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Migrant Barriers to Healthcare

Key points

  • Migrants’ access to healthcare is restricted by the ‘hostile environment’ policy

  • Migrants with health complications abstain from receiving care due to fear of charges and data sharing with the home office

  • The policy has been widely recognised as damaging by the medical community

According to IOM estimates, the number of international migrants in 2018 sat at 244 million. That’s 244 million people whose health is jeopardised not just by the hazardous conditions posed by many migration journeys but by the reluctance of nations to provide health care irrespective of an individual’s migration status. 

The NHS is largely considered to be among the most inclusive and effective health care providers across the world yet migrants residing in the UK are confronted by multiple barriers that restrict their access to healthcare. This is due to the implementation of policy measures, appropriately known as the ‘hostile environment policy’, that impede migrants’ abilities to receive treatment and consultation whilst simultaneously increasing the stress and discrimination faced by migrants. 

Example policies creating the hostile environment: 

  • Upfront charging within NHS trusts when migrant patients are unable to show eligibility for free NHS care

  • Increasing the surcharge to £400 that individuals are required to pay to access NHS services  (the charge is incurred when applying for remain status) 

  • Sharing of patient data with the home office

There is a lack of transparent rules to explain the entitlement rights of migrants to accessing NHS services. Under certain circumstances the charging and eligibility rules are non-applicable. This aims to provide protection for vulnerable groups like survivors of domestic abuse and pregnant women for whom maternity services are free of charge. However, even those who are able to access services may withhold from doing so due the lack of clear information communicated to them. Furthermore, fear is maintained within migrants wishing to seek health services by the aggressive threats of charging and scrutinization from the home office.  

At their worst, hostile environment policies result in vulnerable people being unable to foot extortionate bills for life-saving care, care they will ultimately die without. Elfreda Spencer was denied treatment for her multiple myeloma after being unable to pay an upfront bill of £30,000, and died in January 2018 from complications of cancer. In early 2019, Nasar Ullah Khan died after being refused a heart transplant due to his immigration status. He had received a £32,000 bill for end of life care, that he was unable to pay. 

Essentially, migrants are at risk because immigration status has greater power than health needs. The physical and social condition of individuals is likely to deteriorate facing such adverse conditions, and for a population who is disproportionately affected by mental health, this may have tragic additional consequences to health outcomes. 

The damage of these policies to migrants health has been expressed by the medical community and advocacy to fulfil the UK’s commitment to ensuring heath is possible for all is spreading. Organisations like MEDACT and DocsnotCops are providing platforms to campaign for these damaging policies to be alleviated with the “Patients Not Passports” movement calling for the removal of upfront charging and ID checks within the NHS. 

Currently research is progressing towards de-stigmatising migrant status and providing quality evidence that dissolves the common myths that migrants drain health resources as done by the UCL-Lancet commission on migration and healthcare. This article specifically highlights how international states should revise migration policies with greater consideration towards health and that populations should have equitable access to health services irrespective of their legal and/or migration status.

Further reading

About the authors

Abi is a first-year Human Sciences student at University College London seeking to explore the challenges that inhibit equitable access to healthcare. Abi hopes that engaging with Polygeia will expand her perspective, enabling her to critically evaluate public health policy. 

Christen is a medical student at UCL with a degree in Global Health, interested in examining how the violence of borders, and their infiltration into every aspect of social life, impacts the wellbeing of vulnerable groups.


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