REFUGEES AND THE NATIONAL HEALTH SERVICE

Transcription

1 REFUGEES AND THE NATIONAL HEALTH SERVICE Areport of the Health and Ethnicity programme of North East Thames Regional Health Authority and North West Thames Regional Health Authority

2 REFUGEES IN NORTH WEST AND NORTH EAST THAMES REGIONAL HEALTH AUTHORITIES Edited by Ghada Karmi The Health and Ethnicity Programme North West/North East Thames RHAs April 1992

3 INTRODUCTION This report is intended to provide an overview of the refugee issue in the two North London health regions, so as to highlight a growing and still unrecognised problem for the Health Service. The influx of refugees and asylum seekers has increased dramatically world wide over the last two decades. While Britain has by no means been the largest recipient of this influx of people - we are fifth down on the scale after Germany/ France, Sweden and Austria - the annual increase in numbers of asylum seekers here has nevertheless grown steadily. In 1988, there were 5000 refugee admissions to Britain. In 1990, the figure had risen to and it is still increasing. In addition, a new phenomenon has appeared over the last two to three years, namely, the appearance of unaccompanied refugee children seeking asylum. London is the major destination for refugees. Over 90% of all asylum seekers in Britain settle there. In 1989, the London Strategic Policy Unit estimated that there were 127, 930 refugees in London. The majority of these make their homes in the inner city districts of both the North Thames regions, but exact numbers of refugees in districts are difficult to obtain because refugee statistics, as derived from our main source, the Home Office, are estimated nationally. There is therefore no local breakdown for these figures, and reliance has to be placed on Local Authority and voluntary agency estimates. It is almost certain that such figures are underestimates, but they are the best we have. Based on such estimates, there are currently 79,000 refugees in North East Thames Regional and 37,000 in North West Thames. Within the two regions, the refugees are concentrated in the inner dty districts of North East Thames: Islington and Bloomsbury, City and Hackney, Haringey and Tower Hamlets, and those of North West Thames: Parkside and Riverside. Refugees have specific health needs. Not only do many of them suffer from the stress of insecurity and the effects of persecution, both physical and psychological, but they also have the added effects of social disadvantage and legal ambiguity. Many may have been physically tortured. They will encounter difficulties of access to the services, partly because of language problems and partly because of unfamiliarity with British systems. Most will be unemployed and living in impoverishment. For all these reasons, the health services will need to respond in appropriate and adequate ways to the health challenge posed by refugees. This will be especially necessary for unaccompanied refugee children who have particular educational and sodal needs. The presence of large numbers of refugees in particular districts and FHSAs will have dear implications for the process of contracting for health care and for weighted capitation. Such 'refugee districts /FHSAs' will argue for greater resource allocation on the basis of increased demand for services. For example, Haringey HA, which has a substantial refugee population, was recently successf ul in obtaining extra resources from the RHA because of this fact. But for this practice to be replicated elsewhere, it will be important to have accurate demographic information on refugees as well as adequate needs assessment research. This will not be an easy enterprise,- given- the -dificulty -of -studying-a-population which is more than usually mobile and which has considerable communication and legal problems. It is nevertheless essential to make the attempt and to work out comprehensive health and service strategies for responding to an issue which will not go away. Hopefully, this document will go some way towards raising awareness of the scale and relevance to health care of the problem of refugee groups in our two regions. Edited by Ghada Karmi The Health and Ethnidty Programme North West/North East Thames RHAs April 1992

