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There have always been asylum seekers and refugees going back to the World War but in recent years the United Kingdom (UK) has seen a vast number of asylum seekers coming from different parts of the world in search of security from their troubled regimes. As a signatory to the 1951 United Nations Convention the UK has an obligatory duty to receive and protect asylum seekers until a decision has been made on their individual claim (Hepinstal et al, 2004).
According to the 1951 UN Convention an asylum seeker is defined as,” a person who has crossed an international border in search of safety and refugee status in another country”. To get the refugee status under this Convention a person has to present with;
“A well founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion and is outside the country of his nationality and unable or, owing to such fear is unwilling to avail himself to the protection of that country”.
Too often those seeking asylum travel from their familiar communities to start new life in environments that could be alien to them which makes them vulnerable to social exclusion which is defined by the Social exclusion Unit (SEU),( 2004) as:
“What can happen when individuals or areas suffer from a combination of linked problems such as unemployment, poor skills, low incomes, poor housing, high crime environments, bad health and family breakdown”.
It is a process that deprives individuals and families, groups and neighbourhoods of resources and services needed for their general involvement and their health and well being (Pierson, 2002). Most of these factors affect the asylum population since they face immigration controls on things that shape them as individuals. This affects their engagement with the society towards expressing their individual needs.
For asylum seekers to be socially included in the society certain areas of concern will have to be addressed. This is achieved by firstly understanding what social inclusion means. It is defined by some as, finding ways of preventing and overcoming social exclusion (ncaonline.org.uk). For this to be achieved the following points of views will be discussed on the issues that affect their health and well being, how resources and services from local, regional and national level can support them and the roles and responsibilities of nurses and other health and social care professionals in promoting social inclusion. However the author is going to use different available materials to provide an overview of this diverse group which is often mistaken by the public as a “homogeneous” group. The author is going to focus on asylum seekers (someone who is still in the process of becoming a refugee) rather than refugees (someone who has been granted the refugee status) because refugees just like ordinary citizens have wider choices that can socially include them as compared to asylum seekers who do not have the privilege of choice.
To whatever the destination an asylum seeker flees to, the journey is rather distressing with fears of being discovered, persecuted and arrested which can affects their mental health and physical well being. It is believed that when they arrive some would have been in good health but, the asylum process itself may entail its additional stresses such as conflict with immigration officials, being denied a work permit, unemployment, difficulties registering with GP’s, loneliness and boredom (Hayes and Humphries, 2004). Their mental and physical health may deteriorate within two to three years of arriving due to post-traumatic experiences, unexpected changes, dependency, poverty and poor accommodation (Burnett and Fassil, 2002).
Frequently reported mental health problems experienced by asylum seekers include anxiety, depression, phobias and Post Traumatic Stress Disorders (PTSD) which may cause long term problems if not well attended to. These may have been as a result of domestic abuse, multiple losses, torture, witnessing hostile situations and sexual abuse (Jones and Jill, 1998). Since mental health issues are viewed differently in some cultures, healthcare professionals have to be culturally sensitive towards those presenting with problems related to mental health (NMC, 2004). Those with PTSD will require strong advocacy to ensure that they have access to specialist support.
However, some of the physical health needs usually suffered by asylum seekers are chronic diseases such as coronary heart diseases and diabetes which may not have been detected because of poor health facilities in countries of origin (Burnett and Fassil, 2002). Some conditions may have been acquired en-route to their destinations such as gastrointestinal problems, respiratory infections such as Tuberculosis (TB), malaria and other communicable diseases such as HIV and AIDS. Asylum seekers may present with fear of being seen as disease carriers which means they may suffer in silence, therefore demonstrating sensitivity towards these people will ensure that they are valued and respected regardless of their illnesses. Offering full medical assessments for the benefit of the individuals will help in detecting any unknown problems and find suitable interventions in promoting their health and wellbeing.
Disabilities suffered through torture or war may present health concerns and emotional distress to asylum seekers (Burnett and Fassil, 2002). Those who are disabled will need referrals for assessment of needs where the provision of care may only be granted in regard to their immigration status, which may undermine their basic human needs (Immigration and Asylum Act, 1999). The author argues that this endangers the person with the disability as they will be more vulnerable to social exclusion.
