DOTW contribute to ground-breaking report on sexual and gender-based violence

A ground-breaking report from University of Birmingham has found that there are too many barriers stopping refugee and migrant survivors of sexual and gender-based violence in the UK getting essential health support they need.

The report, Forced migration and sexual and gender-based violence, led by the University of Birmingham’s Professor Jenny Phillimore, shows that victims of sexual and gender-based violence (SGBV) who have been forcibly displaced from their home country are let down by UK health and immigration services. Survivors have high levels of vulnerability and physical and mental health needs and the majority are not accessing health support.

Service users who came to Doctors of the World clinic for health care after surviving violence were amongst those who told their stories to researchers. Leading migrant health experts from Doctors of the World also advised on how the current health system does not meet the needs of survivors of violence, stopping them from disclosing their experience and accessing the essential support they need.

People gave their stories of violence before fleeing their country and on the journey to the UK. These included restriction of movement, physical and verbal abuse, humiliation, torture, starvation, human organ trafficking and slavery, sexual violence, labour exploitation, blackmailing, being thrown into the sea (or threat of), deprivation of possessions including medicines and official papers, or being abandoned. However, once in the UK, many SGBV survivors continued to experience violence and/or were placed at risk of suffering when they couldn’t access services, or the system mistreated them when they did access them.

The combined effects of years of violence and experience of UK systems generated high levels of trauma resulting in physical and psychological harms.

‘I am so tired, psychologically, and physically. I see nightmares every night. I get panic attacks I can’t stop shivering every time I think I might be deported to be killed back home’, said Jordan, a female asylum seeker.

A traumatic asylum process with long decision making and indecisive and inhumane interviews retraumatised victims and stopped them disclosing. Unstable and risky housing caused stress and trauma whilst people waited for an asylum decision. Some forced migrant women were dependent on violent partners for their immigration status and believed they had to endure abuse if they were not to be deported. Respondents talked about injuries and sexually transmitted diseases sustained during their journeys wherein they were unable to access post-rape prophylaxis with some respondents giving birth to children of rape.

Despite this high level of health need and vulnerability the majority of survivors received no physical or mental health support. Many were too fearful to seek medical help or report violent incidents to the police in fear of being deported or being charged for their medical care. Others suggested that health professionals lacked knowledge of lived experiences of forced migrant survivors and the barriers they faced accessing services such as frequent changes of address, language barriers and having No Recourse to Public Funds (NRPF). Lack of training and time to help survivors disclose SGBV experiences meant that both physical and psychological conditions went untreated.

Amardeep Kamboz, Head of UK Services at DOTW, said “At our clinic we see people who have fled to the UK for safety with many different and harrowing experiences of sexual violence, and who haven’t seen a doctor. They’re often worried they’ll be deported or charged for their care. Our doctors do their best to provide care, but they really need access to the NHS and specialist support systems to receive the ongoing care they deserve. We try to get them GP registration and are sometimes turned away because they don’t have proof of ID or address.”

“The whole process made me feel hopeless, made we wish I was dead, made me feel exhausted of everything. I thought coming to the UK would be a fresh start for me, from the trauma I experienced back home – but that was not the case. My life in the UK is a life of pain. I feel hopeless, destroyed and drained.”Erina, a survivor of SGBV who was interviewed by the SEREDA project.

Recommendations included:

Health Policy and Guidance

• Ensure all asylum seekers, including those in initial accommodation and hotels, receive timely information and support to access healthcare and are registered with a GP as soon as possible
• Strengthen healthcare provision for forced migrant SGBV victims and support practitioners to develop capacities to recognise and respond to SGBV
• Home Office, Department of Health and Social Care and Office for Health Improvement and Disparities to ensure firewall between health data and the Home Office and continue improving transparency of communications to refugee and asylum seeker populations about the limited circumstances in which personal data can be shared between Home Office and the NHS
• Department of Health and Social Care to review communication about the exemption from NHS charging for victims of violence as it is not widely known about or used
• Office for Health Improvement and Disparities (OHID), NHS England and NHS Improvement to produce guidance for healthcare professionals about how to support victims and good practice to integrate trauma-informed practice into training and education at different levels
• Ensure GP registration policies do not exclude asylum seekers and that GP frontline and clinical staff understand asylum seekers’ entitlement to primary and secondary care and the possibility they may lack proof of address or ID or immigration documents
• Royal Colleges to provide support and guidance on SGBV and migrant health to enable their members to work effectively with SGBV victims
• Department of Health and Social Care, OHID, NICE and Royal Colleges and Faculties to develop guidelines for good practice to integrate trauma-informed practice into training and education at different levels, building on the online Migrant Health Guide
• Increase NHS capacity to offer specialist mental health support to forced migrant victims.

Frontline healthcare provision

• Implement training for health professionals and support personnel to enable them to identify and support SGBV victims and to raise awareness of referral pathways
• Ensure clinical training covers the specific vulnerabilities and needs of forced migrants and especially SGBV victims
• Inform all patients about their right to request female clinicians, and to request an interpreter.

More information on SEREDA project is available online While the full report can be downloaded here along with the UK Executive Summary.