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Response of the Medical Foundation for the Care of by gjz16706


									 Response of the Medical Foundation for the Care of Victims of Torture to
         the National Asylum Support Service Vouchers Review

Introduction: Nature and scope of the review.

The Medical Foundation for the Care of Victims of Torture believes that there should be an
independent and transparent review of the voucher scheme, conducted by an independent
body, external to the Home Office. This review should take both oral and written evidence
from those subject to the scheme and those working with them. We are pleased to note that
you intend to make public all responses received to the current review, unless the authors ask
that their response be kept confidential. You are free to publish this response. We urge that
the review be followed by an independent evaluation of the type outlined.
The Medical Foundation recalls the terms of the motion passed at the Labour Party
        “We therefore call upon the government to conduct an immediate comprehensive
        review of the voucher scheme. This review will include all aspects of the support for
        asylum seekers and will involve all the relevant stakeholders.
        In the light of experience gained over the last four months, Conference believes that
        the government should take immediate steps to ensure Trading Partners are able to
        give change to vouchers in a way consistent with the Government‟s overall
We had understood the motion, and the response of Minister Barbara Roche, as separating the
issue of change from the review, so that the giving of change would not be dependant upon
the outcome of the review. We urge you to take immediate steps to ensure that asylum
seekers are given change. We also understand the review as being a comprehensive one,
including all aspects of support for asylum seekers. This appears to fit with the questions
posed and it is in this spirit that we have drafted our response. We consider that the review
must be of this type, not limited to an operational appraisal of what is happening.

(1)    What is the nature of your organisation and what is your connection with the
       voucher scheme?

The Medical Foundation for the Care of Victims of Torture is a London-based human rights
organisation that receives more than 4,000 referrals of survivors of torture and organised
violence annually from approximately 90 countries. Almost all of these survivors of torture
or organised violence are asylum seekers. Our staff of clinicians offer medical and other
therapeutic help to them, as well as social and practical assistance. Our studies on torture in
particular countries as well as our clinical examinations and documentation of individual
cases are invoked in the assessment of asylum applications. Under the concessions given
during the passage of the Immigration and Asylum Act 1999, those in need of care and
treatment from the Foundation will not be dispersed, but housed where they can access those
services. Those identified as being in need of our services after dispersal can be relocated to
London. In the course of operating the concession, we see many clients during the
pre-dispersal period, or who are supported by NASS in the London area.

The Medical Foundation has a Regional Training and Consultancy Advisor and a Regional
Development Co-ordinator, appointed as part of the “Breathing Space” Project to address the

mental well-being needs of refugees and asylum-seekers across the UK. These workers
travel throughout the country, meeting with health professionals and others working with
asylum seekers to audit need and identify possible responses.

Many of our clients are directly affected by the voucher scheme because this is the means by
which they are supported.         In this group, we see large numbers in emergency
accommodation. This is partly because they are referred to us at this stage to see whether
they need care and treatment from us that might affect where they are sent. It is partly
because of the very lengthy periods being spent in emergency accommodation. We then see
clients who are supported by NASS in London, because they are receiving care and treatment
from us.

In addition, four groups of clients are indirectly affected by the voucher scheme. We receive
comments on the indirect effects of the voucher scheme on them. The first are those clients
who are refugees or have other leave to remain. Some new referrals already have leave to
remain when they come to us, although the majority do not. The second is those clients who
still receive benefits. This number is diminishing and clients in this group express fears
being made subject to the voucher scheme in future and often experience problems in
receiving services to which they are entitled as it is wrongly assumed that they are part of the
voucher scheme. Unaccompanied minors who attend fall outside the scheme. The same can
be said of the third group, unaccompanied minors, who are outside the scheme. Finally,
some clients are supported outside the NASS scheme, by their own means or by friends and
relatives. Again this group are affected by assumptions that they fall within the NASS
scheme. All these clients are indirectly affected by the voucher scheme because it is
affecting the resources both refugee community organisations and others working with
refugees have to help them.

We are referred clients who are survivors of torture living outside London and contact is also
made with survivors of torture and those who work with them through the Breathing Space

Others who contact us about the scheme include: refugees who are not our clients; NGOs,
including refugee organisations, human rights organisations, housing and welfare
organisations, children‟s organisations and others; health professionals; Local Authority
workers; workers in other statutory bodies; teachers; legal representatives and concerned
individuals. Areas covered include Coventry, Hull, Kent, London, Manchester, Newcastle,
Sheffield, Sunderland.

It is on the basis of our casework with clients who are survivors of torture and organised
violence involved with the NASS scheme, and our development work with health
professionals and others working with survivors of torture and organised violence involved
with the scheme, that we present our evidence to this review.

(2)    In general, how do you think the voucher scheme is operating?

Badly. The Medical Foundation does not consider that the arrangements for the dispersal and
support of asylum-seekers are satisfactory. Neither is their implementation. The scheme is
flawed in conception and a shambles in execution. It is inadequately resourced, and
insufficiently in touch with reality. The people most at risk in these circumstances are those

whose cases are not straightforward, and who have particular needs, into which category
many of our patients will fall. Details are set out below.

(3) Does your organisation receive many comments about the voucher scheme?

Yes. We receive comments from all the groups set out in (1) above, clients and other groups
and individuals. The comments are about problems and difficulties. The comments fall under
two general headings, with most people addressing both.
 First that the scheme is ill-conceived: it has an adverse effect on the therapeutic process,
   creates and perpetuates isolation and hostility and subjects those involved in it to poverty,
   social exclusion and loss of dignity and sense of self-worth.
 Secondly that even within its own terms, no aspect of the scheme is working as planned.
   Delays, confusion, misinformation, lack of resources, inadequate support are all

We would emphasise that in many cases problems do not come to light until a crisis erupts or
until a client is questioned directly about the support they are receiving. It is not possible for
NASS to base its evaluation of the voucher scheme on the number of complaints it receives.
Many of our clients are overwhelmed, bewildered, and exhausted by what has happened to
them, and very frightened of the consequences of making any complaint. In every case
where the support system has been directly addressed, we have discovered problems and
difficulties. These are often very grave and may present a threat to both the client‟s health
and safety and to their mental state.

(4)     What impact has the voucher scheme had on your organisation and/or your
clients? &
(5)     Please describe any difficulties you or your organisation has encountered with
the operation of the voucher scheme.

We have grouped these two questions together. Each and every one of the difficulties with
the scheme impacts on our clients. Each and every one of the difficulties they have impacts
upon our work with them. Not only the Medical Foundation, but the whole sector working
with refugees and asylum seekers, including but not limited to organisations who work
specifically with that group, is in crisis-response mode. The NASS support scheme is the
crisis. Our clients have had enough crisis already in their lives. Crisis response is not an
appropriate way of working with them. Nor is crisis response an efficient way for
organisations to work.

4(A)   The effect of the scheme on Medical Foundation clients (General)

In the Information Document Asylum Seekers Support at paragraph 1.6, the government said
        “The government takes the view that those who are genuinely fleeing persecution are
        looking for a safe and secure environment which offers a basic level of support while
        their applications are being considered. Such people will not be overly concerned
        about whether that support is provided in cash or in kind, nor about the location in
        which they are supported.”

This view has been repeated many many times –for example by the Minister of State, Barbara
Roche MP, speaking at the CRE/LGA/Refugee Council Fringe Meeting at the Labour Party
Conference on 27 September 2000 and in a large number of Ministerial letters to our
supporters via their MPs. However, the argument does not improve with repetition.
Leaving aside the obvious point that an economic migrant may be prepared to tolerate “short
term pain for long term gain”, the Medical Foundation‟s concern is with survivors of torture
seeking protection in the UK. The argument appears to be that they will be so bewildered by
their horrific experiences, so oblivious to the world around them that they will simply not be
aware of what is going on around them. That this is poor psychology will be obvious to
anyone who has themselves been in a situation where emotional havoc and physical
discomfort are combined. Waiting in a hospital waiting room after an accident, one is aware
when it is too cold, or too hot, that the coffee machine is broken and that there is nothing to
drink, that one feels one will never be clean again. One longs to be home, warm, clean and

Even more important, for many of our clients, is that it is their dignity which has been under
sustained attack by their torturers. Central to the therapeutic project is, as stated in the
Medical Foundation‟s Mission Statement, the restoration of the client‟s dignity and sense of
self-worth. We said in our response to the White Paper:
        “One of the aims of the torturer is to destroy the sense of dignity, self-worth and
        strength of the person. One of the central aims of the healing process is to nurture
        that sense of dignity and self-worth and strength, which is often very fragile when a
        person first comes to us, and may remain so for many years. In many cases torture
        survivors have drawn on their last strength to flee.”

Our interviews with clients since the introduction of the voucher system bear out this view.
Clients have few opportunities for self-care or self-determination on the tiny amounts of
support they are receiving, whether in kind or in the form of vouchers. All emphasise the
humiliation and embarrassment they feel when using the vouchers and the extent to which
they feel different, isolated, excluded, unsafe, bewildered and overwhelmed. Contrary to
what the government suggests, they are not oblivious to their social exclusion and humiliation
and the effects of this run wholly counter to our therapeutic work with them.

4(B) The effect of the scheme upon the Medical Foundation as an organisation

The Medical Foundation exists to provide a specialised service to survivors of torture and
organised violence. We are the only such organisation in the UK. As set out in our Mission
Statement this is “to enable survivors of torture and organised violence to engage in a
healing process to assert their own dignity and worth”.

The voucher scheme is reducing our capacity to do this work, and thus the specialised
provision to survivors of torture and organised violence as follows:
i)     Clients are presenting with a massive range of general problems, ranging from being
       homeless and starving because all support has been withdrawn from them, to being

       unable to find a legal representative, to being unaware of their rights and entitlements
       and/or unable to access/exercise these. Dealing with these problems takes up time
       that our workers would otherwise be spending on addressing issues arising directly
       from clients‟ experience of torture and organised violence. Even making a referral to
       another organisation to address the general problems takes time and it is becoming
       increasingly difficult as those organisations see a massive increase in demand for their
       services from clients facing social exclusion, dire poverty, and a chaotic bureaucracy.
ii)    Clients faced with such a massive and overwhelming set of problems in their
       everyday lives are inevitably preoccupied with addressing these problems. Many are
       bewildered and overwhelmed. In these circumstances, it is difficult and often
       impossible for them to engage with therapeutic work relating to their experiences of
       torture. It is a vicious circle, because healing would make them better equipped to
       tackle the practical problems of life in exile and the pursuit of an application for
       protection. As they confront these issues without having been able to engage in a
       healing process, the impact their problems have on their ability to heal is exacerbated.

4(C)   Time spent on vouchers exacerbates these problems

We wish to emphasise the very lengthy periods that clients are spending on vouchers,
whether under the interim scheme (including the preceding National Assistant Act and
Children Act schemes) or the NASS scheme. When the government says that it is meeting its
targets for decision-making, it should be born in mind that this relates only to new cases.
Others have been waiting, and continue to wait, much longer for a decision. We have clients
who have spent more than a year on vouchers.

