Asylum Seeking and Refugee Children: What are their health needs and how they are met in the UK? By: Emily Dodds

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1 1 Asylum Seeking and Refugee Children: What are their health needs and how they are met in the UK? By: Emily Dodds [Children] Their fate is always the most tragic, inevitably. When adults wage war, children perish. We see their faces, their eyes. Do we hear their pleas? Do we feel there pain, their agony? Elie Wiesel. Speaking on the occasion of the seventh White House Millennium Evening Washington, 12 th April 1999 Photo- Howard Davies/ Exile images. As seen in the New Internationalist Nov 05 1

2 2 Abstract Aims: To investigate the health needs of Asylum Seeking and Refugee children in the United Kingdom and how these needs are being met within the current system. Method: Journal articles were accessed through databases provided by the FADE library and relevant papers chosen through key word searches including asylum seekers, Refuges, Mental health and Primary Care. Limits were also put in place to ensure that articles found were recent and therefore relevant to modern times. Websites and statistics were found through the search engine Google and recommendations from the convener. Talking to Asylum Seekers, Refugees and people working in this area was another invaluable source of information. Discussion: Asylum seeking children in the UK have a lot of health needs. These needs can be physical due to torture or ill treatment in their country of origin, but can also be due to circumstance after arrival in the UK. Mental health illness is the largest risk facing the health of asylum seeking children. It arises due to trauma experienced and witnessed in their flea to the UK, personal circumstances and treatment within the current system. Conclusion: In the UK the health needs of asylum seeking children are not being met. This is because the main focus of the current system is to meet removal targets and cut costs not to put the needs of the children first and improve their health and indeed their lives 2.

3 3 Introduction The UN s Convention on the rites of the child states that: In all actions concerning children, whether undertaken by public or private social welfare institutions, courts of law, administrative authorities or legislative bodies, the best interests of the child shall be a primary consideration. 3 There is however one exception to this statute when applied to UK law and that is concerning Unaccompanied asylum seeking Children 2. Around 3000 Asylum seeking children and young people arrive alone in the UK each year adding up to over 15,000 since the year Out of these claims only 5 percent are granted refugee status with 30 percent turned down and the rest given temporary leave to remain until the age of 18 2 when their cases are renewed if all appeals have not already been used up. Children and young people also come to the UK with their families as dependants, and in 2007 these numbered All of these children flee to the UK looking for safety and a new life away from torture, persecution and fear which are a very real part of some children s lives. Figure 1 6 shows the main countries that unaccompanied children came from in the year 2007 and the proportion of fleeing males to females. These Children have not have easy lives and have various health needs ranging from the physical effects of torture and hazardous trips to the stress and insecurity of moving to a new country where their best interests are not the priority of their treatment. Figure 1 6

4 4 Definitions To help in the understanding of this study it is first necessary to define key terms. A Refugee is defined as a person who owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion, is outside the country of his nationality, and is unable to or, owing to such fear, is unwilling to avail himself of the protection of that country " 7 In the UK a refugee has had their claim verified and has permission to remain. An asylum seeker is a person waiting to be granted refugee status. A Child is defined as any person under the age of 18 by the UN convention on the rights of the child. 3 An unaccompanied asylum seeking child is defined by the UK Border Agency as "a person under 18 years of age or who, in the absence of documentary evidence establishing age, appears to be under that age" who "is applying for asylum in their own right; and is separated from both parents and not being cared for by an adult who by law or custom has responsibility to do so." 8 Health is "A state of complete physical, mental and social well-being, and not merely the absence of disease". 9 Discussion There are hundreds of children who each year travel to the UK to seek asylum. Some arrive with family and some alone, but no matter how they arrive or who they arrive with these asylum seekers undergo trauma and stress. These stressful experiences can be described in three stages. The first is trauma experienced in their country of origin, the second during their journey and the third while settling into the UK and going and through the asylum seeking process. 10 The children who enter the UK fall into two main categories those who come with their families and those who are unaccompanied, they come alone. This review will outline what these traumatic events are in each category and how the resulting health needs are met with in the UK. Enshrined in the definition of a refugee is the idea that their home land is unsafe and they therefore cannot remain 7. This may be due to physical torture that leaves children who arrive in the UK in poor health physically and emotionally. Sexual abuse is a reality in many countries around the world and young children are raped. This leaves them at risk of HIV and various infections. 11 Young girls at puberty may have had female genital mutilation (FGM) enforced on them. This does leave children physically harmed, but it is often the emotional distress that leaves the largest scar. 11 This distress may manifest itself as sleeplessness, nightmares, weakness, lethargy, headaches, abdominal pain and neck and back pains, which do not seem to have a physical basis. 11 Although not all children are physically tortured themselves, they may have been a witness to it in the community in which they previously lived. M Fazel and A Stien say in their review on The Mental Health

