Asylum seekers and health : a BMA and Medical Foundation for the Care of the Victims of Torture dossier

Asylum seekers and health : a BMA and Medical Foundation for the Care of the Victims of Torture dossier

Full-text version: "Asylum seekers are among the most vulnerable people in Britain. Displaced from their homes, in flight from persecution, often subject to mental and physical violence, they seek sanctuary in countries with more liberal, compassionate reputations. Yet on arrival in the UK their health, already precarious, often deteriorates. [1] And for good reason. The Government's system for the handling of asylum-seekers is not focused on helping but on deterring them. Present procedures are not compassionate but punitive. Health care for asylum seekers in Britain is patchy, belated and often inappropriate. The entitlements are there and certainly there are some excellent initiatives. But entitlement is not the same as access in practice. There are dedicated clinics in Leeds and Folkestone. The Medical Foundation for the Care of the Victims of Torture (Medical Foundation) has years of committed experience. But these are too few and too under-resourced. The UK signed the United Nations Convention Relating to the Status of Refugees in 1951. By doing so it committed itself to providing health care to refugees but it is failing. What follows is a dossier of cases, passed to the BMA by health care professionals, with their patients' agreement [2], that documents, again and again, the personal cost of this failure, measured in the suffering of refugees. The BMA and the Medical Foundation urge the Government in its current review of asylum policy, to abolish vouchers and forced dispersal and develop a more humane system. Case 1 This 18 month old toddler was referred to the Paediatric Department. The child wasn't crawling. Most children start crawling before the age of one. I am concerned that this child may have cerebral palsy, muscular dystrophy or an unusual metabolic disorder. Luckily a health advocate is present at the consultation since both the parents speak no English. She tells me that the parents are very distressed about the poor quality of their accommodation. The whole family live in one room. The double bed, which they share, fills the room. It then becomes very apparent why the child has not yet started to crawl. There is simply no space in the home environment to crawl. Case 2 I saw a baby with a terrible skin condition. His body was covered in sores, which were oozing. The family was constantly uprooted from one hostel to another. Because of this constant upheaval no GP / specialist was looking after him. I prescribed bath oils and creams and arranged for consultant follow up. I wondered how the family would be able to care for the baby. There was limited access to hot water in the hostel. I worried that the family would be dispersed before the consultant followed them up. I have no idea what happened to the boy. Case 3 I have seen some asylum seekers' children who are failing to gain weight. At times it is easy to see why. Asylum seekers are often forced to live in terrible housing. There may be 10 families sharing a living space. Due to the cramped conditions, the children are at more risk of accidents particularly if cooking, feeding, washing and sleeping are all being done in the same room. Outbreaks of diarrhoea and vomiting are more common when people live in crowded conditions. In some cases mums don't have the facilities to sterilise bottles adequately. Parents may also suffer from mental health problems. Case 4 He was a man with mental health problems and was dispersed to a northern city where he knew no one and had no community support. His mental illness deteriorated. He began to eat poison and was picked up by police as he walked on the motorway on his way back to London. Case 5 She had come to A and E because she was scared that she might be pregnant. She had fled her country two weeks previously. Soldiers had attacked her home in the middle of the night. She had been multiply raped and fled for her life. She doesn't know what happened to her children. Someone she met on the street, from her community, was letting her sleep on the floor. I arranged the appropriate medical follow up and referred her to the Medical Foundation. Case 6 Mr X is a refugee. He is recovering from injuries he received during interrogations. He is in receipt of vouchers but they cannot be redeemed in the area in which he lives. It is extremely painful for him to walk the long distance to a shop where he can use them. He was given a mobile phone but he cannot afford top-up vouchers. Case 7 Ms B is a survivor of cruel torture and violence in her home country and is applying for asylum. She recently delivered a baby, her firstborn. She is unable to breastfeed and, as an asylum seeker supported by the National Asylum Support Service, cannot receive milk tokens. Many women in this situation have to water down the milk for their babies, as otherwise they cannot make it last long enough. There are already great concerns about the nutritional status of refugee children. The asylum process does not recognise that children who are refugees are children first, and deserve proper support. The government's aim is to reduce health inequalities, but disparities in health are being created. A comprehensive review of the voucher system should provide an opportunity to address this. Case 8 This mother and her tiny baby visited their GP because the mother had stomach problems. There was also concern about the baby's failure to gain weight. During the consultation the GP established that the family, including the baby, were sleeping rough with no access to shelter, sanitation or food. The GP contacted local Social Services and paid for a taxi to take the family to the local Social