Asylum Seekers And Refugees Research Articles

Views of emergency care providers in providing healthcare for asylum seekers and refugees

BackgroundThe number of asylum seekers awaiting decisions on their claims in the UK has more than tripled since 2014. How we meet international obligations to provide appropriate healthcare to asylum...

Flight-related determinants of health-related quality of life of asylum seekers and refugees in Germany: a longitudinal study based on the German Socio-Economic Panel (SOEP)

BackgroundGermany played a key role as receiving country during the so-called refugee and displacement crisis with about 5 million asylum seekers arriving in the EU between 2014 and 2020. It is well known that asylum seekers and refugees (ASRs) have a high burden of disease and are particularly prone to mental disorders such as trauma, stress-related and affective disorders. Not much is known about the determinants of health-related quality of life (HrQoL) among ASRs, especially in the context of the flight. Therefore, the aim of this study was to analyze the associations between flight-related characteristics and HrQoL of ASRs in Germany.MethodsThe sample of this study was based on five consecutive waves of the Survey of Refugees samples of the German Socio-Economic Panel (n = 8015; 14,314 observations). Mental and physical HrQoL was measured using the mental (MCS) and physical (PCS) component summary scores of the SF-12v2. Associations between flight-related characteristics and HrQoL were examined using multilevel mixed-effects linear regressions.ResultsThe different countries of birth were associated with varying MCS and PCS scores. The MCS and PCS scores were lower among ASRs with an economic situation below average in their countries of origin. Persecution, discrimination, and poor living conditions as reasons for leaving the county were associated with lower MCS scores. ASRs who were dissatisfied with their own living situation and who were discriminated often due to their origin had both lower MCS and PCS scores. Not feeling welcome in Germany and missing people from one’s country of origin were both associated with lower MCS scores. No worries about not being able to stay in Germany or not being able to return to one’s country of origin were both associated with higher MCS scores.ConclusionsThe economic situation in the country of origin and the presence of persecution, discrimination, and/or poor living conditions as reason for flight may be pre-flight-related determinants of HrQoL of ASRs in Germany. Possible post-flight-related determinants can be the residence status, the satisfaction with one’s living situation, discrimination due to one’s origin and a feeling of missing people from one’s country of origin. With regard to those determinants, the clarity about the residence status, reducing racial discrimination and the mourning of flight-related circumstances must be ensured.

Facilitators and barriers to asylum seeker and refugee oral health care access: a qualitative systematic review.

Objectives Asylum seekers and refugees (ASRs) encounter barriers when accessing oral health care (OHC). A qualitative systematic review was conducted to understand the perceptions, attitudes, behaviours and experiences of ASRs regarding their OHC. Themes were extracted to identify the barriers and facilitators ASRs face when accessing OHC.Data sources PubMed, APA PsycInfo, Cochrane Database, Web of Science and CINAHL were searched on 4 and 5 October 2022.Data selection Primary studies including ASRs of any age or nationality were included. Qualitative data of ASRs' lived experiences of oral health (OH) and accessing OHC were extracted. The Critical Appraisal Skills Programme quality appraisal tool was applied.Data synthesis Data findings were extracted and meta-aggregation performed using inductive reasoning. A total of 13 primary qualitative studies were included. Three barriers were identified, including difficulty accessing treatments and appointments, cultural and language changes, and ASRs' lack of OHC knowledge or incongruous beliefs surrounding OH. Two facilitators were identified as good OH education and support from care providers or government.Conclusions Decision-makers should adapt policy to facilitate access to OHC and educate ASRs on OH. More research is needed to understand the barriers and facilitators to OHC for other people groups who experience health inequalities.

