Refugees & asylum seekers

Question 1

Define a refugee

Answer 1

Owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion, is outside the country of his nationality, and is unable to or, owing to such fear, is unwilling to avail himself of the protection of that country

Question 2

Define an asylum-seeker

Answer 2

A person who is seeking international protection and has applied for refugee status under the convention, but whose claim has not yet been determined.

Question 3

Define a migrant

Answer 3

The United Nations Department of Economic and Social Affairs defines an international migrant as
“any person who changes his or her country of usual
residence”
There is no internationally accepted legal definition of a migrant.

Question 4

Name some common health challenges of refugees and asylum seekers

Answer 4

Question 5

What are the oral health challenges of refugees and asylum seekers?

Answer 5

• Poverty (limited financial resources= poor access to good quality nutrition
• Poor education on OH maintenance/low pirority
• Exposure to human rights violation and trauma
• Dental procedures make evoke trauma response
• Poor social and psychological well-being
• Poor access to high quality nutrition and increased consumption of sugary food and drinks
• Poor or no access to dental services (poor/limited understanding of host country’s HCS, discrimination/lack of awareness on rights of vulnerable groups by staff)
  -Language barrier (different expectations of healthcare)

Question 6

When considering refugees and asylum seekers, what further aggravates the impacts of poor oral health?

Answer 6

Limited understanding of the host country’s healthcare systems, limited financial resources, compromised access to good quality food and clean water, and potential social isolation being away from family and friends
Refugees in camps were more likely to have their teeth extracted instead of restored due to limited access to dental services, limited dental workforce and limited financial resources to pay for dental care

Question 6

Name some OH promotion strategies for refugees and asylum seekers

Answer 6

1. Intervention on arrival: identify needs &timely assess to dental assessment
2. Community engagement: voluntary sectors and community advocates to support access to HC
3. Improve data capture and collection to identify orlal health needs of refugees and asylum seekers
4. Dental workforce training
5. Flexible models of dental care for emergency/routine dentistry
6. Multi-disciplinary approach to care

Question 7

NHS dental charges apply to all NHS patients, unless…?

Answer 7

• the treatment is free (for example to remove stitches, stop bleeding in the mouth, repair dentures)
• the person is under the age of 18, or under 19 in full-time education
• the patient person is receiving certain benefits. Proof of benefits must be shown to the
  dental practice
• the person is pregnant or has had a baby in the last 12 months. A MAT B1 certificate or
  maternity exemption certificate (MatEx) must be shown to the dental practice
• A person can check if they are entitled to free NHS dental care and can check whether they
  are exempt from NHS charges.

Question 8

If an advanced payment has not been received, should emergency/immediately necessary dental treatment be done?

Answer 8

Yes it must be provided
(Human Rights Act 1998)

Question 9

People who are not ordinarily resident are charged to use secondary care services, but some migrant groups are exempt. Which groups are these?

Answer 9

Non-UK nationals who have temporary leave to remain
* Refugees and their dependents
* Asylum seekers and their dependents
* Some refused asylum seekers
* Children looked after by a local authority
* Victims of modern slavery

Question 10

Which NHS services are free, no matter if you are accessing it via secondary care?

Answer 10

• A and E
• Testing and treatment of infectious diseases
• Family planning
• Services for physical or mental treatment caused by torture or violence

Question 11

What is the role of the dental team in regards to refugees and asylum seekers?

Answer 11

Knowledge of service entitlements and willingness to learn about different cultures: sympathetic, personalised approach

OH assessments & prevention

Increased time & resources for oral health care

Referral to health and social professionals (identify individuals/children at risk)

Staff training: trauma informed care

Language interpreting services readily available

Question 12

When is the earliest time a child’s first contact with medical staff can take place?

Answer 12

Before the individual arrives in
the UK, possibly carried out in the country where the refugee has sought protection

Question 13

If a child misses this entry health assessment, when is the next opportunity for a health assessment?

Answer 13

Only when an unaccompanied asylum seeking child is placed under the care of a local authority, which notifies health services

Question 14

When should the initial health assessment be carries out in terms of registration?

Answer 14

28 days after registration

Question 15

Who’s responsibility is it for an unaccompanied child to have a health plan, including
medical and dental care and treatment, and advice and guidance on health, personal
care and health promotion issues’?

Answer 15

The authority responsible