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Hostile Environment

A View from the Frontline

By Kane Shaw, Press and Media Officer to the National Health Action Party, and Dr Louise Irvine, Secretary to the National Health Action Party

We need to challenge the dehumanisation of migrants and asylum seekers

The fallout from the Windrush Scandal shows no sign of abating. Members of the National Health Action Party have previously put forward our views on this issue. However, we also recognise that one of the biggest barriers to our being able to have a rational debate on immigration and its consequences- such as its impact on our public services- is hindered by a process of media framing which has historically attempted to dehumanise migrants and asylum seekers.

Arguably, one of the biggest factors in support of anti-migrant sentiment is that the effects such rhetoric has on people is hidden from those who buy-in to those views. Consequently, we believe it is important to put forward the views of those working in the National Health Service who can testify from first-hand experience, on the reality of so called “health tourism”, and the impact that the “hostile environment” policy is having on patient safety.

Below you can find Dr Louise Irvine, Secretary to the National Health Action Party, personal account from the frontline, of the impact that the “hostile environment” policy is having on patient care.

From the Front Line

I work as a GP in a multiracial part of London where we have patients from all over the world.  Many are British citizens, some are students or temporary workers, some lack documentation to prove that they have the right to live in the UK, and some are refugees and asylum seekers. They are all my patients and our practice provides care to them all without discrimination.

One of my patients has been living in the UK since he was a young teenager, the son of a Windrush generation mother, he now has to prove to the Home Office that he has been here since the 1960s or face deportation. Luckily, he has comprehensive health records going back to that time and we were able to provide him with the evidence he needed. However, that may not be enough as people need four pieces of evidence for each year they have been in the UK– an almost impossible barrier. Health records are not always that useful anyway; as many are incomplete and if someone has been healthy they may not have had contact with health services for periods of years.

Since the Windrush scandal hit the news and shamed the Government I felt hopeful that there would be some policy changes at the Home Office but have yet to hear of anything concrete. If nothing changes the deportations of British citizens will continue, and that could include my patient.  The Government U-turn on collaboration between NHS Digital and the Home Office to share NHS patients’ data, gives hope of a change in culture but I am not counting chickens yet. There have been promises of “relaxing” the rules and paying compensation but I fear that once the furore has died down the Government will continue as before. The demand that something be done seems to have been satisfied with Amber Rudd’s resignation – even though that was not about the hostile environment policy as such but because she misled Parliament.

The hostile environment affects not only the “Windrush generation” but many other people living and working the UK, who have been doing so for years since the time when it was sufficient to be “ordinarily resident” in the UK to be entitled to rights. This includes spouses of UK citizens. I know someone who is married to a UK citizen with whom he has three children, and who has been working and paying taxes in the UK for years but has been repeatedly denied Indefinite Leave to Remain and has had to pay thousands of pounds in fees for temporary resident permits, and the NHS migrant surcharge. He is deemed to be one of those people not automatically entitled to NHS care, even though he has been an active contributor to our society and economy for years.  The 2014 Immigration Act removed the condition of being “ordinarily resident”. It demanded that only those with Indefinite Leave to Remain or citizenship can access free health care. There are many people caught in that state of limbo and who see no way out as the grip of the “hostile environment” tightens.

“I doubt she is still alive”

The “hostile environment” has also been harsh to those migrants who are unlikely to get sympathetic headlines because they are undocumented migrants who have been relabelled as “criminals”.

I remember one such “criminal”:  Grace, a homeless and destitute Nigerian woman in her late 60s. She had been living in the UK for many years having married a UK resident. But when they got divorced she lost her home and all her rights. She slept in the light of the awning of the local leisure centre because she said she felt safer there. No-one would help her. Social services and housing said they could do nothing as she had “no recourse to public funds.” They said she should “go home” to Nigeria, even though she had no-one there to care for her and it had not been her home for decades. Despite having multiple health problems she was not entitled to hospital care. She would regularly turn up at our surgery, without an appointment, legs covered in ulcers, carrying her few bags of possessions, pleading for help. Fortunately GP services are exempt from the ban on providing services to undocumented migrants (for how much longer, I wonder?). We did what we could for her – we provided primary medical care, treated her wounds, and wrote letters supporting her appeals - but we were ultimately unable to help get her status changed and eventually she disappeared. I don’t know what happened to her, but I doubt she is still alive.

