Migration and Health: An International Perspective

Question 1

Where did humans originate from?

Answer 1

Africa

Migration from here started 100,000 years ago.

Question 2

What happened during WW2?

Answer 2

3-7 million people were forced to move during the war

11 to 12 million were forced to move afterwards.

Question 3

How many people were displaced in the partition of India?

Answer 3

Partition of India (1947) displaced over 14 million people along religious lines.

Large scale violence led to estimates of several hundred thousand to 2 million dead.

Question 4

Why do people migrate?

Answer 4

Work, educational, or family reasons.

Migration creates vulnerabilities even in favorable circumstances, such as distancing from habitual support mechanisms.

Question 5

What was the data from 2020 about migrants?

Answer 5

281 million people are international migrants, which is 3.6% of the world population.

Around 1 in 28 people live in a country other than that of their birth, three times as many as in 1970.

Question 6

How is data gathered on who migrates and why?

Answer 6

Data is gathered from various sources like national insurance numbers, GP registrations, and population surveys.

It is almost impossible to gain an accurate picture of undocumented migration.

Question 7

What did the Windrush crisis show?

Answer 7

Some people are unaware of their own immigration status, and official bodies may not be aware of their status.

This complicates gaining an accurate picture of undocumented migration.

Question 8

How many people have irregular or undocumented immigration status?

Answer 8

An estimated 674,000 people have irregular or undocumented immigration status, with around 400,000 living in London.

The number of undocumented children increased 56% between 2011 and 2017.

Question 9

What are the reasons for immigration to the UK (excluding asylum)?

Answer 9

49% work, 27% for study, 13% other/no reason stated, 12% joining or accompanying family.

Question 10

By how much has the population of West Midlands increased since 2011?

Answer 10

The population has increased by 6.7%.

The West Midlands has significantly lower life expectancy than the UK as a whole.

Question 11

How diverse is Birmingham?

Answer 11

Birmingham is very diverse, home to people of more than 187 different nationalities.

In the 2021 Census, 26.7% of the population had been born overseas.

Question 12

What is forced migration?

Answer 12

Refers to the movements of refugees and internally displaced people due to conflicts or disasters.

Question 13

What are some other reasons for forced migration?

Answer 13

Climate change impacts, persecution based on religious or political beliefs, or sexual orientation.

Question 14

How has forced migration changed over time?

Answer 14

Forced displacement is now more widespread and often a long-term phenomenon.

Question 15

How many people are forcibly displaced worldwide?

Answer 15

Over 52,760 dead and over 18,000 children missing in Europe/Mediterranean since 1993.

Question 16

What is mixed migration?

Answer 16

Refers to flows of people traveling together, often forced from their homes or in search of a better life.

Question 17

What type of people are traveling as part of mixed movements?

Answer 17

Asylum-seekers, refugees, stateless people, victims of trafficking, and unaccompanied children.

Question 18

When does mixed migration occur?

Answer 18

Occurs in various political and social contexts, such as the opening of borders in 2015.

Question 19

What is the migration cycle?

Answer 19

Migration isn’t a single journey; it involves moving from origin to destination and possibly returning.

Question 20

What is trafficking?

Answer 20

Recruitment, transportation, or receipt of persons by means of coercion for exploitation.

Question 21

What is the National Referral Mechanism?

Answer 21

An official 45-day recovery program for victims of trafficking after which they may claim asylum.

Question 22

What is smuggling?

Answer 22

Transporting individuals illegally from one country to another for a fee.

Question 23

Define modern slavery.

Answer 23

Holding a person in slavery or requiring forced or compulsory labor, as defined by the Modern Slavery Act (2015).

Question 24

What does slavery include/overlap with?

Answer 24

Includes trafficking and exploitation, and overlaps with smuggling.

Question 25

What is resettlement?

Answer 25

Official programs to move recognized refugees from low- to middle-income countries to high-income countries.

Question 26

What are the 4 phases of the refugee experience?

Answer 26

Anticipation, Adversity, Survival, Integration.

Question 27

What problems are faced during the immigration process?

Answer 27

Culture of disbelief, age disputes, limited access to legal advice, and indefinite immigration detention.