Some women seek asylum while they are pregnant. These may have been as a result of domestic violence, rape as well as prostitution as a result of trying to fend for themselves and their families. They may suffer complications due to late registrations, lack of geographical knowledge and support and poor ante-natal care (McLeish, 2002). In some instances when the woman is being abused her needs may not be identified because men are culturally considered as the main speaker of the family risking misdiagnosis of the illness. It will need tactical nursing skills and knowledge of different cultures for the woman’s needs to be met without disrespecting cultural beliefs and values.
Since April 2004 failed asylum seekers have been asked to pay for their hospital charges which can have a negative impact on their mental and physical health. Since one of the core principles of the NHS towards healthcare is that care is regarded as a universal service for all and a basic human right, therefore service should be provided based on clinical need rather than an ability to pay (Kelly and Stevenson, 2006), it can be argued why asylum seekers are refused treatment and asked to pay for their services when they are not even allowed to work for them to be able to finance this need). If health professionals follow this core principal and exercise empathy it will have a positive impact on those who really need care.
Accommodation is a key resource in the resettlement of asylum seekers. The areas they are dispersed to may be of great impact to their health and well being. The dispersal process may cause long term damage if they are dispersed to areas that are ill-prepared for their unique needs. There is evidence which shows that asylum seekers may be living in substandard housing that is impoverished, overcrowded and with high risks of fire and spreading of diseases (Garvie, 2001). They have no individual preferences and choices of where they want to live and who to share their accommodation with.
While the Immigration and Asylum Act, 1999 makes the care in the community function dependent on immigration status, older asylum seekers who are in need of community care may not be eligible for basic services such as day centre places for those with mental problems, social work support for mental disorders and meals on wheels because they are subject to immigration control which can make their experiences difficult (Cohen, 2001). Okitikpi and Aymer (2000) sited in Pierson (2002) argues that other multi-disciplinary teams such as social workers have an unavoidable political task around the policies of dispersal in order to build broad coalitions in raising local awareness of the legal confinements with which refugee families have to cope.
As granting employment to asylum seekers has been observed as a pull factor for more arrivals, asylum seekers in the UK are not allowed to work until they receive their refugee status, even though there is evidence which shows that unemployment does not have any impact on the number of people seeking asylum (Zetter et al, 2003), they are still not allowed to work and have to live on lower than subsistence levels of income as compared to the general public (Hayes and Humphries, 2004). Unemployment makes them more vulnerable to poverty, as they only receive about 70% of normal income support. Those who have exhausted their claims and being looked after under section 4 of the Immigration and Asylum Act 1999 only receive non cash vouchers which they can only use in certain supermarkerts where-by no change is given back which will further reduce the amount. This stigmatises, discriminates and violates their basic human rights as they will not have wider choices of supermarkets that sell food from their own countries. It is believed that allowing asylum seekers to work whilst awaiting their decisions may reduce negative socio-economic effects on their mental health and enhances their social integration with the society (Hayes and Humphries, 2004).
The United Nations High Commissioner for Refugees (UNHCR) offers international protection to displaced asylum seekers with a well-founded fear of persecution by assuring them of certain clearly defined rights (Loescher et al, 2008). It has a responsibility of monitoring and supporting states’ compliance with the norms, rules and decision making procedures set out primarily by the 1951 Convention.
Nationally in the UK, the National Asylum Support Service (NASS) within the Home Office works to provide accommodation and money for everyday essentials. It provides regional funding to the local councils and registered landlords in the provision of furnished accommodation. Firstly assessments are done following the Immigration and Asylum Act 1999 to check if the person seeking asylum is destitute, so that the level of support needed is clear. NASS can only support those who are awaiting decisions which place those who have been refused status to become destitute and homeless. Voluntary organisations such as Yorkshire and Humberside Consortium for Asylum seekers and Refugees (set up in 2002 co-ordinates with NASS in providing management of accommodation, developing accessible services and promoting integration into new communities (www.harpweb.org.uk). Refugee council provide advice and information in individual languages, emergency accommodation and assistance in different regional areas (www.refugeecouncil.org.uk). Oxfam is also a voluntary or charitable organisation that helps in campaigning for those who are being made destitute by the asylum process to stop them from being deported back to their countries where they may be arrested and persecuted. British Red Cross also help those who are homeless by providing food supplies, clothes and vouchers to buy essentials such as toiletries (www.harpweb.org.uk).
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