Asylum Experience Research Articles

A framework to guide the commissioning of healthcare services for people seeking asylum in England: a qualitative co-production study

BackgroundAlthough people seeking asylum (PSA) in England are entitled to free health services, many face significant access barriers. While localised examples of excellence in healthcare provision for PSA exist, the number of PSA, compounded by delays in case processing, has led to an urgent need for tailored practices. This study aimed to develop a comprehensive framework for commissioning and providing healthcare for PSA to reduce fragmentation and inconsistency. MethodsThis co-production project, commissioned by the British Red Cross and conducted between October 2023 and March 2024, involved three peer researchers with lived experience from the outset. From a literature review of case studies on improving healthcare access for PSA, a preliminary framework of good practice was developed and explored with participants with lived experience of seeking asylum during three in-person workshops. The framework was further refined by two focus groups with policymakers and healthcare professionals (HCPs). The focus groups contributed iteratively with the lived experience workshops and explored challenges in commissioning and delivering services, ensuring relevance to the policy and operational contexts. FindingsIn total, 60 participants with lived experience attended three workshops in London and Stoke-on-Trent and 19 policymakers and HCPs attended focus groups. Workshop participants emphasised the critical role of improving communication in healthcare settings and of educating HCPs and PSA on entitlements and the NHS system. Policymakers highlighted the importance of robust leadership and need for a standardised national approach that can be adapted locally. InterpretationFindings were collated into a framework for commissioners, providers and policymakers, consisting of practical recommendations, across five pillars of good practice; 1) partnership; 2) workforce strengthening; 3) integrating lived experience in service design; 4) data sharing; and 5) strengthening pathways to care. This provides a way forward to enhance the accessibility, consistency and quality of healthcare services for PSA. FundingThe project is Commissioned by the British Red Cross, and Funded by the Health and Wellbeing Alliance. SH, AD, IAS, NR, and AJ are funded by British Red Cross. AD and KM are funded by the MRC (MR/N013638/1). SH is funded by the NIHR (NIHR300072), the Academy of Medical Sciences (SBF005I1), La Caixa Foundation (LCF/PR/SP21/52930003), Research England, MRC, and WHO. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care and UKHSA.

“I think they are actually a bit racist in not giving us everything that we need in terms of medication”: Racialised governance and asylum seeker access to healthcare in England

This paper critically examines the lived experiences of asylum seekers accessing primary and secondary healthcare in England. We employ a framework of racialised governance to assess how historical and political processes of racialisation can manifest in healthcare. It draws upon longitudinal interviews with asylum seekers currently living in the North and South of England. Our findings evidence the multiple barriers to healthcare for asylum seekers in England, including the complexity and opacity of the English healthcare system; significant difficulties accessing face-to-face appointments; denial of access to interpreters; and being dismissed and disbelieved by administrators and clinicians. We demonstrate how these barriers to healthcare can be racialised, marking asylum seekers as a racialised ‘Other’ and contributing to inadequate care. We do also, however, find positive experiences of healthcare and document cases in which poor access to healthcare among asylum seekers aligns with wider institutional resource constraints within the NHS. Nevertheless, we argue that the racialisation of healthcare is fuelled by a politically racist policy agenda, accompanied by complex and often opaque healthcare entitlements for asylum seekers, which together legitimate misinformed and, at times, prejudicial attitudes within the NHS, leading to inconsistent care for asylum seekers across NHS Trusts. We argue it is essential to listen carefully to the healthcare experiences of asylum seekers to understand how equitable and accessible services can – and should – be provided.

Exploring the mental health impact of asylum-seeking of sexual minority men: a qualitative study

