Abused No More? Challenges Faced by Refugee and Asylum-seeking Women When Accessing Health Services in the UK Margaret Greenfields, IDRICS/Bucks New University & Natalia Paszkiewicz, IARS And the Refugee and Asylum-Seeking Women project participants HERON conference, 14 May 2014

About IARS IARS is a leading, international think-tank with a charitable mission to give everyone a chance to forge a safer, fairer and more inclusive society. We achieve our charitable aims by producing evidence-based solutions to current social problems, sharing best practice and by supporting young people and the community to shape decision making. IARS is an international expert in criminal justice, restorative justice, human rights and inclusion, citizenship and user-led research. IARS is known for robust, independent, evidence-based approach to solving current social problems, and we are considered a pioneer in user- involvement and the application of user-led research methods. IARS is also an independent publisher of high quality research in the areas of youth policy, criminal justice law reform, restorative justice, public legal education, equality, human rights and social sciences. To find out more, please visit 2

Three-year Comic Relief and Matrix Chambers funded project which is a user-led skills development and research programme forming an evidence-based awareness raising training for professionals and service providers focusing on the impact of gender-related violence on refugee and asylum-seeking women (RASW). The project aims to generate institutional change and increased gender sensitivity in the treatment of refugee and asylum-seeking women, both by harnessing existing research and by allowing the women themselves to identify the problems they currently face through Community-led action research. Prof Margaret Greenfields ‘Action Research With Refugee Women: Good Practice and Solutions to Community Participation’ Holly Challenger ‘Abused No More: The Voices of Refugee and Asylum- seeking Women’ 3 Abused No More: The Voices of Refugee and Asylum-seeking Women project

Process of the RASW project Challenger (IARS policy officer background in refugee studies) approaches Greenfields 2011 re design of programme. Scoping study/consultation with agencies and support groups Co-production of application (Comic Relief) 2012 – recruitment of 12 refugee and asylum seeking women (diverse communities/ages) to participate in Phase One of project – training as PAR co-researchers to undertake investigation into challenges experienced by RASW.

Series of 12 training sessions in relation to the programme Co-design of key subject areas to be explored Topic Guide development Interview Training Ethics/Self-Care/Referral etc. Joint analysis of findings (46 depth-interviews) Feed-in to publication format Dissemination and opportunities to proceed to Phase 2 – PHASE 2: development of training course for professionals and video production (designed and coordinated my Dr. Natalia Paszkiewicz

Research supports that of FRA (2011) Health research re Europe- wide study of intersectional exclusion/barriers to health access The importance of building trust and communicating empathy A need for more time The importance of the gender The role of human rights Problems with registering with GP practices Consistency of GP care Provision of language support services in GP services The use of informal interpreters in GP services 6 Key findings on healthcare

Health Education England should ensure that current and future GPs receive training on working sensitively with refugee women who have experienced gender-related violence. GP practices should provide double appointments for refugee women patients who require more time. NHS Commissioning Boards in areas of high refugee populations should consider the establishment of specialist services. GP practices should give refugee women a choice regarding the gender of the professionals that they come into contact with. Clear guidance should be issued to reception staff and GP practice managers regarding refugee and asylum seekers’ entitlements to healthcare and types of documentation that can be asked for as proof of address. We support the BMA’s view that practices should use their discretion and consider the individual circumstances of prospective patients. 7 Recommendations

Care must be taken at local practice level to ensure that refugee women receive continuity of healthcare and are seen by the same GP as much as possible. GP practices should create mechanisms to ensure that all GPs within the same practice are aware of vulnerable patients, and to make sure that these patients are not placed in situations where they will be asked insensitive questions. GP practices should issue hand held health records for refugee women patients in order to protect against the interruptions in healthcare being result of transient lifestyle and to ensure some continuity of care. Staff in GP practices should be issued clear guidance around accessing interpreting services and must ensure that professional interpreters are provided for all patients who need them. GPs should not encourage the use of family and friends as a ‘quick- fix’ approach. Training should be provided for GPs on how to use interpreters when working with refugee women with particular emphasis on refugee women who experienced gender-related violence. NHS commissioners in areas of high refugee populations should consider using a modified Quality and Outcomes Framework (QOF) to incentivise GP practices to provide professional interpreting services. 8 Recommendations continued

Short film: In search of health services – Reflections from Refugee and Asylum-seeking Women 9

To find out more about IARS, please visit If you would like to donate to our project, please visit the Big Give website