Victims of Torture

The hostile environment extends to those who are fleeing torture and persecution. There is a strange gap in my patient workload that I worry about. These are patients that I no longer come across. Since I started in my practice over twenty years ago I regularly saw asylum seekers who had suffered abuse and torture in the countries from which they had fled. I often referred patients to charities such as the Medical Foundation for the Care of Victims of Torture (now called Freedom From Torture). I wrote reports documenting the physical and mental impact of abuse and torture for their Home Office asylum requests. But for several years now I have not seen such patients. I can’t remember the last time I referred any victims of torture. Where are those patients now? They must still exist. The world is not a safer place. But they are being denied asylum in our country that once prided itself on welcoming those fleeing oppression and abuse. They are being blocked at points of entry due to the draconian tightening of asylum rules, rounded up, put in detention camps and deported back to the countries which are threatening them with torture and death.

I remember a man from a country in Africa. He had been imprisoned for political reasons and in prison was raped and nearly killed by guards. He managed to escape and get to the UK. But his experience had rendered him almost mute and he did not tell the immigration interrogators about his ordeal.  For him the shame of having been raped was overwhelming and he could not talk about it. He was initially refused asylum but while waiting for his appeal and living in utter destitution, sleeping in a phone box, he was befriended by a caring British woman who eventually married him. As his GP, I spent many months helping him, ensuring he got access to the mental and physical health services he needed, and was rewarded by him gradually starting to talk and finally managing to smile. The couple moved away, and I was hopeful for their future. Not all such stories have a happy ending.

Unless a person immediately on arrival makes a convincing case for asylum, and includes all the details, and never changes the story in any way, they are likely to be refused asylum. The default setting of the immigration interviewers is not to believe asylum seekers, and there is no understanding of the fact that people may not be able to recall all the details accurately or be able to talk about their trauma. Consequently, many who have been refused asylum are actually genuine, and their suffering both in the country they left and after arrival in the UK is beyond the comprehension of many of us.

Economic Migration VS Asylum: a nonsensical distinction?

Then there are the so-called “economic migrants”. I’ve had a few of those as patients too. There is a blurred distinction between refugee and economic migrant because many of the conditions that cause people to flee persecution are also ones that destroy a country’s economy and create poverty and destitution. Is not escape from extreme poverty another form of asylum seeking?  I do not see any of them as criminals.  Government legislation and the “hostile environment” has not only made criminals of ordinary people doing what any of us would do in similar circumstances but treats them worse than criminals. Even criminals in prison are entitled to a roof over their heads, nourishment and health care. Yet the “hostile environment” created by the 2014 Immigration Act deprives many migrants of such basic human rights.  So they are not just being treated as criminals but worse.

It was always a convenient myth that there were thousands of “health tourists” flying into the UK to have free health care.  This played well with the media and helped to fuel popular antipathy to migrants’ healthcare rights. Facts did not seem to have any effect in countering the mythology: the fact that most of the people who wanted access to health care were actually already living in the UK, contributing to our society through their work and their taxes, but being denied health care when they needed it. Or the fact that, overall, migrants paid in to the economy more than they took out. Or the fact that the main impact of migrants on the NHS was a positive one, through the labour of thousands of migrant NHS staff.

Yet it was these myths that served as the pretext for the horrible anti-immigration rhetoric of the right wing press and politicians. It goes back a long way. David Cameron was happy to feed off those myths. He ran the cabinet committee devoted to the “hostile environment” policy. He let Teresa May push the policy on reluctant departments of government. This despicable policy shows that the Tories are not fit to govern.  And if Labour wants to do better it must not acquiesce to racist anti-immigration ideas for fear of losing votes. Dianne Abbott’s recent statements about measures that a Labour Government would take to end the “hostile environment” are to be welcomed. I am disappointed that many doctors and other professionals seemed to have gone along with the hostile environment policies or stayed silent. We must not be complicit in racist, degrading, inhumane and health damaging policies. We all have a duty to speak out.

Dr Louise Irvine, Secretary to National Health Action Party and London GP

May 2018

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