Abstract Background Sexual minority individuals, often called LGBTQ+, encounter significant danger and violence in some countries worldwide. This forces many to seek asylum in a range of European countries. The study aimed to explore the experiences of seeking asylum and its implications for the mental health of sexual minority forced migrant men in Sweden. Methods An exploratory qualitative approach was used, and 15 adult gay and bisexual cisgender men were interviewed individually. Participants were recruited through a combination of purposeful, convenience, and snowball sampling. Systematic text condensation was used to analyze data. The analysis was conducted in close collaboration with three migrants with lived experience. Results The asylum-seeking process proved emotionally challenging, involving procedures with negative impacts on mental health. Challenges included disclosing intimate information during asylum interviews and enduring long periods of uncertainty with limited information on asylum case progress. Fundamental to participants’ experiences were the behaviors and attitudes of the professionals involved in legal procedures. Disrespectful and homophobic conduct during asylum interviews, enacted by interpreters and caseworkers, had been experienced by participants. The accuracy of interpretation emerged as crucial, possibly influencing the outcome of asylum claims as well as participants’ comfort in sharing information. Conclusions Sexual minority men seeking asylum in Sweden find themselves in an unfamiliar and emotionally challenging position. The challenges highlighted in this study implicates that the stressful asylum process may lead to health burdens among this population. The study emphasizes the critical role of a safe, affirming and supportive environment for asylum seekers. Further research is needed to develop effective support methods to ensure the health and well-being of sexual minority forced migrant populations during the asylum process. Key messages • The stressful asylum process may lead to health burdens among forced migrant sexual minority men. • There is a need for public health action to develop effective support methods addressing the mental health challenges faced by sexual minority forced migrants during their asylum process.

A framework to guide the commissioning of healthcare services for people seeking asylum in England

Abstract The increasing number of people seeking asylum (PSA) in England, compounded by delays in processing their cases, has led to an urgent need for tailored practices to overcome barriers to healthcare access. While local examples of excellence in healthcare provision for PSA exist, a national framework to guide healthcare for these groups is lacking, leading to fragmentation and inconsistency in service provision. This collaborative research project with the British Red Cross took a co-production approach, involving three peer researchers with lived experience from the outset. From a literature review of case studies on improving access to healthcare for PSA, a preliminary framework of good practice was developed and explored with participants with lived experience of seeking asylum during three in-person workshops refined this. Finally, two focus groups with policymakers and healthcare professionals (HCPs) explored challenges in commissioning services, ensuring final framework relevance to the policy context. In total, 60 participants with lived experience attended three workshops and 19 policymakers and HCPs attended focus groups. Workshop participants emphasised the critical role of improving communication in healthcare settings and educating HCPs and PSA on entitlements and the NHS system. Policymakers highlighted the importance of robust leadership and a standardised national approach that can be adapted locally. Capacity constraints within the NHS and primary care system were highlighted as barriers to good quality care provision. Findings were collated into a practical framework, describing five pillars of good practice; 1)Working in partnership; 2) Upskilling the healthcare workforce; 3) Including lived experience voices; 4) Improving data on local needs; and 5) Strengthening pathways into healthcare. The framework provides guidance to enhance the accessibility, consistency and quality of healthcare services for PSA, addressing critical gaps in the current system. Key messages • A novel framework to guide commissioning and provision of healthcare for people seeking asylum has been developed, drawing from existing pockets of excellence to aid a consistent national approach. • The framework presents five pillars of systemic good practice, highlighting the importance of strategic partnerships, workforce training and data collection in providing good quality care.

The Paradox of Humanitarian Recognition

Eritreans experience what I call the paradox of humanitarian recognition. Beneficiaries of some of the highest refugee-recognition rates in Global North countries, Eritreans nevertheless experience kidnap, ransoming, extortion, and pre-emptive detention in countries of transit like Sudan and Libya. Efforts by the European Union to address these abuses under multilateral anti-trafficking agreements—as well as broader efforts to externalize European borders and asylum—have further contained and criminalized networks of solidarity that extend beyond countries of transit into countries of settlement such as Italy. Based on twenty months of participant observation and interviews with Eritreans in northern Italy, this article analyzes Eritrean migrants’ experiences of violence in Libya, a country of transit, and efforts of Eritrean activists to both bring this violence to light and to aid recent refugees. Eritreans’ experiences of seeking asylum upend the binaries between legal inclusion and exclusion on which refugee exceptionalism is predicated.

'Your heart is resting and pumping at the same time': Mental health impact of seeking asylum among sexual minority men.

