Asylum seekers often arrive with appalling medical conditions,
so why isn't the NHS prepared to help? Jo Carlowe reports
Sunday June 24, 2001, The Observer
Given that Afghan refugee Soultan Ahmad, 33, spent months hanging
upside down from a ceiling being beaten by his Taliban captors,
it would be a folly to describe him as fortunate. But, relatively
speaking, he is.Since arriving in the UK and awaiting the outcome
of his asylum application, he has had access to a sympathetic GP.
The pains in his head and back are under medical supervision. His
pregnant wife Gulia, 27, gets prenatal care, their six- year-old
daughter Diana has been given her inoculations and Soultan receives
physiotherapy for his legs, damaged during a year of thrashings
and inactivity.
If every asylum seeker was offered similarly appropriate healthcare,
Dr Michael Wilks, chairman of the British Medical Association's
medical ethics committee, would not be so angry. But unfortunately
Soultan's treatment is the exception rather than the norm.
'There has been no real NHS planning for the health needs of asylum
seekers,' Wilks states. 'No thought has been given to their health
needs or the social infrastructure around them and it is possible
to see the whole process as an abuse of human rights in itself.'
Amadou, 31, from Guinea, and his wife Fatoumatou, 28, wouldn't
disagree. Amadou, a shopkeeper and devout Muslim, was one of hundreds
of refugees unwittingly caught up in the fighting between the Guinean
security forces and armed rebels. He was taken to a military prison
after refusing to fight on the front line in Sierra Leone where
he was beaten with a belt and Fatoumatou was imprisoned and then
raped. 'I had no idea about fighting. I am a trader not a soldier
and it is against my religion to kill people,' Amadou comments quietly.
When in March of this year the couple finally escaped to England,
both arrived with health problems. They complained of a loss of
appetite and constant fatigue as well as aching and pain. In addition,
Fatoumatou feared she might be pregnant and, worse still, her rapists
may have carried HIV. They are still waiting to see a doctor and,
at the very least, Fatoumatou needs an HIV test.
So far, only Helen Murshali, the nurse at the Refugee Council's
drop-in centre in Brixton, has offered support. Helen has an extraordinary
case load of patients - most would not look out of place on the
witness stand at the International War Crimes Tribunal in The Hague.
'I see women who have been raped with the specific intention of
giving them Aids,' she explains. 'I come across people from war
zones who have bullets still in their bodies. So many refugees have
physical and psychological problems, but there is no system to check
out their health needs.'
Amadou told Helen: 'My wife and I are very ill. If we don't see
a doctor, I don't think we will survive.'
But if you are an asylum seeker, seeing a doctor is never easy.
Up to 75 per cent of Helen's clients have problems registering with
GPs - one woman was turned away 12 times. Amadou and Fatoumatou
were no exception, despite Helen giving the couple a covering letter
and a list of GPs.
'When we arrived at the surgery, I handed over the piece of paper
from Helen but the receptionist said, "We can't see you - go back
to the place that gave you this,"' Amadou explains. For extra emphasis,
the receptionist added, 'Thank you for leaving' and refused to give
Amadou directions to the next surgery on Helen's list.
At each subsequent surgery the door was similarly closed to them.
'We were exhausted,' Amadou remembers. 'We had walked the whole
day and my wife was extremely unhappy, sick and miserable. But we
can't get even basic healthcare. When we visited Freetown in Sierra
Leone, where there was a war going on, there was at least access
to medical treatment through the Red Cross. Tomorrow we will have
to try to drag ourselves off to a doctor again.'
While it is true that many GPs simply can't take on any more patients,
Helen suspects that many doctors use this as an excuse because they
know that communication can be difficult with asylum seekers and
that they often have complex health needs. 'I do have some sympathy
with GPs, though,' she says. 'The truth is that they just don't
have the resources to back them up for specialist work like this.'
But even when GPs will register refugees, according to a research
paper by the Royal College of General Practitioners, they will often
only register them as 'temporary', even though an asylum seeker
may remain in an area for months or years. The RCGP researchers
suggests that some GPs do this because they fear losing the income
associated with reaching certain targets for cervical screening
and vaccinations. It is understood that women from some ethnic groups
find cervical smears culturally alienating and refuse to consent.
Likewise, health promotional messages such as the need for vaccines
are always harder to get across to patients without a good command
of English.
