Use of the Emergency Department by People Seeking Asylum and Refugees in living in Temporary Accommodation: A Critical Evaluation

Background People seeking asylum and refugees (PSAR) are known to be at risk of multiple and complex health needs and frequently face barriers in accessing appropriate healthcare. Numbers of PSAR arriving in the UK and living in temporary accommodation have increased significantly in recent years due to a combination of factors, including the Afghan Relocation and Assistance Programme (ARAP) established in 2021. This study explores and characterises attendance of people seeking asylum and refugees to the Emergency Department of a central London hospital. Methods A retrospective review was undertaken of attendances to our Emergency Department (ED) by PSAR between September-December 2021. PSAR were identified by postcode of known Home Office temporary accommodation. A cohort of 100 adults and 100 children/young people (CYP) who were not PSAR were randomly selected within the same time period for comparison. Results 715 PSAR presentations were included (260 adult, 455 CYP) by 474 individuals (181 adults, 293 CYP). 90.2% of adults and 96.1% of children were from Afghanistan and, where documented, 93.7% of adults and 93.5% of children had arrived in the UK within the past 3 months. 58.8% of adult PSAR and 72.7% of children and young people seeking asylum (CYPSAR) were deemed to have presentations more appropriate for other settings compared to 39.4% and 41.5% of the comparison group respectively. PSAR were more likely to have multiple presentations (27.6% of adults and 36.2% of CYP; 11% and 27% in comparison group respectively) and were less likely to require hospital admission or follow-up than the comparison group (3.9% of adults and 5.7% of CYP; 13.8% and 10.3% in the comparison group respectively). Conclusion PSAR attending our ED during the study period were predominantly recently arrived from Afghanistan. PSAR were more likely to have a presentation deemed more suitable for other settings, less likely to be admitted, and more likely to have multiple attendances than a non-PSAR comparison group. Further work to understand the reasons underlying these findings is important, to support improved provision of appropriate healthcare services which may contribute to reductions in unscheduled emergency presentations in this vulnerable group.