"The syndemic nature of the threat we face demands that we not only treat each affliction, but also urgently address the underlying social inequalities that shape them— poverty, housing, education, and race, which are all powerful determinants of health.”
Dr. Richard Horton, editor-in-chief of The Lancet (13th November 2020)
It’s Friday 13th March 2020. I watch the woman, around 60 like me, reach for a clear plastic bag of five tomatoes. Just moments before, my bare right hand placed it on the conveyor belt and now, her bare left hand lifts it towards the scales at her workstation. Tapping in her record of its value, she picks the bag up again, bare right hand this time, and sets it down before me.
Suddenly, back with a vengeance, an unnameable feeling that first coursed through me last night as I listened to the Prime Minister on TV, now joined by the sound of a sample from a February 2020 radio broadcast that’s starting up inside my head: “There’s been a sudden global stock market crash”, spoken in received pronunciation. It goes on repeat: “the global stock market crash… the global stock market crash”, the soundtrack of a flickering, mind’s eye film starring the hand shadows of every person from every stage of every process that created this bag of tomatoes. Zooming in and out, one after the other, all those hands before ours, the hands of we two women on either side of this counter. What was it he said last night? “It is still vital, perhaps more vital than ever – that we remember to wash our hands.”
I shiver, refocus my eyes to see hers, smile, extend my hand towards the bag and mouth ‘Thank you’. My Covid19 matrix has begun.
Walking in the front door with the shopping and, like me, my 20-something son who’s living back at home and just starting a new, very short term, contract, is thinking about last night’s TV broadcast: “Should I meet some mates? A pint and a game of pool after this shift?”
“Wear gloves,” is the best I can offer.
Fast forward seven months to last Friday, 13th November 2020. The Lancet published a study by Global Burden of Disease(GBD) explaining why Covid19 is a syn- not a pan-demic: that is, it’s an interaction between coronavirus infection and a number of non-communicable diseases like heart attacks and stroke, cancers, chronic obstructive pulmonary disease, asthma and diabetes. The critical fact though, is that more than three quarters of deaths from these diseases, 32 million deaths globally, occur where there is poverty and inequality, i.e. in low- and middle-income countries. As the Lancet Editorial made crystal clear, communities will not be protected from future infectious outbreaks and population health will not achieve gains unless deep, structural inequalities are tackled.
GBD’s scientific study confirms what the Economic Policy Unit first argued on June 1st: THIS IS A SYNDEMIC. On the 4th October 2020, when Prime Minister Johnson claimed our obesity is very important for explaining Covid rates he missed out the most important bit, most simply put by the editor-in-chief of The Lancet: “The syndemic nature of the threat we face demands that we not only treat each affliction, but also urgently address the underlying social inequalities that shape them—poverty, housing, education, and race, which are all powerful determinants of health.”
On 27th March 2020, 14 days after the Prime Minister told us to wash our hands, organisations representing people without status and their allies - including the BFAWU – began the Status Now For All Network calling for access to health, housing and food for ALL. As soon as the first lockdown was announced , our knowledge compelled us to begin to become visible so that Network members can communicate safely. This is people like Mercy Baguma, with barely enough money to eat, homeless or living in very overcrowded accommodation, not accessing medical help for fear of detention or deportation and working jobs under the radar, without any protection, even without wages, or basic health and safety.
Through Solidarity, all of us become part of the solution: moving forward so that EVERYONE can become safe and able to look after each other.
Last Friday, Kamran Abbasi of the British Medical Journal summed it up: “the medical-political complex can be manipulated in an emergency”.
By Rhetta Moran
 Syndemic: A blend of the words Synergy, from Ancient Greek συνεργία (sunergía, “cooperation”), from σύν (sún, “with, together”) + ἔργον (érgon, “work”) and demic, from the Greek word demos, or “people”..[https://www.wiley.com/en-gb/Introduction+to+Syndemics:+A+Critical+Systems+Approach+to+Public+and+Community+Health-p-9780470472033]
 Matrix: the set of conditions that provides a system in which something grows or develops https://dictionary.cambridge.org/dictionary/english/matrix
Join RAPAR members and StatusNow4All signatories In a peaceful demonstration outside the Asylum and Immigration Tribunal Office in Manchester on Saturday, 19th September, between 1pm and 2.30pm.
This will be part of a national day of action in solidarity with 'Status Now' signatory Regularise which campaigns for the rights of undocumented migrants.
Regularise is holding a protest outside 10 Downing Street in London on the same day and at the same time as the Manchester demonstration.
