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    Refugees in Calais speak of desperate conditions

    As the sun sets on Calais, a new barbed wire fence glints in the evening light, casting a shadow over the growing migrant camp known as the “New Jungle”.

    Through the thick undergrowth of what was once an industrial dumping ground, tents and tarpaulin structures stretch into the distance. These are the makeshift homes currently providing insufficient shelter from the elements for more than 3,000 refugees. On the other side of the fence, cars and lorries trundle towards the port of Calais – and the northern edge of the Schengen Area, where people can move freely across much of Europe.

    With Operation Stack in full force, and the British prime minister, David Cameron, expressing “every sympathy with holidaymakers”, the body count at Calais quietly continues to rise. A migrant died on July 28 as he tried to reach the UK. He was the ninth person to lose his life to the Calais-Dover gauntlet between June and July.

    One of hundreds of informal structures built in the New Jungle in Calais. 

    Cameron has pledged that the UK government will do everything it can to deal with this situation, but sitting in the detritus of the Calais camp, it is clear that the real crisis is humanitarian and is being fatally overlooked.

    We have made two visits to Calais, spending several days at a time interviewing the camp’s residents. Our research is revealing the desperate conditions in which they are living. It is time the UK and French governments took responsibility for a shared issue. So far, all migrants are being given is more barbed wire.

    Life in Calais

    “When I first got to the Jungle, I thought to myself: ‘is this really Europe?’” said Ilyas, a Sudanese migrant whose family were murdered byJanjaweed militia.

    He showed us the rudimentary “kitchen” he uses to cook – a dusty tent propped up with branches, with no place to safely store food. Like many, he had taken the hard route to Europe, through the Sahara desert – where three of his fellow passengers perished – and then the equally deadly boat journey across the Mediterranean.

    Ilyas’s friend showed us a shaky video he made on his phone of his eight-day sea crossing, this time from Egypt: “We did not have any water for three days,” he explained, flicking through his phone to show happier images of friends and family in the country he was forced to leave.

    Their troubles did not end when they reached European soil. Migrants we met in Calais who landed on Italian shores report being abandoned by authorities. Young and able men, in particular, are kept in camps for no longer than a few days; many end up homeless and hungry on the streets of Italy. As Italian agencies struggle to cope with the record numbers of migrants crossing the Mediterranean, some report being explicitly told to travel to northern European countries such as France, Germany and the UK. Others say they have even been shown a map.

    So a small minority of the 137,000 migrants who have arrived in Europe so far this year have ended up in Calais. The New Jungle – less than one square kilometre in area – is where thousands of migrants live in appalling conditions that would not meet any humanitarian standards.

    A resident of the camp cleans his hands with water from a chemical container. 

    Toilet facilities are limited. There are two dozen portaloos and a few wooden toilet blocks with no handwashing facilities. Piles of rubbish attract rats and other pests. There is only access to cold water, often at some distance from the ad hoc living spaces. It is unsurprising then that many residents told us they are suffering from fevers, stomach pains and diarrhoea.

    Some residents of the camp use chemical containers to transport water to their tents – and every morning, men, women and children as young as ten can be seen queuing for hours for a rare opportunity to gain access to a shower. At every turn, migrants can be seen limping and bedraggled, visibly injured by the increasing risks they are taking to enter the UK. Others say they are victims of police brutality and local thugs. Médecins du Monde is doing excellent work in the camp, but the scale of injury and illness is increasing.

    A global crisis

    Calais is undoubtedly a humanitarian and public health crisis. Yet it is only a microcosm of the migration crisis as a whole. In the world today, a population the size of Italy has been forced from their homes, putting global numbers of refugees at a level not seen since the end of World War II.

    A resident of the camp fills his water bottle at one of the five water points recently installed in the camp. 

    Developing countries – not European nations – host most of them. Turkey alone gives refuge to 1.7m refugees from Syria. The next five countries hosting the largest numbers of refugees are Pakistan, Lebanon, Iran, Ethiopia and Jordan.

    On the northern edge of the New Jungle, a huge bunker looms over the people queuing for a shower. Built during World War II to protect Hitler from invasion, it reminds us that this is not the first time Calais has been on the frontline of efforts to keep out perceived existential threats.

    Britain’s home secretary, Theresa May, has pledged to spend another £7m to reinforce Fortress Calais with more barbed wire – and an archipelago of migrant camps is spreading across the continent. For her, and for the British government, this is a security threat. Spending time with the residents of the Calais camp however, things look starkly different. It’s time to wake up to the humanitarian crisis unfolding in the heart of Europe.

