Use of the Emergency Department by People Seeking Asylum and Refugees in living in Temporary Accommodation: A Critical Evaluation

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Numbers of PSAR arriving in the UK and living in temporary accommodation have increased significantly in recent years due to a combination of factors, including the Afghan Relocation and Assistance Programme (ARAP) established in 2021. This study explores and characterises attendance of people seeking asylum and refugees to the Emergency Department of a central London hospital. Methods A retrospective review was undertaken of attendances to our Emergency Department (ED) by PSAR between September-December 2021. PSAR were identified by postcode of known Home Office temporary accommodation. A cohort of 100 adults and 100 children/young people (CYP) who were not PSAR were randomly selected within the same time period for comparison. Results 715 PSAR presentations were included (260 adult, 455 CYP) by 474 individuals (181 adults, 293 CYP). 90.2% of adults and 96.1% of children were from Afghanistan and, where documented, 93.7% of adults and 93.5% of children had arrived in the UK within the past 3 months. 58.8% of adult PSAR and 72.7% of children and young people seeking asylum (CYPSAR) were deemed to have presentations more appropriate for other settings compared to 39.4% and 41.5% of the comparison group respectively. PSAR were more likely to have multiple presentations (27.6% of adults and 36.2% of CYP; 11% and 27% in comparison group respectively) and were less likely to require hospital admission or follow-up than the comparison group (3.9% of adults and 5.7% of CYP; 13.8% and 10.3% in the comparison group respectively). Conclusion PSAR attending our ED during the study period were predominantly recently arrived from Afghanistan. PSAR were more likely to have a presentation deemed more suitable for other settings, less likely to be admitted, and more likely to have multiple attendances than a non-PSAR comparison group. Further work to understand the reasons underlying these findings is important, to support improved provision of appropriate healthcare services which may contribute to reductions in unscheduled emergency presentations in this vulnerable group. People seeking asylum emergency care attendance patterns inclusion health health inequality Figures Figure 1 Introduction In the year ending September 2021, the UK received 44,190 asylum applications, representing 8% of all people seeking asylum and refugees (PSAR) in the EU and UK combined ( 1 ). On the 13th of August 2021, following the withdrawal of NATO forces from Afghanistan, approximately 15,000 Afghan citizens who had worked for/with the UK Government in Afghanistan, were evacuated by air to the UK and placed in government funded temporary accommodation, under the Afghan Relocations and Assistance Policy (ARAP) ( 2 ). University College London Hospital (UCLH) is a central London NHS Foundation Trust with a single emergency department (ED) serving a population of over 1.3 million. In the surrounding boroughs of Camden, Islington and Haringey, 1375 PSAR evacuated from Afghanistan under the ARAP scheme were placed in temporary “bridging” hotel accommodation. A surge in presentations to UCLH ED by PSAR was noted from September 2021. PSAR often have complex and intersecting mental, physical, and social care needs due to circumstances in their home countries prior to departure, and psychological trauma and ill health during their journey. They often experience significant challenges in accessing appropriate healthcare on arrival, due to multiple barriers which may include language, digital poverty, education/literacy level, unfamiliar healthcare systems, limited finances, and challenges with primary care registration ( 3 ). The impact of ED use by PSAR on health systems in the host country remains unclear. A recent systematic review showed no consensus as to whether migrant populations access ED more or less than non-migrant populations, but suggested that they may utilise ED more frequently than the general population, for less acute conditions and without prior consultation of a paramedic or general practitioner (GP)( 4 ). With Emergency Departments in the United Kingdom experiencing increasing pressures and record numbers of attendances ( 5 ), understanding patterns of and reasons for attendance is important for service planning and resource allocation ( 6 ). Here, we explore and characterise ED attendances at UCLH by PSAR between September and December 2021. Methods A retrospective review of routinely collected clinical data was performed for all PSAR living in temporary accommodation presenting to UCLH ED between September 1st, 2021, and December 31st, 2021. PSAR (including children and young people (CYP) PSAR – referred to hereafter as CYPSAR) living in temporary accommodation were identified by interrogation of the demographics of the electronic healthcare records of all attendances to UCLH ED during the study period. These were filtered by postcode of known accommodation sites to identify all individuals residing in Home Office provided temporary accommodation, in the boroughs