As stated in the universal Declaration of Human Rights Article 25 ‘everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services’ – This right applies to citizens of a said state, alongside refugees and those seeking asylum.
In light of this, asylum seekers, refugees (ASR’s), refused asylum seekers, and migrants in the United Kingdom are entitled to certain health care provisions. In brief these provisions cover the following: ASR’s with a current claim, those refused asylum who are receiving section 95 or section 4 support, and unaccompanied children in the care of a local authority are entitled to register with, and be seen by, local NHS GP’s, alongside free access to NHS hospital facilities and related treatment. Access to accident and emergency services in the UK is free to all migrants, including those refused asylum and/or not covered by section 95 or 4 support, however this does not stretch as far as follow up in patient care. Free access to mental health services varies in availability by regional area.
However, as demonstrated by recent waves of research, there are numerous barriers which stand between ASR’S, refused asylum seekers, and migrants access to these healthcare provisions. These include, but are not limited too: language barriers; lack of awareness of the structure and function of the NHS; lack of awareness of their rights and entitlements within the UK; difficulty in meeting supplementary costs, prescription fees, and transportation to and from appointments; and fear of data sharing and/or discrimination. As a consequence, many ASR’s, refused asylum seekers, and migrants in the UK are not able to exercise their right to healthcare on the NHS. In what follows this article will break down each of these barriers in turn.
Lack of awareness
The UK government and publicly funded bodies are responsible for providing individuals seeking or refused asylum with information regarding their healthcare entitlements within the UK. However, these provisions often fall short. NHS England, for example, has published a leaflet on it’s NHS choices website which details access to primary care, but not secondary care or community services. This leaflet is printed in English, although alternative languages are available upon request. NHS Scotland has also published an online leaflet, which is available in multiple languages, however it contained incorrect and outdated information regarding the rights of Asylum seekers to NHS healthcare. In Wales there are unfortunately no official resources for ASR’s or failed asylum seekers covering their rights to NHS healthcare (Nellums et al, 2018: 31-32).
In line with policy, individuals seeking asylum in the UK should get a mandatory briefing which covers signing up to a GP and a dentist, within 24 hours of their arrival at dispersal accommodation. However recent studies have shown that only a small minority of migrants arriving in the UK reported receiving information about the NHS, and their related healthcare entitlements. Those that were informed of their right to healthcare were given very little, if any, guidance in terms of how to go about accessing NHS services. These individuals were thus unsure of how to go about signing up for a GP, making doctors appointments, obtaining prescription medication, contacting the emergency services, or obtaining a HC2 certificate which is necessary for free prescriptions (Kang et al, 2019: 3-4). It is thus clear that this lack of awareness of the NHS system and their healthcare rights and entitlements stands as a significant barrier between ASR’s, refused asylum seekers, and migrants and their access to healthcare provisions in the UK.
The NHS is, in theory, supposed to be responsive and accommodating to the needs of foreign language speakers engaging with their services in the UK. NHS England guidance states that interpretation and translation services should be freely available at all times. NHS Scotland states that individuals have the right to request an interpreter whenever needed. NHS Wales is slightly more vague in their guidance, simply stating that Welsh healthcare providers should address the language and and communication needs of all patients (Nellums et al, 2018: 31)
However, language is still the most frequently cited barrier to healthcare for ASR’s, refused asylum seekers, and migrants in the UK. This barrier can be seen to have an impact on their access to NHS facilities and treatment as early in the process as phoning a local GP in order to register or make an appointment (O’Donnell et al, 2007) which requires a significant amount of paperwork. Unfortunately their are no official translation provisions for ASR’s, refused asylum seekers, and migrants when registering, or communicating, with the NHS, so individuals have to rely on the help of friends or acquaintances. Those that successfully register with the NHS often then go on to experience difficult engaging with their resulting treatments due to linguistic disconnect. This often results in, for example, confusion about diagnosis, treatment, and when and where appointments are held (Kang et al, 2019: 3)
NHS treatments and access to GP services are free to ASR’s, and refused asylum seekers in the UK. As asylum seekers and refused asylum seekers are prohibited from working, they receive an allowance of £37 per week to cover food, clothing, transport, and any other necessities. In light of this they are entitled to a HC2 certificate which gives them free prescriptions, dental treatment, and eye tests under the low income scheme (Kang et al, 2019: 4)
However, £37 per week more often than not fails to cover the basic needs of the ASR’s and those refused asylum, most significantly in terms of their transportation costs to and from appointments on buses, and trains. Many ASR’s and individuals refused asylum report that they are simply unable to afford travel to and from GP appointments and related treatments. Resultantly these individuals are often left with no option but to commute to these appointments on foot, or sometimes, due to distance and/or physical capability, simply not attend appointments at all. Additionally, many ASR’s, refused asylum seekers, and migrants, are not aware of their entitlement to a HC2 certificate, or simply do not know how to navigate the bureaucratic procedure necessary to obtain one due to lack of awareness of the process and/or language barriers (Fang et al, 2015).
Fear and Distrust
Individuals seeking, or refused asylum are often untrusting of NHS services due to fear that approaching the NHS will have a negative impact on their situation – Doctors of the World UK (2015) reports that a fear of being arrested is the forth most common reason that ASR’s, those refused asylum, and migrants do not utilise their right to healthcare in the UK. Significantly, studies have found that having to provide proof of identity in order to access health care in the UK puts many individuals off doing so out of fear that their details will be shared with the Home Office. Additionally, In some situations individuals fear diagnosis of conditions incase said diagnosis effects their asylum status and results in their deportation (Rafighi et al., 2016; Nezafat Maldonado et al., 2018).
This article has briefly discussed some of the leading barriers to healthcare faced by ASR’s, refused asylum seekers, and migrants in the UK. It is clear that although the NHS and UK government has some provisions in place towards facilitating these groups access to healthcare, these alone are not quite enough. In order to aid ASR’s, refused asylum seekers, and migrants in exercising their right to healthcare in the UK more must be done by the government and the NHS to enable them to pass through access barriers such as language, access to information, finance, and fear.
Kang, C., Tomkow, L., and Farrington, R. (2019) ‘Access to Primary Health Care for Asylum Seekers and refugees: a Qualitative study of Service User Experiencing in the UK’, British Journal of General Practice. Doi: 10.3399/bjgp19X701309
Nelums, L., Rustage K., Hargreaves, S., Freidland, J. (2018) ‘Access to Healthcare for People Seeking and Refused Asylum in Great Britian’, Equality and Human Rights commission, Report 121.
O’Donnell, C., Higgins, M., Chauhan, R. and Mullen, K. (2007) ‘They think we’re OK and we know we’re not”. A qualitative study of asylum seekers’ access, knowledge and views to health care in the UK’, BMC Health Services Research. vol. 7, no. 1, p. 75. doi: 10.1186/1472-6963-7-75.
Fang, M., Sixsmith, J., Lathom, R., Mountian, I. and Sharin, A. (2015), ‘Experiencing “pathologized presence and normalized absence”; understanding health related experiences and access to health care among Iraqi and Somali asylum seekers, refugees and persons without legal status’, BMC Public Health, vol. 15, no. 1, p. 923. doi: 10.1186/ s12889-015-2279-z.
Rafighi, E., Poduval, S., Legido-Quigley, H. and Howard, N. (2016), ‘National Health Service principles as experienced by vulnerable London migrants in “Austerity Britain”: a qualitative study of rights, entitlements, and civil-society advocacy’, International Journal of Health Policy and Management, vol. 5, no. 10, pp. 589–97. doi: 10.15171/ijhpm.2016.50.