The 6 month time target covers only part of the case. Two months until the initial decision,
a further four months from the appeal reaching the IAA to the end of proceedings before the
IAA. This leaves out the time the Home Office takes post refusal to consider further
evidence, which now includes other issues raised in the “one stop” notice introduced under
Part IV of the Immigration and Asylum Act 1999. In the “one-stop notice” the client might,
for example, raise issues under the Human Rights Act, which then have to be investigated.
Also the 4 months for an appeal does not cover further appeals, for example to the Court of
Appeal, or because an appeal is reinstated following judicial review. These can take many
5       Difficulties with the scheme and how these impact upon our clients and upon the
        Medical Foundation

There are so many problems that we have been forced to adopt a bullet-point approach in
outlining them, providing illustrations to highlight some of the difficulties. We are happy to
provide further information if requested to do so. Where case studies have been provided,
they often illustrate many problems, rather than just one. To avoid duplication, we keep all
the details of each case together, rather than splitting it up across different sections, but the
case studies should be read with reference to our list of problems as a whole.

5(A)   Applying for support

Here there are a number of problems:

Accessing the support system

Those who are not assisted to access the system
 You define them as “disbenefited”. Families whose benefits are withdrawn are supposed
   to present at the Asylum Seekers Team of the local authority where that authority will
   assist them to make their application for support. The emergency support provisions for
   families in this situation are far from clear and some families in this situation are not
   accessing support.
 Single adults whose benefits are cut off are supposed to phone NASS to request an
   application form which is then sent out by post. But very often they do not have money to
   do this. With the loss of benefits, they may have no address to which the form can be
   sent. Again, emergency support is a problem.
 It can take up to 7 minutes of recorded messages before a person phoning the NASS
   phone gets through all the options to speak to a person. One of our doctors reports that
   her experience of phoning this number is being held in a queue for an average of 10
   minutes. She notes: “How does the asylum seeker understand? How does the asylum
   seeker find money for such a long phone call? This is completely unacceptable.”
 The NASS messages are in English only.
 The asylum seeker must complete the form in full and in English.
 Organisations who are not funded, nor trained to help complete the NASS forms are
   being co-opted into this role. This is a drain on their time and resources, lessening the
   provision they can make for asylum-seekers and refugees. It may also mean that
   application forms are not completed as they should be.
 Asylum-seekers who can find no-one to help them are living in destitution because of

Those who are passed from pillar to post
 Confusion around whether local authorities or NASS is to support some groups. You are
   aware of problems that have arisen in “mixed families” cases, as per Policy Bulletin No
   11. Not all local authorities appear to be aware of its contents, and asylum-seekers are
   passed from pillar to post until someone accepts that they are responsible. In the interim,
   many do not get any support.
 The complexity of the allocation of responsibility also generates confusion as to who is
   responsible for any particular asylum seeker.
 Individuals and families are living in destitution because no-one will take responsibility
   for them.

K family from former Zaire
 Mr K arrived alone. He has been waiting for a decision on his asylum case since 1996. He
is thus still on income support and housing benefit. In September this year his wife and two
children arrived in the UK. He was living in a tiny bedsit in a B&B. His wife and children
moved in, as did a friend, so the three adults and two children are all living in a tiny room.
The council say they have no responsibility to rehouse Mr K as he does not have leave to
remain and his family arrived after 3 April. They referred the family to NASS. NASS
refused to help because the family has income support. Mr K‟s wife is not well. She had
had psychiatric treatment before coming to the UK and has been detained in the past, but she
will not yet talk to anyone about what happened to her. Her husband says that she has

changed completely. She gets very angry and aggressive, including with the children. The
family went to the local MP, but the MP did not want to see them.

Article 3 cases
 Part VI of the 1999 Act makes absolutely clear that those who have applied to remain in
    the UK on the basis that their removal would breach article 3 ECHR (the prohibition on
    torture, inhuman or degrading treatment or punishment) are “asylum seekers” for the
    purposes of Part VI and entitled to NASS support. Yet there seems to be a degree of
    confusion about this in practice, and a reluctance to give these people the support to
    which they are entitled.

Access to support from detention
 At the Home Office meeting on 16 August 1999 to discuss bail and support arrangements,
   attended by Gillian Smith and Kate Hall on behalf of NASS, Ms Smith stated that
   detainees would be given the opportunity to apply for support at the earliest possible
   stage, so that they would have an address from NASS to which they could go if released.
   This has not happened. Some adjudicators will bail to emergency support. Others
   decline to do so. The Refugee Council performs its assistant function for those held at
   the detention centre in Oakington in Cambridgeshire, but for other detention centres no
   arrangements have been made.

Completing the support form with an assistant
 Some clients regard assistants as part of the Home Office and are wary of divulging
  information to them, for example on a history of torture.
 The form is filled in on the first day after being offered accommodation by the assistant.
  The assistants report that clients are not disclosing torture at this stage.
 Some clients are interviewed in areas where there is visual, but not aural privacy, to
  complete the form. These clients are also unwilling to disclose details of torture or other
  distressing and traumatic events.
 The focus of the form is on the asylum-seeker‟s means. The information collected is not
  sufficient to identify special needs nor for a decision on appropriate accommodation,
  including accommodation that will be safe for the particular asylum seeker, to be made.
 Because of delays, the workload of assistants and the distressed state of many asylum
  seekers uncertain about their support, asylum seekers, especially those who are
  traumatised, can find the visits to the assistants overwhelming.

Emergency Accommodation
 At the heart of all the problems with this is that the time spent in emergency
  accommodation was to have been limited to a couple of days, with asylum-seekers
  informed of the position after 7 days if, exceptionally it is implied, a decision had not
  been made on their application (see the Appendix to the Asylum Support Regulations SI
  2000/704). In practice people are spending much more lengthy periods in emergency
  support. In some cases, NASS has not communicated any decision. In others, it has
  done so, but has not made move-on arrangements. We have clients who have remained
  in emergency support for months, longer than the governments‟ time targets for initial
  decisions on their cases.
 The set-up in emergency accommodation is not adequate for a short term stay: it is not
  safe to leave people with support wholly in kind and no cash whatsoever. For the long
  term it is wholly inappropriate.

   The uncertainty and temporary nature of accommodation presents further problems for
    clients. It is unsettling for them to know that this accommodation is temporary and yet
    receive no news of where they are to go next for months on end. False alarms, where
    people are told to pack up their luggage because they are to be moved, and then find that
    nothing ha-ppens, adds to these feelings of uncertainty.
   There are safety issues including issues of child protection and sexual harassment;
    Children are not accessing schools, because the accommodation is supposed to be
    “temporary”. There is clear evidence that this is not being challenged in some, perhaps
    the vast majority, of places providing emergency support. This flouts the statutory duties
    to provide education. The children of some of our clients have missed almost a whole
    term of school. For those approaching school-leaving age, failure to get them into school
    now may mean that they never commence their education in the UK. Parents are
    extremely worried about this, it increases their feeling of helpless to be unable to provide
    for their children.
   Similarly with registration with GPs. Because accommodation is temporary, clients are
    not being registered with GPs in the area.
   Support is wholly in kind, clients get no cash or even vouchers for months on end.
   Support wholly in kind brings with it attendant problems. Clients are unhappy about the
    food and there are issues about suitability of food, especially for pregnant women.
    Clients are unable to purchase warm clothing, which is causing difficulties for those who
    arrived without winter clothes. Clients do not have pens paper, stamps or phonecards.
    This is a particular cause of anxiety for those who have left family members behind. The
    family member may be in danger, or the client may wish to reassure them that the client
    has him/herself reached safety. Perhaps most alarming of all, clients have no money
    whatsoever for travel. They have SEF forms to be completed within 2 weeks but no
    money for travel to see a legal representative, if they have one. The Medical Foundation
    is having to reimburse the travel expenses of those who come to see us, but getting to us
    in the first place can present logistical problems.
   Clients complain about standards of hygiene in the accommodation and kitchens and
    about the quality of food. It is important to register the high level of anxiety clients have
    about these issues, in the light of our comments under 4(A) above.
   Libraries are reluctant to accept temporary accommodation addresses for the purposes of
    allowing those housed there to borrow books.

Emergency Accommodation 1, London
This accommodation contains mostly single men but there are single women, single women
with families and family groups there. There are not separate areas for separate groups.
Women report that they do not want to walk along the corridors on their own. For survivors
of torture and sexual violence, the natural apprehension and fear this situation creates is
An Iraqi Kurdish client with a long history of torture, imprisonment and execution of family
members described the hostel as dirty, the food as inedible and indicated that she was very
frightened of the men in the hostel.
An Afghani client who had fled the Taliban was placed in the hostel with her young child.
She became very frightened by the men in the hostel. Although opposed to the veiling of
women, she has taken to veiling herself in the hostel for her own protection to seek to avoid
sexual harassment.

Mr H from Iran, Emergency accommodation 2, London
Mr H has suffered detention and torture and continues to be in physical pain. He cannot
walk properly and also has problems with his sight, both as a result of his torture. He applied
for support when relatives with whom he had been staying could no longer afford to keep the
family with them. He has a thirteen-year-old child who has not started school because they
have been in temporary accommodation and the child has missed most of this school term.
The parents are extremely worried this.            They queried it with advisors in the
accommodation, but were told that the child could not have a school place because the
accommodation is temporary. They eat only two meals per day. They do not eat any lunch.
They receive no cash at all. Mr H is afraid that the food is not being cooked properly and
expresses concerns about hygiene, both in relation to crockery and to insects in the family‟s
room. He notes that a lot of food is thrown away; this bothers him. He does not understand
what is happening. He does not know his rights. He has received no reply to his
application for support. He is also concerned that the food is not good and that the standard of
hygiene is poor. He emphasises that he does not want to complain, what is happening is “not
very much compared to what we have suffered”. The family appreciate the fact that they
receive support.

Ms A, Emergency accommodation 4, London
Again, Ms A, like many clients in this accommodation, reports that the food is very bad.
Meat is distributed according to religion. Muslims get mainly or all vegetables but
non-Muslims get extra meat, which many do not want. Ms A from Ethiopia has lived in the
hotel for the past few months with her five year old daughter. She says the meat tastes bad.
She asked to have more potato but this was refused. Her daughter is refusing to eat. Both
mother and daughter have lost a lot of weight since their arrival.