Caring and building friendships in the UK’s asylum system

To care and feel cared for are considered fundamental to what makes us human, and what enables us to live and thrive in this world. Yet for the UK’s asylum-seeking population who is living with uncertainties for the future, care appears absent. In such contexts, it is imperative to understand how care is enacted, experienced, and valued amongst spaces and people often considered to be care-less. Drawing on data collected in four collaborative photographic workshops and photo elicitation interviews with asylum seekers and refugees (ASRs) (N: 7), this study aims to gain insight into how ASRs in the UK care and feel cared for and their relative ability to forge friendships during their migration journey. We show how their relationship to caregiving and care-receiving changes over time and is deeply influenced by asylum policies and the refugee experience more generally. Responding to feminist scholars’ calls to disrupt the normative assumptions about how and between whom care is exchanged, this article highlights the diversity of friendships forged while on the move and seeking asylum as well as the caring practices emerging in situations of precarity, the pervasive impacts of the hostile environment on disrupting and distorting such caring relationships, and cautious but agentic and caring ways that ASRs seek to navigate the ambiguities of friendships in hostility. In doing so, the article provides an important counter-narrative to the dominant portrayal of ASRs as passive recipients of care, by highlighting how their way to approach care and friendship varies across time and circumstances.

The role of small voluntary sector organisations in tackling complex social challenges: lessons from a charity serving asylum seekers and refugees

There is a growing body of research on small Voluntary Sector Organisations’ (VSOs) contribution to tackling complex social challenges. It focuses on how small VSOs work to address these challenges, as opposed to what the measurable impact of that work is. This article adds to that body of work by providing a new analytical account of how a small VSO works; in this case what shapes that work is the extent to which it is collaborative, responsive and collective, and voluntarily driven in nature. This article also takes the research to a new setting; that of small VSOs working to better the welfare of Asylum Seekers and Refugees (ASRs).

Exploring contextual effects of post-migration housing environment on mental health of asylum seekers and refugees: A cross-sectional, population-based, multi-level analysis in a German federal state.

Asylum seekers and refugees (ASR) in Germany are dispersed quasi-randomly to state-provided, collective accommodation centres. We aimed to analyse contextual effects of post-migration housing environment on their mental health. We drew a balanced random sample of 54 from 1 938 accommodation centres with 70 634 ASR in Germany's 3rd largest federal state. Individual-level data on depression and anxiety as well as sociodemographic- and asylum-related covariates, were collected and linked to contextual geo-referenced data on housing environment ('Small-area Housing Environment Deterioration' index, number of residents, remoteness, urbanity, and German Index of Multiple Deprivation). We fitted two-level random-intercept models to exploratively estimate adjusted contextual effects. Of 411 surveyed participants, 45.53% and 44.83%, respectively, reported symptoms of depression or anxiety. 52.8% lived in centres with highest deterioration, 46.2% in centres with > = 50 residents, 76.9% in urban, and 56% in deprived districts. 7.4% of centres were remote. We found statistically significant clustering in reporting anxiety on the level of accommodation centres. The model resulted in an intraclass correlation of 0.16 which translated into a median odds ratio of 2.10 for the accommodation-level effects. No significant clustering was found for symptoms of depression. The highest degree of deterioration, large accommodation size, remoteness, and district urbanity showed higher, but statistically not significant, odds for reporting anxiety or depression. District deprivation demonstrated higher odds for anxiety and lower odds for depression yet remained statistically insignificant for both. Evidence for contextual effects of housing environment on mental health of ASR could not be established but residual confounding by length of stay in the accommodation centre cannot be ruled out. Confirmatory analyses with prior power calculations are needed to complement these exploratory estimates.

