Afghan refugees and newly displaced populations: overview and principles
Published 25 April 2022
© Crown copyright 2022
This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gov.uk.
Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.
This publication is available at https://www.gov.uk/government/publications/individual-health-assessments-for-afghan-refugees/afghan-refugees-and-newly-displaced-populations-overview-and-principles
1. Overview
The UK is assisting the resettlement of Afghan refugees under the Afghan Relocations and Assistance Policy (ARAP) scheme and the Afghan citizens’ resettlement scheme (ACRS). In both these schemes, you should support new arrivals to register with a GP shortly after their arrival and attend a new patient health check.
This guidance outlines the best practice in undertaking health assessments of newly arrived Afghan refugees. It supplements guidance already published by the Office for Health Improvement and Disparities in its migrant health guide, including:
- advice for primary care professionals supporting people in the Afghan relocation and resettlement schemes
- advice and guidance on the health needs of migrant patients from Afghanistan
- advice and guidance on assessing new patients from overseas
2 Accessing healthcare
Afghan refugees under the ARAP and ACRS schemes have been granted refugee status. This means all newly arrived Afghan refugees have the same rights to access free healthcare through the NHS as UK residents. You can find more information in this video on entitlements to NHS services for migrants in England:
Entitlements to NHS services for migrants in England.
You should support refugees to understand their entitlement to healthcare. To help with this, we recommend that you share the NHS GP access card with refugees as they may reduce registration refusal once the patient has been re-settled to a new local authority.
If a practice does not routinely support new migrants to the UK, you should visit the Doctors of the World’s Safe Surgeries initiative. The Safe Surgeries initiative supports practices to be inclusive and tackle the barriers experienced by migrants in accessing healthcare.
It is likely that new arrivals will not be familiar with general practice and the role of primary care within the broader healthcare system. You can find information on when to visit various healthcare professionals online, including on:
Citizen’s Advice also provides a full list of services available on the NHS.
3. Main principles
3.1 Trauma-informed care
Refugees and asylum seekers can have complex health needs. They are also likely to have experienced significant psychological or physical trauma before, during and after their journey to the UK. So, it is important that health checks adopt a considered approach because this may be the first opportunity a person has had to talk about their needs. This includes creating a culture of safety, support, and empowerment, by using trauma-informed approaches. You should also provide support in people’s native language (where possible) and use media for different levels of literacy.
Guidance on trauma-informed practice includes:
- Substance Abuse and Mental Health Services Administration: Concept of Trauma and Guidance for a Trauma-Informed Approach
- The King’s Fund: Trauma Informed Care
- NHS Education for Scotland: National Trauma Training Programme Online Resources Summary
- Helen Bamber Foundation: Trauma Informed Code of Conduct
3.2 Language
It is essential that patients are able to communicate and understand the information provided and asked for in the health check. You should offer to provide an interpreter and translated health information to anyone unable to speak English. The 2 main languages spoken in Afghanistan are:
- Afghan Persian or Dari (78% of the population)
- Pashto (50% of the population)
You should always use a professional interpreter. It is not appropriate to rely on family members or friends as there is a risk of miscommunication, breach of confidentiality, and safeguarding concerns. Face-to-face interpretation is preferable for sensitive discussions. It is inappropriate to use children as interpreters.
If you provide written materials to patients, you should use simple and non-technical language, as well as using pictures and diagrams. Some refugees and migrants will speak English, but there are varying levels of literacy in this group, so make sure the patient can read in their own spoken language.
In the group of people staying in the bridging hotels in 2021 to 2022, the main oral languages spoken were Pashto, Dari, but also Urdu. You should check if the patient can easily understand any spoken or written information in different languages.
It is likely that some common concepts in the UK (such as children’s centres or food banks) will not exist within this particular tradition or culture, so you should try and explain these where possible.
3.3 Cultural inclusivity
Gender roles and dynamics in Afghanistan may be stricter than those in the UK. You should offer patients professional services from someone of their same gender to ensure they are comfortable, particularly for women.
Culture and religion can also affect health behaviours and attitudes. It is important that healthcare providers are sensitive to cultural differences and responsive to individual needs. You can access more information at:
- The Cultural Atlas’ Afghan cultural guide
- Public Health England guidance on culturally inclusive practice
4. Definitions
Asylum seeker
An asylum seeker is a person who has applied for protection as a refugee and is awaiting a decision on their claim. For more information, see the eligibility criteria in the government’s guidance on claiming asylum.
Migrant
According to the International Organisation for Migration’s Glossary on Migration, a migrant is any person who is moving or has moved across an international border or within a country away from their usual place of residence, regardless of:
- their legal status
- whether the movement is voluntary or involuntary
- what the causes for the movement are
- what the length of the stay is
Refugee
According to the Convention and Protocol Relating to the Status of Refugees, a refugee is someone who is unable or unwilling to return to their country of origin because they are afraid of being persecuted for their:
- race
- religion
- nationality
- membership of a particular social group
- political opinion