{"id":35553,"date":"2021-07-28T00:00:00","date_gmt":"2021-07-28T05:00:00","guid":{"rendered":"http:\/\/ready-for-feedback3.com\/shape-history\/fmr\/mau-hoagland\/"},"modified":"2024-08-27T15:14:55","modified_gmt":"2024-08-27T20:14:55","slug":"mau-hoagland","status":"publish","type":"fmr_content","link":"https:\/\/www.fmreview.org\/es\/issue67\/mau-hoagland\/","title":{"rendered":"Barriers to accessing services and assistance during COVID-19: learning from those directly affected"},"content":{"rendered":"

In many ways, the COVID-19 pandemic had created solidarity across countries and within communities in efforts to address public health risks and minimise the socio-economic impacts of the virus. After significant advocacy and engagement with governments undertaken by a range of actors, some good practices have emerged; these include expanding free access to COVID-19 testing, treatment and vaccines for all migrants, regardless of status, and enabling stranded migrants and people without visas to access basic services. Yet, while these policy developments are to be welcomed, championed and replicated, we must also reflect on what this extraordinary situation and global public health emergency have meant for those facing continuing barriers to accessing basic services \u2013 including COVID-19 vaccines \u2013 and how this intersects with both individual and public health outcomes. <\/span><\/span><\/span><\/span><\/span><\/p>\n

Research coordinated by the Red Cross Red Crescent Global Migration Lab on how COVID-19 policy has affected migrants\u2019 access to basic services demonstrates that despite policymakers frequently voicing that \u201cwe are all in this together\u201d, the voices of those a long way from home tell a different story.[1]<\/span><\/span><\/span><\/span><\/span><\/a> While the research focused on all migrants, here we focus on people seeking asylum[2]<\/span><\/span><\/span><\/span><\/span><\/a> and refugees: their heightened risk factors for COVID-19 infection and transmission, and the challenges they face in keeping safe and healthy. <\/span><\/span><\/span><\/span><\/span><\/p>\n

Long-standing access barriers, as well as new challenges posed by movement restrictions and lockdowns, have the potential to compromise public health efforts. The research was conducted by National Red Cross and Red Crescent Societies in eight countries: Australia, Colombia, Egypt, Ethiopia, the Philippines, Sudan, Sweden and the UK (and insights from the Sahel region were also considered)<\/span><\/span>.<\/span>[3]<\/span><\/span><\/span><\/span><\/span><\/span><\/span><\/a> The findings conclude that inclusive approaches for reaching and supporting migrants and refugees must be embedded in national and local pandemic preparedness, response and recovery plans, both to end the pandemic and to ensure everyone has the opportunity to receive assistance in a dignified and supportive way. If inclusive policies are not complemented by operational guidance to address barriers in practice, public health risks will remain. <\/span><\/span><\/span><\/span><\/span><\/p>\n

Legal exclusion<\/span><\/span><\/strong><\/span><\/span><\/span><\/p>\n

Exclusion based on legal status was identified as a key barrier to accessing basic services, including health care, during the pandemic. In Australia, for example, <\/span><\/span>67% of undocumented migrants <\/span><\/span>interviewed <\/span><\/span>explicitly cited ineligibility<\/span><\/span> due to visa status as the <\/span><\/span>main<\/span><\/span> barrier to accessing support<\/span><\/span>, while<\/span><\/span> 100% faced some degree of<\/span><\/span> difficulty in accessing basic services including medical care,<\/span><\/span> food, accommodation or financial assistance<\/span><\/span>. And while most countries studied eventually offered free access to COVID-19 testing and treatment to everyone (though not necessarily to wider public health services), health and safety concerns and fear prevented many from accessing support. In the UK<\/span><\/span>, <\/span><\/span><\/span>for example, <\/span><\/span><\/span>immigration checks are carried out<\/span><\/span><\/span> (<\/span><\/span><\/span>and <\/span><\/span><\/span>fees<\/span><\/span><\/span> applied<\/span><\/span><\/span>)<\/span><\/span><\/span> for people with insecure immigration<\/span><\/span><\/span> status <\/span><\/span><\/span>when they <\/span><\/span><\/span>seek secondary health<\/span><\/span><\/span> care<\/span><\/span><\/span>; alt<\/span><\/span><\/span>hough this is not the case for COVID-19 testing and treatment, the<\/span><\/span><\/span> fear of immigration enforcement<\/span><\/span><\/span> remains real, hindering people\u2019s willingness to engage with health services<\/span><\/span><\/span>. <\/span><\/span><\/span>In Australia, a health service provider explained how \u201cp<\/span><\/span><\/span>eople will not present to hospital even though<\/span><\/span><\/span> they are violently unwell because they are fearful of<\/span><\/span><\/span> reporting<\/span><\/span><\/span> and <\/span><\/span><\/span>deportation or detention<\/span><\/span><\/span>\u201d<\/span><\/span><\/span>,<\/span><\/span><\/span> <\/em>despite free access to COVID-19 testing and treatment. <\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n

