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RCGP Safeguarding toolkit

Part 2A: Identification of abuse and neglect

Caring for refugee and unaccompanied asylum seeking children (UASC)

Unaccompanied asylum seeking children are young people who have journeyed to the UK accompanied by a parent or legal guardian. They are automatically a looked-after child under the care of the local authority. They have full entitlement to free NHS care and other public services. Everyone is eligible to register with a GP practice.

The Refugee Council has a glossary of terminology relating to asylum seekers and refugees in the UK.

In the year ending September 2022, the UK received 5152 applications for asylum from unaccompanied children. Many come from Sudan but also from countries such as Iran, Eritrea, Afghanistan, Vietnam, Iraq, Albania, Ethiopia and Syria. The majority are aged between 14 and 17 years but some are younger. Children are also regularly trafficked into the UK to be forced into domestic servitude, sexual exploitation and other forms of forced labour including cannabis cultivation.

This cohort of children may be particularly vulnerable and are likely to have complex physical and mental health needs as well as social needs. Formal interpreters should be used when needed. Some of the areas of health needs are listed here:

  • Physical health:
    • Malnutrition, including stunted growth, obesity and micronutrient deficiencies.
    • Oral health.
    • Unrecognised or unmanaged chronic health conditions.
    • Low vaccine uptake.
    • Trauma and injury, which includes FGM (female genital mutilation).
    • Infections, e.g. tuberculosis, hepatitis B and C, HIV, malaria, leishmaniasis, filariasis, intestinal parasitosis, helminth infection, schistosomiasis, and sexually transmitted infections.
    • Health issues related to sexual trauma/exploitation, such as pregnancy and sexually transmitted infections.
    • Development.
    • Lack of health screening and health promotion (e.g. newborn screening, thyroid function, hearing and vision screening, dental care).
  • Mental health: there may be reactive, underlying and undiagnosed mental health needs. Below are some important issues to consider:
    • Traumatic experiences can include exposure to war and conflict, torture, physical and sexual abuse, detention in the UK or in transit. This may eventually be diagnosed as PTSD (post-traumatic stress disorder), but for some children the trauma is ongoing, with concern about family and managing the immigration system. The journey to the UK is often complex and long and children can accumulate trauma along this journey.
    • Exaggerated responses to normal emotional triggers may be a response to trauma and toxic stress. This needs to be taken into account when considering other conditions e.g. neurodevelopmental or trying to explain and support challenging behaviour.
    • Disruption of important routines e.g. activities of family life, play, education. This can have profound impacts on children particularly at vulnerable life phases e.g. attachment in infancy, independence during puberty.
    • Disruption to sleep, related to journeys and need to travel at night, fears for safety at night, flashbacks, lack of safe place, comfort toys/environment. This can have a negative impact on physical and emotional health, behaviour, and learning/development.
    • Poor mental health of parents or siblings impacting on children.

UASC health has a comprehensive guide for primary care and GPs on the health needs of UASC (see references).

References