PENNINE ACUTE HOSPITALS

Sexual Health Service Education Meeting

Friday 15th January 2010

Dr Rhetta Moran

The Right to Care: Refugee Access to Health

Structure

• RAPAR’s evolution

• What’s the big picture?

• RAPAR Casework (ACT) Context

• RAPAR Casework (ACT) Example

• What should we do?

RAPAR’s evolution2000-2001: ground level reactions to forced

dispersal

RAPAR’s evolution2000-2001: ground level reactions to forced

dispersal

2001-2002: pre 9/11, refugees, academics, practitioners organise together and create a limited company and registered charity

RAPAR’s evolution2000-2001: ground level reactions to forced

dispersal

2001-2002: pre 9/11, refugees, academics, practitioners organise together and create a limited company and registered charity

2002-2007: Salford based. Action Learning Model that tracks the practical consequences of the policy (international and national ) trajectory

RAPAR’s evolution2000-2001: ground level reactions to forced

dispersal

2001-2002: refugees, academics, practitioners organise together and create a limited company and registered charity

2002-2007: Salford based. Action Learning Model

2007- now: City Centre Manchester. Research (PAR), Casework (ACT), Community Development (CEDAR) – all hand to mouth!

RAPAR’s evolution2000-2001: ground level reactions to forced dispersal2001-2002: refugees, academics, practitioners organise

together and create a limited company and registered charity

2002-2007: Salford based. Action Learning Model2007- now: City Centre Manchester. Research (PAR),

Casework (ACT), Community Development (CEDAR) – hand to mouth!

November 2009 National Winner NOVASSCARMAN Elspeth Kyle Award for Best Community Impact

Still hand to mouth!

What’s the big picture?

1999-2000 Eviction into destitution for the first time since 19th century Ireland

What’s the big picture?

Eviction into destitution for the first time since 19th century Ireland

1999 - Accommodation continues to be available to People failed by asylum system but cash is stopped

What’s the big picture?

Eviction into destitution for the first time since 19th century Ireland

1999 - Accommodation continues to be available to People failed by asylum system but cash is stopped

2000 – NASS takes over responsibility for asylum system

What’s the big picture?

Eviction into destitution for the first time since 19th century Ireland

1999 - Accommodation continues to be available to People failed by asylum system cash is stopped

2000 – NASS takes over responsibility for asylum system

2001 – Jack Straw moots concept of “overhauling” 1951 UN Convention on Human Rights (refugees vs. asylum seekers)

What’s the big picture?

Eviction into destitution for the first time since 19th century Ireland

1999 - Accommodation continues to be available to People failed by asylum system but cash is stopped

2000 – NASS takes over responsibility for asylum system

2001 – Jack Straw moots concept of “overhauling” 1951 UN Convention on Human Rights (refugees vs. asylum seekers)

……2001 Intolerance of refugees and asylum seekers is particularly acute in the UK. Council of Europe Racism Commission

Report, 2001, (BBC News 03.04.01. news.bbc.co.uk/1/hi/uk/1257321.stm)

What’s the big picture?

April 2003:

“A political regime – even one supported or elected by a majority of the population – which sought to deny basic rights to those falling within its care would be in danger of forfeiting the right to call itself democratic.”

Cherie Blair QC, addressing 13,000 Commonwealth Lawyers in Australia as reported in Fickling, D. 2003. Guardian Newspaper. 15th April.

politics.guardian.co.uk/cherie/story/0,12713,936861,00html

What’s the big picture?• 10.07.08

Independent Asylum Commission: Deserving Dignity

Healthcare should be provided on the basis of need, and asylum seekers should be eligible for primary and secondary health care until their case is successful, or they leave the UK; in particular and specifically, that all peri-natal healthcare should be free.

What’s the big picture?• 10.07.08

Independent Asylum Commission: Deserving Dignity

Healthcare should be provided on the basis of need, and asylum seekers should be eligible for primary and secondary health care until their case is successful, or they leave the UK; in particular and specifically, that all peri-natal healthcare should be free.

• 11.08 BMA guidelines

http://www.lmc.org.uk/uploads/files/guidance/bmaaccesshealthcareasylumseekersandrefusedasylumseekerssept08.pdf

What’s the big picture?• 10.07.08 Independent Asylum Commission: Deserving Dignity Healthcare should be provided on the basis of need, and asylum seekers should be

eligible for primary and secondary health care until their case is successful, or they leave the UK; in particular and specifically, that all peri-natal healthcare should be free.

• 11.08 BMA guidelineshttp://www.lmc.org.uk/uploads/files/guidance/bmaaccesshealthcareasylumseekersandrefusedasylumseekerssept08.pdf

• 05.02.09 European Parliament Detention centres for asylum seekers are "intolerable"Asylum seekers and migrants complained systematically about insufficient and inadequate medical care, in particular for pregnant women and victims of torture. Access to health care is often made difficult in detention centres which are located in prison establishments, say MEPs. 

http://www.europarl.europa.eu/news/expert/infopress_page/022-48468-033-02-06-902-20090204IPR48467-02-02-2009-2009-false/default_en.htm

Report adopted by 483 to 39 with 45 abstentions

What’s the big picture?• 10.07.08 Independent Asylum Commission: Deserving Dignity Healthcare should be provided on the basis of need, and asylum seekers should be

eligible for primary and secondary health care until their case is successful, or they leave the UK; in particular and specifically, that all peri-natal healthcare should be free.