Mental health resilience among refugees and asylum seekers: a systematic review

Abstract Background >100 million people worldwide have been forced to flee their homes because of torture, conflict, violence, and human rights violations. Asylum Seekers and Refugees (ASRs) make up a third of this group. ASRs are more likely to experience poor mental health compared to the general population. This study systematically reviewed the studies of mental health resilience and potential factors promoting resilience in this population. Methods A comprehensive and systematic literature search was conducted using PubMed, MEDLINE, Cochrane library, Google scholar, ScienceDirect, Sage Journals, and Taylor & Francis online. Electronic search was carried out using terms related to resilience, mental health, and ASRs. Qualitative studies published in English until March 2022 and exploring the role of resilience in mental health and wellbeing of ASRs were eligible for inclusion. The studies were analyzed using a thematic analysis approach using Braun and Clarke's 6 step process. Quality assessment was conducted using Joanna Briggs Institute critical appraisal Tool. Results Of the 9,708 studies identified in the electronic search, 10 were eligible for inclusion. Three key themes were identified as promoting resilience: social support from peers and family, religion and spirituality, and individual factors. The studies emphasized the value of family and peer support in keeping the sprits alive and finding strengths to keep going. Spirituality and religion were reported as crucial factors in staying grounded and hopeful against all odds. Individual factors such as reflection, reframing and positive thinking were described as coping strategies during adversities. Conclusions The review highlighted the important role of resilience related factors in the mental health and wellbeing of ASR populations. More studies in this area are required to inform the development of interventions to promote resilience and improve the mental health and wellbeing of ASRs. Key messages • Peer and family support, religion and spirituality, reframing and positive thinking play keel role in the mental health and wellbeing of asylum seekers and refugees. • There is a dearth of research exploring the factors promoting mental health resilience in asylum seekers and refugees.

Complementary and alternative therapies for PTSD in refugees and asylum seekers: a systematic review

Abstract Background Over 100 million people worldwide are displaced every year, including 26.3 million refugees and 4.5 million asylum seekers. Previous research has identified that up to 46% of asylum seekers and refugees (ASRs) use complementary and alternative therapies (CAT) in their lifetime. This study aimed to systematically review and summarise the findings from existing studies evaluating the effectiveness of practitioner-based complementary therapies in PTSD in ASR populations. Methods The study protocol was registered in PROSPERO [ID: CRD42022311069]. Electronic searches were conducted in MEDLINE, Embase, Google Scholar, PubMed, Cochrane Library, and Web of Science. Studies published in English that considered practitioner-based CAT in PTSD in adult ASRs were eligible. Results from quantitative studies were summarised using effect size and, for qualitative/mixed methods studies, narrative synthesis was conducted using thematic analysis. Quality assessment of the studies were conducted using the Mixed Methods Appraisal Tool (MMAT). Results Of the total 605 studies identified in the search, 15 were included: quantitative (n = 11), qualitative (n = 2), and mixed methods (n = 3). Music therapy was identified as the most widely used intervention (five studies), followed by art therapy, body awareness therapy, meditation, yoga and spiritual therapy. Meditation, yoga and spiritual therapy were significantly associated with reduction in PTSD symptoms whereas the findings varied across the studies in relation to other therapies. Qualitative findings suggested that CAT interventions are acceptable to ASR populations. Conclusions This study suggests that spiritual therapy, yoga, and meditation have a beneficial role in PTSD in ASR populations. However, the findings should be interpreted cautiously as the studies were small with considerable inter-study heterogeneity. Key messages • Practitioner based complementary and alternative therapies are acceptable to asylum seekers and refugees. • Spiritual therapy, yoga and meditation may have beneficial role in PTSD.

Post-migration living difficulties, discrimination, and mental health of traumatized refugees in Germany: data from the refuKey project for timely and need-adapted treatment in a stepped-care setting

Asylum seekers and refugees (ASR) experience many short-term and long-term post-migration stressors, e.g. discrimination after resettlement, leading to increased psychiatric morbidity in this population. Using data from the state-funded stepped-care project refuKey based in Lower Saxony, Germany, that aims to provide better mental health care access for ASR, we investigated the relationship between post-migration stressors and mental health in treatment-seeking ASR. In our naturalistic multi-centric study we assessed mental health (e.g. symptoms of depression, anxiety, traumatization, etc.), post-migration living difficulties, and perceived discrimination in ASR before and after treatment using questionnaires in eight languages consisting of internationally validated scales. Participants displayed poor mental health before, and significantly improved mental health parameters after treatment (p < 0.001). Post-migration living difficulties and perceived discrimination significantly predicted all mental health outcomes before treatment (p < 0.001) but not the treatment effects. However, perceived discrimination only contributed significantly to the prediction of quality-of-life and traumatization. Our findings suggest that refuKey-treatment helps despite the presence of post-migration living difficulties. Asylum policies should aim at reducing and overcoming post-migration living difficulties due to the strong association to mental health levels in treatment-seeking ASR.