of Camden, Islington, Barnet and Haringey. A comparison cohort, from the general population, of 100 adult and 100 CYP, presenting to UCLH ED during the same period were randomly selected using “NEWID()” function in T-SQL (Microsoft™). Data were extracted from the UCLH electronic healthcare records (EHRS) on EPIC TM using SQL programming language to code and extract the required variables into a password protected encrypted Excel csv. file on a secure network. Data were manually reviewed using unique patient identifiers (UIN), to identify duplicate records and to confirm that the individuals in each group were PSAR or non-PSAR, as appropriate. Duplicates and wrongly coded records were excluded. Data were anonymised prior to analysis. The key linking UINs and patient identifiers were stored on a secure NHS server, within an encrypted file. Where electronically extractable variables were not available, notes were manually interrogated, and relevant data points added to a secure Excel database. A blinded panel of four clinicians with experience in delivering clinical care in an ED setting reviewed the “ED diagnosis” of the PSAR and comparison populations, using clinical judgement to classify the encounters as “appropriate for ED” or “more appropriate for alternative healthcare setting.” Alternative healthcare settings were defined as pharmacy, dentistry, primary care, or “other”. Where unanimous consensus was not reached, the coding was resolved by majority agreement. Clinical Data and variables The following data were electronically extracted; age at presentation, sex, duration spent in department, and outcome (admission, defined as an overnight stay of at least one night, or discharge). The following data were manually extracted; country of origin, duration of time in the UK, presence of accompanying individuals, language barrier, use and type of interpreter (defined as telephone interpreter language line, family or friend, staff member or in-person professional interpreter), number of ED attendances during the study period, and ED diagnosis. Ethics Ethics approval was not required. The project was registered as a service evaluation in accordance with local processes. Analysis Descriptive analysis was performed using Microsoft Excel (2016). Results Between September 1st 2021 and December 31st 2021, 41,730 adults and 6,607 CYP attended UCLH ED. After exclusions (see Fig. 1 ), 715 presentations by 474 individuals were identified to be by PSAR. This accounted for 0.6% of all adult ED presentations and 6.9% of all CYP ED presentations during the time of study. 244 non-PSAR (comparison group) presentations, by 185 individuals, were included in analysis. Demographic data is shown in Table 1 , presented at individual (rather than attendance) level. Table 1 Demographic data of participants. Adult PSAR (n = 181) Number (%) CYPSAR (n = 293) Number (%) Adult Non-PSAR (n = 89) Number (%) CYP non-PSAR (n = 96) Number (%) Age (years) Median (Interquartile range) 32 (27–43) 3 ( 1 – 8 ) 43 (26–55) 2 (0–10) Sex Male n (%) 62 (34.3) 120 (41.0) 39 (44.1) 46 (48) Country of origin Afghanistan 110 (60.8%) 271 (92.5%) NA NA Iran 3 (1.7%) 2 (0.7%) NA NA Iraq 3 (1.7%) 1 (0.3%) NA NA Kuwait 1 (0.6%) 2 (0.7%) NA NA Pakistan 1 (0.6%) 1 (0.3%) NA NA Other 4 (2.2%) 5 (1.7%) NA NA Unknown 59 (32.6%) 11 (3.8%) NA NA Duration of time in UK Born in the UK 0 (0%) 2 (0.7%) NA NA 12 months 0 (0%) 2 (0.7%) NA NA Undocumented 118 (65.2%) 154 (52.6%) NA NA Results Country of origin was documented in 67.4% of adult PSAR and 96.2% of CYPSAR; of these, 90.2% of adults and 96.1% of children were from Afghanistan. Length of time since arrival in UK was documented in less than half of PSAR attending ED (34.8% adults and 47.4% CYP) however, where it was documented, 93.7% of adults and 93.5% of children had arrived in UK within the last 3 months. 2 children were born in the UK, increasing the number of attenders from recently arrived families to 94.2% of children for whom data was available. 58.1% of adult PSAR were accompanied by a family member to ED compared to only 15.6% of the comparison adult population. During the study period, COVID-19 pandemic regulations mandated that each CYP should attend with only one additional person. Of those attending with family, this was adhered to in 66.6% of CYPSAR presentations and 87.5% of presentations by the comparison CYP population. For CYPSAR presentations, the accompanying adult was more likely to be the father (25.9% vs 9.6% in the comparison group), whereas the mother attended more frequently in the comparison CYP group (52.9% of presentations in the comparison group vs 10.1% in the CYPSAR group). Both the adult PSAR and CYPSAR populations were more likely to have multiple ED presentations within the study period (27.6% of adult PSAR and 36.2% of CYPSAR attending ED did so more than once, while 11% and 27% of adult and CYP comparison groups respectively did so). The PSAR groups were less likely to require hospital admission or follow-up than the comparison population (3.9% vs 13.8% in adults; 5.7% vs 10.3% in children). 