Ms R from Iran, Emergency accommodation 3, London
Ms R, has been put in a room with three adults, her adult children. Along with almost all of
those who have been placed here she complains of the food and the way in which she and
fellow residents are being treated. The food either looks or tastes very bad and they are
given very little portions. If they want to have two pieces of bread instead of a piece of meat
they will not be given these. They also do not get any fruit. There are also examples of
pregnant women who have been treated very badly by those who distribute the food in this
accommodation. One pregnant woman asked for an apple and was refused in a very harsh
way. A child asked for toast instead of cornflakes. This was refused. In most countries
cornflakes are not eaten for breakfast

Mr P from Afghanistan
Mr P was detained in Afghanistan for two years and tortured there. He fled to the UK where
his brother has lived for over 15 years, with his wife and son. He is suffering serious
intestinal problems which are being investigated in a London hospital. While the family
were living in with his brother, they received vouchers. When his brother could no longer
accommodate them, attempts were made to disperse Mr P to Newcastle. Only the fact that
he was receiving care and treatment from the Medical Foundation meant that he could stay in
London. However, he was yet to get any permanent accommodation in London, he
continues to live in emergency support. The family live in one room in a hostel. A kitchen

is shared. The family receive support entirely in kind. Mr P is on sleeping tablets. He has no
appetite and suffers from headaches. He finds the hostel environment too noisy, too busy.
He feels embarrassed, he does not go to breakfast because he feels embarrassed. He finds it
difficult to eat the food and this embarrasses him, he collects the food for other meals and
takes it back to his room to eat. For breakfast he gets cornflakes, bread and jam and a cup tof
tea. He is concerned because his son does not have a place in school. He says the family
have been told by the hostel that this is because the accommodation is temporary, when they
leave their son will be able to go to school. But they have been in the hostel for months.
Quite a few families are in the same position. They are all very troubled by it. Mr P is also
troubled by inconsistency in the system, some Afghan families who arrived later than he have
been moved out of the emergency accommodation, but his family remains. He feels people
are not being treated equally. Mr P‟s earlier experiences of vouchers are described below.

5(B) The provision of support: dispersal
Again, there are a whole range of problems under this heading.

The Medical Foundation concessions
 The concession that survivors of torture receiving care and treatment from the Medical
   Foundation will be housed in the London area can work only if NASS has contracted for
   sufficient accommodation there. Our experience to date, as reported to NASS, is that
   this has not been done. This shortage of accommodation units in London (340 as of 3
   November 2000) underlines very many other dispersal-related problems for our clients,
   including the administrative difficulties NASS too frequently experiences in fulfilling the
   terms of the government concession and contributing o the lengthy periods our clients are
   spending in emergency accommodation. When we met with senior NASS officials in
   November, we put to them that:
       (a) NASS has a surplus of housing under contract in some dispersal areas due to
           asylum-seekers dropping out of the support system;
       (b) This situation is pushing NASS to fill those empty spaces rather than contract for
           further units in London.
   NASS officials confirmed our view. The Medical Foundation continues to ask NASS
   seek a sufficient number of housing units in London to meet the terms of the government
   concession on clients of the Medical Foundation being accommodated in the London
 We have had several meetings, and exchanged many letters, with NASS and the assistants
   on how the concession is to operate in practice. All parties are feeling their way toward
   the most efficient procedure. The main problem at the moment is that while we feel we
   have achieved agreement with senior officials within NASS that if the Medical
   Foundation accepts a client for care and treatment then that client should be housed in
   London, some caseworkers are not accepting this as sufficient. This can lead to protracted
   exchanges over individual cases.
 The lack of a role for assistants in the applications made to NASS by people who have
   been “disbenefited” complicates the operation of the concession. Where the assistants
   are involved, procedures can be established to cover referral to the Medical Foundation, a
   response as to whether we are taking the case, and for communication between NASS, the
   assistants and the Medical Foundation.           Such systems cannot operate where

   asylum-seekers are completing the forms unaided, or approaching a whole range of
   organisations who have no official role as assistants, for help with completing the form.

Afghani client dispersed to Bradford
This man is a survivor of imprisonment and torture by the Taliban. His torture included
being forced to eat food with sharp wire in. Despite appeals from the Medical Foundation,
this man was dispersed to Bradford. He has profound psychological problems and needs
regular counselling sessions. He is also deeply concerned about his physical state and needs
proper medical assessment and follow-up. When he arrived in Bradford he walked 40
minutes to the local hospital and desperately tried to make himself understood. Fortunately
he had an appointment card from the Medical Foundation which he showed to the nurse on
casualty who telephoned us. We were able to talk to him on the telephone using an
interpreter and it was clear that he was very concerned about the pains in his stomach.
There is no money for fares and it is impossible for him to seek help for his psychological
and physical problems without walking great distances when he is unwell. Efforts are being
made to persuade NASS to rehouse him in London, where there will be still be problems of
no payment of fares and may be problems of poor accommodation, but at least there will be
the psychological and medical help at the Medical Foundation which he desperately needs.

Forced no choice dispersal
 In our experience, forced, no-choice dispersal is often experienced as an attack, a threat.
   This does not create a positive attitude toward life in the dispersal location. Allowing
   asylum-seekers no say in the location to which they are to be sent is disempowering and
   distressing for them.
 We are concerned that the “circumstances” of the asylum seeker taken into account are
   too limited. We have seen cases where attempts have been made to move asylum
   seekers away from family and friends providing emotional and practical support. In
   other cases the health needs of asylum-seekers have not been taken into account.

Mr D from Congo
Mr D was tortured and very badly injured by this in Congo (Brazzaville). He suffers from
severe headaches and severe back pain as a result. He is extremely anxious and frightened,
especially at night. Other symptoms include a burning sensation in his stomach. He is on
high doses of medication to help him sleep, to assist with his appetite problems and to control
pain. When Mr D arrived in the UK, he travelled to Manchester. He attended a Pentecostal
church there and was accommodated by a member of the congregation. When it became
impossible for this person to house him any longer, he applied to NASS. Mr D does not want
to live in London; he found London too frenetic. He wants to be near his church in Salford,
in Manchester. Yet he was dispersed to Sunderland where there are no Pentecostal churches
and few other people from Congo. He lives in a bed and breakfast and has difficulty in
coping with the isolation. He fainted and fell down stairs in his accommodation

Journey to destination
 Significant numbers of those dispersed report having had no idea where they were going
   prior to dispersal. Many are in a confused state and need written information to be
   supplemented with oral explanations.

   We are aware that large numbers of those who do not travel on a coach provided by
    NASS but are instead issued with documents for travel, do not turn up at their destination.
    Lack of understanding of what is happening to them can only contribute to this.
   There have been cases where heavily pregnant women have been dispersed, including
    cases where arrangements for the birth in London had already been made.

Dispersal location
 People were supposed to be clustered in dispersal areas by nationality/language. The
   NASS figures on confirmed arrivals of asylum seekers, including dependants, in each
   cluster as of the end of September, circulated under cover of a letter of 18 October 2000,
   show that this is not happening. To give some examples:
   Kent and Sussex region: Brighton and Hove: 2 Albanians, 3 Algerians, 1 person from
   each of Burundi, Cameroon, Chad, Congo, Estonia, Libya, Montenegro, Morocco,
   Rwanda 3 Iranians, 2 Somalis.
   North West region: Burnley: 1 Afghani, 3 Albanians, 1 person from each of Belarus,
   Cameroon, 3 people from the Czech Republic, 2 Poles, 3 Romanians, 3 Russians, 4
   Somalis, 5 Iranians, 11 Zimbabweans.
   North East Region: Stockton on Tees: 9 Afghanis, 1 person from Congo, 7 Iranians, 14
   Iraqis, 4 Kosovans, 9 Libyans, 1 person from Sierra Leone, 1 person from Sudan, 1
   person from Uganda, 3 people from Zimbabwe.
   Yorkshire and Humberside region: Halifax: 10 Afghanis, 4 Albanians, , 1 person from
   Chad, 1 person from Congo, 2 people from Georgia, 7 Iranians, 13 Iraqis , , 1 person
   from Kosovo, 1 person from Moldova, 3 people from Palestine, 1 person from Russia, 1
   person from Syria, 10 people from “Yugoslavia”
   East Midlands region: Nottingham: 9 Afghanis, 2 Albanians, 5 Angolans, 12 people from
   the Czech Republic, 5 Iranians, 7 Iraqis, 4 people from Israel, 1 person from Kosovo, 1
   person from Palestine, 10 Syrians, 2 people from Turkey and 3 Yugoslavs.
   West Midlands Region: Walsall: 3 Iraqis, 1 person from Rwanda.
   Because these figures include dependants, some figures of more than one for a person of a
   particular nationality will simply mean one couple or family group. These are not viable
   clusters of people who can provide support to each other. Asylum seekers and those
   working with them from different regions complain of isolation.
 Much dispersal is to poor areas, where there is a high level of social exclusion among the
   existing population and public services are not meeting the needs of that population.
   Isolation and lack of support are key problems in dispersal areas.

Council Richard Kemp of Liverpool City Council, spoke at the Immigration Advisory
Services conference on 22 June of the NASS system as “a shambles”, “a disgrace”, and “an
effrontery”. He said that under NASS contracts, people had been housed in Liverpool in two
unsuitable tower blocks, which are badly managed. There is no strong minority community in
the area. No doctor in the area has a waiting list. Legal advisors are overwhelmed.    The
Council has had to resort to a range of measures, including invoking the powers of local
trading standards officers, to protect asylum seekers from exploitation.

The NASS contracted housing there is in an area with a predominantly white population, high
unemployment, and high levels of poverty and social exclusion. Social Services there were
already struggling to cope with the needs of the local population.

Providers are buying properties in the poorer city centre area which were formerly occupied
by students. They are not housing according to nationality. They are also housing a large
number of people in the estates on the outskirts of the city, where unemployment runs at

In quite a few of the areas where there is a ready supply of accommodation are areas where
schools are under “special measures”. The Local Authority is seeking to follow government
educational guidance which says such schools are not appropriate for children whose first
language is not English – they cannot get the support they need, and the other children may
also be put in a worse position. The children are therefore having to travel distances to
school. The council states that where accommodation cannot be found near a suitable
school, it assists with costs of travel to school.

Dispersal of those with mental health problems
 Asylum seekers with special needs have been sent to accommodation providers who do
   not have the facilities to meet those needs. In one case, detailed reports evidenced to
   NASS that the asylum-seeker was suffering both mental illness and was mentally
   disabled. This was translated by NASS into the statement “brain problems”. The man
   was then dispersed to a housing provider that had indicated it did not have facilities to
   house people with mental illness. Absolutely no information was provided by NASS to
   the housing provider to indicate that the man had any mental health problems whatsoever.
   When they saw the man, the housing provider sent him straight back. The disruption and
   distress caused to him by this were considerable.