To explore the experiences of seeking asylum and its impact on mental health among sexual minority forced migrant cisgender men living in Sweden. Exploratory qualitative study based on individual semi-structured interviews with 15 adult gay and bisexual cisgender men recruited via a combination of purposeful, convenience and snowball sampling. Data were analysed with systematic text condensation through a collaborative approach with three migrants with lived experience. Seeking asylum had been an emotionally challenging journey for the participants in this study, involving several procedures that negatively impacted mental health. Being expected to disclose intimate information during asylum interviews had been a significant challenge, alongside needing to wait through long periods in uncertainty with little information about the progress of their asylum case. The behaviours and attitudes of professionals involved in the legal procedures had been a central aspect, as participants encountered interpreters and caseworkers who acted disrespectful and homophobic during asylum interviews. Participants mentioned that the behaviours of interpreters and the accuracy of the interpretation could influence the outcome of asylum claims and how comfortable they felt in sharing information. Thus, participants emphasized the importance of adequate and accurate interpreter services. Sexual minority men are faced with an unfamiliar and emotionally challenging position when seeking asylum and undergoing asylum interviews. The findings highlight the importance of adequate competence among professionals involved in asylum interviews, including interpreter utilization. Research is needed to determine effective methods to support these men throughout their asylum process.

Navigating challenges and workarounds: A qualitative study of healthcare and support workers' perceptions on providing care to people seeking sanctuary.

Healthcare and support workers play a pivotal role in delivering quality services and support to people seeking sanctuary who have experienced poor physical and mental health linked to previous trauma, relocation and loss of freedoms. However, they often encounter various challenges in their daily work, ranging from communication barriers to resource constraints. This qualitative study seeks to delve into the perspectives of healthcare and support workers' experience of workarounds, employed to overcome barriers to providing care. This study aims to describe healthcare providers', practitioners' and health and third sector support workers' views on barriers and workarounds to providing care for people seeking sanctuary, to inform policy and practice. A qualitative study was carried out using semi-structured telephone interviews. This study focused on primary, secondary, community and specialist National Health Service (NHS) support services for people seeking sanctuary in Wales, United Kingdom (2018). We interviewed 32 healthcare providers, practitioners and support workers employed by primary care and third sector organisations. Our approach involved obtaining verbal informed consent before digitally recording and transcribing all interviews. To analyse the data, we used the Four Levels of Change for Improving Quality model as a guiding framework for interpretation. Our study findings reveal that certain respondents expressed challenges in meeting the needs of people seeking sanctuary; notably, their experience of delivering care differed by care settings. Specifically, those involved in providing specialist NHS care believed that there was room for improvement. Mainstream primary, secondary and community health practitioners faced limitations due to resource constraints and lacked tailored information to address the unique circumstances and needs of sanctuary seekers. To address these gaps, workarounds emerged at both individual and local levels (team/departmental and organisational level). These included establishing informal communication channels between providers, fostering cross service collaboration to fill gaps and adapting existing services to enhance accessibility. Understanding healthcare providers', practitioners' and support workers' perspectives offers invaluable insights into ways to enhance healthcare delivery to sanctuary seekers. Acknowledging challenges and harnessing innovative workarounds can foster a more effective and compassionate service for this vulnerable population. The HEAR study actively involved public contributors in the design, delivery and dissemination of the research. Two public contributors (S. M. and G. R.) who had personal experience of seeking asylum served as study co-applicants. They played pivotal roles in shaping the research by participating in its development and securing funding. Alongside other co-applicants, S. M. and G. R. formed the Research Management Group, overseeing study delivery. Their contributions extended to strategic decision-making and specific feedback at critical junctures, including participant recruitment, data collection, analysis and reporting. Additionally, S. M. and G. R. were instrumental in recruiting and supporting a team of peer researchers, enhancing respondent participation among people seeking sanctuary. To facilitate effective public involvement, we provided named contacts for support (A. K. and R. F.), research training, honoraria, reimbursement of expenses and accessible information in line with best practice.

Coproducing a film resource for asylum seekers in the UK—A field reflection

Abstract In this field reflection, we critically explore our experiences of coproduction, as a group comprising people with lived experience of seeking asylum in the UK, and clinical academics. We collaboratively developed a film resource for people facing the challenges of the asylum system and for professionals who support them. We aim to (1) reflect on how this collaboration came about and how it led to both planned outputs and unanticipated outcomes, (2) identify a range of personal, organizational, and system factors that enabled or constrained our collaborations as researchers and asylum seekers or refugees in the UK, and (3) explore our own assumptions about ways of working together to enable partnership and equality of engagement. We reflect on our experiences in relation to four conditions of coproduction: combining knowledge and experience, commitment to the project and each other, flexibility in our ways of working together, and our valued achievements.