9.5% of CYPSAR had siblings concurrently presenting to ED; this was not seen in the comparison paediatric population. A documented language barrier was more prevalent in the PSAR population compared to the comparison population (59.2% vs 2.8% in adults; 42.9% vs 3.7% in CYP). Where interpreter use was recorded, this was more likely to be a family member than a certified telephone or face to face interpreter (70.7% of adults where data was available and 53.8% CYP). For both adult PSAR and CYPSAR groups, a higher percentage (43.5% and 44.8% respectively) presented within working hours than the comparison group (36.7% and 36.8% respectively). ED diagnosis is shown in Table 2 . Table 2 ED diagnosis (presented at encounter level) Adult PSAR n = 260 CYPSAR n = 455 Adult non-PSAR n = 109 CYP non-PSAR n = 135 Appropriate for ED n = 107 41.2% of total presentations n = 124 27.3% of total presentations n = 66 60.6% of total presentations n = 80 59.2% of total presentations n; % of ED-appropriate presentations Medical emergency 47 (43.9%) 31 (25%) 29 (43.9%) 14 (17.5%) ENT emergency 0 (0%) 3 (2.4%) 1 (1.5%) 4 (5%) Safeguarding concern 0 (0%) 3 (2.4%) 0 (0%) 1 (1.3%) Accident/injury 13 (12.1%) 33 (26.6%) 15 (22.7%) 33 (41.3%) Asked to attend/re-attend or transfer from another hospital 3 (2.8%) 9 (7.3%) 3 (4.5%) 2 (2.5%) Respiratory infection 6 (5.6%) 44 (35.5%) 3 (4.5%) 22 (27.5%) Eye problem 1 (0.9%) 0 (0%) 1 (1.5%) 0 (0%) Musculoskeletal problem 3 (2.8%) 0 (0%) 2 (3.0%) 0 (0%) Psychological problem 1 (0.9%) 0 (0%) 3 (4.5%) 2 (2.5%) Pregnancy complication 19 (17.8%) NA 0 (0%) NA Gynaecological problem 8 (7.5%) NA 1 (1.5%) NA Surgical problem 4 (3.7%) 0 (0%) 0 (0%) 0 (0%) Other 2 (1.9%) 1 (0.8%) 8 (12.1%) 2 (2.5%) Appropriate for non-ED setting n = 153 58.8% of total presentations n = 331 72.7% of total presentations n = 43 39.4% of total presentations n = 56 41.5% of total presentations Minor medical problem 36 (23.5%) 19 (5.7%) 8 (18.6%) 12 (21.4%) Chronic problem including prescription request 37 (24.2%) 29 (8.8%) 1 (2.3%) 7 (12.5%) Self-discharged before seeing clinician 9 (5.9%) 8 (2.4%) 1 (2.3%) 2 (3.6%) No abnormality detected 10 (6.5%) 36 (10.9%) 2 (4.7%) 10 (17.9%) Minor ENT problem 12 (7.8%) 21 (6.3%) 4 (9.3%) 2 (3.4%) Social problem – nil safeguarding 1 (0.7%) 0 (0.0%) 0 (0.0%) 0 (0.0%) Mild Respiratory infection 16 (10.5%) 141 (42.6%) 11(25.6%) 18 (32.0%) Minor eye problem 0 (0.0%) 5 (1.5%) 2 (4.7%) 1 (1.8%) Minor musculoskeletal problem 3 (2.0%) 6 (1.8%) 8 (18.6%) 0 (0.0%) Anxiety 3 (2.0%) 0 (0.0%) 1 (2.3%) 0 (0.0%) Minor pregnancy related problem 0 (0.0%) 0 (0.0%) 0 (0.0%) 2 (0.6%) Uncomplicated genitourinary problem (including sexually transmitted infections) 9 (5.9%) 0 (0.0%) 3 (7.0%) 0 (0.0%) Dental problem 7 (4.6%) 17 (5.1%) 0 (0.0%) 0 (0.0%) Minor skin problem 10 (6.5%) 47 (14.2%) 2 (4.7%) 4 (7.1%) For 58.8% of adult PSAR (vs 39.4% of the comparison adult population) and 72.7% of CYPSAR (vs 41.5% of the comparison paediatric population), presentations were assessed to be more appropriate to be managed in non-ED community settings. The commonest of these “inappropriate” presentations in both groups of CYP was mild respiratory infection (42.6% in CYPSAR vs 32.0% in comparison group). In adults, the commonest “inappropriate” presentations in PSAR were chronic problems (including repeat prescription request) at 24.2% (2.3% in the comparison group). Skin presentations were more common in CYPSAR than the comparison group (14.2% vs 7.1%). Of note, there were multiple presentations of common self-limiting conditions such as chicken pox, Hand Foot and Mouth disease and insect bites in the CYPSAR population, which were not seen at all in the comparison group. Dental problems were also commoner in the PSAR and CYPSAR population than comparison populations (4.6% vs 0.0% and 5.1% vs 0.0% respectively). Minor medical problems were commoner in the comparison group (21.4% vs 5.7% in the CYPSAR group) and children were more frequently discharged with “no abnormality found” in the comparison group (17.9% vs 10.9% in CYPSAR) or seen with chronic problems (12.5% in comparison group vs 8.8% CYPSAR). Of those presentations felt to be appropriately managed in ED, those classified as medical emergencies were most common in both adult PSAR and the comparison adult population (49.3% in both groups). In the paediatric population, respiratory tract infections were the commonest presentation in the CYPSAR population (35.5% in CYPSAR vs 27.5% comparison) as compared to accidents in the comparison paediatric population (41.2% in comparison vs 26.6% in CYPSAR). Only the PSAR adult group presented with pregnancy-related problems including hyperemesis gravidarum, and suspected miscarriage and only the CYPSAR group presented with any pregnancy related problem. In CYP, no CYPSAR presented with mental health problems, whereas this was seen in 2.5% of the comparison population. Discussion We reviewed the UCLH Emergency Department presentations by PSAR in the four-month period (September - December 2021) after the UN withdrawal from Afghanistan. PSAR represented 0.6% of all ED presentations and 6.9% of CYP ED presentations during this period. The majority of PSAR attending during this period were from Afghanistan and had arrived very recently to the UK. This