Health needs and perception of health care quality among Asylum Seekers and Refugees in an Italian local health authority: A qualitative study.

Migrants, Asylum Seekers and Refugees (ASRs) represent a vulnerable diversified population with increased risks of developing health problems, and in the hosting countries several barriers often hamper their access to the health services. Gathering information about ASRs' experiences and perceptions of host country health care systems may contribute to improve the quality of health care provided. The aim of this study was to explore the health needs in their bio-psycho-social meaning, and the quality of health care as perceived from the ASRs' perspective. The qualitative descriptive study was conducted as part of the Project "G-START - testing a governance model of receiving and taking care of the Asylum Seekers and Refugees." Through purposeful and snowball sampling, four Focus Groups conducted in English, Italian and French were carried out between July and August 2019, involving 50 ASRs hosted by four reception centers located on the territory pertaining to an Italian Local Health Authority covering a general population of 500.000 people. The analysis of data was categorical, and was performed using N-Vivo software. The macro-categories emerged were the ASRs' bio-psycho-social health needs, including mental health, sexual and reproductive health, food and nutrition, knowledge of the health care system, need for inclusion; healthcare services access, including barriers before and after the access and the ability of the local health system to respond to existing and evolving demands; strengths of the healthcare and reception systems, and suggestions for improving them in the future. ASRs present vulnerabilities and specific health needs, and the health care system is not always able to guarantee access or to respond to these needs. Several obstacles have been highlighted, such as linguistic barriers and lack of cultural mediation, bureaucratic and administrative barriers, lack of knowledge of the Italian health care system. An effective reorganization of services driven by a more detailed output analysis of the target population needs, together with the use of cultural mediation, peer to peer education and support, and the training of health professionals are recommended to ensure a more accessible, equitable and effective health care system at local level.

Are asylum seekers and refugees provided with appropriate mental health support in the United Kingdom?

ABSTRACT Over 220,000 asylum seekers and refugees (ASR) lived in the United Kingdom in 2021. Traumatic experiences lived during the different phases of the migration process make people seeking asylum vulnerable to mental health conditions, including post-traumatic stress and depression. Assessments conducted by various local authorities since 2016 stress the need to improve ASR’s access to appropriate mental health support, but lack clarity on how to achieve this. This article explores perceptions of mental health support needs for ASR, and contrasts them to service provision. Data were collected via semi-structured interviews with nine ASR and six individuals who provide wellbeing support to ASR living in Brighton and Hove, and were analysed via thematic analysis using NVivo. Three main themes emerged, relating to the need for holistic mental health support for ASR, the disjunctive between perceived needs and the available support, and the barriers to accessing existing services. Findings highlight the need for holistic, specialised, culturally sensitive and sustainable mental health support for ASR, and illustrate how training healthcare receptionists on the rights and entitlements of ASR and greater support services coordination can help strengthen ASR’s access to the available support services and their mental wellbeing.

Inequalities in health system responsiveness among asylum seekers and refugees: A population-based, cross-sectional study in Germany.

Global migration has sparked renewed interest in Universal Health Coverage in high-income countries. However, quality of care has received little attention. This study uses the concept of responsiveness to study quality of care for asylum seekers and refugees (ASR) in Germany and identify inequalities among this group. We report results from a population-based, cross-sectional health monitoring survey in Germany's third-largest federal state using random sampling methods. Established instruments were used to measure responsiveness, health status and socio-demographic factors. Data were weighted and adjusted logistic regression models applied to identify inequalities related to health status, structural and socio-demographic factors. N = 344 survey participants were included in the analysis (response rate 39.2%). Combined responsiveness was 77% (95%CI: 68%; 83%) but varied between domains. Responsiveness was poor for individuals with symptoms of anxiety (OR 0.35, 95%CI 0.13,0.99), longstanding illness (OR:0.42, 95%CI:0.17,1.06) and diminished health-related quality of life (OR:0.24, 95%CI:0.06,0.95). Individuals from Southern Asia (OR: 0.24, 95%CI: 0.07,0.86) and young participants (OR:0.31, 95%CI:0.12,0.82) also reported less responsive care. Unique patterns of explanatory factors were identified within each responsiveness domain. We found important differences in responsiveness related to health, socio-demographic and structural factors, both in combined responsiveness and in individual domains. Inequalities related to health status factors are particularly concerning given the potential implications for equity of access. Future research should explore responsiveness for different sectors, include individuals who have not utilised healthcare and allow for the adjustment of differential expectations of care between population groups.

