Uncategorised

Providing healthcare in the streets

One Londoner in fifty is homeless.

Whether a person is experiencing street homelessness or is living in temporary shelters, squats, or insecure accommodation, homelessness has a deep impact on physical and mental health.

This winter, we are piloting a mobile health service for homeless people in London. We are offering an innovative and flexible solution that can reach them in the streets, parks, shelters and homeless centres.

Many people experiencing homelessness will not see a doctor for long periods of time, due to difficulties in registering with a GP, travel distance from the clinic, and fear of stigma.

Our volunteer doctors and nurses provide a first medical assessment, prescribe medicines, dress wounds, and provide advice. Our caseworkers help patients register with a GP, supporting them in building up their trust to access healthcare.

Durga, GP and Mobile Clinic coordinator, said “It has taken a few weeks but I think the local homeless population is starting to warm to us and are interested in seeing us.  I still feel we have a long way to go through to try and reach as many people as possible in the limited time we have”.

 

This February, make a special gift for Valentine’s day and support people who need healthcare.

£32 could pay for prescriptions for two patients

£49 could pay for a week of travel expenses for a volunteer

£160 could contribute towards the training and recruitment of our medical volunteers

£280 could help toward the running costs and medical supplies for our clinic

Salim’s Story

Yesterday I met Salim. He was kicking some rocks around in the middle of the forest near his temporary migrant camp in Dunkirk, France. Around him, all that was left of what had been his home for the last two weeks was an extinguished fireplace, a can of beans thrown on the floor, empty bottles of water, and clothes hanging to dry on trees.

On Tuesday morning, French riot police had surrounded the camps, evicted the 700 people living there and made some arrests. Scared, Salim ran away with other dispossessed people, deeper into the woods. All he had in the world…a few beans he’d been cooking for his breakfast trampled into the earth. His only shelter from the sun, the flies, the dirt and the wind…a tent…gone who knows where?

Salim is only 14. He’s from Iraq. A country scarred by decades of war.

He’s one of the unaccompanied minors that live in the informal settlements of Dunkirk. There are many small settlements in the area: empty corners of land among the trees where people pitch their tents and cook food together. Salim’s settlement had been there for months before the eviction.

When I met him with the rest of Doctors of the World (Médecins du Monde) team, we’d gone to the camp to assess the situation and health needs. That morning, the state-run camp of Grande-Synthe had been evicted. We’d heard some of the asylum seekers might have escaped the eviction (which meant being moved to far away parts of France) by joining a makeshift camp in the forest.

We were not prepared for what we saw. The people living in the forest had been cleared out too. A man told us about the violence used against them forcing them to abandon their camp. Salim and these other young men, fifteen in all, were afraid that the police might come back. They had run out of water and food but were too scared that the police would reappear to venture beyond the edge of the forest. Charities would be distributing food later that evening. But these frightened people didn’t want to risk it. It took a lot of persuasion for us to reassure them and make sure they’d have basic provisions to see them through the night.

We took Salim with us. As a child, he’s entitled to special protection. We contacted another charity to make sure he’d be safe and cared for. But what if yesterday he had refused to tell us his age? Often, children like Salim are nervous of strangers, too afraid to speak.

The people in Calais and Dunkirk often ask about Brexit. They have families and communities in the UK they want to be reunited with. Some are their parents, children, and loved ones; others are their neighbours and relatives. Each of these women, men and children have a history, a life, and a desire to move on – to reach a safe place where they can restart their lives.

The UK government must do more to guarantee safe and legal routes for people seeking asylum in the UK. Humanitarian needs must always be the highest priority, and more must be done to support people in these desperate circumstances.

Britain has a proud history of providing safety to those in need. We shouldn’t turn our backs on boys like Salim.

 

Originally appeared in OpenDemocracy

Palestine: obstacles to health in Gaza

“Diana is a newborn baby and the last girl of the Al-Gazaoui family. She has an intolerance to breast milk.

The Minister of Health is not capable of offering her the therapeutic milk substitute she needs. The family attempts to buy one but due to the high price and limited demand, there isn’t enough and they can’t even pay for what they need.

After they run out of the milk substitute, Diana develops cardiac problems and her health deteriorates rapidly”.

 

Palestinians in Gaza have to face a maze of obstacles to access secondary health services outside the Gaza Strip.

Doctors of the World’s report, “The Labyrinths of Health in Gaza“, highlights that the current short-term humanitarian funding schemes directed to the health sector are not addressing the medium and longer-term development needs of a sector trapped in a protracted conflict.