Services office. When the family returned to the GP surgery one week later, for medical review, the GP was horrified to learn that Social Services had been unable to provide any support for the child or family and they were back living rough. The baby had lost more weight, looked pale; the only nutrition offered was breast milk, as the mother had no solid food, cooking facilities or financial support available to her. The baby was referred to A and E for further paediatric assessment during which it became apparent that the family had failed to comply with dispersal policy and as a consequence all their support including financial support, and rights of access to emergency accommodation, had been withdrawn. The mother wanted to stay in the place where she had a social support system. She was also under treatment at the local hospital. We tried for hours to get the asylum support services / social services to help the family but to no avail. Eventually we managed to convince the duty social worker that emergency accommodation for the baby was essential from a child protection perspective. It took 10 hours to locate emergency housing, by which time the family had disappeared. We have had no contact with the family since. Case 9 I saw a young man whose face has been mutilated as a result of torture. He is now blind, speaks no English and lives alone. He is totally isolated in a place where he can't communicate. He is extremely depressed and distressed. Imagine not being able to communicate. In a way it is a continuation of torture. Case 10 I saw an elderly woman living in temporary accommodation. She had severe curvature of the spine. I think she probably had polio as a child. She is completely alone and unable to communicate. She has major medical problems. We spend a lot of time trying to help her. I worry what will happen to her if she is dispersed. Case 11 I was asked to do a report on an asylum seeker who had been dispersed. We arranged to meet on a weekday morning. I was astounded to learn that he had set off from his home at 10pm the previous night. He had walked 35 miles throughout the night because he didn't have any money for the bus fare. He has to survive on £10 cash per week. Case 12 An asylum seeker was forced to flee a regime under which as a doctor he was forced to amputate the noses and ears of army conscripts who had deserted. This doctor is studying for exams that will allow him to work in this country. He wants to contribute to the society that has given him refuge, not be forced to depend on it. Case 13 A young man was refused accommodation by the local homeless unit. He ended up sleeping in a car for months. He had severe mental health problems and was at serious risk of self-harm. We were all very worried about him at the practice and asked the local homeless unit to come and explain to us what the problem was - we were told they no longer had a duty to house single people, they have 8,000 people on their lists and 150 properties available. I have had no training in dealing with asylum seekers - it's all been learning on the job. Case 14 I know of a doctor in this practice who has given money on more than one occasion from her own purse to asylum seekers who were utterly desperate. They often come on a Friday afternoon when social services are closed. They are desperate for money for food, often food to feed their children. Case 15 I have seen a number of people suffering from extreme anxiety. A couple I saw had fled after an incident when soldiers had killed a number of members of their family, including cutting the throat of a child. The couple witnessed this murder. During the flight, moving through mountains from place to place the woman's mother died. On arrival in England, the couple was just about able to function despite these circumstances. The woman then had a baby. They have no family in England at all. She began to suffer severe anxiety attacks and nightmares, during which she sleepwalks, and tries to take the baby to her, risking either smothering or dropping him. Her husband has to supervise her, and she takes both anti-depressant and anxiolytic medication. Case 16 A young man from Z arrived in England with a chronic productive cough. He was seen and sent for a chest x-ray, which showed evidence of pneumonia, but no other features suggestive of tuberculosis. By the time the X ray report was received he was ready to be dispersed from. On arrival in his new city he did not recover and was subsequently found to have tuberculosis. Contact tracing involved contacts that he had pre and post dispersal. They had all been dispersed to other destinations. Case 17 A woman came to see me with back and leg pain following war injury back home. She has been to orthopaedics and physiotherapy. She has now been advised to use the municipal gym and pool exercise facilities to strengthen muscles. She cannot access these because she cannot pay in vouchers. Case 18 A few weeks ago we received a fax from the local Primary Care Group (PCG) informing us that a number of refugees would be arriving in the area, and that we should be prepared to take them on to our lists. Despite this information having been with the PCG for two weeks the first that our practice knew of it was a contact from the practice manager of a neighbouring practice informing us that they had had a number of refugees signing on with them that morning and that we should be prepared to do the same. Although we are a port of entry it is not usual for us to deal with asylum seekers and refugees and from my experiences in dealing with an asylum seeker previously, I knew that the infrastructure to cater for the special needs of this group is simply not available locally. As a consequence asylum seekers can feel extremely isolated and ignored by the system and it can be a real struggle to get even the