The Health Experiences of Asylum Seekers and Refugees in Wales The experience that I have is killing me every day Quote from participant talking about seeking asylum in the UK

  The Health Experiences of  Asylum Seekers and Refugees in Wales Technical Report of the HEAR Study March 2019   Acknowledgements The authors thank all those who completed questionnaires or took part in interviews and focus groups to provide data for this study. We thank the third sector collaborators for their support in facilitating data collection, in particular the peer re-searchers for administering the questionnaires. The research team are very grateful to Neil Jenkinson for administrative sup-port across the study, to Rebecca Cushen and Charlotte Grey for proof-reading and to Claudine Anderson and Professor Mark Bellis. Finally, we thank the peer reviewers Dr Robert W Aldridge, Rachel Burns, Dr Alisha Davies and Professor Mark Johnson. Public Health Wales is an NHS organisation providing professionally independent public health advice and services to protect and improve the health and well-being of the population of Wales. Public Health Wales funded this study and report, and collaborated on the research design, analysis, authorship and review of this report. For information, contact:Health Services Research TeamPatient and Population, Health and Informatics Swansea University Medical School ILS2, Singleton Campus Swansea SA2 8PPa.khanom@swansea.ac.uk March 2019ISBN 978-1-78986-067-2 © 2019 Public Health Wales NHS Trust, Swansea University.Material contained in this document may be reproduced under the terms of the Open Government Licence (OGL) www.nationalarchives.gov.uk/doc/open-government-licence/version/3/ provided it is done so accurately and is not used in a misleading context. Acknowledgement to Public Health Wales NHS Trust to be stated.Copyright in the typographical arrangement, design and layout belongs to Public Health Wales NHS Trust, Swansea University.  1 Ashrafunessa Khanom 1 ; Wdad Alanazy 1 ; Lauren Ellis  2 ; Bridie Angela Evans 1 ; Lucy Fagan 2 ;   Alex Glendenning 1  ; Matthew Jones 1 ; Ann John 1 ; Talha Khan 3 ; Mark Rhys Kingston 1 ; Cathrin Manning 4 ; Sam Moyo 5 ; Alison Porter 1 ; Melody Rhydderch 6 ; Gill Richardson;  2 Grace Rungua 5 ; Daphne Russell 1 ; Ian Russell 1 ; Rebecca Scott 2,6  ; Anna Stielke  2 ; Victoria Williams 1 ; Helen Snooks 1 1: Swansea University 2: Public Health Wales3: University College Cork 4: British Red Cross5: Patient and public involvement members 6. Displaced People in Action (DPIA)Authors’ names are in alphabetical order by surname, with the exception of the first and last authors. Management group membership Swansea University Professor Helen SnooksAlex GlendenningDr Ather HussainDr Ashra Khanom Neil JenkinsonProfessor Ann JohnDr Alison Porter Dr Victoria WilliamsStuart Gooding Gozde Polat Public Health Wales Dr Gill Richardson (Chair - Research Management Group)Lauren Ellis Lucy FaganRebecca Scott (formerly DPIA)Anna Stielke Third sector collaborators Dr Melody Rhydderch (Director) – Displaced People in Action Cathrin Manning (Policy and Public Affairs Officer) – British Red Cross Rocio Cifuentes (Director) – Ethnic Minorities and Youth Support Team Wales (EYST) Tracey Sherlock (Executive Director of Policy & Communications) – Welsh Refugee Council Patient and Public Involvement Members Samuel Moyo (also Peer Researcher)Grace Rungua (also Peer Researcher) Health Service – Abertawe Bro Morgannwg University Health Board Jean Saunders (Specialist Asylum Seeker Health Visitor) – Swansea Health Assessment Team Other peer researchers Naseem Aslam Hamed Ghanbari Thanuja HettiarachchiRehmat Khalil Hina Noor-ul-ain Mohammed Safdar The Health Experiences of  Asylum Seekers and Refugees in Wales  2 The Health Experiences of Asylum Seekers and Refugees in Wales Glossary  Asylum Seeker A person who has lef their country o srcin and ormally applied or asylum in another country but whose application has not yet been concluded. i  An asylum seeker becomes a reugee on receiving leave to remain. There are various stages to the process o claiming asylum, which affect legal rights and entitlements.  Section 95 support Asylum seekers are excluded rom claiming mainstream welare beneits and in most cases rom working. Section 95 o the Immigration and Asylum Act 1999 gives the Home Office power to grant support to asylum seekers, and their dependents, whose claims are ongoing, or who are destitute or about to become destitute. Support is usually provided in the orm o urnished accommodation (ree rent and utilities), plus a weekly cash allowance o £37.75 to enable the persons to meet other “essential living needs”. This cash allowance was increased rom £36.95 in February 2018.  