 Hello, everyone. Welcome to the People's Health Dispatch video interview. Recently, the UK Home Office has come under severe criticism by human rights and health activists for its plan to deport asylum seekers from UK to Rwanda. Former Home Secretary Preeti Patel's plans have caused alarm and have been quoted to breach basic human rights and international law. In addition to widespread mobilization against the removals, the policy led to actions by many professional groups, including physicians. In this episode of People's Health Dispatch, we are meeting with Liana Reynolds and Sipeda Saleh, co-signatories of an appeal sent to Patel by more than 400 doctors in the UK. Welcome Liana and Sipeda. Hello. To begin with, could you tell us a bit more about the context in which this policy was shaped and what did it set out for you actually as the gone? This is a fantastic but slightly complicated question for someone who is really just a hematology trainee with a conscience. There is so much interplay with history and economics, climate change, global politics and local politics that all have created the perfect storm for this situation really. But the concept of seeking asylum isn't new. Where there are wars and natural disasters, if there's desperation, then people are going to take their future in their hands and migrate and seek refuge somewhere new. And historically, the Universal Declaration of Human Rights in 1948 and then later the Geneva Convention, so 1951, formalized the responsibility of neighboring countries and countries all around the world to recognize the rights of people who are in that desperate situation and who are seeking asylum. And the real question I think is if it's been going on for such a long time, why is it a problem now? Why is now when people are getting so up in arms about it? And sadly, between global economics being not so great at the moment, a large number of wars, climate change and the effects that's having with natural disasters, famine, drought, there is an increase in people seeking asylum, including people seeking asylum in the UK, but actually worldwide. 89 million people were forcibly displaced over the last year with 53 million being internally displaced, 27 million are people who already have asylum status, who already are refugees and 4.6 million are people who are seeking asylum. So when you look at the big numbers, actually, it's a very small number of people who are seeking asylum, but massive numbers of people are being displaced, including this internally displaced. And it is a major problem. So why are people coming to the UK? Well, although it's a smaller proportion of people, the UK is considered an attractive place to go to because it's perceived as being safe. It's perceived as being a peaceful place and the UK has fostered, it has created influence over other countries, over generations. And that's via the media. I think Mr Bean and Friends has been played on every ferry or plane I've been on ever. It's education, it's the language. And to be frank about it, we colonize lots of the world. So England has had a major part in the history of large proportions of the world. And that's something that we have to own. It is our history. And because of that influence being broadcast globally for generations, people see the UK as a place that would be good to restart their life. And I think we probably want people to think that UK is a good place to be. So it kind of fits. But where did this policy of actually sending back people, citizens, citizens is a different thing. But they are sending back someone who is in the UK right now. These asylum seekers. So what's the root of this policy or this act of sending back? And we also see this comes with a lot of nationalism, with a lot of right-wing kind of understanding also sometimes. And in the name of actually saving money, austerity, doing good to the citizens by pointing out that someone who has come from Uganda has the main problem. Sipida, would you like to say something in addition to what Liana has to say? So yes. I think there's many aspects to this, of course. We have what started with, well, started long before it. But Theresa May had a policy, this billboard that proclaimed go home everywhere. And there were a number of policies around that time, high profile policies, which really aimed to make it difficult for people who are seeking asylum in the UK, make life more difficult. And around that there was a wider system of so-called hostile environment through the legal systems, etc. And this can really worsen, I think, the trauma for people who are essentially just seeking a safe place to live. In addition, in this country, it tends to cost so much more in terms of benefits and legal fees and just prevents people from getting what they need in a country which is just a safe, fresh start, I think, and then a chance next to start contributing to the economy and working as humans, like we all do here. So this kind of deterrent policy that started many years ago but was also brought up again by Theresa May. However, I think it's really important to recognise that people before they enter the UK, they don't know about this. They have no idea. And traveling here, they're just coming to what they perceive to be like Liana says, a place of safety. So it's very, very unlikely to be working as any sort of deterrent for people who are just trying to come over and start a new life, essentially. I think Uncle Ones, sorry. I don't think it's aimed at them either. I don't think it's aimed at the people that are on their way here. I think it's a very cunning play after an economic downturn in the UK where British system quality of life has decreased. And instead of saying the problem is this, that, and the other, they've sort of pointed the problem is them. So the hostile environment is not really aimed to stop people coming to the UK because people don't know. If you were in a camping alley, you do not know that there is someone going around with a billboard in London telling people to go home. How could you? So it's aimed for appeasing a group of people in the UK. And let's be frank about it. It's a group of people in the UK who are fundamentally brought up in a racist system. We have a country which was built around