Asylum and health: insult and injury

Zrinka Bralo
18 June 2008

What we say about refugees and immigrants in our public space is hardly ever nice. Sadly, how we treat refugees and immigrants is increasingly adding injury to insult.

My challenge, as I see it, is to bring some humanity and common sense into dehumanising, emotional and misinformed conversations about immigration. A few months ago I was a guest speaker at a training session for NHS staff from around the United Kingdom. At the half day session in the scenic English countryside, we exchanged some work experiences. I spoke about the challenges in accessing services for vulnerable migrants and refugees, and their experience of daily life in a climate of highly hostile and stigmatising xenophobia.

Zrinka Bralo, a journalist from Sarajevo, has campaigned for refugee and human rights since her exile in 1993. In the past ten years she has worked as a
journalist, anti-deportation campaigner, commentator and researcher. She is Executive Director of the Migrant and Refugee Communities Forum in West London and Co-Chair of Asylum Rights Campaign.

One participant told me how they worked really hard to help secure mental health treatment for a woman refugee who had been tortured and raped, and had a child as a result of the rape. When they were finally able to provide specialist treatment for a severely traumatised patient, it was she who did not show up. She had been refused asylum and was either detained or went underground. ‘Do you realise that I had to juggle limited resources to provide this care for her, and she disappeared!' complained the colleague from the NHS.

I said nothing. The words of a wise Rabbi, Yehuda Bauer, spoken on the first Holocaust Memorial Day, were ringing in my ears: "You shall never be a victim! You shall never be a perpetrator! You shall never be a bystander!" We are all bystanders and complacent about all kinds of injustices around the world all the time. It is almost impossible to lead an ethical life in a consumerist society. But here in front of me was a new breed of dedicated bystander. Pictures of war and genocide around the world are upsetting. We condemn them in horror, but what can one do? Then one day the victims and survivors come to our door or our work place, and there is something we can do. But we have to make a moral choice.

The whole picture

This health professional had not doubted for one moment that the raped refugee woman was speaking the truth: she had indeed been raped, and had a child as a result, and obviously needed urgent mental health care. Moreover, she and her colleagues did something about it. But at no point in the process had they contemplated the possibility that this woman might be refused sanctuary in our country. Nor asked themselves why this was the case. This caring professional obviously worked hard to provide care, but failed to grasp the whole picture. More worryingly, she had not seen the failure to provide protection for this patient as anything to do with her. She and her colleagues are just regular professionals doing a job, juggling resources. But raped refugees refused asylum are not their problem.

This article forms part of MigrantVoice on refuge, a special project celebrating UK Refugee Week 2008.Have your say on our multiauthored blog, bringing unheard voices to the forefront of the debate. Also in openDemocracy: Philippe Legrain, "Open Britain", Irshad Manji, "For a future bigger than our past" Mamphela Ramphele, "The rainbow nation's lesson", Hsiao-Hung Pai, "Chinese migrant workers: lives in shadow", Brian K Murphy, "Open borders, global future".

I find this one of the biggest challenges that I face. It is easier in a way to comfort a victim or stand up to a straightforward xenophobe. But what can one say to an essentially good
bystander in denial? Someone too busy to ask "why?", let alone think that they should and could do something to prevent it.

I kept thinking, how did we get here? What turns a caring professional into someone who doesn't wish to know? I am not seeking to apportion blame. But more than the damage that is done to people whose lives are stuck in a vortex of prejudice and misinformation, I worryabout how this affects such fundamental principles of our society as tolerance and fair play.

In their attempt to curb so called "health tourism" the government introduced tighter restrictions on NHS access for foreign nationals. But preventing overseas visitors from accessing free health care gradually turned into a bureaucratic nightmare, requiring doctors to become immigration police, refusing care for those who may morally as well as legally be entitled to it.

A choice to care

Two years ago, the international aid charity Médecins du Monde, set up a clinic in London to provide health care for undocumented migrants and those in the limbo of the asylum system. 29% of patients they treated were legally entitled to free NHS health care but were turned down because of confusion about eligibility rules. Patients had been in the UK an average of three years before seeking medical help. In a recent report they claim that there is no data to support the idea of large numbers of overseas visitors coming to the UK specifically to seek out free treatment.

So what is the reality of these eligibility rules? In May 2006, Elizabeth Alabi died at the age of 29 leaving behind 3-month-old twins and another two-year-old child. Elizabeth was a Nigerian who fell ill and urgently needed a heart transplant. She was visiting her partner, the father of her children, who was, by the way, a taxpaying resident in the UK. Heavily pregnant, unable to return due to illness, she was denied the chance of a heart
transplant on the basis of her immigration status. The legal challenge was too slow and she died before the judge made a ruling.

