been exposed to and their narrative of any traumatic experiences can help you to diagnose any complaints they present with, screen for other conditions and make referrals for specialist care, if appropriate.
Refugees who come to the UK through one of the Government’s formal resettlement programmes do not need to make an application for asylum when they arrive in the UK.
They are given a relatively high level of formal support, including help to register with a GP. Despite this, they may experience barriers to accessing healthcare.
Resettled refugees receive a full health assessment before coming to the UK, but records may not be available to GPs.
Although some asylum seekers arrive in the UK by air, many travel over land or by sea for long periods before reaching the UK.
There are very few legal ways for people to openly come into the UK as asylum seekers and, in many cases, they may initially enter the country illegally.
Individual circumstances can vary widely. For example, people may enter the UK on a valid visa but later be unable return due to political changes in their home country, or they may be trafficked into the UK against their will.
Asylum applications can take months or even years to decide.
Asylum seekers may only have access to an allowance of £5.39 a day per person from the Home Office while awaiting a decision, often in the form of vouchers or on a pre-paid card. This can make it difficult to manage every-day demands such as food, prescriptions, sanitary products, transportation to appointments, fees for medical letters and phone credit.
During this period asylum seekers are at risk of health problems linked to poverty, such as malnutrition. Extended periods of stress and uncertainty can also lead to declines in mental health, including among patients who arrived in the UK in good mental health or who had no previous history of mental health problems.
Asylum seekers are able to register with a local GP at any point in the course of their claim. However, in practice, they often have difficulty accessing services.
Refused asylum seekers
More than two thirds of asylum seekers (67%) have their first asylum application refused. This can be due to difficulty in providing sufficient evidence to support their asylum claim.
Refused asylum seekers can appeal the decision, particularly if they have new evidence, including medical evidence. Many appeals are ultimately successful.
In some cases, asylum seekers may be detained and held in IRCs (immigration removal centres). Although this is more likely for refused asylum seekers, it can occur at any stage.
Caring for and meeting the health needs of detained asylum seekers poses particular challenges. Part four of our report 'Locked up, locked out' provides information for doctors and other health professionals working in these settings.
Refugees granted asylum or other Leave to Remain in the UK
Many refugees face a very difficult period just after their application is approved. Organisations that support refugees say their mental health often gets worse at this time.
Home Office accommodation and financial support ends 28 days after an asylum claim is approved. Local Authorities are responsible for housing new refugees. However, there are often delays to getting on mainstream benefits and new refugees are at high risk of being made homeless.
Refugees can have difficulty getting back to work due to lack of UK work experience and deskilling in the case of some professions.
The BMA provides support to help refugee doctors get back into practice through our Refugee Doctor Initiative.