The protest in Manchester will focus on the re-opening of Immigration Reporting Centres in the UK and Britain First's harassment of refugees who have been placed in hotels. It will be held at the Asylum and Immigration Tribunal Office on Saturday 19th September, 1pm-2.30pm, Piccadilly Exchange, 2 Piccadilly Plaza, Mosley Street, Manchester M1 4AH.
You are most cordially invited to register here. (All registered attendees will receive the zoom link and details in their registration emails).
As the country locked down in March, RAPAR and other organisations started the new Status Now campaign - calling for Leave to Remain for all undocumented, destitute and migrant people in the UK and Ireland, irrespective of their immigration status.
RAPAR believes the call for Status Now is the only way to ensure equal access to health, housing, food and financial support for all in the time of the Covid-19 global pandemic. The Status Now Network is growing by the day and has its official launch on Saturday July 11th.
An Early Day Motion calling for Status Now has been tabled in Parliament. Please ask your MP to support it.
The BBC carried this report about some of our work last week.
At the end of March the Network called on the British Prime Minister and Irish Taoiseach to grant leave to remain, Status Now, to all undocumented, destitute and migrant people in the legal process in both the UK and Ireland, to ensure their and others’ safety during the Covid-19 pandemic. The open letter to the heads of states has received over 65 organisational signatories, the online petition has gained over 3,700 signatories and counting, and an EDM (early day motion) calling for leave to remain has been put down in the UK Parliament.
We can’t #controlthevirus unless we give everyone the same access to healthcare, housing, food and welfare. #StatusNow
Can’t #stayhome if you don’t have one! Grant #StatusNow to all undocumented, destitute migrant people to #savelives
Please encourage others to Join our campaign for welfare, housing and healthcare for all: #HealthAndSafetyForAll
And please add your name to the Open Letter and sign the petition here.
Hashtags: #healthandsafetyforall #StatusNow4all
Who we are: Women? Men? Children? Elders? People with disabilities?
Where we are from: East? West? North? South?
Where we live: London? Birmingham? Manchester? Glasgow? Anywhere?
How many of us live there: Single room? Family in a room? Community cluster in a house or a flat?
Our health status: Healthy? Sick? Dying? Dead?
The jobs we had before COVID19 arrived in the UK: manual labour as builders, careworkers, childminders, cleaners, decorators, prostitutes, sauna workers, seasonal workers, and security guards?
The jobs we still have: Careworkers?
How many more of us will die before 7th May? That’s the next time the Home Affairs Select Committee will sit to hear oral evidence session for its ongoing enquiry into Home Office preparedness into Covid-19.
The causes of our deaths: the systematic exploitation and oppression of working class people all over the world that results in Malnutrition, Overcrowding, Poverty, and Stress all of which compromise our physical abilities to stay well and fight any and all infections and diseases, including COVID19? Today's Guardian is telling us that COVID19 deaths are twice as high in poor areas.
One of the signatories to our 27th March 2020 Open Letter that was received on that date and remains UNacknowledged by the Prime Minister, is Positive Action in Housing. This morning they advised us that, currently, they assist 2,500 families a year, 92% of whom are living below the poverty line or in destitution.
Within the last 6 hours, RAPAR has been contacted by an NGO describing the sequence of events that have culminated this morning with a woman carer, known to them for 15 years, presenting herself for committal at a mental health institution:
Emily (not her real name) came to Britain on a work permit 15 years ago. She worked as a carer in the private sector, looking after the elderly. When the visa rules for migrant care workers changed in 2007 Emily became undocumented. When the campaign led by Kanlungan Filipino Consortium won concessions in 2008, she became redocumented, at which point she trained, became registered as a nurse and began to work in the privatised care home sector.
Since COVID19 emerged she has been expected to work without PPE. As the pressure mounts for PPE to be supplied, Emily, alongside many other frontline workers, has asked for PPE to be made available to her. Two weeks ago, one of the Filipino carers working with Emily died with COVID19 and, at the same time, Emily started to suffer with fever and cough.
The company that employs Emily has told her that if she does not present for work she will be dismissed.
She told us, via text overnight last night, “I don’t want to go back to work but the company is threatening staff to dismiss them if they won’t return to work”.
This morning, Emily has presented for mental health services and been admitted as an inpatient. One of her last texts before admission read: “Regardless of color, skin or race we should be treated with dignity. I don’t want to die but to live.”