is unsurprising in the context of several recently opened contingency and bridging hotels in the vicinity, in the immediate aftermath of the Afghan evacuation in 2021 ( 7 ). Patterns of attendance were different in the PSAR group compared to a comparison group, as were the conditions with which they attended, with a notably higher rate of presentations in the PSAR group deemed more appropriate to non-ED settings compared to the non-PSAR group. Although the age and sex distribution were broadly similar across the PSAR and non-PSAR groups, it was more common for the PSAR group to present to ED within working hours, a finding at variance with some other studies ( 8 ). This may reflect that this group had very recently arrived and thus were less likely to be employed than the non-PSAR group and so able to attend during the working day. The PSAR group may also have been less aware of alternative “in hours” options for seeking care, such as primary care ( 9 , 10 ), dental services, pharmacies, and urgent-care services. This was further supported by the types of presentation identified, with PSAR being more likely to present with dental concerns, for repeat prescriptions, and for minor medical problems. The frequency of dental problems seen in PSAR is likely to reflect both high rates of dental problems in this population ( 27 ) (likely resulting from poorer dental care in their country of origin) and lack of access to an NHS dentist, because of both known resourcing issues in the UK ( 28 ) and likely challenges navigating the NHS system. The PSAR group were more likely to be accompanied by a family member than the non-PSAR group and this was more likely in the CYPSAR group to be the father rather than the mother. This may reflect poorer access to education in girls and women in much of Afghanistan ( 11 ), increasing the likelihood that those speaking English, and thus attending to interpret and navigate the healthcare system, are male. Although the prevalence of a language barrier in the PSAR population is unsurprising, it is interesting to note the frequency with which a family member was used to translate. This is not in line with best practice, which recommends use of a trained interpreter ( 12 , 13 ) and may reflect the significant numbers of PSAR seen during this period, resulting in resorting to family members for translation due to constraints on time and resources. Presentations from the PSAR group were more often deemed suitable for management in non-ED community-based settings compared to the comparison group. Specifically, 41.2% of adult presentations and 27.3% of CYPSAR presentations in the PSAR group were considered appropriate for ED care, compared to 60.6% and 59.2% in the respective comparison groups. This higher rate of presentations more appropriate for other services may reflect a lack of awareness of alternative healthcare options and difficulty in accessing these services. PSAR populations are known to encounter multiple barriers to appropriate healthcare access. These include language barriers, financial and digital poverty, stigma, and a lack of awareness about entitlement to free NHS care ( 14 , 15 , 16 , 17 , 18 ). A European systematic review reported increased ED use among migrants (across all backgrounds) compared to native populations. This review also noted a higher frequency of ED visits for low-acuity presentations ( 8 ), aligning with our findings that fewer PSAR presentations required admission or ongoing management in a secondary care setting compared to the non-PSAR group. Another review of 107 studies ( 19 ) revealed more varied patterns: only 18% of studies showed greater healthcare use among migrant populations, with few focusing specifically on PSAR. However, a sub-analysis on ED use found higher rates of ED visits among migrant populations. A 2023 systematic review on ED utilization by migrant and non-migrant populations ( 4 ) similarly noted that migrants tend to access the ED for less urgent conditions. However, it found no consensus on whether migrants accessed the ED more frequently overall, and again, only a minority of the included studies specifically examined PSAR. It was notable that the rate of re-presentation to ED was almost double in the PSAR group compared to the general ED population (27.6% of adult PSAR and 36.2% of CYPSAR vs 11% and 27% of adult and CYP comparison groups respectively). Whilst it is beyond the scope of this article to look for causality, plausible explanations may include barriers to access to care (such as language, digital poverty, lack of knowledge of rights of access to care) resulting in challenges to assessment and therefore reducing diagnostic accuracy, limitations of understanding in the PSAR population regarding discharge/pharmacy instructions and challenges with navigating the healthcare system. Poor and crowded living conditions may contribute to increased rates of infection and re-infection between family members and other hotel residents with pathogens such as chickenpox, scabies, and impetigo, consistent with previously published data ( 24 , 25 , 26 ). Disruptions to healthcare and trauma experienced in the country of origin, on the journey