PITCH: Observations on the continued need for improved access to healthcare in northern France and Belgium following the dismantling of the 'Jungle', following a healthcare professional visit in September 2017.
Problem
Background: In October 2016 the French government dismantled the main refugee camp in Calais known as the 'Jungle' and sent people to asylum reception centres. Many did not leave but moved to informal settlements around Northern France and Brussels. As of September 2017, there were an estimated 700 refugees, including 120 unaccompanied children but little has been documented about the health conditions experienced and healthcare provision available.
Aim: Establish the health needs and healthcare provision available to refugees in Northern France.
Approach
Study design: Service mapping and stakeholder analysis.
Methods: A group of health professionals visited Calais in September 2017. The group was multilingual (French, Spanish, Italian, Arabic, Kurdish) to enable accurate stakeholder analysis. Due to the numerous settlements instead of a single camp it has become methodologically difficult to access refugees, so mobile first aid clinics run at already established food distributions were used as the main point of access. Service mapping was performed through an iterative process using stakeholder analysis, online searches and site visits. Resources on the site visits and demographics and morbidities of refugees who attended clinics were recorded.
Findings
There were two governmental organisations; Calais Hospital and Dunkirk Hospital Centre of which the former was the only service to offer out-of-hours access. Many refugees were refused access here due to documentation and language barriers. 'The Pass' sexual health clinic operated Monday to Friday. There were three health-specific aid groups operating, Doctors of the World (DotW), Red Cross, and First Aid Support Team. Due to legalities only DotW provided medical clinics, the others offered basic first aid and advocacy. Volunteer numbers were fluctuant and unpredictable. There were numerous other grass-roots aid organisations.
The majority of refugees seen were males aged 14-30. The main health conditions seen were scabies, fungal foot infections, diarrhoea, musculoskeletal pains, dehydration, respiratory tract infections, malnutrition, poor dental health, and mental health conditions. There were also numerous injuries related to attempts to cross over to England. There was very limited access to prescription medications. Of the over-the-counter medications donated many were out-of-date. Provision of basic human rights such a sanitation, water, food and shelter were extremely limited. Individuals reported rapid confiscation of sleeping bags and tents by French authorities and some had resorted to sleeping in sewers.
Consequences
Conclusion: Services available to refugees in Northern France are fragmented, short of resources and unsustainable as they are largely provided by volunteers. Extremely limited access to adequate living conditions, preventative medicine, education, and prescription medications is likely to result in deterioration of chronic disease, mental health problems and spread of infectious diseases.
Recommendations: Raise awareness of refugees needs since dismantlement of the 'Jungle'. Further assessment is recommended for health needs of women and children.