How to engage with refugees and asylum seekers
Refugees and people seeking asylum are at significant risk of a range of health inequalities. They are at higher risk of poor physical, mental and emotional health due to their previous experiences and current circumstances.
They can face further barriers to accessing care, due to a lack of understanding of the healthcare system in Scotland, and having no knowledge of patient rights and responsibilities that apply to all NHS service users. They are also faced with language and literacy barriers and a lack of staff training about their needs.
How do we deliver a Person Centred Care service to Refugee and Asylum communities? What can we learn from this community that helps us understand their needs and experiences that will help with meaningful engagement?
Arriving in the UK
Refugees and asylum seekers have been displaced from their homes and forced to flee because of persecution, war or violence, arriving with a wide range of backgrounds, cultures and reasons for seeking refuge. But these conditions can also be barriers to engaging and make it more difficult to navigate and understand what services are available to them.
A refugee is a person who has been forced to leave their country in order to escape war, violence or persecution. Refugee status is recognized by the UK Government under the 1951 UN Convention. An asylum seeker is someone who has left their country and is seeking protection from persecution and human rights violations. They apply to the UK government for refugee status.
The Immigration and Asylum Act 1996 began the programme of dispersing people who had made an application for asylum across the UK. Asylum seekers are dispersed (placed in a given location as part of the process, determined by the UK Home Office) to specified local authority areas across the UK.
The Scottish Government is committed to integrating refugees and asylum seekers into Scottish society. Its New Scots Strategy 2018 sets out a vision of rights and freedoms that work toward inclusion. The Government wants to see asylum seekers and refugees becoming active citizens who are able to fully engage with health and care services and third sector organisations:
as part of supporting asylum seekers and refugees actively, policy encourages services across Scotland to support them to become involved in helping to shape strategy and delivery of services. It also aims to increase participation in local and national health forums, ensuring there are opportunities for refugees and asylum seekers to benefit from peer support toward improving their knowledge of health care systems and health improvement strategies. This includes those that have a positive impact on their mental health and wellbeing.
New Scots Integration Strategy – 2018-22 (summary), Health and Wellbeing
commitment to continuous support
The strategy aims to empower asylum seekers and refugees to know about their rights and to understand how to exercise these rights. It further states:
'the principle of supporting refugees and asylum seekers is the right thing to do; people should be able to live safely and realise their human rights'
New Scots Strategy 2018, Scottish Government
Coming to Scotland
Asylum seekers and refugees are entitled to the same social, economic and healthcare rights as all UK citizens, with full access to medical treatment, education, benefits, housing and employment upon arrival in the UK and Scotland. They are protected by the Equality and Diversity Act 2010.
They are first allocated temporary accommodation, usually within the central belt of Scotland, while their applications are being processed. From here, they are moved on (dispersed) to accommodation at short notice which can be anywhere in Scotland, especially Falkirk, Lanarkshire, Perth and Aberdeen. Scottish Government statistics show 5,210 people were being supported while going through the asylum system in 2022.
Such short notice change impacts on all services they have used or had access to, in particular NHS services. They will have to re-register with all NHS services, including GPs and dentists, and relocate to the new location's hospitals and outpatient clinics.
Some challenges facing asylum seekers and refugees
Most people arriving in Scotland live in and around Glasgow. Public services across the city have developed specialist approaches through years of experience along with a range of community organisations, that help and support people to settle into their new home. However, accessing support services across Scotland can be difficult, especially in more remote and rural areas.
Children and young people may arrive with their families through the asylum dispersal process and through refugee resettlement programmes, or as unaccompanied children. They may have missed significant amounts of education, experienced traumatic events and parents may require help and information to support them.
Women may have faced gender-based violence that has created a fear of how they will be treated that can impact on their mental health as well as being particularly isolated from their family and the wider community. They they may lack of confidence and have had disrupted or limited access to education. They can experience a lack of caring responsibilities or of childcare as well as family resistance to activities out with the home environment. In particular, pregnant women and new mothers may face barriers to healthcare.
LGBT+ people can face challenges within the asylum process and as refugees. Homosexuality is illegal or unacceptable in many countries and their experiences may have had a serious impact on their wellbeing. They may find it difficult to be open about their LGBT+ identity. There can be language barriers to describing their identity and accessing support and advice. LGBT+ asylum seekers are particularly vulnerable and may face discrimination and harassment if detained.
Mental health issues are a key cause of disability among asylum seekers and refugees. Disabled asylum seekers experience significant isolation which can also contribute to deteriorating mental health.
Refugees may face racism or discrimination. They may face hate crime, anti-immigrant prejudice and structural racism.
Poverty, destitution and homelessness can be serious threats for refugees (although refugees arriving through resettlement schemes receive more significant support).
They may face digital exclusion and lack IT access and training.
When planning engagement activities, especially in group settings, it is important to understand participants' culture and background. It is useful to find out about social taboos and religious beliefs that may impact their opportunity or ability to participate.
The asylum process can itself be very challenging and traumatic. It may involve periods of detention and many asylum seekers feel their lives can be on hold for extended periods. As a result, some refugees can become passive and dependent and additional strategies may be required to gain their input. A trauma-informed approach can help empathise with and respond to individuals' previous experiences.
Information in writing should be made available in a range of translations and easy-to-understand formats. Professional interpreters should be involved rather than using family members or friends.
Thank you to the staff at the following organisations for feedback to the contents of this page: Scottish Refugee Council, Mental Health Foundation (Asylum and Refugee Programme), Caledonian University, NHS Greater Glasgow and Clyde's Improvement Team