to UK, in addition to cultural differences in the approach to healthcare may contribute to health anxiety and increased health seeking behaviour. This hypothesis is further supported by the finding that relatively few PSAR required admission or ongoing management in a secondary care setting, indicating that their presenting condition may have been better managed by alternative services. It should however be highlighted that within the paediatric population, certain categories of presentations—such as “minor medical problems”, “seeking a prescription”, or being discharged with "no abnormality detected"—were more common in the non-PSAR group. This pattern of use of ED for children and young people (CYP) is supported the literature ( 20 ) and may be due to the perceived urgency of minor medical issues and a reluctance to wait for community-based appointments. These factors may be more pronounced in the non-PSAR group, who may feel more empowered to seek medical attention and exhibit the "worried well" effect ( 21 ). Although numbers were small, there appears to be a lower frequency of mental health related presentations in the PSAR group; this may perhaps result from cultural beliefs or perceived stigma around recognition of mental health pathology. Pregnancy issues were relatively common in the PSAR group (17.8% of appropriate presentations); this may relate to a significant majority of Afghan families arriving in the evacuation being of childbearing age, and with multiple successive pregnancies being more common in Afghanistan than in the UK ( 22 ), meaning a higher likelihood that a woman is pregnant at any given time. A small number of CYPSAR presented with pregnancy related concerns: this was not seen in the comparison group. This may reflect cultural differences in age at marriage, however, it could be due to the political instability and inequalities faced by this population, leading to pregnancy at an early age for multiple reasons. ( 23 ) UCLH hosts a service for PSAR, providing proactive health assessment, care planning and signposting. Due to complexities in commissioning arrangements, PSAR arriving via the ARAP scheme were not eligible for this service during the period for which data was collected. It is notable that no PSAR who had received proactive health assessments presented to UCLH ED during the period of this review. Although it is not possible to infer that this was causatively related to the health assessment they had received, the authors postulate that proactive health holistic assessments and early identification of medical, psychological, and social concerns may contribute to a reduction in unscheduled emergency presentations in this vulnerable group. Limitations We were not able to perform statistical analysis on our data, due to small numbers, and lack of formal age-matching of our comparison group. We only examined a snapshot of time, which may not reflect longer term trends. It is possible that our coded ‘PSAR population’ inadvertently omitted some PSAR from the analysis, if they were not resident in the known accommodation addresses, unknowingly introducing a possible selection bias. Assessment of appropriateness of presentation were, by necessity, subjective. As this is an evaluation of a service in one NHS trust at one timepoint, it is not possible to generalise our findings to other populations or settings. Conclusion This review highlights important patterns in Emergency Department use among PSAR following the 2021 Afghan evacuation. While PSAR constituted a small proportion of overall ED attendances, their presentations were more often for non-urgent issues better suited to primary or community care settings. This, alongside higher re-presentation rates and a reliance on family members for interpretation, underscores the impact of structural barriers, including language, digital exclusion, and lack of familiarity with the UK healthcare system. Cultural beliefs and disrupted prior healthcare access may also influence presentation patterns, including under-representation of mental health concerns and higher rates of pregnancy-related visits. Although causality cannot be inferred from our data, the absence of ED presentations from PSAR who had received proactive health assessments suggests that early, coordinated, and accessible care pathways may help reduce inappropriate ED use. Targeted interventions, such as improved access to interpreters, enhanced signposting to primary care, and culturally sensitive community engagement, are essential to support the health needs of this vulnerable and growing population. Abbreviations ARAP Afghan Relocation and Assistance Programme CYP children and young people CYPSAR children and young people seeking asylum and refugees ED emergency department EHRS electronic healthcare record system GP general practitioner PSAR people seeking asylum and refugees UCLH University College London Hospital UIN unique identifier number Declarations Ethics approval and consent to participate: Ethics approval was not required as determined by the Children and Young People’s Governance Review Panel, UCLH. The project was registered as a service evaluation in accordance with local processes. All work adhered to the Declaration of Helsinki. Consent for publication: this was deemed not to be required by the Governance review panel above. Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: none. Authors' contributions: SD, S Eckersley, NL and S Eisen conceived the manuscript. S Eckersley, SD, MD and BJ collected data. S Eckersley and SD analysed the data. S Eisen and NL reviewed and edited the manuscript. Acknowledgements: we would like to acknowledge the support of the UCLH Data team in extracting data from EHRS. References The UN, Refugee Agency UK. Asylum in the UK [Internet]. 2024 [cited 2024 Sep 21]. Available from: https://www.unhcr.org/uk/asylum-uk Gov.UK. 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Available from: [ https://www.healthwatch.co.uk/news/2024-07-08/our-position-nhs-dentistry] Additional Declarations No competing interests reported. Supplementary Files Appendix1.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 28 Oct, 2025 Reviews received at journal 25 Jul, 2025 Reviews received at journal 24 Jul, 2025 Reviewers agreed at journal 18 Jul, 2025 Reviewers agreed at journal 14 Jul, 2025 Reviewers invited by journal 11 Jul, 2025 Editor assigned by journal 07 Jul, 2025 Editor invited by journal 18 Jun, 2025 Submission checks completed at journal 17 Jun, 2025 First submitted to journal 17 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6879195","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":485126662,"identity":"9b3f1429-11e6-45cf-b0c6-552dc9fddb42","order_by":0,"name":"Sarah Denny","email":"","orcid":"","institution":"University College London Hospitals NHS Foundation Trust","correspondingAuthor":false,"prefix":"","firstName":"Sarah","middleName":"","lastName":"Denny","suffix":""},{"id":485126663,"identity":"78900918-a528-406c-a1c0-deaac3a56ce6","order_by":1,"name":"Sophie Eckersley","email":"","orcid":"","institution":"University College London Hospitals NHS Foundation Trust","correspondingAuthor":false,"prefix":"","firstName":"Sophie","middleName":"","lastName":"Eckersley","suffix":""},{"id":485126665,"identity":"0afa174d-d532-40fe-9ad7-ee3685022f7e","order_by":2,"name":"Milly Duckett","email":"","orcid":"","institution":"University College London","correspondingAuthor":false,"prefix":"","firstName":"Milly","middleName":"","lastName":"Duckett","suffix":""},{"id":485126666,"identity":"cb81d4e2-9c10-4b0d-8b9d-6798cf4ec54c","order_by":3,"name":"Benjamin Johnstone","email":"","orcid":"","institution":"University College London Hospitals NHS Foundation Trust","correspondingAuthor":false,"prefix":"","firstName":"Benjamin","middleName":"","lastName":"Johnstone","suffix":""},{"id":485126667,"identity":"6d6b6faf-ab50-45b5-8154-450eaab7a0a7","order_by":4,"name":"Nicky Longley","email":"","orcid":"","institution":"University College London Hospitals NHS Foundation Trust","correspondingAuthor":false,"prefix":"","firstName":"Nicky","middleName":"","lastName":"Longley","suffix":""},{"id":485126669,"identity":"5e3927bd-6cbc-4c8a-8a63-248126743504","order_by":5,"name":"Sarah Eisen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3UlEQVRIiWNgGAWjYJACZiDmAWLGB4wNJGphNoBoYSZOCwiwSRClRb797MPPBQw2MvLtvceqC3fUMZiz9x/Aq8XgTLqx9AyGNB6DM+fSbs88c5jBsucwflsMGNIYpHkYDvMYSOSY3eZtO8BgcCOZgMP6nzH/5mH4zyM//41ZMW9bHYPB/cf4tTDcSGMD2nKAh+EGjxkzbxsz0BYC3je48YzNmscgGeiXHGNp3jagC88kGxBwWBrzbZ4KO3v59jOGn4EOkzM4fvABAZeB7UIweYhQPgpGwSgYBaOAEAAAJwg7GnXImMcAAAAASUVORK5CYII=","orcid":"","institution":"University College London Hospitals NHS Foundation Trust","correspondingAuthor":true,"prefix":"","firstName":"Sarah","middleName":"","lastName":"Eisen","suffix":""}],"badges":[],"createdAt":"2025-06-12 10:08:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6879195/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6879195/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86784671,"identity":"ff1f64d6-b2b0-460e-a06f-3d035888c103","added_by":"auto","created_at":"2025-07-15 13:57:42","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":165167,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eEncounters included in analysis.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6879195/v1/abd622763d7454d1ca29978b.png"},{"id":86787554,"identity":"20ad43a1-17b4-4aef-a96e-e8ab2a0bea93","added_by":"auto","created_at":"2025-07-15 14:21:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":878622,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6879195/v1/d29e59eb-05a5-4b4f-a580-6b72647e5c98.pdf"},{"id":86784668,"identity":"d55b8f49-d5ea-470e-95d0-a187cf739503","added_by":"auto","created_at":"2025-07-15 13:57:42","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":13590,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6879195/v1/b4db7670caed41851c628989.