    This article is a joint effort by  and .  It first appeared on the Conversation

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    Lewisham Council supports World AIDS Day on the 1st December 2015. It is an opportunity to show support for people living with HIV, remember those who have lost their lives because of HIV and learn the facts of HIV today in the UK and worldwide.

    Councillors unanimously supported a motion proposed by Councillor Alan Hall supporting World AIDS Day but expressed concern at the the Government’s plans in the Immigration Bill.  He said:

    “These proposals will subject the most vulnerable asylum seekers and migrants living with and affected by HIV to further destitution and will undermine their ability to manage their health. This will subsequently affect their individual health and the wider public health.

    HIV treatment is available to everyone living in the UK, regardless of immigration status, but it must be adhered to exactly to be successful. In 2012, the Government removed any residency-based restrictions on access to HIV treatment in light of the immense public health benefit of universal access. Access to and adherence to HIV treatment means that a person living with HIV can maintain good health and become effectively non-infectious by suppressing their viral load, the amount of HIV present in the body. By contrast, poor adherence increases the risk of poor virological control, which is associated with illness and also HIV transmission.

    The Immigration Bill rather than strengthening the integrity of the immigration system will undermine it through forcing people into destitution, homelessness and ill health.

    We anticipate the removal of basic subsistence support may even encourage some Appeal Rights Exhausted asylum seekers to lose contact with the immigration system and abscond as they will have little incentive to remain in contact with the authorities once support is withdrawn. We are particularly concerned that if the latter were to happen, it would be detrimental to those living with HIV who may also avoid accessing HIV treatment and care services out of fear of being detected by the authorities

    Access to good quality and stable housing is a vital element in maintaining the health and wellbeing of all people living with HIV. Privacy and stability are essential to support the necessary daily adherence to HIV medication. Poor quality housing, including damp or poorly maintained accommodation, can endanger someone with a compromised immune system. Measures to further restrict  asylum seekers access to housing as will increase homelessness and destitution in an already vulnerable population group. Evicting  asylum seekers living with HIV runs the risk of removing the stability needed to adhere to medication and remain healthy.”

    The National AIDS Trust recommends that proposals to enable landlords to evict people because of their immigration status means they do not have a right to rent are not upheld in the Immigration Bill.

    Lewisham Council agreed to call on the Government to remove these provisions in the Immigration Bill and for the Government to fully fund Local Authorities for their work as the ‘budget of last resort’.

    Full text of Lewisham Council’s motion is here

    For more information contact the National AIDS Trust:

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    Over the last two years I have been part of a small team of maternity professionals contacting and visiting pregnant women who were being held in Yarl’s Wood Immigration Detention Centre in Bedford. We volunteer for a charity called Medical Justice, which aims to defend and promote the health rights, and associated legal rights, of immigration detainees in the UK. Medical Justice advocates for many vulnerable patients but, as midwives, we were assessing and providing medical reports just for pregnant women.

    Being a midwife is a huge part of my identity, my purpose and passion in life. I have worked for the NHS, volunteered for midwifery and mother’s groups and worked as a midwife in Malawi for a while. The stories of the women I met in Yarl’s Wood had the most profound effect on me. To offer what expertise and support 1 could was immensely rewarding, but the circumstances in which they were put were without a doubt the most shocking thing I have seen in my career,. All the more shocking is that this is happening in the UK, here, within our own health service.

    The Centre is very like a prison, with tough security, locked door after locked door, isolation rooms and control over access to food and other basics of life. Because of their histories, most of the mothers we met were very vulnerable even before their detention. Sometimes the reasons they came to the UK (fleeing gender based violence for instance) made their pregnancies more fragile and worsened their mental health. Others had pre-existing health problems and complicated obstetric histories. 1 performed a review of cases for a nine-month period in 2013/2014, which comprised of all 21 pregnant women seen by Medical Justice during that period. There is no official record of how many pregnant women are detained, so we do not know what proportion of the total number of detained pregnant women that this review contained.

    I estimated that, compared to the urban multi-ethnic trust population in which I worked, the women seen by Medical Justice in immigration detention in the above review were around seven times more likely to have  ‘high risk’ pregnancies – that is pregnancies that we would typically refer for obstetric led care and multi-professional support (such as psychiatric assessment). Additionally, of course, disruption in antenatal care and being an asylum seeker in the first place would promote most of us to seek further specialist support for these women. The NICE (2010) guidelines clearly state that ‘Recent arrival in the UK’ ,’asylum seeker or refugee status’ and ‘difficulty speaking or understanding English’ are examples of ‘complex social factors’ which require more intensive support and care. Furthermore, the CMACE Report of 201 I finds that continuity of care is particularly important in asylum seeking women, due to their increased vulnerability.