4 I OBJECTIVES The objective of this report is to provide a statistical profile of refugees in the North West Thames and North East Thames Regional Health Authorities. II THE BACKGROUND "Refugee" is the term given to people granted protection by governments under the provisions of the 1951 UN Convention and the 1967 Protocol relating to the status of refugees. To be recognised as a refugee under the 1971 Immigration Act for regulating entry into the UK, the rules state that: "A person may apply for asylum in the United Kingdom on the ground that if he were required to leave/ he would have to go to a country to which he is unwilling to go owing to a well-founded fear of being persecuted for the reasons of race, religion, nationality, membership of a particular social group or political opinion. Any such claim is to be carefully considered in the light of all the relevant circumstances." (1) World wide, it is estimated that there are approximately million refugees, as defined by the 1951 UN Convention. The vast majority are from the third world and seek asylum in other third world countries. "Surprisingly, only a very small proportion of the world's asylum seekers, less than 2%, comes to Europe and only a fraction of these comes to Britain." (2) Despite the fact that Britain received only a small proportion of the world's refugees in the last 3 years, the number of people in west Europe applying for political asylum or acquiring refugee status has trebled. Whereas in Sweden one in every 100 people is a refugee, in France the ratio is one to 314, and in Britain the ratio is one to 4/692. The Home Office states that, since 1988, the number of refugees arriving in the UK has risen by over 500%. Most come from Ethiopia, India, Iran, Iraq, Ghana, Turkey, Somalia, Sri Lanka, and Zaire. Much of the reliable data is on a national level, and not on a local level. Therefore, most of the statistics provided on a district basis are estimates made by the various statutory agencies, voluntary groups, and local refugee support organisations. Alarmed by the rising numbers of third world refugees/ and with the advent of the single-market at-the-end -of , EC -governments arc-collaborating in devising a common immigration policy designed to limit the numbers eligible for refugee status. "The Cabinet Office is preparing new controls against refugees settling in Britain amid ministerial anxiety that recent world events will increase the numbers of black asylum seekers and could re-awaken the immigration debate and fuel radst sentiment..-alf Dubs, Director of the Refugee Council, said he feared the government was so desperate to keep the numbers down that its measures would deny access to Britain for people in real fear of death and torture." (3)

5 hi June 1990, the Dublin Convention Treaty was signed by all the 12 EC countries. This agreement will determine which nation is responsible for hearing an asylum application made within the EC. If an asylum application has been rejected by one EC country it cannot be heard by another. Another measure designed to limit immigration to Europe is the Schengen Agreement, signed in June 1990, which is a joint agreement between Italy, Luxembourg, Germany, Holland, France and Belgium. This allows for a) A common visa policy, which will eventually result in a single visa for all Schengen countries. b) A computerised information exchange on migrants, tourist, refugees and people under surveillance. c) Provision for legislation to fine airlines and other carriers which transport people without the correct travel documents. "Humanitarian organisations fear that the future common European asylum regulations will be based on the principle of the lowest common denominator; that national regulations least favourable towards refugees will determine the level of future European refugee policy. This is expressed as 'fortress Europe' with open internal borders, but high external walls barring those who wish to seek asylum." (4) On July 2nd 1991, responding to an accusation by the Labour M.P. for Tottenham, Bemie Grant, who stated that the government was: "intent on using the numbers game, both on immigration and on asylum seekers to create a radst backlash", the Home Secretary, Kenneth Baker, announced the following measures: i) People who fail to claim asylum in the first safe country they reach will be sent back to it, unless they have very close UK links. ii) Airlines bringing in passengers without valid documentation will face fines of up to 2000 a passenger. iii) Finger printing is being considered to combat evidence that some asylum seekers make multiple asylum applications, and claim sodal security benefits under a number of different identities. iv) Handling refugee applications will be speeded up. Extra adjudicators and other support staff will be recruited. v) Legal aid will be stopped for refugees who wish to appeal against decisions made by the Home Ofice. Instead, advice and assistance will be provided by the UK Immigrants Advisory Service. vi) The Bill being introduced to simplify procedures will speed up the handling of 'dearly unfounded cases'. An adjudicator will be able to dismiss an appeal without an oral hearing if he has dedded there is no substance to the daim.

6 Of those seeking asylum in the UK/ 90% setle in the London area. Although the overall flow of newly arrived ref ugees remains constant, very often / local districts have to deal with sudden influxes of specific refugee groups. Their complex sodal and health care needs place a great strain on existing statutory service provision and resources for these impoverished groups remain desperately inadequate.