For further information contact:
Rhetta Moran at rhetta.moran(at)rapar.org.uk / 0777-626-4646
Susan Cueva at info(at)kanlungan.org.uk/ 0739-779-6238
We’re all in shock. Not that we easily admit it to ourselves or each other, but we are. We’re shocked about the existence of COVID19 and, every day, every time we hear another example of the shockingly bad management of COVID19 at Local, National and International levels by States and Agencies vested with the power to advance Public Health, our individually shocked selves get zapped again... and again.
What’s more, whether it arose from a single or multiple/continuous incidents, salt is pouring on the wounds of everyone, everywhere, who is living with any trauma that existed before Covid19.
Right now, who are the people who aren’t:
1. Able to access housing, food and the same sources of income from the State as everyone else?
2. Living in an environment where it is doable and sustainable to follow the Public Health directives: self-isolate as necessary, maintain social distancing, keep cleaning our environment and boosting our immunities, and thereby limit COVID19 viral transmission to the minimum?
In the UK… they are:
Residents, who may also be families that include essential or front line workers, living now in care homes, detention centres, hostels and houses for people seeking asylum, london busses, overcrowded and under-resourced social /private housing/ flats, prisons, psychiatric hospitals, and in the case of young UK people who are undocumented, other peoples’ tenancies.
They are UNABLE to do 1. or live in 2.
If the British State wasn’t previously aware that members of these population groups are living and dying, every day, with barriers between them and environments where it is possible to exercise and sustain vital public health behaviours, IT - as in the British State - became aware of these incontrovertible public health facts on 27th March 2020 when 10 Downing Street received our Open Letter calling for Status Now to secure access to healthcare housing and food for all.
Across Europe… they are:
Among others, our Refugee Sisters and Brothers, advocating for the end of the Direct Provision centres in Ireland and profoundly concerned about a very recent Death in Direct Provision: “is deeply traumatic… among people who escaped deeply traumatic experiences and have often experienced trauma on their migration journey.”
Trauma… that’s what’s being reported by Human Rights Watch too, on the outer edges of Europe where they describe Greek Island refugee camps, ill-prepared for COVID19: ‘Greek authorities have not done enough to address the acute overcrowding and lack of health care, access to adequate water, sanitation, and hygiene products to limit the spread of Covid-19 in camps for asylum seekers’. They call upon Greece’s government to ‘immediately take measures to… avert a public health crisis in environments where “Even handwashing and social distancing are impossible in these circumstances".'
In the Mediterranean Sea itself, the emergence of COVID19 is reported as being used as an excuse not to action the rescue of people in boats within Maltese and Italian Sea Action Rescue zones, leaving people to die of dehydration. Such fatal decisions make activists trying to save lives on the edges of Europe question why, for example, the International Office of Migration “seeks to criminalize so-called "irregular" migration instead of defending the rights of people on migration routes?" They conclude that COVID19 is being weaponised in defence of fortress Europe while the people on those migration routes continue to be UNABLE to do 1. or live in 2.
RAPAR didn’t know the Kanlungan Filipino Consortium before COVID19 but in practically no time our shared commitment to secure healthcare, housing and food for all has forged an indissoluble bond. Illustrating another example of how COVID19 is being weaponised, its coordinator Susan Cueva told us yesterday: "In the Philippines destitution and hunger are growing, especially in urban poor areas as the government’s lockdown measures mean thousands have lost their incomes with no effective measures of government support. President Duterte has ordered his military to shoot-to-kill protestors: on 21 April Winston Ragos, a retired resident in an urban poor area of Manila was shot dead on the spot by soldiers who claim he was violating the lockdown."
Similarly, messages to RAPAR members from family, friends and comrades around the world describe lives becoming evermore difficult in the shadow of COVID19. Alongside every documented worker in the UK whose pleas for PPE and competent testing mechanisms remain unanswered, and every migrant worker in, for example, Singapore who is now experiencing a new 'hard end' as COVID19 resurges there, our Members and our Networks - already in deep distress at the UK and Irish Governments’ blanket non-response, to date, to our call - are also experiencing layer-cake levels of insult: they are stacking on top of our injuries, that are on top of our compounded traumas, that are on top of our original traumas, and if it wasn’t for the knowledge that we will never give up, and therefore we will succeed, the State we’re in would defy description.