The research highlighted inconsistent application of relevant laws and policies; this reflects the need for policy changes to be paired with operational guidance for frontline staff. In Egypt, for example, the government extended the period for renewing residency permits for refugees and allowed expired permits to be used to access certain services, including health care. However, respondents explained that this national-level policy was not always mirrored at the local level in frontline service delivery and some were denied access to support. This was also evident in Australia, where one service provider explained: \u201c[t<\/span><\/span><\/span>here is] confusion around<\/span><\/span><\/span> free COVID-19 testing\u2026among clients and service<\/span><\/span><\/span> providers. One client went to a private clinic because<\/span><\/span><\/span> he was directed by a public health [official] to go there.<\/span><\/span><\/span> This affected access not just for him but also possibly<\/span><\/span><\/span> his community. He had to pay for the test… this gave<\/span><\/span><\/span> the impression the testing is not free.. This creates a barrier [and] future reluctance to<\/span><\/span><\/span> get tested.<\/span><\/span><\/span>\u201d <\/span><\/span><\/span><\/span><\/span><\/span><\/p>\n

Information access<\/span><\/span><\/strong><\/span><\/span><\/span><\/p>\n

The lack of accessible information on COVID-19 in languages spoken and channels used by migrant and refugee communities relates directly to individual and community health. As one refugee in the UK described: \u201c<\/span><\/span>People are very confused\u2026 they are not getting the<\/span><\/span> right information…<\/span><\/span> They do not know what to do or even where to go<\/span><\/span> to get <\/span><\/span>information\u2026<\/span><\/span>\u201d<\/span><\/span> In Egypt, National Society staff and volunteers supported the government in translating official public health messaging from Arabic into languages spoken by migrant and refugee communities, recognising that key information was not reaching these communities. Without the availability of accessible information on COVID-19 prevention and on where and how to access testing and treatment, risks of increased prevalence or transmission are heightened. <\/span><\/span><\/span><\/span><\/span><\/p>\n

Financial barriers<\/span><\/span><\/strong><\/span><\/span><\/span><\/p>\n

It is not just access to health care and information, however, which have the potential to either support or undermine public health efforts to control the virus. Access to health care overlaps with economic impacts. Financial barriers to health care existed prior to the pandemic and have increased during the pandemic due to loss of livelihoods and income. Economic hardship and financial insecurity were one of the main impacts highlighted in the research. As one respondent in Egypt explained, \u201c<\/span><\/span>the main determinant in getting services is money and<\/span><\/span> you get money through work<\/span><\/span>,<\/span><\/span> which was affected by<\/span><\/span> lockdown<\/span><\/span>.\u201d <\/span><\/span><\/span><\/span><\/span><\/p>\n

This loss of income was combined with a tendency for migrants without permanent residency status (including refugees and people seeking asylum) to be excluded from socio-economic support measures for nationals or permanent residents, as well as exclusion from mainstream welfare services and access to public housing. Such exclusion increases the likelihood of living in insecure housing, prevents access to medical treatment, and contributes to increased risks of infection and transmission as people are unable to follow public health recommendations (such as to physically distance or isolate). In Australia, 14% of respondents surveyed stated that they had to keep working despite facing risk of exposure to the virus as they had no other means of financial support. In the UK and Egypt, because of increased costs and loss of livelihoods, respondents faced difficulties in purchasing soap, hand sanitiser and masks to keep themselves safe. <\/span><\/span><\/span><\/span><\/span><\/p>\n

Recommendations<\/span><\/span><\/span><\/strong><\/span><\/span><\/span><\/p>\n

The evidence suggests that the exacerbation of pre-pandemic barriers to basic services <\/span><\/span><\/span>is contributing to disproportionate impacts on the health, safety and well-being of people seeking asylum and refugees. On an individual level, barriers in accessing health support have led to worsening health outcomes, particularly those connected with mental health. As put bluntly by one refugee in Egypt, <\/span><\/span>\u201c[COVID-19] turned our lives<\/span><\/span> upside down \u2026we already have<\/span><\/span> trauma.<\/span><\/span>\u201d On a community level, barriers to basic services and exclusionary practices continue to place everyone at risk. <\/span><\/span><\/span><\/span><\/span><\/p>\n

It is the primary responsibility of States to respect, protect and fulfil the human rights of all migrants, including their economic and social rights. The research report recommends that States work together with other stakeholders to ensure that all migrants, irrespective of legal status: <\/span><\/span><\/span><\/span><\/span><\/p>\n