The health risks of the UK's new asylum actBMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7252.5 (Published 01 July 2000) Cite this as: BMJ 2000;321:5
The health of asylum seekers must be closely monitored by service providers
- Jim Connelly, senior lecturer in public health,
- Martin Schweiger, consultant in communicable disease control
- Nuffield Institute for Health, University of Leeds, Leeds LS2 9PL
- Leeds Health Authority, Leeds LS1 4PL
Personal view p 59
A refugee is “any person, who owing to a well founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his/her nationality and is unable or, owing to such fear, is unwilling to avail himself/herself of the protection of that country; or who, not having a nationality and being outside the country of his/her former habitual residence, is unable, or owing to such fear, is unwilling to return to it.”1
The United Nations' 1951 Convention on the Status of Refugees (and the 1967 protocol updating it) gave refugees a limited level of protection and support.1 In 1999, the United Kingdom received 71 415 applications from people seeking asylum, second in the European Union only to Germany, which had 95 331. However, in relation to the size of its population the United Kingdom ranks ninth in Europe and Germany ranks 12th. People asking for asylum are seeking recognition as refugees, a situation that gives them few rights. In the United Kingdom, despite much criticism,2 the Immigration and Asylum Act 1999 became effective in April.
Under the new legislation up to 2600 people seeking asylum will be dispersed each month into regions outside London and the south east. Accommodation will be provided for asylum seekers, but they will have no choice over where it is located. Asylum seekers requesting support will be given benefits to a maximum of 70% of the state benefit level, which for a single person is £36.54 ($25) per week. Of this, £10 will be given as money and the rest in vouchers that can be exchanged for food, clothing, telephone calls, and transportation costs. Shopkeepers who agree to accept vouchers will be unable to give asylum seekers change from their purchases. Asylum seekers will not be allowed to work.
This new legislation is meant to relieve pressure on London and the south east, speed up processing and decision making (to within four months instead of the current average of 27 months), and result in fairer decisions. Despite these laudable aims there is concern that the new procedures will increase ill health among an already vulnerable population.
The health of refugee communities in the United Kingdom is poor.3 Many people who have had to flee their homelands will have suffered physical or mental torture.3 Asylum seekers in the United Kingdom now face an uncertain time trapped in poverty and absolute dependence, a situation characterised by the Medical Foundation for the Care of Victims of Torture as humiliating and likely to jeopardise the psychological and physical health of refugees.4 Poverty is a cause of ill health, and social dislocation combined with poverty is especially hazardous for mental health. 5 6 The health of children is especially sensitive to poor accommodation and the parental stress caused by such conditions. 5 6
Asylum seekers will have free access to the NHS, but without interpreters it will be difficult for many to make use of these services. 5 7 The situation will be exacerbated by the dispersal of refugees to areas where appropriate services have not been developed and where there are no local communities of people of the same ethnic origin as the asylum seekers.7 Asylum seekers can register with a general practitioner, but an exemption certificate for prescription charges, dental, and optical care will only be issued after they have been allocated accommodation.
Local authorities will be obliged to provide accommodation for asylum seekers, but these departments are already under pressure. It is essential that local councils, health authorities, and voluntary agencies plan and coordinate services. Strategies for providing primary care for asylum seekers may be funded by the NHS using money set aside for schemes that are developed locally.8
The Refugee Council recommends that service planners work explicitly to combat the negative images and racism that have characterised much of the media coverage of refugees in the United Kingdom. 9 10 Health service providers will need to look at ways of promoting positive images of asylum seekers and refugees locally. This might be done most constructively by involving refugees who arrived in the area some time ago and who are now settled in the community. Thompson has commented that “practice which does not take account of oppression and discrimination cannot be seen as good practice, no matter how high its standards may be in other respects.”11
Much could be accomplished by encouraging the media to present asylum seekers and refugees as resourceful and capable survivors. Among their numbers are healthcare professionals and other people with a wide range of skills and experiences. Finding ways of developing such valuable human resources would benefit both the host community and the individual.12 For now all service providers need to ensure that the health of asylum seekers, who are being forced to live below the poverty threshold in conditions devoid of many human rights and in absolute dependence, is sensitively monitored. In the light of such monitoring a rethink of current law may well be required.
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