Getting ready for action
Column from Medical Independent on 24 September 2015.
Ireland is often not the welcoming place it claims to be. Media images of refugees putting their lives at risk to get to Europe, and in particular the shocking sight of the dead body of Aylan Kurdi, the three-year-old Syrian washed up on the coast of Turkey, triggered a rush of good will from Irish citizens.The Government eventually announced that 4,000 refugees would be welcomed here under relocation and resettlement programmes over the next two years. So what are these refugees’ health needs and how will the Irish health system respond?
Often, people who manage to flee their home countries are the healthiest and wealthiest. Think of the pictures of those arriving in Europe, scrambling through Eastern Europe, making those treacherous crossings of the Mediterranean to Greece and Italy. One does not see too many old people or disabled people among these refugees. And often the ones who can leave their own countries are the ones with the resources to do so, leaving behind their poorer, often sicker and older, fellow country people. So some of those who arrive are relatively fit, healthy and young, despite the traumas of their journey here and what they left behind.
Ireland has a good track record with its refugee resettlement programme. In existence since the 1950s, over 5,000 people have been welcomed here; the largest numbers came from Bosnia and Kosovo in the 1990s and early 2000s. During our own economic crisis, the numbers were reduced, with just 324 coming here as part of the programme since 2010. Ireland has taken relatively few refugees over a long period of time.
Earlier this year, the Government agreed to significantly up the numbers — to take 520 refugees, mainly from Syria and Eretria into the resettlement programme as a response to the international refugee crisis. For those who come in through the resettlement programme, they are vetted in their home countries or wherever they are based before coming here. They get health screened by the UN’s Refugee Agency — the UNHCR, and the system is ready for them on arrival.
When refugees first step foot on Irish soil, they are entitled to a medical card and if in need of specific services, these are accessed as they are for all other Irish citizens. These newly-arrived refugees have good supports, translation services and are linked into their local communities.
Every group of refugees who comes here has different health needs. Often, those coming from camps have significant oral health needs and untreated chronic conditions but these can be easily managed, once they have been linked into health services. It is often after some time, when refugees are settling in and feeling safe, that underlying mental health issues emerge. And they have to encounter the same obstacles as the rest of the population in accessing mental health supports. Overall, refugees in the resettlement programme have their health needs met and fare well in the Irish health system.
This is quite different to those in the asylum seeking process. While asylum seekers also get medical cards on the basis of their low income, they do not receive the social welfare or public services supports that programme refugees do. The poor health of asylum seekers in Ireland is well documented, often due to the length of time they are left in the asylum process, especially if left in direct provision centres, where they live in cramped accommodation with little privacy, no choice over meal times, denied the right to cook and to work.
In particular, asylum seekers experience poor mental health and services are not there to meet their needs.
The working group report entitled Report to Government on Improvements to the Protection Process, including Direct Provision and Supports to Asylum Seekers, published in June 2015, outlined many of the inadequacies of the asylum system, including poor access to health services.
On the same day as Minister for Justice Frances Fitzgerald announced the number of 4,000 refugees to come here, Minister for Health Leo Varadkar announced that asylum seekers in direct provision would no longer have to pay prescription charges as €2.50 per item. At long last, recognition that it was just too much for people living on €19.50 a week to pay. However, it also emerged that 3,500 of the 4,000 refugees due to arrive in Ireland will come in under the asylum system, not under the successfully-proven resettlement programme.
Surely refugees arriving from Syria, Eretria and other war-torn countries deserve more? And if the health system is going to adequately meet the needs of the 4,000 new arrivals, then it needs to be adequately resourced to do so.