Primary care & population health, University College London, London, UK; Migrant solidarity group, Medact, London, UK.
Migrant solidarity group, Medact, London, UK.
Lancet. 2023 Nov;402 Suppl 1:S38. doi: 10.1016/S0140-6736(23)02093-7.
Concerns about the housing of migrants and asylum seekers have escalated since the COVID-19 pandemic. From the use of quasi-detention facilities and so-called contingency accommodation to outbreaks of diphtheria in processing centres, there is a worrying trend to normalise potentially damaging conditions. The aim of this study was to assess the health risks posed by contingency housing for asylum seekers in the UK.
In this cross-sectional survey, a 10-point online questionnaire was sent to professional networks working with refugees and asylum seekers within the UK. Responses were collected between March 4, and April 11, 2022, using a mixture of convenience and snowballing sampling approach. The objectives of the survey were (1) to identify and document unmet needs, (2) to offer practical support, and (3) to map out services and organisation. The survey was designed by six medical professionals with experience of working with migrants and validated by three doctors who had experience running out-reach medical clinics for asylum seekers within contingency accommodation. Background details of geographical location and occupation were collected, and a combination of closed and open questions were used to collect information across five domains (medical, legal social, integration, and basic essentials) using a social determinants of health framework. A code book thematic analysis using a deductive/inductive hybrid approach was used to identify health and social needs as well as specific rights being denied.
There were 68 responses from around the UK, of which 30 (44%) were health-care professionals, and 38 (56%) were from the wider voluntary sector. 45 (67%) had visited an accommodation site, and 21 (33%) had worked with those living in contingency accommodation in other respects. Respondents reported observations regarding sites across most parts of the UK. Major themes of access to health-care, access to other services, barriers to access, and safeguarding were identified, with subthemes on access to primary care, maternity, and mental health services (eg, "Vast unmet need in mental health provision, several suicide attempts"); access to basic essential services (eg, "Food was not fit for purpose" "[c]hildren often did not receive breakfast"); education, and legal support; and frequent moving and communication.
Through several themes we highlight the substantial impact of structural isolation of asylum seekers through contingency housing, its major effects on wellbeing and the exacerbation of health inequities. We are using these results to work with asylum seekers and local non-governmental organisations to campaign for improved housing conditions. Study limitations include sampling bias, and a lack of voices of those with lived experience.
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自 COVID-19 大流行以来，人们对移民和寻求庇护者住房的担忧加剧。从使用准拘留设施和所谓的应急住宿，到处理中心爆发白喉，将潜在有害条件正常化的趋势令人担忧。本研究旨在评估英国为寻求庇护者提供应急住房所带来的健康风险。
在这项横断面调查中，向英国境内从事难民和寻求庇护者工作的专业网络发送了一份 10 分制的在线问卷。使用便利抽样和滚雪球抽样的混合方法，于 2022 年 3 月 4 日至 4 月 11 日期间收集了答复。调查的目的是：(1) 确定和记录未满足的需求；(2) 提供实际支持；(3) 规划服务和组织。该调查由六名具有移民工作经验的医疗专业人员设计，并由三位在应急住宿中为寻求庇护者开办外展医疗诊所的医生进行验证。收集了地理位置和职业的背景细节，并使用社会决定健康框架，通过封闭式和开放式问题在五个领域（医疗、法律社会、融入和基本必需品）收集信息，采用了基于演绎/归纳混合方法的编码书主题分析。
来自英国各地的 68 人作出答复，其中 30 人（44%）是医疗保健专业人员，38 人（56%）来自更广泛的志愿部门。45 人（67%）访问过住宿地点，21 人（33%）曾以其他方式与居住在应急住宿中的人合作。答复者报告了英国各地大部分地区的观察结果。确定了获得医疗保健、获得其他服务、获取障碍和保障的主要主题，并在初级保健、产妇和心理健康服务方面确定了子主题（例如，“精神健康服务存在巨大的未满足需求，有几次自杀企图”）；获得基本必需品服务（例如，“食物不适合食用”，“儿童经常不吃早餐”）；教育和法律支持；频繁搬迁和沟通。
通过几个主题，我们强调了通过应急住房对寻求庇护者进行结构性隔离的重大影响，以及对福利的重大影响和加剧健康不平等现象。我们正在利用这些结果与寻求庇护者和当地非政府组织合作，争取改善住房条件。研究的局限性包括抽样偏差和缺乏有实际经验的人的声音。
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