Meeting health needs of asylum seekers

BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7184.671 (Published 06 March 1999) Cite this as: BMJ 1999;318:671

White paper will make access to health care more difficult

  1. Helen Hogan (h.hogan{at}btinternet.com), General practitioner
  1. University Health Centre, Reading RG2 7HE
  2. Primary Care Act Pilot Scheme for Homeless People and Travelling Families, Thameside Community Healthcare NHS Trust, Grays, Essex RM16 2PX

    EDITOR—Jones and Gill outline the barriers currently affecting the ability of primary care to decrease the burden of ill health carried by refugees.1 Primary care alone will not be able to address the complex health needs of this group. Indeed, the authors call for the institution of a comprehensive national strategy. The government's recent white paper on immigration and asylum lays out a strategic approach to the processing of asylum claims and the settlement of refugees in this country.2 Unfortunately, no reference is made to improving their health. In fact, the white paper in many ways contradicts the government's commitment to reducing health inequalities set out in Our Healthier Nation.3

    If the white paper's suggestions are implemented refugees entering the United Kingdom are likely to be dispersed widely around the country and will have no access to cash based benefits. Their increased isolation and poverty will lead to worsening health. Many services available in areas with a high density of refugees may not be available to more dispersed groups, including local health authority outreach services, comprehensive language support, and specialist mental health services targeted at victims of torture. General practitioners may also experience difficulty in dealing with the wide ranging social, psychological, and physical needs of these individuals if unsupported by such services. Particularly in London, refugee community groups provide vital support and advice to newly arrived refugees. Many are working with local health authorities to promote health within their own communities, and some have been able to lobby for increased recognition of their unique health problems. Dispersed refugees are unlikely to have access to refugee community groups or to attain the level of organisation required to form them. Under the new proposals refugees will face greater difficulties accessing the NHS, substantial barriers to appropriate specialist health services, and as a consequence poorer health.

    Coming from a government whose stated aim is to reduce levels of ill health, particularly among vulnerable and socially excluded groups, the white paper is a disappointment and represents a lost opportunity to create a coherent national strategy which looks holistically at the health and social needs of refugees.


    Practical approaches can make care easier

    1. Philip Matthews, General practitioner
    1. University Health Centre, Reading RG2 7HE
    2. Primary Care Act Pilot Scheme for Homeless People and Travelling Families, Thameside Community Healthcare NHS Trust, Grays, Essex RM16 2PX

      EDITOR—Jones and Gill's article on refugees' health was timely.1 More and more doctors outside multiethnic inner city areas will find themselves dealing with refugees and asylum seekers, especially as people from eastern Europe are being brought in by lorry and set down at ports and along major roads in the home counties. Furthermore, if the government's current proposals go ahead, asylum seekers will become the responsibility of national rather than local authorities and so may be dispersed across the country to wherever accommodation is available.

      Working with asylum seekers is rewarding but can be difficult. There are, however, ways to make it easier. Language is often a problem. Trained interpreters are the ideal solution. (Contact your local health authority or social services department to find out about local provisions.) However, when an interpreter cannot be arranged, we have found the Red Cross Emergency Multi-lingual Phrasebook extremely useful. It is available from The British Red Cross, 9 Grosvenor Crescent, London SW1; price £8.50.

      Asylum seekers who do not claim asylum at their “port of entry” (so called “in country applicants”) are not allowed to claim income support or job seekers allowance and so can find it difficult to afford prescription charges, unless they are exempted on the grounds of age, pregnancy, etc. They can, however, obtain free prescriptions by filling in an HC1 “claim for health costs” form and sending it off for a HC2 exemption certificate. As these forms can take several weeks to process, during which time the person may need treatment, it is advisable to check whether asylum seekers are on income support when they first try to register with a general practitioner and, if not, to ask them to fill in a HC1 form. Better still, social services departments can be encouraged to ask “in country” applicants to fill in the form when they first have contact with them.

      Health authorities are ideally placed to encourage and support general practitioners working with asylum seekers. Furthermore, the new arrangements available through Primary Care Act pilots, the salaried doctors scheme, and section 36 arrangements provide opportunities for innovative ways to meet the needs of this vulnerable population.


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