1Zelalem Mengesha and 2Esther Alloun
1Centre for Health Equity Training, Research & Evaluation (CHETRE), UNSW Australia Research Centre for Primary Health Care & Equity, A Unit of Population Health, Member of the Ingham Institute, Sydney, NSW 2170, Australia
2Health Equity Research and Development Unit (HERDU), UNSW Australia Research Centre for Primary Health Care & Equity, Sydney Local Health District, Sydney, NSW 2050, Australia
Migrant populations are not homogenous in relation to their migration pathways, visa status, health and social care rights, and experiences of the COVID-19 pandemic in their countries of residence. Specifically, asylum seekers and undocumented migrants are the two most vulnerable groups of migrants as they frequently do not have health and social security rights because of their legal or visa status. There is emerging evidence which suggests that the COVID-19 pandemic exacerbated pre-existing socio-economic inequities and other barriers to accessing basic services. New challenges also emerged during the COVID-19 pandemic.
We conducted a global scoping review and unmasked the unequal effects of the COVID-19 pandemic on asylum seekers and undocumented migrants. Here is what we found.
COVID-19 hits asylum seekers and undocumented migrants the hardest
Asylum seekers and undocumented migrants’ increased exposure to the SARS-CoV-2 virus due to living in overcrowded housing and shared accommodation, together with higher vulnerability to the infection, led to frequent outbreaks, hospital admissions, and deaths.
Governments excluded them from pandemic response policy measures
Based on their legal status, asylum seekers and undocumented migrants were routinely excluded from COVID-19 related unemployment and economic stimulus measures including income support.
In some countries, they were also disincentivised from accessing social benefits since financial autonomy remained a condition for residency applications. This was further compounded by reduced availability of other socio-economic support during the pandemic making them feel “we will die either from the virus or hunger”.
Measures implemented to curb the spread of the pandemic were not equally effective
A lack of culturally and linguistically appropriate information for asylum seekers and undocumented migrants on one hand and a lack of access to official media channels (structural barriers) on the other hand led to misinformation and confusion about the pandemic.
Information and trust deficits drove significant vaccine hesitancy among asylum seekers and undocumented people. This group also faced serious barriers to accessing vaccines, such as direct and indirect costs, fear of immigration checks, and pre-existing issues accessing mainstream primary care such as language barriers.
Asylum seekers and undocumented migrants experienced greater adverse consequences from control measures
Asylum seekers and undocumented migrants faced unique and disproportionate negative consequences due to pandemic control measures such as lockdowns and social distancing. Consequences include worsening anxiety and depression levels, restricted access to health care, visa processing delays, economic instability from loss of work with flow-on consequences on food and housing insecurity, and social isolation.
Furthermore, asylum seekers and undocumented migrants “lived the pandemic twice” by experiencing the disproportionate effects of the pandemic in their countries of residence and worrying about the pandemic’s effect on their families in their countries of origin.
How should governments prepare future pandemic response measures that involve community-based asylum seekers and undocumented migrants?
Begin by addressing current social and economic marginalisation
Preparation for future pandemics starts now by addressing current socioeconomic marginalisation of asylum seekers including poverty, poor housing and living conditions.
Inclusive pandemic-induced policy measures
Future pandemic-induced health, social, and economic policy measures should include asylum seekers and undocumented migrants regardless of their visa status. The COVID-19 pandemic proved that no one is safe unless we are all safe.
Proper engagement with migrant communities
Actively involving asylum seekers and other precarious migrants and consulting with frontline providers and advocates (including relevant NGOs, community and faith leaders, and ethno-specific community groups) can help tailor and disseminate health messages in linguistically appropriate and culturally responsive ways. This can build trust and increase the success of pandemic control measures.
Inclusive COVID-19 inquiries
Finally, Australia’s promised inquiry into the handling of the COVID-19 pandemic should include the voices of community-based asylum seekers and those in detention.
The original review article was financially supported by the NSW Refugee Health Service.
Zelalem Mengesha, Health Equity Research Fellow, UNSW Sydney; Esther Alloun, Research Associate, UNSW Sydney
Image: Warren Wong/Unsplash