7 Ill HISTORICAL PERSPECTIVES Historically / Britain has had a long history of receiving refugee groups. Yet today, with the rise in the numbers arriving from third world countries, Britain along with the rest of western Europe now seems more concerned with introducing legislation which will restrict the numbers of ref ugees entering the country. As has been stated earlier, refugees are those people who have left their homeland in order to seek protection and sanctuary in another country. A person becomes a refugee because not to do so may mean death, imprisonment, or torture. Today however, refugees are increasingly not seen as people who were physically uprooted from their homelands, but rather as a potential cause of problems for the receiving countries. Refugees and the aftermath of the Second World War The rise of fascism within Europe provoked an enormous movement of refugees and displaced people, m the 1930s many Jews began to leave Germany voluntarily. The end of the Second World War resulted in over 30,000 Jews settling in the UK. Approximately 250,000 Eastern European refugees (approximately 200,000 were Poles) arrived in Britain as a direct consequence of the end of the Second World War. The Hungarian revolution of 1956 resulted in 15,000 Hungarian refugees arriving in Britain. " The Czechoslovakia Uprising in 1968 resulted in 5,000 Czech refugees fleeing to Britain. In the last 25 years, political and economic instability in the Third World, combined with superpower rivalry and the world-wide spread of modem weaponry, have produced major refugee movements in every part of the globe." (5) The changing pattern 1970 onwards World events such as the Vietnam war, the Afghan War, and the political events in third world countries have resulted in a new phenomenon, the immigration of third world refugees to the developed countries of the West. As a result, refugees tend to seek refuge in a country where they have some sort of established -relationship, for example,-a- common language such as English. In the United Kingdom, this new flow of refugees from the third world has meant, not only an increase in its ethnic minority population, but, as we have seen, has also prompted the Government to introduce legislation and administrative practices designed to restrict the numbers of those claiming asylum. The current world economic recession has been crucial to the formulation of such policies.

8 Migration of refugee groups onwards In 1972, 28,000 Ugandan Asian refugees arrived in the UK. During this period : "Uganda witnessed the worst killing of its own people. Between 100,000 and 500,000 Ugandans disappeared or were murdered. Many who managed to survive fled the country and took ref uge all over the world." (6) In 1973, the coup in Chile which resulted in a military dictatorship led to 3/000 Chilean ref ugees being granted asylum. In the same year, refugees from Ethiopia (Eritreans and Tigrayans) began to enter Britain. The outbreak of civil war between the Ethiopian and Eritrean factions had caused many to flee their homes and seek asylum in neighbouring states, including Sudan. The Refugee Council estimates that, in 1989, there were 1,200 refugees seeking asylum in the UK. Today, Ethiopians and Eritreans make up one of the largest groups of refugees arriving in the UK. The civil war in Sri Lanka in 1973 caused large numbers of Tamils to seek asylum elsewhere. The Tamil Refugee and Immigrants Welfare Association believes that up to 7,000 Tamil refugees are living in London, with the biggest concentration in the London boroughs of Newham and Camden. Following the Greek colonels' coup in Greece and the Turkish invasion of Cyprus in 1974, some 10,000 refugees from the Greek and Turkish communities came to Britain. At the end of the Vietnam war in 1975, Britain accepted 20,000 Vietnamese refugees most of whom were granted automatic refugee status. In 1978, civil war broke out in Somalia when the military regime banned multi-party politics and dissolved the National Assembly. Since then approximately 2 million Somali's have fled the country. The London Strategic Policy Unit estimates that 1,200 Somali's have applied for asylum in Britain during the last 18 months. With the establishment of the new government in Iran in 1979, and the start of the Iran-Iraq war in 1980, 11,500 Iranians applied for asylum to Britain. At the same time, more than 3,000 Kurds (mainly from Turkey) also claimed asylum. In 1982, a military coup in Ghana overthrew the civilian government, and led to an exodus of Ghanaians from the country. The Ghana Welfare Group believes that there are between 5,000 and 10/000 Ghanaian refugees in London, although official figures provided by the Home Ofice show that in 1989 only 2,000 Ghanaian refugees claimed asylum in Britain. For those who have been allowed to remain, the government has shifted the responsibility for their welfare largely to local authorities, and to the refugee support agencies. Resources for these two groups remain inadequate.