Social Connection, (Im)material Gains and Experiences of Inclusion of Asylum Seekers’ and Refugees’ Volunteering in Glasgow

Volunteering is an activity based on a non-profit idea of engagement in productive transactions. This paper examines why and how asylum seekers and refugees (ASRs) partake in volunteering focusing particularly on the everyday, mundane experiences of volunteering and the role of the material and financial gains as part of it. Data is drawn from 30 interviews conducted with ASRs from 15 countries residing in Glasgow, 20 interviews with the third sector and state agency staff, and supplemented by participant observation conducted in third sector organisations involved in ASRs’ integration and settlement. Despite the individual and situational differences, volunteering appeals to ASRs as it enables them to gain familiarity with and social connectivity in their new environs as well as supplements subsistence needs, providing material and financial benefits. These mundane and seemingly secondary gains from volunteering consist of the flesh of the otherwise abstract processes of inclusion, due to the symbolic and logistic significance they have in the ASRs’ lives.

The patient journey of newly arrived asylum seekers and responsiveness of care: A qualitative study in Germany.

BackgroundResearch on health and healthcare for asylum seekers and refugees (ASR) has focused strongly on accessibility and legal entitlements, with quality of care receiving little attention. This study aimed to assess responsiveness, as non-medical quality of care, in the narratives of ASR patients recently arrived in Germany.Methods31 ASR with existing medical conditions were recruited in six refugee reception centres and three psychosocial centres. Semi-structured, qualitative interviews were conducted which reconstructed their patient journey after arrival in Germany. Interviews were recorded, transcribed verbatim and evaluated using thematic analysis.ResultsThe experiences of participants throughout the patient journey provided a rich and varied description of the responsiveness of health services. Some dimensions of responsiveness, including respectful treatment, clear communication and trust, resurfaced throughout the narratives. These factors were prominent reasons for positive evaluations of the health system, and negative experiences were reported in their absence. Other dimensions, including cleanliness of facilities, autonomy of decision-making and choice of provider were raised seldomly. Positive experiences in Germany were often set in contrast to negative experiences in the participants’ countries of origin or during transit. Furthermore, many participants evaluated their experience with healthcare services in terms of the perceived technical quality of medical care rather than with reference to responsiveness.ConclusionThis qualitative study among ASR analysed patient experiences to better understand responsiveness of care for this population. While our results show high overall satisfaction with health services in Germany, using the lens of responsiveness allowed us to identify particular policy areas where care can be strengthened further. These include in particular the expansion of high-quality interpreting services, provision of professional training to increase the competency of healthcare staff in caring for a diverse patient population, as well as an alignment between healthcare and asylum processes to promote continuity of care.

Factors affecting oral health care for asylum seekers and refugees in England: a qualitative study of key stakeholders' perspectives and experiences.

Aims To investigate factors influencing oral health behaviours and access to dental services for asylum seekers and refugees (ASRs).Methods A qualitative research study using purposeful sampling was undertaken in South West England. Online semi-structured interviews with stakeholders working with or supporting ASRs were analysed through reflexive thematic analysis.Results Twelve participants providing support to ASRs in various capacities participated. Two interviewees had lived experience of forced displacement and the UK asylum process. Key themes into what hinders ASRs' oral health care were: prioritising safety and survival; variations in cultural norms and practice; lack of knowledge about dental care; financial hardship and affordability of care; a gulf of understanding of what dental care would be like and experiences of it; and structures of dental services that leave vulnerable groups behind. Opportunities for improving oral health care were: accessible oral health education; partnership working and creating supportive environments; translation; providing culturally sensitive and person-centred care; and incorporating ASRs' views into service design.Conclusions Several factors affect to what extent ASRs can and are willing to engage with oral health care. Co-developing accessible and relevant prevention programmes and ensuring equitable access to dental services for ASRs is important. Future research should explore ASRs' views and experiences of dental care and explore informed suggestions on how to optimise oral health promotion and provision of care.Supplementary InformationZusatzmaterial online: Zu diesem Beitrag sind unter 10.1038/s41415-022-4340-5 für autorisierte Leser zusätzliche Dateien abrufbar.

