I think most of us would like to provide incredible care for anyone having to flee their country. It occurred to me that I haven’t learnt anything on this topic since I was a student and given all the events in the world right now, I was overdue for some study.
Here’s what I found, both from all4maternity and from my own research which the module prompted:
Refugees are people who have been granted asylum in the UK.
Asylum seekers are those still going through the process.
In 2017 there were more than 120,000 refugees and more than 40,000 pending asylum cases in the UK.
Interestingly, it’s developing world countries that offer the most places for refugees. Turkey currently has 3.5 million refugees with Pakistan and Uganda also taking large numbers.
Reasons for this might be Turkey receiving international credit for taking refugees but there's also a culture of helping others in Islam which is prompting this care. Though obviously, Turkey shares a border with Syria so proximity is a reason too.
Being a refugee in Turkey is very different from in the UK, though. Refugees often receive only a temporary right to stay in Turkey and they may be expected to stay in camps.
I think many people in the UK believe that refugee applications are rising but actually they've been stable since around 2002.
The UK asylum process is incredibly tough, complex, and often seems unfair; for instance, in 2015 38% of appeals on asylum cases were upheld in the asylum seeker’s favour.
Imagine what it would feel like to run from your country, apply for asylum, supply all documents and evidence that may be very difficult to get and then to have your application refused on unfair grounds. You’d have to be brave to challenge this, even if you knew the decision was wrong.
It’s intensely distressing to think of a pregnant woman or a new mother going through the asylum seeker process.
Other factors that healthcare professionals need to consider include the experiences of mothers and families escaping from political or other persecution. Refugees have often walked hundred of miles, lost their homes and possessions, and seen death and violence. Mental illness, particularly PTSD will be a concern. There’s good evidence to suggest continuity of care might be a wonderful way of supporting women in these situations (imagine having to retell your story every time you see a midwife, as it’s a new person – continuity of care would avoid this and help you find coping strategies for labour and parenthood).
Malaria and tropical diseases screening and care are also factors to think through with this group of women.
If a woman presents as very unwell and she is a refugee or has spent time in a refugee camp, she is at much higher risk of these. A midwife caring for a woman being removed from the UK needs to consider if anti-malarial prophylaxis is necessary as well.
Asylum seekers do have the right to full, free NHS care but sometimes they don’t know this.
Women in the immigration system are at risk of not coming for care anyway so it’s important to get this info to them. Combine a woman reluctant to seek care with a language barrier, and perhaps inappropriate translation going on and you can see why this group is at risk. Professional translation services should always be used, there might be safeguarding or accuracy risks if friends or family members are used.
What I found extremely startling was the transition between being an asylum seeker and being a refugee. In the UK, once you’re granted refugee status, you have 28 days to start claiming benefits and find new accommodation; in practice, this is often unachievable and many refugees end up on the street.
In summary, being a refugee can be a lonely, terrifying process and midwives can offer life changing care. You can support someone at their lowest. (see the 'p.s.' below for a real example of this).
I would highly recommend subscribing to all4maternity.com and heading over to do some further learning with their refugee module. It's the online learning tool put together by the journal The Practising Midwife, perfect for aspiring, student and qualified midwives.
The references are all there too.
All4maternity has some brilliant learning on subjects as diverse as refugee women, delayed cord clamping and midwifery resilience. It’s easy to navigate and if you learn best curled up with a hot drink with your laptop, instead of at the library with lots of hefty books, you’ll love it.
Now I’d love to hear from you! Leave me a comment letting me know your experiences with women seeking asylum – or your own personal experiences?
Is this care you’d like to be involved with?
I know you might feel stretched thin at times but your contribution to women’s lives means more than you realise.
Much love and keep going x
For a bit of inspiration on what midwives can do for asylum seekers, see this interview with Deborah Hughes – who offered a woman on her caseload asylum and helped her retrieve her baby from Africa where she was scheduled to have FGM.
Honestly, if you’re ever doubting midwives have an impact, this blog will help #faithrestored