Janet Riddell-Heaney, MA, RN, RHV, DipChild Protection, Cert Ed.
Designated Nurse for Child Protection, Harrow Primary Care Trust, HarrowBritain has a long history as a multicultural environment. There is an established history of unaccompanied children coming here in response to various political upheavals, wars and disasters (see Box 1). 'Separated children' are children under 18 years of age who are outside their country of origin and separated from both parents, and their previous/legal customary primary care giver.
Britain has a long history as a multicultural environment. There is an established history of unaccompanied children coming here in response to various political upheavals, wars and disasters (see Box 1). 'Separated children' are children under 18 years of age who are outside their country of origin and separated from both parents, and their previous/legal customary primary care giver.
According to the 1951 Geneva Convention (OHCR, 1951) a refugee is someone who:
'Owing to a well founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his (or her) nationality and is unable or, owing to such fear, is unwilling to avail himself (or herself) of the protection of that country' (Article 1A 2).
An asylum seeker is:
'Someone who has fled their country and is seeking refugee status.'
Refugees are not one group of individuals. There are differences in age, gender, race, culture, belief structures, religion, education, ability, class, urban/rural status, interests, language, personality, individual hopes and aspirations and circumstances leading to exile.
Fewer than 10% of all those who seek asylum do so in the more affluent countries of the northern hemisphere.
The number of refugee and asylum-seeker families in Britain is growing, due in part to the wars ongoing in other parts of the world. There are specific issues for refugee and asylum-seeker children involving separation from parents, bereavement, loss of a familiar environment, language and infrastructure.
Some children are totally alone. Others may be living with extended family members or other adults. Some children may appear to be 'accompanied' but the accompanying adults are not necessarily able or suitable to assume responsibility for their care.
Where the children come from
In 2000 some 2735 unaccompanied children under the age of 17 applied for asylum in the UK. The countries of origin of the largest numbers of children were:
- Yugoslavia: 665
- Afghanistan: 300
- Somalia: 175
- Sri Lanka: 170
- Turkey: 155
- China: 115
- Iraq: 110
- Angola: 100
These are figures found in the report Where are the Children? (Refugee Council and BAAF, 2001). It identifies that most unaccompanied asylum-seeker children are aged 16-18.
These children and young people may suffer physical, social and psychological damage as a result of being without the care and protection of their parents or previous carers. Separated children may be seeking asylum because of fear of persecution or lack of protection due to human rights violations, armed conflict or disturbances in their own country. They may be victims of trafficking for sexual or other exploitation, or they may have travelled to the UK to escape conditions of serious deprivation.
Many of them have experienced terrifying events or conditions of severe hardship.
Instruments of protection
Separated children seeking asylum are entitled to international protection under a broad range of universal and regional instruments such as the UN Convention on the Rights of the Child 1989 (UN, 1991). They are also covered by the Children Act 1989 in most situations. Among other rights such as the right to legal representation to assist with the asylum claim, they are fully entitled to health-care and social-care provision if they fall into the appropriate social services category.
Unaccompanied children in the UK broadly fall into one of four categories of 'support':
- Children looked after by local authorities
- Children receiving informal support within their own communities
- Youngsters receiving financial support from social services and living independently
- Children held in detention.
This has huge implications for health-care service providers and front-line staff as asylum seekers and refugees who have specific health needs change the face of the local population.
Where do they go?
Where are the Children? (Refugee Council and BAAF, 2001) provides a comprehensive breakdown of numbers of unaccompanied children who are being supported by local authorities in small regions.
Although the Home Office (2002) states that most children and young people seeking asylum in the UK are not moved around the country, the Refugee Council and BAAF identify that many local authorities throughout the UK have unaccompanied asylum-seeking children and young people in their care. This necessarily affects the level and type of services health-care professionals can provide.
In a joint report by the Children's Society, Refugee Council and Save the Children called A Case for Change (2002) it was highlighted that children and young people who seek asylum in the UK are exceedingly vulnerable and are in need of further protection. There are repeated reports of lack of consideration for the child or young person. They report in one instance about a young person who could not face being moved away from the environment in which he had begun to feel comfortable at the age of 18, so he chose to 'disappear' and be lost to the care system.