Association between housing and health of refugees and asylum seekers in Germany: explorative cluster and mixed model analysis

BackgroundAccommodation for asylum seekers and refugees (ASR) in Germany differs in many ways depending on a range of political, structural, social, and environmental factors. These contextual differences present a challenge for assessing health impacts of refugee accommodation. We aimed to devise a broad typology of refugee accommodation that allows to assess associations between housing and health of ASR.MethodsWe performed a cluster analysis of population-based, cross-sectional secondary data in Germany to identify clusters of refugee accommodation. We then assessed health disparities across clusters by performing bivariate analysis and linear mixed model regression analysis.ResultsWe identified four clusters, three of them reflected different types of private accommodation and one pointed to collective accommodation. The collective accommodation cluster clearly differed from the private accommodation clusters in terms of space, area, level of restrictions, social connections and respondent satisfaction. Across private accommodation clusters we also found differences in space, area, and level of restrictions. In regression analysis, belonging to one of the private accommodation cluster was significantly associated with better mental health compared to belonging to the collective accommodation cluster. Physical health was significantly lower in one private accommodation cluster characterized by poor access to public transport and a higher level of restrictions compared to a private accommodation cluster showing better connections and a lower level of restrictions.ConclusionWe demonstrate that unfavourable conditions cluster in collective accommodation with negative outcomes for mental health but not for physical health. We also found health disparities across types of private accommodation. We conclude that housing plays a role in the production of health inequalities in ASR but needs to be assessed in a differentiated, multidimensional way.

Pilot evaluation of a group stabilisation intervention for refugees and asylum seekers with PTSD.

Post-traumatic stress disorder (PTSD) is commonly experienced by asylum seekers and refugees (ASR). Evidence supports the use of cognitive behavioural therapy-based treatments, but not in group format for this population. However, group-based treatments are frequently used as a first-line intervention in the UK. This study investigated the feasibility of delivering a group-based, manualised stabilisation course specifically developed for ASR. The second aim was to evaluate the use of routine outcome measures (ROMs) to capture psychological change in this population. Eighty-two participants from 22 countries attended the 8-session Moving On After Trauma (MOAT) group-based stabilisation treatment. PHQ-9, GAD-7, IES-R and idiosyncratic outcomes were administered pre- and post-intervention. Seventy-one per cent of participants (n = 58) attended five or more of the treatment sessions. While completion rates of the ROMs were poor - measures were completed at pre- and post-intervention for 46% participants (n = 38) - a repeated-measures MANOVA indicated significant improvements in depression (p = .001, ηp2 = .262), anxiety (p = .000, ηp2 = .390), PTSD (p = .001, ηp2 = .393) and idiosyncratic measures (p = .000, ηp2 = .593) following the intervention. Preliminary evidence indicates that ASR who attended a low-intensity, group-based stabilisation group for PTSD experienced lower mental health scores post-group, although the lack of a comparison group means these results should be interpreted with caution. There are significant challenges in administering ROMs to individuals who speak many different languages, in a group setting. Nonetheless, groups have benefits including efficiency of treatment delivery which should also be considered.