After 12 years of blockade, and with the ongoing de-development of the Gaza economy, lack of drugs, equipment, and qualified medical resources are a daily reality of the healthcare sector.

The current situation is negatively driving the financial burden towards an unsustainable referral-based system, which is reaching its limits, with dire consequences for patients and the whole healthcare system. We encourage all actors involved to join forces to strengthen the humanitarian-development nexus and address very concrete challenges in improving the geographic distribution of health services. However, we stress that these development steps can only work if concrete political measures are taken at addressing the root causes: the blockade and the occupation of the Palestinian people.

Based on the real stories of Palestinians in Gaza, the report follows the fictional Al-Gazaoui family in its journey through the different obstacles Palestinians and the health system itself are facing on a daily basis. This includes showing how the current referral system is a substantial and complex component of the labyrinth to health. Through the examination of paediatrics, orthopaedics and oncology specialised health services, it also thorws light on other structural challenges such as the availability of drugs, equipment and specialised human resources.

Read the report

Fears of a Windrush scandal in the NHS for EU citizens

Doctors of the World is extremely concerned about the impact that the Withdrawal Agreement Bill will have on the health of vulnerable EU citizens and public health as a whole.

MPs are currently debating the Bill in Parliament. If passed, it will entrench the EU Settlement Application route into UK law. EU nationals and their families will become subjected to the Hostile Environment.

This could create a new, larger, Windrush scandal. And the most vulnerable will be facing the higher risks, such as elderly people and people experiencing homelessness.

EU nationals who have not been able to apply for pre-settled or settled status will lose their lawful status in the UK. They will risk being excluded from healthcare and will be charged up-front for their care, or have treatment withheld if they can’t pay. This policy is likely to result in serious harm being done to patients: hospitals, which are already struggling to implement the current charging regulations, have denied lifesaving care to patients. Even those eligible for care are likely to face obstacles in accessing treatment.

Under the Settlement Application scheme, EU citizens could have one of six types of immigration status, each corresponding to different entitlements to access NHS services. EU citizens will have to prove their status to be able to access secondary care, and hospitals will be put under the huge burden of having to check patients’ eligibility for care.

In our London clinic, we see regularly cases where lifesaving care is withheld because it is classified as not urgent. Those affected include some of the most vulnerable in our communities, such as victims of trafficking, asylum seekers, and undocumented migrants. Last December, an elderly woman was wrongfully refused potentially life-saving treatment because she couldn’t afford to pay £150k upfront. A few months before, a young man died after having been denied a heart transplant, and a patient with multiple tumours was refused palliative care and discharged on the street.

The government is aware of the harm the charging regulations have created. Yet, they are willing to expand its reach to an even wider part of the population.

 

We urge MPs to:

• Withdraw all charging, so that services are always given on need rather than ability to pay.
• Allow everyone who has lived in the UK for 3 months or longer to receive free NHS care.
• Guarantee that EU nationals will be exempt from health charges, including the IHS, after Brexit.
• For those who are charged for NHS care, set healthcare bills at the NHS tariff (rather than 150%) and allow patients on lower incomes to pay NHS bills in installments.

We also urge NHS Trusts to

• Ensure exempt groups are not charged for their care
• Use clinical discretion to classify treatment as “urgent or immediately necessary”, when appropriate
• Encourage engagement with treatment despite charges

Victory: Novartis withdraws an abusive patent for an over-priced cancer medication

On 3 July 2019, Doctors of the World and Public Eye, represented by Lionel Vial, filed a patent opposition at the European Patent Office against a patent covering Kymriah®.

Kymriah® is a gene cancer therapy from Novartis, for which the French Social Security is billed €320,000 per patient. The aim was to denounce an abusive patent that aimed to strengthen a monopoly, allowing an exorbitant price to be imposed. At the end of November 2019, Novartis announced that it was withdrawing this patent and asked for it to be revoked.

Novartis withdraws one of the patent covering Kymriah®, a victory achieved by mobilising civil society 

The case made by Doctors of the World and Public Eye denounced the exponential increase in prices for new treatments arriving on the market. The aim was to draw attention to the prices of new gene therapies for cancer, which, at over 300,000 euros per person, put pressure on national health service budgets, and consequently access to healthcare for patients. In 2014, the exorbitant prices for medicines for hepatitis C led the French government and its counterparts in Europe to take rationing measures. As the same causes produce the same effects, it is very likely that cell therapies for cancer could also be hit by rationing measures. By creating the conditions for lower price negotiations, Doctors of the World and Public Eye also intend to reduce the prices of all future therapies of this kind. Patent opposition is a strong and effective tool to achieve this as it obliges the patent holders to respond to the arguments of the complainant.