    In short, these women were extremely vulnerable and often unwell. They showed remarkable courage and strength in the face of extreme adversity, but there is no doubt in my mind that the health, both mental and physical, of the women I met was worsened by detention.

    Immigration detention was created to be a short term ‘holding’ place for people who were to be immediately deported. In the review of cases above, I found that the mean length of detention of the pregnant women seen by Medical Justice was 50 days. The range was 10-122 days. All of the women in the review were eventually released by about 30 week; of pregnancy and none were deported until after the birth of their babies, or were not subsequently deported at all as their asylum claims were eventually accepted. Many of them were ‘not fit to fly’ which means that they did not meet the standard international aviation criteria for health and would not be allowed to board a plane during their pregnancies. Furthermore, it is not now legal for immigration personnel to use physical force to make a woman leave the Centre and board the plane, so if a woman refuses to go, there is no way of making her do so.

    Yarl’s Wood has a small health care unit, staffed 24 hours by nurses (not midwives) and managers, with a GP in attendance on most working days. The unit is run by a private healthcare company, but of course all of the clinical staff are registered with the relevant professional bodies. Sometimes the pregnant women I met with would be given kind and compassionate care. However, all too often a culture of disbelief seemed to prevail which, coupled with a lack of midwifery/ obstetric specialism, led to many worrying symptoms and alarming risk factors being dismissed by the staff. For example, I saw a case in which it seemed not to be recognised that the limits of normal blood pressure are different in pregnancy than in the non-pregnant woman.

    My major concern for these women was the denial of emergency assessment and treatment and delays in allowing women access to acute obstetric care. Cases that you or I would have immediately referred into hospital were left for days, sometimes weeks, with worrying symptoms ignored, or attributed to ‘attention seeking’. Once, a woman I was very concerned about, called herself an ambulance, as she was afraid for her health and for her baby, after several weeks of increasingly severe symptoms. The ambulance was cancelled by the health care staff, without her consent.

    The mothers I met told me of the extreme discomfort of being in the Detention Centre whilst pregnant. Most did not find the food palatable and the restrictions on when and what they were able to eat worsened pregnancy related sickness for many of them. Several also told me how frightened they were by the guards, and by a lack of privacy in the Detention Centre leading to sometimes feeling exposed and ashamed.

    As above, we do not know how many pregnant women are in Yarl’s Wood Immigration Detention Centre, though we suspect, from very rough estimates based on what women inside are able to tell us, that it is not a very large number. The pregnant women that we saw were not deported during their pregnancies due to health concerns, and were released without deportation making their detention pointless. In addition, the immense physical and mental stress of being in a detention centre had a negative impact on many of their pregnancies, not least because of the disruption to their pregnancy care and lack of access to emergency assessment and treatment. Detention is damaging for these mothers. It doesn’t really matter what you think about immigration. Perhaps you are in favour of tougher screening for asylum seekers and further limits in the number of migrants given permission to stay in the UK, or perhaps you have more lenient views. Either way you would realise that there will always be a process to follow to assess claims for asylum and immigration. Most people would be of the opinion that such a process should be fair (everyone gets treated the same), reliable (we are able to usually tell who is genuinely in need of asylum) and humane.

    Most people would also add that it should be efficient – at the lowest possible cost to the taxpayer.

    The detention of pregnant women is none of these things. The cost to their wellbeing is disproportionate because of their greater health needs .Their ability to cope is reduced by the normal but difficult symptoms of pregnancy and further by their higher risk of serious pregnancy complications; they are vulnerable. Furthermore, as deportation is more difficult when a woman is pregnant, because of airlines’ health related restrictions and because the immigration personnel are not allowed to use physical force on a pregnant mother, it becomes pointless. The high cost of keeping a woman in detention, potentially causing her and her baby to suffer, only to release her without deportation, is to needlessly spend money.