the idea that white people deserve a better life than everyone else. That's what came up initially. That's where we started. And although people are working hard to get away from that, and there's less and less in frank open society, that is the foundation that the UK is built on. And it gets people's backs up and people don't like it. And it's not always conscious. People may not realise they do it, but it's there. And we have to recognise it in order to move forward. And that benefit system that was put in place to support people who are struggling is for everybody, but is perceived by white British people to be for white British people. And that is part of the problem. So yeah, a bit of misdirection. To an extent, diverting the whole situation from crony capitalism and the economic downturn towards showing that a few asylum seekers are the reason for the present situation in the UK. But you know, and also it has its roots, of course, in xenophobia and racism to an extent. And I think we do know the colonial past also adds to this. But coming to the camping, in your letter that you have sent to the home secretary, you have listed out a set of reasons that provoked you as health workers to react to the, to whatever has been happening. Can you please walk us through some of those maybe both Liana and then Cepeda? I have to say on this one, I thought started the letter. But I've, I wasn't the person that gave it form. So I am, I developed an interest in, in helping friends. I have friends who are seeking asylum, who I was supporting in the, in the area where I live. And through that, I have seen how ridiculous the policies are and how ridiculously difficult it is for people who just want to get on with their lives to contribute and start afresh to do that because of the barriers that are put in place by the home office. And they are massive barriers. There's, it's made very difficult to, to get education. It's been made very difficult to contribute in any meaningful way. And we have massive uncertainty, relocation around the country at regular intervals. People don't get a chance to make friends. So just being a friend and knowing people means that this is important to me. And then I saw this policy come into place. And I think the, the real backdrop to the policy, one of the main things was the, the 2015 Allen Curdie, a two-year-old boy from Syria was found on a beach in Turkey. And there was this big outcry of boats are sinking, people are dying, this must stop. And that came from a good place, I think. But the government at the time took a whole bunch of people who were sympathetically saying, boats must stop. This is, this is not right. And a whole bunch of people who are for other reasons saying the boats must stop, people can't be having our benefits, our system, money is limited, we need it for our own. And it combined this together into the policy of we need to not have people migrating to the UK, including not having refugees. So that's, that's sort of where that policy's backdrop is. And when this policy came through, and I saw the information that it was having, that's going to cause and the terrorists causing people, I just thought this is not, this is not right. We can't do this. This is not what my, this is what my country should be doing. And I saw a letter from a group of professionals in media that was a professionals letter about the Rwanda policy appealing not to, not to do it. And I saw, well, I'm a professional and there are professional reasons not to do this. There are very good medical reasons not to do this. We should write a letter. So I put a post on a Facebook group with, oh, I don't know how many doctors are on that group now, quite a few, but they're all medical and they're all mumps. And said, shall we write a letter? Can someone help? And then Sapeeda, thank goodness, answered and provided content, which is exactly what I was struggling with. So I'm probably better to hand over to Sapeeda when it comes to the actual content of it. Thank you so much, Leanna. And thank you for explaining so much about the background and where you're coming from. And I'd like to say the content, I think was very much there. I came from a slightly different perspective where I had done research with asylum seekers in the past and kind of made friends and things as well, of course, from that setting. So having insights, having done interviews and written about people who are in this situation, again, as you say, it became so clear how these asylum seekers just are a group of people who, firstly, they may well be medically and psychologically vulnerable, but this is because they've been so resilient to what we see as often extreme hardship before migration. So what we would call a pre-migration and migration histories to so many people like you and me, but who had before migrating and throughout their migration, which was often complex and dangerous, have faced a lot of hardships. So I'd say taking this and taking both of our social research and our medical backgrounds, we kind of try to set out some of the reasons, as you say, for being against this as medical people being against this policy. So talking about, just to note now, I'm using the word forced location or forced relocation rather than deportation, which is often used because the people that we're talking about here, they've not had their cases heard or denied. So that would have been the definition of deportation. So the policy of relocating people to Rwanda really is a forced relocation. So this forced relocation to Rwanda that we're talking about with, as it is, no clear plan for health care, for maternity care, for any kind of psychiatric or psychological support that people need. We would have said it's unethical, clearly unethical to say the least, and it's not something that most medical professionals and certainly the large number of people signing the letter would accept for any of the people under their care, any of our patients. So to talk through a couple of just clear examples of this, one particular example is a medical issue like malaria. So in the UK our guidance for all travellers and anyone, any citizen states that malaria risk in Rwanda is high throughout the year in all areas of Rwanda and it recommends