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Use of the Emergency Department by People Seeking Asylum and Refugees in living in Temporary Accommodation: A Critical Evaluation","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn the year ending September 2021, the UK received 44,190 asylum applications, representing 8% of all people seeking asylum and refugees (PSAR) in the EU and UK combined (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). On the 13th of August 2021, following the withdrawal of NATO forces from Afghanistan, approximately 15,000 Afghan citizens who had worked for/with the UK Government in Afghanistan, were evacuated by air to the UK and placed in government funded temporary accommodation, under the Afghan Relocations and Assistance Policy (ARAP) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eUniversity College London Hospital (UCLH) is a central London NHS Foundation Trust with a single emergency department (ED) serving a population of over 1.3\u0026nbsp;million. In the surrounding boroughs of Camden, Islington and Haringey, 1375 PSAR evacuated from Afghanistan under the ARAP scheme were placed in temporary \u0026ldquo;bridging\u0026rdquo; hotel accommodation. A surge in presentations to UCLH ED by PSAR was noted from September 2021. PSAR often have complex and intersecting mental, physical, and social care needs due to circumstances in their home countries prior to departure, and psychological trauma and ill health during their journey. They often experience significant challenges in accessing appropriate healthcare on arrival, due to multiple barriers which may include language, digital poverty, education/literacy level, unfamiliar healthcare systems, limited finances, and challenges with primary care registration (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe impact of ED use by PSAR on health systems in the host country remains unclear. A recent systematic review showed no consensus as to whether migrant populations access ED more or less than non-migrant populations, but suggested that they may utilise ED more frequently than the general population, for less acute conditions and without prior consultation of a paramedic or general practitioner (GP)(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). With Emergency Departments in the United Kingdom experiencing increasing pressures and record numbers of attendances (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), understanding patterns of and reasons for attendance is important for service planning and resource allocation (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHere, we explore and characterise ED attendances at UCLH by PSAR between September and December 2021.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA retrospective review of routinely collected clinical data was performed for all PSAR living in temporary accommodation presenting to UCLH ED between September 1st, 2021, and December 31st, 2021.\u003c/p\u003e\n\u003cp\u003ePSAR (including children and young people (CYP) PSAR \u0026ndash; referred to hereafter as CYPSAR) living in temporary accommodation were identified by interrogation of the demographics of the electronic healthcare records of all attendances to UCLH ED during the study period. These were filtered by postcode of known accommodation sites to identify all individuals residing in Home Office provided temporary accommodation, in the boroughs of Camden, Islington, Barnet and Haringey.\u003c/p\u003e\n\u003cp\u003eA comparison cohort, from the general population, of 100 adult and 100 CYP, presenting to UCLH ED during the same period were randomly selected using \u0026ldquo;NEWID()\u0026rdquo; function in T-SQL (Microsoft\u0026trade;).\u003c/p\u003e\n\u003cp\u003eData were extracted from the UCLH electronic healthcare records (EHRS) on EPIC\u003csup\u003eTM\u003c/sup\u003eusing SQL programming language to code and extract the required variables into a password protected encrypted Excel csv. file on a secure network. Data were manually reviewed using unique patient identifiers (UIN), to identify duplicate records and to confirm that the individuals in each group were PSAR or non-PSAR, as appropriate. Duplicates and wrongly coded records were excluded. Data were anonymised prior to analysis. The key linking UINs and patient identifiers were stored on a secure NHS server, within an encrypted file.\u003c/p\u003e\n\u003cp\u003eWhere electronically extractable variables were not available, notes were manually interrogated, and relevant data points added to a secure Excel database.\u003c/p\u003e\n\u003cp\u003eA blinded panel of four clinicians with experience in delivering clinical care in an ED setting reviewed the \u0026ldquo;ED diagnosis\u0026rdquo; of the PSAR and comparison populations, using clinical judgement to classify the encounters as \u0026ldquo;appropriate for ED\u0026rdquo; or \u0026ldquo;more appropriate for alternative healthcare setting.\u0026rdquo; Alternative healthcare settings were defined as pharmacy, dentistry, primary care, or \u0026ldquo;other\u0026rdquo;. Where unanimous consensus was not reached, the coding was resolved by majority agreement.\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003eClinical Data and variables\u003c/h2\u003e\n\u003cp\u003eThe following data were electronically extracted; age at presentation, sex, duration spent in department, and outcome (admission, defined as an overnight stay of at least one night, or discharge).