In March 2010, a refugee and her son died in Westminster, London. The boy died of acute malnutrition on the 8th – his mother, who was HIV positive, was arrested the same day, given a medical assessment and subsequently hospitalised. She died two days later of a rare brain infection.
The inquests for the boy and his mother’s deaths were conducted on 19th April 2010, and verdicts of accidental death, and death by natural causes, were returned respectively. An initial post mortem examination on March 10th found that there was no food in the boy’s stomach or digestive tract. He was described by the paediatric pathologist as “severely underweight and dehydrated”; and this was “clearly the immediate cause of death”. Why did the boy starve? Was it due to deliberate neglect from the mother?
There were in fact several reasons for the circumstances of the boy’s death – all of which highlight critical shortcomings in the way that asylum seekers and refugees are treated in the United Kingdom. Firstly, there were significant problems in transferring the family from Home Office to mainstream welfare support services. Added to this were ineffective social-service support to the mother, despite being at severe risk of domestic abuse from her husband; health problems of the son not being diagnosed accurately; poor communication between various authorities; and the mother’s anxiety in regard to both domestic abuse, and her asylum status, which – despite being granted indefinite leave to remain in the UK – left her reluctant to use interpreters when dealing with local authorities, social services, and health workers. All of these factors eventually culminated in the mother and her son dying in Westminster, six months after moving there.
Westminster Council held a Special Case Review in April 2010. It found that the mother and son had become dependent on charitable handouts, and were living hand-to-mouth, despite being granted refugee status, and therefore being eligible for financial support. In fact, the Serious Case Review revealed a torturous and complex series of failings by various local authorities in the mother’s places of residence – Sandwell, Birmingham, and London.
The family first became known to social services in Sandwell during July 2006. The mother had been in contact with several health and social agencies, dating back to the birth of her first child the previous May. The Serious Case Review notes that “delivery of all services to Mrs G and her children was complicated because of her limited English and a consistent reluctance to allow use of an interpreter”. This reluctance to communicate effectively was at least in part due to the domestic abuse the mother had suffered: whilst living in the Midlands, seven incidents of domestic abuse requiring police involvement were recorded.
The mother gave birth to her second child in March 2009 – in September that year, she and her two children moved to London, in order to escape her abusive husband. When in Westminster, she was provided with emergency accommodation; before being moved into long-term temporary accommodation once the risk of further domestic abuse had been confirmed. According to the Serious Case Review, the family “received high levels of health support (health visiting, physiotherapy and some occupational therapy), medical treatment as well as lesser levels of input from Children’s Social Care and latterly mental health services” during the six months they lived in Westminster.
However there were several factors which made the mother’s circumstances far more complex than this suggests.The nature of seeking asylum was one key cause of problems. The Serious Case Review notes that:
“throughout this case and in spite of considerable efforts made by many professionals, there remained insufficient understanding of the origins of both parents’ upbringing, traumatic life experiences or respective journeys to the UK and the consequences of these matters for their functioning here as parents. A partial explanation explored later, is that both parents were probably reluctant to share too much detail with organisations lest it impact adversely on their prospects in the UK”.
As noted above, the mother was afraid of her abusive husband; this anxiety and subsequent lack of effective communication were compounded by “the authority represented by all the agencies with which she had to deal” as an asylum seeker, then as a refugee even when her status had been assured.
The asylum/refugee system played another operative role in the mother’s problems. Financially, there were significant problems in the transition from National Asylum Support Service to mainstream social security in both the Midlands and Westminster. Furthermore, the mother needed to receive UK Border Agency papers and – fairly absurdly – had to actually become homeless before the local authority or Benefits Agency could assist her; both of which left the mother and her children in a position of extreme uncertainty. In both the Midlands and later in Westminster, the family ultimately became dependent upon makeshift payments by local agencies. No data is reported in the Serious Case Review about the amount of money this involved – but given the squalor of the mother’s living quarters, it seems highly likely to have been extremely minimal, as well as unreliable.