9 IV THE PROCESS OF GAINING LEGAL ENTRY INTO BRITAIN Under Article 33 of the 1951 UN Convention, all political asylum seekers must be given the right to stay in Britain in the first instance. It is the responsibility of the Home Office to decide whether a political asylum seeker has the right to stay in Britain. Refugees who arrive in Britain fall into two main categories : i) Programme refugees. ii) Non-programme ref ugees. Programme refugees are those who have been granted automatic refugee status, (normally after negotiations with the United Nations Commissioner for Refugees). These refugees will be provided with government assistance and re-settlement programmes will be created for them. Examples include Czechoslovaldan refugees (1968)/ Chileans (1973) and, most recently, Vietnamese refugees. Non-programme refugees who account for approximately 80% of refugees in Britain, are those individuals who claim refugee status on or after arrival in this country. "It is in this second group that there is need for the most concern, since they do not have the benefit of government assistance and programmes, and most often wait several years virtually in limbo for Home Ofice decisions on their applications for refugee status." (7) Tamils, Lebanese, and black Africans are examples of non-programme refugees. Many are under threat of deportation and others are kept in detention centres whilst their fate is being decided. There are 3 main categories which the Home Office is able to assign to asylum applicants: i) Refugee Status. Here, full political asylum is granted, which means that the asylum seeker has the right to stay in Britain indefinitely and is granted a 'resident permif, allowing him/her the right to travel outside the UK and to apply for children or spouses to join him/her. ii) iii) Exceptional Leave to Remain (ELR). Here, the applicant is granted a stay of one year, subject to renewal after that time and again after a further 3 years. - The-Home Ofice -states that - ELS- is- granted when "the applicant does not qualify for refugee status but, for a variety of reasons, we do not think it right to enforce departure from the UK." (8) Refusal. Here, the applicant is refused the right to stay in Britain and will be deported to his/her country of origin, subject to any right of appeal. The Refugee Council believes that it takes the Home Ofice make an initial decision. at least 18 months to

10 In 1989, 59% of refugees were granted 'exceptional leave to remain'. This means that each year the Home Office will have to sanction their right to stay/ which may be revoked at any time. The long wait means that: a) While asylum seekers await the Home Office decision, they are still entitled to full statutory rights, i.e. sodal benefits, housing and health care. b) There is much anxiety and insecurity amongst many refugees, who are afraid of being expelled or deported.

11 V PROBLEMS FACED BY REFUGEES Unlike immigrants who came to Britain in search of a better standard of living, most refugees have had to flee their countries. The majority arrive in the UK without money or appropriate clothing, and are completely dependent on local authorities to house, clothe and feed them. "From our findings of our survey, we can see that refugee groups are the most disadvantaged groups in housing. It has come to light from our interviews with refugees and our visits to their accommodation that their housing conditions are quite appalling. The findings of our research show clearly that there is a high rate of homelessness among refugees. This housing situation is a real obstacle for the resettlement of refugees." (9) Many are unable to communicate in English, whilst others may be highly qualified but unable to find employment in keeping with their qualifications. The majority have experienced great distress during and preceding their journey to the UK, as well as psychological or physical torture in their countries of origin, and when they arrive in this country some are detained by the Home Office for many months. As a result, they suffer from varying degrees of stress, depression, high levels of anxiety and mental illness. For example, among Ethiopians, there seems to be an unusually high incidence of schizophrenia, especially in the year old age group. (10) In summary, refugees face the following problems: i) A high proportion are homeless, and have no choice but to live in run-down and overcrowded hotels, or private rooms, which lack all but the basic facilities. ii) iii) 50% of the recent arrivals from Somalia and Eritrea are women and children, as the men are not allowed to leave. The majority are only able to communicate in their own language, and this has prevented many from finding work. Those who do have a job are usually employed in the most menial and low-paid sectors of the economy. All of the community organisations we contacted reported that 90% of their members were unemployed. iv) Many are unable to understand Britaiirs -iegal, health care and social security systems, and rely on voluntary centres to provide limited help with interpreting and welfare advice. v) Refugees, especially from Somalia and Turkey, are much more likely to have on average, 4 to 5 children. vi) The traumatic experience of losing their homes, relatives and social status, causes deep depression, and many are in need of counselling and mental health care.

12 vii) viii) ix) Clothing is a real problem. Many arrive with inadequate clothing, and without any money. They are unable to afford to buy suitable clothing and rely on charitable organisations to supply their needs. Some have been tortured and need intensive medical care. A pattern is also emerging which shows that many of their physical disorders are symptoms of their social conditions and emotional problems. Applying for refugee status can be a long and anxious process. They have to wait a long time for a response from the Home Office. This period could be up to 3 or 4 years. While they wait, most live with the fear of being deported. As they do not understand their welfare rights, many do not register with the appropriate statutory services, for fear of being deported. As a result, there are large numbers who are never registered with statutory agendes and do not receive all their statutory rights and benefits.

