Introduction
Asylum seekers, refugees and migrants are distinct groups of people with distinct differences from each other, however, they have a common factor in that they have all migrated from their country of origin. Reasons for migrating from a country of origin are the main difference in whether these individuals are referred to as asylum seekers, refugees or migrants. It is important to examine the differences between those who are considered ‘asylum seekers’ and those who have been granted refugee status as this may have a clear effect on their health needs and access to health care. The differences between the groups can be better understood from the following definitions:
An asylum seeker “is a person who has applied for protection through the legal process of claiming asylum, they have left their country of origin and are waiting for a decision as to whether or not they are a refugee. In other words, an asylum seeker is someone who has asked the Government for refugee status and is waiting to hear the outcome of their application. (UNHCR, 2017)
A refugee is, “someone who has been forced to flee his or her country because of persecution, war, or violence. A refugee has a well-founded fear of persecution for reasons of race, religion, nationality, political opinion or membership in a particular social group. Most likely, they cannot return home or are afraid to do so. War and ethnic, tribal and religious violence are leading causes of refugees fleeing their countries” (UNHCR, 2017)
A migrant “should be understood as covering all cases where the decision to migrate is taken freely by the individual concerned, for reasons of 'personal convenience' and without intervention of an external compelling factor” (UNHCR, 2017)
This definition indicates that “migrant” does not refer to refugees or others who are forced to leave their homes. Migrants are people who make choices about when to leave and where to go, even though these choices can sometimes be very restrained.
It is evident from these definitions that there are distinct differences between these groups, and as such, each group has different needs. Research and evidence has been gathered from local, regional and national sources and analysed to understand the needs of asylum seekers, refugees and migrants in Nottingham. This JSNA chapter aims to recognise and understand the current health and wellbeing needs of these population groups, and contribute towards improving their health and wellbeing.
Unmet needs and service gaps
- There is a lack of sufficient records on the number of asylum seekers, failed asylum seekers and number of deportees within Nottingham. This could be due to the lack of ethnicity recording among some services. This has shown to be particularly challenging in determining the needs of this population group and the commissioning of appropriate services.
- Some groups of migrants experience difficulties accessing healthcare services due to a number of barriers, including poor understanding of the role of the NHS, language and healthcare entitlements.
- There are challenges around GP registration and difficulties accessing primary and community healthcare services, this is primarily due to an inability to provide the necessary documentation, particularly in ‘failed’ asylum seekers. There is also often a misconception of what is required for GP registration
- There are difficulties in accessing dental services due to the associated costs, particularly for those with no recourse to public funds (NRPF)
- There is work undergoing to help improve access to interpreting provision at dental practices, however, local intelligence suggest that some dentist are not aware of the free translation services. In addition, there are challenges around accessing face to face translation services which can be a barrier when undertaking physical examinations.
- Mental Health provision is not tailored to meet the needs of asylum seekers, refugees and migrants and some people struggle to manoeuvre through the healthcare system.
- There is no commissioned Mental Health trauma service to respond to the needs of asylum seekers, migrant’s and refugees who have experienced incidences such as torture, violence and trafficking.
- There is a lack of interpreting services to cover out of hour’s services.
- Nationally, pregnant women with complex social factors are much less likely to access maternity services early in pregnancy and data suggests this is also the case in Nottingham. Early access amongst these groups during 2014/15 ranged from 10% to 83% (all below the 90% target).
- Pregnant women who are recent migrants, asylum seekers or refugees, or those who have difficulty reading or speaking English are the least likely to access Maternity services within recommended timescales.
- Issus such as forced marriage & honour-based violence needs to be further explored, local intelligence suggests that there is lack of awareness of legal services that advocate against honour base violence in Nottingham.
- Migrants in Nottingham are being exploited by working long hours for low wages; this can have a detrimental effect on physical and mental health.
- There are concerns that Unaccompanied Asylum Seeking Children (UASC) are finding it difficult to access secondary school education at certain times in the year and at a specific age, also the numbers of exclusions from school are rising in children from refugee backgrounds as well as other emerging communities
- There is no access to ESOL classes for asylum seekers until after 6 months of being in the country, this is preventing people from learning to speak English and is therefore a barrier to accessing services.
- The Gypsy, Roma and Traveller (GRT) communities are less likely to access healthcare, ESOL and other public services due to a lack of knowledge about how to navigate through the UK systems and a lack of trust in authorities. There is a need for targeted interventions that foster community engagement within these communities.
- There are delays in accessing benefits and employment due to language barriers. This can lead to poverty and destitution, which can have adverse effect on physical and mental health.
- There is a lack of a standardised approach/pathway or protocol to assessing individuals for social support who have No Recourse to Public Funds.
- Discussing mental health difficulties within many asylum seeker, refugee and migrant communities is a cultural taboo and therefore identifying and supporting need is difficult as families are reluctant to access support. In addition, some medical terms do not exist in other languages, particularly learning disabilities and mental health problems, and this can cause difficulties and fear accessing support.
