Refugee and asylum seekers’ experiences of using the NHS
Refugees and people seeking asylum are entitled to NHS care. This includes GP services, A&E, and maternity care.
However, our feedback suggests that many face barriers to getting the care that they need. We have also heard that when they can access health care, it can sometimes be culturally inappropriate or insensitive.
What's the difference between refugees and asylum seekers?
Refugees are people who have been granted permission to stay in the UK for at least a minimum of five years, while people seeking asylum are awaiting their claim to stay to be processed by the Home Office.
Both groups have the same rights to the NHS as British citizens.
Barriers to accessing NHS care
Information and awareness
One of the key barriers to care experienced by refugees and people seeking asylum is difficulty understanding how the NHS works and what services they are entitled to.
The NHS is often very different to the healthcare systems that refugees and people seeking asylum are used to. Coupled with the fact that many people speak English as a second language, finding the proper care can be challenging.
We heard about people who were unsure how to access different health services, including people who did not know how to register with a dentist and others who were uncertain how to get help with mental health issues. Healthwatch in West Yorkshire even reported that some women seeking asylum did not access maternity care when pregnant, as they assumed that they would have to pay for the service.
In some instances, insufficient information or support contributed to poor experiences of care. People living in temporary accommodation or with host families sometimes did not have formal systems in place to support them to get healthcare and were reliant on hosts or sponsors to help them with things like registering with a GP. Those housed in hotels tended to have more information and help available, though in some cases this was still not enough.
Digital exclusion
Access to online systems was an issue for some people, especially those who did not have smartphones to access the internet easily or had not set up an email address. Without these tools, many people are unable to use online booking or information systems and reliant on written information and/or host families to help them access NHS care.
“Many Ukrainians still are [sic] not registered with the NHS or with GPs. For example, not every host would like to support them with this, especially if you have very elderly people who doesn’t [sic] know how the [online] system works in general or doesn’t [sic] need to use any computers, laptops or whatever.”
Story shared by Healthwatch Hertfordshire
Financial exclusion
People seeking asylum are entitled to an Asylum Support payment of up to £49.18 per week, plus up to an additional £9.50 per week per child aged three or under. This is intended to cover food, clothing, toiletries, and other personal expenses. Refugees stop receiving these payments once they have been granted permission to stay, but can then apply for mainstream benefits and, sometimes, a refugee integration loan.
However, like other low-income people in the general population, many refugees and people seeking asylum describe being unable to afford the costs associated with taking care of their health and care.
“I have complex needs and can't get the equipment I need including a suitable wheelchair, I'm having to use crutches, but I struggle to walk far with them… I have been told that as an asylum seeker I have to pay for everything including equipment and medication but as I can't work how am I supposed to have the money?”
Story shared by Healthwatch Lancashire
We heard from people who were unable to access dental care because no practices were seeing patients on the NHS, and they could not afford to go private. People also told of not being able to afford to pay for transportation to appointments, and not being able to afford the cost of medical equipment, like mobility aids.
“I am struggling to get to my hospital appointments as I can't afford the bus fare… I have metal plates in my left leg and need to get checked regularly. Bus fares are £15 return to get to hospital or to local support services. I cannot afford it; I only get £45 per week to live on.”
Story shared by Healthwatch Warwickshire
Language barriers
Refugees and asylum seekers may be unable to read and speak English very well, or not at all. This causes issues when trying to understand both written and verbal information from the NHS. We were told of people who struggled to read posters and leaflets about services in GP practices, as well as appointment letters.
Others had difficulty booking appointments over the phone and through online systems because English was their second language.
These people sometimes had to rely on charity workers to help them understand the information, which may not be appropriate or wanted, given the sensitivity of health information. One person also noted that people may not be literate in their first language, and so there needs to be other support to ensure full understanding.
“Sometimes the notices in a GP practice are all in English, even if the practice is in a very diverse area… It is not all about translation into other languages: sometimes people are not literate in their own language, so there needs to be a further step beyond just sending a document in the person's native language.”
Story shared by Healthwatch Richmond upon Thames
Stigma
A report from Healthwatch Gloucestershire found that many refugees and asylum seekers actively avoid using NHS services because they perceive themselves as a "burden" on the system, despite being entitled to support.
Many people attributed these sentiments to messaging and narratives they've seen online and in the media, as well as lived experiences of racism and discrimination.
Barriers to mental health support
A report by Healthwatch Hertfordshire highlighted difficulties in accessing mental health support. Access to this support is crucial, as many refugees and asylum seekers have fled from war-torn countries and traumatic experiences. Poor mental health was the most common issue reported by those Healthwatch Hertfordshire spoke to.
Healthwatch Hertfordshire’s report described local charity workers doing all they could to support refugees and people seeking asylum with their mental health, such as offering 10 one-to-one informal support sessions while people waited to be seen by the local mental health trusts. But sometimes the charity had to pause taking on new clients, due to high demand for support while people endured long waits for NHS specialist care.
Healthwatch Hertfordshire also heard about onward referrals to local mental health services being refused, despite severe symptoms and safeguarding issues being raised.
“I had to leave because of conflict in my home country. I feel very depressed. I have some trauma from what I have seen. I was told I would be waiting a very long time for help.”
