JRS UK’s new research on the experience of people made destitute by the asylum system reveals a painful reality in which people can be homeless, either rough-sleeping or precariously couch-surfing between nights on the streets, for years.
One of its key findings is that this long-term destitution is really damaging people’s health. Over time, people’s mental and physical health had deteriorated, and many had serious chronic health conditions. And added to this, it was impossible for people to look after their health properly, or follow medical advice, because they were destitute. People struggling with chronic ill health had to skip medication, could barely sleep because they were on park benches, could not eat well because they had no money, and were constantly at risk of developing further illness.
One woman who contributed to our research had one kidney. She was perpetually in terror of becoming infected – something that could prove fatal to her.
This research echoes the longstanding experience of JRS’s Destitution Team, of a range of other research and of testimony from those in destitution. It is a widespread and longstanding problem. Destitution is putting health and life at risk. And destitution among refused asylum seekers is deliberately created by government policy. Government policy makes people vulnerable intentionally, as a tool of immigration control. This is horrifying.
And there’s more. Having made people vulnerable, government policy intentionally denies these very people desperately needed healthcare under rules on NHS charging.
Read our updated briefing on the NHS charging
NHS charging is a Hostile, or Compliant, Environment measure, designed to make life unbearable for people refused asylum, and others without immigration documents, ostensibly in the hope they will leave the UK. It was introduced gradually in England between 2015 and 2017. As it stands, people without immigration status living in England have to pay for hospital care and most other secondary care.
In many cases, people receive huge bills they have no hope of paying after going to the hospital. In others, if the care was not deemed urgent, they may be denied treatment altogether.
Even if people are not denied treatment, going to the hospital has become a risky business, because the NHS shares migrants’ data with the Home Office as part of the charging regime, and, in a move of pernicious cruelty, an unpaid bill of £500 or more counts against someone in an immigration application.
People without immigration status are effectively made to choose between going to hospital and regularising their status – that is, finding a way out of the limbo that is damaging their health, among other things. It must be a horrendous dilemma to have.
And to make matters even worse, NHS Charging rules are often applied where even government rules say they shouldn’t be – for example, to someone who is waiting for a decision on their asylum claim. Indeed, JRS UK supported a pregnant woman who was waiting for the Home Office to respond to her fresh claim. Because she had an outstanding claim, she should not legally have been charged for healthcare. But after she went to the hospital, she received a letter saying she owed money. This was very scary because she could not pay. She explained: “[It was] very stressful. You are worried, you need to pay, I was crying a lot.” Troublingly, she missed a post-natal appointment because she was so afraid she would incur more debt. Ultimately, with JRS UK’s support, she managed to challenge the charges. Others may not be so lucky. And her experience shows how vulnerable people are being dissuaded from seeking vital care.
Through policies that deliberately marginalise people without immigration status, successive governments have made people vulnerable and sick. They have then denied those same people healthcare. Many of those impacted came here looking for someone safe to rebuild their lives. This approach is as destructive as it is cruel. The , noting among other things its negative impact on public health. The new government has an opportunity to stop sacrificing human life and public good on the altar of immigration control. It must end the Hostile Environment. A good start would be to end NHS Charging.
