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Physical and Mental Health of Refugees
and People Claiming Asylum
Refugee Health Special Interest Group.
Dr Linda Agnew
The 1951 UN (Geneva Convention) gives an
international legal definition of an asylum seeker
and a refugee
A refugee is a person who has left their home
country “owing to a well founded fear of
persecution for reasons of race, religion,
nationality, membership of a particular social
group, or political opinion.”
Process of asylum
In the UK, a person is recognised as a
refugee only when their application for asylum
has been accepted by the Home Office. When
a person has lodged an asylum claim with the
Border Agency (BA) at the Home Office and is
waiting for a decision on their claim, s/he is
called an 'asylum seeker'.
Outcome of claim
Refugee status
given asylum and “leave to remain”, a residence
permit that allows you to enter and stay in the
United Kingdom for an initial period of five years.
Until 2005 people were granted “indefinite leave to
remain” (permanent)
Refusal
If an asylum application is refused, there is the right
to appeal with in certain time limits.
NASS (National Asylum Support Service)
entitles destitute asylum seekers to:
Housing – initial emergency accommodation
(often hostels), then rented accommodation
Benefit (70% income support)
Education for children
(people claiming asylum are entitled to NHS
services)
Be culturally aware.....
....but do not stereotype
we are where we are.....
WHO – current definition of
health
“Health is a state of complete physical,
mental and social well-being and not
merely the absence of disease or
infirmity.”
“everything is different here...”
What factors may affect the
health of an asylum
seeker/refugee?
On arrival?
As a person claiming asylum?
As a refugee?
As a person who has exhausted all legal options
Health on arrival (1)
Education about NHS
Disorientation,
distress, fear,
mistrust, anxiety
Health on arrival (2)
What may affect health?
genetic traits,
country specific diseases
previous health and lifestyle,
experience in country of origin,
threat or actual harm to self or family
planned flight/unplanned,
how they travelled (plane/lorry/boat),
how they were treated in transit, food, water
Health on arrival (3)
Infectious disease screening
Maternity and contraceptive services
Female genital mutilation/circumcision
Language
Mental health – screening?
Integration
Health as a person claiming asylum
(1)
How a person
perceives their case is
going
Not allowed to work
(few exceptions)
poverty, social
isolation, poor
housing and
bereavement
Health as a person claiming
asylum(2)
physical health, which may be affected by food and
diet
smoking, alcohol & drugs.
Be aware of traditional medicines or drugs which
may be available in certain cultures
Racism
Health as a person claiming
asylum(3)
Mental health
Uncertainty about the future
mental health and sometimes suicidal ideation – will often
fluctuate and require reassessment
anxiety at critical times
cultural beliefs
Family
Other support – statutory and voluntary
Health as a refugee (1)
Family reunion
Red Cross have a
family tracing service
Health as a refugee (2)Losses
• Culture “cultural
bereavement”
• Familiar
surroundings,
weather, food etc
• Employment
• Family – parents,
children, spouse
• Friends
• Bereavements
• Home
• Social status
• Qualifications
• Faith and how it is
practiced
• Self belief
• Language
• Confidence
• Family life
• Expectations
Health as a refugee (3)
Physical health
Lifestyle – past and present
Past experiences and past health
Mental health
Complex, fluctuates
How do we avoid overmedicalisation or
underdiagnosis (at all stages)?
Health as a refugee (4)
Somatisation – the physical
manifestation of psychological
distress
Real
Common
Difficult for the patient and the
doctor
Important to recognise and
manage
Health as a person who has been
refused asylum and has exhausted all
appeals.
• Homelessness.
• Poverty
• Isolation
• Entitlement to
services?
“I’m not prejudiced, but.......”
Sources & Information
http://www.hpa.org.uk/MigrantHealthGuide/
www.dh.gov.uk/asylumseekers
Introduction to NHS – multilingual
Entitlement to NHS treatment table
www.hpa.org.uk
www.bma.org.uk
various statements on access to services and
healthcare.
Asylum Seekers:Meeting Their Healthcare
Needs 2002 (10 recommendations)
http://www.refugeecouncil.org.uk/ Refugee
council
Freedom from Torture (formerly Medical
Foundation fo r the Care of Victims of Torture)
http://www.freedomfromtorture.org/
Helen Bamber Foundation
http://www.helenbamber.org/
Centre for the Study of Emotion and Law
http://www.csel.org.uk/
http://www.ukba.homeoffice.gov.uk/asylum/
UKBA
LOCAL VOLUNTARY GROUPS
www.nicras.org.uk
NICRAS is a Refugee Community Organisation
(RCO) which was established in 2002. It is a
refugee led organisation in Northern Ireland that
represents the interests of the refugee
community.
http://www.nicras.btck.co.uk/RedCrossBelfast
Support and family tracing
www.inclusiveneighbourhood.org
Community integration project
Sources & information www.brysongroup.org search for One Stop Service
(NASS support)
www.embraceni.org/ Book: “Embracing Diverstity” information update 2011. Up to date information on immigration in NI (free)
BOOKS TO READ
The Spirit Catches You and You Fall Down, by Anne Fadiman: “A Hmong Child, her American doctors, and the collision of two cultures” ISBN 0-374-52564-1
The Other Hand, by Chris Cleave: a novel. ISBN 978-0-340-96342-5
