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Health experts fear impact of deteriorating hostile environment

Patient rights must be protected as UK policies and government rhetoric indicate a shift from a hostile environment to an abusive one, say a group of experts and campaigners involved in refugee and migrant health.

In a new commentary, published by the Journal of the Royal Society of Medicine, the group describes a decade of destitution and ill-health caused by the hostile environment, which was introduced in 2012 through a set of policies embedding immigration control within a range of public and private services.

Lead author Dr Ryan Essex, a research fellow with the University of Greenwich, said: “While the hostile environment has had sweeping force, its impact on health and the provision of healthcare has been particularly concerning as it undermines the founding principles of the NHS.”

In their commentary, the authors highlight how the NHS employs teams responsible for upfront charging which in practice targets refused asylum seekers, undocumented migrants and others caught up by the dysfunctional immigration system, selling their data to bailiffs who go on to harass them.

As a result, urgent and immediately necessary care is often wrongly delayed and withheld from vulnerable patients. People are deterred from seeking treatment, with many fearful of potentially being detained and deported. Thousands more have been wrongly turned away from services.

A number of services exist to fill gaps created by the hostile environment, with countless frontline migrant support organisations working to navigate extremely complex charging regulations and supporting people to access healthcare. These include grassroots, migrant and health worker-led networks.

Dr Essex said: “For healthcare professionals, these policies raise a range of clinical and ethical issues. At the heart of these is the risk of being co-opted to act with policies that clearly undermine health and wellbeing, as a de-facto boarder guard.”

“Given the current course of the UK government, including the Nationality and Borders Bill currently being debated, it seems that only through collective action will patient rights be protected and the hostile environment resisted. One can hope that after another decade, we are not having this conversation and that these policies are scrapped and replaced by ones that move the NHS toward the truly universal ideals upon which it was founded.”

Notes to editors

A decade of the hostile environment and its impact on health (DOI: 10.1177/01410768221078327) by Ryan Essex , Ayesha Riaz, Seb Casalotti, Kitty Worthing, Rita Issa, James Skinner and Aliya Yule, will be published by the Journal of the Royal Society of Medicine at 00:05 hrs (UK time) on Wednesday 9 February 2022.

The link for the full text of the paper when published will be:

For further information or a copy of the paper please contact:

Rosalind Dewar

Media Office, Royal Society of Medicine

DL: +44 (0) 1580 764713

M: +44 (0) 7785 182732


The Journal of the Royal Society of Medicine (JRSM) is a leading voice in the UK and internationally for medicine and healthcare. Published continuously since 1809, JRSM features scholarly comment and clinical research. JRSM is editorially independent from the Royal Society of Medicine, and its editor is Dr Kamran Abbasi.

JRSM is a journal of the Royal Society of Medicine and it is published by SAGE Publishing.

Sara Miller McCune founded SAGE Publishing in 1965 to support the dissemination of usable knowledge and educate a global community. SAGE is a leading international provider of innovative, high-quality content publishing more than 1000 journals and over 800 new books each year, spanning a wide range of subject areas. A growing selection of library products includes archives, data, case studies and video. SAGE remains majority owned by our founder and after her lifetime will become owned by a charitable trust that secures the company’s continued independence. Principal offices are located in Los Angeles, London, New Delhi, Singapore, Washington DC and Melbourne.

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