Nobody who has been watching the news over the last month or so can have failed to be moved by the plight of Ukrainians fleeing the Russian invasion of their country. Many of them are vulnerable women and children, and some of them have made their way to the UK, seeking safety and healthcare.

There was a good news story earlier in March which told the story of 21 Ukrainian children who had arrived in the UK for lifesaving cancer treatment. The news shone like a beacon of hope in an otherwise bleak picture.

Refugees from humanitarian crises face many barriers to a safe and healthy life; bureaucracy, education, health, social interaction and more. One common denominator to all of these is the issue of language and communication. Being able to communicate with refugees from whichever country they are from is a crucial part of the NHS’s duty and service. English is one of the most widely known languages in the world, and it’s true that many refugees can already communicate satisfactorily. But we shouldn’t simply expect it. Especially at such a stressful and unfamiliar time in their lives, refugees need to have the familiarity of their mother tongue at the very least.

There is a legal duty on healthcare services, under the NHS Act 2006, to “reduce inequalities for patients who cannot speak English in respect to their ability to access health services, and the outcomes achieved for them by the provision of health services." Unfortunately, that isn’t yet true on the scale that we should be seeing it. When we add face masks into the equation, communication can become even more strained.

In 2016 an Accessible Information Standard (AIS) was devised, mandating healthcare providers to produce information in an accessible format, for example by using sign language or easy read forms. A review of this Standard is ongoing and is expected to be published in spring 2022.

Research done recently by Healthwatch lists some of the barriers faced by refugees entering Britain:

• Poor availability of interpreting services  
• Quality of interpretation   
• Limited access to urgent care services
• Lack of translated information in other languages 
• Low awareness of communication support
• Services not being joined up - patient information not shared effectively enough

So what can practically be done in primary care to help solve these issues?

An NHSE bulletin published March 2022 set out updated guidelines on how best to provide care to incoming refugees, in light of an update from the Office for Health Improvement and Disparities. The letter reminded GP practices that proof of identity is not required for registration at a practice, and the inability of any individual to provide them is no reason to refuse registration. It also went on to explain how healthcare professionals can best communicate with people from Ukraine and check they have all the documents and information they need. Their specific advice for the needs of Ukrainian refugees not only includes medical pointers but also stresses the need to establish good communication and cultural/religious sensitivity and awareness:

• Screen all new entrants, including children, for tuberculosis
• Ascertain any risk factors for hepatitis B infection that may indicate the need for screening (owing to its low prevalence in the UK)
• Consider screening for hepatitis C, because of a considerably higher prevalence in Ukraine than in the UK
• Ensure that travellers are offered typhoid immunisation and advice on preventing enteric fever
• Consider nutritional and metabolic concerns (anaemia, vitamin D, vitamin A, iodine)
• Work with a professional interpreter where language barriers are present
• Consider the effects of culture, religion, and gender on health
• Assess for mental health conditions, and
• Refer pregnant women to antenatal care.

The recommendations given by Healthwatch go somewhat further, and highlight the immediacy of the need at the moment.

Healthwatch recommendations for next steps:

• Department for Health and Social Care and NHSE should urgently introduce new statutory guidance for all health and care providers on commissioning interpreting and translation services.
• NHSE should carry out a review of standards surrounding interpreting and translation to include all major areas for improvement identified in Healthwatch’s recommendations for the review of the Accessible Information Standard (AIS).
• NHSE and leaders across Integrated Care Systems (ICS) should use the transition to ICS to clarify their duties in the provision of interpreting and translation services.

Of course, another way of making communication easier and more reliable with refugees is to employ doctors from their home countries. This week we had the news that GPs who are fleeing Ukraine and want to practise in the UK will see their GMC registration fast-tracked. Whilst this is of course a welcome move, they should also be helped to move back to help rebuild and support their native people as soon as it is safe to do so.

There are already many hurdles that vulnerable people fleeing conflict and poverty have to face; it is up to us in countries of refuge, when we provide life-saving support to them, to ensure that language doesn’t become just another barrier.

Further information on Ukrainian migrant health can be found in this gov.uk guide.