Healthcare for immigrants – an issue of justice

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From 23 October, there will be a legal obligation on every hospital department in England to check every patient’s immigration status before treating them, to see if they are required to pay for their care. In addition, charges are being extended to community health services. An open letter has been written to Jeremy Hunt protesting the implementation of these regulations without debate or evaluation of impact and long-term costs. The regulations affect many who are already vulnerable including those whose application for asylum has been refused.

For several years now, refused asylum seekers in England without the right to work and with no government support, most of whom are also homeless, have been chargeable for most secondary care. They will now face up-front charges for non-urgent care and will be chargeable for a range of community health services including community midwifery and health visiting, and community mental health care.  This deters vulnerable immigrants from accessing healthcare, even that to which they are entitled, as does the recent ‘memorandum of understanding’ between the Home Office, the Department of Health and NHS Digital under which non-clinical details including addresses of patients are shared with immigration enforcement authorities.

Why should individual Christians, churches and organisations such as CMF be concerned about this?

These regulations demonstrate injustice and lack of concern for the poor and needy. These are prominent themes throughout the Bible.  Arrogance and indifference characterised the godlessness for which Sodom was condemned. The story of Joseph is an example of personal experience of injustice which can be inflicted by a jealous family member, another vindictive individual or a cruel system.  The treatment of the Israelites in Egypt is an example of injustice against foreigners as a minority group. It illustrates how laws can become increasingly draconian and harsh due to prejudice or fear.

If there is one group of people in the UK who are currently facing injustice and mistreatment, whom the UK government are actively encouraging us to regard with suspicion and hostility, it must be foreigners and in particular those currently seeking asylum or trying to enter the country to do so.  This includes a ‘culture of disbelief’ with resultant poor decision-making noted in numerous reports on the UK asylum system and a ‘hostile environment’ towards those regarded as illegal immigrants.

There are many consequences of this, including homelessness and destitution as government policy towards those refused asylum, indefinite detention in centres with widespread abuse (including employing detainees for £1/hour who are not permitted to work in the community), and restriction of access to healthcare resulting in for example a three-fold increased maternal mortality of asylum-seeking women.

Those in the family, workplace, neighbourhood or country in which injustice takes place can stand against it and act to protect those affected- though this stance may risk their own comfort or safety.  God honours those who do so- we see this in the example of the Egyptian midwives who refused to kill the Hebrew babies despite Pharoah’s order.

Many churches and individual Christians are actively involved in reaching out to refugees and other foreigners. This is surely evidence of the Holy Spirit’s work causing us to fulfil God’s command to protect the stranger from mistreatment and the identification of Jesus himself with the stranger – he himself had been a refugee.

However, we are also commanded not to keep quiet in the face of policies which cause suffering: ‘Speak up for those who cannot speak up for themselves, for the rights of those who are destitute. Speak up and judge fairly; defend the rights of the poor and needy’ (Prov. 31: 8-9). Or as Jim Wallis put it, ‘Our calling is not only to pull people out of the river, but to go upstream to find out who or what is pushing them in’.

Sometimes as Christians we want to receive recognition from our society for our good works or demonstrate only a concern about our own religious freedom or limited issues related to sexuality or personal morality. Other issues of widespread concern such as human trafficking can too readily be separated in our thinking from economic policy or asylum legislation which promotes them.  However, as has been noted by authors such as Tim Keller (‘The Reason for God’, ‘Generous Justice’), young adults are at the forefront of changing attitudes in many evangelical churches in promoting social justice as well as social action, recognising that these cannot be separated from evangelism and discipleship.

Christian organisations, churches and denominations need to be prepared to openly criticise and campaign against government policies such as this one which are unjust and cause suffering and exploitation to the vulnerable and voiceless in our nation.


Becky Macfarlane is a GP in Glasgow




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