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From Iraq to Tilbury: migrants, health and borders

We bear powerless witness to mountain massacres, to bombs raining on life-saving hospitals. But does our compassion evaporate when those fleeing such strife reach our borders in steel containers?

US fighter planes scour the sky above Mount Sinjar. Dried blood of Yazidi Kurds stains the arid slopes. Talk of humanitarian rescue and evacuation echoes across Western media outlets. 

In the cold dawn at Tilbury Docks, frantic thumps and cries are heard from within a freight container. Twenty one adults, thirteen children and one dead man lay within. Traumatised, dehydrated and hypothermic they clamber in to ambulances to be whisked to local hospitals. 

With the recent Immigration Act our social conscience is split. This dichotomy starts with the crossing of borders.

We have legislated that those without recognised status to be within our country should not be able to open a bank account, rent private accommodation or have equal access to health care. 

What images did the travellers hold in their minds as they made their fraught lightless journey over the sea? 

From here, where might the paths of these migrants take them:  from ambulance to Home Office, to a stay at Yarl’s Wood detention centre and a flight home? To our communities, where family members may already be settled? To work within the ‘illegal’ sub-terrain of our society? Jobs in coffee houses or building sites? Jobs in the sex trade?

With the aim of “sustaining services and ensuring fairness in the NHS,” the Department of Health released their ‘Visitor and Migrant NHS Cost Recovery Programme’. It proposes an upfront charging system for non-European temporary residents and undocumented migrants accessing NHS care.

This charging system will cover A&E, walk-in services, community care & primary care outside of initial GP consultations. Undocumented migrants will be expected to pay in full for their care at 150% NHS tariff to incentivise the establishments to recover costs.  The average A & E visit in 2012 cost £114. Imagine asking, gesturing if there is no shared language, for £171 from the empty pockets of the individuals from Tilbury dockside.

Article 25 of the Human Rights Declaration enshrines that every individual has the right to medical care.  We have protected the right to health care for refugees and asylum seekers, but beyond this lines are blurred.

The numbers affected by new charges is difficult to predict. The London School of Economics estimates that in 2007 there were between 417-000- 862,000 irregular migrants and children living in Britain. Those vulnerable and living below the radar face barriers beyond costs when seeking health care: fear of being recognised by the authorities and sent home; uncertainty about health entitlements and how to access care; and language barriers amongst other things. Undocumented migrants risk bringing treatable infectious diseases into communities, missing antenatal care, presenting late with complications of common health problems & living without support for mental health needs.

We criticise foreign tyrants for human rights abuses yet we selectively apply human rights legislation in our own democracies.

Through the panes of our TVs, we see need in the families of Sinjar Mountain. Need for protection, need for shelter, need for healthcare. If we would provide for those on Mount Sinjar, shall we look too at our homes? What if we could provide and make healthcare accessible for those marginalised within our own communities? 

About the author

Joy Clarke is a doctor working in Brighton with an interest in health equity, development of the NHS and human rights.


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