5 5 of Refugee Children that Studies of newly arrived refugee children show rates of anxiety from 49% to 69% with prevalence dramatically increased if at least one parent has been tortured of if families have been separated 10 There is also a possibility of malnutrition and the illnesses resulting from it but this is regarded as an indicator of community nutritional stress. 12 Asylum seekers in the UK have access to the NHS so physical health needs are met within the system. This will be discussed in more detail later on in the study. Most asylum seekers I talked to arrived in the UK through airports having flown in, this is not traumatic in itself but the travellers have much on their minds and children may be scared, confused and unaware of their situation. When visiting centres for this project I had the privilege of talking to Person A who escaped from Belarus in the recent conflict in Georgia. She told me of her journey to the UK in the back of a Lorry. This journey took three days in which they had to remain quiet and not move from the back of the Lorry amongst the goods. Person A was reluctant to go into any further detail and it was easy to see that she did not want to remember an unpleasant journey. She was brought safely to Liverpool. Person A is an adult but it is easy to imagine what that journey must be like for a child cramped, dark, not knowing what was happening and being told to remain quite. To ensure their success and safety while leaving their home country and passing immigration controls, more families are now splitting up. This may give the children a better chance of gaining their status but often puts them into the hands of smugglers and traffickers. 10 Children arriving alone in the UK may face a dispute over their age and this causes even more distress. 13 As we have seen asylum seeking children weather alone or with family arrive in the UK with a variety of health needs most to do with mental health. But as we will discover the system is not always beneficial, in fact it is often a major contributor to problems children develop. Claiming asylum in the UK is a daunting task especially for children doing it alone. Families have to report to the home office daily and their parents face interviews and court hearings trying to establish their case. 14 This often leaves the parent with symptoms of post traumatic stress which affects their parenting and rub off onto the children. 10 Unaccompanied children face this alone. The staffs are not trained to deal with children and seem to lack knowledge about support, housing and education available to these children 13. Interpreting facilities vary and can lead to the children being misrepresented; affecting their success and interviews conducted by untrained staff can be traumatic adding to the child s health needs 13. Housing is another main issue that affects these children s health. Housing is provided by NAAS for asylum seeking families 15 but is often substandard or overcrowded.

6 6 Unaccompanied asylum seeking children are usually placed in foster care which can work well and remind them of their language and culture, but on the other hand when these things are not taken into consideration it can be disaster. 13 These children must leave care at 18 a stressful time when their cases are up for review and the support would be most beneficial. 13 Older children are given independent accommodation with only four hours of support a week. These children are often lonely and remember the past leading to a decline in mental health. 13 All children in the UK are entitled to a free education. 16 This education is imperative for asylum seeking children as it provides them with a vital support network where they can develop educationally, socially and emotionally. 10 A worker told me of a visit he recently made to a school. He asked the children what an asylum seeker was and received the reply terrorist, so clearly it is not all plain sailing. Dispersal is a big factor in education as although and place in a school must be guaranteed before children can be dispersed this does not always happen and language classes and necessary social services may no longer be available. 17 Uprooting these children again can reverse previous progress made with their mental health. 10 Detention is another issue that affects the health of asylum seeking children. It can feel like a prison and make people feel as if they have done something wrong. For some it can bring back memories of torture or past incarcerations and fill them with fear. 11 Within British law it is illegal to detain children under the age of sixteen 16 yet in the year 2007, 380 children were detained were also removed from detention in 2007 taken back to the situation they were trying so hard to escape. 5 Unaccompanied asylum seeking children have a hard time when it comes to obtaining their status. Only 5% of claims are granted while 30% are turned down. The rest are granted temporary leave to remain until the age of 18 when their cases will be reviewed. 2 At these children start panicking knowing they may have to leave their new lives behind this causes mental health issues to re-surface. 13 If they have previously used up all rights to appeal this young people have to leave on reaching Figure 2 10 (below) is a good summary of the health need of children due to the current system.