    I am first and foremost a midwife. My commitment to the NMC Code of Conduct (2015), as the bedrock of my professional integrity, is true no matter where a woman comes from, no matter where she is living or who is master of her. Whilst these vulnerable women are in the UK, their care must be held to the same standard that we pride ourselves on in our daily practices. I have reported my concerns through our supervisory system but since the women are almost ‘outside’ of midwifery, and can’t access midwifery care by themselves, it is hard to see what can change whilst they are still detained. The NMC Code states that we must:

    • Make the care of people your first concern, treating them as individuals and respecting their dignity
    • Work with others to protect and promote the health and wellbeing of those in your care, their families and carers, and the wider community
    • Provide a high standard of practice and care at all times

    (NMC Code 2015)

    This is demonstrably not always the case for the women we have met in Yarl’s Wood, and this has to change.

    How you can help

    • Become a midwife-volunteer for Medical Justice (see below or contact me)

    Donate to Medical Justice

    • Write to or email your MP with your concerns

    References and Links

    Centre for Maternal and Child Enquiries (CMACE) Saving Mother’s Lives: 2006-08. The Eighth Report on Confidential Enquiries into Maternal Deaths in the United Kingdom.BJOG, I 18 (suppl. I) 1-203.

    National Institute of Clinical Excellence (2010) Pregnancy and Complex Social Factors. London, NICE Guidelines.

    Nursing and Midwifery Council (2015) The Code. HMSO, London.

    Public Health England (2013) Guidelines for Malaria Prevention in Travellers from the UK. PHE publications gateway number: 2013054. London, HMSO.

    Medical Justice APPG 2015 report on detention and Expecting Change can also be found on their website.

    Tsangarides, N.,Jane Grant, J. (2013) Expecting Change, the case for ending the detention of pregnant women. Medical Justice, London.

    First published in Midwifery Matters ISSUE 145 Summer 2015

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    This updated briefing:

    • comments on the decision, announced by the Department of Health in February 2015, to defer proposals to extend the overall NHS charging regime;
    • comments on the introduction of the new Immigration health charge or surcharge;
    • gives detailed consideration to the National Health Service (Charges to Overseas Visitors) Regulations 2015 due to come into force on 6th April 2015;
    • provides an overview of the charging regime for NHS hospital services currently in place and notes some key changes associated with the National Health Service (Charges to Overseas Visitors) Regulations 2015.

    The Department of Health decision to extend the charging regime beyond hospitals on hold

    The Department of Health announced that a decision has been taken to deprioritise extending and amending charging in primary care in order to focus on making the existing charging regime work better and introduce the new immigration health charge. However, we understand that the current Government still intends to look at extending charging beyond the current rules.  If implemented, the extended charging regime, could in due course lead to:

    • the introduction of charges for A&E care, outside EHIC collection in NHS hospital settings (supposedly without compromising rapid access to emergency care for those in immediate or urgent need); and
    • the extension of charges, in NHS services outside NHS hospitals, to the majority of NHS services including community services, dentistry, optics and pharmacy and extending current charges to treatment provided by all commissioned providers of NHS services.

    Subject to the outcome of the general election in May 2015, consultations with various stakeholders and interested parties will take place before a final decision is taken as to whether to extend charging into primary care and A&E; these consultations will not take place before the autumn of 2015. However we should not be complacent and the recent assessment by the Migrants Rights Network strikes an important cautionary note.

    The new Immigration health charge or surcharge

    The Immigration Act 2014 gives the Secretary of State the power to issue an order to require certain migrants (those seeking leave to enter, remain or entry clearance) to pay an immigration health charge. (Regulation 10, The National Health Service (Charges to Overseas Visitors) Regulations 2015)  Whilst previously it had been thought that the rate might be £150 for international students and £200 for other categories, it would now appear that the charge may be considerably higher, possibly £600 per person. However, the actual rate will need to be confirmed in statutory regulations. The statutory regulations containing this order are due to be laid before Parliament and are meant to come into force in April 2015.

    The National Health Service (Charges to Overseas Visitors) Regulations 2015

    According to guidance on the DH’s website on the changes:

    • Overseas visitors who need healthcare while in England will soon be charged differently for using the NHS as part of efforts to recoup £500 million a year by 2017 to 2018.
    • From April [2015], the way the NHS charges these visitors is being changed so that it does not lose out on income from migrants, visitors and former residents of the UK who have left, who should all pay for their care while in the country.
    • Within the UK, free NHS treatment is provided on the basis of someone being ‘ordinarily resident’. It important to note that changes in the Immigration Act 2014 redefine and provide a more restrictive definition of ‘Ordinary residence’. It is not dependent upon nationality, payment of UK taxes, national insurance contributions, being registered with a GP, having an NHS number or owning property in the UK.
    • The changes which come into effect from April 2015 will affect visitors and former UK residents differently, depending on where they now live.
    • Treatment in A&E departments and at GP surgeries will remain free for all.