Section 98 support Section 98 support is a orm o temporary support that is provided to asylum seekers who appear to be destitute and who are awaiting a decision on their application or Section 95 asylum support. Section 98 support is supposed to be provided or a short period and includes accommodation and meeting “essential living needs”.  Section 4 support Section 4 o the Immigration and Asylum Act 1999 gives the Home Office power to grant support to some destitute asylum seekers whose asylum application and appeals have been rejected. To qualiy or Section 4 support, reused asylum seekers must be destitute, or be likely to become destitute within the next 14 days (or 56 days i they are already receiving support); and satisy one o the ollowing ive conditions:   ■ They are taking all reasonable steps to leave the UK or place themselves in a position in which they are able to leave the UK ■ They are unable to leave the UK because o a physical impediment to travel or or some other medical reason ■ They are unable to leave the UK because in the opinion o the Secretary o State there is no viable route o return ■ They have applied or judicial review o the decision on their asylum claim and has been granted permission to proceed ■ The provision o accommodation is necessary to avoid breaching their human rights Those who receive the support are generally provided with accommodation and £35.39 loaded weekly onto a cashless payment card that can be used to buy ood and other essential items where card payments are accepted. ii   i United Nations High Commissioner or reugees http://www.unhcr.org/uk/asylum-in-the-uk.html [Accessed 13 March 2019] ii Asylum support, section 4(2): policy and process Version 1.0, Home Office, February 2018. https://assets.publishing.service.gov.uk/govern-ment/uploads/system/uploads/attachment_data/ile/682495/asylum-support-section-4_2_-policy-and-process-v1.0ext.pd   3 The Health Experiences of Asylum Seekers and Refugees in Wales Refused asylum seeker A person whose asylum application has been unsuccessul and who has no other claim or protection awaiting a decision. A reused asylum seeker may have the right to appeal the decision, or, i all appeal avenues have been ollowed unsuccessully, may be ‘appeal-rights exhausted’. At this stage, reused asylum seekers may have all inancial support withdrawn and may have to leave their asylum accommodation.  Destitute refugees and asylum seekers Destitute reugees and asylum seekers include anyone who has claimed asylum or is in the process o doing so, and is without any orm o statutory support. This may occur at various stages o the asylum process, including though not limited to: through delays to Section 95 or Section 4 applications; withdrawal o support ollowing a reusal; withdrawal o Section 95 or Section 4 support ollowing a grant o leave to remain but beore employment or mainstream beneits have been secured.  Community Sponsorship The UK Government launched the Community Sponsorship Scheme in July 2016 to enable community groups, including charities, aith groups, churches and businesses to take on the role o supporting resettled reugees in the UK as ‘sponsors’. Sponsors provide housing or the reugees, as well as helping them to integrate into lie in the UK, access medical and social services, arranging English language tuition and supporting them towards employment and sel-sufficiency. Groups must demonstrate evidence o available unding o at least £9,000 and meet a number o criteria to demonstrate their competence as a community sponsorship group. In Wales, there are currently a number o community sponsorship groups, including Croeso groups in Narbeth, Fishguard, Aberystwyth, Haverordwest, Cardigan, Penarth and Bangor.  Family Reunion Afer being granted leave to remain, reugees are entitled to apply or amily reunion visas or their close amily (partner and children under the age o 18). There is no ee or applying or eligible amily members, but individuals do have to pay the cost o travel rom country o srcin to the UK.  HC2 certificate An HC2 certiicate holder qualiies or the ollowing: ■ ree NHS prescriptions   ■ ree NHS dental treatment   ■ ree NHS sight tests   ■ help with the cost o glasses or contact lenses   ■ help with the cost o travelling to receive NHS treatment   ■ ree NHS wigs and abric supportsFrom 3 rd  April 2000, the National Asylum Support Service (NASS) on behal o the Department o Health has been issuing NASS supported asylum seekers directly with HC2 certiicates to obtain ull help with health costs together with the irst support voucher they receive.