Standards of accommodation
 We are concerned about the standards of accommodation provided to those housed by
   NASS. Those clients we accept for care and treatment are being housed in the London
   area.    As we have indicated above, NASS has not contracted for sufficient
   accommodation in the London area. The accommodation it has provided frequently does
   not meet health and safety standards.
 We have been told that NASS only inspects properties with 6 or more applicants. If this
   is correct then it places those housed in smaller properties at risk.
 The Observer newspaper reported on 4 June 2000 that, following the paper‟s exposés of
   problems around the housing being used under the NASS contracts, which included
   asylum seekers living in flats sold as unfit for council tenants, documents being withheld
   from residents and residents not being allowed visitors without the landlords permission,
   the Property Advisor to the Civil Estate, who is responsible for all Civil Service Housing,

    would inspect property used in dispersal. We consider that the findings of the Property
    Advisor should be made public. We understand that the Property Advisor deals only with
    physical defects in the property and that NASS teams handle other issues. The findings
    of the NASS teams should also be made public.
   Medical Foundation caseworkers identify the following concerns: the need for locks on
    doors, windows and toilets; rodent and pest control; disabled access; proper assessment of
    need and care should be made prior to the allocation of accommodation.

Health visitors in Scotland contacted us to voice concerns that asylum-seeker families with
young children had been housed on the higher floors of tower blocks where no locks had
been placed on the windows.
Iranian Kurdish Client – NASS accommodation in London
This client has a long history of persecution, execution of family members, imprisonment and
torture in Iran. Her husband, also a survivor of imprisonment and torture arrived several
months before her and was dispersed to Birmingham where he was subject to racial
harassment and abuse. The client was placed in highly unsatisfactory emergency
accommodation, dirty, with poor food and harassment from men in the accommodation.
Efforts were made to disperse her but the Medical Foundation‟s representations were
accepted and she was allowed to stay in London. After further representation she was
housed with her husband in a small damp room infested with mice. The bathroom and toilet
were shared with five or six other asylum seekers and she has to go down several flights of
stairs in a poorly lit building to reach them. The toilet and bathroom are in a bad state of
repair and are not kept clean.
This client is desperate to attend college to have some sort of structure to her life, but the
NASS support system, in which the definition of essential living needs expressly excludes
travel and there is a zero allowance for travel expenses, does not allow her any fares.

Algerian client: accommodated in London
This client was tortured in Algeria. He suffered TB in Algeria and is extremely frightened of
suffering a recurrence of this disease. He is awaiting the results of tests. He is very worried
because his accommodation is dirty and he thinks there are mice. He is worried about
laundry as there is no washing machine and he has no money for the laundrette.

Responsibilities of housing providers
 The NASS system is predicated upon a model of supported housing, but this is not how it
   is operating in practice. NASS has contracted with providers who have no experience in
   providing any form of supported housing. There are problems with the fact that these
   responsibilities have been imposed on housing providers at all, the extent of the
   obligations imposed on housing providers, and with their fulfilment of the obligations
   they have.
 The responsibilities imposed by the contracts with NASS are insufficient to ensure that
   people get what they require. The contract requires housing providers to “facilitate”
   getting a GP, getting children into schools etc. Some discharge this responsibility by
   giving the asylum seeker a GP‟s name and address on a piece of paper, written in English.
   There is no follow-up to ensure that the asylum-seeker has actually managed to contact
   the GP and succeeded in registering. Many do not. The extent of the obligations in the
   contracts should be reviewed.

   In other cases, housing providers are not fulfilling these responsibilities at all. Many are
    not even aware of them. This happens where a provider has contracted with NASS to
    provide a certain number of units of accommodation and then subcontracts to fulfil these
    quotas. Some sub-contractors are wholly unaware of the “support” side of their
    obligations and do not appear to be monitored or evaluated.
   We are extremely concerned that child protection issues and issues to protect women
    from sexual harassment have not been addressed in shared accommodation.
   We understand that the NASS contract with housing providers does not require them to
    have a local office. In many cases, the monthly inspections they are supposed to carry
    out either do not happen at all, or involve the most cursory exterior inspection to check
    that the property is still occupied.

Medical Foundation Welfare Officer
Our Welfare Officer summarises some of her key concerns, which need urgently to be
addressed, as follows:
 Understanding how important a safe environment is for our clients who need to build trust
 Understanding the needs of torture survivors, the need for compassion, kindness and
 Accommodation providers, NASS and the One Stop Services need to work together each
   with a clear understanding of the role of the others. A coherent approach is needed
 Inappropriate, inadequate, sub-standard housing is causing severe problems for our
 Accommodation must be fit for human habitation
 It must not be infested with mice or cockroaches.
 Secure locks are needed on doors, including lavatory doors, and windows.
 Accommodation must not be overcrowded.
 Accommodation must be accessible and appropriate for able-bodied and disabled clients
   according to their need. This can only be done if a proper assessment of need is being
   made and then accommodation identified which meets that need.

Medical Foundation workers visiting Liverpool in July reported the following problems in
properties provided under the NASS system:
 Health and safety
 Male and female single people being made to share flats
 Workers, including health workers being denied access to the property
 Noise
 Vandalism

One Stop Services
 The problems of insufficient support from housing providers might be less acute is
   asylum seekers were able to obtain support from the One-Stop Services. But many are
   40 miles from their nearest one-stop service, and have no way of getting there.
   Regulation 9 of the Asylum Support Regulations 2000 (SI 2000/704) makes clear that
   there is absolutely no allowance for travel in the sum provided by NASS to cover
   essential living needs (Asylum Support Regulations, Regulation 9(4)). A substantial

    number of our caseworkers have identified the exclusion of travel from essential living
    needs as “the worst thing about the NASS system”
   Even where an asylum seeker is able to make contact with the One-Stop Service they may
    not be able to obtain help. Speaking at the Benefits Agency Asylum Seekers and
    Refugees Forum on 15 September 2000, Eni Banakole Race who heads up the
    Inter-Agency-Project, a joint venture between those voluntary sector agencies (eg
    Refugee Council, Refugee Action, Refugee Arrivals Project) who have contracted to the
    Home Office to set up One-Stop Services in cluster areas, explained that One-Stop
    Services are not funded to see every dispersed asylum seeker. They may not know who
    is there. They have only statistics on who is dispersed to their area – not contact details.
    Some asylum-seekers are 20 miles from nearest One-Stop Service. Some One-Stop
    Services have outreach services. One-Stop Services cannot even see every asylum seeker
    who wants to see them.
   You will be aware of the circumstances in which Refugee Action closed their Liverpool
    Office and will receive representations from that organisation in response to this review.
    An extra burden is placed on the One-Stop Services because responsibilities have
    inappropriately been placed upon housing providers and because housing providers are
    not fulfilling the responsibilities they have. The One-Stop Services are seriously
    under-resourced and cannot in any event hold together a crumbling system.

Lack of regionalisation of NASS
 NASS has one officer for the North West. The overwhelming majority of NASS staff are
   in London. The level of knowledge within NASS of what is happening in different
   regions and NASS‟s ability to tackle problems are both severely impeded by this failure
   to disperse the staff responsible for overseeing the safety and welfare of dispersed

Support from Local Services is impeded because NASS are not supplying sufficient
 Mike Boyle, leading for the LGA on asylum issues, speaking at the Immigration
    Advisory Services Conference: Dispersal: Punitive or Practical on 22 July 2000 noted
    the difficulties caused to local authorities because NASS is not sufficiently open about
    what they are doing.
 Councillor Richard Kemp, of Liverpool City Council, speaking at the same conference,
    noted that NASS could not tell Liverpool City Council how many asylum seekers had
    taken up their offers of accommodation in Liverpool, nor how many had stayed.
 Richard Palmer, Programme Manager for the Sheffield Council Asylum Seekers Team,
    speaking at a public meeting in Sheffield on 2 November 2000 described how when
    NASS contracts with private providers, it does not tell the local authority who is going
 It is difficult to know what the rights of individual asylum seekers are, and what the
    NASS procedures are supposed to be. Ms C Gardener of NASS stated in a letter dated 3
    November 2000 that the NASS Process Manual for the Asylum Support System “had
    been replaced by the NASS Caseworker instruction manual….The text is primarily for the
    use of caseworkers and is subject to constant revision in view of the early stage of
    development of the new arrangements. These instructions are in a constant state of flux
    and a definitive version is not yet available.” We urge NASS to make the manual
    available as soon as possible.
 The NASS “Stakeholder Group” has not met since mid-1999. It is moribund. We
    understand that the Benefits Agency have contacted NASS asking them to take over the

    Benefits Agency Asylum Seekers and Refugees Forum so that there will be a system by
    which NASS gets input from users. We do not know the NASS response. At the
    moment there is no similar forum for user/stakeholder input into NASS.
   The NASS website contains only minimal information – a page of general paragraphs.
    We urge NASS to update the website and to post its policy bulletins, Caseworker
    Instruction Manual, and monthly statistics, on this website.
   Lord Greaves, speaking in the House of Lords, described the situation in Pendle in
    Lancashire. The Medical Foundation has visited Pendle and can concur with the account
    set out below.

Pendle (as described by the Lord Greaves in the House of Lords, see Hansard HL Report 7
July 2000 col. 1753).

“The first that anyone knew of the fact that NASS was sending anyone to our area was when
a young man from a North African country who could not speak any English presented
himself at the check-out at Morrison's with his vouchers and managed to make it understood
that he wanted English lessons. … the initial major area of concern was the question of
secrecy. Whenever anyone asked questions, there was a blanket silence, a wall of secrecy. …
In particular, local authority were being kept in the dark.
On Tuesday (4th July) the Lancashire Evening Telegraph reported as follows:
         „15 asylum seekers have arrived in Burnley but the council doesn't know who they are
or where they are living. Council Labour leader Stuart Caddy slammed as appalling and
unacceptable the Government's refusal to provide information ... denying the local authority
the chance to provide help and guidance‟.
I can tell noble Lords lots of horror stories but I quote just one involving a traumatised
teenage girl from another North African country. Her home was in a village in a war zone
which had been recently bombed. She was placed alone in a house without any contacts or
knowing anybody. In the middle of the night she awoke with severe stomach pains. The only
people she knew were others who had arrived with her on the same bus. They happened to
live across the road. She managed to wake them and, somehow, they took her to the casualty
department of the local hospital. Two days elapsed before the hospital discovered who she
was and why she was there. The hospital only discovered her identity when a teacher in a
local FE college was told in an English class that a girl had been taken to hospital. She rang
the hospital and spoke to the ward sister, who said, „Thank goodness someone has rung. We
have no idea who this girl is‟. Such events occur because the Government rely on private
sector providers at local level to provide a whole range of services of which they have no
experience and understanding; and some of them have no intention of providing these

A great deal of planning had been done to prepare for the reception of asylum seekers.
Suddenly, they have learned that NASS has signed a contract with a private provider and,
without warning, is starting to send asylum seekers to Plymouth. The careful planning is
being undermined.