Carceralities and Approved Gender Violence: The Case of Direct Provision in Ireland

In this article, we argue that Direct Provision in Ireland is a state approved form of gendered carcerality which creates and exacerbates conditions of gendered violence. Direct Provision is a system of processing asylum seekers in Ireland where they are temporarily provided accommodation while they wait for a decision on their refugee status claim. This article shows how carceral practices are layered and gendered, making some spaces and bodies more carceral than others. These carceralities increase the institutional burden which agglomerates in human bodies and makes the lives of an already precarious population unliveable. Through a review of the strategies adopted by the government in relation to migrants, undocumented workers and asylum seekers, this article shows how the gendered experiences of certain asylum seekers like mothers and sexual violence survivors become the political site where state approved carceral practices and gendered violence merge.

Belonging-Assemblage: Experiences of Unaccompanied Young People Seeking Asylum in the UK

In this article, I examine how belonging takes place within lives shaped by the hostile milieu of UK immigration policies and politics, by focusing on the everyday experiences of unaccompanied young people seeking asylum. Drawing on Deleuze and Guattari’s assemblage, I suggest an understanding of belonging as a rhizomatic assemblage, comprising the interactions and relations of diverse forces and flows. Based on the analysis of in-depth interviews with unaccompanied young people and the professionals who care for or work with them, I conclude that belonging is reconfigured in-between relations, always incomplete and in transition. I argue that belonging is characterised by inconsistencies and ruptures and made possible by the ‘micro-politics’ of those unaccompanied young people encounter in their everyday lives. I contribute to the literature by conceptualising the sociological notion of belonging in a novel way and exposing its key components and nature formed under precarious conditions.

Enduring Borders: Precarity, Swift Falls and Stretched Time in the Lives of Migrants Experiencing Homelessness in the UK

In this article, we draw attention to the border and border governance as key mechanisms of class and ‘race-making’ in the context of an increasingly hostile immigration environment. Focusing on the life story narratives of migrants experiencing homelessness, we extend the reach of analysis beyond the experiences of asylum seekers to gain a stronger understanding of migrant experiences more broadly. In our analysis, we reveal the temporal continuum of suffering endured, ranging from the ‘slow violence’ of the everyday, rooted in precarity and restricted access to the labour market and support services, to moments of rupture where there is a swift decline in circumstances, leading to homelessness. When, at last, the tempo of suffering slows again, these individuals are increasingly excluded from meaningful calendars of activity as they spend their time waiting, often in vain, for an outcome of a Home Office application or for the possibility of some longer-term accommodation.

Refugee Chronicles: excerpt from the diary with an introduction

The following text is an excerpt from The Refugee Chronicles, a fictional diary written by Evgeny Shtorn, poet and activist, from his experience of seeking asylum. Shtorn had to flee Russia due to the government’s hostile policies toward both queer sexualities and political dissent right after he was interviewed by the Russian secret police FSB in 2018. The run for life and liberty brought him to the utmost end of Western Europe, Ireland. Shtorn’s experience of claiming asylum made him question clear cut boundaries between the West and the East along the lines of guarantees and protections of human rights. He also noted how queer sexuality plays a specific role in the asylum application process as a protected and even desired ground for granting refugee status. His experience of a lengthy stay in the dormitory for asylum seekers converted into a book-length, semi-fictional chronicle was published by an independent press, Poryadok Slov, in St. Petersburg, Russia. The book is full of queries, ambiguities, and doubts that surround the issues of queerness, migration, and the politics of human rights. The following chapter is introduced with a short pre-word by a scholar of sexuality studies Alexander Kondakov who offers a brief contextualization and conceptualization of The Refugee Chronicles.

