Intended for healthcare professionals


​​​The UK asylum accommodation system—a child safeguarding crisis and human rights failure

BMJ 2022; 379 doi: (Published 21 November 2022) Cite this as: BMJ 2022;379:o2797
  1. Amy Stevens, public health registrar and advocacy co-lead12,
  2. Amaran Uthayakumar-Cumarasamy, clinical fellow and advocacy co-lead32
  1. 1Yorkshire and Humber Deanery, UK
  2. 2International Child Health Group
  3. 3Evelina London Children’s Hospital, London, UK

The UK has repeatedly failed to meet the safeguarding needs of children seeking asylum, say Amy Stevens and Amaran Uthayakumar-Cumarasamy

“There are a lot of children, they shouldn’t be here. They should be in a school, not prison.” So reads the note in a bottle that was thrown over the fence by a young girl to journalists and protesters at the Manston processing centre in early November.1 Her words provide insight into a system that is inflicting untold harm on children and young people who are already made vulnerable by the life experiences that have forced them to flee their home country and undertake dangerous and traumatic migration journeys.

The United Nations Convention on the Rights of The Child outlines the responsibilities of signatory states to uphold the child’s right to protection, health, and education.2 The Borders, Citizenship, and Immigration Act 2009 requires the Home Office to carry out its responsibilities in a manner that accounts for the need to safeguard and promote the welfare of children in the UK, and the safeguarding responsibilities of providers contracted by the Home Office are also clearly laid out.34 Yet the current provision for asylum seeking children residing in holding facilities and contingency accommodation funded by the Home Office clearly violates child rights and the UK’s legal obligations.

Mounting evidence shows that the current standards of provision are having an adverse effect on the health of people seeking asylum, who already have a higher risk of physical and mental health problems than the general population.5678 Children are accommodated in settings with little privacy, limited provision of enrichment activities and play resources for wellbeing and development, and no safe outdoor space. Many are without access to nutritious food that meets their dietary and cultural requirements.

Despite it being a legal right, children’s enrolment in education is frequently delayed. This precludes their access to stable social support, English language development, opportunities to recognise if they are children in need, school nursing services, and the achievement of skills and qualifications that will help their future employability and financial security. Residency in contingency accommodation including hotels and military barracks increases children’s social isolation and limits their ability to integrate, affecting their mental health.

Healthcare provision for children in facilities funded by the Home Office is also inadequate. Inspections have found that holding centres have poor clinical governance, with some not having the facilities to store controlled or refrigerated medication.59 Where on-site healthcare is provided, there are reports of children being assessed and treated in public areas rather than designated treatment rooms. Appropriate data sharing between agencies so that quality healthcare can be provided is a known problem. Failure by the Home Office and its accommodation suppliers to inform healthcare providers of known health concerns prevents these needs being prioritised and attended to. Communication failures meant that medical teams at Manston were not always alerted to the presence of children who might have been trafficked and needed more detailed health assessments.9 Health risks also arise when children are subjected to the Asylum Dispersal Policy and National Transfer Scheme, which sees children moved to accommodation under different local authorities, disrupting continuity of care.

Many asylum seeking children have experienced physical and sexual violence, persecution, torture, and human rights abuses. They might be the survivors of human trafficking and modern slavery and potentially have experienced exploitation at the hands of human smugglers. It is, therefore, imperative that we have a trauma informed immigration system that prioritises the protection and wellbeing of children seeking sanctuary on our shores.

Such a system is glaringly absent in the UK. For-profit agencies housing children in holding facilities, including the notorious Manston site, were unable to provide inspectors with safeguarding policies.9 Children at holding facilities were unlawfully held over prolonged periods, with no provision of a place to sleep. Inspectors reported multiple instances of children receiving public rub-down searches by staff who were observed to be at times abrupt and impatient, and unaccompanied asylum seeking children experienced 12 hour waits to see a social worker. Childcare plans showed little or no evidence of meaningful engagement with children and a neglect of their welfare needs.

Devastatingly, more than 220 unaccompanied asylum seeking children have gone missing from Home Office funded accommodation, and there have been reports of children housed in hotels being sexually abused.1011 Recently published inspection reports on short term holding facilities and hotels housing unaccompanied asylum seeking children have highlighted failures in carrying out the appropriate security checks and clearances for staff.912 These safeguarding risks are exacerbated when unaccompanied asylum seeking children are wrongly identified as adults and housed in adult accommodation without the protection they are entitled to.

The appalling circumstances witnessed at Manston in recent weeks are emblematic of a deeper, systemic, and longstanding neglect of vulnerable children and young people and their safeguarding needs. In this immigration-industrial complex (that draws striking parallels with documented failures in privatised child social care), the distinction between prisons and immigration centres has been “tenuous at best.” The government’s repeated failures to meet children’s safeguarding needs have gone hand in hand with a lack of political accountability.13

Evidence accumulated over the past few years and the events of recent weeks should serve as a call to action for child health professionals to demand urgent reform of the UK’s asylum accommodation system. The processes we have in place for children seeking asylum should uphold the rights of the child, integrate safeguarding into every part of the system, and operate in a way that is trauma informed. Provision of appropriate housing, guarantee of personal safety, and access to healthcare are essential if asylum seeking children are to recover from the physical and mental health harms of forced migration and achieve their right to the highest attainable standard of health.


  • Competing interests: None declared.

  • Provenance and peer review: Not commissioned; not externally peer reviewed.