Unreasonable level of demands on front-line workers in dispersal areas
 Lack of resources, infrastrucutre and central planning, and the weakness with the
   provision from NASS, One Stop Service and housing providers, as outlined above, mean
   lack of support for front-line workers, for example GPs, teachers, and members of
   voluntary organisations who come forward to help asylum-seekers dispersed to their area.
   They find themselves with inadequate resources to make their own specialist contribution,
   and moreover find that they are the sole port of call for a multitude of enquiries – housing
   problems, where to find legal advice, problems with education, language, vouchers.
   They become overwhelmed and cease to be able to cope with the work. The effect is a
   reduction in the support available, rather than an incremental increase.

 This is an overwhelming problem in many areas and resources are needed to make
   concerted attempts to address it. In certain areas it is difficult to find interpreters
   speaking many of the refugee languages. Where there are interpreters, they have many
   demands made on their time.
 In these circumstances, commercial telephone interpreting services can provide a
   back-up. However in many areas, GPs and others are not making use of interpreters, or
   of telephone services.

The Primary Care Group has made funds available for interpreters, but a lack of interpreters
still proved a problem.

Kosovo HEP Programme provides an example
Under the HEP, resources were available for interpreters. Only one language was needed.
However, it proved extremely difficult to find interpreters in situ in many areas. Interpreters
had to be brought in from other areas, often far afield, and many were not trained professional
interpreters. All too many had family members themselves caught up in the fighting in
Kosovo or the exodus from the region, and thus found their work extremely upsetting. We
cite this not as a criticism of a well-resourced HEP programme, but as an indication of the
scale of the difficulty of finding interpreters and as highlighting the need to use professional
interpreters with good support and supervision.

5(C)   Access to services

The range of problems under this head are not limited to dispersal areas, although in most
cases the greatest problems are found in dispersal locations.

Access to health care
 We highlight again the many problems created by lack of language support. The
   Promoting the health of refugees report of the Health Education Authority‟s Expert
   Working Group on refugee health, on which the Medical Foundation served, highlights
   dangers of “misdiagnosis, inappropriate use of medicines and patients being forced to go
   from pillar-to-post trying to be understood and to understand”. The Expert Working
   Group noted the danger of over-reliance on family members to interpret. It is
   inappropriate, and may be impossible, for people to speak of terrifying and humiliating
   events before family members. Doctors may seize the symptom through miming and

    pointing and a few words of broken English, but never get anywhere near understanding
    the cause, or how discrete symptoms are related to torture.
   We have examples from many parts of the country of GPs and dentists refusing to register
    asylum seekers, or registering them only as temporary patients. We have examples from
    many parts of the country of GPS closing their lists to asylum-seekers. Baroness
    Howells of St Davids drew attention to these problems
         “Do the dispersal arrangements--they are concerned solely with housing--adequately
         ensure that asylum seekers have access to GP services? There is strong anecdotal
         evidence, usually from lawyers advising asylum seekers, that they have great difficulty
         getting on to GP lists… When asylum seekers are sent to areas from which
         populations have moved, there is a strong likelihood that there are insufficient
         numbers of GPs to meet the ordinary health needs of asylum seekers” (Hansard HL
         Report 7 July 2000 Col 1758)
    Temporary registration prevents access to any past records and affects services provided.
    There are in any event problems where some GPs deny asylum-seekers access to certain
    types of health care, with treatment to which they are fully entitled being denied them.
    More efforts are needed to promote understanding of asylum-seekers‟ entitlements.
    There is a need for resources to ensure information and promotion of such information
    throughout the health professions, but also for extra information for asylum seekers
    themselves, in languages they understand, on their entitlements.
   Health professionals express concern about lack of knowledge of the asylum system, and
    express a desire for training on this, on the situations from which asylum-seekers have
    fled, on issues on transcultural medicine, in particular mental health, and on trauma. At
    the Medical Foundation our workers are supported by their fellow clinicians; a person
    listening in relative isolation to histories of torture, may need support and supervision to
    ensure adequate self-care.
   Many health professionals in the areas we have visited have identified as a key problem
    the difficulties they have in referring on asylum-seekers with special needs. They identify
    what is required; then find it does not exist in the area. For example it can be extremely
    difficult to find counselling services, and in particular services with linguistic support, to
    whom these clients can be referred. Lack of resources and isolation impede the sharing of
    good practice
   Purchasing over-the-counter medicines is a problem. They are very expensive and
    private pharmacies do not tend to accept vouchers.
   The DFEE has made a grant available to schools receiving asylum seeker children
    dispersed by NASS. The Education and Employment Secretary made an announcement
    about this on 30 June 2000 (298/00). While there are questions around the adequacy of
    this grant, it must be contrasted with the situation in health. No similar per capita grant
    has been made available by the DOH to Local Health Authorities or GPs surgeries taking
    asylum seekers. It is desperately needed.          The notion that extra health costs can be
    picked up in standard spending assessments is an inadequate response. Money is needed
    up-front, or the cycle of pressure on services, increasing hostility and increasing isolation
    described above, will continue to flourish.
   In 1999 the government conducted an Adult Psychosocial Assessment of Kosovars who
    came to the UK on the Humanitarian Evacuation Programme. The assessment document
    was based upon the protocol developed under the auspices of UNICEF Macedonia and
    the Centre for Crisis Psychology in Bergen, Norway. The information gathered has the
    potential to inform the development of health care services for asylum. We urge the
    government to publish the results of this survey, which could inform health provision
    around dispersal.

   The Medical Foundation has the agreement of NASS to consider rehousing those needing
    on-going care and treatment from us in London if they are identified post dispersal.
    However, we are concerned that asylum-seekers‟ high level of social exclusion, the lack
    of services that could identify them and the lack of resources for these services where
    they exist, mean that survivors of torture are not being identified. Their isolation and
    social exclusion increases, and eventually they drop out of the dispersal system and out of
    all support.

In one Midlands town we visited, most of the asylum seekers were registered with GPs, but
none had access to interpreters. One had a lost an eye through torture a year ago. He
needed treatment but his GP had not done anything. In the same town, an asylum seeker
with bullet wounds in his leg had been to hospital many times to ask for help. They did not
provide an interpreter, had not examined him, and gave him tablets.

Private providers are not adequately helping people access GPs. They simply provide a list
of addresses.

On 30 June 2000 the leading article in the Leicester Mercury reported that St Mathew‟s
Medical Centre on St Mathew‟s Estate in Leicester had decided to close its books on new
patients after the surgery had reached “crisis point” trying to help more than 35 refugees and
asylum seekers every day. The Medical Centre cited the needs for interpreters, help with
filling in forms and explaining NHS and other services, as reasons why they were
overwhelmed. NASS had dispersed 120 asylum seekers to Leicester, but this was in parallel
with dispersal by local authorities. An editorial in the paper “Give the City the Means to
Help” spoke of “a proud history of providing sanctuary” but warned that resources were
needed for this to work.

Glasgow: Turkish Kurdish woman
Dispersed to Glasgow when heavily pregnant, with her husband, a survivor of torture, and
their young child. Throughout her care in Glasgow she was given a male interpreter,
although she repeatedly protested that she found it impossible to talk about these issues in
front of a man. Attempts were made to find a female interpreter, but these were
unsuccessful. When two weeks overdue, she went to hospital to have her child induced.
She waited in the hospital for 7 hours, but no interpreter could be found and the hospital sent
her home, telling her to come back a week later. By then she would have been three weeks
overdue. The panic-stricken family were all set to give up all their support and return
unsupported to London, and only the intervention of her health centre toward the hospital,
averted this.

In one city in the North-East, most asylum seekers dispersed through NASS were on arrival
registered with GPs. However there were a number of problems. In the case of one housing
provider, those accommodated have to contact the office when they need to see a GP. They
then have to wait until enough people ask to go so they can al go together with one
interpreter. Housing providers sent them along to GPs with interpreting provided by fellow

asylum-seekers, who are not only untrained as interpreters and untrained in medical
terminology, but are also inappropriate to be used in situations where medically confidential,
and sometimes intimate, information is being discussed.

Access to legal advice
 There is a crisis in legal advice in many parts of the country. There are simply not
   enough specialist asylum lawyers. A cursory search of the Community Legal Services
   Directory reveals this.

Newcastle and Gateshead
A search of the Community Legal Services Directory reveals that the nearest lawyers to
Gateshead with an immigration franchise are in Newcastle. But while there are good asylum
lawyers in Newcastle, there are far too few to meet the demand. We know of asylum seekers
in Newcastle (where there are some good asylum lawyers but far too few to meet the
demand) who have had to go to Leeds and indeed much further afield to get legal advice.

NASS support and the claim for protection
 The NASS support system appears to us entirely to disregard the fact that they are dealing
  with the people whom they are supporting precisely because these people have put
  forward a claim for protection.
 As set out above, asylum seekers are dispersed to areas where there is no, or very little,
  specialist advice on asylum. However, this is not the end of the story. The Home
  Office requires the Statement of Evidence Form (SEF) to be completed in full and in
  English and returned to them within two weeks. For a person who cannot read and/or
  write English, this means that whether or not they find a lawyer, they will need someone
  to help them if they are to attempt to comply with the Home Office instructions.
 Home Office timescales utterly disregard the timescales for dispersal. Asylum seekers
  may be interviewed on, or shortly after, arrival. Then they have only five days to put in
  further evidence in support of their application. Others are given a SEF, with the 14-day
  deadline. As has repeatedly been pointed out to the Home Office, under the proposed
  NASS supported applicant is supposed to spend the first seven or so days of this period in
  emergency accommodation provided by the assistants and then be dispersed. This cuts
  straight across the SEF timescale, giving them five working days in one place to find a
  lawyer, five working days in another.
 In the event, most people will not leave emergency support before the deadline for the
  completion of the SEF is past. No funds are made available for travel to lawyers within
  this period. Thus for example, even travel across London to see a lawyer may be made
 The result is that many people (38% of initial decisions in October were non-compliance
  refusals) are being refused for non-compliance – failure to submit their SEF completed in
  full, in English within the timescale. People have been refused on non-compliance
  grounds for filling in the SEF in their own language. It is impossible to convey the
  distress these refusals cause to clients, including people who, where we have intervened
  to put evidence before the Home Office, have almost immediately been recognised as
  refugees. We have seen cases where non-compliance refusal has resulted in the physical
  collapse of the client.

   People can also be refused for non-compliance for failing to attend an interview. But in
    many cases, NASS is failing to issue travel warrants in time for the person to travel to
    attend the interview. To receive a payment for travel to the interview the client needs to
    fill out an application form which is included in their dispersal pack. They need to send
    this to NASS 21 days before the date of travel and NASS should send a ticket. The
    application form is lengthy and is in English. Most interviews are not scheduled with 21
    days prior notice.

