1. Inclusive Centenaries Conference NUI Galway, June 2016 Iryna Pokhilo: Cairde

2. “The Republic guarantees religious and civil liberty, equal rights and equal opportunities of all its citizens, and declares its resolve to pursue the happiness and prosperity of the whole nation and of all its parts, cherishing all the children of the nation equally…” 1916 Proclamation of the Irish Republic

3. Ireland in 1916 “…exiled children in America “ 1916 Proclamation Ireland in 2016 Diverse and multicultural society Census 2011: number of people identified as being born outside Ireland - 766,770 Any other white background- 412,975 African- 58,697 Asian background- 66,858 Chinese- 17,832 Mixed background – 40,724 There are an estimated 7,937 people in the asylum system, 55% (4,350) have been in the system for over five years. 21% of the total are children (June 2015)

4. Health Inequalities Vulnerable groups: Roma, Travellers, asylum seekers, undocumented people, homeless people, women and children experiencing violence. Marginalised groups not often a priority in broader schemes….”one size fits all approach” Fragmentation and inconsistencies in service provision Impact of socio-economic deprivation on health “Inverse care law” – those most likely to need services are less likely to get them

5. Health Inequalities Social determinants of health “ Inequalities in health arise because of inequalities in society – in the conditions in which people are born, grow, live, work and age" Sir Michael Marmot, 2010, President of the World Medical Association Gender and age Immigration status Accommodation Unemployment Education Healthcare Nutrition, water etc.…

6. Current challenges Immigration Status – undocumented people, asylum seekers Accommodation -homelessness, direct provision as “ an open prison” Unemployment – people in the asylum process are not allowed to work, loss of skills and creation of dependency Education – 3 rd level education is not available for asylum seekers Gender – gender-based violence, access to maternity services for undocumented women, crisis pregnancy Nutrition- poor quality of food and lack of cooking facilities in direct provision centres

7. Current challenges Mental Health and Wellbeing Racism and discrimination Stigma attached to mental illness Gender-based violence Post-traumatic Stress Disorder Pre-migration, migration and post-migration stress Higher levels of depression amongst asylum seekers Institutionalisation and isolation in DP centres Inadequate provision of mental health services

8. Equity in Health Examples of good practice Specialist FGM clinic Roma GP busses Ethnic Equality monitoring Emergency Multilingual Aid Recommendations Full implementation of McMahon’s report Holistic approach to health with taking into account a burden of disease (medical, psychological and social needs) Reduction in time people spend in Direct Provision Access to medical cards for asylum seekers who reside outside Direct Provision (means test) Mental health screening for asylum seekers as part of multidisciplinary assessment Mental health awareness training for staff in Direct Provision

9. Thank you! Contact details: Iryna Pokhilo Cairde 19 Belvedere Place Dublin 1 Tel: 018552111 www.cairde.ie