- Email: [email protected]
Failed asylum seekers and access to free health care in the UK
Correspondence
I declare that I have no conflict of interest.
Yujiro Kida Department of Anatomy II, Tsurumi University, School of Dental Medicine, Department of Nephrology, Tokyo Medical and Dental University, 2-1-3 Tsurumi, Tsurumi-Ku, Yokohama, 230-8501, Japan 1
2
3
4
Krentz AJ, Wheeler DC. New-onset diabetes after transplantation: a threat to graft and patient survival. Lancet 2005; 365: 640–42. Baid S, Cosimi AB, Farrell ML, et al. Posttransplant diabetes mellitus in liver transplant recipients. Transplantation 2001; 72: 1066–72. Kasiske BL, Snyder JJ, Gilbertson D, et al. Diabetes mellitus after transplantation in the United States. Am J Transplant 2003; 3: 178–85. Bloom RD, Rao V, Weng F, et al. Association of hepatitis C with posttransplant diabetes in renal transplant patients on tacrolimus. J Am Soc Nephrol 2002; 13: 1374–80.
Failed asylum seekers and access to free health care in the UK Sally Hargreaves and colleagues (Feb 26, p 732)1 discuss proposals to restrict health-care access for people whose asylum claims have failed. I lead a primary-care team caring for 600 refugees in northeast England, including at least 45 failed asylum seekers—ie, people who have been refused asylum by the Home Office and have exhausted all appeal rights. More than half the failed asylum seekers in my practice are African, and the remainder Middle Eastern. Most rely on friends and charity for food and shelter, and are prohibited www.thelancet.com Vol 365 May 21, 2005
from working. Some Iraqis have recently been given accommodation after acknowledgment that they could not safely be returned. Most of the others (from places such as Ethiopia, Sudan, Zimbabwe, and Iran) cannot safely, or will not, be deported. These people are not “bogus” asylum seekers. Most have described devastating experiences. Eight women and three men have disclosed rape, 14 men and two women other forms of torture, and 20 have described being imprisoned in their country. Of the remainder, one described the murder of his parents, one the murder of her father, and one the murder of her husband; one had his house burnt down by a governmentsupported mob, one was beaten by soldiers, and one fled after his father was imprisoned. Usually patients’ presentations are accepted at face value, and we recognise that traumatic experiences such as rape are under-reported. However, sceptics will argue an incentive to exaggerate an asylum case. I cannot vouch for the veracity of all these claims, although the anguish and grief accompanying painful disclosures gives me no reason to suspect that anyone has lied. Many people have psychological conditions that would require in-depth knowledge of the International Classification of Diseases2 to fake. 12 have been diagnosed with post-traumatic stress disorder, a further 12 with depression, and a further six have anxiety disorder. Why do claims fail if people have suffered such trauma? Refugee status is conferred only if someone can prove they would undergo persecution if returned to their country. Many cannot meet the standard of proof required, and are accused of fabrication. Rape and torture are described as “individual acts of indiscipline” instead of persecution. Sometimes shame prohibits disclosure of innermost secrets to culturally insensitive Home Office interviewers through interpreters that may be of the opposite sex.3 Notwithstanding the need for psychological support, some failed asylum
seekers have important physical problems. Two of my patients have HIV, two are pregnant, one has diabetes requiring insulin, and one has rheumatoid arthritis. None of these conditions would be treatable on the National Health Service (NHS) if proposals to exclude “overseas visitors” from NHS primary care are implemented.4 More research is needed into the needs of this politically and socially ostracised group.1 It is wrong for the government to target the most vulnerable on the basis that they are health tourists, when there is no evidence that people seek asylum for health gain. There is neither an economic nor a moral case for waiting until problems become urgent before allowing access to treatment. I declare that I have no conflict of interest.
Paul D Williams [email protected] Arrival, Massey Road, Teesdale, Stockton-on-Tees TS17 6EY, UK 1
2
3
4
Hargreaves S, Holmes A, Friedland JS. Charging failed asylum seekers for health care in the UK. Lancet 2005; 365: 732–33. World Health Organization. The ICD-10 Classification of mental and behavioural disorders and diagnostic guidelines. Geneva: WHO, 1994. Amnesty International. Get it right: how Home Office decision making fails refugees. London: Amnesty International, 2004. Department of Health. Proposals to exclude overseas visitors from eligibility to free NHS primary medical services : a consultation. http:// www.dh.gov.uk/assetRoot/04/08/22/67/0408 2267.pdf (accessed March 6, 2005).
Tobramycin dosing in cystic fibrosis
Rights were not granted to include this image in electronic media. Please refer to the printed journal. Empics
development of PTDM was significantly associated with HCV infection before transplantation in patients receiving liver transplantation.2 A similar finding was reported in patients receiving renal transplants.3 Among HCV-infected renal transplant recipients, PTDM occurred more often in those treated with tacrolimus than in those treated with ciclosporin (57·8% vs 7·7%; p0·0001).4 These findings show that treatment of HCV infection is very important for preventing PTDM and that the choice of immunosuppressive drug affects its development.
We read the Comment by Heather VandenBussche and Michael Klepser (Feb 12, p 547)1 on our paper2 and welcome the opportunity to address the issues raised. The secondary outcome measures in our study (C-reactive protein, time to next intravenous antibiotics, and clinical score) are of great importance to clinicians and their patients. Some data were omitted from our report because of limited space. Ceftazidime was given in a dose of 50 mg/kg three times daily, 1767
I declare that I have no conflict of interest.