Access to education
 We have already commented upon the lack of access to education in emergency support
   and the difficulties that housing in some areas has created for access to children. As
   noted throughout this report, the refusal to include any travel expenses in the definition of
   essential living needs, creates serious problems for children in seeking to access
 Adults‟ access to education, including to English language provision, is impeded by the
   NASS system. We are appalled by regulation 14 of the Asylum Support Regulations
   2000 (SI 2000/704) which states:
       “14(1) The services mentioned in paragraph (2) may be provided or made available
       by way of asylum support to persons who are otherwise receiving such support, but
       may be so provided only for the purpose of of maintaining good order among such
       (2) Those services are –
           (i)     Education, including English language lessons,
           (ii)    Sporting or other developmental activities” (Emphasis added)
   As noted in many parts of this report, the refusal to include travel expenses within the
   definition of essential living needs is also impeding adult access to education, including to
   English language classes.
 The separateness of the NASS system creates further problems, in particular for adults.
   Receipt of benefits is in many cases the passport to reduced, in some cases, minimal, fees
   for education and training. NASS support does not serve as a similar passport in many
   cases, and the very poorest people in the country are forced to pay the higher level of fee,
   thus excluding them from education.
 School uniform presents a particular problem and NASS must make clear whether it is
   going to pay for school uniform. Families cannot.
 School uniform presents a particular problem and NASS must make clear whether it is
   going to pay for school uniform. Families cannot.

5(D) Level and Type of support

Level of support: general
 The definition of essential living needs, on the basis of which the sum to be provided in
   support is calculated, is set out in the Asylum Support Regulations (SI 2000/704). The
   regulations also cover the ways in which support is to be provided. Regulation 9 says:
        “9(3) None of the items and expenses mentioned in paragraph (4) is to be treated as
       being an essential living need of a person for the purposes of Part VI of the Act.
       9(4) Those items and expenses are -
       (a) the cost of faxes;
       (b) computers and the cost of computer facilities;
       (c) the cost of photocopying;

        (d) travel expenses, except the expense mentioned in paragraph (5);
        (e) toys and other recreational items;
        (f) entertainment expenses.
        9(5) The expense excepted from paragraph (4)(d) is the expense of an initial journey
        from a place in the United Kingdom to accommodation provided by way of asylum
        support or (where accommodation is not so provided) to an address in the United
        Kingdom which has been notified to the Secretary of State as the address where the
        person intends to live”
        In summary, this means that support is calculated so that asylum-seekers are not given
        a penny toward travel expenses, or toward toys for their children. If they chose to
        spend their £10 cash on such things or, where they have vouchers and can use
        vouchers for the particular expense, if they choose to spend their vouchers on such
        things, they are digging into the amount that has been calculated to cover basic food
        and hygiene. The exclusion of travel means that clients have no money to go to the
        one-stop service, to the post office where they can collect their vouchers, to GPs‟
        surgeries or to visit other medical specialist, to school or other education classes, to
        see their lawyers, to attend community organisations or to go to distant shops. The
        exclusion of toys and recreational activities violates the UK‟s obligations under the
        UN Convention on the Rights of the Child.
   Medical Foundation caseworkers report that they are seeing clients who are
    malnourished, because they are unable to obtain sufficient suitable food.
   The Medical Foundation, by arrangement with the Red Cross, gives out Red Cross food
    and toiletry parcels. The level of support provided by NASS is insufficient to meet
    essential living needs.

Secondary school children in Gateshead receive a free bus pass if their school is over three
miles from home. The school attended by most asylum seeker children is 2.9 miles from
their home and they are therefore not eligible. One mother is currently having to pay £5 per
week for her two children, leaving her just £5 in cash. One school is meeting fares through
its hardship fund but this will have to cease soon when the money runs out.

Disabled Asylum Seekers
 Concern about how NASS is looking after this group was expressed at the Benefits
   Agency Forum on 15 September 2000, where Mr Bob Hopkinson of NASS was present.
   He said that disabled asylum seekers are given the same amount of support in
   kind/cash/vouchers as the able-bodied – stating, somewhat to the astonishment of his
   audience, that to do otherwise would be discrimination.
   We are concerned that this response indicates a lack of understanding of the nature of
   discrimination and the methods of achieving equality for disadvantaged groups, such as
   the disabled. Equality in service provision is not about giving each person the same
   support as everyone else, but ensuring that each person enjoys the same level of services.
   For those who cannot access services as easily as others, or whose needs are greater, this
   involves giving them more.
 Concerns about the way the NASS system is dealing with disabled asylum seekers were
   expressed by inter alia the Medical Foundation and Disability Alliance in the article
   “An Act of Cruelty” which appeared in The Guardian on Wednesday 8 November 2000.
   We ask you to take the contents of that article into account in your review.

   NASS has neither the expertise nor a mechanism for importing the expertise to look after
    the special needs of this group. At the Benefits Agency Forum mentioned above, Mr
    Hopkinson of NASS indicated that needs of the disabled could be met by local
    authorities. However, members of the Forum noted that, for example, the location of the
    accommodation and the fixtures and fittings within it, were matters for NASS. If they got
    these wrong, the accommodation might not be safe for, for example, a blind person.
   Under Part VI of the 1999 Immigration and Asylum Act, NASS could provide extra
    support to disabled asylum-seekers through one of two routes: either as having different
    “essential living needs” to the able-bodied, or by regarding disability as an “exceptional
    circumstance” in respect of which extra money can be given.

Pregnant women and those with children
 Asylum seeker mothers do not have access to infant formula, or free milk, as mothers on
   benefits do. Vouchers cannot be exchanged in NHS clinics where reduced price milks
   are available. While mothers are encouraged to breast-feed, mothers under extreme
   stress, in poor health, or suffering from malnutrition are often unable to do so. Mothers
   with HIV should not breastfeed their babies. Health visitors have repeatedly voiced
   concerns to us that mothers are being forced to use cows milk to feed their children.
   This is another example of the separate system for asylum-seekers meaning that they are
   not automatically passported into the provision that is made for those on benefits and
   thereby increasing their poverty and social exclusion.
 You will be aware of the case highlighted by Refugee Action in their press release when
   they closed their Liverpool office, of the woman from Zaire who had been forced to use
   newspapers to clean her baby because she had no vouchers and could not obtain nappies
   for the child.
 NASS has now taken steps to provide for a discretionary maternity payment of £300 for a
   new-born child and this is welcome. However, this sum is provided in vouchers, which
   cannot be redeemed for cash. The NASS guidance notes that vouchers are exchangeable
   in a variety of outlets, implying that vouchers will cover all the purchases a parent might
   need to make. We are concerned that the range of outlets available to any particular
   asylum seeker (bear in mind that NASS makes a zero allowance for travel expenses) may
   be very limited: all depends on who accepts vouchers in the area in which you are living.
 The application procedure for these payments does rather ignore the fact that the women
   in question is giving birth, and may have a few other things on her mind than
   bureaucracy. The six week window for making an application - four weeks before birth
   and two afterwards is particularly problematic and, we would suggest, unnecessary.
   There is also of course an expiry date on the vouchers, which means that they have to be
   spent within a limited period.
 The Medical Foundation is a member of the Refugee Children‟s Consortium and we refer
   you to their submission to the review. You will also find throughout this response
   examples of how the system is affecting children.
 Vouchers do not allow school uniform to be purchased. This is creating enormous
   problems as many schools will not allow children to attend without a uniform.
 Children turning 18 are being transferred to the NASS system without notice. We have
   seen children receive a letter on their 18th birthday telling them that their support is being

Children’s experiences of vouchers

The following are quotations from primary and junior school-aged children who are clients of
the Medical Foundation.
        “People in shops take vouchers like this [mimes screwing up face while holding a
voucher up to eyes] and say we are refugees. They said horrible things about me and mum.”
This primary school-aged child from Iran did not want to say what the horrible things were
(“I cannot remember” “Ask mummy”) although he had already described them to his
therapist. He did not want to think about them again. The people in the shop had said the
family were dirty refugees, and wore horrible clothes. This despite the fact that although
their mother gets only £70 per week for herself and the three boys, the children are clean and
        “Not all the shops take vouchers. We live in Manor Park and it is about one hour on
foot from the place where we live to the shop that takes vouchers”
        “If the shop that is near that accepts vouchers does not contain what you want, you
go to the other shop but there you cannot buy anything because it does not accept vouchers.”
        “You only get a little cash and the vouchers are £5, £10, £15, so you have to add
things up in the shop. When you spend £3 you don‟t get change.”
        “If you spend £1.80, sometimes you have to give £5. If you spend £1.50, sometimes
you have to give £2.”
[Q: What is the cash you get spent on?]
        “Clothes, things not in the supermarket. Like shoes.”
[Q: Do you use it for travel?]
        “I walk to school. It takes 45 minutes or 1 hour each way”
This child lives just inside the 3 mile zone beyond which travel to school should be paid by a
local authority. To pay the travel each way for a week would use up the cash for him and his
mother. So she walks with him to school and back, returning on foot to collect him from
school when they both walk back. Touchingly, this child prefaced his remarks by saying “I
don‟t have big problems with the vouchers. Just lots of little ones.”
        “In the supermarket they don‟t usually have clothes, not in the ones that take
        “If you have money you can buy clothes in the market.” [from a little girl whose
family are supported under the Children Act and receive cash]
        “I live in Hackney; some people they hate refugees. Some people.”
        “Sometimes my school has things after home-time, we can‟t do it, because we don‟t
have money.”
        “I could not go on my school‟s trip to the Millenium Dome. I could not pay the
        “I‟m not going anywhere. If I did not have to have vouchers I would go anywhere.
Everywhere. Anywhere.”
        “I would go to the cinema.”
        “I would go to the football.”
Asked at one of their weekly group therapy sessions at the Medical Foundation what they
would like to say to the Prime Minister about vouchers, primary and junior school children,
“Stop the vouchers”
“Vouchers are good for nothing.”
“You would not want your children to live on vouchers, even for one day”

Vouchers: delay
 Delays in receipt of vouchers continue to be reported from all areas.

Vouchers: main Post Offices
 Many people have to travel long distances to collect their vouchers. The NASS
   provision for essential living needs under the Asylum Support Regulations 2000 makes
   absolutely no allowance for this.

In Nelson, despite the Lord Greaves‟ communications with the Lord Bassam on this issue
earlier this year, Nelson post office still does not issue vouchers. The asylum-seekers
accommodated in Nelson therefore have to travel to the main post office in Burnley, over
three miles away, to collect their vouchers.

All asylum seekers in Gateshead must collect their vouchers from one central post office in
Eldon Square, over the river in Newcastle. This is about 1 ½ hours walk from where most
are living.

