The negative health effects of hostile environment policies on migrants: A cross-sectional service evaluation of humanitarian healthcare provision in the UK.

Lucy Jones,Sophie J. Weller,Robert W. Aldridge,Eleanor R. Turnbull,Liam J. Crosby,Rachel Burns,Anna Miller

doi:10.12688/wellcomeopenres.15358.1

Abstract

Background: Recent UK 'hostile environment' immigration policies, including obligatory charging and sharing of confidential data between NHS Digital and the Home Office, have created an atmosphere of fear and exposed already highly marginalised and vulnerable groups to significant health risks by increasing barriers to accessing NHS care. Methods: This is a cross-sectional observational study of patients accessing healthcare at Doctors of the World (DOTW) in the UK. DOTW is a humanitarian organisation, providing care to those excluded from NHS healthcare. We aimed to describe population characteristics of individuals using DOTW services and identify groups at greatest risk of facing 'hostile environment'-related barriers to NHS care, specifically being denied healthcare or fear of arrest. Results: A total of 1474 adults were seen in 2016. Nearly all were non-EU/EEA nationals (97.8%; 1441/1474), living in poverty (68.6%; 1011/1474). DOTW saw a large number of undocumented migrants (57.1%; 841/1474) and asylum seekers (18.2%; 268/1474). 10.2% (151/1474) of adults seen had been denied NHS healthcare and 7.7% (114/1474) were afraid to access NHS services. Asylum seeker status was associated with the highest risk (adjusted odds ratio (OR): 2.48; 95% confidence interval (CI): 1.48-4.14) of being denied NHS healthcare and being undocumented was associated with the highest risk of fearing arrest (adjusted OR: 3.03; 95% CI: 1.70-5.40). Conclusions: Our findings make visible the multiple and intersecting vulnerabilities of individuals forced to seek care outside of the NHS, underlining the public health imperative for the government to urgently withdraw its 'hostile environment' policies and address their negative health impacts.

Highlights

There are an estimated 258 million international migrants worldwide, of which 25.9 million are refugees and asylum seekers[1]
Our study describes the characteristics of the population using Doctors of the World (DOTW) services in London and Brighton, providing a unique and timely insight into a highly excluded population and the likely impacts of the increasingly ‘hostile environment’ imposed on some migrant groups in the UK
Identifying groups at greatest risk of facing ‘hostile environment’-related barriers to National Health System (NHS) care, we found a tenth of individuals have sought and been denied NHS care and asylum seekers were at highest risk

Summary

Introduction

There are an estimated 258 million international migrants worldwide, of which 25.9 million are refugees and asylum seekers[1]. The UK’s Immigration Acts of 2014 and 2016 extended ‘hostile environment’ immigration policies into far-reaching aspects of public life. This led to mandatory upfront charges to ‘non-ordinary residents’ for National Health System (NHS) secondary care, including undocumented migrants and those denied asylum. Recent UK ‘hostile environment’ immigration policies, including obligatory charging and sharing of confidential data between NHS Digital and the Home Office, have created an atmosphere of fear and exposed already highly marginalised and vulnerable groups to significant health risks by increasing barriers to accessing NHS care. We aimed to describe population characteristics of individuals using DOTW services and identify groups at greatest risk of facing ‘hostile environment’-related barriers to NHS care, being denied healthcare or fear of arrest. Conclusions: Our findings make visible the multiple and intersecting vulnerabilities of individuals forced to seek care outside of the NHS, underlining the public health imperative for the government to urgently version 1 published 22 Jul 2019

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