Public Health Asylum Seekers and Refugees Jill

Public Health & Asylum Seekers and Refugees Jill Pooler Senior Lecturer Primary Care And Public Health University of Plymouth Oct 2006

Health Needs of Asylum Seekers and Refugees: Intended Learning Outcomes l l l To identify the current legislation which underpins health work with asylum seekers and refugees. To demonstrate an awareness of some of the health needs of asylum seekers and refugees. To discuss some for the challenges for public health of working with asylum seekers and refugees. To develop cultural awareness. To begin to consider socio-political issues associated with asylum seekers and refugees nationally and internationally.

Quiz

Definitions Refugee l. . is a person who… owing to a well founded fear of persecution for reasons of race, religion, nationality, membership of a particular social group, or political opinion, is outside the country of his nationality, and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country; … (Office of the High Commissioner for Human Rights. The 1951 Convention relating to the Status of Refugees Article 1. ).

Definitions Asylum Seeker l l l Is a person that has asked for political asylum under the 1951 Convention, and is waiting for a decision from the Home Office about whether they will be recognised as a refugee. (a) s/he is at least 18 years old, (b) s/he is in the United Kingdom, (c) a claim for asylum has been made by him/her at a place designated by the Secretary of State, (d) the Secretary of State has recorded the claim, and (e) the claim has not been determined. (Nationality, immigration and Asylum Act 2002)

Definitions Illegal Immigrant Term widely used but officially it does not exist. The closest term is ‘illegal entrant’.

Legislative History l 1951 United Nations Convention Relating to the Status of Refugees. l l l l l Article 3 “No one shall be subjected to torture or to inhuman or degrading treatment or punishment. ” 1967 Protocol relating to the Status of Refugees Immigration Act 1971 and 1988 Asylum and Immigration Appeals Act 1993 Asylum and immigration Act 1996 Special Immigration Appeals Commission Act 1997 Immigration and Asylum Act 1999 Nationality, Immigration and Asylum Act 2002 Asylum and Immigration (Treatment of Claimants, etc) Act 2004

Public Health Issues to Consider

Rights and Entitlements

Rights and Entitlements. Asylum Seekers l l No right to work since 2002 NASS accommodation-no choice in dispersalaccommodated by private housing providers (Clearsprings/Adelphi) and LA-type and level governed by the contract. l l Private & Public providers also offer basic support. GP/Refugee Action/Post Office/School Financial Support- 70% of Income Support via ARC Card

Rights and Entitlements. Asylum Seekers l l l Legal Aid – 5 hours Appeal – 4 hours Limits on use of an Interpreter Free Health Care Education up to age 16 yrs for children-EMAS -Helen Taylor Free English language lessons-Open Doors/CFE

Exclusion from NASS Support l l l EU nationals-allowed to work and expected to support themselves Section 55 (NIA Act 2002)-those denied on the grounds that they did not apply ‘as soon as reasonably practicable’ Section 57 (NIA Act 2002) l l l There is no right to appeal Section 54 and Schedule 3 (NIA Act 2002) Refused Asylum

Rights and Entitlements-Refugees l Those with refugee status will be issued with a NASS 35 l l Have 28 days to move into mainstream support-Apply for NI No. /Income Support/Job-Seekers Allowance/Housing Benefit/Council Tax Benefit/Child Benefit/Community Care Grant/disability Benefits/Working Families Tax Credit/Bank Account/Travel freely/Vote after granted British Citizenship (citizenship ceremony). Same rights and entitlements as a British Citizen

Entitlement and Access to Health Care l l Asylum seekers, Refugees with ILR/HP/DLR fully entitled to access all available NHS services. Asylum seekers need HC 2 (exemption cert) renewable 6 monthly.

Health care and unsuccessful asylum seekers at the end of process l In UK <12 months l l l Primary Care and Walk-in centres encouraged to charge for routine treatments Emergency free of charge (discretionary) Life saving treatment-will be charged Hospital Care-charged (>12 mths not charged) Can get help with travel costs to and from hospital (need to produce HC 2)

Health Needs-Financial Support l l Special Needs/Severe or Enduring Disability l May be entitled to extra support from NASS under section 47(1) of the NHS and Community Care Act 1990, and Section 21 of National Assistance Act 1948 -duty of LA re accommodation and assistance to those in need of ‘care and attention’ l Needs assessment via social services Hospital Admissions l Subsistence support at reduced rate l l > 7 days support reduced to £ 10 pw Need to arrange for family member or other to collect payments from post office

Maternity Support l Maternity Grant l l £ 300 per child l Applications with medical evidence (Mat B 1) to NASS up to one month before EDD and 2 weeks after with original Birth Certificate. NASS l l l Pregnant women and children between 1 y and 3 y entitled to additional payment of 33 pw. Babies <1 y an additional £ 5 pw Women advised not to Breastfeed for health reasons can apply for additional payments

Health Status

1 minute activity l What are the perceived health needs of asylum seekers on arrival in the UK?

