Another Border-crossing: Barriers to Healthcare for Asylum Seekers and Refugees in the UK 

 An obstacle course of barriers and obstructions litter the path to healthcare services for one of the most vulnerable groups in society. Equitable access to healthcare for asylum seekers and refugees (ASR) in the UK is a fundamental right. Regulations maintain that refugees, asylum seekers and even refused asylum seekers are eligible to receive free-of-charge primary care. However, the reality of this is more dismal.  

Where our National Health Service (NHS) is designed to give free and accessible healthcare to UK citizens, the service often seems to fall short when it comes to ASRs. The knowledge and understanding of ASR rights in healthcare services is severely lacking, with many being charged for or refused access to primary care and interpreting services, both of which they are eligible for and which are essential to their health needs.  
An interview conducted by Tomkow et al. detailed how one ASR found herself ‘receiving multiple letters demanding payment for medications prescribed by the GP, which should have been free’ resulting in a ‘negative impact onli her mental health’. 
The same group conducted a survey and found that only ‘only 26% of HCPs [healthcare professionals] correctly identified that all migrants were entitled to free GP services’ and only 6% of the sample understood NHS charging regulations and which groups ‘are entitled to free NHS care’. This lack of understanding on refugee and migrant rights severely threatens the wellbeing and health of these communities.  
However, the study also demonstrated that ASRs have limited knowledge of their healthcare rights and especially of how to access healthcare. This has primarily been due to lack of information and initial support.  
The marginalisation, language and cultural barriers and general isolation faced by multiple refugee communities pose as significant obstacles to accessing health services and realising entitlements to free primary care and interpretation (and often free secondary care for some groups as well). One interviewee detailed how he was unaware of how to call an emergency ambulance when needed. It was found that the individuals who had a support network ‘appeared to have better knowledge of how to use healthcare services’.  
An additional barrier has been the digitalisation of healthcare services, this has severely impeded the access routes for ASRs and increased marginalisation. Where mobile phones and the internet are growing to be essential in registering for and accessing healthcare, digitalisation has inadvertently created another obstruction. One ASR interviewed, recounted his experience of accessing health services: ‘any form you have, you have to write your address, your postcode, your door number….when I fill any form without an address it doesn’t accept that’. Simple complications can result in severe and health-damaging consequences. 
Refugee Council have reported that pregnant ASRs often avoid accessing antenatal care for fear of being charged ‘or even detained and deported if they engage with health services’. This fear is highly plausible when considering how healthcare is being used widely throughout European countries to enforce immigration control. The 2012 British ‘Hostile Environment’ policies were designed to restrict access to healthcare and welfare services by ‘irregular migrants’ as a way to deter immigration flows.  
What is more, is that the 2021 New Plan for Immigration and the 2022 Nationality and Borders Bill detailed a ‘new reception centre model’ for asylum seekers, designed to house up to 8,000 people ‘for periods up to six months’, with the ‘purpose of the monitoring of residents and removal of people with unsuccessful claims’. Doctors of the World have highlighted how these proposed centres do not demonstrate how ‘meaningful access to appropriate healthcare services will be provided’.  
The Napier Barracks, housing over 400 asylum seekers has been labelled a ‘prototype’ by the Home Office. DOTW have clarified that there is a ‘well-evidenced link’ between this type of housing and the health of asylum seekers, in which the physical and social environment and condition of the housing influences mental and physical health.  
Studies and findings have shown that conditions such as overcrowding and isolation blocks, in particular, can have poor mental health impacts. Most of the residents at Napier Barracks had experienced depression and a third expressed suicidal feelings. The impacts on children especially are extremely harmful, PTSD, depression, mutism and development delays being only a few of the effects that have resulted from this type of accommodation. 
In terms of the pandemic it was virtually impossible to self-isolate when up to 30 people were sharing a room and bathroom facilities. Moreover, DOTW highlighted that asylum seekers were not even provided with COVID-19 information in their native languages, thus being another obstruction to accessing healthcare and information.  
It is this, the ‘punitive use of institutional forms of accommodation’ like the barracks and proposed centres that will ‘deter forced migrants from exercising their right to seek asylum’ (DOTW).  
The anti-immigration rhetoric of the UK government has led to the erosion of healthcare rights and living conditions of asylum seekers and it is clear that improving the understanding and knowledge of refugee and migrant rights by healthcare professionals is fundamental to improving the health of ASRs. As stated by the Refugee Council, it is ‘vital that access to health is free from immigration control …that there is no firewall between the Department of Health and Social Services and the Home Office’.  
Paiwand offers free mental health support and talking therapies in Dari, Farsi, Pashto and English - please find more information here
Paiwand also provides supported accommodation and housing services for young refugees and asylum seekers in the UK - please find more information here or contact us with any questions or problems you may have. 


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