What is made clear, though not directly acknowledged by Westminster Council’s Special Case Review, is that the children of asylum seekers are especially vulnerable to adverse circumstances in a number of key aspects. This became acute in the transitional period between withdrawal of funding by the National Asylum Support Agency, and entitlement to social security. In one respect, the vital handover of information between health visitors when the woman’s status changed was inadequate; and so failed to ensure continuity of care. During this period, the aforementioned impact of language barriers on the mother’s ability to access specialist support services, and communicate her needs and vulnerabilities, became acute.
However, this case highlighted failings within local authorities in their own right, irrespective of asylum policies. The reality of asylum seekers/refugees’ lives leaves people particularly vulnerable to problems caused by these shortcomings. For example, poor information sharing within or between agencies – as well as between colleagues – which was rendered more ineffective still by the mother and her children moving from city to city. Reports were also found to have suffered from inaccurate/partial recording: some of these, authorities were unable to access – others contained misleading information. Ownership and authorised access to professional records between multi professional services was confused in places – limiting effective use of the information they contained.
The weight monitoring of babies was another factor – as the Serious Case Review notes:
“such monitoring is a fragmented practice carried out by different professional groups with different approaches (in this case, hospital, midwife, health visitor, clinic) and is not joined together through a nationally agreed policy from birth to five”
Which means that minimum standards of care are not reliably met. Initial assessments by children’s Social Care authorities were also delayed in both the Midlands and Westminster.
In fact, the Serious Case Review contains a catalogue of specific failings by various authorities, including:
- Weaknesses in the Child Development Service responses in response to apparent evidence of the baby’s ‘weight faltering’ after his assessment in early December 2009.
- Failure by midwifery services at two hospitals to inform the health visiting service of the mother’s pregnancy. Subsequently, there was no contact between June 2008 – March 2009. Health visitors remained unaware of the mother’s pregnancy and the family was not accorded due priority.
- The mother’s expressed wish to terminate her pregnancy was not effectively referred to or fully explored; and took no account of linguistic or cultural issues.
- An opportunity to capture an accurate weight record for the son who was born at thirty eight weeks of gestation was missed; and this error continued to cause confusion in the delivery of health services throughout the remainder of his life.
- Health visitors were unaware of the provision of a ‘Language Line’ interpretation service for face-to-face client contacts.
- The loss of the community children’s nurses’ records represented a significant lost opportunity for better-informed practice by colleagues and for development of a more complete picture for this serious case review.
- Failure to recognise the centrality of domestic abuse – for example, at the initial child protection conference – lost the local network an opportunity to focus on assessing relevant risks and developing a multi agency response.
So there were clearly a number of key factors specific to the mother and her son’s personal circumstances, which left them extremely vulnerable to the shortcomings of social agencies, health providers, local authorities, and the asylum system itself. Social isolation was a powerful reason underlying this case: it left the mother incapable of providing adequate care for her son – but she was herself subject to insufficient care from organisations whose role was to provide support for refugees, women, and mothers.
