Send to

Choose Destination
Wellcome Open Res. 2019 Jul 22;4:109. doi: 10.12688/wellcomeopenres.15358.1. eCollection 2019.

The negative health effects of hostile environment policies on migrants: A cross-sectional service evaluation of humanitarian healthcare provision in the UK.

Author information

Academic Foundation Programme, North Central and East London Foundation School, Health Education England, Stewart House, 32 Russell Square, London, WC1B 5DN, UK.
School of Public Health, St Mary's Hospital, Imperial College London, Praed St, Paddington, London, W2 1NY, UK.
Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, NW1 2DA, UK.
Doctors of the World UK, 29th Floor, One Canada Square, London, E14 5AA, UK.
Contributed equally


Background: Recent UK 'hostile environment' immigration policies, including obligatory charging and sharing of confidential data between NHS Digital and the Home Office, have created an atmosphere of fear and exposed already highly marginalised and vulnerable groups to significant health risks by increasing barriers to accessing NHS care.  Methods:  This is a cross-sectional observational study of patients accessing healthcare at Doctors of the World (DOTW) in the UK. DOTW is a humanitarian organisation, providing care to those excluded from NHS healthcare. We aimed to describe population characteristics of individuals using DOTW services and identify groups at greatest risk of facing 'hostile environment'-related barriers to NHS care, specifically being denied healthcare or fear of arrest. Results: A total of 1474 adults were seen in 2016. Nearly all were non-EU/EEA nationals (97.8%; 1441/1474), living in poverty (68.6%; 1011/1474). DOTW saw a large number of undocumented migrants (57.1%; 841/1474) and asylum seekers (18.2%; 268/1474). 10.2% (151/1474) of adults seen had been denied NHS healthcare and 7.7% (114/1474) were afraid to access NHS services. Asylum seeker status was associated with the highest risk (adjusted odds ratio (OR): 2.48; 95% confidence interval (CI): 1.48-4.14) of being denied NHS healthcare and being undocumented was associated with the highest risk of fearing arrest (adjusted OR: 3.03; 95% CI: 1.70-5.40). Conclusions: Our findings make visible the multiple and intersecting vulnerabilities of individuals forced to seek care outside of the NHS, underlining the public health imperative for the government to urgently withdraw its 'hostile environment' policies and address their negative health impacts.


UK; asylum; barrier; health; hostile environment; migrants; refugees; undocumented

Conflict of interest statement

Competing interests: RWA received consultancy fees from Doctors of the World, outside the submitted work to complete the 2017 Médecins du Monde Observatory Report. LJ and AM are both employed by Doctors of the World. SJW, LJC, ERT and RB have no conflicts of interest to declare.

Supplemental Content

Full text links

Icon for PubMed Central
Loading ...
Support Center