A lottery of services
According to the report Separated Children in the UK (Ayotte and Williamson, 2001) children under 17 are facing a lottery of unco-ordinated social services provision. This leaves many children and young people vulnerable and alone. The report identifies areas of good practice such as the Refugee Council's Independent Panel of Advisers for Unaccompanied Children (funded by the Home Office). However, there are areas of concern. These include:
- Many separated children, some as young as 15, are expected to look after themselves as if they were adults
- There are still anomalies in government funding to local authorities
- Some separated children are kept locked up in detention centres when they have committed no crime
- Racism and racially motivated attacks in the UK add to the fear and trauma children have already experienced
- Most children are given only temporary immigration status (Exceptional Leave to Remain), leaving them in fear of being returned and insecure about planning a future
- Increased barriers across Europe are forcing children into the hands of dangerous smugglers and traffickers as their only way of reaching a place of safety.
The duty of local authorities
Once a child has entered the country he or she becomes subject to national laws. The Children Act 1989 and the associated guidelines and regulations are influential. The Children Act is clear that local authorities have a duty to provide accommodation for any child in need within their area who appears to need accommodation as a result of:
- There being no person who has parental responsibility for him or her
- The child having been lost or having been abandoned
- The person who has been caring for him/her being prevented from providing suitable accommodation or care.
Refugee and asylum-seeker children are unique and have unique stories to tell. Because of their experiences, they may well present to health services quickly. Burnett and Peel (2001) describe the effects of past experiences on refugee and asylum-seeker families.
They state that victims of torture and organised violence (normally as a direct or indirect result of war but not necessarily) can present to the health-care services with a range of non-specific medical problems, both physical and psychological (Burnett and Peel, 2001).
As organisations, the health-care services do not fully appreciate the problems. Staff need to know how to manage an asylum-seeker child or young person so that traumatisation is not further increased by ignorance. Staff need to know that refugee and asylum-seeker children:
- Have an individual story to tell, although they will have the same broad needs as any other children
- Must receive the same standards of legal protection offered to all children
- Need to be nurtured, to feel safe and loved and to have a supportive network of friends and family, and, where possible, community
- Need skilled intervention to assist on issues of loss and to deal with the traumas and stresses that they have experienced before, during or after their flight into exile (Burnett and Peel, 2001).
The trauma and stress experienced by refugee and asylum-seeking children is described in Box 2 (NSPCC, 1997). Children will demonstrate all five different signs of stress and trauma in relation to past experiences and a move to a new host country.
Adolescents are in general more able to cope with short-term disruption and separation from families and communities. However, long term it can be very damaging to the psychological well-being of any teenager.
What children need
Continuity and consistency of care must be re-established in positive, sensitive and culturally appropriate ways. The child needs:
- Love and security, encouragement in demonstrating affection
- Development through play and language, both individually and in groups
- Praise and recognition to build self-esteem
- Responsibility and opportunity to participate in events and activities.
Children will cope with their new situation in different ways. Ways in which health and social-care staff can help are discussed in Box 3.
Carers responsible for the child must demonstrate a desire to work in the child's best interests and work in partnership with the agencies and communities that will be able to offer the child some or all of the above.
In our previous papers, we have identified how children and young people are at increased risk of abuse and have a greater need for protection if they are from families that are socially excluded (Riddell-Heaney, Allott 2003a; 2003b; 2003c).
The needs of asylum-seeker children and young people are therefore a greater priority than ever. This is a highly vulnerable group of children, in financial, physical and emotional need.
Unaccompanied children and young people who seek asylum in the UK, by definition, have had to be strong and brave to be able to survive the earlier periods of upheaval in their lives and then undertake the subsequent journey here.
As health-care professionals, it is our responsibility to 'do no harm' and act in the best interests of all the patients who we encounter (NMC, 2002). Boxes 4 and 5 provide details of useful resources.
We need to be actively securing the safety of refugee and asylum-seeker children and young people by ensuring that we have a sound knowledge base about some of the issues they may have, and by ensuring that our services are appropriate, relevant and accessible to all.