13 VI NATIONAL AND EUROPEAN OVERVIEW Statistics from the Refugee Council as supplied by the Home Ofice, show that: In 1988 just over 5,000 refugees were admitted to Britain. In 1989 this figure had tripled to 15/530. In 1990 this figure had doubled to just over 30,000. Table 1: Annual number of refugee admissions to Britain. Source: The Home Ofice. Although the Home Office says that there were 30,000 claims in 1990, a five -fold increase in 10 years, there is considerable disagreement by all the refugee support groups, who believe that the figures are inflated by counting applicants who are already here as well as new arrivals. As it takes, on average, 18 months for a claim to be processed, people are in effect being counted twice. Compared to other countries in Western Europe, the number of those who qualify for refugee status in Britain is small. For instance^ in 1989, France admitted refugees compared to Britain 's 15/500 in the same year. The majority of refugees come from Africa, Asia and the Middle East.

14 Table 2: Countries of origin of refugees to Britain. Source: Asylum applications received 1990, Home Office statistics/ supplied by the Refugee Council. Country No of refugees No of refugees West Germany 103/ /434 France 34/352 61/372 Sweden 19/500 29/000 Austria 15/233 18/252 Britain 5/263 15,500 Holland 4/486 13,898 Belgium 4,855 8,200

15 Table 3: Source: Numbers of refugees by receiving European country. The Refugee Council

16 Refugees Arrivals Project The Project reports a marked rise in the numbers of "vulnerable" arrivals ; that is unaccompanied young people or children. The statistics for 1990 give a good indication of the current refugee groups arriving in the country. Table 4, males and Table 5, females: 14 largest refugee groups by country. Source: Refugee Arrivals Project, 1990 statisi t cs. Male Female

17 Table 6: Total number of refugees seen by the Refugees Arrival Project. Source: Refugee Arrivals Project In 1989, the Refugee Arrivals Project dealt with 2,634 refugees; in 1990, this figurejiad nearly doubled to 5/164. The Project also reports a new phenomenon / children or young people who arrive unaccompanied, without any parents or adult relatives.

18 VII METHODOLOGY Information for this study was compiled in the following ways: a) Outreach - contracts. b) Telephone interviews. c) Postal Questionnaires. Field work was carried out with the following organisations: 1) Local refugee community support groups and voluntary sector projects in all the London inner dty districts. 2) National agencies such as the Refugee Council, and Save the Children Fund. 3) Statutory agendes such as local authorities and health authorities. 4) The Home Office/ the Refugee Arrivals Project, Amnesty International, and the UK Immigrants Advisory Service. Agendes were asked to provide the following information: i) A breakdown by ethnic group of refugees in their areas. ii) iii) Data on age and sex. Places of residence in their areas. Problems encountered with estimating figures at local level 1) Since information relating to refugees remains on a national basis, and is not available at local level, many agencies rely on statistics provided by the Home Office. 2) The Refugee Arrivals Project has offices based at Stansted and Heathrow airports. It provides practical help to newly arrived refugees who do not have any contacts in the UK, and is one of the few voluntary projects which keeps detailed statistics on refugees (estimated to be 46% of the total number of refugees arriving in the UK). However, it is unable to provide statistics on the eventual settlement of refugees. 3) The Home Office keep detailed statistics on refugees. However, these statistics are disputed by various agendes such as the Refugee Council and the Refugee Arrivals Project who question the methods used in compiling the figures. Nevertheless, statistics produced by the Home Ofice seem the most reliable indicator of the numbers of refugees arriving in Britain. But the Home Office is unable to provide data on exactly where refugees settle in Britain.

19 4) Local statutory services, such as housing and social services, only keep statistics on ref ugees when they fulfil their priority need criteria. This mainly applies to families or single mothers with children. As the majority of refugees do not qualify, this information is of limited value. Local education services keep records on the numbers of refugee pupils in their schools and colleges. 5) The London Strategic Unit is able to provide some information on those refugee groups residing in the capital, but as this information was collected in 1987, much of it is now out of date, (see Tables 7 and 8). In 1987, the London Strategic Unit estimated that the largest refugee groups were Iranians (43/000), Kurds (20,000), Vietnamese (12,500), Liberians (9,130) and Sudanese (8,000). Ethiopians, Eritreans, and Tamils numbered 5,000 each. Table 7: Estimated refugee figures for London Source: London Strategic Unit. But our telephone survey, (carried out in March 1991), of ref ugee community groups and statutory organisations in North West Thames and North East Thames RHAs showed that the numbers of many. -groups such as the Somalis. and Ethiopians /Eritreans had increased substantially. The largest groups are now the Somalis/ Ethiopians and Kurds.

