Migrants are a diverse group consisting of those who migrate for work, education, family, socio-political reasons, persecution and war. The health needs of the migrant population are very heterogeneous, reflecting the great diversity of where people come from, the circumstances of their migration and the environment in which they live post migration.
What is an Asylum Seeker?
An asylum seeker is someone who has applied for protection through the legal process of claiming asylum and is waiting for a decision as to whether or not they are a refugee. In other words, in the UK an asylum seeker is someone who has asked the Government for refugee status and is waiting to hear the outcome of their application.
What is a Refugee?
A refugee is a person who:
'owing to a well-founded fear of being persecuted 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 to or, owing to such fear, is unwilling to avail himself of the protection of that country'
Source: Article 1, 1951 Convention Relating to the Status of Refugees
What is a Migrant?
The UN Convention on the Rights of Migrants defines a migrant worker as a "person who is to be engaged, is engaged or has been engaged in a remunerated activity in a State of which he or she is not a national." From this a broader definition of migrants follows:
"The term 'migrant' in article 1.1 (a) 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."
This definition indicates that 'migrant' does not refer to refugees, displaced or others forced or compelled to leave their homes. Migrants are people who make choices about when to leave and where to go, even though these choices are sometimes extremely constrained. Indeed, some scholars make a distinction between voluntary and involuntary migration. While certain refugee movements face neither external obstacles to free movement nor is impelled by urgent needs and a lack of alternative means of satisfying them in the country of present residence, others may blend into the extreme of relocation entirely uncontrolled by the people on the move.
Source: UN Convention on the Rights of Migrants
Unmet needs and gaps
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.
- Difficulties accessing appropriate mental health teams and navigating through the mental health system has been highlighted for asylum seekers, refugees and migrants within Nottingham.
- There is a lack of interpreting services to cover out of hour’s services.
- There is a lack of ethnicity recording amongst some services.
- Nottingham has high rates of communicable diseases (HIV, TB, Hepatitis)
- There are an increasing number of births to non UK born mothers.
- The Impact of additional dispersal to Nottingham city on health & social care systems and initial support services is having a detrimental effect on the capacity of the 3rd sector in particular to meet needs/targets & the lack of long term funding.
- Free or subsidised formula milk for the babies of HIV positive mothers is available for asylum seekers on a case by case basis .(Needs to be requested)
- There is a lack of a standardised approach/pathway or protocol to assessing individuals for social support who have No Recourse to Public Funds.
- High smoking rates amongst some EU migrant groups.
- Nationally, pregnant women with complex social factors are much less likely to access maternity services early in pregnancy and data suggests this is mirrored 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.
- Almost one third of Nottingham’s births are to mothers born outside the UK. 280 (6%) mothers had difficulty reading or speaking English; these women and their babies are at increased risk of poor pregnancy outcomes.
- There is an increasing need for translation services during pregnancy and challenges in gaining timely access to these services, particularly in emergency situations.
- FGM, Forced Marriage & Honour Based Violence needs more specialist workers
- Sexual exploitation including Child sexual exploitation and human trafficking
- Concerns of young UASC migrants finding it difficult to access secondary school education at certain times in the years & at a specific age, also the numbers of exclusions from school of migrant children.
Recommendations for consideration by commissioners
Continue the implementation of work funded through the Migration Impacts Fund which includes:
- Commissioning a health outreach team to work with asylum seeker and refugee communities
- Notification for NHS Nottingham City of the arrival of new asylum seekers into Nottingham by target contract providers
- Data collection and analysis of health needs of migrants
- Translated welcome pack/information for migrants
- Modification of the Asylum Seeker and Refugee Locally Enhanced Service
- Health promotion work, including education about communicable diseases
- Improving private housing conditions in the city & particularly Sneinton (where there is a large migrant population)
- Assisting migrants to exercise their housing rights to secure appropriate housing that is not overcrowded
- Consider targeted mental health work with the asylum seeker and refugee community to encourage access to mainstream mental health services. Also we need to have a particular focus on Unaccompanied Asylum seeking Children (UASC).
- Clarity of the mental healthcare structures and pathways to care for migrant communities.
- Encourage ethnicity recording to ensure access to services is equitable for all groups.
- Provide culturally appropriate education and screening for communicable diseases.
- Promote antenatal & maternal services including access amongst migrant communities.(Obstetric & Screening)
- Clarify a mechanism through which HIV positive mothers can access funding for formula milk in order to reduce the risk of HIV transmission to their child through Public Health’s agreement for formula milk for HIV positive mothers on a case by case basis
- Standardise the approach for assessing and providing social support for individuals with No Recourse to Public Funds.
- Utilise 3rd sector organisations and community organisations in order to disperse health information and target at risk groups. For example, dispersal of smoking cessation information through Polish groups.
- Provide training opportunities for key organisations in relation to the social and health needs of migrant communities.
- Health protection through GP registration of Asylum seekers/Refugees to include health assessments and screening for TB, HIV & Hep B & C
- Look at access to education for young migrants and exclusion from schools of young migrants
- Provide figures on incidents of exclusion in city schools and investigate the option of ESOL classes for those UASC who arrive at 15-16 years old in the city.
- More specialist workers/support services for migrants who have been trafficked, sexually exploited including FGM, Forced Marriage & Honour Based Violence as part of the serious crime bill 2015.
- Training & raising awareness for professionals on their responsibilities in reporting FGM, HBV, sexual exploitation & FM.as part of the professional responsibility, and the Serious Crime Bill 2015.