- The fifth and final paper in this series will examine issues on how we listen to children.
Discuss what information you would require to be able to influence the way you act when caring for a child who is a refugee.
Access www.refugeecouncil.org for the joint report Where are the Children? (Refugee Council, BAAF, 2002). Examine Appendix 4 and consider how the number of unaccompanied asylum children in your area impacts on your practice.
Reflect on how the infrastructure within the department in which you work allows for children and young people to come forward to ask for help. Consider what would make this process easier for them.
Discuss with other colleagues in your department what measures could be taken within your team to enhance your knowledge and skills when caring for children and young people who are actively seeking asylum.
Consider joint working practices between the health and social services with specific regard to children and young people seeking asylum. How could measures be implemented to allow children and young people smooth transition periods between the services?
Burnett, A. (2002)Guidelines for Health Workers Providing Care for Asylum Seekers and Refugees. London: Medical Foundation for the Care of Victims of Torture.
Burnett, A., Peel, M. (2001)Asylum seekers and refugees in Britain: what brings asylum seekers to the United Kingdom? British Medical Journal 322: 485-488.
Burnett, A., Peel, M. (2001)Asylum seekers and refugees in Britain: health needs of asylum seekers and refugees. British Medical Journal 322: 544-547.
Department of Health. (1995)Child Protection Messages from Research. London: The Stationery Office.
Department of Health, Home Office, Department for Education and Employment. (1999)Working Together to Safeguard Children: A guide to inter-agency working to safeguard and promote the welfare of children. London: The Stationery Office.
Department of Health, Home Office, Department for Education and Employment. (2000)Framework for the Assessment of Children in Need and their Families. London: The Stationery Office
Department of Health. (2002)National Standards for the Provision of Children's Advocacy Services. London: DoH.
Madge, N. (2001)Understanding Difference: The meaning of ethnicity for young lives. London: National Children's Bureau.
Salinsky, M., Dell, S. (2001)Protection not Prison: Torture survivors detained in the UK. London: Medical Foundation for the Care of Victims of Torture.
Woodcock, J. (1995)Family therapy and human rights: working with refugees. Mental Health Nursing 15: 5, 20-22.
Ayotte, W., Williamson, L. (2001)Separated Children in the UK. An overview of the current situation. London: Save the Children.
Burnett, A., Peel, M. (2001)Asylum seekers and refugees in Britain: the health of survivors of torture and organized violence. British Medical Journal 322: 606-609.
Children's Society, Refugee Council, Save the Children. (2002)A Case for Change: How young refugee children in England are missing out. London: Refugee Council.
Home Office. (2002)Asylum Statistics UK 2000 (Statistical Bulletin 17/01). London: Home Office.
Muslim Information Resources. (2003)A time Line of Refugee Arrivals in UK. Available at: www.salaam.co.uk
National Society for the Prevention of Cruelty to Children. (1997)Turning Points: A resource pack for communicating with children. London: NSPCC
Nursing and Midwifery Council. (2002)The Code of Professional Conduct for Nurses Midwives and Health Visitors. London: NMC.
Office of the High Commissioner for Refugees. (1951)Convention Relating to the Status of Refugees. Geneva: United Nations.
Refugee Council and British Agencies for Adoption and Fostering (BAAF). (2001)Where are the Children? A mapping exercise on numbers of unaccompanied asylum seeker children in the UK Sept 2000-March 2001. London: Refugee Council.
Riddell-Heaney, J., Allott, M. (2003a)Safeguarding children: 1. The role of health and other professionals. Professional Nurse 18: 5, 280-284.
Riddell-Heaney, J., Allott, M. (2003b)Safeguarding children: 2. Identifying and preventing institutional racism. Professional Nurse 18: 6, 350-354.
Riddell-Heaney, J., Allott, M. (2003c)Safeguarding children: 3. Getting to grips with culture and ethnicity. Professional Nurse 18: 8, 473-475.
United Nations. (1991)Convention on the Rights of the Child. London: Children's Rights Development Unit.