When we’re not pulling our hair out we’re scratching our heads at the managerial classes, as in those working to manage the pandemic on behalf of failing States. For example, there is a COVID19 policy google group fronted by the British Red Cross that composes the visible communication interface between the British Home Office and those organisations working in ‘migration’, particularly ‘asylum’ and invited to its network. This very morning the Refugee Council of Great Britain used this google group to tell workers in the sector that ‘the majority of the [Home Office] Statelessness Determination Team are now back up and running’…. The question is, where exactly are they running to?
Some musical salve?
It is one month today since RAPAR published its first response to the emergence of COVID19.
It is one month minus one day since its first public statement and press release called upon the State to suspend all detention and deportation activities, including legal processes, and invite all undocumented, displaced and destitute people, i.e. those most acutely vulnerable to COVID-19, to come forward for safe housing, without fear of being snatched or locked up, and so that they may contribute, openly, to making the population as safe as possible. This grounded the Open Letter Petition that anyone can sign here.
RAPAR Patron, Mark George Q.C. says: “The current health crisis has shown us all that when necessary governments take all sorts of action they would not normally consider taking. Now we need the government to take this important action to protect the health and welfare of everyone in our society.”
In the last 24 hours, RAPAR has been:
RAPAR Patron, Canon Professor Nicholas Sagovsky says: 'The Covid-19 crisis has shown us how reliant the NHS and carehomes are on people from many countries who have made Britain their home. Sadly, a growing number have given their lives caring for others. RAPAR is showing us that for many migrants, especially the undocumented, it is impossible to remain safe. This is not acceptable and must be changed.'
Over ten years ago, sitting in the garden of a house inside the Westminster village, a RAPAR member was in discussion with a Lord whose family had been vested with the title in the 1100’s. He observed “The ruling class have perfected the art of doing nothing. They grind you down by doing nothing.”
When people know that what they are doing - or failing to do - is both completely avoidable and deadly, they are committing crimes against humanity.
Today, I'm a part of you dear.
For any Government to call itself Democratic it must be prepared to
Furthermore, however much time is available, fear inhibits learning (see esp. page 16) and so, at this juncture, let’s remember and reflect on Marie Curie’s words:
“Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that we may fear less.” Maybe Marie can help us to work out how we can minimise fear and maximise #healthandsafetyforall.
The ‘hostile environment’* was up and running long before ‘COVID19’ developed. And the Institutionalised Racism upon which the Hostile Environment rests was identified half a century ago.
Yesterday, the New York Times carried a quote about this very issue from Professor Aneez Esmail. He is the leader of our campaign for the Registration of Medical Professionals in the UK and you can read Professor Esmail’s comment, following the publication of that NY Times article, here.
Hostility breeds fear: that’s exactly what it is intended to do. How much fear is out there? And how quickly can the people and organisations who reject both institutionalised racism and the hostile environment learn?
People who are Destitute + Documented + in the UK = DDUK = People…
who are denied the right to work legally and who the Government knows are in the UK, somewhere. The Government knows they are in the UK somewhere because they are either:
Are you Destitute and Undocumented in the UK (DUUK)?
People who are Destitute + Undocumented + in UK = DUUK = British People and Anyone Else…
who has no address, which means that the Government does not know exactly where they are right now, there is no lawyer currently on their case, and/or they don't have paper 'proofs' about who they are, like birth certificates or household bills. If they are not British they have also been denied the right to work legally. All of them have fallen through the cracks of either:
“With Covid19 our situation has worsened. Some cases have been suspended altogether, and people cannot meet their lawyers to discuss issues relating to their cases. They are hoping for their cases to be treated and to be given the freedom they deserve but they are not getting this. They live with friends who are sharing their shelter with them or through charitable hosts set up to help destitute people. Essentially, they are living with people who were strangers to them before they became destitute and who have offered them places to stay.
Very few people seeking asylum have phones and the few who do are unable to top up their phones so it is even more difficult for them to connect with their support networks. Some have laptops but cannot gain access to wifi. This has greatly slowed down the support and advocacy activities the people had developed within our communities. It is a trying moment for most of us because we have no way of getting any money to buy top ups or wifi connection. Practically all the organisations that used to support us with bus fees to travel to get their food, or join in on their events, have now been closed down and, in fact, accessing food has become a very big problem.
Many of the charitable organisations that people knew, that used to provide food or help us with food banks weekly, they are closed. Worst of all is the fact that some people are on the verge of being thrown out of their homes and it will be even more difficult for them to survive on the street.”