In a letter dated 29 November 2019, the legal firm representing Novartis and the University of Pennsylvania, the patent holders, announced that the proprietor no longer approves the text on the basis of which the patent was granted, and would not present an amended version of the patent in question. The firm said that they were requesting that the patent be revoked themselves. Through this decision, the procedure stopped and the patent no longer exists.

This is a historic decision and a first step towards fair access to treatment.

It confirms the abusive nature of the patent, which should never have been granted by the European Patent Office. ‘This patent withdrawal demonstrates monopolies’ abuses, in particular with new, expensive gene and cell therapies. The States agree to high prices based on unjustified intellectual property rights which are never called into question. They are however responsible for guaranteeing that medication patentability criteria are observed, and should never allow abusive patents that will cost millions to healthcare systems,” explains Olivier Maguet, head of the medication price and healthcare systems mission at Doctors of the World.

However, Kymriah® is protected by other patents. This decision does not enable a biosimilar version of the treatment to be produced. Yet, it is a landmark decision. It strengthens public hospitals’ capacity to produce similar off-patent versions, at lower costs, which could therefore reduce the price of ‘branded’ therapies. And this alternative exists and is viable, because other countries in Europe use it. It also strengthens’ institutions involved in the price negotiation, to demand lower prices arguing on the basis of weak intellectual property rights, and therefore illegitimate monopolies. Finally, it should enable civil society organisations throughout the world to use similar arguments to object to similar abusive patents.

This decision is a first, and calls for others. Doctors of the World and Public Eye intend to take similar initiatives again that could reduce prices and guarantee fair access to treatment. It’s a decisive step, and we remain more prepared than ever.

Hodeidah still most dangerous place in Yemen

One year since Stockholm Agreement, Hodeidah is still most dangerous place in Yemen for civilians. A quarter of all civilian casualties across Yemen in 2019 were recorded in Hodeidah governorate. Despite a ceasefire in the port city being at the heart of last year’s Stockholm Agreement, Hodeidah has seen 799 civilian casualties since the Agreement was signed, the highest toll countrywide.

 

Families continue to flee for their lives with close to 390,000 Yemenis uprooted from their homes across the country so far in 2019. Half of all those displaced came from just three governorates – Hajjah, Hodeidah and Al Dhale’e.

Despite drops in the levels of violence compared to 2018, Hodeidah, Sa’ada, Taizz, Al Dhale, and Hajjah remain the most dangerous governorates for civilians in 2019.

As aid agencies working in Yemen, we are outraged that after almost five years, Yemenis continue to suffer from an incalculable humanitarian crisis fuelled by conflict. Civilians continue to bear the brunt of the violence. Houses, farms, markets and health facilities are damaged and destroyed worsening an already dire humanitarian situation.

« Ten million people face starvation and 7 million are malnourished. »

Yemen is the world’s biggest humanitarian crisis. Ten million people face starvation and seven million are malnourished. Fighting and restrictions put in place by the authorities, are hampering our organisations from reaching the communities in greatest need. Conflict also continues to block people’s access to markets and services, and inflicts damage on essential infrastructure such as hospitals, schools, and water systems.

Last month’s signing of the Riyadh Agreement as well as a general de-escalation in hostilities presents a real window of opportunity to end the war. If urgent action is not taken we could see another five years of conflict, leading to a greater catastrophe for civilians.

« We call on all conflict parties, the UN Security Council and countries with influence, to work together and speed up implementation of the Stockholm Agreement. »

We call on all conflict parties, the UN Security Council and countries with influence, to work together and speed up implementation of the Stockholm Agreement. The recent announcement on opening Sana’a airport for medical flights is a positive sign, and if actioned it will help thousands of sick Yemeni’s access lifesaving medical care.

Now is the time to build confidence towards peace through the Agreement and beyond, by implementing revenue-sharing from Hodeidah port to pay salaries across the country, and ending the politicised deadlock over fuel to resolve the crisis.

While we call for full implementation of the Stockholm Agreement, it should not be a pre-condition for peace in Yemen. A nationwide ceasefire must also be immediately put in place to secure long-overdue peace talks. What Yemen needs most is an end to the violence, through a political solution to the conflict that takes into account the needs of women, youth and all of civil society.

