Relocating the asylum procedure: a dangerous gesture for health

The delocalization of the asylum procedure is not without precedent. Since 2001, successive Australian governments have supported a policy of mandatory detention of asylum seekers in Nauru and Manus Island, Papua New Guinea. Thousands of people, including children, have been detained indefinitely in poor conditions, suffering severe abuse, inhuman treatment and medical neglect. A survey found that 90% of inmates met the criteria for serious mental health problems, while medical care was often substandard. An Israeli program, introduced in 2013, forced migrants (mainly Eritreans and Sudanese) to choose either to return to their country or to settle in Rwanda or Uganda; not going both ways led to imprisonment. Those who opted for relocation were abused and exploited, and many fled through dangerous smuggling routes to Europe. The Australian and Israeli plans failed.

Rwanda has said it is committed to providing “adequate support to ensure the health, safety and well-being” of those relocated from the UK, but the details could hardly be vaguer. Migrants often have complex health care needs, post-traumatic stress disorder and depression are often common, and many may need urgent care for untreated communicable diseases and poorly controlled chronic conditions. Rwanda already hosts nearly 150,000 refugees and asylum seekers, mainly women and children from Burundi and the Democratic Republic of Congo; 90% of refugees and asylum seekers live in camps run by the UNHRC. For those transferred to Rwanda from the UK, it is unclear whether they will be cared for under Rwanda’s much-lauded universal healthcare system—Mutual health—built on principles of equity and people-centeredness. If the UK program is to go ahead, there will need to be comprehensive health care for these people. It is not right for the UK to relinquish its duty of care and instead place the burden on a health system, albeit an effective one, which relies on international aid, especially given the culture of repression under the autocratic government of President Paul Kagame. . Rwanda has an appalling human rights record with extrajudicial executions and severe restrictions on press freedom.

More generally, a position of hostility towards migrants is not good for health. Research shows that irregular migrants often avoid seeking treatment for early symptoms because they fear the risk of deportation. UK policy will only intensify this fear, leading to adverse health outcomes when migration is seen instead as an opportunity to provide healthcare. In fact, by not embracing immigration, the UK government is missing a vital opportunity to strengthen its own health sector. In 2018, UCL–Lancet The Commission on Migration and Health has argued that investing in migrant health pays off: healthy and successful immigrants bring significant benefits to societies and economies. Population projections have shown that net immigration will be needed to support labor markets, economic growth and social programs in countries, such as the UK, with low fertility rates. Immigrants have proven essential to the UK’s health workforce.

The policy does not address the treatment of refugees. It is nothing but mass deportation. If this goes ahead, the UK government will permanently damage the country’s global health record. Denmark recently legalized the outsourcing of the asylum process and reports indicate it is also considering a deal with Rwanda, similar to the UK’s. Relocation and resettlement policies should not be an option. Evidence, history and common sense show that they do very little for immigration numbers and only serve to increase human suffering. Last but not least, these practices are detrimental to the health and well-being of the individuals and countries that implement them.