prophylaxis, malaria prophylaxis for all travellers. But for these asylum seekers being forcibly sent to Rwanda, there's no plan for any sort of prophylaxis and that's clearly putting them in a position of danger. Another example of just immediate harms that we see from this policy is that of LGBTQI plus people, so gay and lesbian people, trans people seeking asylum in the UK due to immediate dangers in their home country. So again I've met a lot of these people doing research, a lot of asylum seekers and heard really harrowing accounts of the oppression that happened physical violence often from these people who were brave enough to have made it over here to seek safety and in Rwanda there's a clear record of risks to this group of people. So there's been regular detention, there's been harassment and physical violence against gay and transgender people. This has been reported by organisations like Human Rights Watch and even in a Home Office report in the UK. So there are in fact even gay Rwandan people seeking asylum in the UK for this reason so the removal of these vulnerable people to a place of what will be essentially a great danger is absolutely unthinkable to medics and other health professionals as well as I'm sure to the general public. And then finally just to talk a little bit about the wider repercussions of this policy and how that affects generally people around the country. So again in my work with asylum seekers I'm sure Leanna has experienced very similar with her contacts and friends. It's so clear how this fear of forced relocation to unimaginable and dangerous circumstances suddenly becomes this overwhelming force in individual's lives. So they're essentially trying to protect their safety and protect the safety of their children and a large number of asylum seekers will therefore avoid contact with any services including services to which they are legally they have a legal right. So so many people then avoid end up avoiding seeking healthcare for acute conditions, chronic conditions, avoid seeking maternity care in pregnancy and so on. Then at times this can create such bigger and actually much more expensive in the long-term problems in the UK just later along the line and then in addition there's a huge huge mental burden of living under these circumstances that you hear so often speaking to asylum seekers and this is all just unconscionable I think for health professionals in this country. It's quite inhuman about how you're actually putting back a person in the same circumstances that they came here you know tried to leave or have left and come here and then instead of being helpful to the asylum seeker who has come leaving all this trauma behind you're actually also having a chilling effect where it looks like from what I understand that the health service I mean the health services and the social services there instead of being receiving and showing warmth are actually giving a chilling effect by scaring them away from using or reaching out to any of these services you know I think in the past also we have heard many campaigns in similar by health professionals in UK which will come to at a later thing but you know you have written a letter to the home secretary's office and you know what is the present situation of this policy what is the status of the policy as we meet today how many people have been impacted by this policy and are there any plans to take forward building of alternative discourse is there much more activism is there much more resistance to what is happening and what is the kind of reaction from both the health and medical fraternity but also beyond generally politically in the UK. I think it's worth saying that the health care community is slightly atypical in the UK because we are a diverse group and we choose to work in the NHS which generally means that we're used to a bit of suffering for the sake of the greater good because it's basic it's not what people would opt for if they realised and so I think I think for months health care workers you you see a lot more sympathy when it comes to this kind of thing and and that's that's a positive thing to take forward but I also think as health care workers we see more of the consequences just like Sir Peter said when people come in with a complication of pregnancy if they haven't seen anyone all the way through that's that's us there dealing with that and you compare that to recently we had a group of refugees coming from Afghanistan who were granted asylum before they came into the country and the process by which they were seen by medical personnel and everyone who needed predical input were put into the local systems immediately and we saw some children come through the pediatric hematology department who went straight on to prophylaxis for their their conditions and went on to be living normal lives contributing and paying taxes and doing all the things that the family that we want people to do in the UK and that that's the system that works for everyone it's cheaper for the UK taxpayer it's better for people who are going through it surely that is what we're looking for and the direction that policy taking us at the moment is completely opposite to that and that's that's what needs to change and there are some organizations taking the home office to court about the policy and no one yet has been forcibly relocated to Rwanda thank goodness but there are still people being issued with letters there are still people who are right now in detention centers fearing being deported at short notice or being relocated at short notice and the effect of that is is massive on those individuals and while people are being harmed by it we can't just sit back and let it happen so it's a it's something that people are getting involved with and people are trying to change but it's individual people that's that's how all the groups start that's where it comes from it's one person going onto a Facebook group and saying hey let's do something about this and then it's another person saying hey yeah let's do that let's just do something so as medical professionals there is medact which we can get involved with and are very good they're doing a campaign called patients not passports which is a very important campaign there are the