News Release

Asylum seekers must have access to health-care services, argues doctor

Personal View: Asylum seekers and undocumented migrants must retain access to primary care

Reports and Proceedings

BMJ

Asylum seekers and undocumented migrants must retain access to primary care, argues a doctor in this week's BMJ.

Dr Paquita de Zulueta calls on colleagues to "overcome bureaucratic barriers and register patients irrespective of their residential status."

She describes some of the vulnerable people she sees as a GP and clinical volunteer for a health advocacy programme in London. "They are like Dante's lost souls," she says, "wafting in limbo, neither in heaven nor hell, but in a cold and lifeless purgatory, a place the world refuses to acknowledge."

"Many of them have not sought medical help for several years despite serious medical problems, some brought on by the lives they lead or the trauma they have experienced," she adds.

She recalls some harrowing stories - a woman brought to the UK and forced into sexual slavery; a teenager with severe post-traumatic stress disorder at risk of harming himself or others; women giving birth at home without any clinical supervision.

"These people are all in clinical need yet have been unable to access primary healthcare in the United Kingdom," she writes. "Despite pleas to my colleagues to take them on … they still turn them away."

Do healthcare professionals expect women to deliver their babies in the street, she asks? What happens to people who have severe mental health disorders and chronic untreated diseases? And what of the risks to public health?

The BMA reminds doctors that there is no requirement to determine someone's immigration status to access primary care services, and the General Medical Council's guidance requires that doctors do not discriminate unfairly but provide care and treatment to meet the clinical needs of all patients. Yet Dr Zulueta takes note of "the small acts of unkindness and indifference meted out by my peers."

She acknowledges the bureaucratic barriers to providing care, but argues that "these impositions carry no valid legal or ethical authority."

And she warns that government plans to expand its existing restrictions to free secondary care and include primary care "does not augur well for the vulnerable and dispossessed in need of humane clinical care - particularly as compassion seems to be a dwindling resource in modern medicine."

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