Vulnerability and migration during the pandemic in the UK: a wellbeing perspective

Problem

The impact of the Covid19 pandemic has been particularly severe for the health and wellbeing of disadvantaged and excluded populations. While the policy of ‘Everyone in’ for homeless people has been overall successful (Local Government Association 2020), inequalities have been exacerbated for migrant populations living in precarious situations (DOTW UK, 2020).

Approach

This presentation draws on data collected by Doctors of the World UK on 107 individuals or families with migrant backgrounds who contacted their telephone clinic during April and July 2020 to request help with accessing health services. This data consists of free text notes outlining details of the health concerns service users sought to address and the actions taken until the problem was resolved or contact with the service user was lost. A qualitative content analysis of the free text notes focused on the domains of service users’ health status, health services needed, current situation (work/ housing/ immigration status), barriers and facilitators to accessing health services and how their health concerns were resolved (or not). Within these domains, we assessed the ways in which Covid19 influenced service users’ health and wellbeing.

Findings

We found a range of impacts of the pandemic; some were direct i.e. reporting symptoms of Covid19, being unable to work or return home. In particular, several women who contacted DOTW to access antenatal care had lost their jobs due to Covid. However, indirect impacts were more widespread, including- DOTW clinics moving online; letters and documents now need to be sent to what could be a temporary address instead of handing over in person- Difficulty registering with a GP (being told the practice did not register new patients due to Covid19, having to contact practices remotely, complex registration apps)- Wider technological issues making contact and registration harder such as lost phone/ using someone else’s phone, running out of credit for internet access, no printer- Impacts particular to people in state-run accommodation (homeless, asylum seekers) such as being moved to a different hotel or reluctance to register people from a particular address- Mental health implications (worry, loneliness, feeling homesick)

Consequences

Our findings support the idea that Covid19 has exacerbated the situation of people with precarious or unregulated migration status. In our sample, the pandemic added barriers for people with already complex needs such as financial precarity (leading to unstable housing or digital exclusion) or existing physical and mental health conditions. Our analysis gives an indication of health needs and barriers to health access which are in all likelihood continuing. Primary care practitioners should be aware of these barriers and consider the impact that changes implemented due to Covid19 might have on patients at greatest risk of becoming vulnerable.