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Clinicians caring for migrants need more support

Prof Cornelius Katona
Piyal Sen, Lauren Z Waterman, Grace Crowley, Mishka Pillay, Cornelius Katona
British Medical Journal

Recent political events, including the conflict in Ukraine, the Taliban takeover in Afghanistan, and the passing of the Nationality and Borders Bill, are set to worsen the effect of the UK’s immigration system on asylum seekers and other migrants with irregular immigration status. These developments widen the gulf between asylum seekers’ needs and what clinicians are allowed to do for them.

Concerns have been raised about the risks of moral injury, institutionalisation, and vicarious traumatisation for clinicians working in immigration detention and quasi-detention settings. For example, a clinician treating a suicidal detainee can prescribe medication and recommend close supervision but cannot influence their detention status, the most important factor contributing to their risk of suicide. Here, immigration status trumps a patient’s clinical need.

This editorial calls for nationally agreed standards to be be developed, co-produced by clinicians and experts by experience, to address the needs of healthcare staff and provide best clinical care for migrants. Professional medical bodies must support the introduction and monitoring of trauma informed practice in all settings housing migrants.

Professional bodies and individual clinicians should press for more ethical and socially just migration policies, including reforming the structures that perpetuate and aggravate migrant health inequities and create challenges for the health professionals who work with them. Health leaders should also call for better support and supervision for clinicians working with migrants, both in the community and in detention settings.