Question 28

Describe the 'hostile environment' in the UK.

Answer 28

Proof of 'right to reside' needed for accommodation, employment, and healthcare.

Question 29

Describe the 2022 immigration bill.

Answer 29

Applies to arrivals from June 2022; those arriving irregularly face removal to Rwanda.

Question 30

Describe the illegal migration bill (2023).

Answer 30

Places a legal duty on the Home Secretary to remove anyone arriving irregularly to the UK.

Question 31

Does the 2023 bill apply to everyone?

Answer 31

No, it does not apply to unaccompanied children.

Question 32

What happens to people arriving after 20th July 2023 in this bill?

Answer 32

Their asylum claims will be declared 'inadmissible' and they will be detained and swiftly removed.

Question 33

Is there a legal duty on the Home Secretary to detain people?

Answer 33

No, there is only a power to detain people.

Question 34

What are the 2 circumstances experienced for people claiming asylum in the UK?

Answer 34

Pre July 2023: route to full refugee status; Post July 2023: inadmissibility and threat of removal.

Question 35

Describe the path to 'Indefinite leave to remain' (ILR) - regular migration.

Answer 35

Initial status is usually 'Limited Leave to Remain' for 2-5 years, needing 10 years in the UK for ILR.

Question 36

What is admissibility in the context of asylum?

Answer 36

Admissibility refers to the threat of removal to Rwanda or other 'Third Country', where many face basic isolated accommodation in refugee camp-like conditions with limited freedom of movement. A small number of people in very limited circumstances will have admissible claims.

Question 37

What is the path to Indefinite Leave to Remain (ILR) in the UK?

Answer 37

The initial status is usually 'Limited Leave to Remain' (LLR) for 2-5 years. To obtain ILR, one must accumulate 10 years in the UK, with LLR granted in 30-month chunks necessitating recurrent applications. The total cost of achieving ILR and citizenship exceeds £20,000.

Question 38

What is destitution?

Answer 38

Destitution is going without the bare essentials needed for survival, such as home, food, heating, lighting, clothing, shoes, and basic toiletries. It is defined as lacking two or more of these essentials over the past month due to affordability issues or having an income of less than £70 a week for a single adult.

Question 39

What percentage of refused asylum seekers remain in the UK and face destitution?

Answer 39

90% of refused asylum seekers remain in the UK and face destitution rather than electing to leave. This situation is exacerbated by the Illegal Migration Act, which may increase destitution and restrict access to accommodation, education, and healthcare.

Question 40

What does NRPF stand for in regular migration?

Answer 40

NRPF stands for 'No Recourse to Public Funds', which applies to individuals granted the right to stay in the UK but who cannot access welfare benefits or housing support.

Question 41

What confusion exists around NRPF?

Answer 41

There is confusion about what individuals with NRPF are entitled to claim or access. NRPF does not refer to healthcare or social services, meaning individuals cannot claim welfare benefits or housing support.

Question 42

What backlash has occurred due to migration?

Answer 42

Public discourse in high-income countries often presents migrants as a burden, leading to stigma, hostility, and hate crimes. However, migration benefits the economy, such as the NHS, more than it costs.

Question 43

What statistics support the benefits of migrants in the UK?

Answer 43

37% of doctors in the UK gained their qualifications abroad, and a 1% increase in migration correlates with a 2% increase in GDP per person.

Question 44

What problems do migrants face internationally when integrating into new societies?

Answer 44

Migrants face cultural and language barriers, loss of status, family separation, and difficulties gaining employment, often ending up in low-wage occupations with high risks.

Question 45

What is the 'healthy migrant' phenomenon?

Answer 45

The 'healthy migrant' is a debated concept; data shows that migrants to high-income countries often have a mortality advantage compared to non-migrants, with lower self-reported long-term conditions.

Question 46

Who has better reported mental health, migrants or UK born individuals?

Answer 46

Migrants who arrive under favorable circumstances report better mental health than UK-born individuals (5% vs 10%).

Question 47

What adversities may migrants face that affect their mental health?

Answer 47

Migrants may face torture, detention, ongoing uncertainty regarding asylum cases, and challenges with integration, which can lead to mental health issues.

