More food? You're lucky to be here

The UK government has voiced its commitment to tackling the link between ill health and poverty, so why is it ignoring those most at risk - the children of refugees? ask Margaret Lawson and Elizabeth Ojaba.

In recent years war, violence and persecution in many countries have left large groups, often families with children, with no option but to abandon their homes and flee. A growing number of asylum seekers and refugees come to Britain seeking a better life. It is estimated that 240,000-280,000 refugees live in the United Kingdom, many in London. Contrary to popular belief, however, the UK is not a major destination - it hosts only about 1 per cent of the world's refugees. Many much poorer countries support far more refugees than any of the affluent Western European countries.

A 1999 study by East London and City Health Authority suggests that refugees constitute the most economically deprived and socially excluded segment of the UK population. Refugees and their children find access to services difficult. The 1996 Immigration and Asylum Act removed asylum seekers' rights to the same welfare benefits as British citizens. This left local authorities to determine the level of support they could provide.

In 1999, responsibility for providing adequate resources was returned to central government, and the voucher scheme for those seeking political asylum was introduced. A single asylum seeker over the age of 25 is entitled to £36.53 a week, £10 of which is redeemable for cash. This is 70 per cent of the level of income support (considered to be the minimum to prevent destitution) given to British citizens. Children of asylum seekers get the same benefits as British children. This means that a British family with two children on income support receives £149.40 a week; a similar refugee family gets £110.57. Asylum seekers are not entitled to benefit from the Welfare Food Scheme, and they have no right to free vitamins or to subsidised milk tokens for their children.

The voucher system, introduced in April 2000, created such difficulties that the government announced a Home Office review of it in September last year. Token Gestures, a report published in October 2000 by various groups including Oxfam, was highly critical of the system. Vouchers can be exchanged only for food and other essentials at designated shops that have signed up to the scheme; these are mainly supermarkets and chains. Cheaper sources of food, such as market stalls and small local shops selling food that is culturally familiar, fall largely outside the scheme.

The bureaucracy involved often means families can be left without any income for food for days or even weeks. Retailers often do not understand the system and may deny asylum seekers items they require. They are also unable to give change from vouchers in cash. Refugee organisations have stated that they are "extremely concerned with the physical health impact of vouchers" and that "the ability to maintain good health on vouchers is questionable".

Young children are particularly vulnerable to the effects of poor nutrition, which can have lifelong consequences. Malnutrition in pre-school children has profound effects on mental and physical development. It has been shown that babies and toddlers who suffer from iron deficiency are delayed in their development and may never catch up, even if the iron deficiency is treated.

Children of asylum seekers are at high risk of an inadequate food intake. Parents already handicapped with a low income may be unfamiliar with British foods. Many asylum seekers are Muslims and choose not to buy meat because few shops accepting vouchers sell halal meat. Some may spend their scanty resources on unsuitable foods with the best of intentions: the extremely malnourished toddler, for example, who had been fed largely on Coca-Cola. The parents, who were illiterate, concluded that, as advertisements depicted healthy children consuming the drink, it must be good for their child.

In the UK, studies of the nutritional and health characteristics of children of migrant and poor families have found a high prevalence of micro-nutrient deficiencies and low-grade infections. A study by the Institute of Child Health/Great Ormond Street Hospital showed that up to 35 per cent of Asian children aged two years had iron-deficiency anaemia and were at risk of developing rickets because of vitamin D deficiency.

Refugees worldwide share problems relating to children's nutrition and health outcomes. A high prevalence of poor diets, limited access to food, iron-deficiency anaemia, vitamin A deficiency and beriberi (vitamin B deficiency) have been observed among refugee children. These reports give cause for concern that refugee children in the UK may face similar, if not worse, health problems. Many refugee families tend to stay in their host country. For the children who grow up in the UK, it is vital that everything be done to ensure that they are able to take full advantage of their education and fulfil their physical and mental potential.

There are few studies looking at the nutritional status of refugee children in the UK. We do not know the extent of the problems, nor how best to overcome them.

In an environment where it is not possible to follow traditional methods of child rearing and feeding, parents need appropriate messages about infant and child feeding as well as vitamin supplements.

Scientific evidence on the magnitude of health deprivations of refugee children would support attempts to give refugee health serious policy consideration. However, government, industry and charitable organisations seem reluctant to fund this basic research in a new area of healthcare provision. The Childhood Nutrition Research Centre at the Institute of Child Health is Europe's largest research group devoted to child nutrition. It has a record of high-quality research publications and is ideally suited to conduct a research project of this type, and is experienced in carrying out large studies of migrant populations.

We have made 15 grant applications to different government and non-government agencies to conduct a study to examine the health and nutritional status of pre-school refugee children. So far, 13 have been rejected and two are outstanding. We have had some very positive rejection letters that expressed interest in the project and sympathy with its aims. But, they go on, it is "not the sort of project that our organisation is able to support" or "does not fall within the remit of any of the trust's funding schemes".

Our unit has a history of successful grant applications. Why is this project proving so difficult to fund? Is it because we do not want to know that children in Britain may be suffering from malnutrition?

Perhaps the public (and its ministers) prefer to believe some media sources that portray asylum seekers as bogus opportunists living in luxury at the taxpayer's expense - as long as there is no hard evidence to contradict this.

Margaret Lawson is senior lecturer in paediatric nutrition, and Elizabeth Ojaba is research fellow, Childhood Nutrition Research Centre, Institute of Child Health, University College London. The institute will be presented with the Queen's Anniversary Prize for Higher and Further Education on February 15 for its "innovative and high-quality training programmes".