Over four weeks in September and October, people living in contingency accommodation in Northern Ireland convened to bring together evidence of human rights failings and propose solutions. Their report was presented to elected representatives and officers from a range of government bodies and oversight institutions on 14 October 2022.

The Human Impact

Health was a frequent concern in residents’ meetings, and featured in more than half of the individual formal complaints submitted to Mears Group, the Home Office, the NI Executive Office and Migrant Help during September and October 2022.

Some residents reported suffering from pre-existing medical conditions, which were made worse because they have been unable to access local health care, “[my] husband has chronic disk and back pain issues but no help was provided” noted on resident in a complaint to Mears Group.

Some residents reported waiting between 12 and 14 hours between evening meals and breakfast and having become malnourished and/or anaemic due to poor quality food, including mouldy bread and uncooked chicken served on a rigid schedule. Some parents reported their children were failing to grow or losing weight. In several cases residents reported being hospitalised for treatment, only to be returned to the exact same conditions upon discharge.

Residents reported digestive disorders and high blood pressure, which require flexibility in diet and meal times. However in contingency accommodation residents are not allowed to prepare and cook their own food – despite some asylum seekers, who are also banned from working, being trained chefs. Hotel and Mears staff have on one-off occasion permitted charities to access kitchens for people to cook their own food, but this provision has not been rolled out regularly or across all accommodation.

Residents carrying underlying trauma from the impact of having to flee their own countries require clear standards, minimal rules, uniformly respectful treatment and effective working complaints procedures, which are absent in contingency accommodation.

Residents reported that general living conditions, including children living for prolonged periods in tight spaces with no room to play or socialise, contributed to poor physical and mental health for parents and children. One complaint from a resident noted the obstacles placed in front of families trying to secure healthy accommodation: “[we] were informed by a MEARS employee that they are not moving us to a house unless they get the house specification from the doctor, I booked a doctor appointment two months ago who gave us an appointment in a period of four months.”

Image caption: Infestations caused by poor cleaning standards contribute to skin complaints

At one site, the lifts were off-limits to residents, including pregnant women who – as residents are not allowed to have food in their rooms – had to climb up and down stairs repeatedly in order to eat. One family reported that this contributed to a miscarriage.

Other residents reported that isolation, uncertainty, harsh and unfair rules and being treated with disrespect by staff caused their mental health to deteriorate. Residents carrying underlying trauma from the impact of having to flee their own countries require clear standards, minimal rules, uniformly respectful treatment and effective working complaints procedures, which are absent in contingency accommodation.

The Human Rights Context

The UK Government ratified the International Covenant on Economic Social and Cultural Rights in 1976. All government bodies, including local councils, departments, public authorities, elected representatives and public officials, are duty bearers charged with progressively realising human rights under local and international law.

The rights protected by this treaty apply equally to everyone, regardless of birthplace or legal status. Article 12 sets out “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health”.

International standards regarding the right to the highest attainable standard of health set out its ‘inter-related and essential elements’: availability, accessibility, acceptability and quality of services.

The first, availability, is not the issue: throughout the UK, refugees and asylum seekers with an active application or appeal are entitled to free NHS primary and secondary level care. NI statutory rules reflect this. The General Medical Services contract  recognises the entitlement to GP registration, while NI Direct sets out relevant non-discrimination provisions.

The Mears contract (schedule 2, 4.4.5 and annex D.1.6) imposes a duty to assist people with some pre-existing medical conditions, pregnant women, babies and people with acute mental health needs in registering with a GP. The Migrant Help contract (schedule 2, 5.5.2 and 5.5.3) requires that people who express concerns over their medical conditions or healthcare needs be referred to the ‘appropriate party’.

Despite these local and international obligations on duty bearers, the evidence collected by residents indicates that these provisions are not being routinely followed in all cases, resulting in people with healthcare needs being denied the services to which they are entitled. In many cases people’s living conditions compound health issues, increasing pressures on the struggling NHS.

The Executive Office’s draft Integration Strategy for this group proposes additional measures that would help. It includes, for instance, an action to “ensure early health screening is available… and pathways to health services are clearly communicated” (p. 8). Early health screening in particular would help ensure that people get timely access in real life to the care to which they are entitled on paper, and would prevent their being placed for long periods in conditions that risk exacerbating their conditions.

Residents’ recommendations to improve health care

Image caption: Residents presented their findings at a public meeting in Belfast

To the Home Office, Mears and Migrant Help:

• in partnership with the Department for Health, support all residents to register with a GP
• regularly audit residents’ health care needs to establish whether new arrivals and existing residents are registered and have GP access. Standardise fair procedures and access to healthcare across all accommodation

To the Home Office and Mears:

• provide fresh, nutritious and culturally appropriate meals. Where possible hire kitchen staff from the same cultural / culinary background as residents to facilitate this, or provide the ingredients and facilities for residents to prepare their own meals to their own needs and tastes
• provide a range of fresh, healthy, accessible snacks for children and others for whom three set meals a day are insufficient or inappropriate
• for pregnant women, people who are ill and people with medical dietary requirements, provide daily tailored meals that meet their specific health needs. Facilitate access to kitchens for family members willing and able to cook what these people are required to eat
• to promote health and minimise health risks, ensure daily rubbish collection and disposal so that all areas are clear of accumulated waste
• to promote health, ensure adequate play space for children and socialising space outside of their rooms for adults to combat isolation and depression
• prioritise people with healthcare needs for moving on to dispersal accommodation

To the Home Office:

• lift the ban on asylum seekers working so that they can earn a living and meet their families’ food and other needs themselves

To the NI Executive Office, NI departments and agencies and NI political institutions:

• ensure that all asylum seekers have in practice the access to the free primary and secondary health care to which they are entitled. Where barriers exist, identify and dismantle these
• implement in a timely manner the actions identified in the Integration Strategy, particularly with regard to early health screening and clear pathways to care for asylum seekers
• ensure primary and secondary school places for children to meet their developmental needs and protect their mental health
• include asylum seekers in crisis programmes aimed at supporting vulnerable groups, such as emergency food distribution and other emergency support
• facilitate asylum seekers’ access to all public cultural, educational, leisure, sport or other programmes, to facilitate their integration and well-being (per the example of Belfast City Council with gym membership, for instance)
• facilitate the building of affordable housing to guarantee safe, healthy and sustainable homes for every person resident in this jurisdiction
• going forward, plan in flexibility in order to be able to respond to the health care needs of  potentially rising numbers of people seeking international protection due to catastrophic events (war, political conflict, climate change)

To the oversight bodies NIHRC, NICCY, NI Equality Commission and NIPSO

• use all of your powers to investigate the state of health promotion and prevention work as well as health care provision to people placed in contingency accommodation, to bring about changes where needed
• work with public officials working in health and related fields to help them understand and work to fulfil their human rights obligations to those members of the public who are asylum seekers and refugees
• make your findings and your work public, in the interest of the greater good and to combat misinformation around asylum generally and around the use of hotels for hostel accommodation in particular