On Easter Sunday, RAPAR member Mary, Destitute and Undocumented in the UK, DUUK, sent this photo and writing:
“RAPAR gave me good encouragement the other day, by saying to stay strong because the next day one of the lady that I work with she text me to come as she was missing seeing somebody. Then I call her she was crying as she was having some problem and I remember RAPAR said to be strong. So I had to be strong for other people and she was happy when she saw me she gave me food and some money. I keep remembering what you said. We have to be strong for each other. Some days I feel a bit low but I keep remembering what you said to me. Before this, I worked in a shop in xxx. Then I did caring and now I am working in family homes. I wasn't interested in working in people's home but out of it good came. I met good people who understand my situation and are helping me.”
For almost 20 years, since it first began to systematically evict people failed by the migration system into destitution the British State has stoked a fire. But, thankfully, no human being is an island, including the human beings who live in countries that also happen to be islands. A ‘fog of war’*** surrounds us ALL. With each other’s help, can we clear our vision sufficiently to enable ourselves and each other to think out loud, reach rational decisions together and act accordingly?
At this juncture, the only actions that are any use are those based in truthful information: concrete and real, coming from comprehensive, accurate, valid and reliable information sources that are as near to ‘objective’ reality as possible i.e. not intrinsically biased because of the way in which their ‘facts’ have been created.
In the 1990’s, Patricia Hill Collins explained to us : 'For any body of knowledge, new knowledge claims must be consistent with an existing body of knowledge that the group controlling the interpretive context accepts as true.’ She went on to say, ‘The methods used to validate knowledge claims must be acceptable to the group controlling the knowledge validation process.' Her truth invites us to walk in the footsteps of the sociolinquistic theorist Volosinov, who developed a theory of 'language creation from below'. We’ll come back, another day, to retrace those footsteps but, in the meantime, here’s a pdf of his book .
On Easter Sunday, one mainstream press article advised us, statistics wise, about what can we trust and what should we ignore. It began with the assertion that statistics about ‘the number of people who have actually become infected… depend[s] crucially on the testing regime.’
Of course, it’s a massive challenge to decide what to publish on the internet but, if it’s going to be of real use for the overwhelming majority of people, then whatever is published must be precise.
In a Journal of Advanced Nursing website blog about problems with the government lockdown, its first point ‘There might be a real increase in cases but there is a form of categorization occurring in the NHS where deaths with the non-specific symptoms of SARS-CoV-2 (the presumed viral agent)(Covid19 is the disease) are being attributed to SARS-CoV-2 without serological or laboratory (tissue culture) confirmation.’ prompts many questions. As does its third point: The tests for Covid19 are not yet calibrated to different populations like those without symptoms. ‘Died after testing positive for Covid19’ (what we hear daily in the media) is not the same as ‘died due to Covid19’ which is an evidence-based statement of disease causation. This Easter Rising blog began with a Clinical Governance-based reference to how organisations learn. Just in is this early release (due out May 2020) paper from the Centres for Disease Control and Prevention about Emerging Infectious Diseases. Public Health England, the UK Department of Health and the medical Royal Colleges must take the time to respond to all the points being raised through these scientific critiques from JAN and CDC.
And while we’re on the subject of timely responses…
As yet, the Office of the UK Prime Minister has neither acknowledged, nor responded to our Open Letter sent to Downing Street on 27th March and now platformed as a petition for anyone to sign. The Office of the Irish Taoiseach has advised us that he referred our letter to the Minister for Justice and Equality , but that Minister received his own copy of our Open letter at the same time as the Taoiseach and, like Number 10, his Office hasn’t responded, as yet.
It isn’t the first time: See Channel 4 in the spring of 2016 in News from Calais.
While we wait, and rest assured we’re not holding our breath, our Filipino Sisters and Brothers are preparing shrines to honour their dead, and our Congolese Sisters and Brothers who continue to mourn their deaths, are also asserting are lives.
For any Government to call itself Democratic it must be prepared to subject itself to scrutiny, hold itself to account and engage with its population, whether they are ‘Citizens’ or not.
For those of you who’ve arrived here… we hope you enjoy this.
*Moran RA, (2003). Clinical Governance: An International Journal. Volume 8 Number 1 pp. 46-56
**Also see Forthcoming, McMahon G. and Moran R.A. (2020) Young people seeking asylum: voice and activism in a ‘hostile environment’. In Young people’s participation, Revisiting youth and inequalities, editors, Maria Bruselius-Jensen, Ilaria Pitti and Kay Tisda. Bristol, Policy Press
***According to Wikipedia, the first known use of the exact phrase "fog of war" in text only dates to 1896, described as "the state of ignorance in which commanders frequently find themselves as regards the real strength and position, not only of their foes, but also of their friends." “The fog of war” by Col. Lonsdale Hale, Royal Engineers (retired), Aldershot Military Academy, March 24, 1896.
