It’s my sixth or seventh phone call when I start to secretly hope the receptionist doesn’t pick up.
I’m on hold for 12 minutes, but eventually the call is answered. I launch into the speech – my friend, Rosa, doesn’t have valid residency status or identification documents, but she wants to register with a GP to get a Covid-19 vaccination. Can she register with your practice?
Earlier conversations have left me uneasy, having to fend off questions tinged with hostility: Why does she not have residency status? How did she get into the country without a passport?
Registering with a GP is the simplest route to a Covid-19 vaccination. NHS England guidelines are clear: anyone can register with a GP; you do not need proof of address or immigration status. But the reality is entirely different.
This call is uncomfortably similar to my previous ones. The conversation lapses into silence as the receptionist checks with their practice manager – who insists Rosa provides paperwork.
My calls were part of an investigation by Bureau Local, which revealed that most GP surgeries across several cities in England, Scotland and Wales would not register Rosa (our dummy “patient”) without documentation. This means the estimated 1.2 million undocumented migrants in the UK are effectively cut off from the main route to coronavirus vaccinations.
The problem is more than simply an institutional oversight. It is evident in the pauses in conversation, the disbelief that someone could be without any documentation. The majority of the people who answer the phone to me quickly become uncomfortable with the line of inquiry. Their suspicion is almost reflexive. It makes for exchanges that teeter on the verge of interrogation.
The story came about following grassroots research on poor access to healthcare for undocumented migrants. Local groups had been sounding the alarm for years. In 2017, Doctors of the World found that their attempts to register a patient were wrongfully refused one out of five times. Several surveys of GP surgeries over the past two years have all shown the same thing: most won’t register patients without proof of address or ID. When the pandemic struck, we partnered with grassroots organisations to report these barriers facing undocumented migrants, which were now a matter of urgency.
And the problem is not unique to the UK – it spans continents and affects numerous vulnerable groups, including migrants, refugees, indigenous populations, homeless people and sex workers. The issue of healthcare access exists across borders, so we brought our local and global teams together to report on it. We began to ask: what was happening in Europe?
The administrative barriers on the continent stem from national or regional authorities themselves. Countries including Germany, Spain, Norway, Italy, and Bulgaria require some form of ID, health card or a residency permit. In Hungary, Belgium, Slovakia and Greece, vaccinations are officially available only to people with a social security number. Norway, like the UK, relies heavily on GP practices to provide patient information for vaccinations.
The investigation provided a damning portfolio of ill-prepared vaccination efforts that stem from historic barriers to healthcare. Across Europe, the number of undocumented people for whom the vaccine is being kept out of reach rises to almost 4 million.
Most of the undocumented people I talk to speak languages I don’t understand, but even through an interpreter it is clear they carry the trauma associated with refugees: memories of fleeing war-ridden nations or oppressive regimes, being displaced from their homes and their loved ones. They seem afraid that voicing the details of their pasts might invite an invisible force to their doorstep.
But unlike refugees, undocumented people are not registered on a database that guarantees access to healthcare, education and social services. They rarely garner the widespread sympathy and support people extend to recognised asylum seekers.
Sofia, a 60-year-old grandmother living in northern Spain with chronic lung disease and cancer in her left lung, can’t get the Covid-19 vaccine because she doesn’t have a health card. Her voice cracks as she reflects on her life in Venezuela. “I asked for help, but at the time there was no asylum, none of that,” she tells me. “The journey came about because I had to leave Venezuela in a hurry, like other people, otherwise I wouldn’t be here talking to you.”
I also spoke to Sadiqa, who fled Afghanistan more than 15 years ago. She was midway through her qualifications to become a teacher when the conflict began. Under the Taliban, her father, once a professor of microbiology, became a fugitive. They escaped to Pakistan with little money – the government at the time seized their home and belongings – and eventually, she made it to Bulgaria. But she can’t get a Covid-19 vaccine without proof of ID, such as a passport.
A few weeks after our conversation, the Taliban seizes Kabul. I watch in horror as footage emerges of desperate Afghans passing their babies over barbed wire or clinging to the outsides of departing planes. Countless people will never make it out.
Applying for asylum is complicated and lengthy. Amid the chaos of a collapsed nation, a lucky few will be granted asylum while thousands of others fall through the cracks. Many are left with little choice but to escape without any paperwork.
One of my most enlightening interviews is with a doctor in Malta. Tanya Melillo, head of the country’s infectious disease prevention and control unit, describes how the island owes its impressive vaccination accessibility to the close relationship between the health ministry and migrant NGOs. She tells me that, because of its immigration procedures, Malta’s population of undocumented migrants remains small.
As we discuss Malta’s migrants, Melillo flits between talking about asylum seekers, university students and third-country nationals. It seems obvious: everyone who wasn’t born in Malta is a migrant.
She tells me two boats of migrants have arrived on the island in the last two days. One of them had caught fire, leaving several passengers with burns. Many of the migrants from Central Africa come via Libya, a journey that can take years; some who arrive in Malta are as young as 14.
Her team is there to greet them once they arrive, along with immigration forces. They are assessed for any urgent medical care and sent to the health centre, where they are screened for infectious diseases and tuberculosis, given vaccinations, and registered with the national health system. Once they go out into the community, they have free access to healthcare – including a Covid-19 vaccine.
The immigration officers also take their details, including fingerprints and photographs, and automatically submit them for asylum. Most are granted asylum status, Melillo says; those rejected do not get deported.
This is in glaring contrast to the situation in Britain. Last summer major broadcasters filmed from vessels that approached migrants’ dinghies in the Dover Strait; in one case, the camera zoomed in to show passengers trying to get water out of their boat. The reporting came after the Ministry of Defence confirmed it was considering a Home Office request to deploy navy vessels to stop migrants crossing the Channel. Six people, including two children, died trying to reach the UK last year.
One day while I’m writing up the investigation, I drive to Stevenage in the UK to receive my second vaccine dose. A huge building that housed council offices has been gutted and sterilised to act as a mass vaccination facility. I hand over my vaccine card, half-completed after my first jab, and wait in a room two metres apart from 20 other masked faces.
It is over in seconds. There’s a sharp pinch before the needle gives way to a tiny drop of blood. The nurse presses a cotton pad to my arm, probably her hundredth arm of the day, and I’m ushered into the waiting area where a volunteer offers me a biscuit.
While I sit there, I think of Sofia. There is a wave of relief, followed by guilt. For a healthy 24-year-old, the vaccine feels like a ticket back to normal life. For Sofia, it could be the difference between life and death. There are millions of undocumented migrants across the UK and Europe asking anyone who will listen about the vaccine. In two weeks, I will be fully protected. They will still be waiting for an answer.
My flimsy vaccine card, now filled in completely, is yet another piece of paperwork that separates us.
Reporter: Sarah Haque
Project reporters: Rachel Hamada, Emiliano Mellino, Vicky Gayle, Sarah Haque, Robyn Vinter, Ruth Bushi, Siriol Griffiths and Laura Margottini
Bureau Local editor: Emily Wilson
Global health editor: Chrissie Giles
Investigations editor: Meirion Jones
Production editors: Alex Hess and Emily Goddard
Illustration: Soofiya Andry
Our reporting on health inequality is part of our Bureau Local and Global Health projects, which have several funders. None of our funders have any influence over the Bureau’s editorial decisions or output.