    The regulations are divided into 5 parts and 4 schedules. 5 of the regulations (3-7) focus on making and recovering charges. NHS bodies are required to recover charges from individuals unless the NHS body has determined that the individual is exempt (regulation 5). The rate of charge will depend on whether the individual comes from a country that is a member of the European Economic Area (EEA). For those who come from outside the EEA the charge will be set at 150% of the NHS national tariff for any care they receive.  ‘People who live outside the EEA, including former UK residents, should now make sure they are covered by personal health insurance, unless an exemption applies to them. Anyone who does not have insurance will be charged at 150% of the NHS national tariff for any care they receive.’

    The National Health Service (Charges to Overseas Visitors) Regulations 2015

    The DH’s Implementation Plan, published in July 2014, stated that where vulnerable groups are not currently exempt, the DH  would consider ‘strengthening exemptions, or other ways of ensuring necessary treatment is provided, for victims of domestic violence, human trafficking and vulnerable children.’ The plan also stated that ‘the Government committed to ensuring that any new system takes into account international law and our humanitarian obligations… vulnerable groups such as asylum seekers, refugees, humanitarian protection cases, victims of human trafficking and children in Local Authority care will continue to have free access to the NHS and will not be subject to the surcharge.’ The exemptions are overviewed in appendix 1 (5). Broadly speaking the scope and range of these exemptions are very welcome. However, it is unclear:

    1. how all those who are exempt will be identified;
    2. how practical or realistic it will be to recover the £500 million a year by 2017 to 2018 planned by the DH;
    3. how any financial shortfalls will affect hospitals and their budgets;
    4. what actions will be taken to ensure that racial profiling will not determine who will be asked for their papers/ documentation to prove their immigration status;
    5. how the complex range of exemptions will be operationalized by NHS staff and made clear to would be service-users.

    This note was first published, with more detail, by the Race Equality Foundation.  If you would like to receive further updates from Leander Neckles, please sign up to the Race Equality Foundation’s monthly e-bulletin.

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    Extracts from the Implementation Plan 2014–16

    The programme is subdivided into four main phases of work, these are:

    •  Phase 1: Improving the existing systems
    •  Phase 2: Aiding better identification of chargeable patients
    •  Phase 3: Implementing the migrant health surcharge. The introduction of the health surcharge is being managed by the Home Office.
    •  Phase 4: Extending charging

    Who will be charged?

    Non-EEA temporary migrants (including students and workers)

    Will be expected to pay a health surcharge as part of the visa process, unless they are exempted. This will mean they are entitled to use the NHS, as an ordinarily resident patient would, whilst they have valid leave to remain (usually between 6 months to 5 years).

    Non-EEA visitors

    Those in England for less than 6 months continue to be chargeable (unless covered by a country specific reciprocal agreement or other exemption) but will be more likely to be identified and charged.


    Under current rules, expatriates are normally chargeable for NHS care (or should use EHIC/S2 mechanisms if residing in another EEA country) on the grounds that they are not ordinarily resident in the UK. However, the Government is considering whether to exempt from charges expatriates who have made significant National Insurance contributions in the past.  No final decision on this has been taken.

    Vulnerable groups who are not currently exempt

    We are considering strengthening exemptions, or other ways of ensuring necessary treatment is provided, for victims of domestic violence, human trafficking and vulnerable children.

    People who are here illegally

    Will continue to be chargeable, as they are now.

    What services are currently free for everyone but will be chargeable for visitors?

    NHS hospitals

    Will be considering introducing charges for A&E care, outside EHIC collection (without compromising rapid access to emergency care for those in immediate or urgent need).

    NHS services outside NHS hospitals

    Will be considering extending charges to the majority of NHS services including community services, dentistry, optics and pharmacy. Extending current charges to treatment provided by all commissioned providers of NHS services.

    Services exempt from charging

    GP and nurse consultations in primary care

    Will remain free, ensuring everyone will continue to have access to prevent risks to public health such as HIV, tuberculosis (TB) and sexually transmitted infections.

    A note on immediately necessary and urgent treatment

    NHS providers have a statutory obligation to make and recover charges from patients who are deemed chargeable under legislation. However, providers also have human rights obligations, meaning that treatment which is considered by clinicians to be immediately necessary (which includes all maternity treatment) must never be withheld from chargeable patients, even if they have not paid in advance. Failure to provide immediately necessary treatment may be unlawful under the Human Rights
    Act 1998.