Vouchers – retail outlets
 All Medical Foundation clients, from tiny children to old people, English speakers and
   non-English speakers alike, when asked how they are treated when they spend their
   vouchers, mime what happens. They lift their fingers and rub them together, as if
   examining a voucher held between them for authenticity, squint at the imaginary voucher,
   and frown heavily. The similarities between the mimes performed by different clients
   are uncanny.
 Clients from many different areas, shopping in many different shops, report shop
   assistants refusing to accept vouchers in exchange for certain goods, in some cases
   limiting them to the purchase of food only. Examples are given below. We understand
   this to be contrary to NASS policy, but it is what is happening in practice.
 The voucher bears the asylum-seeker‟s name. The Buy-pass voucher is used only by
   asylum-seekers. It passes out of the asylum-seekers‟ possession, still bearing the
   asylum-seekers‟ name. It identifies them by name to the checkout assistant, and all those
   who subsequently have sight of the voucher, as an asylum-seeker. We regard this as a
   breach of the IND‟s undertakings to keep the asylum claim confidential.
 Vouchers for the whole family are issued to the principle applicant for support, in that
   applicant‟s name. Other members of the family have problems using the vouchers, for
   example a wife when the vouchers bear her husband‟s name. We consider that this raises
   issues of discrimination.
 Retail outlets accepting vouchers, and/or accepting vouchers in return for certain goods,
   may be at some distance from the asylum seeker‟s home.               Given that the NASS
   calculation of the sum provided for essential living needs makes zero allowance for
   travel, this presents enormous problems. Particularly badly affected are those of our
   clients whose mobility has been affected by torture. Nor can they always avoid carrying
   large loads, because of the need to spend the large denomination vouchers in one go and
   because if they need to use public transport, they struggle to pay for one journey and
   cannot afford several.

Mr T :Turkish Kurd
Mr T‟s worst experiences of persecution and torture were compounded by his military
service when he was sent to an area in the South-East of Turkey. He was forced to fight
against his own Kurdish people and was witness to shocking atrocities. He is in this country
with his wife who was exposed to considerable harassment in Turkey and his child.
Mr T finds the voucher system humiliating. The vouchers are in his name so that if his wife
wants something for herself, he must always accompany her. This is difficult for her as
there are some toiletry items, such as sanitary protection, which she would prefer to purchase
alone. This is a cultural issue for the couple.
He becomes very anxious when he is in the queue particularly when he is asked by the
cashier at the counter for his name and address. He feels that everyone knows that he is an
asylum seeker and he becomes very distressed when the queue becomes impatient. He feels
There are many Turkish Kurdish shops in the vicinity where he lives and he believes that his
wife would benefit if she could cope and feed her family with food she understands. They
both feel confused and overwhelmed by the large stores.
His caseworker notes:
“He is a quiet, withdrawn man and his description of the difficulties he has in going to the
store indicate the difficulties that many asylum seekers are facing”.

Mr K
Mr K was born in 1971 in Kinshasa in the Former Zaire. He is an educated man, speaks
extremely good English and was a finance inspector in the Ministry of Finance in his country
of origin. He was also a preacher in his Pentecostal church.
He fled to the UK in August 2000 having recently been detained and tortured repeatedly over
a period of three weeks. He arrived with open wounds on his shoulders, side and back, his
scalp and left side of face. He also had an unsightly wound on his left hand which is in the
process of healing. He complained of some loss of hearing and severe generalised bodily
pain. He was depressed and forgetful and was particularly haunted by the memory of torture
and his sleep was disturbed by violent nightmares.
His scars were photographed by a medical photographer. He has been seen weekly or
fortnightly for counselling at the Medical Foundation.
In view of his recent history of torture and his physical and psychological condition, the
Medical Foundation asked NASS to allow him to remain in London so as to attend the
Medical Foundation.
Mr K lives in a hostel, sharing a room with one other. He receives £38 worth of vouchers
per week for food and clothing. The shops that he can go to appear to be Sainsburys,
Peacocks and another clothing store.
He finds the procedure in Sainsburys humiliating. The fact that he is usually the only one in
the counter queue with vouchers makes him feel exposed as a second-class citizen. On 28
November he reported to Helen Bamber, Director of the Medical Foundation, that the cost of
the goods that he purchased was less than the value of the vouchers. The cashier wanted to
give him back a £1 voucher and she requested him to give her 5p. He searched in all of his
pockets to no avail and the man behind him in the queue gave him the 5p. He said he
thanked the man but he felt like “a beggar”.
On another occasion, the cashier asked him if he had any ID to prove that he was the person
entitled to the vouchers. He had no papers with him and the queue became impatient with

Ms Bamber notes:
“The fact that there is no system for giving change leads to his belief that the store profits
and certainly not the asylum seeker.
Mr K, shares with all my clients, the fact that they cannot choose food familiar to them, often
available in markets, and this compounds a sense of being singled out for punishment.
Mr K is a devout Christian and has taken up ministry with a group of believers and hopes
that they will soon be able to meet in a hall or proper meeting place. He longs for his wife
and small child, whose whereabouts are unknown to him. He is a man who is still suffering
pain, headaches and tormented dreams. He tries to hide his scars so that no-one should
know that he was tortured.
He never voluntarily complains about the voucher system but asked me today for what
purpose it was designed.”

Mr A from Algeria
Tortured in Algeria, Mr A is seen weekly at the Medical Foundation. He is suffering chest
pain and joint pain especially in his knees. He finds it difficult to carry his provisions back
from the supermarket. He cannot avoid large loads because of the denomination of the

Familiar and culturally appropriate foods can be obtained in Gateshead, but not from the
shops there that accept vouchers.

Again, Halal meat can be obtained in Leeds, but not in the supermarket chain accepting
Ms ED: Turkey
Ms ED is a 31-year-old Turkish Kurdish woman who is a trained physiotherapist. She was
referred to Helen Bamber, Director of the Medical Foundation, for counselling by Dr John
Rundle, the Medical Foundation‟s neurologist. She has been attending Dr Rundle regularly
since June of this year for treatment of her post-traumatic epilepsy. She was a perfectly
healthy young woman until her detention and very severe beatings which resulted in a head
injury. Her epilepsy originated from those events. The condition has been difficult to
control and she has had a series of blackouts, dizziness, headaches and memory problems.
Dr Rundle indicates that shopping has been a difficulty for her.
Following her traumatic experiences, her hair turned white and this has distressed her
Miss ED is receiving vouchers and shops at Sainsbury. She was extremely humiliated when
she was told publicly that she was not entitled to buy the hair dye which she uses to hide her
white hair.
Ms Bamber notes:
“In summary Miss ED is a young woman of 31 who was detained and tortured. During
severe beatings she received a head injury with subsequent post-traumatic epilepsy. She
was referred to the Medical Foundation on 21 March of this year suffering from fits, and
being brought by a neighbour who was very worried on her account.
Following her traumatic experiences, her hair turned white and this, together with her quite
severe illness, is a constant reminder to her of her torture. Her epileptic seizures are now
controlled with the help of the Medical Foundation‟s neurologist. It would seem a very

human response for her to wish to dye her hair which is her way of controlling another

Mr P from Afghanistan
Mr P‟s experiences of emergency support are described above. Prior to that, he was on a
support only package, receiving vouchers. He explained “When I take the vouchers from my
pocket, everyone knows I am refugee. I feel so embarrassed – I just cannot go, the
humiliation. I asked my wife to go instead. It is like being a beggar, going to beg for money.
Two or three times I just bent my head with embarrassment, I did not even say anything, I just
left.” Mr P reported that on most occasions he was unable to spend the full value of the
vouchers and lost money. He cannot understand why the voucher system has been created,
“Who has done this to us, when we are refugees?”

Mr A from Iran
Mr A worked to help children in Iran; this led to his persecution there. When asked about
vouchers he was at pains not to appear ungrateful, emphasising that he is aware his troubles
here cannot be compared to what he has suffered in the past; and from his own country too.
He appreciates that he is getting support from another country; he does not want to complain.
He lives in a bedsitting room in a 5 bedroomed house, where he shares his kitchen with the
Mr A is living in Barnet. He can use his vouchers in Sainsburys and Iceland. Iceland is close
by, Sainsburys is some distance away. In both shops, he is only allowed to buy food by the
staff. When he tried to buy clothes and a plate, he was told he could not. He has no winter
shoes, nor any warm clothing. He needed to buy a kitchen knife, again he was told he could
not. He has to attend hospital regularly, his £10 cash does not cover expenses attendant on
this, it will not cover his weekly travel to the hospital. When he arrived at the Medical
Foundation, he had not been assisted to complete form HC1, which would allow him to
obtain free prescriptions. There are also costs of travel to hospital. He has no money left to
travel to his lawyer. He is at college, this is a distance away. The journey costs £3.50.
Mr A comments that all is well in the shop until you pull out the vouchers. Then they look
at you differently. He describes “The way they look at you; the humiliation of it. We are not
like everyone else.”
Mr A loses money each time he makes a purchase with his vouchers. The most he has lost
on a £5 voucher is £2, because the goods he bought cost only £3.
Mr A received no information about his rights. When he was given the agreement by his
landlord to sign, he could not sign it because he not read it. He did telephone NASS, but the
messages were all in English, so that did not help.

Support in kind
 Sainsbury‟s supermarket stated in their letter to The Guardian of 15 March 2000 that they
   finally decided to take part in the voucher scheme “because the alternative is for
   supermarkets to hand out bags of shopping to asylum seekers; taking away their right to
   choose what they want to buy”. Clients and Medical Foundation staff working with
   them find support in kind even worse than vouchers. Clinicians and caseworkers are
   seeing clients receiving food parcels who are showing signs of malnutrition.
 In most cases asylum seekers supported in kind are fed in the accommodation where they
   are living. Other asylum seekers are being dispersed without a pack and have to exist on

   food parcels until vouchers are obtained from them. The delays in obtaining vouchers
   are often lengthy.

Support in kind received by J –Burmese client
The client receives the following every fortnight:
Food he eats:
½ kilo rice. 1 tin of chicken. 1 litre fruit juice. 1 packet cornflakes. Tea, coffe or
chocolate. 1 packet of bread. 1 or 2 pieces of fruit. 2 potatoes. 2 onions.
Food he does not like to eat: 1 tin tuna. 2 tins corn. 1 or 2 tins baked beans.
Food he does not eat:
1 tin mutton ,(it is not halal)
His caseworker here has complained that he is receiving insufficient food and is feeling dizzy
and weak as a result.

Iranian client: London
This 20 year old man lives in a hostel in London. Each day he receives the same food, a foil
pack containing rice and something else that no-one has been able to identify (he has brought
one of the packs to show his therapist here. He gets exactly the same food every day. He is
losing weight rapidly.

GPs have reported weight loss in asylum seekers housed in hostel accommodation and
expressed fears that these people are not getting enough to eat.