Mental healthcare for asylum-seekers and refugees residing in the United Kingdom: a scoping review of policies, barriers, and enablers

BackgroundSince 2011, a large influx of asylum-seekers and refugees has put pressure on the UK’s under-resourced national health services and mental health services. Asylum-seekers and refugees (ASR) may experience traumatic events pre-departure, life-threating circumstances on their journeys, and difficulties integrating into host countries related to immigration policies, social isolation, poor living conditions, and unemployment, all of which can significantly affect their mental health. This topic is increasingly important due to the numbers of people seeking asylum and growing concern for their mental health on resettlement. This study examined UK-wide policies and guidance, healthcare practices, barriers, and enablers of mental healthcare for ASR residing in the UK.MethodsWe conducted a scoping review using Arksey and O’Malley’s 2005 framework, which included semi-structured interviews with stakeholders from non-governmental organisations, academia, UK National Health Service, and community groups. We synthesised and analysed literature and interview data thematically to examine current barriers and potential enablers of ASR mental health support in the UK.ResultsWe included 39 literature sources, of 1,638 identified, and 10 stakeholder interviews. Sources, most published in 2019 (n = 13), included data from England (n = 13), Scotland (n = 3), Wales (n = 3), and Northern Ireland (n = 2) and covered access to care (n = 16), mental health disorders (n = 7), impacts on health (n = 7), barriers to care (n = 13), policies and plans (n = 4), and clinical recommendations (n = 3). Synthesised themes from literature and interviews included existing barriers (i.e. communication difficulties and lack of funding, resources, and political will) and potential enablers (i.e. proposed provision practices, social needs of ASR, and policy changes).ConclusionsThere is a gap in the literature regarding UK-wide assessment of access and delivery of mental healthcare for ASR in the UK. Time sensitive and culturally appropriate approaches are needed, with greater funding and resource support from the UK Government. This study provides justification for a call to relax hostile environment policies, and for ASR-specific mental health services and support to be considered within the UK. Further research is needed to assess implementation of guidelines across the UK.

Can Community-Based Social Protection Interventions Improve the Wellbeing of Asylum Seekers and Refugees in the United Kingdom? A Systematic Qualitative Meta-Aggregation Review

The Sustainable Development Goals 2030 call for an end to poverty in all its forms everywhere through the adoption of integrated social protection policies. However, recent literature suggests an implicit and explicit discrimination towards asylum seekers and refugees (ASRs) in United Kingdom social policy, leading to high rates of destitution, poor health and isolation. Due to the limited nature of UK government support, many ASRs become involved with semi-formal and informal social protection. This systematic literature review synthesizes existing qualitative literature that documents the impact of these interventions on the wellbeing of adult ASRs in the United Kingdom. The literature offers useful insights into asylum seeker and refugee perceptions of wellbeing, agency, and support responsibility, and how their interaction with social protection providers constrains or enables the realization of their fundamental human needs. The findings demonstrate that government support is inadequate to meet the needs of many asylum seekers and refugees, leading to disempowerment, lack of agency and exploitation. Positive wellbeing outcomes are linked to semi-formal and informal interventions, summarized into six categories: the positive impact of volunteering; physical space and intentional gathering; practical and material support; training and skills development; solidarity, inclusion and understanding; and peer support and advice.

Measuring deterioration of small-area housing environment: Construction of a multi-dimensional assessment index and validation in shared refugee accommodation.

Housing is an important health determinant, in particular for asylum seekers and refugees (ASR) living in state-provided accommodation and struggling for residential autonomy. However, few validated objective measurement tools exist to measure housing quality in the sense of the deterioration of the housing environment. We aimed to construct and validate an instrument to enable resource-efficient monitoring of and health research on such housing quality. After considering existing theoretical frameworks on housing effects on health, we constructed an easily applicable tool measuring the degree of “Small-area Housing Environment Deterioration” (SHED), based on the “Broken Windows” - index. In a validation study, we tested SHED index's objectivity and reliability, measuring inter-/intra-rater reliability and internal consistency and discussed its strengths and limitations by means of cognitive testing. We ran a field-test as part of a population-based, cross-sectional refugee health survey in a random sample of 58 shared accommodation centers across 44 districts of the German federal state of Baden-Wuerttemberg, enabling us to test index applicability and convergence with ASR's satisfaction with their living place. The new SHED index provides a validated and field-tested measure of deterioration of small-area housing environment with substantial reliability. Serving both researchers and policy-makers, SHED offers an easily applicable index to support epidemiological analyses on housing as a contextual and social determinant of health as well as evidence-informed decision making in questions of housing policies.