Do you treat patients who are refugees or asylum seekers? New BMA guidance focuses on their specific health needs and how to overcome common barriers
What’s there to know about asylum seeker and refugee health?
Much. They can receive free NHS care. They face unique health challenges and many have experienced violence and persecution. Your medical evidence can be crucial to their asylum claims but they may have difficulty trusting doctors. Compassion and sensitivity are required. Caring for the patients may be emotionally affecting – you need to look after yourself, too.
What does the guidance cover?
There is background on who refugees and asylum seekers are, the often very stressful and cumbersome process of applying for asylum in the UK, and the particular health challenges and barriers to accessing care they face. There are also links to information resources, specialist organisations and online tools that can help you support patients.
Is it my job to decide if their treatment is free?
No, but doctors can be responsible for identifying when a patient requires care which cannot be delayed (for example, when it is urgent or immediately necessary), or which is exempt from charge. The guidance explains how entitlement to free NHS care differs between primary and secondary care, across the nations, and if your patients’ asylum applications have been refused.
What are the particular health challenges of asylum seekers and refugees?
They’re what you might expect for people arriving after perilous journeys from countries in turmoil with poor healthcare: untreated communicable diseases, poorly controlled chronic conditions, maternity care, and mental-health needs. Patients who have experienced violence and trauma may also need specialist support.
Anything else I should look out for?
Experiences in the UK can also cause problems. Asylum seekers are at risk of malnutrition and other conditions linked to poverty. They’re generally banned from working. Uncertainty over their future can lead to poor mental health. They face a particularly difficult period immediately after their applications are approved, as they are no longer supported by the Home Office and have to make applications for services such as housing.
What about cultural sensitivities?
It’s good to be mindful of this. People from different backgrounds can express mental illness differently. They may complain of head or stomach aches instead of emotional distress, for instance. You may also want to take account of factors such as genders and political background when choosing an interpreter.
There is far more detail in the full guidance. It’s worth checking the ‘useful resources and organisations’ section for links to support groups, too.