‘Serious Case Review: Executive Review – Child EG’ by Westminster Safeguarding Children Board; 25th April 2012: http://www.westminster.gov.uk/workspace/assets/publications/EG-Executive-Summary-April-2012-1336483036.doc
‘Child Starved To Death After Benefits Delay’ by Keith Cooper, Inside Housing; 5th October 2012: http://www.insidehousing.co.uk/care/child-starved-to-death-after-benefits-delay/6524052.article
‘Charities’ Plea Over Failed Asylum Seekers’ by Emily Twinch, Inside Housing; 20th July 2012: http://www.insidehousing.co.uk//6522849.article
‘Baby Starved To Death Under Health Services Care’ by Sarah Boseley, Guardian; 24th March 2010: http://www.guardian.co.uk/society/2010/mar/24/baby-starved-death-london
‘Double Death In Asylum Seeker Family Reveals Gap In State Benefits’ by Amelia Gentleman, Guardian; 5th October 2012: http://www.guardian.co.uk/uk/2012/oct/05/immigration-children
For a lengthy report on the problems experienced by children due to the deliberate nature of destitution imposed upon asylum seekers by the British government see ‘I Don’t Feel Human: Experiences of destitution among young refugees and migrants’ by The Children’s Society; 2012: http://www.childrenssociety.org.uk/sites/default/files/tcs/research_docs/thechildrenssociety_idontfeelhuman_final.pdf
‘Refugees’ Experiences and Views of Poverty in Scotland’ by Kate Lindsay, Morag Gillespie and Louise Dobbie, Scottish Poverty Information Unit; 2010: http://stillhumanstillhere.files.wordpress.com/2009/01/refugees-experience-and-views-of-poverty-in-scotland.pdf
‘The Experiences and Needs of Refugee and Asylum Seeking Children in the UK: A Literature Review’ Rachel Hek, Department For Education And Skills; 2005: https://www.education.gov.uk/publications/eOrderingDownload/RR635.pdf
Problems with the overall impact of British asylum policy on children is discussed in ‘NSPCC’s Response to Planning Better Outcomes and Support for Unaccompanied Asylum Seeking Children’ by the National Society For Prevention Of Cruelty To Children; 2007: http://www.nspcc.org.uk/inform/policyandpublicaffairs/consultations/2007/2007_uasc_wdf48635.pdf
A catalogue of Serious Case Reviews concerning the mistreatment of children in the UK is also provided by the NSPCC: www.nspcc.org.uk/scrs
Three short articles by the Guardian exemplify previous examples of the shocking treatment of asylum seeking children and their families by British authorities:
‘Boy, eight, freed from detention centre after legal challenge’ by Helen Pidd, Guardian, 6th September 2008: http://www.guardian.co.uk/uk/2008/sep/06/immigration.humanrights?INTCMP=ILCNETTXT3487
‘Failed asylum family face losing children’ by David Batty, Guardian, 23rd August 2005: http://www.guardian.co.uk/society/2005/aug/23/asylum.uknews?INTCMP=ILCNETTXT3487
‘Breastfeeding mothers detained away from babies’ by Matt Weaver, Guardian; 18th August 2006: http://www.guardian.co.uk/uk/2006/aug/18/immigration.immigrationandpublicservices?INTCMP=ILCNETTXT3487
 The mother had a daughter, also, born several years earlier. The Westminster Serious Case Review refers to her as ‘FG’, and to the mother/son as ‘Mrs G/EG’ respectively. The daughter appears to have survived this ordeal – but was undoubtedly old enough to have been fully aware of what was occurring. I have omitted discussion of the daughter herein because too little information is provided to address this aspect of the case adequately.
 Page 2.‘Serious Case Review: Executive Review – Child EG’ by Westminster Safeguarding Children Board; 25th April 2012.
 According to the Serious Case Review:
“The family had chronic and complex health and social needs. The level of challenge presented to agencies in seeking to meet the family’s needs was raised because Mrs G was an asylum seeker who had limited understanding of English and was caring for one and later two, vulnerable children. The difficulty for professional services was increased because of Mrs G’s fear of further domestic abuse and a reluctance to use an interpreter. The above challenges were then compounded by what appears to have been at times, a reluctance by Mrs G to be entirely open with the authorities from which she sought help e.g. about ongoing contact with her ‘ex partner’”.
 Page 9. ‘Serious Case Review: Executive Review – Child EG’ by Westminster Safeguarding Children Board; 25th April 2012.
 Page 9. ‘Serious Case Review: Executive Review – Child EG’ by Westminster Safeguarding Children Board; 25th April 2012.
 Page 10. ‘Serious Case Review: Executive Review – Child EG’ by Westminster Safeguarding Children Board; 25th April 2012.
 Page 19. ‘Serious Case Review: Executive Review – Child EG’ by Westminster Safeguarding Children Board; 25th April 2012.
 Page 21. ‘Serious Case Review: Executive Review – Child EG’ by Westminster Safeguarding Children Board; 25th April 2012.
 Pages 14-15. ‘Serious Case Review: Executive Review – Child EG’ by Westminster Safeguarding Children Board; 25th April 2012.