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A mile in their shoes: understanding health-care journeys of refugees and asylum seekers in the UK

Prof Cornelius Katona
Isobel Talks, Buthena Al Mobarak, Jane Hunt, Niall Winters and Anne Geniets
International Journal of Migration, Health and Social Care
Refugees and people seeking asylum worldwide face numerous barriers in accessing health systems. This is despite the fact that research has shown that they tend to have a greater burden of and more diverse healthcare needs in comparison to host populations.

In the UK, prior research indicates that multiple obstacles, such as language barriers; interpersonal trust issues resulting from months or years of abuse and persecution; and difficulties in discussing their health concerns due to the shame or the trauma that this may trigger, negatively affect the health of refugees and asylum seekers.

However, much of this research work took place before charges for migrants to access National Health Service (NHS) healthcare were introduced in 2017. More recently, the Equality and Human Rights Commission identified further evidence gaps including a lack of research regarding the “specific experiences of people seeking or refused asylum” as well as “an absence of data on people’s experiences of secondary care".

The research reported in this paper involved speaking to refugees and asylum seekers at different stages of the asylum process in the UK about the full trajectory of their health-care journeys (from their first encounter with health services through to secondary care), in order to gain a more comprehensive understanding of the current barriers to healthcare as well as of who and what helps refugees and people seeking asylum facilitate access to and navigate the health system.

This study illustrates general limitations in the NHS, as experienced by the broader population in the UK, but also specific obstacles faced by people seeking asylum and refugees which compound these barriers. It demonstrates the importance of “front loading” knowledge and advice about the health service early in an asylum seeker's journey and that “facilitators” of refugees’ and asylum seekers’ health-care experience are vital. It suggests that host families, friends and third-party organisations can all play an important role in ensuring refugees and people seeking asylum receive the healthcare they need – which is a crucial part of their journey towards a brighter future. These vital facilitators can not only help them overcome the systemic and material barriers that otherwise would have held them back from accessing and using the health-care system, but also help humanise their health service experience in the context of an increasingly hostile environment.


Key obstacles
  • Lack of knowledge about how to access the health service initially and how the different parts work
  • Lack of confidence in approaching health
  • Lack of communication between different parts of the health service.
  • Language barriers
  • The “need” for proof of a fixed address
  • Frequent moves at short notice
  • Lack of financial resources to be able to travel to medical appointments
  • Digital poverty (affordability, access to digital technology)
  • Dehumanising procedures and policies
  • Fear of authorities (immigration)
  • Absence of support from facilitators
Key recommendations
  • Early information about how to access and use the NHS
  • Access to facilitators (such as NGOs, volunteer organisations, host families, neighbours, friends)
  • Improved cross-sector care and communication
  • Efforts to make data and technology available
  • Need for eHealth Literacy and translated online health information
  • Access to good interpreters
  • Encouragement and development of peer support systems
  • Retaining the “human” contact in health contacts
  • The need to build an evidence base on current and developing best practices

Click on the link below to read the article in the International Journal of Migration, Health and Social Care. Open Access articles can be read via the Social Sciences Research Archive and the Forced Migration Archive / Refugee Research Network at York University.