Doctors of the World has launched a report on the impact of the COVID-19 pandemic on excluded people in England.

Based on a Rapid Needs Assessment (RNA) carried out at the height of the COVID-19, An unsafe distance shows excluded groups are being left behind in the UK’s COVID-19 response as control measures amplify existing health inequalities and put life-saving advice and care further out of reach.

Researchers looked at the pandemic’s effect on a wide range of groups: refugees; people seeking asylum, including unaccompanied asylum-seeking children; undocumented migrants, including survivors of trafficking; people in and recently released from immigration detention; people experiencing homelessness, Gypsy, Roma and Traveller communities; sex workers and people recently released from prison.

The full RNA made a series of recommendations for the NHS, health services and community and voluntary sector organisations, as well as central and local government. Although the study focuses on England, its recommendations are valid across the UK.

Key findings include:

  1. People in excluded groups are at higher risk of being exposed to the virus due to:
    • difficulty accessing COVID-19 guidance and key public health messages, because of digital exclusion and language barriers.
    • Where COVID-19 guidance is accessible, it is often not feasible to implement as the guidance has failed to consider the living situations of people in vulnerable circumstances
  2. People in excluded groups are struggling to access and use healthcare services during the pandemic. People seeking advice on and healthcare for COVID-19 because of:
    • Fear and distrust of health professionals, the NHS, and government, caused by legislation that increases certain groups’ risk of criminalisation, and previous negative experiences.
    • Digital exclusion and language barriers, which made it difficult for some people to use NHS 111.
  3. People also struggled to access routine, non-COVID-19 health services, for example registering with and accessing a GP. This is a particular problem for newly released prisoners, new asylum seekers, mobile groups who arrive in a new area during ‘lockdown’ and people experiencing homelessness who are being displaced as they are housed in hotels.
  4. People in excluded groups are at the sharp end of the pandemic. Excluded people have fewer resources and access to support to mitigate against the negative impacts of COVID-19 and the social control measures implemented to address the pandemic, and face a range of social and economic challenges:
    • School closures have led to exclusion from education for children. Families with low literacy, little physical space or no access to technology have limited ability to provide home schooling.
    • The pandemic has also increased people’s vulnerability to extreme social isolation, violence and abuse, and hate crimes and discrimination. This is a particular risk for children and sex workers.
    • As England has locked down, those employed informally, seasonally or domestically have experienced job losses and, in some cases, become destitute.
    • Undocumented migrants, sex workers, domestic workers and families living on traveller sites were at risk of eviction if they displayed symptoms of COVID-19 or were unable to pay their rent.