'As a result of temporary registration, the refugee may be denied
a basic health check, and will not have a complete set of medical
records. All refugees, irrespective of status, have the right to
register with a GP and use the full range of NHS services free of
charge,' the paper states. 'Some GPs appear to be confused about
this.'
GPs, hospitals, pharmacists, opticians and dentists are also entitled
to use health-authority interpreting services and reclaim back the
costs, but many physicians still complain that consultations with
asylum seekers take too long. The irony is that those patients who
most need healthcare are the ones most likely to be denied it.
The knock-on effect, according to Helen Murshali, is that many
refugees end up requiring hospitalisation for conditions which could
have been easily treated at an earlier stage. Denying refugees healthcare
is a false economy.
'Sometimes I send my patients to A& E just to get a repeat
prescription,' Murshali says, 'and I always send people there if
they have a temperature. I've had several phone calls telling me
that this is not right and I understand this, but I am not a trained
doctor and if a GP can't see them, someone has to take responsibility.'
Dr Laurence Buckman, of the BMA's General Practitioners Committee,
says that GPs simply must not turn patients away just because they
are hard work. 'If you have room on your books, then it is too bad.
These people need our help. They are here because they are at risk
of death if they go back to their countries. We should treat them
humanely. They may be a nuisance and take up time, but someone who
has just come out of a Bosnian concentration camp deserves a sympathetic
hearing.'
He explains that the NHS (Primary Care) Act 1997 enables health
authorities to provide financial incentives to encourage GPs to
take on asylum seekers. In Wakefield, for example, the health authority
pays GPs an additional £40 for each asylum seeker to compensate
for the extra time needed for consultations. Unfortunately not all
health authorities have taken advantage of the scheme. Dr Buckman
would like to see it more widely used.
An alternative favoured by Dr Michael Wilks, of the BMA's ethics
committee, is the setting up of one-stop primary care centres specifically
for the treatment of asylum seekers.
There are also a number of innovative schemes run by socially conscious
GPs. Soultan and his family have benefited from a project organised
by Dr Duncan Trathen of the Newham Transitional Primary Care Team
in east London. Dr Trathen works closely with the community trust's
health advocacy service, which provides interpreters for 25 languages.
Day to day, the surgery is like any other, except patients are only
registered for six to 12 months. During this time, Dr Trathen helps
the patient register with a permanent GP practice. This short-term
registration allows the asylum seeker to obtain proper medical records
and a route into the NHS during those early days of displacement.
Proper access to healthcare should also help reduce the spread
of communicable disease. In theory, new arrivals are supposed to
be picked up by Port Health Control Units at Gatwick and Heathrow
and screened for tuberculosis. In reality, Port Health Control only
sees about 25 per cent of the total number of asylum seekers who
enter the country each year and fails to provide these newcomers
with any additional information about how to access healthcare.
Dr Peter Davies, director of the TB Research Unit in Liverpool,
describes the screening process as haphazard. 'All they can do is
spot people who are coughing and screen them - the rest are randomly
selected.'
So even if you feel less than welcoming towards new immigrants,
there is a still a valid public health argument for offering asylum
seekers proper access to healthcare. As Dr Trathen explains: 'Even
if yours is a cynical view, if you don't want asylum seekers to
be here, by addressing illnesses early, providing patients with
health promotion advice and inoculation against disease, you relieve
the burden on the NHS later.'
Some names have been changed to protect identities
Taking refuge: the facts
Ý One in six refugees has a physical health problem which is severe
enough to affect their way of life.
Ý The 1999 Immigration and Asylum Act took away an asylum seekers'
automatic right to free prescriptions and sight tests. Now refugees
must apply for an exemption certificate by filling out a complicated
form in English.
Ý Around half of all asylum seekers have mental- health difficulties
associated with depression and post-traumatic trauma.
Ý The Refugee Council, a registered charity, claims that up to
75 per cent of its clients have difficulty registering with a GP
despite the fact that all asylum seekers have a right to be registered
with a doctor and there is no obligation for GPs to check the immigration
status of people wanting to join their lists.
Ý Only around 25 per cent of asylum seekers are screened for TB
when entering the UK. Some experts estimate that one in 40 Asian
immigrants and one in 20 African refugees will go on to develop
TB within five years of entering the country if not offered preventative
treatment.
Ý The Refugee Council is running a campaign to protect a person's
right to seek asylum. To support this campaign, go to www.refugeecouncil.org.uk.
For more information on the events taking place during Refugee Week,
call 020 7820 3055.