7 7 Policy aspects Description and background Example of possible impact on children dispersal Accommodation centres Reporting centres Detention centres Tighter immigration controls Refers to a forced resettlement of asylum seekers If a refugee decides not to move they then lose entitlement to benefits and New pilot policy to build three accommodation centres for up to 750 asylum seekers to live until their status is determined Centres to be set up throughout the country, where refugees will have to report in person at regular intervals. The government goal is to be able to detain up to 4000 asylum seekers. In 2001, four new detention centres were built, increasing the total in the UK to eight. Placing a fine on carriers Improving border controls, e.g. gamma scanners. Yet one more forced relocation for children and moves children away from a school they might have settled in Can be moved to an area without important statutory and nonstatutory services Children for first six months to be educated on these sites and away from mainstream education Adds to the uncertainty of the refugee determination process and inability of families to settle, as each reporting time might imply sudden departure to an unknown destination. Detention of children under the age of 16 is against British law; however, this is being increasingly ignored for asylum seeking children No statutory provision for those that are detained. Greater likelihood to turn to illegal and/or dangerous means to enter the country, and exposure to other forms of abuse by traffickers.

8 8 Figure 2 10 Conclusions In relation to the title Asylum Seeking Children: What are their health needs and how they are met in the UK? the following conclusions can be drawn from this review. Children may arrive in the UK with physical health needs due to past treatment in their country of origin and mental health problems due to the trauma of their situation and travel to this country. The asylum seeking process in the UK seems to be the cause of a lot of health needs. Due to the interview process, the need to report, dispersion, detainment and deportation the mental health of these children seems likely to deteriorate on arrival in the UK. Not enough is done to improve the health of these children due to the current policy s desire to deal with all claims as quickly as possible and with minimum expense. Recommendations The current system and treatment of Asylum Seeking children is far from perfect and after spending the last month considering the problem I think the following improvements need to be considered. Home office staff who conduct interviews and age assessments with unaccompanied children need to receive specialist training so as to be more sensitive to them. This will not only benefit the children but will provide the home office with more accurate information. Social clubs and child friendly counselling services need to be made readily available to these children so they can meet other children and find a way of restoring their mental health. The older children should have the option of remaining in foster care past the age of 18 so that they can obtain the support they need when going the traumatic experience of having their case reviewed as an adult.

9 9 Reflection Before starting this project I knew next to nothing about asylum seekers in the UK. I had read articles in the paper and heard reports on the television but really took little notice. This project has really opened my eyes to the situation of thousands in this country and to the violations of their human rights. Talking to Asylum Seekers themselves and to people working in voluntary organisations to help them has made me thankful for the life I have been born into. Hopefully I will use this new found knowledge of the situation to spread awareness and dispel myths about the way these people are treated. Bibliography Fell P, Hayes d. What are they doing here? A critical guide to asylum and Immigration, 1 st ed. Birmingham: BASW, This book was passed to me from the convenor and has been very helpful providing me with information about education and Unaccompanied asylum seeking children. Its simplicity is both its strength and its weakness, being understandable but not containing much detail. Fazel M, Stien A. The mental health of refugee children. Arch Dis Child 20002; 87: This article has been very useful to me, displaying findings logically under relevant headings. It is however a review and contains no research of its own. I found this article by searching online databases. Burnett A, Peel M. The health of survivors of torture and organised violence. BMJ 2001;322: This study is again east to read and obtain information from due to its layout, but is not specifically related to children the object of this project. This paper was given to me in journal club. Chase E, Knight A, Statham J. Promoting the emotional wellbeing and mental health of unaccompanied young people seeking asylum in the UK. Thomas Coram Research unit, Institute of Education, University of London, July ( This summary is of recent research undertaken and provides insight into the feelings of the children. It is however funded by the home office and although it claims not to necessarily express their views it does have a small bias.