• 11.08 BMA guidelineshttp://www.lmc.org.uk/uploads/files/guidance/bmaaccesshealthcareasylumseekersandrefusedasylumseekerssept08.pdf

• 05.02.09 European Parliament Detention centres for asylum seekers are "intolerable"Asylum seekers and migrants complained systematically about insufficient and inadequate medical care, in particular for pregnant women and victims of torture. Access to health care is often made difficult in detention centres which are located in prison establishments, say MEPs. 

http://www.europarl.europa.eu/news/expert/infopress_page/022-48468-033-02-06-902-20090204IPR48467-02-02-2009-2009-false/default_en.htm

Report adopted by 483 to 39 with 45 abstentions

• 03.09 English Appeal Court judges back Department of Health decision to charge failed asylum seekers in England for access to the NHS.

What’s the big picture?• 10.07.08 Independent Asylum Commission: Deserving Dignity Healthcare should be provided on the basis of need, and asylum seekers should be

eligible for primary and secondary health care until their case is successful, or they leave the UK; in particular and specifically, that all peri-natal healthcare should be free.

• 11.08 BMA guidelineshttp://www.lmc.org.uk/uploads/files/guidance/

bmaaccesshealthcareasylumseekersandrefusedasylumseekerssept08.pdf

• 05.02.09 European Parliament Detention centres for asylum seekers are "intolerable"Asylum seekers and migrants complained systematically about insufficient and inadequate medical care, in particular for pregnant women and victims of torture. Access to health care is often made difficult in detention centres which are located in prison establishments, say MEPs. 

http://www.europarl.europa.eu/news/expert/infopress_page/022-48468-033-02-06-902-20090204IPR48467-02-02-2009-2009-false/default_en.htm

Report adopted by 483 to 39 with 45 abstentions

• 03.09 Appeal Court judges back Department of Health decision to charge failed asylum seekers in England for access to the NHS.

• 19.06.09 Welsh Regulations changed to allow failed asylum seekers access to free healthcare http://www.wales.nhs.uk/newsitem.cfm?contentid=12363

The change to rules in Wales were signalled by the assembly government's Health Minister Edwina Hart in 2008.

"I have made clear that the aim of these changes is to ensure that people who are in need of healthcare receive it," she said. "I believe the mark of a civilised society is the way in which it treats its people, particularly the sick and dying."

In Scotland, there is no firm legislation on the issue. However the Scottish government says that for all practical purposes, if a failed asylum seeker was living there when they applied to stay, they should continue to receive free health care until they are finally deported.

RAPAR Casework (ACT) ContextNo accurate data about how many people failed by system are living in

the North West

Red Cross Destitution project350 people who are on Red Cross’s list for Greater Manchester’s

destitution project

Approx 280 reach it every week, present the correct paperwork (a form of ID and another document confirming that they have been rejected by the asylum system) and receive a food parcel.

Anecdotally, about 25% of the clients are women and the ages range from 20 to 60 years.

In the first quarter of 2008, 93 people presented to this project for the first time, representing a 26.5%(93/350) increase in a year.

RAPAR Casework (ACT) Context

Lifeline condom and syringe provision

Of the mostly sauna based sex workers questioned in 2007:

36%(33/91) self-defined as White European 34%(31/91) self-defined as other than White British

Anecdotally, sauna workers report working 72-hour shifts.Vast majority are not accessing injecting equipment, are disclosing use

of cocaine, cannabis and other amphetamines to stay awake.

(Craig, D. 2007. A Revealing Massage. Manchester: Lifeline)

How many women sex workers are from the categories of female, older and younger refugees, and asylum seekers dispersed to regional areas who are most vulnerable to unemployment?

(Bloch, A. 2004. Asylum and migration working paper 2. London: Institute for Public Policy Research)

RAPAR Casework (ACT) Context

RAPAR regularly interacts with people living in Greater Manchester who are completely undocumented when they present to us.

As an example, a mother – survivor of violence from her husband - and four of her children from Pakistan, had not claimed asylum when they first arrived (2006) and, as time passed, they had become increasingly frightened of claiming.

The children therefore, had never been to school here.

These clients are now inside the asylum system

(Identifying the needs of displaced people in Greater Manchester: Let’s Talk (1) 21608 RAPAR paper for BASW-UNISON Conference. Copyrighted to RAPAR.)

RAPAR Casework (ACT) Example• Referred via London• Woman, late 30’s, 5th floor flat, outskirts Manchester• Seven years in UK, refused almost 2 years ago• 2 years old, very sick, child with British father - estranged• On section 4 support, in receipt of voucher not cash

Presenting Issues– Accommodation: stairs, no washing machine, no hoover– Isolation: physical (support groups) and organisational

(advocacy/interagency working)– Child’s treatment adherence and management:

keeping/reaching appointments; alerting health system when needed

– Mental Health (Mother)– Paediatric Development (Child)– Immigration case without a legal representative

RAPAR Casework (ACT) ExampleWhat do we do?

The presenting client is living their complexity– enable them to re-present that, to themselves and you in the first

instance, in writing, in a structured, chronological, detailed, and documentarily evidenced way

Explore• Overarching Context/Environment:

» Reasons for the “push” factors that led to flight from home» UK Legal status as sub-human

• Self – confidence and Sense of Self Worth» Who are they?» What can they do?» Who can they work with?

• Material bases of the health needs• Whether and how to use the legal framework• Whether and how to profile their circumstances publicly

• Where they fit into the big picture and who else is there? - YOUAct with Compassion and Tenacity

Contact details:

Dr Rhetta MoranRAPARFriends Meeting House6 Mount StreetManchesterM2 5NSUK

E: rhetta.moran@rapar.org.ukT/F: 0161-834-8221

W: www.rapar.org.uk

Registered Charity 1095961 Company Limited by Guarantee 04387010