 

Latest casualty (deaths and injuries) and humanitarian figures

• A total of 1,008 civilians were killed by armed violence so far this year, down from 2,049 for the whole of last year.
• More civilians were killed or injured by ground fighting this year than in the 12 months before.
• Over 2,100 incidents of armed violence impacted civilians since the Stockholm Agreement – no improvement on the 12 months prior.
• Increased number of civilians were killed or injured by explosive ordnance, from 349 people impacted last year to 504 so far this year.
• 327 incidents of armed violence directly impacted civilian houses in 2019, 60 per cent of the total incidents. Half the child and women casualties in 2019 resulted from incidents impacting houses.
• Over 40 per cent of all incidents of armed violence impacting civilians occurred in Hodeidah Governorate. A quarter of all 3,086 country-wide civilian casualties took place in Hodeidah, followed by Taiz Governorate.
• The overall number of civilian casualties dropped compared with 2018, largely owing to a significant reduction in airstrikes in Hodeidah, and a recent de-escalation of violence across the country.
• Data and analysis on civilian casualties and impact on civilian infrastructure was conducted by ACAPS and CIMP. This is open source data and has not been separately verified by the INGOs that are signatories here.

 

List of signatory organizations

Action contre la Faim

Adventist Relief and Development Agency

CARE International

Danish Refugee Council

Handicap International – Humanity and Inclusion

Islamic Relief

International Rescue Committee

Intersos

Medecins du Monde

Norwegian Refugee Council

Oxfam

Première Urgence Internationale.

Saferworld

Vision Hope International

ZOA

Mobile Clinic team to support people experiencing homelessness

Today, we’re launching a new Mobile Clinic service helping people experiencing homelessness and sleeping rough in the City of London.

Volunteer GPs and nurses will offer advice on health conditions, register patients with local GP practices, attend to immediate health needs, provide new socks and gloves and offer screenings for HIV, chlamydia and gonorrhoea.

The aim is to work towards sustainable access to healthcare, so that people experiencing homelessness will be able to access mainstream NHS services and rely on them in times of need.

We have teamed up with the City of London Corporation, which governs the Square Mile, to run the service as a six months pilot on a weekly basis.

Visitors will be offered hot drinks and refreshments, and referred to other support services, such as dentists, opticians, and drug and alcohol teams. Women experiencing homelessness will be offered sanitary products and referred to our Women and Children’s clinic.

Marianne Fredericks, Chairman of City of London Corporation’s Health and Wellbeing Board said:

“We know that rough sleepers experience a whole host of barriers when it comes to accessing proper healthcare.

“Doctors of the World provides fantastic support for the most vulnerable in our society, and this pioneering service will be invaluable for the Square Mile’s homeless population.

“Together we are supporting the them with medical care in a safe environment, and helping them get off the streets for good.”

Durga Sivasathiaseelan, NHS GP and Mobile Clinic Coordinator said:

“It is incredibly hard for people experiencing homelessness and sleeping rough to access healthcare. And when diseases go untreated, they can worsen dramatically and affect people’s long-term health.

“This is particularly true for those who are experiencing street homelessness or live in unstable accommodation, where their lives can be chaotic, making it more challenging to address health needs.

“Accessing healthcare becomes less of a priority when you are worried about where you are going to sleep and if it will be safe and warm.

“Our volunteer doctors and nurses and support workers will provide medical consultations, help patients’ register with a GP and access other mainstream NHS services.

“The mobile nature of this clinic will allow us to reach the most vulnerable people in the City in a way that is flexible to their needs.”

Dr Mark Rickets, Chair of NHS City and Hackney Clinical Commissioning Group, said:

“Supporting and doing all we can to provide health and care services to some of the most vulnerable people living on our streets, is crucial to reduce inequalities.

“By working with an organisation like Doctors of the World UK, we can hopefully reach individuals that may not have had any other opportunity to access services, and in turn improve their quality of life in some way.”

For more information, please contact our Media team at media@doctorsoftheworld.org.uk

The gift of healthcare for children

Abdul was just 13 when he arrived in the UK in the back of a lorry. He escaped war in Afghanistan: his father and brother were killed by the Taliban, and Abdul was next. 

When Abdul came to us, he still didn’t know the outcome of his asylum application. He’d been living in the streets for four years and was struggling to find his feet in the UK: nightmares, flashbacks, and unimaginable stress. 

It is incredibly scary and traumatic to be so far away from home at such a young age. Abdul was so scared of his surroundings that it took him a long time to open up. When he fell from a bench in the park whilst asleep, Abdul was so afraid of being reported to the police that he left the hospital despite his head injury. 

We were able to register Abdul with a GP and refer him on for other help. Too many children are alone in the UK with no access to health care or support. 

