Refugees and primary care: tackling the inequalities

doi:10.1136/bmj.317.7170.1444

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David Jones, lecturer (d.l.jones@ucl.ac.uk)a,
Paramjit S Gill, senior lecturer.b

^aDepartment of Primary Care and Population Sciences, Royal Free and University College Medical Schools, Whittington Hospital, London N19 SNF
^b Department of General Practice, University of Birmingham, Birmingham B15 2TT

Correspondence to: Dr Jone

Accepted 15 October 1998

As the 20th century draws to a close, outbreaks of hatred between human population groups show no sign of abating and conflicts continue to erupt. Families across the world find themselves forced to leave their homes and seek refuge where it can be found.

Globally, there are 18 million refugees with 230 000 living in the United Kingdom (see box 1).1Almost half of these live in London, where 100 000 people are refugees or awaiting confirmation of refugee status.2Asylum seekers come from several countries around the world (see box 2). Many refugees have health problems but experience difficulty having their needs met by the NHS.3 This article explores the challenges that refugees pose for primary care and suggests alternative strategies to address inequalities in the care of refugees.

Summary points

The refugee population in Britain is highly diverse and is likely to remain large as conflicts continue to occur throughout the world

Refugees, unlike other migrants, have had to flee to escape oppression

The refugee population is concentrated in the greater London area, but new legislation will result in dispersal throughout the United Kingdom

Refugees may be vulnerable to mental health problems yet have difficulty communicating their needs because of language barriers

All refugees are entitled to the full range of NHS services free of charge, including registration with a general practitioner

A strategic approach is needed to address the inequalities in primary care

Box 1—Definition of refugees

Those applying for asylum (refugee) status in the United Kingdom
Those who have been given temporary admission by the immigration service while their applications are considered
Those who have been given exceptional leave to remain in or enter the country
Those who are required to renew their status at the Home Office at regular intervals
Those given refugee status
Those who gain the …