Undocumented Workers now looking after British Elders in Care Homes and Irish Carer workers still stuck in Direct Provision Centres
Today, a representative from a Filipino community organisation, which advocates on behalf of frontline nurses and care home workers in the UK, including undocumented workers who lost their jobs in the current crisis and who cannot access any State support, contacted RAPAR. Deaths attributed to the coronavirus have occurred among undocumented workers in the Filipino community.
The representative described how one such worker, Rose, forced to leave her care home job because of Home Office changes to requirements for visas for migrant care worker, is living in a British City with six other undocumented people in cramped accommodation. Rose is surviving from the money she is getting from the children of British elders who are paying her to go into the nursing home where their parents live to look after them.
No one outside of an environment where they can self isolate as needed, stay clean, and maintain social distancing has the power to follow the Public Health directives necessary to limit COVID19 viral transmission to the absolute minimum. Anyone can now sign the Open Letter petition, launched by 37 organisations across Ireland and the UK, with receipt now signed for at Downing Street and the Dublin offices of the Taoiseach, calling upon the UK Prime Minister and the Taoiseach of Ireland to use their vested powers to instruct the British and Irish States to act immediately and in all ways necessary so that ALL undocumented people, destitute people and migrant people in legal process in both the UK and Ireland are granted Status Now: Leave to Remain.
Also today, MASI (Movement of Asylum Seekers in Ireland) told RAPAR “People seeking asylum in Ireland who work as care givers are risking their lives to protect the Irish people and are still having to return to over-populated rooms in Direct Provision Centres. The number of people in the Centres who are presenting with COVID-19 symptoms keeps on growing, yet no one from the Irish Government is disclosing the number of people living in Direct Provision who are testing positive. We call on the Irish Government to house Carer Workers alongside everyone else currently in Direct Provision, in safe places from which they may continue their exceptional work caring for others.”
The Irish and British Governments have the power to enable undocumented people, immediately, to care and protect themselves, their loved ones and their living and working communities. RAPAR asks “When will they stop moving the deckchairs*, use their power and save lives?” (*move (the) deckchairs on the Titanic’: To partake in or undertake some task, activity, or course of action that will ultimately prove trivial or futile in its possible effect or outcome.
64Open Letter to UK Prime Minister Boris Johnson and Irish Taoiseach Leo Varadkar is calling on both governments to create access to health and safety for all. People can sign the petition, just launched, HERE.
The Open Letter, which has been signed by 64 organisations (as at 17th June 2020) in the UK and Ireland, says it is imperative that everyone’s basic needs are met during the current Covid-19 pandemic and the only way to ensure this happens is by giving Leave to Remain to all refugees and migrants both inside and outside of the asylum and immigration system.
People living in extreme poverty, destitution and without immigration status are unable to socially isolate, many cannot access health care and other support, and they are prevented from helping to make the population as safe as possible during this time of global crisis. Migrant people who are in the legal system cannot keep physically safe on their allowances because those allowances are not enough for them to eat healthily or buy appropriate cleaning materials. Many are living in accommodation where it is impossible for them to socially isolate.
People who are destitute or undocumented fear what will happen to them if they identify themselves. They cannot access healthcare, emergency shelter and food. Or report or seek protection from domestic violence, rape, exploitation and other abuses – the levels of which are already rising.
One of the signatories to the Open Letter, All African Women’s Group, said:
“Many of us are living in dangerous and abusive conditions, either in slum asylum hostels or as unwelcome guests in other people’s homes. We need money of our own and the right to stay. Now is the time for the government to take practical measures to prevent infection. Now is not a time for racism, segregation, enforced destitution or a hostile environment for anyone. We will only survive if everyone has status in the UK and can get food, healthcare and housing.”
Black Women’s Rape Action Project added: “We know that domestic violence has soared but what remains hidden is the violence and exploitation against women seeking asylum, or with no status, who have been left dependant on others for their survival. Women must have the right to stay and an independent income and housing so they can be safe.”
ATD Fourth World UK said: "Now, more than ever, it is imperative to ensure that the most vulnerable of us are protected. Those in immigration limbo are overlooked, unsupported and left to struggle; the COVID 19 pandemic once again shows the fragility of their existence and we call for them to receive the care and attention we all deserve, not just now, but always.
