Topic summary on People Seeking Sanctuary

People fleeing conflict or humanitarian crises, undocumented migrants, refugees, asylum seekers, and people who have been trafficked, may be more vulnerable than other migrants. These groups of people may have significant health and care needs associated with their experiences before, during, or after migration. These needs can make them particularly vulnerable to illness and poorer health outcomes. Delivering healthcare services to these groups can also be complex. This has implications for health systems and for the work of the various professionals involved in supporting the needs of these diverse populations.  

Manchester has a long history of being a place of welcome for people seeking sanctuary. Recent government initiatives to help accommodate the increased number of people seeking sanctuary have meant that Manchester has provided a place of safety for large numbers of this group. The city’s three-year strategy for people seeking sanctuary (“A Manchester Welcome”) reflects the Council’s commitment to social cohesion and inclusion. An action plan has been developed to monitor the delivery of activity to address their needs. It is designed to ensure that Manchester is a welcoming and supportive city for people seeking sanctuary. 

There is no standard definition of people seeking sanctuary. For this JSNA, we mean people seeking humanitarian protection status, including:

• people who are claiming asylum

• people who have been granted refugee status, and

• people who have experienced displacement.

People seeking sanctuary may also include:

• people who have been trafficked. E.g. brought to the UK to be exploited through forced labour, slavery, or prostitution.

• Undocumented migrants (i.e. people living in the UK with no legal status).

• Low paid migrant workers; and

• refugee children (referred to by the Home Office as Unaccompanied Asylum Seeker Children).   

This JSNA summarises the evidence and data regarding the needs of people seeking sanctuary. It describes some issues known to affect the health and wellbeing of people seeking sanctuary, the size of the migration routes through which people seeking sanctuary have come or been allowed to remain in Manchester, and what members of these communities, and the services that work with them have told us about their experiences. It also describes what the Council, the NHS, and other organisations in Manchester are doing to support them. Finally, it runs through some of the opportunities that make this support possible.

Key points highlighted in the JSNA include: 

• People seeking sanctuary face many of the same health problems as the general population, but they are likely to have a poorer awareness of how the health and care system operates. They can face barriers to treatment that may result in delays in accessing care. These groups may have significant health and care needs associated with their experiences before, during, or after migration. These needs can make them especially vulnerable to ill health, resulting in a situation where their physical and mental health outcomes remain worse than the general population. This is even the case after a period of residence in the UK. 

• Common health issues in people seeking sanctuary include injuries, impairment, or disabilities; acute and chronic conditions, like respiratory infections (including undiagnosed / untreated conditions); infectious diseases such as TB; skin conditions and infestations; malnutrition, poor diet and nutritional deficiencies; and dental and ophthalmic problems.  

• National evidence suggests that up to 30% of refugees and people claiming asylum have been tortured. Many have experienced or witnessed war, exploitation, violence, and rape. For that reason, people seeking sanctuary are more likely than the general population to have psychological ill-health, mental health needs, and psychiatric disorders. Still, it is important to distinguish between natural reactions to very stressful circumstances and 'clinical' mental health problems.  

• Recently, the University of Manchester analysed national data on suicides among psychiatric patients who migrated to the UK. There was some uncertainty in the data, but they found that the suicide rate among those seeking permission to stay in the UK appeared to be over twice as high as the general population's. The study also found that the amount of recent migrants who died within three months of discharge from psychiatric in-patient care was higher than that among non-migrants.  

• There are specific issues impacting the health of refugee children and young people seeking sanctuary. Exposure to violence and war, and experience of rape or torture, mean that more than 50% of refugee children experience some psychiatric symptoms. Many refugee children will also have experienced disruption to schooling. Some may never have been able to attend school. Unaccompanied and age disputed children are especially at risk of exploitation. They need rapid identification and safeguarding.  

• People seeking sanctuary may experience other stressors that begin, continue, and sometimes worsen after arriving in the UK. These stressors include poverty, isolation, loneliness, loss of self-esteem, racial harassment, discrimination, and a sense of powerlessness. People whose asylum claim has been refused may also be destitute and homeless. These factors increase their risk of abuse, exploitation, and poor mental health. 

The JSNA describes the range of services directly provided by the Council that are dedicated to working with people seeking sanctuary, or where there are staff dedicated to working with these groups embedded within universal services, such as Libraries and the Work and Skills Teams. It also describes the specialised services for people seeking sanctuary that are commissioned and funded by the Council, but delivered by Voluntary, Community, Faith and Social Enterprise (VCFSE) sector organisations.  

The JSNA describes the new NHS Greater Manchester model of care for migrant health services, the primary care medical (GP) offer for residents of contingency asylum hotels in Manchester, the sources of support and advice for pregnant women and new mothers seeking sanctuary, and the work undertaken by the Community Health Protection Team (CHPT) to ensure infection prevention and control in accommodation for people seeking sanctuary, including tuberculosis (TB) screening for people claiming asylum and new migrants from countries with high rates of TB.  

Many of the key actions to address the identified needs of people seeking sanctuary are in the three-year Manchester Local Authority of Sanctuary Action Plan and the Manchester Inclusion Health Action Plan. The Manchester Inclusion Health Action Plan was co-produced between the Community Health Equity Manchester (CHEM) Inclusion Health Sounding Board and the Inclusion Health Working Group.    

Other specific opportunities for action identified in the JSNA include:  

• Latent TB screening for new migrants and people claiming asylum,

• Supporting pregnant women and new mothers seeking sanctuary, and

• Identifying data about people seeking sanctuary as part of a planned audit of local suicide inquest reports.

The JSNA also summarises the actions being considered by the NHS Greater Manchester Strategic Migrant Health Group. These actions include:

• developing a minimum dataset to inform strategic direction of the migrant health work programme and drive consistency of approach,

• continuing to review the Greater Manchester service models and delivery,

• developing and launching a Greater Manchester training programme to upskill providers with specialist skills required, and

• reviewing and strengthening safeguarding contractual standards for commissioned providers. 

This JSNA was completed in May 2025. It was presented to the Health and Wellbeing Board on 4 June 2025. 

A full copy of the JSNA can be accessed as part of the papers for that meeting.