As often as the sentiment that we’re all in this together has been touted since the arrival of COVID-19, one of the clearest lessons of the pandemic is how varied its effects have been among different social groups. Not only have pre-existing inequalities in wealth, employment, education and healthcare widened, they’re also reflected in susceptibility to and the impact of COVID-19 on specific groups of people.
Compared to white people, for example, minority ethnic groups in the UK are more likely to be exposed to COVID-19, more likely to become sicker when infected, and are also more likely to face greater financial insecurity. Together, these disparities further exacerbate the health and social challenges ethnic minorities already face, such as access to satisfactory healthcare.
People from ethnic minority groups have more limited access to specialised medical treatment, are at higher risk of receiving incorrect treatment (such as such as medication errors), and are more likely to report feeling unsafe and discriminated against when receiving healthcare.
These healthcare-related challenges are even more pronounced when the ethnic minority members in question are migrants, because they also have to contend with seeking healthcare in a new culture. Undocumented migrants living in UK immigration removal centres are particularly affected by these issues. Even prior to detention, migrants face discrimination, poverty, challenging work conditions and fear of deportation, all of which have an impact on health and wellbeing.
While in detention, migrants experience high levels of poor health, including anxiety, depression, and suicidal thoughts due to prolonged uncertainty and separation from existing social networks. Despite this, many don’t seek help or are dissatisfied with the healthcare they receive. Common issues include shortage of medical staff, long waiting times, rude behaviour of staff, and inadequate health assessments.
Our recent study investigated how and why the contexts of migration and detention affect detainees’ willingness to seek help, their likelihood of accessing appropriate healthcare, and their satisfaction with any care they do receive.
Lacklustre support
Through interviews with UK immigration removal centre detainees and staff, we found that factors that deterred detainees from seeking help included a lack of knowledge about their right to healthcare access, poor understanding of the UK health system, fear of being turned away by health professionals, feelings of powerlessness, concerns about disclosing mental health issues and perceived lack of access to quality services. Detainees believed that staff would misinterpret their attempts to seek help as disingenuous, or attempts to influence their immigration case, which did indeed reflect staff perceptions.
Many detainees said that the support they receive is fundamentally inappropriate and ineffective. They indicate that it fails to address the cause of their suffering, namely their potentially unlimited detention period, which many perceived to be unfair. The healthcare that is offered provides short-term relief at best, and at worst compounds feelings of frustration and disappointment.
One male detainee who had spent nearly two years in detention explained why healthcare offered by staff inside detention was problematic:
This person has been in that room for a very lengthy period. They don’t know when they [are] coming out and they don’t know when they (are) going back to their home country or whether they’re going to be released. You [as staff have] seen this health has been deteriorating. You keep saying you’re offering them help. What help can you offer when you know what’s triggering the problem is him being in there?
Some staff were equally frustrated with the uncertainty surrounding the length of detention periods, which they believed made it very difficult for them to offer effective support. Despite this understanding, the mutually distrusting relationship with staff continued to be a major barrier preventing detainees from seeking help.
Trust issues
Detainees were also concerned that requesting help would negatively affect their immigration case, because they felt they would be considered a burden to the healthcare system. These fears often led to disengagement with health services and unwillingness to seek help.
As one detainee explained when referring to centre staff and health workers:
I don’t go to them because I don’t know what they can do. I don’t trust any of them.
Our findings also reflect some of the challenges minority groups experience through continuous social discrimination and alienation as they make decisions about accessing health services. Lack of trust in health professionals (and scepticism among health professionals’ about migrants’ help-seeking) can prevent migrants from accessing much-needed healthcare, including crucial COVID-19 tests and vaccinations. This could lead to underestimating the needs of such groups, their disengagement with healthcare and other services perceived as problematic behaviour. This was the case for a detainee we spoke to who refused to share her medical records with a health professional in detention.
As English health charity the King’s Fund notes, to avoid such outcomes, governments and healthcare services must ensure that health policies, practices, and decisions about the allocation of resources address the social and structural inequalities faced by ethnic minorities and other disadvantaged groups. As our data suggests, it’s only through this type of systemic change that we can hope to provide effective healthcare to all members of our communities.