Leicester Joint Strategic Needs Assessment (JSNA). Health and social care needs of new arrivals, asylum seekers and refugees, 2016.
A migrant is someone who makes a conscious voluntary choice to leave their country of origin. Should they choose, they can safely return. Economic migrants leave their home country to seek work.
An asylum seeker is a person aged 18 and over who has fled persecution and has made an asylum claim under the 1951 UN Convention on Refugees, or against a breach of the European Convention on Human Rights. A refugee is someone whose claim to be at risk of persecution has been accepted. A failed asylum seeker has exhausted the available legal avenues, and has not met the legal criteria to become a refugee.
Who’s at risk and why?
Migrant health problems are complex. As with the general population, migrants experience different physical health conditions and some migrant communities may struggle more with access to services than others.
The most common physical health problems affecting asylum seekers include: communicable diseases, sexual health related needs, chronic diseases, dental disorders, the consequences of injury and torture, psychosomatic disorders, women’s health issues and disability issues. To add to this, there is acknowledgement that irregular or undocumented migrants have significant health needs and these are largely hidden from health services.
Compared to the general population, the incidence of mental illness is higher among asylum seekers and refugees. The following issues can have a detrimental impact on the mental health of asylum seekers and refugees:
- The process for claiming asylum, which can cause stress and insecurity
- lack of English language skills
- work and benefits
- failed asylum seeker status
- healthcare restrictions
- having children or being a child or young person.
The level of need in the population
Public Health England shows Leicester has the largest, long term, non-UK born population (18% resident for more than 10 years) in the East Midlands. The city is becoming more diverse, thanks in part, to more inward migration. The main reasons for migration are family (41%), employment (26%), education (14%) and refugees (5%).
There are at least three different groups of recent, new arrivals. The first comprised people of Somali background arrived from the Netherlands, Sweden and Denmark in the 2000s. The second group were economic migrants, originating mainly from Eastern Europe. Finally, there are asylum seekers and refugees who first began to arrive in the 1990s. This group has comprised people from the Balkans, Iraq, Iran, Afghanistan, Turkish Kurds and sub-Saharan Africa, such as Zimbabwe.
Although a high proportion of migrants become long term Leicester residents, there is a relatively high rate of short term migration and turnover among new arrivals.
With regard to asylum seekers and refugees, Leicester is a National Asylum Seeker Service (NASS) designated dispersal city. Leicester is host to about 1,000 of the 2,500 asylum seekers resident in the East Midlands. These are mainly from the Middle East or Asia.
Once asylum seekers are accepted as refugees, they are free to settle anywhere. A large recent refugee group in Leicester is people from Zimbabwe, estimated to number 2,000-3,000 people.
Leicester is known to be home to many failed asylum seekers and illegal immigrants. The details of these people are unknown, but could also include people who have been trafficked. Many people in this group survive by sofa surfing and by assistance from local charitable organisations. There could be as many as 3,000 ‘hidden people’ living in the city.
Nearly 50% of Leicester births in 2013 were by non-UK born mothers, which is the highest proportion in the East Midlands.
Current services in relation to need
Timely access to appropriate health and social care for migrants depends on circumstances and need. Working economic migrants may find access to services to Leicester to be straight forward. However, meeting the health and social care needs of asylum seekers and refugees requires the input of different services and expertise.
There are a number of services working to support and address the needs of asylum seekers. They include publicly funded and voluntarily funded services:
- Leicestershire Citizens Advice
- Highfields Centre
- Community Logg Sewa
- The British Red Cross
- G4S Care and Justice Services
- Leicester City of Sanctuary
- services working with the Diocese of Leicester, such as the Leicester Faiths Support Group
- the Welcome Project
- the Open Hands Trust
- Leicester City ASSIST Practice
- the After 18, (a Freedom Club run by the Centre Project)
- the Pass it On Scheme.
Further details can be found in the full section, which is downloadable below.
Projected services use and outcomes in 3-5 years and 5-10 years
There is considerable volatility in the number of people claiming asylum in the UK. Numbers of individual asylum seekers in Leicester at any one time have ranged from 450 in 2011 to over 1,000 in 2007. In 2013, numbers began to increase once again, such that in January 2016 there were 1,023 asylum seekers locally.
Asylum seekers dispersal numbers do not include unaccompanied asylum seeker children, asylum seekers with negative decisions, those who are not supported, and those whose appeal rights are exhausted.
The expectation is that whilst current non-dispersal areas will be expected to accommodate some asylum seekers, current dispersal areas will have a threshold which is beyond present numbers.
The best estimate at the moment is that the number of asylum seekers will increase until they meet the Home Office formula of one asylum seeker for every 200 people, or about 1,650 people about 600 more people than presently accommodated in Leicester, an increase of 57%.
Unmet needs and service gaps
The health needs of new arrivals in Leicester are varied. Economic migrants are generally younger and have fewer health needs. They may have infrequent contact with healthcare services, but may be users of emergency health care and/or may be vulnerable to issues such as unemployment, which in the past has been linked to an increase in homeless migrants in Leicester.
There has been volatility in the number of people seeking asylum who are based in Leicester. However, these are gradually increasing, such that in 2016 there are consistently more than 1,000 asylum seekers in the city. Meeting the needs of asylum seekers requires a co-ordinated approach.
Recommendations for consideration by commissioners
Recommendations for commissioners include establishing effective multiagency partnership working through which a local strategy will be developed and a health needs assessment focusing on asylum seekers will be carried out; along with promotion of an understanding of the diverse and complex needs of asylum seekers, particularly amongst health professionals and commissioners of services.
- Joint Specific Needs Assessment on Mental Health
- Joint Specific Needs Assessment on Asylum Seekers
- Health of migrants to the East Midlands, September 2016
- Still Human Still Here