General Health Status l l On arrival in UK-Not perceived to be a major problem Post arrival-Perceived to deteriorate l Exacerbated by psychological state related to traumatic events London Health Observatory (2003) The Health of Refugees in London. http: //Lho. org. uk/hil/refugess. htm

Health Issues l Physical health-related to poor living conditions of county of origin l l l l l GI Infections-H. Pylori/Parasitic disease due to contaminated water Rheumatic Heart Disease Diabetes Haemoglobinopathies Fungal infections of skin-due to poor hygiene Respiratory Illness-due to poor nutrition and smoking Musculoskeletal-torture and violence Eyes-related to diabetes/exposure to nerve gas Tuberculosis Tropical Diseases-Malaria/Hepatitis A, B, C. HIV-AIDS (Eddystone Trust work closely with GUM) Female circumcision-Africa/SE Asia/middle East Oral health-limited access to dentist/refined sugar Mental and Physical health-due to trauma/torture- and somatisation Domestic Violence-tolerated in some cultures Polio Unplanned pregnancy

Health Status-Influences Influenced by legal rights and entitlements to health and social care. In addition: l Cultural and Religious differences in child rearing practices l Long term medical neglect l Long term dental neglect l Stress and related conditions l Impact of change of climate l Special educational needs l

Access to Health and other Support Services Influenced by language barrier and expectations of health care provision. • Health Screening on dispersal-facilitate access to mainstream services-Mental Health Access Team. • Interpreter/Translated material. • Health Promotion-sexual health, smears, mammography/diet /mental health/substance misuse/Immunisations/smoking all influenced by language, money, culture. • Health Records usually in English-Parent Held Child Health Record for babies born in England/Personal Health Record for adults and dependants. • Multi-agency.

Specific Public Health Issues to Consider l HIV/AIDS TB Reproductive health services Mental Health services l Health surveillance-ongoing l l l

Health Issues-Specific Groups l l l Older people-not represented in large numbers l Chronic health problems-poor diet l Grief l Isolation l Memory loss/confusion Families l Separation-Red Cross Family Tracing Service l Framework for assessment Children and Adolescentsl Separation-Grief-Loss l Depression l Trauma l Change Disability l Hidden issue-some 10% reported as having a form of disability related to war injury, infections, and congenital disability. Refugee Carers l Isolated l Not receiving support

Service Delivery l Health visitors l Ill-prepared for working with this group of people l l l l Structural-temporary nature of accommodation Prioritisation-children/adults-physiological and safety needs Social and Emotional needs often outweigh other needs Existing Health Assessment Models-Maslow/Roper/Orem Language Accessing services-advocacy Ethics Agents of Social Change? (Mc. Neill P. (2003) Public Health Ethics: Asylum Seekers and the Case for Political Action. Bioethics. 17. 5 -6. 487 -502. ) Drennan, V, (2005) Health visiting and refugee families issues in professional practice. Journal of Advanced Nursing. 49 (2) 155 -163

1 minute activity l What are the challenges for Public Health?

The Challenge for Public Health l Organisational: l l l Collection and collation of health data to inform service organisation & delivery. Training of Public Health & Acute Sector workers Support services such as translation and interpretation. Multi-agency. Public Health Ethics arising in a political context.

Client l l Anxiety and expectation of ‘state officials’ Psychosocial issues-emotional/stress/pre-existing mental illness Frequent removals Language and culture

Socio-Political l Racial Harassment l l l Police NASS Refugee Council The Monitoring Group-Rural Racism Project Tel: 0800 374 618 International Perspective Mc. Neill P. (2003) Public Health Ethics: Asylum Seekers and the Case for Political Action. Bioethics. 17. 5 -6. 487 -502.

Cultural Awareness l l Religion Spirituality Aspects of interaction-smiles, facial expressions, gestures, distance, touchhead/feet, pointing. Cultural beliefs about health and disease Question, Consider, Observe

Re-Cap: Health Needs of Asylum Seekers and Refugees: l l l Identified the current legislation which underpins health work with asylum seekers and refugees. Demonstrated an awareness of some of the health needs of asylum seekers and refugees. Discussed some of the challenges for public health in working with asylum seekers and refugees. Begun to develop cultural awareness. Begun to consider socio-political issues associated with asylum seekers and refugees nationally and internationally.

How would asylum seekers and refugees like to be treated? Courtesy of the Cultural “Lots of smiles if Kitchen-Plymouth possible, it could make a big difference to our Asylum seeker, dispersed to the health” North West

Website References l l l l http: //www. refugeecouncil. org. uk/ http: //www. dh. gov. uk/asset. Root/04/05/09/15/04050915. pdf Caring for Dispersed Asylum Seekers. http: //www. london. nhs. uk/newsmedia/publications/Asylum_Refugee. pdf health Needs of Asylum Seekers and Refugees http: //www. asylumsupport. info/asylumcity. pdf Asylum City http: //www. refugeecouncil. org. uk/downloads/rc_reports/hungry_homeless_apr 04. pdf Hungry and Homeless http: //www. refugeecouncil. org. uk/downloads/briefings/Newasylummodel. Sept 05. pdf New Asylum Model http: //www. refugeecouncil. org. uk/downloads/publications/advice_guides/london_sept 04. pdf Information for Advisors http: //www. homeoffice. gov. uk/rds/immigration 1. html Statistics http: //www. asylumsupport. info/nass. htm National Asylum Support Service http: //www. rcn. org. uk/resources/transcultural/foundation/index. php RCN http: //www. rcn. org. uk/resources/transcultural/childhealth/index. php RCH 2 http: //news. bbc. co. uk/1/hi/programmes/asylum_day/default. stm# Asylum day http: //www. ind. homeoffice. gov. uk/ind/en/home/news/archive/2004/july/a_national_strategy. html Refugee Integration

References l l Roberts, K. Harris, J (2001) Disabled Refugees and Asylum Seekers in Britain: Numbers and Social Characteristics. University of York. Rutter, J. (2003) Supporting Refugee Childern in 21 st Century Britain: A compendium of essential information. Trentham Books. Staffordshire.