BARRIERS THAT REFUGEES AND ASYLUM SEEKERS FACE IN HEALTHCARE (Dissertation Sample)

BARRIERS THAT REFUGEES AND ASYLUM SEEKERS FACE IN HEALTHCARE Name: 2025 Final Project submitted in part fulfilment of the requirements for the BSc (Hons) Nursing University of the West of England. I certify that this is my own unaided work. Name: .......................................... Word Count: 5990 Final Project Options: Student Guide 2025/26 Table of Contents TOC \o "1-3" \h \z \u Table of Contents PAGEREF _Toc203660517 \h 2 Chapter 1: Introduction and Background PAGEREF _Toc203660518 \h 6 Research Questions PAGEREF _Toc203660519 \h 6 Chapter 2: Methodology PAGEREF _Toc203660520 \h 10 2.1 Rationale for a Literature Review PAGEREF _Toc203660521 \h 10 2.2 Research Framework PAGEREF _Toc203660522 \h 10 2.3 Search Strategy PAGEREF _Toc203660523 \h 11 2.4 Keywords and MeSH Terms PAGEREF _Toc203660524 \h 11 2.5 Inclusion and Exclusion Criteria PAGEREF _Toc203660525 \h 12 2.6 Search Outcomes PAGEREF _Toc203660526 \h 12 2.7 Critical Appraisal PAGEREF _Toc203660527 \h 13 2.8 Data Synthesis Approach PAGEREF _Toc203660528 \h 13 2.9 Limitations PAGEREF _Toc203660529 \h 13 Chapter 3: Results PAGEREF _Toc203660530 \h 15 3.1 Access and Registration Barriers in Primary Care PAGEREF _Toc203660531 \h 15 3.2 Psychological Distress and Mental Health Service Gaps PAGEREF _Toc203660532 \h 16 3.3 Cultural Insensitivity, Stigma, and Systemic Neglect PAGEREF _Toc203660533 \h 18 3.4 Coping Mechanisms, Workarounds and Good Practice Examples PAGEREF _Toc203660534 \h 20 Chapter 4: Discussion PAGEREF _Toc203660535 \h 23 4.1 Synthesis of Key Findings and Relation to Existing Knowledge PAGEREF _Toc203660536 \h 23 4.2 Implications for UK Nursing Practice PAGEREF _Toc203660537 \h 24 4.3 Limitations of the Review PAGEREF _Toc203660538 \h 25 4.4 Areas for Service and Practice Improvement PAGEREF _Toc203660539 \h 26 4.5 Recommendations for Future Research PAGEREF _Toc203660540 \h 27 Chapter 5: Reflection on Learning PAGEREF _Toc203660541 \h 28 5.1 Description and Feelings PAGEREF _Toc203660542 \h 28 5.2 Evaluation and Analysis PAGEREF _Toc203660543 \h 28 5.3 Conclusion and Action Plan PAGEREF _Toc203660544 \h 29 References PAGEREF _Toc203660545 \h 30 Appendix A PAGEREF _Toc203660546 \h 38 Appendix B PAGEREF _Toc203660547 \h 40 Abstract Introduction and Background Refugees and asylum seekers (RAS) in the United Kingdom experience disproportionate obstacles to care in the National Health Service (NHS), where there are policies aimed at ensuring universal access. Such impediments are language problems, administrative gatekeeping, cultural stigma and the psychological aspect of forced migration. The growing population of displaced people in the UK exerts pressure on healthcare systems to provide integrative, traumatised and equitable services and care. The literature review aims to examine the experience of RAS-related healthcare in the UK in order to isolate cancellations, cultural deficits, and points of good practice. Method and Design A qualitative literature study based on five databases (CINAHL, Medline, PubMed, PsycINFO, and Scopus) was chosen and implemented. Inclusion criteria were directed at the UK-based primary qualitative studies published within the period of 2013-2024. Nine studies were selected and subjected to critical appraisal using the CASP Qualitative Checklist and synthesised thematically. Four areas of thematic analysis were defined based on the following themes: obstacles to access to primary care, mental health care shortages, cultural insensitivity and discrimination, and coping strategies, such as frontline workarounds and engagement of the third sector. Conclusion The review revealed that while the NHS policy on universal access is favourable, its implementation has been inconsistent. Structure-based language barriers, inappropriate policy application by health administrators, and the lack of culturally effective care contribute to health disparities. The results indicate the necessity to introduce changes to the system itself, specific staff education, enhancement of the interpretation services, and long-term investments in culturally inclusive care. These effects are important to nursing practice, with implications for future service design and research. Keywords: Refugees, asylum seekers, NHS, healthcare access, primary care, mental health, cultural competence, language barriers, and stigma. Chapter 1: Introduction and Background Healthcare is one of the core human rights, and still, in the United Kingdom, the accessibility of asylum seekers and refugees to the National Health Service (NHS) is significantly hampered by several obstacles. The Refugee Council (2023) indicated that in the year ending March 2023, 75,492 asylum applications (about 91,047 people) were received in the UK, 33% more than during the previous 12 months. A rising inflow of refugees in the UK has increased the burden on healthcare road networks and practitioners to provide them with proper