Story shared by Healthwatch Hertfordshire
Experiences of NHS services
Culturally competent and trauma-informed care
Some refugees and asylum seekers experienced poor cultural sensitivity when accessing healthcare. We also heard about people experiencing significant trauma not being treated appropriately.
One person told us that they were often given male doctors and consultants for women's health issues, which is not appropriate in their culture. Healthwatch Hertfordshire also described one instance where a survivor of domestic abuse and sexual assault was only assigned male healthcare professionals, despite repeatedly being informed that they were unable to speak to men. Issues such as these led to many women not attending appointments, and therefore not getting the care they needed.
“We often get male doctors and consultants for women's health, and it's not appropriate for our culture. Many women who are refugees/asylum seekers will not attend an appointment if it's a man, which means appointments get missed.”
Story shared by Healthwatch Lancashire
Healthwatch Hertfordshire and Healthwatch in West Yorkshire found that continuity of care was particularly important to refugees and people seeking asylum, particularly those who had experienced traumatic experiences. Seeing multiple healthcare professionals meant that people had to repeatedly share and relive their trauma.
“I had a very frustrating experience whilst here because I had many initial assessments but none of them led to some action that would actually help me. So, my trauma just kept resurfacing.”
Story shared by Healthwatch Hertfordshire
People told Healthwatch Hertfordshire that NHS clinical and non-clinical staff needed a better understanding of refugees’ and asylum seekers’ experiences in order to provide them with the best quality of care. In particular, a better understanding of the trauma refugees and people seeking asylum may have experienced, and how this affects their mental and physical health.
“The GP compares together with the same health problems of those from here…our back home experience is not the same as the British who grew up in this environment… even me at 40 – is like an 80-year-old person here. But they’re trying to treat me as a British person of the same age, which is absolutely not relevant at all.”
Story shared by Healthwatch Hertfordshire
Translation services
NHS guidance states that translation and interpretation services should be made available to those who may need them. This includes people with good conversational English, who may not be able to fully understand discuss or read health-related information in English.
People told us that these services are often not available resulting in difficulty understanding diagnoses and treatment options. In one such case, a woman who had a loss of pregnancy needed to make important decisions around her care without the help of interpretation services. Another woman was reliant on a charity worker to help her understand her recent diagnosis of human papillomavirus.
Healthwatch in West Yorkshire and Healthwatch Hertfordshire both described interpretation services being unavailable in specific dialects, people not being offered interpreters due to their level of conversational English, and reports of people relying on family and friends for interpretation.
“Despite multiple times me mentioning that he doesn’t speak English, or he needs an interpreter- he’s never had an appointment with an interpreter...Doctors avoid or reject or for some reason they do not provide a translator, and I have to go and translate or over the phone translate what he’s describing. And again, I’m not a certified translator and I shouldn’t do that but just because I know there is no one who will pick up the phone and do that, so I do it.”
Story shared by Healthwatch Hertfordshire
Healthwatch in West Yorkshire also found the quality of interpretation services, once provided, varied. They reported that interpreters occasionally misinterpreted information or did not understand medical terms. The report highlights the need for health-related information to be relayed clearly in plain English, even when using interpretation services.
Improving NHS engagement and experiences
Generally, refugees and asylum seekers spoke positively about their interactions with healthcare professionals, often describing them as helpful, caring, and kind. Healthwatch Sheffield commented that this had a very positive impact on people and how confident they felt about seeking out care in the future, leading to increased engagement with services and improvements to their overall health.
However, the feedback we received suggests that more can be done to support refugees and asylum seekers to find information about how the NHS works, understand spoken and written communications, and adapting services to provide culturally competent and trauma informed care. The World Health Organization and the British Medical Association both emphasise the importance of culturally competent and trauma-informed care for refugees and asylum seekers.
While the NHS has published guidance on culturally competent care within mental health inpatient settings, no general guidance appears to be available on treating the specific needs of people arriving in the UK after experiencing significant trauma.
Recommendations
The British Red Cross, which is the largest independent provider of support to asylum seekers in the UK, published research in late 2024 which found there was no national frameworks for providing and commissioning healthcare for people in the asylum system.
Its report highlighted barriers to healthcare as well as examples of best practice and made extensive recommendations. These included calls for improvements to the way people receive health screening on arrival and are first registered with GPs, get routine access to interpreters and translated information, and receive trauma-informed care from health professionals.
We endorse many of these recommendations and call for particular action on:
Communication support
Health commissioners and services should ensure interpreters and translated materials are made available and people’s communication needs are routinely recorded in their GP records so services can make arrangements to meet needs, especially if people are moved around the country or referred for specialist support.
Culturally competent and trauma-informed care
As we recommended in our 2025 report on trauma cards, the NHS should improve training on trauma-informed care for frontline health and care professionals. NHS leader should also consider producing wider guidance on culturally competent care.
Social and practical support
Integrated Care Boards and local authorities should involve and fund local voluntary and charity organisations to provide vital health and wellbeing support that helps asylum seekers and refugees navigate the health system, know their right, help with food and clothing, link people up with language classes and offer social connections.
