The hardships faced by modern day refugees seem to form an unending list, yet while these prisoners of geography display outstanding resilience and bravery, the Western world continues to play the role of bystander and watch passively as innocent people are reduced to the collateral damage of war. As of late, the media has begun to portray a mood of international support through the simple message of “refugees welcome”, which begs the question, why is it that for thousands, the struggle for a better standard of living does not end upon their arrival to the UK?
The stark reality is that undocumented migrants experience a myriad of barriers that deny them the medical attention they need.The NHS at its core stands for universal entitlement to primary care, emergency care and treatment of infectious diseases. But the statistics do not reflect this; 94% of patients attending a Doctors of the World (DOTW) clinic in East London have been unable to register with a GP, despite having lived in the UK for an average of six years. A small group of doctors and support workers provide an extraordinary voluntary service for homeless people, drug users, sex workers, victims of trafficking, refugees, asylum seekers and undocumented migrants – the individuals that collectively form the most vulnerable demographic in our population. In a few small rooms in Bethnal Green, these volunteers help individuals overcome the ever-increasing barriers to UK healthcare access faced by those living on the margins of society. However, within our healthcare system, there should be no need for organisations and clinics such as this in the first place. Nor should there be disparities between the quality and level of healthcare received by non-migrant and migrant individuals. Even so, a recent report found that only 1/3 of pregnant migrant women had their first antenatal consultation in the first trimester of pregnancy compared to 3/4 of non-migrant women in England – a shocking statistic considering the NHS’s standpoint on providing necessary and immediate antenatal care to all pregnant individuals.
As a clinic support worker for Doctors of the World, a medical student and someone who has dedicated a considerable part of their life to working with displaced individuals, I am too often appalled by the failures of our NHS to meet the needs of people with multiple vulnerabilities. In the clinic my role is simple: to help users access the main-stream services to which they are entitled. Unfortunately, bureaucracy and case complexity obstruct this supposedly simple and easy access to healthcare for all, and add to the mounting list of barriers which put it out of reach. Ultimately, I have witnessed this shortfall result in the children of undocumented migrants being unable to receive essential immunisations; a pregnant woman who has not sought antenatal care in 19 weeks, for fear of being reported to the Home Office; a victim of human trafficking suffering from renal failure kept off the waiting list for an organ transplant due to his pending immigration status; and a distraught woman who had been billed £6000 for maternity care even after her baby had died.
A lack of formal documentation, in the form of ID and proof of address, is often referred to as the principle reason refugees and asylum seekers are turned away from GP practices. However, this has no legal basis because these documents are not necessary for registration.This is reflected very clearly at the DOTW clinic: 29% of service users cite administrative or legal barriers and 17% a lack of knowledge about individual rights as reasons for not getting medical attention. Shockingly, there have even been instances in which GP practice managers have instructed their administrative team to turn away anyone without British citizenship. Unfortunately, children are not spared the obstacles to healthcare faced by adults, thus resulting in potentially dangerous failures to safeguard young people. As a nation, we are overlooking the most vulnerable members of our population and it is to our own detriment.
Widening access to healthcare is key to maintaining population health and simultaneously cutting costs within the NHS. Prevention of further health complications through implementing antenatal care and childhood immunisations to these marginalised population groups protects individuals and communities. At the same time, the cost of providing late effective secondary care services to treat complex presentations can be avoided with earlier and more efficient detection and treatment. Healthcare professionals have been misled into acting as immigration enforcers, when they should be invested first and foremost in the safeguarding of people’s health.
The NHS is often praised for its adherence to the values of universality, equality and high quality care.Yet it is this same organisation which, since the Immigration Act of May 2014, has been working to make it “more difficult for illegal immigrants to settle in the UK and in April 2015, brought in a £200 per year healthcare surcharge for those seeking to stay in the UK for over six months”. Individuals living outside the European Economic Area without personal health insurance began to be charged 150% more than the cost of their NHS treatments.The definition of an “ordinary resident” was also changed such that anyone without indefinite leave to remain in the UK would be subject to the charge.The introduction of the Migrant andVisitor NHS Cost Recovery Program saw the Department of Health aim to expand the scope for profit and to identify more chargeable patients. The NHS has been rapidly changed to mirror our society – one set on profiting from the plight of individuals who have already experienced unfathomable hardship.
Irrespective of politics and bureaucracy, it is painstakingly clear that healthcare infrastructure, both nationally and internationally, requires urgent repair to reduce barriers to medical access for marginalised populations.This by no means involves ceasing to charge for healthcare altogether – that would be foolishly unsustainable. Individuals who are liable to charges and have the means to pay should do so. However, we cannot continue to put vulnerable people at risk of serious harm as a result of the current and proposed policies denying them access to vital services.This suffering is avoidable and inexcusable. Healthcare professionals have a professional duty to all of their patients, regardless of their immigration status. Much more needs to be done to help protect dispossessed people from the innumerable threats they face. It is only through tireless advocacy that we can bring about policies and practices that support robust healthcare provision for all.
By Nazanin Rassa
MBBS Year 3, intercalating in Global Health