In 2014, I was a nurse in the excellent Emergency Department at Derriford Hospital in Plymouth. Several military colleagues from the department were deployed to Sierra Leone in response to the Ebola epidemic. Confronted with the appalling stories of suffering coming out of West Africa, and in the knowledge that uncontained Ebola threatened millions of people globally, I felt that without dependents and with useful skills, I could and should volunteer. I applied after a night shift and woke up that afternoon wondering what had I done, and how on earth I would tell my mum.
I was thrilled to be a small part of an amazing operation involving NHS staff, the military, NGOs and, most of all, the healthcare and sanitation workers from Sierra Leone, who were often ostracised for working with Ebola patients and struggled with the devastating impact on Sierra Leone’s economy, education and health systems. Prior to Ebola there were only 120 doctors serving a country of six million people. Of those, 20 died from Ebola in the first few months, including most of the infectious disease specialists. “Eye opening” doesn’t really cover it.
Some months after I returned, I received a medal for my service. I was honoured to receive it, and yet today I am returning it. My main knowledge of medals comes from my father who was in the Navy in the Second World War, who wore his medals with pride and whose we wore on Remembrance Sunday after he died. I have a huge respect for those that make sacrifices and are honoured for them, and I can’t in good conscience keep it. I went to Sierra Leone because I felt solidarity across borders for people who were suffering, I can’t respect a government that has so little humanity it won’t recognise the needs of vulnerable people within our own borders.
Recent regulations require the NHS to contribute to the “hostile environment”, meaning undocumented people are forced to pay 150 per cent of the cost of their treatment upfront. Rather than deterring health tourists, these charges are penalising some of the most vulnerable people in our society, including pregnant women, children, those fleeing torture, and victims of human trafficking. Equivalent countries with greater proportions of undocumented people and refugees have not brought in such harsh measures, and France has ensured that pregnant women and children do have access to healthcare.
The cost to the NHS is approximately 0.3 per cent of its budget by the government’s own analysis, whereas the alienation and failure to treat vulnerable people, and the long term impacts on health and society are unquantifiable. The arguments in favour of public health and common decency are drowned out by anti-immigration rhetoric and the scapegoating of vulnerable groups. This also obscures the chronic underfunding of our heroic NHS. There are more migrants working to support our NHS and care services at a loss to their own country’s healthcare systems, than are “draining” resources from ours.
We expect our nurses to be bottomless wells of compassion and kindness to our patients, without providing them with even basic supervision or emotional support, and then this government is expecting us to turn that compassion off if a vulnerable child doesn’t have the correct paperwork. It wants nurses to be border guards, and I won’t do it. The hostile environment is at odds with the founding principles of the NHS, and threatens public health. It creates unnecessary suffering as people delay or avoid seeking help altogether for fear of detention or detection.
These regressive regulations may have a huge human cost, but may also cost more than they save, due to worsening public health from undiagnosed and untreated infectious diseases. Patients with infectious diseases are supposedly exempt from the hostile environment restrictions, but in practice people have symptoms, not diagnosed diseases, before they see a healthcare professional. In practice, they are too frightened to seek help. We are calling for the government to repeal these regulations, to ensure that all children and pregnant women have access to healthcare and to suspend charging, pending a public health impact assessment with a focus on vulnerable groups.
Lord Alf Dubs, who fled the Nazis as a child, is helping us to return these medals. His participation reminds me how history will judge us if we fail to stand up for refugees today. It also reminds me of my father’s generation that stood up to fascism, believed in internationalism and that with rights come responsibilities. I believe that compassion may save the world. It recognises that your suffering is also my suffering, and your happiness impacts on mine. It led me to go to Sierra Leone, and I am handing my medal back today to stand up for it.
Charity Garnett has a background in environmental policy, and decided to retrain as a nurse in 2010. In 2015, she was working working in Emergency Medicine and volunteered to go to Sierra Leone. She currently works as a Nurse Specialist in Palliative Care.