Imagine how Elizabeth felt in her hospital bed, dying in the most advanced health care system in the world, not because it could not help her, but because it chose not to. I wondered if Elizabeth knew what one prominent commentator had written about her in a national tabloid just three days before she died. He was ranting against the Human Rights Act and wrote: "When will we wake up to the fact that this country cannot wipe the bottom of the world?"... "We are stuck with a Nigerian woman shrieking for a free operation for her dodgy ticker."

Two years on and I still think about Elizabeth. What if she was married? What if she had lived for the few more days it took for the judge to make a ruling? What if this commentator had taken an interest in her as a person, writing about an afflicted mother with compassion and an appeal for help, rather than using her for cheap point-scoring in an ugly debate.

I wonder, how is it possible that all migrants coming to this country are "supermigrants" who can simultaneously steal our jobs while being so ill that they end up in hospitals draining our resources? How is it possible that all these bogus, job stealing, terminally ill, donkey-eating migrants come to England and Wales - but not to Scotland, where there are no restrictions on healthcare for refused asylum seekers and undocumented migrants?

Enforcing the rules

In March 2007 the Home Office published Enforcing the Rules: A Strategy to Ensure and Enforce Compliance with our Immigration Laws, to, "ensure that living illegally becomes ever more uncomfortable and constrained until they leave or are removed."

I try to imagine a bureaucrat or a politician who came up with this idea: a conversation and/or a meeting where someone proposed that we should be seen to refuse to help the
sick as a forced removal measure. I try to imagine their discussion on how uncomfortable is "uncomfortable". What kind of people they think we are if this is supposed to appeal to us to vote for them? I try to imagine what kind of doctors and nurses they think we have working in the NHS who would agree to become an immigration enforcement force in addition to all the work they have to do?

The media is full of horror stories about the NHS: deadly hospital bugs, long waiting lists, a postcode lottery for cancer patients, mixed sex wards, the poor treatment of elderly patients... and yes, many of these glaring deficiencies are true. But we all also know that this is not the whole truth about the NHS. There are problems, but we all use the NHS and we all benefit from it when we need it most. Imperfect as it is, it is probably one of the best healthcare systems in the world.

Suddenly, when we talk about foreigners' entitlements to health care on the NHS, a combination of myths and denial produces a very different picture: the NHS suddenly becomes the best if not the only healthcare system in the world, with millions of people with "dodgy tickers" from every corner of it invading our hospitals to take away our legitimate taxpaying transplants. This is all because we are such a soft touch. How soft? Ask Elizabeth and her children.

People come in all shapes and sizes everywhere in the world, and there will be some who will attempt to take advantage of everything life can offer, including free healthcare in the UK. But by flatly refusing to treat everyone with no immigration status we are punishing those whose lives are already damaged, who are exploited, disadvantaged and who need help. And somewhere in the middle of this line at the border there will also be those who are coming here to provide that much needed healthcare.

The cost of our humanity

I wish I could offset refugees and migrants who need health care with all migrant and
refugee health professionals who keep the NHS running, but I am not sure that offsetting works for carbon emissions, let alone for people. The bottom line is that when it comes to matters of life and death, there is no "them" and "us": there are doctors and there are patients.

In the last few years since hospital care was denied to refused asylum seekers I have met two terminally ill, refused, asylum seekers who could not be returned to their home
countries. They were dying in the fourth richest country in the world from diseases they contracted as a result of the destitution they were forced into. Their tragedy and helplessness was not contagious. If anything, their survival against so many odds was inspiring. Surrounded by our wealth they were dying in pain. And yet, there was no bitterness or anger.

Pragmatic discussions about the cost of and entitlements to free healthcare are necessary, but in order to have that serious discussion, we cannot ignore the cost of our humanity. Some things are not for sale. Flippant prejudice and knee jerk reactions are not the answer. If we wrongly blame migrants and refugees for everything that we do not like in our society, this prevents us from understanding the problems. The danger is that we have taken up the task of dehumanizing refugees and immigrants with such vigour, that somewhere in this process of denial we are losing our humanity. This cannot be fixed by an integration strategy or by "community cohesion" newspeak. The more we refuse to take a hard look at ourselves, the harder it will be for future generations to reverse the damage. We don't need blame: we need solutions. Humane and reasonable solutions.

There is a reason why basic human rights should not be messed with. There is a reason why some lines should not and cannot be crossed, especially not by the media, politicians and bureaucrats. For once we go down that road, there is no coming back.

Thankfully, the voice of reason and humanity emerged on 11 April 2008, in the High Court, when the judge ruled that a Palestinian refused asylum seeker must be given NHS treatment for liver disease. Although his asylum application was refused he cannot return, even though he wants to. He had been given support as a destitute person, but as
refused treatment for his liver disease because of his immigration status. The hospital said it was following NHS guidance, but his lawyers challenged the guidance. In his judgement, Mr. Justice Mitting said that refused asylum seekers and refugees were "penniless", and ruled that the hospital in this test case had an obligation of care.

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