Question 48

What is the hierarchy of needs?

Answer 48

The hierarchy of needs is a psychological theory that ranks basic physiological needs at the bottom and self-actualization at the top. Migration often drives individuals down this hierarchy, negatively impacting mental health.

Question 49

What percentage of refugees have been tortured?

Answer 49

21% of refugees have been tortured, and 30% of torture survivors meet the diagnostic criteria for PTSD.

Question 50

Are torture survivors safe from harm from their clinicians?

Answer 50

A substantial proportion of torture survivors report direct or indirect involvement of clinicians in their abuse, and their experiences are often under-recognized.

Question 51

What levels does torture impact a person's wellbeing?

Answer 51

Torture impacts physical, psychological, integrity, and spiritual wellbeing, contributing to social stigma and marginalization.

Question 52

What are the aims and effects of torture?

Answer 52

Torture aims to degrade, dehumanize, and debilitate individuals, leading to a breakdown of cognitive and behavioral functions with pervasive and long-lasting effects.

Question 53

What is the result of migration?

Answer 53

Migration can lead to fear and sadness, with ongoing risks of destitution, detention, and deportation. Many individuals, especially the undocumented, may remain in limbo for years.

Question 54

What risks do both genders face during migration?

Answer 54

Both genders are at risk of sexual violence, exploitation, and transactional sex before, during, and after migration, with girls and women facing increased risks of early and forced marriage.

Question 55

What is the access to reproductive health and contraception for migrants?

Answer 55

Access to reproductive health and contraception is often poor, influenced by host nation culture and legal/social structures.

Question 56

What is maternity care like for migrants?

Answer 56

Migrant maternal and infant mortality and morbidity rates are very high compared to resident populations, affecting access to care during the antenatal period, labor, and post-natal care.

Question 57

What are migrants, especially women, with unstable immigration status at risk of?

Answer 57

Migrants with unstable immigration status are at risk of intimate partner and domestic violence.

Question 58

What is a damaging myth regarding migrants and disease?

Answer 58

The suspicion that migrants are the cause of disease outbreaks is a persistent and damaging myth, as migrants often come from countries with different infectious disease profiles.

Question 59

As a clinician, what should you always ask migrants?

Answer 59

Always ask about immunization status and offer catch-up immunizations, as these can be disrupted by migration.

Question 60

What are the benefits and criticisms of screening migrants for diseases?

Answer 60

Screening can benefit individuals and reduce healthcare costs but may lead to stigmatization and negative media messages.

Question 61

Do migrants transmit disease to host populations?

Answer 61

It is highly unlikely that migrants transmit diseases to host populations; transmission is more likely within migrant communities.

Question 62

What diseases should clinicians screen for in migrants?

Answer 62

Clinicians should screen for TB, HIV, Hep B, and Hep C based on the country of origin risk.

Question 63

What is universal access to healthcare?

Answer 63

Universal access to healthcare means all people can use necessary health services without financial hardship.

Question 64

What advantages does equitable access to healthcare bring to society?

Answer 64

Equitable access to healthcare reduces health inequalities, which can lead to social inequality, economic instability, higher crime rates, and lower happiness.

Question 65

What access is there to primary care for migrants?

Answer 65

Access to primary care does not depend on nationality or immigration status; anyone in the UK can register with a GP without charge.

Question 66

Why is access to healthcare important?

Answer 66

Access to healthcare is crucial for ensuring the health and wellbeing of all individuals, particularly in the context of public health.

Question 67

What are the rules on charging in secondary care for migrants?

Answer 67

Only clinicians should decide what care is 'urgent and immediately necessary', and recent regulatory changes caution against assuming someone will return home within six months.

Question 68

What is the NHS surcharge?

Answer 68

The NHS surcharge is a fee for using NHS services during a stay in the UK, payable by anyone applying for a visa over six months. It doubled from £200 to £400 in January 2019.

Question 69

What are the criticisms of restricting access and charging for NHS services?

Answer 69

Critics argue that it undermines the principle of free care at the point of delivery, can lead to erroneous charging, racial profiling, and deter individuals from seeking care.