"Although we are glad to see some public policy measures being taken to mitigate the impact of Covid-19 on people in deep poverty, we are reminded that it is only on the ground that it is possible to measure that impact and to understand whether policies are actually reaching their intended beneficiaries. Expertise by experience is essential to getting the response right, as demonstrated by this Open Letter."
Fizza Qureshi, CEO of Migrant Rights’ Network: "At a time of an unprecedented public health crisis, we need this government to react with a humane response so no migrant fears accessing healthcare, or any other service they need. MRN along with others urges the UK government to offer legal status to all undocumented migrants, and those awaiting a decision on their immigration claim, and on public health grounds because everyone deserves safety and protection during these difficult times."
Lucky Khambule, co-ordinator of MASI – Movement of Asylum Seekers in Ireland, says: “Since the start of the Covid19, MASI has always been critical of the way the Department for Justice and Equality responded in assuring the safety of those seeking asylum and living in direct provision. Currently there are over 60 direct provision centres and emergency hotels accommodating, with about 7,500 asylum seekers in the Ireland. For the past 14 months there has been an increase in the number of new applications and this has made the government accommodate people beyond centres’ capacity.
“The life style and living arrangements in direct provision is a recipe for disaster and should there be an outbreak in any of the centres, it would be very difficult for the department to cope. There is no social distancing as advised by the HSE, it is impossible for those living in direct provision as they are forced to share the same space with no privacy as all.
“Even the suggested on site isolation rooms are a joke as they put six to eight beds in one room very close to each other. We have been proactive in letting the Justice Minister and his colleagues know our concerns and made suggestions on what the immediate attention should be. On the 18th March 2020, we wrote to the Minister and amongst other things, we requested that all vulnerable people above 60 years and on long term illnesses be moved immediately from the direct provision set up and housed in a safer environment.”
Dr Rhetta Moran, from RAPAR, added: “Deeds not words save lives and create futures worth living.”
Please contact admin(at)rapar.org.uk for more information.
Call for refugee Doctors to be fast-tracked into the NHS- two years after RAPAR launched a similar campaign.
12th April 2020 Update
Our Campaign leader, Professor Esmail was quoted yesterday in the New York Times. Today he tells us:
"The COVID-19 pandemic had laid bare the reliance of the NHS on migrant labour. Nearly 40% of doctors are from BME backgrounds (the majority qualifying abroad). They are currently bearing the brunt of the burden in terms of deaths in the workforce probably because they work in the most deprived and therefore under resourced parts of the NHS. When this emergency is over the sacrifice of these people should be acknowledged and the contribution of all BAME staff to the NHS recognised and rewarded. The NHS represents the best of Britain because it is so international and diverse."
Refugee doctors say:
"LET US WORK TO HELP CORONAVIRUS PATIENTS IN THE UK"
More refugee doctors have come forward to offer their skills to the NHS during the increasingly grim battle with the Coronavirus pandemic.
Two years ago, RAPAR joined refugee doctors to launch a campaign which called for the unrealistically high levels of English language testing to be reviewed and relaxed so that many more highly qualified doctors, nurses and other medical professionals could work in the NHS.
See ITV news item this week which features a Syrian doctor.
The group of medical professionals we have been campaigning with have signed an Open Letter sent by 37 organisations to Prime Minister Boris Johnson and Irish Taoiseach Leo Varadkar. Nearly 1,000 individuals, groups and organisations have signed the petition.
Dr Aneez Esmail, Professor of General Practice at Manchester University Medical School, has backed our campaign from the start. Read his article here in the medical magazine Pulse.
"It is deeply disappointing that just as the NHS faces an acute shortage of medics, hundreds of doctors, including potential GPs, are being excluded from joining the workforce because of an arbitrary change in English language proficiency standards.
At a press conference to raise this issue, I spoke to four doctors in the audience all of whom are legally entitled to live and work in the UK because they are refugees or have been given leave to remain.
They are all highly experienced having worked in Sudan, Iraq and the Congo in very difficult situations. They spoke fluent English – conversing easily with me as they explained their background. Yet none are practising as doctors in the UK because they failed the first hurdle in trying to get registration to work as doctors in the UK.
Current regulations require them to score 7.5 in the International Language Testing System (IELTS). All had previously sat the exam and scored 7, but in 2016 the GMC raised the bar for people wanting to register for the next stage of the registration process – which requires doctors seeking UK registration to sit the Professional and Linguistic Assessments Boards (PLAB) test – to 7.5.
