Safeguarding Children Seeking Asylum

1. Safeguarding Children Seeking Asylum Sarah Nathaniel

2. Background • Cardiff Medical School final year project • Safeguarding issues presenting at initial assessmentin a Cardiff Asylum Clinic • Children seeking asylum (2009): • Accompanied: 4,391 • Unaccompanied: 3,175 • Vulnerable group with significant health needs • Safeguarding involves protecting children from harm and the promotion of their health and wellbeing

3. Methodology • Case series • Specialist paediatric clinic in St David’s Hospital • Clinic letter sent to the GP between January 2008 and December 2010 • Qualitative analysis of cases with safeguarding concerns • Systematically categorising findings into key themes

4. Findings • 204 appointments: • 64 did not attend • 7 clinic letters not located • 140 clinic letters analysed • 64 cases safeguarding concerns raised • 61% male 39% female • Age: 5 months – 18 years • Most prevalent country of origin: Pakistan

5. “[He] is not recognised as a child within the care system although tells me that he is coming up to 15 years of age. He was withdrawn and distressed following 10 days at a detention centre.” • “[There are] safeguarding concerns about safety of these children and the isolated and unsupported situation this very vulnerable woman is in. She is not appropriately emotionally available for these children because of her own vulnerability and her inability to control their behaviour makes them vulnerable to accidents.” • “Child’s experiences pre-flight, during flight and post-flight (including detention in the UK) have been traumatic and he has shown serious attempts at self harm and suicide in the past.”

6. Four themes: • Theasylum process: unaccompanied children, age-disputed cases, accommodation, isolation, education, immunisations • Socio-cultural factors: female genital mutilation, trafficking • Theparent/guardian: mental health, abuse • The child: physical health, mental health, abuse • Interplay between these factors

7. Safeguarding Web: Progression Prevention Protection Provision Education and Immunisations Trafficking Asylum Process Socio-cultural Age Dispute Unaccompanied Children Accommodation Vulnerability Unsuitable Unsafe Inappropriate FGM Isolation Abuse Physical Verbal Emotional Sexual Child Health: Physical, Mental, Emotional, Relational and Spiritual Stress Anxiety Depression Trauma Parent/s

8. Discussion • The indigenous child and the child seeking asylum • Most at risk: • Unaccompanied children seeking asylum • Age-disputed children • The asylum process both causes and exacerbate safeguarding issues • Maslow’s Hierarchy of Needs • Basic physical needs • Security • Social

9. Limitations • Dynamic nature of safeguarding issues • Purpose of the clinic • Time restrictions • Drawbacks of qualitative analysis • Need for a prospective study

10. Recommendations • Multi-agency service provision • Health surveillance that, using the Multidisciplinary Team and relevant Non Government Organisations, is: • Accessible • Consistent • Specific • Specific mental health services: parent and child • Abuse • Maternal mental health

11. Summary • Significant safeguarding concerns • Multi-factorial • Mental health of family unit • Multi-agency service provision • Further research needed

12. Thank you for listening Contact: sarahnathaniel@doctors.org.uk