    Treatment which is not immediately necessary, but is nevertheless classed as urgent by clinicians, since it cannot wait until the overseas visitor can return home, should also be provided, even if payment or a deposit has not been secured. Providers are
    nonetheless strongly encouraged to obtain a deposit ahead of treatment deemed urgent if circumstances allow. However, if that proves unsuccessful, the treatment should not be delayed or withheld for the purposes of securing payment.

    Non-urgent treatment should not be provided unless the estimated full charge is received in advance of treatment.

    Treatment is not made free of charge by virtue of being provided on an immediately necessary or urgent basis. Charges found to apply cannot be waived and should be applied. Providers should take a pragmatic approach as to the most appropriate time
    to discuss financial arrangements with the patient.

    The Department’s Guidance on Implementing the Overseas Visitor Hospital Charging Regulations includes assistance to providers on what constitutes immediately necessary, urgent and non-urgent treatment and how this must be determined by
    clinicians only.

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    In 2012, 6,071 women came to the UK seeking  asylum in their own right and 1,902 women who had sought asylum were detained.

    For this report, Women for Refugee Women talked to 46 women who had sought asylum and had been detained, mainly in Yarl’s Wood Immigration Removal Centre, about their experiences.  This report also includes new official statistics  on women who have sought asylum and been detained, supplied by the Home Office to Women for Refugee Women.


    We found that 33 women, or 72%, said that they had been raped, 19 women, or 41%, said that they had been tortured. 40 women, over 85%, had been either raped or tortured. More than half of the women we spoke to said that they had been persecuted, ‘Because I am a woman.’ Eight women, or 18%, were persecuted because they are lesbians.

    ‘When the big door closed it brought back everything that had happened to me back home when I was in prison. I thought that I was going to be raped. The fear overtook me. I felt that I was not strong enough to go through anything like that again.’


    All of the women in our sample told us that detention made them unhappy, 93% felt depressed, 85% felt scared, and more than half thought about killing themselves. Ten women, more than one in five, had tried to kill themselves. One third had been on suicide
    watch in detention.

    ‘Living is not worthwhile anymore. Being dead would be much better.’


    Within our sample, the shortest stay in detention was three days, the longest stay was 11 months and the average was nearly three months. Home Office statistics show that of the 1,867 women who had sought asylum and left detention in 2012, 735, or 40%,
    had been detained for more than a month.

    ‘The most depressing thing is that you don’t know how long you’re going to be here or if you’ll still be here tomorrow.’


    40 women said they had been guarded by male staff and 70% of these said this made them uncomfortable. 50% said a member of staff had verbally abused them. Three women said they had been physically assaulted and one said she was sexually assaulted.

    ‘They are verbally abusive in here…They just see you like animals.’

    ‘The way they treat you. They want to get rid of you. You feel neglected and unwanted.’

    Detained Fast Track

    12 women in our sample were held in the Detained Fast Track, in which the whole asylum case is heard in detention at accelerated speed. All but one said they were victims of rape or torture. In 2012, 429 women who had sought asylum were taken into the Detained Fast Track, of whom 20, or fewer than 5%, were granted leave to remain at the initial decision.

    Fast track makes you feel nervous and unsafe. Constant worrying and heartache.


    Home Office statistics released for this report show that of the 1,867 women who had sought asylum and who left detention in 2012, only 674, or 36%, were removed from the UK. The others were released into the UK. Our research suggests that this unnecessary
    detention has an ongoing impact on the mental health of vulnerable women.

    ‘When I left detention, Yarl’s Wood followed me to Manchester. Sometimes I feel like I’m in a trance, I feel I hear the footsteps of the officers, I hear the banging of the doors and the sound of their keys. Even though I’m out of detention, I’m not really out – I still have those dreams.’


    We believe that detention has no place in the asylum process and that women who seek sanctuary in the UK should not be detained while their cases are being considered. Their cases can be heard while they are living in the community at much less cost and with
    less trauma to the asylum seekers themselves.

    This is the Executive  summary of Detained:Women asylum seekers locked up in the UK

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    The introduction of a new NHS charging system has been on the cards since the release of a joint public consultation on NHS charging in England by the Department of Health and the Home Office last year. The framework for some of these changes is now embedded in the Immigration Act 2014, which has put in place some of the necessary foundations for a new healthcare charging system.

