The response to refugees arriving in the UK after the international emergency in Afghanistan requires health professionals to be equipped for the needs of this population. The integration of this community from a health and social care perspective is key in terms of ensuring equitable provision. The Equality and Diversity Act (2010) must frame this planning, from where services can monitor and embrace this community to ensure they are not being disproportionately impacted. [1] The UK has committed to accepting 20,000 refugees over five years in response to the political takeover by the Taliban in Afghanistan. Healthcare professionals will need to develop allyship and effective working practices including challenging discrimination, stereotypes, racism, and xenophobia.
There must be relevant training and resources within health and social care teams and departments to ensure that refugees’ needs are met and communication is safe. The Cultural Atlas (2021) provides one of the most comprehensive educational tools in understanding the culture and guiding healthcare practice on etiquette and communication. [2] The lack of available acceptable housing is going to be one of the largest issues facing Afghan refugees. There needs to be a close working relationship between community health services, homeless teams, and housing services. Such relationships are key as there is a duty of care to anyone in the local area to be housed even if that is in temporary accommodation. Health professionals may be the first responder in ensuring that local signposting to organisations and advocacy agencies are appropriately done.
Another issue that will need to be addressed in a timely fashion is the lack of money and finances. Contrary to myths surrounding refugees and asylum seekers who enter the country, they will not have money to live the lifestyle alleged by many. An asylum decision takes at least 28 days and at this point, there may be more destabilisation incurred for the families as temporary accommodation could cease. The usual expectations are to secure work or study but often children of this group barely get food, clothes, or toys, and families rely heavily on charitable donations.
Telephone language services have been a long-term resource available in the UK. The language needs of the Afghan community are likely to be Pashto and Dari. In areas of high dispersal, the use of key workers from the same background would be useful in ensuring others in teams learn about the cultural and religious disposition of this community.
There may be a need to refer or to seek advice from safeguarding teams, where a child is in need or at risk. We cannot assume that the refugee status mitigates such referrals, and any impact on children is a usual way of life. Where there are needs not being met in the form of finances or a child is not able to get to school, for example, social services have a duty of care to ensure both risk and “needs” are assessed under the Children’s Act.
Trauma interventions in terms of what is an effect of resettlement, or witnessing events in Afghanistan recently or in the past, will require robust resources. Combat stress, a veteran support line, reported an exceedingly high number of calls from veterans who served in Afghanistan and required mental health support, including suicidal ideation due to post traumatic stress disorder. [3] Prioritising support within the NHS workforce, which has already been impacted by covid-19 will be quite a challenge. Additionally, services need to be aware that culturally many Afghan refugees will feel more at ease talking in a group setting, as opposed to individual support sessions. Grief is often seen as a community experience rather than an individual one. The need to develop community kinships and innovative methods to engage with these groups would be advisable.
Suffering, grief, and ambiguous loss will feature in many presentations, which will not be restricted to trauma. Separation from loved ones and death related losses will be part of the psychological needs of the refugees. Therefore, there may be a need to increase the service provision in primary care psychological services for trauma and complex grief, at local and national levels.
Health services and the health and social care workforce will need to be skilled and culturally ready to welcome Afghan refugees to the UK. The double burden of covid-19 and poor healthcare has impacted the already burdened healthcare system in Afghanistan. [4] After ensuring the population is registered with a local GP, another complicating factor in the present circumstances is the impact of covid-19. Health professionals will have to quickly establish the refugees’ covid status, where they are in the vaccination programme, and introduce the refugees to covid-19 adjustments that the UK population has become used to. A big factor impacting the refugees will be their housing. If, as seems highly likely, they will be housed in overcrowded accommodation then this is the perfect breeding ground for covid-19 to spread. As stated, many will arrive in the UK in physically poor health, that in combination with substandard accommodation, and the threat of covid may prove fatal. Health professionals must be outspoken in trying to stop this scenario from unfolding.
The health and social care interface have the resources to support and ensure that a good value base is demonstrated through their practice. The disproportionate impact of covid-19 has already affected ethnic minorities across the globe. There is a small window of opportunity for services now to predict and assess their cultural responsiveness rather than rely solely on less appraised community-based initiatives.
Harjinder Kaur-Aujla, lecturer in mental health nursing, University of Birmingham.
Christopher Wagstaff, senior lecturer school of nursing, University of Birmingham.
Competing interests: none declared.
References:
1.Equality Act (2010). [online] Available at: http://www.legislation.gov.uk/ukpga/2010/15/contents
2. Cultural Atlas (2021) Cultural Atlas. Available at: https://culturalatlas.sbs.com.au/afghan-culture/afghan-culture-core-concepts#afghan- culture-core-concepts
3. Jakupcak, M., Cook, J., Imel, Z., Fontana, A., Rosenheck, R. and McFall, M. (2009), Posttraumatic stress disorder as a risk factor for suicidal ideation in Iraq and Afghanistan War veterans. J. Traum. Stress, 22: 303-306.
4. Lucero-Prisno, D.E., Essar, M.Y., Ahmadi, A. et al. (2020) Conflict and COVID-19: a double burden for Afghanistan’s healthcare system. Confl Health 14, 65. https://doi.org/10.1186/s13031- 020-00312-x