The COVID-19 pandemic and healthcare disparity
On World Health Day, we have the opportunity to focus on health as a public good, and a common good – that is, a good shared by all. This feels especially apposite after two years of a global pandemic. We have been, and continue to be, painfully reminded of the importance and precarity of our health, and the interdependence of our health, and our flourishing, on each other’s is powerfully evident. At the same time, the exclusion of some from healthcare and protection which is enjoyed by others shows a stark contrast. Globally, there is a vast disparity in sheer access to vaccines. In myriad other ways, those on the margins have been placed at greater risk throughout the pandemic. This includes JRS UK’s refugee friends and others with precarious immigration status. Government-enforced destitution and marginalisation of refused asylum seekers and others have continued during the pandemic, placing them at greater risk of COVID, and sacrificing wider public health to immigration control in the process. NHS charging and the possibility of data-sharing between the NHS and the Home Office also played out, contributing to vaccine hesitancy among other things. This was and is horrendous. It is cause for self-reflection, and self-rebuke, as a society. Now, we can and should pause and consider the many ways in which refugees and asylum seekers are excluded from the goods of health.
Obstacles to asylum seekers accessing healthcare – at all and with dignity
Ongoing obstacles to accessing healthcare are a key part of this. The hostile environment creates very real barriers to healthcare. For people refused asylum, most hospital care is chargeable, and the charging regime involves data sharing between the NHS and the Home Office, which means that accessing healthcare can result in immigration enforcement action. This can dissuade people from accessing healthcare even where it would be free because the system is complex and entitlement often unclear. I vividly recall listening to a refugee friend explain that she was so afraid of being charged for healthcare, and getting into debt, that she had missed post-natal appointments.
Healthcare barriers in Detention
Specific institutional barriers to healthcare exist in both detention and Napier barracks. In detention, people regularly struggle to get doctors’ appointments and to access even basic medication. Conducting research on detention, I interviewed one woman with asthma who spent months in detention without an inhaler, despite badly needing it and requesting it repeatedly. Furthermore, in order to access healthcare, people in detention are regularly subjected to dehumanising practices, like being handcuffed when taken to hospital appointments. People placed at Napier barracks can’t make GP appointments the way anyone else could, but have to go via the onsite nurse. Sometimes, the nurse doesn’t make the appointment when requested, but this is not the only problem. Here and in detention, explaining health problems to an onsite member of staff can be very difficult – onsite healthcare is perceived as part of the institution, and therefore trust is lacking. Furthermore, Napier residents are denied agency over their healthcare. This is profoundly dehumanising.
Greater healthcare needs
This all happens against the backdrop of greater health vulnerabilities among people seeking asylum. These arise partly from trauma experienced in refugees’ countries of origin and are frequently compounded by years of destitution, deep poverty, and periods of detention. Detention and destitution both take a huge toll on both physical and mental health.
Mental health and the asylum system
Through practices of marginalisation and dehumanisation, our asylum and immigration system retraumatises people seeking sanctuary. In detention, in particular, suicidal ideation is common and people frequently lose a sense of self and acquire long-term anxiety. When we conducted research on detention a couple of years ago, a refugee friend explained to us:
“Detention still affects me. Hearing the word, or seeing documentaries on telly about it – it disturbs my health.”
Our detention outreach team has witnessed a similar pattern in Napier, with mental health deteriorating as weeks pass by, and the trauma of Napier having an impact long after release.
An asylum system that is bad for health and people
An asylum society that traumatises people needing sanctuary is cruel. It is also incompatible with a politics that cares about human flourishing, including human health. One participant in our detention research reflected on how the trauma inflicted by detention ran counter to wider public health goals:
“People will pick up mental health problems in there, anxiety. Then you release them into society. On the one hand, the government is saying they have to reduce mental health problems, on the other, they are causing them.”
This participant made an excellent point. As we strive for a society that promotes and protects the health and wellbeing of all, we need to take a holistic approach that counters systemic marginalisation, dehumanisation, and injustice. And therefore, we need a better, more humane asylum system.
Dr Sophie Cartwright is Senior Policy Officer, JRS UK.
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