Historically, migrants, particularly asylum seekers and refugees, experience several barriers when it comes to accessing health care and also face increased risks of various illnesses and health complications. Difficulties faced by refugees have intensified amid the COVID-19 pandemic and with the introduction of the Nationality and Borders Act, a piece of legislation that increases the standard of proof required to obtain permission to receive asylum and support in the U.K. By educating the public and advocating for vital policy changes, the U.K. is striving for improved health care access among asylum seekers and refugees.
An Interview with Dr. Dominik Zenner
Dr. Dominik Zenner is a general practitioner in London and also specializes in infectious disease epidemiology. Prior to this, he worked as the senior migration health advisor for the European Union and European Economic Area.
Dr. Zenner confirms the increased vulnerabilities of migrant populations to infectious diseases. He cites a systematic review from the 2018 Lancet Commission series on migration and health, which found that, on average, deaths from infectious diseases are higher among migrants than among native populations.
One can attribute these vulnerabilities to infectious diseases in part to migrants’ “origin and circumstances,” Dr. Zenner says. Furthering this vulnerability are barriers to effective treatment. According to Dr. Zenner, health workers in the U.K. may be “less familiar with some illnesses, including tropical diseases, risking a delay in diagnosis.”
The COVID-19 pandemic has likely increased existing vulnerabilities in both direct and indirect ways. Even before the pandemic, many migrants were unsure of their health care entitlements and how to access health care. The WHO ApartTogether survey shows that during the pandemic itself, one out of every six undocumented migrants did not seek medical support for themselves or their household when suffering from COVID-19 symptoms. However, twice as many respondents with citizenship or permanency accessed health care services when faced with these symptoms.
Dr. Zenner names “closures and inaccessibility” as significant barriers to health care, specifically “the shift to teleconsultations,” which can be more difficult for migrants to access. A study by his colleagues revealed an approximate 20% drop in consultation rates for migrants during the first year of the pandemic. This stands in sharp contrast to the approximate 9% drop in consultations for non-migrants.
Housing and COVID-19
Poverty, housing and COVID-19 are also closely connected, with the COVID-19 mortality rate increasing for those from low-income backgrounds. The living conditions of poorer people, such as densely populated living spaces, increase the risk of COVID-19 transmission.
Dr. Zenner also discusses living conditions in refugee camps. These camps face “increased transmission of respiratory viruses, alongside decreased access to care, with high-density camps seeing the worst of this.” Some camps’ locations in remote areas may heighten risks, meaning that “emergency care and ambulances might not arrive there fast enough.” In general, Dr. Zenner states that camps are definitely “not ideal human habitats.”
The Nationality and Borders Act
The Nationality and Borders Act may exacerbate the health care access struggles faced by migrants. The act’s introduction of a higher burden of proof to gain refugee status could make it harder for asylum seekers to access health care support and security. Dr. Zenner highlights the concern of the increased difficulty gaining refugee status with these changes, which could lead to “adverse health outcomes and worse health care access for those seeking safety.”
Dr. Zenner’s travels and visits to refugee camps support his view that “health care access should be universal, not just in terms of legal eligibility but accessibility.” However, this is currently “not always the case for many migrants and definitely not for asylum seekers,” he says.
Roles and Responsibilities of the UK Government
Dr. Zenner says U.K. aid cuts have resulted in “research projects promoting our knowledge of infectious diseases being downsized or canceled, further limiting scientific advances.” He argues that access to care can be an even bigger issue than eligibility and that more signposting and support services for migrants are necessary. “The government should ensure that there is access to free care for everyone. We have witnessed tragedies; mothers unable to access maternity care and being criminalized when they can’t afford treatment. These tragedies are entirely preventable,” he says.
When asked about the U.K.’s divergence from WHO guidelines, Dr. Zenner says “for most areas, divergence is for good reasons.” For example, the U.K. has “conducted more TB screenings than initially recommended by WHO, but this turned out to be the right idea and set a precedent.” In fact, the U.K. plays a key part in informing WHO guidance.
Provisions for Future Improvement
Some measures to improve health care among asylum seekers and refugees are visible in the U.K. These are available at a local level, from organizations offering mental health support services, and at a government level with the NHS Low Income Scheme, through which migrants and other disadvantaged groups can apply for financial aid to cover health costs.
Also, GP practices can register new patients without a passport and there is no obligation to ask for proof of immigration status. Doctors should not deny registration to those who cannot provide documents and the rules are flexible in this regard.
Dr. Zenner strongly feels that “the needs of migrants should be addressed as a matter of urgency,” not only to benefit individuals but also for public health reasons in general. This includes sustainable and robust funding and a recognition that there will be no equality until vulnerable communities receive sufficient support.
– Lydia Tyler