This Christmas, you can make sure Abdul and others get the care they need by generously giving today.

For Abdul’s appointment with one of our volunteer GPs the costs stack up as follows: 

Translation for one hour @90p per minute: £54 

Travelcard for transport to and from the clinic: £10 

Prescription for drugs: £9

Please give what you can.

Maternity Charging

Since the introduction of the Hostile Environment, hospitals have had to charge undocumented migrants living in the UK for non-emergency medical care. This includes pregnant women.

Bills of £7,000 for the basic maternity package (an uncomplicated pregnancy and delivery) are the norm. Often they are much higher.

One of the more shocking cases Doctors of the World supported was a woman sent a bill of £9,600 soon after her 22 week miscarriage.

A pregnancy is a great undertaking for all women. But time and time again we see pregnant women at the clinic who delay accessing or avoid visiting hospitals altogether for fear of incurring huge debts that they cannot pay. There is also a very real fear that having an unpaid maternity care debt will result in being reported to the Home Office.

“The NHS says antenatal care should always be provided, but we regularly see women who’ve been put off getting that care, which puts both mother and child at risk,” says Phil Murwill, who runs Doctors of the World’s London clinic. “We see women who are 40 weeks pregnant turning up at our clinic having received no antenatal care at all. This includes extremely vulnerable women such as survivors of trafficking and sexual violence.”

These women are managing their pregnancies with no knowledge of whether their baby is healthy.

When a pregnant woman comes to the Doctors of the World clinic we’re able to support her in registering with a GP and give advice on setting up a payment plan to pay her bill. Our doctors and volunteers know how to build trust and will spend time with women to ensure they’ve received all the care we can offer.

Doctors of the World is also calling on policy makers to withdraw all charging, so that services are always given on need rather than ability to pay.

Womens Rights

A woman’s body is her own.

Sexual and reproductive rights mean you should be able to make your own decisions about your body and have the right information to assist decision making around:

• Managing menstruation
• If you want children
• Who you want to have children with
• Contraception and family planning
• Aborting a pregnancy if it is your wish

In the UK thousands of women are being denied these rights. Their status as undocumented migrants means they are fearful of accessing healthcare services so many of us take for granted.

These are women who have frequently had traumatic experiences of trafficking, sexual abuse, relationship break ups, and ill treatment in their home countries or in the UK.

Every week we meet women whose sexual and reproductive health is being put at risk because they are too fearful to access healthcare.

For years, policies that impact migrants’ access to healthcare have become more hostile. Charging for non urgent healthcare is enforced and those with unpaid bills are reported to the Home Office. Plus systems are now so complicated that people are wrongly being denied healthcare they should rightfully be able to access.

Doctors of the World runs a specialist Women and Children’s Clinic, led by female clinicians, at our centre in east London. Here women can speak to volunteer nurses and GPs in confidence and without fear. We’re able to answer their questions, help registrations with GPs, offer free contraception and sanitary products and assess the health of women in the early stages of their pregnancy.

 

Hostile Environment

In 2012 Theresa May stated her aim “was to create here in Britain a really hostile environment for illegal migration”. The goal was effectively to make life as difficult as possible for any illegal migrant in the UK to continue living in the country.

A year later there was a public outcry when vans drove around the streets of London with slogans reading ‘go home or face arrest’ painted on their sides.

Seven years in, Doctors of the World are still fighting for all Hostile Environment policies to be scrapped. They have weaved their way into all public services and further into society.

In 2015 laws were passed stating that anyone living in the UK as an undocumented migrant had to pay to access non-emergency healthcare. Charges are calculated at 150% of the cost to the NHS, for most conditions payment is expected upfront, and unpaid bills result in personal data being shared with the Home Office.

Following the devastating fire at Grenfell in 2017, volunteers were meeting survivors who were too scared to seek medical care.

A Doctors of the World volunteer, De Zulueta, saw an African woman in her early 40s who had fallen down the stairs while escaping from the tower and whose partner and relatives were missing. The woman was suffering from dizziness and memory loss, symptoms that suggested she could have a brain injury, but she didn’t want to go to A&E.

“She was frightened that she would be reported to the Home Office. I had to persuade her and reassure her, and eventually she went with an escort,” De Zulueta said.

At our clinic in east London our volunteer doctors and nurses provide medical consultations for undocumneted migrants, while our caseworkers help them register to see a GP so that they can see a doctor in the future.

We spend many hours in the clinic persuading people who are very sick or heavily pregnant that the risk of not accessing the healthcare they need outweighs their fears of the Hostile Environment.