Slipping through the cracks

07 February 2020

Luna Williams of the Immigration Advice Service outlines the many challenges asylum-seeking children and families with disabilities face as they go through a ‘flawed’ system.

Fleeing your home country to seek refuge in another is traumatising in itself. Why a person is fleeing, how long and far they have journeyed, and how long their claim takes to process can all add to that pain.

For child asylum seekers, this trauma is even more debilitating and can cause a range of emotional and psychological issues during their formative, teen and adult years.

What’s more, those with physical disabilities and/or mental health problems are especially susceptible to experiencing ongoing trauma, as they very often do not receive the care they need while going through the UK’s asylum process. As a result, their disabilities are exacerbated, which brings with it a further stream of problems for children and families.

A lack of care

It is not surprising that there is a high prevalence of trauma-related mental disorders among asylum seekers, with many experiencing signs of PTSD. This is especially common in children and young people, who are more susceptible to developing disordered modes of thinking as a coping mechanism for trauma (Kaminer et al, 2005).

However, non-physical problems are often overlooked during assessments of both unaccompanied and accompanied child asylum seekers (Jakobsen et al, 2017). Most people who seek asylum are required to wait for several months before they can receive any kind of professional mental assessment because it is not considered an urgent problem (Hvidtfeldt et al, 2019).

There is also evidence to suggest that refugee families and children are already more vulnerable to mental illness. The loss of freedom and the uncertainty they face in detention centres and family care units while they wait for their claim to be processed only increases the severity of this mental strain. Often, children will become re-traumatised when they are placed in care units; a fact that is especially true for those who have experienced being held in confined spaces in their home countries and during their journeys to the UK.  

Those with physical disabilities have higher prospects of treatment, though these are still often inadequate. When a physically disabled child claims asylum they will usually receive an urgent assessment from the local authority. This is where it will be decided what type of care they receive, and they will be referred to the appropriate route. If their condition is life-threatening, they will be taken to a hospital, while specific accommodation and day-to-day care may be arranged for non-life-threatening physical disabilities. However, due to the legacy of the government’s hostile environment policy, this referral system does not always work, and many children, young people and adults are left with untreated and unsupported physical ailments and disabilities while they await the outcome of their claim.

The hostile environment

The UK Government’s domestic economic policies and its stance towards asylum seekers have created a perfect storm in making access to care unnecessarily difficult. In 2012, then home secretary Theresa May announced the government’s ‘hostile environment’ policy, which was designed to make it as hard as possible for illegal immigrants to stay in the UK. The policy resulted in various cases of racial profiling, scandals and miscarriages of justice (for example: Briggs, 2019; BBC News, 2018; Malik, 2018).

Added to this were hundreds of data-sharing breaches and scandals, as the police, employers and NHS were encouraged to refuse their services to and report anyone who might have insecure status (Townsend, 2018). This has resulted in deep distrust in asylum-seeking, refugee and migrant communities, with many families opting not to seek the vital care and support they urgently need from health services as a result.

A doubtful status

A recent report by the Equality and Human Rights Commission (EHRC, 2018) has also outlined how asylum seekers have gone without care since ministers forced the NHS in England to impose upfront charges to access help. The most vulnerable, including pregnant women and asylum seekers with disabilities, have been unable to access treatment as their allowance will not cover the cost, leaving many to rely on charities for help, or going without care altogether (Bridge, 2019).

According to the Care Act (2014), people seeking asylum who need care are entitled to receive it from the NHS. However, the combination of hostile policies and hiked health costs has made receiving this difficult and, in some cases, impossible for some families with children who have severe disabilities and specialist care needs.

CPs should be aware there will be barriers, and often a level of distrust in authority, as a result of hostile immigration policies

What’s more, the Care Act itself also presents several difficulties for people who fall outside the ‘asylum claimant’ or ‘refugee’ categories. According to the Act, stateless people, undocumented people, over-stayers and failed asylum seekers are ineligible for any form of care in the UK. This includes undocumented children – of which it was revealed last week there are more than 100,000 living in London (University of Wolverhampton, 2020).  

