Unsafe and unstable housing for refugees and asylum seekers is a threat to intergenerational health

Further uncertainties

People arriving in Europe to seek protection and asylum are increasingly segregated and isolated in confined contingency accommodation. While families are housed in temporary, state organised accommodation, women continue to become pregnant and give birth but still face potential rehousing or dispersal to a new location at any given time.14 All too often, women seeking asylum receive poor maternity care.15

Insecurity often persists after refugee status is granted,16 and the “move on” period in the UK for people receiving refugee status leaves them only 28 days to find permanent housing.17 In Denmark refugee status is reviewed every two years and is granted with the aim of providing temporary protection to asylum seekers, promoting an eventual return to their country of origin rather than integration into Danish society.18 Gaining access to refugee status can therefore expose people and families to further uncertainties, including homelessness and deportation,19 which adversely affects mental health.20

Delivering appropriate care in initial and dispersal accommodations has proved extremely challenging.21 Altogether, chronic housing uncertainty and arbitrary geographical dispersal to different accommodation sites lead to exhaustion and isolation for people and families seeking asylum and for those supporting them,1 including healthcare practitioners and social workers who invest time and resources to build relations and provide support.

As researchers engaging with forcibly displaced women who have given birth in the UK and Denmark, we see the pervasive and lasting damages of housing uncertainty for people seeking asylum. Parents face many challenges in receiving basic yet critical healthcare, worsened by the uncertainty around accommodation. Through our research we have heard accounts from parents staying in temporary accommodation in UK hotels who were struggling to wean their infants onto solid food because of insufficient access to a kitchen or equipment such as highchairs. Although meals may be provided for adults, these foods are unsuitable for infants, and baby food is unavailable.

We have also seen in asylum accommodation an absence of opportunities for infants and young children to socialise beyond their immediate family, which is further hindered because poor accommodation negatively affects the parents’ mental health.

Oppressive structures

State run accommodation can harm pregnant asylum seekers’ psychosocial health because of housing uncertainty, fear for personal safety within the accommodation, a lack of personal space, and disrupted social networks, the stress of which can have long term effects across generations.2223 Midwifery and health visiting teams are trained to support intergenerational health by fulfilling the health needs of mothers and babies. But despite provision of targeted multidisciplinary healthcare, the persistent uncertainties and stress for mothers—including around housing—mean that these service providers can’t achieve their full potential and are constrained in their capacity to challenge underlying oppressive structures, such as discrimination and racism.

Acknowledging the links between health deprivation and structural injustices for children born to refugee parents, such as inadequate housing and temporary residence, is critical for cross sectorial protection. The frame of social justice relating to health and housing aims to dismantle the structures that keep people in precarious conditions and silence their aspirations.24 Efforts from the healthcare and social sector to reduce the intergenerational effects of stress and trauma need to go hand in hand with structural changes that eliminate uncertainty and provide a stable environment.

Action based on social justice includes considering how repeated relocations, dispersals, and uncertainties around residence may threaten existing relationships between asylum seekers and healthcare practitioners, disconnect women from their social networks, and disrupt children’s development and enrolment in schools and early years care, as well as recognising that this disruption can have devastating consequences. For example, a case review examining the death of “Baby T” in London in 2017 revealed the disjointed healthcare received by the infant’s asylum seeking mother, exacerbated by frequent rehousing.15 It is imperative that health and housing services are joined up to promote secure accommodation plans and ensure a clear handover of care to all relevant agencies when relocation is absolutely necessary. No health initiative can replace a safe and stable home.