20 Table 8: Telephone survey of refugees in the North East and North West Thames RHAs March Source; Maya Balcioglu-Brisley (researcher ). Refugee community groups could only estimate the numbers of refugees living in their districts / so these figures may not be accurate. Nevertheless they indicate a general trend. Limitations of the study data The lack of adequate statistics can be attributed to a number of factors: 1) Refugees are not centrally directed by the Government to live in specific districts. 2) Refugees are a shifting and not a settled population. (11) 3) Communities such as the Somalis and, to a lesser extent the Tamils/ are immigrant groups who have been settled in Britain for years. Many have British citizenship, but are still included in formal refugee statistics compiled by the Home Office and other agencies. 4) The number of asylum seekers in North East and North West Thames RHAs is increasing daily, and so statistical data is likely to become rapidly out of date. 5) Local authorities have little up-to-date information on the number of new refugee arrivals.

21 6) Refugees are often housed by housing departments in areas outside their jurisdiction. As there seems to be little communication between the different local authorities, there is a tendency for these asylum seekers to be left out of statistical estimates, both by the authorising council and the one in which they live. 7) Figures provided by refugee community groups are based on those ref ugees who use their services, and therefore do not represent the total number of refugees in their localities.

22 VIII REFUGEE GROUPS IN THE NORTH WEST AND NORTH EAST THAMES REGIONAL HEALTH AUTHORITIES As has already been stated there are no official figures about the numbers of refugees living in London. Organisations such as the Home Office and the Refugee Council are only able to provide national statistics. As a result, it must be noted that the local statistics produced in this chapter are estimates from refugee community groups and statutory organisations. The Association of London Authorities, the London Strategic Policy Unit and the Refugee Council estimate that 90% of refugees settle in the London area. "The patterns of settlement of refugees in London are variable / but, generally speaking refugees tend to live in inner city boroughs such as Hackney, Haringey, Camden or Lambeth, where housing is cheaper, councils more accommodating and refugee communities have been long established." (12) In 1989, The London Strategic Policy Unit estimated that there were 127/930 refugees in London. Our estimated figures show that there are at least 110/000 refugees residing in the North West and North East Thames Regional Health Authorities alone. The majority live in the inner city districts, and therefore districts such as West Essex, North East Essex, Mid Essex, North Bedfordshire, North Hertfordshire / East Hertfordshire and North West Hertfordshire have very few refugees. Inner London districts Inner London districts of the two regions are: NETRHA HACKNEY HARINGEY ISLINGTON & BLOOMSBURY NEWHAM TOWER HAMLETS NWTRHA PARKSIDE RIVERSIDE These districts have large numbers of settled ethnic minority communities. There is a tendency for refugees to'either gathemselves orlorbe placed in areas where their community is already established. Tower Hamlets has the largest community of Somali refugees in London, estimated to be 10,000. Research carried out in Islington and Bloomsbury districts in 1988 showed that between 8/000 and 12,000 refugees of 30 nationalities lived in the Camden area alone. The largest groups comprised those from Iran, Ghana, Eritrea, Ethiopia and Sri Lanka. Women accounted for 25% of the total (13)

23 In Harmgey, research carried out by the district health authority in September 1991 estimated that there were 15,000 newly arrived refugees. Indeed, together with City and Hackney, these two districts have the largest numbers of Kurdish refugees in London. (14) Outer London districts Outer London districts of the two regions are: NETRHA ENEfiLD HAMPSTEAD REDBRIDGE WALTHAM FOREST NWTRHA BARNET EAUNG HARROW flllingdon HOUNSLOW & SPELTHORNE It is to be noted that these districts have much smaller numbers of refugees compared to the inner cities. Outer London districts in the North West Thames Region have higher numbers of newly arrived refugees from Eastern Europe. For instance/ 20/000 Yugoslavs, (many of whom arrived as refugees after the second World War) live in Riverside. It is likely that this district can expect influxes of refugees from Yugoslavia due to the present dvil war. Ealing has a large Polish Community. From 1984 to 1990, approximately 1/000 Polish refugees settled in the district. Ealing also has high numbers of Afghan refugees.