만주망명가사〈원별여사향가라〉의 특징과 가치

만주망명가사〈원별여사향가라〉의 특징과 가치

Seeking Asylum and Mental Health—A Practical Guide for Professionals, Chris Maloney, Julia Nelki and Alison Summers (eds)

Seeking Asylum and Mental Health opens with a powerful Foreword from Dr Waheed Arian, an Afghan refugee who sought refuge at the age of fifteen. His testimony sets the tone for the piece, which aims to be rooted within the experience of those who have been forced to flee their home and are attempting to navigate the asylum process. The title establishes its role to be a practical guide for professionals and, whilst it provides an eloquent and robust exploration of the asylum process, in terms of a practical guide it could have benefited from conclusions at the end of each chapter offering suggestions for practice directly taken from that chapter. The text is interspersed with the testimonies of asylum seekers, refugees and practitioners which make powerful statements. It does feel like a missed opportunity, as acknowledged within the opening statement, that none of the authors have lived experience of seeking asylum.

Refugees Welcome? Illustrative storytelling to challenge apathy towards refugees

The illustrator and storyteller Hayfaa Chalabi writes and draws about what kind of design the Migration Board uses to visualize the asylum process. She tells about her own asylum experience and the roles that refugees are forced into. The work becomes a place for memory and history writing where Chalabi tries to understand how to document a process that is prohibited to be documented by the person undergoing it. How and why is the same emotion, such as fear, expressed and processed differently depending on one’s possibilities or impossibilities? This essay therefore aims to explore the tool of illustrative storytelling to challenge governmental restrictions faced by refugee narratives in Sweden. This exploration is done through the study of stereotypes that stigmatize the refugee’s identity. The figure of the refugee is often shaped by the visual representation one consumes via mass media and the words one hears in political debates and social discourse. Refugees are often portrayed as immigrants and nothing but immigrants, faceless victims on news and often de-named suffering people drowning in some ocean. This portrayal makes the humanity of the refugee invisible. A human who has a face, a name, a past, a story beyond his/her refugee story and most importantly an identity and rights.

Lockdown and the list: Mexican refugees, asylum denial, and the feminist geopolitics of esperar (waiting/hoping)

Between 2018 and 2020, dramatic changes in US-Mexico policy transformed experiences of asylum on the border. Quotas on applications at ports of entry (known as "metering"), the “Remain in Mexico” policy, and the deployment of the pandemic era “lockdown” through Title 42, each severely limited asylum opportunities. In response, a host of informal waiting lists emerged, developed and were utilized by a binational network of non-governmental and government agencies, shelters, cartels, and individuals. In this article we use a feminist geographic lens to examine the intimate geopolitics of esperar created by these lists. Via in-depth oral histories with Mexican asylum-seekers, shelter staff, legal advocates, and the wider border bureaucracy, we examine their formation, everyday management, the slow violences and immediate threats they posed, and their work as an informal technology of state control. Our analysis demonstrates how the lists operated as informal tactics of diversion and delay, producing a false sense of certainty while using indefinite waiting times as soft and surreptitious mechanisms to block displaced people’s legal claims for asylum. This imposed distinctly gendered burdens on women and youth. However, we also identify how the lists, where appropriated by migrants themselves, became tools to resist the hierarchies of the US nation-state and its territorial impositions. Our work extends established political geographic analyses of migration by attending to the interscalar, quotidian, and embodied realities of border practice – manifest amidst today’s lockdown by the slow violences of waiting.

Asylum Ways of Seeing: Psychiatric Patients, American Thought and Culture. By Heather Murray

In many ways, “Asylum Ways of Seeing” by Heather Murray, is an extended riff on the term “asylum”—what it meant for psychiatry and for patients, and how this meaning changed over time. To explore this change in meaning, Murray employs a “history of emotions” framework and takes an overtly cultural and intellectual history approach to center the experiences of patients themselves. In this way, she argues not only that we need to try and understand the history of psychiatric institutions from the point of view of the people who were in them, but that there is a relationship between the way psychiatric patients made sense of their experience, and changes in institutional policy. This is an ambitious approach and requires Murray to draw on a broad array of archival and historiographical sources. This creates a tension for the book, because it is a difficult enterprise, and reveals some of the ethical and logistical issues in any attempt to take a “history from below” approach to psychiatry. How do we get at the patient experience, given the nature of archives and laws that (rightly) protect patient privacy? And how do we make sense of those records even if we do have access to them, given they are always so heavily mediated by the clinical encounter? To try and get around this problem, Murray draws largely on patient letters contained in state archives or in personal collections, and on the extensive body of work in the domain of patient narrative. While much can be gleaned from these sources, there is an important limitation born of the fact that the people with the resources to write and publish such a memoir are almost entirely white, and usually middle or upper class. This tends to skew the whole book towards that type of patient experience, and this causes a ripple effect throughout the book that Murray herself is aware of—the idealized perception of the asylum experience.

