1. Safeguarding Children Seeking Asylum Sarah Nathaniel

2. Background Cardiff Medical School final year project Safeguarding issues presenting at initial assessment in a Cardiff Asylum Clinic Children seeking asylum (2009): Accompanied: 4,391 Unaccompanied: 3,175 Vulnerable group with significant health needs Safeguarding involves protecting children from harm and the promotion of their health and wellbeing

3. Methodology Case series Specialist paediatric clinic in St David’s Hospital Clinic letter sent to the GP between January 2008 and December 2010 Qualitative analysis of cases with safeguarding concerns Systematically categorising findings into key themes

4. Findings 204 appointments: 64 did not attend 7 clinic letters not located 140 clinic letters analysed 64 cases safeguarding concerns raised 61% male 39% female Age: 5 months – 18 years Most prevalent country of origin: Pakistan

5. “[He] is not recognised as a child within the care system although tells me that he is coming up to 15 years of age. He was withdrawn and distressed following 10 days at a detention centre.” “[There are] safeguarding concerns about safety of these children and the isolated and unsupported situation this very vulnerable woman is in. She is not appropriately emotionally available for these children because of her own vulnerability and her inability to control their behaviour makes them vulnerable to accidents.” “Child’s experiences pre-flight, during flight and post- flight (including detention in the UK) have been traumatic and he has shown serious attempts at self harm and suicide in the past.”

6. Four themes: 1.The asylum process: unaccompanied children, age- disputed cases, accommodation, isolation, education, immunisations 2.Socio-cultural factors: female genital mutilation, trafficking 3.The parent/guardian: mental health, abuse 4.The child: physical health, mental health, abuse Interplay between these factors

7. FGM Safeguarding Web: Progression Prevention Protection Provision Parent/s Asylum Process Child Health: Physical, Mental, Emotional, Relational and Spiritual Unaccompanied Children Age Dispute Accommodation Vulnerability Unsuitable Unsafe Inappropriate Stress Anxiety Depression Trauma Education and Immunisations Abuse Physical Verbal Emotional Sexual Trafficking Isolation Socio- cultural

8. Discussion The indigenous child and the child seeking asylum Most at risk: Unaccompanied children seeking asylum Age-disputed children The asylum process both causes and exacerbate safeguarding issues Maslow’s Hierarchy of Needs Basic physical needs Security Social

9. Limitations Dynamic nature of safeguarding issues Purpose of the clinic Time restrictions Drawbacks of qualitative analysis Need for a prospective study

10. Recommendations Multi-agency service provision Health surveillance that, using the Multidisciplinary Team and relevant Non Government Organisations, is: Accessible Consistent Specific Specific mental health services: parent and child Abuse Maternal mental health

11. Summary Significant safeguarding concerns Multi-factorial Mental health of family unit Multi-agency service provision Further research needed

12. Thank you for listening Contact: sarahnathaniel@doctors.org.uk