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How the Hostile Environment is Harming Public Health

In the wake of Byline Times’ exclusive investigation into charging migrant women for abortion, Sian Norris analyses the impact migration policy has on healthcare

Former Home Secretary Theresa May. Photo: Nicolas Landemard/Le Pictorium/MAXPPP

How the Hostile Environment is Harming Public Health

In the wake of Byline Times’ exclusive investigation into charging migrant women for abortion, Sian Norris analyses the impact migration policy has on healthcare

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An exclusive investigation by Byline Times into the charging of migrant women in need of abortion care raises questions about the ‘hostile environment’ and how it interacts with healthcare. 

The investigation revealed that up to 59 women across 14 NHS trusts were charged more than £18,000 to have a safe, legal abortion since rule changes in 2017.

It comes after reports that migrant women were being charged up to £14,000 to give birth, with some women feeling they had no choice but to take risks with their and their baby’s health, and go through pregnancy and labour without medical support. 

Charging for reproductive healthcare is just one example of how a tiered healthcare system, which demands people with certain immigration statuses pay for a range of medical treatments, creates health inequality and worsens health outcomes. 

Back in 2012, then Home Secretary Theresa May told the Telegraph that her aim was “to create here in Britain a really hostile environment for illegal migration”. Since then, the term has been used to describe the raft of policies that turned everyone from landlords to university administrators and even sexual assault referral centre staff into border guards, sniffing out people who are in the country illegally. 

When it comes to healthcare, the hostile environment extends to the NHS working with the Home Office to check people’s immigration status to charge them for care – bringing with it the anxiety that an appointment with a doctor could lead to a referral to border control. 


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Fears of being reported to immigration enforcement and of being unable to meet the cost of treatment, causes people to delay accessing healthcare. This can be deadly.

A 2017 Doctors of the World report found that people were delaying treatment for severe illnesses such as cancer, kidney failure and post-stroke complications. Delaying cancer treatment by even a month can impact survival rates. 

Not all care is chargeable under the ‘National Health Service Charges to Overseas Visitors Regulations’. Primary care such as Accident and Emergency services are free, as is treatment for sexually transmitted diseases, family planning (except abortion and childbirth) conditions as a result of torture, female genital mutilation, domestic abuse and sexual violence, and some forms of palliative care. Everyone is also allowed to register with a GP – although as the Bureau of Investigative Journalism revealed last year, this is not always happening in practice. 

Charging comes into play for abortion services and secondary healthcare.

But many people are unaware of what they are entitled to or are afraid to come forward for care in case they are referred to immigration enforcement. 

The British Medical Association warned as early as 2018 that the charging system not only impacts the individual’s health, but presents a public health risk too. It highlighted “the potential for increased infectious disease transmission because of late detection and patients not attending for fear of being charged”.

It also expressed concern that “the exemption of certain public health services from charging was not well understood by the public, and so did not counter the overall deterrent effect of the regulations”. The Institute for Public Policy Research found in 2020 that the charging system was plagued with racial profiling and poor decision making.

Despite warnings, in 2018 the Department for Health and Social Care concluded a review into charging by saying that it did not have a deterrent effect on people seeking medical care. 

Concerns about the policy took on a new urgency when the Coronavirus pandemic hit. Treatment and vaccines for COVID-19 were exempt from NHS charges and people were urged to come forward to get medical support whatever their immigration status. 

Migrant Women Charged £18,000for Abortion Services Since 2017

Sian Norris

But, as previously reported by this newspaper, the years of hostile environment policies that saw vulnerable people referred to immigration enforcement as a consequence of seeking healthcare meant that many were reluctant to come forward for help. 

Nearly half (46%) of migrant people with no recourse to public funds who were surveyed by the rights organisation Joint Council for the Welfare of Immigrants said they would be “scared to access healthcare if they became unwell during the pandemic”.

A report into the Coronavirus experiences of precarious Filipino migrants, published in June 2020, revealed how several undocumented people died at home with symptoms of COVID-19 due to fear of being deported. 

The hostile environment extends beyond healthcare. It inhibits people coming forward to cooperate with the police, and has even led to women being shopped to immigration enforcement have sought support after rape. 

But, rather than re-evaluate the impact in the wake of a public health crisis, the Government continues to push forward with an increasingly hostile immigration agenda. Indeed, every Conservative leadership candidate has committed to maintain some of the most criticised migration policies of the Boris Johnson administration. 

In the meantime, women in the UK are being forced to make a terrible choice: do they pay for an abortion they can’t afford and risk the debt impacting their residency application? Or do they continue with an unwanted pregnancy? 

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