24 Estimated figures of refugees in the North West and North East Thames Regions NETRHA NWTRHA ISLINGTON & BLOOMSBURY 20,000 PARKSIDE 13,000 CITY & HACKNEY 15,000 RIVERSIDE 10,000 HARINGEY 15,000 EAUNG 7,000 TOWER HAMLETS 12,000 BARNET 3,500 NEWHAM 9,000 HOUNSLOW & ENHELD 3,000 SPELTHORNE 2,000 WALTHAM FOREST 3,000 HARROW 1,000 HAMPSTEAD 2/000 HILLJNGDON 1,000 TOTAL 79,000 TOTAL 37/000

25 MAP 1- ESTIMATED NUMBERS OF REFUGEES IN THE NORTH EAST THAMES REGIONAL HEALTH AUTHORITY

26 MAP 2- ESTIMATED NUMBERS OF REFUGEES IN THE NORTH WEST THAMES REGIONAL HEALTH AUTHOR ITY

27 Estimated figures combining both regions ISLINGTON & BLOOMSBURY 20,000 CITY & HACKNEY 15/000 HARINGEY 15,000 PARKSIDE 13/000 TOWER HAMLETS 12,000 RIVERSIDE 10,000 NEWHAM 9,000 EAUNG 7/000 BARNET 3,500 ENFIELD 3/000 WALTHAM FOREST 3,000 HAMPSTEAD 2,000 HOUNSLOW & SPELTHORNE 2,000 HILUNGDON 1,000 HARROW 1,000 TOTAL 116,000 Table 11: Source: Refugees in both regions. Figures from refugee community groups.

28 wp l- T^TWM'I.I - Niir^'r.h:.' ^',' n-.m-.n-:^ IN " ITIK ^::'FnT r.v.r ^n> ^-mi LJ!-,.!- r..\r<s Ki^iUNU UMLni rtlrnio i l yi ^

29 Refugees by ethnic group 1) Africans - general In trying to collect information on African communities, the only refugee community groups which were able to provide local estimates of their communities were two Somali groups, an Eritrean group and a Ugandan group. This means that we are unable to comment on other groups, such as those from Ghana, Zaire Angola and Sudan. In the last 5 years, the numbers of refugees arriving from black African countries has tripled. Of more than 20,000 requests for asylum received this year, a tenth came from Africans. Table 12: African Refugees. January to October Source: Home Office statist cs obtained from the Refugee Council.

30 2) Somalis Somali communities have been established in the UK for over 100 years, when shipping and trading links between Britain and Somalia brought Somali seamen to work the docks and the shipping industries of the East End. Later between 1965 and 1974, the British Government allowed the spouses and children of Somalis to immigrate to the UK. (15) Table 13: Somali applications for asylum 1980 to Source: The Refugee Council. Like all other ref ugee groups, Somalis are spread throughout the two regions. Our estimates show that the largest communities are based in Tower Hamlets where the numbers are estimated at 8,000-10,000, and the smallest community is in Harrow with approximately 500.

31 Table 14; Somali groups by district in North West Thames RHA Table 15: Somali groups by district in North East Thames RHA Source: Estimated figures by refugee community groups. Map 4 shows the distribution of the Somali community in the two regions.

32 MAP 4- ESTIMATED NUMBERS OF SOMALI REFUGEES IN THE NORTH EAST AND NORTH WEST THAMES REGIONAL HEALTH AUTHORITIES

33 3) Eritreans Eritrean refugees have been arriving into the UK for more than a decade. Eritreans are an ethnic minority group who have been fighting for independence from Ethiopia since Specific statistics on Eritreans are difficult to obtain, as they all hold Ethiopian passports. Table 16: Eritrean applications for asylum 1980 to Source: The Refugee Council In 1988, the Labour Force Survey estimated that there were 2/000 Eritreans in the London area. Our figures for 1991 show that there are more than 5/000 Eritreans living in the two North Thames regions.