    Key changes in the Act

    When its provisions enter into force, the Act will introduce two key changes in primary legislation:

    Firstly, the Immigration Act will change the definition of ‘ordinarily resident’ for the purpose of accessing NHS services. Currently, entitlement to free NHS hospital treatment is based on ‘ordinary residence’ in the UK – broadly decided on whether an individual is living here on a lawful and properly settled basis. It does not include a minimum time period for residence. The Act redefines the ‘ordinarily resident’ test to exclude all migrants who do not have indefinite leave to remain in the UK. This introduces a much higher threshold for ‘ordinary residence’, as ILR can only be applied for after a minimum of 5 years residence in the UK. Temporary migrants who can currently access free NHS care in the UK as they are considered ‘ordinarily resident’, including students, workers and family members, will need in future to pay an additional charge, prior to entry, in order to cover any potential NHS costs further down the line.

    We are concerned that the introduction of such a high threshold for migrants to access free care (although it may seem easier to explain to the public) will have an uneven impact across migrants whose circumstances often do not fall into neat categories. Healthcare providers will in future not need to consider individual circumstances when judging whether a patient is ‘ordinarily resident’ or not. This raises real concerns that migrants with complex immigration histories, and/or those who entered the UK prior to the introduction of the new rules, could be unfairly refused access to free healthcare, regardless of how long they have lived here. Steps must be taken to address these concerns.

    Secondly, the Immigration Act now allows the Home Secretary to introduce a new charge for some migrants at the point of applying for a visa, prior to their entering the UK. We know from the Home Office consultation that the Government’s intention is for this to be paid by temporary migrants coming here for between six months and five years, including students, migrant workers and family migrants, among others. It is likely that the levy will be paid as part of the individual’s visa fee, in advance of their arrival in the UK, and will secure the same access to primary and secondary NHS services in the UK as someone considered to be ‘ordinarily resident’ during their stay here.

    Changes in practice

    So – the legal framework is in place, but what does this mean on the ground? As ever, the devil will be in the detail, and much remains unclear. Although the Immigration Act is now securely in place, the new changes will not come into force for some months while civil servants within the Department of Health work up the implementation plan. It is also unclear how the changes will impact across the four countries of the UK, as although access to healthcare is governed by devolved administrations, the provisions of the Act apply across the UK. We understand that the regulations on the implementation of the healthcare levy are still being drafted, and that details will be made public during this coming autumn.

    Unfortunately, this means that it is also unlikely that we will get answers for a while yet about the further, arguably much more controversial, bits of the Government’s proposed reforms. The introduction of charging for certain primary care and A&E services for migrants who have been here for less than 6 months, as well as for irregular migrants, is apparently to take place in the next phases. Currently these services are free and provided at the point of need (and at the discretion of GPs in the case of primary care services).

    But Government plans that, in England at least, new charges will be applied to some primary care services (including some GP services beyond initial consultations; dental, optical and pharmaceutical services for some migrants currently exempted; and some NHS care given in the community) as well as to some Accident and Emergency services.

    Because such charges would be a new addition to the NHS, it is not yet clear how they would operate, or which groups of migrants would be chargeable in future. The Government has confirmed that refugees and asylum-seekers will be exempted, but it is not clear what the position will be for other groups like refused asylum-seekers, or irregular migrants in particularly vulnerable positions including those with mental health problems, pregnant women and children.

    These questions are of real significance, because there are dire implications of a new charging system for such critical services. Aside from the logistical difficulties of implementation, and the potentially discriminatory impacts of the regime, there will be real individual and public health consequences. For many irregular migrants, paying for care will be impossible, so the danger is that groups with serious health needs simply won’t access the help they need.

    Also problematic is the Government’s scoping out of ‘better data flows’ between the DoH and the Home Office, potentially allowing the Home Office to access information on the immigration status of NHS patients. This would be a disaster. It is hard to think of a more effective way to deter irregular migrants – already reluctant to seek treatment from mainstream services – from crossing the threshold of a GP surgery or hospital. The result will be to deepen the vulnerability to chronic health problems of any migrants with doubts about their immigration status, with widespread public health implications across our communities.

    Over the past few months various healthcare and migrant rights groups, including MRN, have been in touch with the Department of Health on all these issues, in an effort to inform the development of the regulations. The Department of Health was due to release an ‘implementation plan’ for all changes in March this year, but that deadline has now passed. We gather, instead, that an update will be issued in June, which will make clear how the Government plans to tighten up the existing charging system. This will apparently be followed by announcements in the Autumn on the healthcare levy and in the Spring for further developments on GP and A&E charging.