groups such as detention aid care for Calais who are taking the home office to court over the policy and I recommend following those groups and contributing to those groups I hear lawyers are expensive so if anyone can financially help that is useful protesting I know that's harder at the moment but we can protest much more safely than people seeking asylum can so it's a good thing to do write to your local newspaper raise a discussion with people you read me write your MP consider policies when you vote particularly policies about immigration and about how we treat those that are vulnerable in society and challenge prejudice at all times every time you see it it's hard no one likes to argue with their man but challenge it anyway and challenge it within yourself question yourself when you look round a room and you're standing in a group of white people and there's a group of other people over there that you didn't go and stand with and why did you do that and move around and if you want to you can sign our letter we've got one we'll keep sending it but I think it's the other things that matter more thank you thank you um I think lianna has talked a lot about the whole range of things and actions and it really is a kind of ecosystem that makes these things work from the people lying on the street in London and stopping the vans going out to the lawyers doing pro bono work and everyone else um I think it's really important to say um something I think we were just mentioning earlier is the kind of wider environment there there are things as lianna mentioned about the political environment and how our voting and also our discussion can change that can kind of shift the overton window really of what's acceptable and what's not acceptable at times I think in this country it seems like things have shifted so far to a place you know to a place where cruelty and exclusion seems almost more okay and maybe bringing things bringing discussions up we talked earlier about um histories of colonialism and their issues of climate colonialism which really are bringing up a lot more um displacement and migration and unfortunately I think we'll see a lot more of that in the future so I think bringing those up to this question and making sure that um that everything is is up for critique is also another way of contributing I guess I mean it's great to know but that nobody has been forcefully relocated until now and that you know to an extent we might say is a small success of various groups that have been putting up some sort of resistance to this you know and also it's quite positive to see when you say that you know as NHS workers you are actually or as medical students and workers in different uh in the medical sector end of the day you're also workers and this sort of interlinkages of solidarity it's not like you're taking over the cause of someone else but providing that's all that and how important is actually this uh you know necessity to uh work across uh various groups I mean how do you think uh I mean I in in more importantly like when you reach out to 400 doctors or so on like how do you get this through to fellow doctors sometimes it also might look like you know our medical doctors and so on very apolitical but on the other side we see that both uh there's a huge push on decolonizing health and medical care and recognizing the fact that race and xenophobia and these all are systemic issues that we need to deal with as medical professionals so how should you know how what is the kind of discussions or debates or uh you know activities that happen among fellow medical doctors and so on I mean jointly connecting these 400 but also generally also how does this happen um I would say that in my experience in my experiences both in medicine and public health and in research and just in the wider world um there's such a variety of people and there are such a variety of ways to get through to people I think going full on climate colonialism with everyone isn't going to get through um so there are people for which just discussing about the humanity and those elements and and the fact that essentially we all could be in that position and it could be all our children might make more headway um there are people for whom legal discussions will make more sense and and we'll get further so human rights discourse in general absolutely and then I think that there is definitely a space for interrogating where this all came from um and to think a bit more about our histories and and how we're implicated in this country um but possibly not for everyone and not for everyone at this moment but the world's a big place with a lot of people in it thanks I think it's all about meeting people and getting to know people I think it's much easier to hate them over there than hate Kenny who lives with me through that painting and is a beautifully wonderful lady like once you get to know somebody and and hear a story and see what they're like you realize there's there's no malice here there's only potential and there's no point in squashing that thanks a lot yeah I think in the people's health moment we often keep saying that the struggle for health is the struggle for a more caring world and I hope that on this note uh really uh you know all the best for your future struggles and we hope that uh struggles like these or initiatives like these uh will not be necessary I don't mean uh uh you know we we have a systemic answer to some of these uh right from you know uh the root causes for forced migration uh to the necessity that where governments uh actually welcome asylum seekers and you know do not act in the way that they're doing right and I hope that we go towards you know avoid without racism and you know if you're aware is also take the root in uh and all the best for your uh future struggles and hope that you keep organizing both medical students medical doctors and of course the you know we we also I think as doctors there is a certain hierarchy but the the need to have a larger discourse nurses and the sanitary staff and everyone together and I think this is a definitely a step in the right direction congratulations on that and thank you so much for joining the people's health dispatch thank you so much for having us thank you thank you