Experiences of Asylum Seekers and Refugees in Wales (HEAR) Dr Ashra Khanom, Research Fellow, (Swansea University) for the HEAR team 3rd October 2019 Background Sanctuary in Wales Long history of welcome in Wales for those fleeing
persecution/war. Asylum seekers have been dispersed to Wales from other parts of the UK since 2001. International conflict and human rights abuse has contributed to the rise in people seeking sanctuary throughout Europe. Concern that some of those seeking sanctuary have unmet health needs and experience difficulty in accessing services. About the Study Aims
To investigate health, well-being & healthcare experiences of adult sanctuary seekers in Wales, including views of recipients & providers. To establish what helped or hindered healthcare access & experiences of sanctuary seekers. If you dont know what the problem is, you cant solve it (quote from study) Collaborative Working Peer researchers and third sector partners
Methods Mixed methods study Searched for published evidence about factors influencing use of healthcare by sanctuary seekers in high income countries. Recruited & trained team of 8 volunteer sanctuary seekers to survey 210 sanctuary seekers. Conducted 8 focus groups across Wales with 57 sanctuary seekers and their supporters. Interviewed 32 health professionals & support
workers delivering care to these patients. The service is very good and actually they are really thorough in the care that they provide Person seeking sanctuary Findings Evidence Review We identified 5 themes which help or hinder sanctuary seekers in accessing healthcare. Many experience difficulty in accessing services. [through an Interpreter]
Language and communication; If I had an emergency I Cultural understanding and values; couldnt call 999, how would I speak to them, Presence or absence of trusted relationships; they wouldnt Structural barriers, such as out-of-pocket expenses; and understand me in Knowledge of the health system and how to navigateArabic. it. Stigma of disclosing mental & physical health problems, and fear of adverse effects
on their immigration status, deters some sanctuary seekers from accessing care. Findings Cross-sectional Survey 23% of respondents did not know how to access an emergency ambulance. Reassuringly 94% reported that they were currently registered with a GP. But only 36% found appointments easy to make, and only 26% knew how to access out of hours GP. Of those that had used services 66% had used any service in hours and 28% out of hours. NHS 111 was familiar to 36%.
Fewer than half of respondents (44%) knew of the Emergency Department. Findings Focus Group Respondents understood role of primary care in providing and coordinating care; and accepted that they themselves also had responsibility for maintaining their health. Reported barriers included: language difficulties including lack of interpreters; fear of being reported; unrecognised needs; perceived stigma and discrimination; out-of-pocket expenses, especially for
travelling to appointments. Importance of mental health noted but also the poor provision of mental healthcare. Findings Interviews Mainstream health professionals lacked resources to care for these groups, notably staff time, knowledge of healthcare in countries of origin, lack of knowledge of the asylum process and information in appropriate languages.
Health professionals recognised that these groups often needed repeated contacts to receive appropriate healthcare. It was suggested that pressures on NHS, lack of services tailored to sanctuary seekers, & their isolation contribute to poor mental and physical health outcomes. They bring their trauma with them, that that usually manifests itself as PTSD symptoms, mild, moderate and severe. Health Professional Recommendations arising from this research
We could improve integration, health and well-being of people seeking sanctuary in Wales by: 1 2 3 4 Acknowledgements We are most grateful to HEAR team for their expertise & teamwork:
Wdad Alanazy, Lauren Ellis, Bridie Evans, Lucy Fagan, Alex Glendenning, Ann John, Talha Khan, Mark Kingston, Cathrin Manning, Sam Moyo, Alison Porter, Gill Richardson, Melody Rhydderch, Grace Rungua, Ian Russell, Daphne Russell, Rebecca Scott, Anna Stielke, Victoria Williams, Helen Snooks Special thanks to all Peer Researchers: Hina, Sam, Grace, Hamed, Rehmat, Thanuja, Naseem & Safdar. Thanks to all people seeking sanctuary and health professionals who contributed and to our peer reviewers from Public Health Wales, De Montford University, Leicester and University College London. Email: [email protected] Tel: 01792 606649