The test does not reflect the skills required for good communication in medicine
It might seem an inconsequential change, but this has barred hundreds of doctors seeking registration in the UK. The IELTS test is graded in bands and skills are assessed in speaking, listening, reading and writing. At Band 7 the person’s standard of English is considered ‘Good’ – meaning they would handle complex language well and understand detailed reasoning. To give an idea of the standard, students from non-English language speaking countries wishing to study in the UK would be required to have an IELTS score between Bands 6 and 7 by most Russell Group universities.
It is essential that everyone seeking to practice medicine in the UK has excellent communication skills – it’s a central skill in medicine and it is right that language skills are assessed and only those shown to speak English at a high standard should be allowed to register and practice medicine.
But the IELTS is designed for academic study and does not properly reflect the skills required for good communication in medicine. It’s partly in recognition of this that the GMC has recently introduced the Occupational Exam Test (OET), which more accurately reflects the level of English needed to practice medicine.
The OET was developed in Australia (where the IELTS requirement is Band 7) and many doctors believe it will be a better assessment of English required to practice medicine here. However, the exam is prohibitively expensive for doctors in this situation, costing three times as much as the IELTS – which many have already paid to sit.
Interestingly, the UK regulatory bodies for pharmacists and dentists set the level of IELTS at 7 and 6.5 respectively.
In the UK, we face a shortage of doctors in a range of specialties including general practice. We have a group of doctors, the majority of them highly experienced, who have ended up in the UK and who are desperate to contribute their skills and expertise.
Setting the standard at an arbitrary level (there is no evidence that having a score of 7.5 as opposed to 7 makes the doctor any safer or better) is not the best way of determining whether someone is able to practice medicine. This approach subordinates people to policy, denying employment to a group of people who almost certainly have the experience and talent to help us deal with an acute shortage of doctors.
We need to support this group of doctors through tests that we have set – most of them legitimate – so that we can use their skills to contribute to the NHS. We could help by offering dedicated training to learn the conversational skills required for medicine in the OET, offering loans so that they can attend the courses to help them do this. We should also avoid setting arbitrary test scores that don’t test the specific requirement for language skills for the practice of medicine.
This is a waste of talent that we need now. Amongst the many hundreds of doctors caught in this state of limbo, there are doubtless a large number of GPs who with the right help and training could help relieve the acute shortage that we are facing, rather than waiting for the promised 5,000 new GPs in five years’ time."
For more information about the campaign see here.
On 26th March 2020, RAPAR blogged:
As tonight’s call went out for the country to Clap For the NHS, health workers and MPs were clamouring for the Government to fast track the registration of refugee doctors in the UK.
Instead of using their skills to care for people who have been hospitalised because of the Covid-19 pandemic, refugee doctors and other health professionals have been forced to work as taxi drivers and in takeaways because the re-accreditation process in the UK is lengthy, expensive and onerous.
Dr Mohammad Haqmal, a refugee from Afghanistan, told The Guardian newspaper that his background in public health and specifically HIV meant he had a lot to offer in the fight against the pandemic. He works in medical research but did not go through the re-accreditation process as a doctor because of the difficulties and expense. He knows many qualified doctors who are driving taxis and working as shopkeepers when they would rather be treating patients.
Under pressure and with an increasing number of health workers falling ill themselves, Health Secretary Matt Hancock has said he will look at the proposal to expedite qualified doctors from overseas into the NHS.
Yet just over two years ago, when NHS cuts continued to threaten the lives of patients and the well-being of health workers, RAPAR worked with a group of medical professionals to launch a campaign calling for the registration process to be less complicated, less onerous and less expensive.
Five hundred medical professionals signed up to the campaign and hundreds more signed a petition. Despite coverage in the medical press and widespread lobbying of MPs, the call was ignored – to the frustration of the refugee doctors themselves and leading NHS medical staff.
Dr Aneez Esmail, Professor of General Practice at the University of Manchester’s Medical School, backed the campaign and said at the time: “When the NHS is really desperate for extra staff, it is strange that there is a failure to recognise the contribution that refugee doctors and other medical professionals from outside the UK can make.”
Dr Hiba Alzamzamy, one of the campaign founders, produced research exposing the unrealistically high level of English testing set by the General Medical Council – one of the barriers to re-accreditation. She said: “We are highly skilled people who want to help patients at a time when the NHS is in crisis.”
It has taken a pandemic for the Government to be forced to listen to that plea.
For more information about the campaign see here.