AVR for Migrants with Health Needs

1. International Organization for Migration (IOM) AVR for Migrants with Health Needs 1

2. Presentation Outline • AVR in the UK: Historical Context and Statistics • Healthcare Provision for Migrants in the UK • AVR Procedure for Migrants with Health Needs • Part 1: Pre-Departure • Part 2: Providing Return Assistance • Part 3: Post-Arrival • Part 4: Case Studies

3. AVR in the UK

4. 4 AVR in the UK • 1999: VARP started after Kosovo crisis • 2002: VARP becomes VARRP • 2002 – 2010: Range of reintegration budgets from £500 to £4000 • 2004: AVRIM introduced • 2010: AVRFC introduced • 2011: Scheme awarded to Refugee Action

5. 5 AVR in the UK 2010 – 11: Three Programmes Programme Name Category of Migrant Assistance Provided Reintegration Provision

6. AVR in the UK: Statistics 6 • AVR from the UK by Programme, Calendar Year 1999 - 2011

7. AVR in the UK: Statistics 7 • AVR from the UK by Programme, Calendar Year 1999 - 2011

8. 8 AVR in the UK • Vulnerable cases • Within each programme • Victims of trafficking • Single-parent families • Migrants with medical needs • Migration process can increase health vulnerabilities • Marginalised population • Unable to engage in work or education

9. Healthcare for Migrants in the UK

10. Healthcare for Migrants in the UK 10 • National Health Service • Entitlements for migrant populations differ (primary and secondary) • Free for asylum seekers • At Doctor’s discretion for irregular migrants (primary) • Only immediately necessary treatment • Some services and treatment are provided free of charge to all • In secondary care, charges can be made to irregular migrants

11. 11 Healthcare for Migrants in the UK • Challenges • Barriers exist • Migrants have significantly varying needs • Doctor’s discretion results in major variations • Certain areas have disproportionate burden • Tension: restrictive policies and initiatives to tackle ill-health and inequality among migrant populations

12. AVR Medical: The Procedure

13. 13 Part 1: Pre-Departure • Referrals • NHS / social services • Outreach and awareness – NHS and NGOS • Direct Contact • Council staff, police and community leaders • Manage expectations of service providers and migrants • Range of medical conditions and across all programmes • Medical case: • in need of escort during flight • follow-up treatment in the country of origin • affected by malign disease or dependent on specific medicines

14. Part 1: Pre-departure 14 • Important First Questions • Is the applicant able to travel safely on an aeroplane? • Fit-to-fly considerations • Will flying exacerbate condition? • Written details need • If not receiving care, referral to NHS for treatment and report • Checks by MHD in HQ • Decision-making by AMO

15. 15 Part 1: Pre-departure • Important First Questions • What special arrangements need to be made • a) for the flight? • - e.g. Escort, oxygen, stretcher, wheelchair, risks to others • b) for medical care in the country of origin • - Report detailing follow-up care • - Arrival provisions • - Engage IOM overseas offices and MHD • - Support from family in CoO

16. 16 Part 1: Pre-departure • Important First Questions • Are the necessary funds and resources available? • - Applicant eligible for existing scheme? • - Is the donor willing to cover all costs: • a) for Patient? • transportation to airport • air ticket • equipment • b) For escort? • transport to (and from) UK and to (and from) CoO • accommodation • fees

17. 17 Part 1: Pre-departure • Important First Questions • Is the AVR application voluntary? • Capacity to make a decision to return home? • Mental health problems? • Undue pressure to return from healthcare provider? • Signing of declaration in presence of IOM officer • Usually very strong motivations for return

18. Part 2: Return Assistance 18 • Escort • What kind of escort is needed? • Medical report essential • Checked by the MHD in HQ • If a medical escort is required, consider: • Gender and language • Ability to travel at short notice • Nurse or doctor? • If only an operational escort is required, consider: • Gender and language • Level of intervention needed

19. Part 2: Return Assistance 19 • Transportation to and from the airport • In host-country • Airlines will not take responsibility for this • Arrangements sometimes made by hospital at no extra cost • Private car, taxis or ambulances available as alternative • At airport, authorities can assist with carriage - advance request needed • Airline can sometimes provide wheelchair – advance requested needed • In Country of Origin • Available options may be limited • Arrangements should be made well in advance • Overseas office can provide airport assistance

20. Part 2: Return Assistance 20 • Special equipment and cabin arrangements • Not usually provided by airline (other than oxygen cylinders) • NHS or medical escort can provide equipment but at a cost • Use of equipment needs to be authorised in advance by the AMO • Equipment and medication must be supervised at all times • Cabin arrangements usually specified by the AMO • May involve recommendation for business or first class • Stretchers can usually be accommodated but costs can be high

21. 21 Part 3: Post-Arrival • Access to emergency healthcare in country of origin • Patients should be aware of what is available • IOM overseas offices can help (costs) • If care needed, should be arranged far in advance • Full up-to-date medical summary should be provided • Certain drugs may not be available in the country of origin • Patient may require several weeks’ supply of drug or conversion to more readily available drug in advance of departure • May still wish to travel and have specific motivations to return

22. 22 Part 3: Post-Arrival • Reintegration Assistance • Objective: to support more sustainable return • Prioritises income-generating or skills development activity • Medical component • treatment • Medication • psycho-social counselling • Main budget for reintegration activity can be redirected if needed • Flexible approach • Forward referral to other support agencies

23. 23 Zambia Pregnant lady, terminal cancer Baby born prematurely Wish to return to die and ensure child with family No travel on commercial flight Air ambulance with incubator Family reunited, returnee passed away after 2 weeks Kenya Elderly couple with mobility issues Male with dementia in care home Familial and medical pressure Escort – Kikuyo language Onward transportation Assistance for ongoing care Georgia Stroke left lady with poor mobility and speech problems Felt isolated and homesick Travelled with nurse and Russian-speaking friend for translation Reunited with daughter Assistance for accommodation and medical care Jamaica Lady suffering from schizophrenia In and out of hospital Lengthy process, for time when fit-to-travel Escorted by mental health nurse Assistance for accommodation and small business Congo Terminal bladder cancer Wished to return to see family Immobile, transported to LHR in ambulance Escorted by doctor and son Assistance to cover medical costs Passed away after return Part 4: Case Studies Iraq Male diagnosed with terminal cancer – asylum decision pending Escorted by doctor Reintegration assistance transferred to brother to invest in small family business Housing support also provided

24. 24 Key Points What IOM can and cannot do: Managing expectations Help provide continuity of care Challenges: Costs Complex cases Emotions and stress Support services in country of origin Motivations: Individual wishes Family situation

25. 25 Thank You