The right to health is one we expect in the UK and upon which the NHS was built. The World Health Organization asserts the right to health is “one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”. Reinforced in the 1978 Declaration of Alma-Ata, this right to health is enshrined under international law and states have an obligation to put in place measures to realise the right to healthcare on a non-discriminatory basis.
As trained nurse, registered midwife and public health professional, my commitment to working in international health has been driven by social injustice. As a UK citizen, I benefit from free healthcare simply because of the country which I was born in and the parents to whom I was born. As part of the international health community, we work towards universal health care – a vision where every person can access health, especially for people marginalised by conflict, disaster or poverty.
I saw these inequities laid to bear during the 2014-16 Ebola outbreak in west Africa where I worked in Sierra Leone focussing on mother and baby health. It was an honour to contribute to the response funded through the UK Government.
The NHS is now rolling out the overseas visitors amendment which was put into law in October 2017. This means that people who cannot prove their immigration status have to pay for care and treatment upfront, at 150% of the true cost. This hostile environment sits in juxtaposition with our professional and social codes of conduct and against the UK’s obligation to ensure the right to health.
There are around half a million undocumented migrants living in the UK, including 120,000 children. Many of these people will have made treacherous journeys in the hope of being able to provide their families with financial and physical security and are likely to be more vulnerable to health issues. Even pregnant women will have to pay for 150% of their care. We know that women and their babies who do not receive basic maternity care are more likely to experience complications which can have long-lasting negative health effects. Charges will also be applied for terminations of pregnancy, with the potential to drive people fearful of being detected by the authorities, to seek unsafe abortions. This is a step backwards, especially in light of what was widely seen as progress with our neighbours in Ireland voting to repeal the 8th Amendment and legalise abortions.
I am shocked and dismayed by our Government’s regressive policy to charge vulnerable people for basic healthcare. Universal healthcare coverage is a collective and societal responsibility to enable affordable access to basic health care services such as antenatal check-ups and care during childbirth. Further, the policy creates confusion about who is entitled to free care and will deter women and girls from seeking medical advice and receiving the care they need. This poses clear risks to their health.
As a British citizen, I am ashamed to hold a medal awarded to me by the UK government for my contribution, and that of my colleagues, to the Ebola response when the government is not upholding the right to care for vulnerable migrants in our own country. I therefore join many colleagues and health professionals from the NHS, academia and aid agencies in returning my Ebola medal to the government. I do this in protest against this NHS policy and in support of the principles of global justice, solidarity, and human rights. Visit our website to learn more about the medals4migranthealth campaign.
Dr Sara L Nam, PhD, Registered Midwife, Technical Specialist in Reproductive and Sexual Health, Options and LSHTM Alumni.