Clinical Review Asylum seekers and refugees in Britain

Blood pressure measuring devices: recommendations of the European Society of Hypertension

BMJ 2001; 322 doi: (Published 03 March 2001) Cite this as: BMJ 2001;322:544

This article has a correction. Please see:

  1. Angela Burnett (, senior medical examiner,
  2. Michael Peel, senior medical examiner
  1. Medical Foundation for the Care of Victims of Torture, London NW5 3EJ
  1. Correspondence to: A Burnett

    This is the second in a series of three articles

    People who are seeking asylum are not a homogeneous population. Coming from different countries and cultures, they have had, in their own and other countries, a wide range of experiences that may affect their health and nutritional state. In the United Kingdom they face the effects of poverty, dependence, and lack of cohesive social support.1 All these factors undermine both physical and mental health. Additionally, racial discrimination can result in inequalities in health and have an impact on opportunities in and quality of life.2

    Refugees' experiences also shape their acceptance and expectations of health care in the United Kingdom.3 Those from countries with no well developed primary healthcare system may expect hospital referral for conditions that in Britain are treated in primary care. This can lead to disappointment for refugees and irritation for health workers, who may also feel overwhelmed by the many and varying needs of asylum seekers, some of which are non-medical but nevertheless affect health. Addressing even a few of these needs may be of considerable benefit.

    Previous studies in the United Kingdom have found that one in six refugees has a physical health problem severe enough to affect their life and two thirds have experienced anxiety or depression. 4 5 Disentangling the web of history, symptoms—which may be minimised or exaggerated for a range of reasons—and current coping mechanisms requires patience and often several sessions. Medication should be as simple as possible.

    Summary points

    Asylum seekers and refugees are not a homogeneous group of people, and have differing experiences and expectations of health and of health care

    Symptoms of psychological distress are common, but do not necessarily signify mental illness

    Trained interpreters or advocates, rather than family members or friends, should be used wherever possible …

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