Helen Bamber Foundation

PurposeRefugees and asylum seekers worldwide face numerous barriers in accessing health systems. The evidence base regarding who and what helps refugees and asylum seekers facilitate access to and the navigation of the health system in the UK is small. This study aims to address this gap by analysing 14 semi-structured, in-depth interviews with refugees and asylum seekers of different countries of origin in the UK to identify where, when and how they came into contact with the health-care system and what the outcome of these interactions was.Design/methodology/approachSemi-structured, in-depth interviews were chosen as the key method for this study. In total, 14 individual interviews were conducted. A trauma-informed research approach was applied to reduce the risk of re-traumatising participants.FindingsThe paper identifies key obstacles as well as “facilitators” of refugees’ and asylum seekers’ health-care experience in the UK and suggests that host families, friends and third-party organisations all play an important role in ensuring refugees and asylum seekers receive the healthcare they need.Originality/valueTo the best of the authors’ knowledge, this is the first qualitative study in the UK that looks at comprehensive health journeys of refugees from their first encounter with health services through to secondary care, highlighting the important role along the way of facilitators such as host families, friends and third-party organisations.

The United Kingdom government has made a concerted decision to ramp up its 'hostile environment' policy towards asylum seekers and refugees. The original policy took the form of 'a package of measures designed to make life so difficult for individuals without permission to remain in the UK that they will not seek to enter the UK to begin with or if already present will leave voluntarily'. The Nationality and Borders Act provides a new legislative framework for issues relating to nationality, asylum and immigration which makes asylum claims less likely to succeed and limits the rights available to many of those whose claims are successful. Critics of the policy have raised serious moral and ethical concerns relevant to both health and legal professionals. In addition, it appears that it will fail to deter those planning to make risky journeys to the UK for protection, as the government has argued in justification.

ABSTRACT Spiritual rituals have potential for misuse as a form of control in human trafficking. A lack of understanding of this process can lead to challenges in supporting trafficking survivors. This article is a metasynthesis of systematically reviewed qualitative literature on ritual use in human trafficking, providing insight into ritual practices and their impact. Relevant qualitative research was identified via blind screening. A total of 3087 studies were screened; 24 met inclusion criteria. Data were analyzed using thematic synthesis, yielding eight themes incorporating 27 sub-themes: These were 1) background vulnerabilities that make a ritual a powerful control mechanism, 2) trafficker intention to exploit, 3) power and consent issues in agreement to a ritual and contract, 4) powerful and often frightening ritual experiences, 5) control mechanisms arising from the ritual experience, 6) impact of the ritual on the victim, 7) challenges for the victim in leaving and getting help, and 8) successes in helping survivors who have escaped exploitation. We offer an illustrative framework for considering the relationship between rituals and human trafficking. We discuss implications for policy making that empowers trafficking survivors and promotes just outcomes within legal, governmental and health care systems.

BackgroundThe number of asylum seekers, refugees and internally displaced people worldwide has increased dramatically over the past 5 years. Many countries are continuing to resort to detaining asylum seekers and other migrants, despite concerns that this may be harmful. In light of the considerable body of recent research, this review aims to update and expand on a 2009 systematic review on the mental health consequences of detention on adult, adolescent and child immigration detainees, which found (on the basis on 9 studies) that there was consistent evidence that immigration detention had adverse effects on mental health.MethodsThree databases were searched using key terms relating to immigration detention and mental health. Electronic searches were supplemented by reference screening. Studies were included if they were quantitative, included individuals detained for immigration purposes, reported on mental health problems and were published in peer-reviewed journals. Two reviewers independently screened papers for eligibility, and a further two reviewers completed quality appraisals for included studies.ResultsTwenty- six studies (21 of which were not included in the 2009 review) reporting on a total of 2099 participants were included in the review. Overall, these studies indicated that adults, adolescents and children experienced high levels of mental health problems. Anxiety, depression and post-traumatic stress disorder were most commonly reported both during and following detention. Higher symptom scores were found in detained compared to non-detained refugees. In addition (and more clearly than was evident in 2009), detention duration was positively associated with severity of mental symptoms. Greater trauma exposure prior to detention was also associated with symptom severity.ConclusionsThe literature base reviewed in this paper consistently demonstrated severe mental health consequences amongst detainees across a wide range of settings and jurisdictions. There is a pressing need for the proper consideration of mental health and consequent risk of detention-related harm in decisions surrounding detention as well as for improved care for individuals within detention facilities. Recommendations based on these findings are presented, including increased focus on the identification of vulnerability and on minimising the duration of detention.