most basic of their needs addressed, if at all. There has been no offer of special training for us, or even a contact list for groups who offer support to refugees, which do not seem to exist outside London. Although I am happy to look after these individuals I do not feel adequately prepared to do so. Although the numbers we are talking about are small, the needs of this group are complex and will take up a lot of our time, even assuming that an interpreter is made available. I feel that these people deserve better and am worried that my best may not be good enough. Case 19 After one man was recognised as a refugee his asylum seeker status support was cut off after the statutory 14 days and he had to wait for income support to come through. His torture left him with severe physical and psychological disabilities. These include epilepsy as a result of brutal beatings of his head. He still didn't get income support 10 weeks after his last voucher. He went to the benefits agency several times, with supporting letters from doctors at the Medical Foundation, but was not allowed into the income support office without an appointment. His sole support came from his brother, who had not yet received a decision on his case and was therefore in receipt of vouchers. The two brothers share the vouchers. Case 20 A client was dispersed to Bradford. This man is a survivor of imprisonment and torture. His torture included being forced to eat food which had sharp wire hidden in it. Despite appeals from the Medical Foundation, this man was dispersed. He has profound psychological problems and needs regular counselling sessions. He is also deeply concerned about his physical state and needs proper medical assessment and follow-up. When he arrived in Bradford he walked 40 minutes to the local hospital and desperately tried to make himself understood. Fortunately he had an appointment card from the Medical Foundation which he showed to the nurse in Casualty who telephoned us. We were able to talk to him on the telephone using an interpreter and it was clear that he was very concerned about the pains in his stomach. There is no money for fares and it is impossible for him to seek help for his psychological and physical problems without walking great distances when he is unwell. Efforts are being made to persuade the National Asylum Support Service (NASS) to re-house him in London, where there will still be problems of no payment of fares and may be problems of poor accommodation, but at least there will be the psychological and medical help at the Medical Foundation which he desperately needs. Case 21 A 31-year-old woman was referred for counselling to the Medical Foundation's neurologist. She has been attending counselling regularly since June of this year for treatment of her post-traumatic epilepsy. She was a perfectly healthy young woman until her detention and very severe beatings which resulted in a head injury. Her epilepsy originated from those events. The condition has been difficult to control and she has had a series of blackouts, dizziness, headaches and memory problems. Shopping has been a difficulty for her. Following her traumatic experiences, her hair turned white and this has distressed her considerably. She is receiving vouchers and shops at Sainsburys. She was extremely humiliated when she was told publicly that she was not entitled to buy the hair dye which she uses to hide her white hair. It would seem a very human response for her to wish to dye her hair which is her way of controlling another "symptom" and is a daily reminder of her torture. Case 22 Mr X's family arrived after him in the UK. He has been waiting for a decision on his asylum application for a long time, and is thus one of those asylum seekers still in receipt of benefits. He was in receipt of housing benefit and income support and this was extended to the family. But his accommodation was not changed. He was living in a bedsit in a B&B. There are now three adults and two children living in that tiny room. He was advised to seek private accommodation but could not do this because of the demands of deposit, rent in advance, and difficulties people have in securing rented accommodation when on housing benefit. His wife is unwell, following four difficult years without her husband, including her being detained. She had received psychiatric treatment in her country of origin and first country of refuge, before she joined her husband. Her husband feels she has completely changed and that a factor in her distress is the tiny room. She gets very angry and then hits the children. The husband therefore has to be there constantly and also take the children out to give her some respite. Although all these case histories are based on real cases, certain key details have been altered to maximise the privacy of the individuals concerned. Case Histories provided by the following doctors: Dr Kate Adams, Senior House Officer Dr James Barratt, consultant psychiatrist Dr Jackie Bucknall, consultant paediatrician Dr Angela Burnett Dr Sheila Cheeroth GP Dr Sam Everington GP Dr Peter Le Feuvre GP Dr Anna Livingstone GP Dr Kay Saunders GP Dr Ron Singer GP References [1] See, for example, A Burnett and M Peel, 'Health Needs of Asylum Seekers and Refugees', BMJ 2001; 322:544-547 (3 March) [2] In cases where it has proved impossible to obtain explicit consent, doctors have provided a general summary drawn from their experience of many similar cases. Request for further information and all enquiries should be directed to: Press Office British Medical Association BMA House, Tavistock Square London WC1H 9JP E-mail: press@bma.org.uk Website: www.bma.org.uk October 2001 The BMA's Medical Ethics Committee has produced a guidance note called 'Access to health care for asylum seekers' ."

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