care using fair, culturally moral, and trauma-respected precautions. What is particularly interesting is the academic and clinical concern over the special healthcare vulnerabilities of displaced populations, especially those coming to the UK after being exposed to war, torture, persecution, or forced migration. Such individuals are mostly reported to have complicated physical complications that arise due to untreated injuries, highly contagious diseases, or chronic health conditions and psychological distress, including post-traumatic stress disorder (PTSD), depression, and anxiety (National Institute for Health and Care Excellence, 2018). According to the report prepared by Jones et al. (2022) for Doctors of the World UK, most of the citizens staying in the Napier Barracks have already had a history of depression, and one-third of them have experienced suicidal feelings, and the people are at risk of self-destruction in the poor conditions of isolation. In Australia, 60% of refugees and asylum seekers who were managed by the institutions of Médecins sans Frontières in Nauru intended suicide, and one in every three people had attempted suicide. According to Jones et al. (2022), two-thirds suffered from moderate or severe depression, 25% from anxiety disorders, and 18% from post-traumatic stress disorder. Research Questions What are the physical and psychological health challenges faced by refugees and asylum seekers in the UK? How do stigma, discrimination, and socioeconomic barriers affect their access to and experience within the NHS? Nevertheless, the situation with the NHS acknowledging and addressing such needs is different in different localities, and different service models and gaps are seen in access, continuity, and the suitability of care (James, 2019). Mental health has emerged as a significant issue. A survey carried out by the Refugee Council in England ascertained that 61% of asylum seekers suffer serious mental illness and are five times more likely to have mental health needs compared to the UK population (Laing, 2022). A study by Nyikavaranda et al. (2023) found that many young females face stigma in health settings, which have a low rate of service uptake due to various obstacles to accessing care, leading them not to seek help from family or services. This systematic review highlights the negative psychological effects of the long-term trend in asylum processing on asylum applicants (Shahzad, Katona, and Glover, 2025). On a regular basis, the waiting times can be long, sometimes exceeding the European standards, and they are related to the increased rates of depression, anxiety, and psychotic disorders. This shows that trauma-informed and culturally responsive mental healthcare is needed in the NHS. Stigma and discrimination in the healthcare sector also cause disparities. The impediments can be the lack of information about rights and the fear of paying to use services, the feeling of discrimination, the fear of being deported, and the inability to find the interpreters (Khanom et al., 2021). Asylum seekers and refugees encounter discrimination when seeking mental health support in the NHS, which overlaps with their race and disability. Linguistic and interpretation-related issues, treatment disparities, mistrust of mental health providers, and financial factors also impact access (Kienzler, 2024). These experiences do not only deter the use of health services but can also strengthen underlying trauma and mistrust. Notably, the evidence indicates that these experiences are not individual but represent more systemic problems in the healthcare delivery. Socioeconomic disadvantage significantly contributes to both health access and health outcomes. The asylum seekers in the UK are not allowed to work, and they normally live on low state benefits. According to research conducted by Rana, Kent, and Page (2025), insecure tenancy and financial constraints related to housing affected their capacity to have a healthy lifestyle and access nutritious food and other healthcare services. General practice websites in London found that 75% required documentation to register, but most of them phrased it as demanding (Worthing et al., 2022). Patients who lack access to documentation cite this as a factor, which prevents them from registering with a GP. Although policies supporting vulnerable individuals and groups have been established and include the guidance of NHS England regarding GP registration (NHS England, 2023) and the statutory guidance of the Department of Health and Social Care concerning equal access (DHSC, 2024), enforcement is uneven. These gaps show that there is a need to understand the interaction between stigma and institutional practices in clinical care in order to influence this group of patients. Nevertheless, it is also necessary to identify places where good practice can be observed. Asylum seekers and refugees are direct beneficiaries of the NHS Inclusion Health framework that is aimed at individuals normally s...