34 Table 17: Eritrean groups Table 18; Eritrean Eritreal groups by district in by district disti in North East Thames RHA North West ^ Thames RHA Source: Estimated figures by refugee community groups. Astudy by Islington Council (1990) showed that: 1) 74% of the community are under 25 years. 2) 42% have completed high school before arriving in the UK. 3) 25% were at secondary school when they were forced to Hee their homeland. 4) 30% are not registered with a General Practitioner.

35 4) UGANDANS Home Office statistics show that the numbers of Ugandans arriving in the UK peaked in However, this figure is expected to fal dramatically after the imposition of UK visa requirements in March Table 19: Ugandan applications for asylum 1980 to Source: The Refugee Council. Although Ugandans are distributed throughout the London area, the Uganda Asylum Seekers Association estimates that there are approximately 3,000 Ugandan ref ugees living in Newham Health District.

36 5) European Refugees Arab Refugees Home Office statistics show refugees from the Middle East and Europe account for the third and fourth largest refugee groups in It is interesting to note that Turkey is now considered to be part of Europe, and is included in all European statistics. Table 20: European statistics. Source: The Home Office. Table 21: Asylum applications from the Middle East Source: The Home Office.

37 6) Kurdish refugees Kurdish refugees in the UK mainly come from Turkey/ but also from Iraq and Iran. It is estimated that there are approximately 20,000 Kurdish refugees in the UK. The numbers of Kurds peaked in 1989 when Home Office figures show that 4,650 applied for asylum. Most settled in Haringey, Islington and Hackney where there are established Kurdish communities. Table 22: Turkish applications for asylum 1980 to Source: The Refugee Council Fie chart 1; Kurdish groups by district. Source: Estimated figures by refugee community groups.

38 SUMMARY AND CONCLUSIONS 1) Although only 2% of the world's refugees arrive in Europe, statutory services are unprepared for the recent increase in numbers of refugees. 2) As has been stated throughout this report, local figures on the eventual settlement of refugees were difficult to obtain. 90% of all refugees settle in the London area. Our estimates show that at least 110,000 are currently living in the North East Thames RHA and North West Thames RHA. This has enormous consequences for health care services. 3) Refugee organisations argue that their clients are much less likely to be given full access to health services. They claim this because: a) Many are unable to communicate and do not have access to interpreting facilities. b) Health workers such as doctors, dentists, and primary health care workers do not understand the status of refugees and view them as illegal immigrants, and therefore are unwilling to provide them with services to which they are entitled. 4) In view of this situation we conclude that district health authorities need to instigate more local research in order to ascertain which refugee groups are living in the district, and to provide more data on their housing, employment and other social factors relevant to health. Without such information, district health authorities will be unable to provide adequate services to these groups. Joy Awiah Researcher North East and North West Thames Regional Health Authorities April 1992

39 BIBLIOGRAPHY 1) Amnesty Inter ational British section. Deficient Policy and Practise for the Protection of Asylum Seekers. London, November ) London Borough Grants committee. Refugees the Struggle for Equality, page 13, quote from introductory speech by Cardinal Basil Hume, Archbishop of Westminster. London/ ) The Guardian Newspaper 4th January ) Published by Baling Racial Equality Council, August ) Frances D'Souza, Jef Crisp and Stevanne Hill. The Refugee Dilemma. The Minority Rights Group. Report No 43, page 6. London ) Joseph M Musoke. The Ugandan Asylum Seekers Handbook, page 2, London ) Race Equality Working Group of the London Strategic Policy. Discrimination and Refugees, A resource pack. The London Strategic Policy Unit, London ) Amnesty International British section. Deficient Policy and Practise for the Protection of Asylum Seekers. Page 6. London, ) Jamal Benomar. Downward Social Mobility, a Survey on Refugees in Camden. Camden Race Committee, Page 29. London, ) Ethiopian Community in Britain, News Letter. Summer 1990 Vol. 1 No ) Nick Chadwin, Camden law Centre. 12) Discrimination and Refugees, page 10. Race Equality Working Group of the London Strategic Policy Unit, London ) Jamal Benomar, Downward Social Mobility: A Survey on Refugees in Camden. Camden Race Committee. London, ) Joy Awiah, Refugee Groups 'in Haringey. Haringey Health Authority, London ) Ahmed Abdullahi, Health and Social Circumstances of the Elderly Somali Population of Tower Hamlets. "Royal London Hospital, London 1990.