Child First, Migrant Second
This month, the hearts and minds of the public have been drawn towards the plights of Syrian refugees as vivid images of ill-fated journeys have saturated our media. The seemingly callous approach of European governments in preventing these families from entering their countries has been widely condemned and of late there appears to be a shift on a higher level towards doing what is right in the eyes of humankind. I have faith that in the end our government will do the right thing and provide a home for those in desperate need. However I think it is important that we realise that for these families, the journey doesn’t end when they set foot upon British soil. A new and unique set of challenges will present themselves as they try and start anew, plagued still by the memories of their past experiences and all that they have left behind.
Within these families are the most vulnerable group of all; the children. As citizens of our world, they have the same rights as all other children; the right to learn, the right to play, the right to protection and the right to the best possible health. To ensure their rights are met, we as paediatricians need to be aware of their unique needs and how we can best provide for them. I decided to do a bit of research to try and improve my understanding of this vulnerable group and share with others what I have learnt.
The definition of a refugee is a person who “owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion, is outside the country of his nationality, and is unable to or, owing to such fear, is unwilling to avail himself of the protection of that country”. An asylum seeker is someone who has applied for asylum and is waiting for a decision as to whether or not they are a refugee.
For child asylum seekers, life may have been fraught with danger and uncertainty prior to arrival. They may have witnessed and experienced atrocities that no child should ever have to experience including the loss of those close to them. Some may arrive as ‘unaccompanied minors’. In 2008, their were 3905 applications for asylum in the UK from this particular group alone. On being granted asylum, the majority pass into the care of our local authorities and the looked after children system.
Children seeking asylum have often travelled from areas of poor health care provision following societal breakdown in their home country. They may have been subject to poor nutrition and sanitation, resulting in increased incidence of malnutrition and communicable diseases. Immunisation coverage may be poor and catch up schedules will need to be arranged.In some cases, children have experienced rape, torture and violence (include female genital mutilation), leaving lasting physical and psychological scars. Depression and anxiety are common as well as post traumatic stress disorder which is frequently poorly recognised.
Families of child asylum seekers may have difficulties in accessing appropriate healthcare due to lack of awareness of entitlement or how to access services as well as added language barriers. Lack of understanding of the complex needs of this population amongst healthcare staff and poor multiagency working between health and social care accentuate the health care inequalities experienced by this particular group.
Current approaches to helping resolve these inequalities include improved training of health care professionals about the needs of asylum seekers and the development of specifically designated GP practices or GPs/Paediatricians assigned to work with this group. Specific school based mental health projects for vulnerable children as well as community based refugee support groups are also valuable resources.
In our current global climate, the needs of asylum seeking and refugee children are increasingly prevalent and as paediatricians it is essential that we understand how we can best meet these needs, so that all our worlds children have the opportunity to live up to their potential.