Migrant and refugee health

Migrants, refugees and asylum seekers encounter a number of challenges when accessing healthcare services. This article explores some of the key issues that migrants face with regards to healthcare in the UK, as well as the approaches that nurses and healthcare organisations can take to reduce these barriers. This article uses the term ‘migrant’ to include ‘immigrants’, ‘refugees’ and ‘asylum seekers’, however these terms are not interchangeable and have important distinctions, as outlined in the ‘Migrant status’ section below.

Introduction

Developing insights into the circumstances of and barriers faced by migrants when it comes to accessing healthcare is the first step towards improving care outcomes for this vulnerable group of people. Nurses can encounter migrants at various points in healthcare settings, and play an important role in supporting their diverse needs.

People across the globe seek to rebuild their lives in different countries for a number of reasons. Some leave their home country to get a job or an education, while others are forced to escape persecution or human rights violations, such as torture. Millions of people flee from armed conflict or other forms of crises or violence. Some no longer feel safe, they may have been targeted on the basis of their identity or beliefs, for example, their ethnicity, religion, sexuality or political opinions (Amnesty International, 2023). Migrants, refugees and asylum seekers are some of the most marginalised populations worldwide. Nurses interact with migrants, refugees and asylum seekers both in healthcare and community settings, so they should understand the challenges these groups face in order to provide appropriate care.

Migrant status

A migrant can be broadly defined as an individual who changes their country of usual residence, but this definition cannot be generalised, as people who have moved countries often have vastly differing experiences, circumstances and legal statuses. Sturge (2023) notes that there are three distinct ways to define a migrant, these being:

• someone whose country of birth is different to their country of residence
• someone whose nationality is different to their country of residence
• someone who changes their country of usual residence for a period of at least a year, so that the country of destination effectively becomes the country of usual residence

When using the terms ‘migrant’, ‘immigrant’, ‘refugee’ and ‘asylum seeker’, healthcare providers must understand the legal definitions and contextual meanings before applying them (Table 1).

Migrant health

All migrants are entitled to the protection, respect and fulfilment of all human rights, regardless of their status.

Being a migrant is a key health determinant. Refugees and migrants may experience xenophobia, discrimination, poor living, housing and working conditions, limited access to health services, as well as physical and mental health problems (World Health Organization, 2022). Refugees and migrants have the right to health, and the UK has a duty to provide refugee- and migrant-sensitive healthcare services. Refugees and asylum seekers who have an active application for asylum or appeal are fully entitled to free NHS care.

The four UK nations provide guidance and advice regarding services that explains how the NHS operates. Refugees, asylum seekers and refused asylum seekers can register for and receive primary care free of charge, in the same way as any other patient in the UK (British Medical Association, 2022). A migrant’s health may be affected by a variety of factors, ranging from experiences they had before, during and after migration to the UK; their work, education and socioeconomic status; and ethnicity. Nurses must bear this in mind while providing holistic and person-centred care, which will improve patient experiences and help migrants adjust to life in the UK.

The nurse's role

Hunt and O’Leary (2022) acknowledged that addressing the healthcare needs of migrant populations can sometimes be challenging. Nurses can have a positive impact by offering high quality care and understanding the barriers migrants may face when trying to access care services.

The nurse’s role varies depending on the healthcare setting, patient population, as well as specific job responsibilities and scope of practice. The Nursing and Midwifery Council (NMC) Code of Conduct (2018) emphasises that registered nurses must put the interests of people who use or need nursing services first, make their care and safety a key concern, ensure that their dignity is maintained and needs are recognised, assessed and responded to. The nurse has to treat those receiving care with respect, uphold their rights and challenge any discriminatory attitudes and behaviours.

In order to treat people as individuals and uphold their dignity, the NMC (2018) stipulate that nurses must:

• treat people with kindness, respect and compassion
• ensure that they effectively deliver the fundamentals of care
• avoid making assumptions, and recognise diversity and individual choice
• ensure that any treatment, assistance or care for which they are responsible is delivered without undue delay
• respect and uphold people’s human rights

The NMC Code (2018) covers the professional standards that all nurses, midwives and nursing associates must uphold. It is structured around four themes, each of which apply equally to migrants, refugees and asylum seekers who are accessing healthcare in the UK:

1. prioritise people
2. practise effectively
3. preserve safety
4. promote professionalism and trust

Commodore-Mensah et al (2021) suggested that promoting the health of migrants and refugees is a matter of social justice. Nurses have a key role in advocating for social justice and equity; this includes how resources are allocated, access to care and the provision of social services. Refugees and asylum seekers are likely to have significant underlying physical and mental health conditions, therefore providing appropriate and adequate healthcare is a priority.

Access to healthcare is a fundamental human right. The NHS provides healthcare to all residents, regardless of their immigration status. However, in practice, there are several barriers that could prevent migrants from accessing healthcare, including language and awareness of healthcare services. Some migrants may not be registered with a GP, which can make it difficult for them to access routine healthcare services. Otherwise, migrants may be hesitant to seek healthcare because they fear that their immigration status will result in refusal of care or discriminatory treatment.

Nurses have a number of opportunities to improve the healthcare experiences of migrants. It is important to provide targeted support to assist migrants when navigating the healthcare system. Further support could include providing information regarding registration with a GP, accessing emergency healthcare services and interpretation services. Community health workers, voluntary and third-sector organisations can also play an import role in helping migrants access healthcare services.

Health services should be equipped to address the needs of migrants by providing translation and interpretation services. Translating healthcare materials into different languages and providing language support for healthcare professionals can help to ensure that the workforce is trained to offer culturally-competent care and address health literacy.

Nurses are often the first point of contact for migrants who are accessing healthcare. Nurses may need to advocate for patients who are experiencing discrimination, having difficulty accessing healthcare services or who may be reluctant to seek care because of fears around immigration status.

When working with migrant populations, nurses will be required to collaborate with other professionals, including social workers, community health workers and interpreters, to offer comprehensive care that can address migrants’ specific needs. The role of the nurse is to provide patient-centred care, including addressing the unique challenges faced by migrants in healthcare. Nurses must be culturally sensitive and work in a cooperative manner to provide the highest possible quality of care.

It is essential that the broader social determinants that can impact the health of migrants are addressed, such as access to affordable housing, education and employment. Addressing these issues can help to improve the overall health and wellbeing of migrants.