10 10 Acknowledgements Many thanks to the following for all their help and input, Dr O Neil, convener- for his explanations into the nature of this report. Jan Mcintosh and Julia Taylor at MRSN- for their organisation and explanations. Kieran Lamb at the FADE Library- for his help in searching databases. Irene Campbell and WASSO -for sharing her passion for the plight of asylum seekers. Louise Msamba at MRANG - for giving me the opportunity to talk to asylum seekers. All at Sahire House- for explaining the effects of HIV and aids on the community. All at Amina house- for showing us round and talking to us about mental health issues. Uka from Shelter- for explaining the law concerning asylum seekers and homelessness. Maggie Green at Asylum Link- for showing us around and providing the opportunity to talk to asylum seekers. References 1. (Accessed Mon 9th Feb) 2. d-asylum-seeking-children.html (Accessed Wed 11th Feb) 3. Convention on the rights of the child. General resolution 44/ th Nov ( 4. Chase E, Knight A, Statham J. Promoting the emotional wellbeing and mental health of unaccompanied young people seeking asylum in the UK. Thomas Coram Research unit, Institute of Education, University of London, July ( 5. Home office statistical bulletin. Asylum Statistics United Kingdom ( (Accessed Mon 16th Feb) 7. Article 1. The convention relating to the status of refugees. (

11 11 8. Planning better outcomes and support for unaccompanied asylum seeking children. Feb 2007 ( tions/closedconsultations/uasc/consultationdocument) 9. Mental Health ( 10. Fazel M, Stien A. The mental health of refugee children. Arch Dis Child 20002; 87: Burnett A, Peel M. The health of survivors of torture and organised violence. BMJ 2001;322: Davis, Austen P. Targeting the vunerable in emergency situations: Who is vunerable? Lance 1996;348: Chase E, Knight A, Statham J. Promoting the emotional wellbeing and mental health of unaccompanied young people seeking asylum in the UK. Thomas Coram Research unit, Institute of Education, University of London, July ( 14. Asylum seeking process. ( 15. Asylum Seekers rights. ( 16. Education Act 2005 ( 17. Fell P, Hayes d. What are they doing here? A critical guide to asylum and Immigration, 1 st ed. Birmingham: BASW, 2007.

12 12 Appendix Timetable of activities during period of study Week Day Activity 1. Beginning January 26 th Monday 26 th Visited the FADE library at Regatta Place and Tuesday 27 th was taught how to search online databases. Visited the Women s group MRANG where Louise Msamba Introduced us to the asylum Seekers predicament. The remainder of the morning was spent entertaining the children. The afternoon saw us travelling to Chester to meet with the Convenor Dr Joseph O Neil and the specifications of this study explained Wednesday 28 th We visited a newly formed Women s group where Irene Campbell talked to us about how the media and public view asylum seekers. Friday 30 th I re-visited MRANG where I helped making dentist appointments and registering new women. 2. Beginning February 2 nd Monday 2 nd Visited Sahire House where we were given a presentation on HIV and Aids in the U.K. Tuesday 3 rd We visited Amina House Hostel and learned about the work done there housing people with mental illnesses. 3. Beginning February 9 th Monday 9 th Attended a talk on the law concerning asylum seekers, refugees and homelessness. Tuesday 10 th The morning saw us visiting Asylum link and talking to asylum seekers. In the afternoon we visited Chester to meet with Dr O Neil to talk through questions we may have. During this week I decided on the topic of study and started reading relevant literature. I also started drafting the study. 4. Beginning February 16 th This was the last week of the study and was set apart for writing up and formatting information gained.

13 13 The following diagrams are included to help the reader understand the general asylum seeking process and the health care that they are entitled to. References 1. Refugee community training and development project run by Shelter. Course workbook. 2. Overseas visitor s eligibility to primary care

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