If global health equity is to stand a chance, the UK must cancel its plans to offshore asylum seekers to Rwanda

 

The United Kingdom (UK) government’s recently announced plans to send asylum seekers to Rwanda for offshore processing and never allow them to return to the UK raise major health and human rights concerns. The UK defends the policy by saying it aims to break smuggling networks and stem migration flow across the channel; a claim unfounded in evidence. However, multiple commentators have said this likened to is likely to push people to take more dangerous and clandestine journeys, particularly in the absence of dignified, safe, and regular routes as well as erode their physical and mental health. Asylum-seeking is a fundamental human right, all asylum applications must be processed regardless of entry route and these plans violate the Geneva Convention.

The policy of deportation to Rwanda is part of a package of assaults on refugee rights in the Nationality and Borders Bill, which will also criminalise arrival in the UK, expand the use of detention centres, and enable border forces to push back boats crossing the Channel. A recent report by Doctors of the World and the University of Birmingham found that by detaining asylum seekers in initial and contingency accommodation, there is significant impact on their health and lack of access to healthcare. As migration health researchers, healthcare workers, migrants, and UK residents ourselves, we are alarmed and concerned about the impact of these policies on health and wellbeing. We argue that the UK government’s obligations to uphold health and human rights is a reason in itself to abandon this inhumane policy and the Nationality and Borders Bill. 

High-income countries host only a fraction of global refugees, and there is no ‘crisis’ in the number of refugees arriving in the UK. The UK has the capacity to manage asylum claims fairly and compassionately but deliberately fails to do so in existing policies. The hostile environment, inhumane accommodation and housing for asylum seekers, and the increased use of border force surveillance in services such as education and healthcare already violate the human rights of refugees and asylum seekers. Deportation to Rwanda will cause further significant harm by diverting people to take even more dangerous routes to seek safety in Europe. This policy targets those arriving through ‘illegal’ routes whilst failing to provide safe ones, but the same government has created specific schemes for people fleeing Ukraine. There is no illegal route to seek asylum, and this blatant racial distinction has significant implications on health.

Offshore processing policies have caused immense human suffering. The UK government models its offshore policy on that of Australia. Australia’s offshore process of asylum seekers caused them inhumane treatment, exacerbate health problems for refugees, and caused medical neglect resulting in alarming mental health distress, and an “epidemic of self-harm”. Post-traumatic stress disorder, depression, anxiety, self-harm, psychosis, and ultimately suicide, are prevalent among asylum seekers. There is a great need to improve the availability, accessibility, acceptability, and quality of mental health care for all in Rwanda and in the UK. This policy promotes the opposite- by re-traumatizing people through forced displacement.

Rwanda already hosts more than 127,000 refugees and their access to healthcare is impaired by multiple barriers. The Memorandum of Understanding (MoU) that outlines the policy between the UK and Rwanda only mentions health three times and does not provide any details on access, type, and quality of health services to be provided. Issues around sexual and gender-based violence are rife and well documented to target refugees residing in camp-like situations. Rwanda has strict abortion laws, and recently, the outbreak of COVID-19 has had a negative impact on sexual and reproductive health rights (SRHR) in refugee camps. Access to mental health and psychosocial support services remains scarce in Rwanda. LGBTQ+ or other minority groups may feel particularly threatened. Lesbian and bisexual women living in Rwanda reported feeling discrimination including in healthcare settings. Congolese refugees in Rwanda experienced exacerbated risks of suicidal ideation and attempt associated with living in camps. Along migration journeys, and amidst poor living conditions, there is an increased risk of communicable disease transmission, which could further impact on health, and it is not clear what provision is being made for vaccination, screening, and other preventative healthcare. Moreover, Rwanda’s current refugee housing struggles to maintain an adequate standard of hygiene in a limited context which relies on funding from civil society.

European countries are, directly and indirectly, responsible for the violence, climate disaster, and economic disruption driving many to seek refugee status. What the UK owes these people is reparations, not deportation. We call for both countries and the international community to immediately revoke this policy and offer dignified and safe options for asylum seekers that uphold human rights, including the right to seek asylum and the right to health. We urge for immediate measures to be put in place to protect the health and wellbeing of all those being targeted by processing asylum claims in-country and reviewing the health conditions and treatments in UK detention centres. We note with alarm a recent poll which shows 35% of the UK public support the Rwanda policy, and there is talk of other countries following suit. We urge the public, including health professionals, to advocate against the policy and the Nationality and Borders Bill. For global health equity to be a reality, we must tackle the deep-seated racist belief that the people of the global majority do not deserve full dignity, compassion, health, and rights.

 

About the authors:

Rosemary James is an academic junior doctor in England and independent global health consultant. She holds a degree in Medicine from the University of Ireland Galway, and an MSc Global Health from the University of Maastricht. She is the coordinator for the Lancet Migration European Regional Hub.

Rhiannon Osborne is a medical student at the University of Cambridge, researcher and campaigner for climate justice and global health equity. She sits on the executive committee of the UK Health Alliance on Climate Change and organises globally and nationally with the People’s Health Movement. Her research focuses on philosophies of health, access to medicines, and the impact of climate change on health.

Saleh Aljadeeah is a pharmacist. In 2014, He worked for the German Red Cross in Cologne in a refugee emergency department until September 2016. Starting from October 2016, He worked as a research assistant at the Institute of Healthcare Management and Health Sciences at the University of Bayreuth on the project: “Effects of the influx of asylum seekers on healthcare in Bavaria”. Currently, he is working on a research project about the access to and use of medicines among refugees in Germany.

Seyed-Moeen Hosseinalipour is a medical laboratory scientist with an MSc in global health, presently studying international affairs. He previously worked as a junior consultant at WHO and is now a research assistant at the Geneva Centre of Humanitarian Studies, focusing on refugee and migrant health. He is also a volunteer with the Lancet Migration European Regional Hub.

Aliki Traianou is a Global Health and Education Consultant, and a medical doctor. She holds an MSc in Primary Care form the University of Glasgow and DTM&H from Liverpool School of Hygiene and Tropical Medicine. Her research and advocacy interests include Refugee and Migration Health, Universal Health Coverage and health systems strengthening. She has worked with the UN, Orbis, FCDO and the NHS, and is currently working with the Lancet Migration as a research fellow, teaching Global Health at the University of Glasgow and completing her training in primary care.

Shivani Patel is an incoming junior doctor (University of Leeds), with a Master’s in Health and International Development from the London School of Economics and Political Sciences (LSE). Her areas of interest are refugee and migration and health, and the provision of healthcare in humanitarian crises and armed conflict.

Chrysanthi Tatsi is a sociologist who holds a Master’s in Public Health-Healthcare Management. Her work focused on the humanitarian crisis with extensive experience implementing community mental health and psychosocial support interventions in urban settings with SOS Children’s Villages Greece.

Eszter Szocs is a Refugee Trauma and Recovery certified mental health professional who holds a Master’s in Health Sciences, a MA in Humanities and Social Sciences and a Specialization in Epidemiology for Public Health. Her area of interest includes the health status and health outcomes of refugees and migrants in Global context, her PhD thesis work in Mental Health focuses on community resources within vulnerable populations.

Competing interests: None

Handling Editor: Neha Faruqui

 

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