Many of these children have no choice as to whether they do or don’t have a secure immigration status and know no other way of life, with more than half being born in the UK and speaking English as their first language (University of Wolverhampton, 2020). Those who experience any physical or mental disabilities of any kind are at a very real risk of falling through the cracks and being unable to receive vital and urgent care for their entire lifetimes.

How to help

All community practitioners (CPs) working with child asylum seekers with special care needs and disabilities should be aware that they may struggle to discuss, express or accept their experiences properly. They may also experience trust issues and fear of being touched.

CPs should encourage asylum-seeking parents and their families to register with a local GP. They should explain the importance of this in simple, clear language and ensure that the asylum seeker is aware of the benefits of registering. When assessing the care needs of asylum-seeking children and families, CPs should be aware that there will be barriers, and often a level of distrust in authority, as a result of hostile immigration policies.  

As it stands, the IAS believes that the UK’s immigration process is not fit for purpose. It treats adults, families, and children with hostility and allows the most vulnerable and marginalised in our society to fall to the wayside. The IAS says that hostile immigration policies must be officially expunged and that the referral process laid out by the Care Act should be immediately reviewed.    

Luna Williams is the political correspondent for the Immigration Advice Service, an organisation of immigration lawyers that offers free advice and assistance to asylum seekers and trafficking victims. 


Time to reflect

How might you adjust your practice to help asylum-seeking children and families with disabilities, given the many challenges they face? Join in the conversation on Twitter @CommPrac


BBC News. (2018) Windrush generation: who are they and why are they facing problems? See: bbc.co.uk/news/uk-43782241 (accessed 15 January 2020).

Bridge O. (2019) Newborn babies and pregnant mothers face the wrath of ‘hostile environment’ policies. See: immigrationnews.co.uk/newborn-babies-and-pregnant-mothers-face-the-wrath-of-hostile-environment-policies (accessed 15 January 2020).

Briggs B. (2019) Home Office accused of racial profiling after 200 targeted in Glasgow. See: theferret.scot/home-office-racial-profiling-glasgow (accessed 15 January 2020).

Care Act. (2014) Care act 2014. See: legislation.gov.uk/ukpga/2014/23/contents/enacted (accessed 15 January 2020).

Equality and Human Rights Commission. (2018) The lived experiences of access to healthcare for people seeking and refused asylum. See: equalityhumanrights.com/en/publication-download/lived-experiences-access-healthcare-people-seeking-and-refused-asylum (accessed 15 January 2020).

Hvidtfeldt C, Petersen JH, Norredam M. (2019) Prolonged periods of waiting for an asylum decision and the risk of psychiatric diagnoses: a 22-year longitudinal cohort study from Denmark. See: academic.oup.com/ije/advance-article/doi/10.1093/ije/dyz091/5491481 (accessed 15 January 2020).

Kaminer D, Seedat S, Stein DJ. (2005) Post-traumatic stress disorder in children. World Psychiatry 4(2): 121-5. See: ncbi.nlm.nih.gov/pmc/articles/PMC1414752 (accessed 15 January 2020).

Jakobsen M, Meyer DeMott MA, Wentzel-Larsen T, Heir T. (2017) The impact of the asylum process on mental health: a longitudinal study of unaccompanied refugee minors in Norway. See: bmjopen.bmj.com/content/7/6/e015157 (accessed 15 January 2020).

Malik N. (2018) ‘I felt a nausea of fury’ – how I faced the cruelty of Britain's immigration system. See: theguardian.com/uk-news/2018/mar/05/immigrant-home-office-british-citizenship-hostile-environment (accessed 15 January 2020).

Townsend M. (2018) Police face first ‘super-complaint’ over immigration referrals. See: theguardian.com/uk-news/2018/dec/15/police-face-immigration-data-sharing-super-complaint (accessed 15 January 2020).

University of Wolverhampton. (2020) Mayor calls for urgent action to secure the future of undocumented young Londoners. See: wlv.ac.uk/news-and-events/latest-news/2020/january-2020/mayor-calls-for-urgent-action-to-secure-the-future-of-undocumented-young-londone.php (accessed 15 January 2020).


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