Example: Support in kind received by an Algerian client in his thirties.
This client has severe post traumatic symptoms following five years of imprisonment in
extremely harsh conditions and torture suffered in Algeira. He suffers from, inter alia,
stomach pains and flashbacks. His counsellor at the Medical Foundation identifies him as
being at risk of a breakdown. This client gets the same food parcel each fortnight. Of the
food in it, he eats:
4 tins tuna             1 jar honey 1 packet rice             2 tetrapacks milk
6 eggs                  4 apples       4 or 5 potatoes        3 or 4 onions
3 or 4 tomatoes         1 aubergine occasionally, a small packet of cheese
1 loaf bread (he does eat this, because he gets hungry, but it upsets his stomach.
4 oranges (these also upset his stomach)
He also receives the following each fortnight, but does not eat them. Some of them make
him ill - aggravating his stomach and large intestine and causing both bloating and vomiting
(he is a survivor of torture and it is not uncommon for people who have been subjected to
certain forms of torture to have digestion problems, for a variety of reasons)
2 tins white beans in tomato sauce 2 tins maize               1 packet dried red beans
2 tins evaporated milk                 1 packet spaghetti     1 bottle cooking oil
1 jar of instant coffee                2 tetrapack orange juice
2 tins fruit salad
This client is losing weight rapidly.

Black market in vouchers
 People are purchasing vouchers at less than face value for cash. This is very often
   accepted by asylum seekers who consider that they are better off with a lower sum in cash
   than the smaller amount in vouchers. Detailed information on this is sensitive and
   difficult to obtain and has been released to the Medical Foundation from organisations
   and individuals in various areas in confidence, with no permission to pass on any details.
   They, and we, feel however that the repeated government suggestions that vouchers
   prevent fraud are inaccurate and have to be challenged.

18-year-old girl
An 18 year old girl in London stands outside a supermarket and sells her vouchers for less
than their face value in cash. A whole range of concerns are raised by this, not least that a
young and vulnerable girl‟s isolation and need for money are made all too visible to those
who might exploit these in a variety of ways.

Housing providers buying vouchers for cash
We have reports from different areas of housing providers who purchase the vouchers from
the people they are accommodating for cash sums that are less than the face value of the

Retailers buying vouchers for cash
We have reports from different areas of retailers who will purchase vouchers for a cash sum
less than the face value of the vouchers (£8 for a £10 voucher).

Voucher touts
We have reports of areas in which third parties approach asylum seekers to buy their
vouchers for cash at less than the face value of the voucher.

Difficulties on recognition as a refugee or grant of ELR
 Throughout the passage of the 1999 Act we emphasised that while we did not wish to see
    those with leave to remain staying in the NASS system for any longer than was necessary,
    the 14-day period before all support was withdrawn was too short. Experience has born
    out our fears. Fourteen days is insufficient time for people to find alternative
    accommodation, or to access the benefits to which they are entitled, let alone make
    informed choices about their future, or find employment.
 This situation appears to run completely counter to government aims for those with leave
    to remain, as set out in “Full and Equal Citizens”.
 One of the main issues raised by Medical Foundation caseworkers and clinicians is that
    clients are spending their first days as refugees destitute, sleeping rough or under threat of
    eviction. There is inevitably a feeling, on learning that one has been granted leave, that
    “everything is going to be all right”, however much therapist and client seek to prepare
    for the fact that this will not be the case. Therefore people are particularly vulnerable at
    this stage. The distress being caused is enormous.

   Benefits agencies are not always processing applications as quickly as they should be in
    these circumstances. We have not seen evidence of any joint working between NASS
    and the BA to ensure a smooth transition. However, even better provision under this
    head will not solve the problems of those who have been housed by NASS and have to
    find alternative accommodation.
   Problems are particularly acute for those whose appeals are allowed as this serves, at least
    for single adults, as the trigger for termination of NASS support, but accessing benefits,
    being able to work etc, tend to require the papers confirming recognition as a refugee or a
    grant of ELR by the Home Office. These papers may not arrive until months later.

Mr I from Algeria
Mr I is a refugee from Algeria who is suffering from serious mental health problems as a
result of the torture he underwent. When he was granted refugee status he was given 14 days
to leave the shared accommodation he had been allocated as an asylum seeker.
He was directed to the local council housing department (outer London). For two weeks he
went there every day from 8 am to 4pm. Every day he was told to go and get a different
paper. Toward the end of this period he took a report on his mental health from the Medical
Foundation where he was having treatment. The worker threw the report at him saying „This
is rubbish as far as I‟m concerned - I need a letter from your GP proving that you are on
medication‟. He was subsequently homeless for two days. Finally he was sent to a B and B
and told he would be given Special Needs housing. He was still in the B & B three months

Dropping out of the system
 The first stage at which people are dropping out of the system is at the dispersal stage,
   because they do not report to travel to the dispersal area.
 Others drop out of the system when they leave the dispersal accommodation. Isolation,
   including issues such as lack of access to people who speak their language and
   community support, medical care and legal advice, and racism, appear to be the main
   reasons for this. You will be aware of decisions of the Asylum Support Adjudicators
   overturning NASS decisions that people who left their accommodation because of racist
   attacks had made themselves intentionally destitute.
 To these groups must be added those who lose all support at the end of the process, when
   their asylum application is finally determined, regardless of whether they have made an
   application for judicial review or whether they can be removed.
 The Medical Foundation has repeatedly voiced its opposition to a system that leaves
   certain groups without any entitlement to food and shelter. We are seeing such cases.
   The distress to the individuals is immense. Helping these people is taking an increasing
   amount of the energy of refugee community organisations, groups working with refugees,
   and others. It is not a question of assisting people to access their entitlements, because
   they have none. We strongly suggest that NASS act before the limited mechanisms that
   do exist for offering a modicum of containment reach saturation point.
 The criteria for “hard cases” support makes it all but inaccessible, in particular to those
   who can certainly not evince any desire to leave the country, because they are still in
   danger and are challenging the decision on their asylum claim by means of judicial
   review, or who have representations outstanding at the Home Office.

5(E)   Racial harassment, racially motivated violence and racism.

   This is a grave and growing problem, as Mike Boyle of the LGA emphasised at the
    Immigration Advisory Services conference on 22 June. He noted that the resurgence of
    Combat 18, the BNP and the National Front in areas where they had not had support for
    years was of particular concern to the LGA.
   Many of the accounts above detail hostility, harassment and the fear this engenders.
    They are relevant in this regard.

Report from Medical Foundation workers visiting a Midlands town
One of our workers states:
“The group were very frightened to leave their homes due to danger of racist attack. There
were many stories, these are a few:
 About six weeks ago, a group of four passed a group of 200-300 young men in the city
    centre; it is possible that they were football fans, or a demonstration. The Kurds were
    attacked by a mob from this group with broken bottles. Three managed to run away but
    one was severely beaten and hospitalised. Local people watched and did not intervene as
    did the police. No action was taken by the police afterwards.
 During a client interview our caseworker asked to see a bullet wound [from experiences
    in Iraq], instead he was shown a knife wound to the thigh made in a recent racist attack.
    The clients living in the house we visited had gone shopping that morning...they had been
    verbally abused in the shop”
The worker continues:
“We asked the group what they wanted. The main problem was loss of dignity, they could
not understand why local people were so unwelcoming and racist. This was the main cause
of distress for the group. Other issues were:
 Good legal advice
 Access to health care
 Counselling
 Clothes (most were still in the clothes they had worn on arrival)
On the morning of the visit of Medical Foundation workers to the city two of the men had
visited the supermarket to buy food for our lunch. While paying for the food with the
vouchers they were verbally abused. They believed that the vouchers contributed to their
identification as asylum seekers.”

Mr C from Africa, dispersed to Liverpool
Mr C is a young adult from Africa [country removed to protect identity] who has been
imprisoned and tortured in his country very recently. He does not speak English. He was
placed in a hostel in an isolated impoverished all-white area in Liverpool, known for a
problem with racism. On three separate occasions he was beaten up by gangs of youths. The
attitude of hostel staff was „that‟s what happens round here‟ : they discouraged him from
going to the police. Eventually he left Liverpool of his own accord and came to London
where he was initially homeless.

A young, 18-year-old Congolese man dispersed to Liverpool is housed alone on an estate and
is abused when he goes out. He had asked the reception centre at Greenbank whether he
could sleep in their corridor at nights, as he did not wish to return to his accommodation.

The local authority have developed a strategy for placing people sensitively, but private
providers have put large numbers of people into certain areas. Asylum seekers are being
housed in very hostile areas. For example, 200 principle applicants from 21 communities
were housed in Blakely where the BNP and NF are active. When a new family arrives, local
people are writing the addresses on the wall so that people can go and attack them. There
have been incidents of racial harassment across the city, including attacks and graffiti.

Ms R from Rwanda, dispersed to Scotland
This client has had problems since the 1994 genocide in Rwanda, which culminated this year
in her husband and two children being killed and she herself horribly attacked. On arrival in
the UK, she was dispersed to Scotland. She was happy with both her housing and the
medical treatment she received there. What drove her to return to London was the racist
violence she experienced there. That started when she was seen going to the local post office
to collect her vouchers. She was stoned in the street. Then she was followed back to her
hostel and windows there were smashed.

(6)    If you are a retailer who accepts Buy-pass vouchers, have you made any surplus
       profits as a result of vouchers not being exchanged for their full face value (i.e. as
       a result of the policy which prevents you from giving change)?

We are not a retailer accepting buy-pass vouchers. However, we note:
 Sainsburys‟ letter to The Guardian of 15 March 2000 in which they stated “we do not
  want to keep the change and profit at the expense of asylum seekers”.
 We are also aware of the Somerfield letter to NASS of 13/10/00. As of the beginning of
  December, Somerfield had not received any reply. Somerfield noted that the current
  allocation of a number of large denomination vouchers (e.g. £5) to make up the benefit
  does not allow individuals to budget easily on a day-to-day basis.
 Clients have related losing as much as £8 change out of a £10 voucher. Every single
  client reports having lost money on at least some transactions, some that they lose money
  on all transactions. In these circumstances, it is inconceivable that retailers are not
  making a profit on transactions.

Improvements to the voucher scheme

(7)    Are there any improvements to the voucher scheme you want to suggest?

Our responses in the parts above indicate the difficulties our clients, we and our colleagues
are encountering. Given the extent and nature of these comments, it will come as no surprise
to learn that the Medical Foundation considers that the voucher scheme is past salvaging.
From both a policy and an operational perspective, the only response that will get rid of the
problems is to abolish it. We draw special attention to the importance of not replacing
vouchers with support in kind. This support has caused a multitude of problems, of which
malnutrition, humiliation and institutionalisation are only three.

Other comments

(8)    Do you have any other comments on the voucher scheme?

The primary function of the voucher scheme is to act as a deterrent to asylum-seekers and as
such vouchers contribute nothing to the reform of the asylum process, heralded as becoming
“fairer, faster, firmer”. Vouchers are inherently discriminatory and run counter to any notion
of fairness. They affect the physical and mental well-being of many asylum-seekers,
including our clients, thereby inhibiting full disclosure of information and potentially
distorting and slowing down the fact-finding process. Nor does a scheme that encourages
people to drop out of the system and disappear from view appear to promote firmer
procedures. We await an independent evaluation.

For further information, please contact Alison Harvey, Advocacy Officer at the Medical
Foundation for the Care of Victims of Torture, phone and fax 0207 813 4535 , email


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