Yujiro Kida Department of Anatomy II, Tsurumi University, School of Dental Medicine, Department of Nephrology, Tokyo Medical and Dental University, 2-1-3 Tsurumi, Tsurumi-Ku, Yokohama, 230-8501, Japan 1
2
3
4
Krentz AJ, Wheeler DC. New-onset diabetes after transplantation: a threat to graft and patient survival. Lancet 2005; 365: 640–42. Baid S, Cosimi AB, Farrell ML, et al. Posttransplant diabetes mellitus in liver transplant recipients. Transplantation 2001; 72: 1066–72. Kasiske BL, Snyder JJ, Gilbertson D, et al. Diabetes mellitus after transplantation in the United States. Am J Transplant 2003; 3: 178–85. Bloom RD, Rao V, Weng F, et al. Association of hepatitis C with posttransplant diabetes in renal transplant patients on tacrolimus. J Am Soc Nephrol 2002; 13: 1374–80.
Failed asylum seekers and access to free health care in the UK Sally Hargreaves and colleagues (Feb 26, p 732)1 discuss proposals to restrict health-care access for people whose asylum claims have failed. I lead a primary-care team caring for 600 refugees in northeast England, including at least 45 failed asylum seekers—ie, people who have been refused asylum by the Home Office and have exhausted all appeal rights. More than half the failed asylum seekers in my practice are African, and the remainder Middle Eastern. Most rely on friends and charity for food and shelter, and are prohibited www.thelancet.com Vol 365 May 21, 2005
from working. Some Iraqis have recently been given accommodation after acknowledgment that they could not safely be returned. Most of the others (from places such as Ethiopia, Sudan, Zimbabwe, and Iran) cannot safely, or will not, be deported. These people are not “bogus” asylum seekers. Most have described devastating experiences. Eight women and three men have disclosed rape, 14 men and two women other forms of torture, and 20 have described being imprisoned in their country. Of the remainder, one described the murder of his parents, one the murder of her father, and one the murder of her husband; one had his house burnt down by a governmentsupported mob, one was beaten by soldiers, and one fled after his father was imprisoned. Usually patients’ presentations are accepted at face value, and we recognise that traumatic experiences such as rape are under-reported. However, sceptics will argue an incentive to exaggerate an asylum case. I cannot vouch for the veracity of all these claims, although the anguish and grief accompanying painful disclosures gives me no reason to suspect that anyone has lied. Many people have psychological conditions that would require in-depth knowledge of the International Classification of Diseases2 to fake. 12 have been diagnosed with post-traumatic stress disorder, a further 12 with depression, and a further six have anxiety disorder. Why do claims fail if people have suffered such trauma? Refugee status is conferred only if someone can prove they would undergo persecution if returned to their country. Many cannot meet the standard of proof required, and are accused of fabrication. Rape and torture are described as “individual acts of indiscipline” instead of persecution. Sometimes shame prohibits disclosure of innermost secrets to culturally insensitive Home Office interviewers through interpreters that may be of the opposite sex.3 Notwithstanding the need for psychological support, some failed asylum
seekers have important physical problems. Two of my patients have HIV, two are pregnant, one has diabetes requiring insulin, and one has rheumatoid arthritis. None of these conditions would be treatable on the National Health Service (NHS) if proposals to exclude “overseas visitors” from NHS primary care are implemented.4 More research is needed into the needs of this politically and socially ostracised group.1 It is wrong for the government to target the most vulnerable on the basis that they are health tourists, when there is no evidence that people seek asylum for health gain. There is neither an economic nor a moral case for waiting until problems become urgent before allowing access to treatment. I declare that I have no conflict of interest.
Paul D Williams [email protected] Arrival, Massey Road, Teesdale, Stockton-on-Tees TS17 6EY, UK 1
2
3
4
Hargreaves S, Holmes A, Friedland JS. Charging failed asylum seekers for health care in the UK. Lancet 2005; 365: 732–33. World Health Organization. The ICD-10 Classification of mental and behavioural disorders and diagnostic guidelines. Geneva: WHO, 1994. Amnesty International. Get it right: how Home Office decision making fails refugees. London: Amnesty International, 2004. Department of Health. Proposals to exclude overseas visitors from eligibility to free NHS primary medical services : a consultation. http:// www.dh.gov.uk/assetRoot/04/08/22/67/0408 2267.pdf (accessed March 6, 2005).
Tobramycin dosing in cystic fibrosis
Rights were not granted to include this image in electronic media. Please refer to the printed journal. Empics
development of PTDM was significantly associated with HCV infection before transplantation in patients receiving liver transplantation.2 A similar finding was reported in patients receiving renal transplants.3 Among HCV-infected renal transplant recipients, PTDM occurred more often in those treated with tacrolimus than in those treated with ciclosporin (57·8% vs 7·7%; p0·0001).4 These findings show that treatment of HCV infection is very important for preventing PTDM and that the choice of immunosuppressive drug affects its development.
We read the Comment by Heather VandenBussche and Michael Klepser (Feb 12, p 547)1 on our paper2 and welcome the opportunity to address the issues raised. The secondary outcome measures in our study (C-reactive protein, time to next intravenous antibiotics, and clinical score) are of great importance to clinicians and their patients. Some data were omitted from our report because of limited space. Ceftazidime was given in a dose of 50 mg/kg three times daily, 1767