Nada Khan is an Exeter-based NIHR Academic Clinical Fellow in general practice and GPST4/registrar, and an Associate Editor at the BJGP. She is on Twitter: @nadafkhan
The war in Ukraine has sparked the fastest growing refugee crisis since the second World War.1 Although the total numbers of refugees currently in the UK are low, this is expected to increase as the conflict continues and more Ukrainians arrive under the Home for Ukraine sponsorship programme. And as numbers increase, GPs might expect to start seeing Ukrainian refugees in their own surgeries.2 What does this mean for us in practice?
Ukrainian refugees will be able to access NHS services free of charge, and NHS England has recently issued guidance to GPs…
Ukrainian refugees will be able to access NHS services free of charge, and NHS England has recently issued guidance to GPs on providing healthcare to Ukrainian refugees.3 The guidance mainly focuses on screening and referrals for infectious disease, mental health conditions and reproductive health. Ukraine has the fourth highest incidence rate of TB in Europe, and one of the lowest rates of Covid immunisation in Europe with only 35% fully vaccinated up to February 2022.4,5 Accordingly, NHS guidance suggests screening every Ukrainian refugee for TB, and checking immunisation status for childhood disease and Covid vaccination status.
Aside from these initial, practical checks, however, this population of refugees have experienced real and recent trauma that needs careful early and long-term management. The terrifying images from this brutal war are a lived experience for those fleeing conflict, mental health must be a priority for refugees. However, while experts insist that any response needs to be trauma informed, the NHS is struggling with a lack of specialist support in an already strained mental health service.6 I worry about the long term health of this population, and our lack of preparedness and capacity to provide appropriate care over time to deal with these traumatic events. I have struggled for years to access such services for patients under my care, some of whom were asylum seekers with harrowing personal histories. I am not sure yet how to rapidly provide additional access to trauma-based psychological therapy for Ukrainian refugees. I would welcome any informed advice from readers in the comments to this article.
Alongside mental health considerations, it is worth thinking beyond just the initial checks for infectious disease. If continuity of care is like a thread linking patients, their health and their healthcare providers, this thread has been severed most unjustly for refugees. It is imperative to try and do what we do best as GPs to identify and manage long-term conditions such as diabetes, depression and hypertension. This is no easy fix, and will take time, care and repeated consultations to pick up on these lost threads of continuity.
It is no bad thing to be reminded that while recent policy focuses on Ukraine, in practice these principles apply to all refugees and asylum seekers.
It is no bad thing to be reminded that while recent policy focuses on Ukraine, in practice these principles apply to all refugees and asylum seekers. The UN Refugee Agency estimates that there were 135,912 refugees in the UK as of mid-2021, the majority of which were from Iran, Eritrea, Albania, Iraq and Syria,7 though I would expect increasing numbers from Afghanistan given the recent regime change and UK resettlement schemes. Last year, Clark and Farrington summarised guidance on care for Afghan refugees for BJGP Life, and their piece is worth a re-read for anyone looking after this population.8 So while our focus today might be on Ukraine, at least for me, this is a time to reflect on the specific health needs of asylum seekers and refugees coming to the UK. And probably, to consider the severe long-term mental health risks associated with the trauma of being pulled away from a home, a community, a country, a life.
- Siegfried K. The Refugee Brief – 11 March 2022 2022 [Available from: https://www.unhcr.org/refugeebrief/the-refugee-brief-11-march-2022.
- Department for Levelling Up HaC. ‘Homes for Ukraine’ scheme launches 2022 [Available from: https://www.gov.uk/government/news/homes-for-ukraine-scheme-launches.
- Disparities OfHIa. Ukraine: migrant health guide 2022 [Available from: (https://www.gov.uk/guidance/ukraine-migrant-health-guide.
- Data OWi. Coronovirus (COVID-19) Vaccinations 2022 [Available from: ttps://ourworldindata.org/covid-vaccinations?country=OWID_WRL.
- Holt E. Growing concern over Ukrainian refugee crisis. The Lancet. 2022;399(10331):1213-4.
- Davis N. Prioritise mental health support for Ukrainians arriving in UK, experts say. The Guardian. 2022.
- Agency TUR. Asylum in the UK 2021 [Available from: https://www.unhcr.org/uk/asylum-in-the-uk.html#:~:text=How%20many%20refugees%20are%20there,are%20hosted%20by%20developing%20countries.
- Clark EF, R. Migrants in vulnerable circumstances: not a quick fix: BJGP Life; 2021 [Available from: https://bjgplife.com/migrants-in-vulnerable-circumstances-not-a-quick-fix/.