Preventing suicide in refugees and asylum seekers: a rapid literature review examining the role of suicide prevention training for health and support staff

BackgroundRefugees and asylum seekers are exposed to a unique set of circumstances and experiences that are associated with an increased suicide risk. Suicide prevention training has been recognised as a central component supporting a comprehensive approach to suicide prevention. Limited literature exists exploring the role of suicide prevention training for health and support staff working with refugee and asylum seeker consumers.MethodsTo determine the impact suicide prevention training for health staff may have in supporting refugee and asylum seeker suicide prevention, researchers undertook a rapid literature review exploring what elements should be considered when developing suicide prevention training for health and support staff working with refugee and asylum seeker consumers.ResultsResults of academic and grey literature screening identified 14 studies exploring suicide prevention training for health and support staff working with refugee and asylum seeker consumers. Findings of the literature review suggest suicide prevention training for health and support staff working with refugee and asylum seekers should consider the inclusion of content which increases participant competence and confidence to identify and respond to suicide risk; provide staff with an understanding of cultural differences and its impact on refugees and asylum seekers recognition of mental health and suicide as a health matter; highlight the importance trauma informed practices in care and consider the lived experience of refugees and asylum seekers.ConclusionsInclusion of specific content in refugee and asylum seeker suicide prevention training may provide health and support staff increased competence and confidence to identify and respond to suicide risk in refugees and asylum seekers.

Rights to Speak

Vignette Around the time I was preparing to write this commentary, I attended a poetry event in Glasgow celebrating Palestinian poetry. Due to unforeseen circumstances I was asked to step in and read the English translations, unprepared, in place of a distinguished Scottish poet/translator, alongside a Palestinian poet, Iyad Hayatleh, who read Arabic originals from an anthology followed by his own poems in the language and then a short story he had written in English. The anthology contained poems from a range of Palestinian poets with translations into Standard English with occasional Scots English expressions (e.g. ‘two wee hands’) and into Scots and Gaelic and Shetlandic. All the translations I in fact read were into this occasionally Scots-inflected Standard English. Iyad read from the anthology in the first part of the reading, and I read the English translations in my southern English accent. So far, so conventional. In the second part of the reading, however, it turned out that Iyad’s poems in Arabic were to be followed by his own translations of them into English. At this point it seemed to me rather odd that I should be reading Iyad’s own translations. So when he had finished reading the first poem and handed the manuscript over to me to read, I suggested to him that he should read the English (there having been no time before the reading to plan this). At this point, however, he indicated that he would rather not, so I carried on reading the English. After this Iyad went on to read his short story, which is an account of his experience of seeking asylum, his reading in English creating a very powerful effect in the room.

“How Can You Put This All Down in One Story?” Transgender Refugees’ Experiences of Forced Migration, Border Crossings, and the Asylum Process in Canada Through Oral History and Photovoice

Research on asylum experiences for sexual and gender minority refugees has increased within the past decade. However, even within this growing body of research and critical commentary, the voices of gender minority or transgender (trans) refugees and their particular experiences navigating migration and asylum processes can sometimes be overlooked or lost within the larger subject of queer refugee experiences. Understanding the individual experiences of trans refugees can help scholars to further understand how gender identity and sexual orientation are regulated in migration and settlement. This article focuses on the narratives and photovoice of two trans refugees in Vancouver, British Columbia, Canada. Canada offered them relief from the state and social persecution they were experiencing in their countries of origin. Yet, they also experienced hyper-regulation by the Canadian state that caused them to be detained and interrogated by the Canada Border Services Agency (CBSA) as well as fear and silencing in their asylum hearings by the Immigration and Refugee Board (IRB) of Canada’s. Their experiences reveal how trans individuals are both hyper-regulated and marginalized by asylum and immigration processes in Canada. These government processes work to reinforce heteronormativity and the gender binary in which trans asylum seekers are marginalized.