    In the meantime, migrant advocates need to keep a close watch on all developments and be ready to argue where possible for fair and responsible policy-making so that the NHS does not become a site for enforcement against, rather than treatment of, those who need care.

    Migrants Rights Network

    This article was first published by the  Migrants’ Rights Network

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    Charging migrants is unethical, and would cost taxpayers more than it would save.

    migrant clinic

    I remember trying to talk to a teenager from Afghanistan whose family were killed in front of him and who had been imprisoned, subjected to torture and probable sexual assault. He had tried on repeated occasions to throw himself from the balcony of his cousin’s house. He had received no psychiatric help and had no GP.

    I remember seeing two women in one day who were both 39 weeks pregnant, who’d had no antenatal care because they were refused GP registration.

    I’ve seen women who have given birth at home, unassisted, because they couldn’t access care. I’ve seen individuals with advanced cancer, heart failure, diabetes, and other conditions -all denied access to care.

    These are just a few of the hundreds of cases I dealt with while volunteering for Doctors of the World’s drop-in clinic in east London. Despite the situation already being critical for many here in the UK, this year the government published two consultations to extend current provisions for charging migrants accessing the NHS based on alleged costs of ‘health tourism’.

    Some of the proposals in the consultations are reasonable and sensible, such as strengthening mechanisms to recoup charges from other European countries and ensuring that those who should be insured – such as tourists, foreign students and economic migrants – use their insurance to pay for their healthcare costs.

    But the economic and ethical justifications fail in the proposal to charge those in clinical need who have no way of paying the £200 levy, or any other costs for that matter. These include vulnerable groups such as undocumented migrants (who have no access to public funds), trafficked people (usually women and children), visa over stayers and domestic slaves.

    Debunking myths

    We need to get the facts straight and debunk the two main myths propagated by the media, politicians and even some healthcare professionals around this subject: the myth of ‘health tourism’, and the myth of the UK’s ‘soft touch’ on asylum seekers.

    Firstly, there is little evidence that access to healthcare services plays a significant role for attracting migrants to the UK and ‘health tourism’ is being deliberately conflated with forced migration. Seven years of data from Doctors of the World’s walk-in clinic in London shows that on average service users wait more than three years before trying to access healthcare and less than two percent come here for health reasons.

    The actual sum lost treating foreign nationals is around £12 million, around 0.01% of the NHS budget compared to the £16.3 billion contribution made by migrants to the UK economy. A sobering comparison is the £10 billion (and rising) cost of taxpayers’ money spent on failed IT schemes in the NHS.

    Secondly, Britain is a low provider for asylum compared to the rest of Europe and there has been a sharp decline in asylum applicants to the UK since 2002. The UK has less than two percent of the world’s refugees, 0.33% of the UK population. Two-thirds of asylum applications fail here and only one-fifth of appeals are successful.

    The economic case against charging migrants

    Ascertaining who should be charged for care would represent an enormous and expensive administrative burden and a huge imposition on a large number of UK residents. It would not be legally permissible to only ask some residents for proof of eligibility, as this would be discriminatory.

    Moreover, prevention is better and cheaper than cure. By denying access to primary care, more sick people will be driven to presenting at hard-pressed A&E departments where care is much more expensive. Untreated infectious diseases can spread in communities and lead to more serious illnesses requiring costly secondary care. A Doctors of the World study showed that a timely diagnosis and treatment of Type 2 diabetes amongst irregular migrants would save the NHS £1.2 million.2

    Thankfully, the argument has finally been made for HIV with treatment free to anyone diagnosed with the virus in England regardless of their eligibility for NHS care, which was not the case prior to October 2012.

    The UK, despite the recession, is not a poor country and this state of affairs is shocking and unworthy of a civilised nation. Even if we believe some individuals should not be in the country, are we independent professionals or border agents of the state?

    Refugees and asylum seekers represent a burden of care for busy practitioners. Many practices already offer them a wonderful service, but CCGs, local authorities and NHS England should ensure there are adequate resources to cover vulnerable people. They should indeed reward, not penalise, practices for their hard work, enabling them to deliver culturally sensitive, competent and compassionate care.

    Dr Paquita de Zulueta is a GP working as a volunteer in Doctors of the World’s clinic in Bethnal Green, London.

    This article first appeared in Pulse.