\u003c/p\u003e\n\u003cp\u003eThe following data were manually extracted; country of origin, duration of time in the UK, presence of accompanying individuals, language barrier, use and type of interpreter (defined as telephone interpreter language line, family or friend, staff member or in-person professional interpreter), number of ED attendances during the study period, and ED diagnosis.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eEthics\u003c/h3\u003e\n\u003cp\u003eEthics approval\u0026nbsp;was not required. The project was registered as a service evaluation in accordance with local processes.\u003c/p\u003e\n\u003ch3\u003eAnalysis\u003c/h3\u003e\n\u003cp\u003eDescriptive analysis was performed using Microsoft Excel (2016).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eBetween September 1st 2021 and December 31st 2021, 41,730 adults and 6,607 CYP attended UCLH ED. After exclusions (see Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e), 715 presentations by 474 individuals were identified to be by PSAR. This accounted for 0.6% of all adult ED presentations and 6.9% of all CYP ED presentations during the time of study. 244 non-PSAR (comparison group) presentations, by 185 individuals, were included in analysis.\u003c/p\u003e\n\u003cp\u003eDemographic data is shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, presented at individual (rather than attendance) level.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDemographic data of participants.\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAdult PSAR (n\u0026thinsp;=\u0026thinsp;181)\u003c/p\u003e\n\u003cp\u003eNumber (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCYPSAR (n\u0026thinsp;=\u0026thinsp;293)\u003c/p\u003e\n\u003cp\u003eNumber (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAdult Non-PSAR (n\u0026thinsp;=\u0026thinsp;89)\u003c/p\u003e\n\u003cp\u003eNumber (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCYP non-PSAR (n\u0026thinsp;=\u0026thinsp;96)\u003c/p\u003e\n\u003cp\u003eNumber (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge (years)\u003c/p\u003e\n\u003cp\u003eMedian\u003c/p\u003e\n\u003cp\u003e(Interquartile range)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e32\u003c/p\u003e\n\u003cp\u003e(27\u0026ndash;43)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003cp\u003e(\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e43\u003c/p\u003e\n\u003cp\u003e(26\u0026ndash;55)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003cp\u003e(0\u0026ndash;10)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSex\u003c/p\u003e\n\u003cp\u003eMale n (%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e62 (34.3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e120 (41.0)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e39 (44.1)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e46 (48)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCountry of origin\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAfghanistan\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e110 (60.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e271 (92.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIran\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (1.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (0.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIraq\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (1.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (0.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eKuwait\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (0.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (0.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePakistan\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (0.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (0.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOther\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (2.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 (1.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUnknown\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e59 (32.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11 (3.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDuration of time in UK\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBorn in the UK\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (0.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;1 month\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34 (18.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e68 (23.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u0026ndash;3 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25 (13.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e61 (20.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u0026ndash;6 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (1.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 (1,7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6\u0026ndash;12 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (0.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (0.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;12 months\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (0.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUndocumented\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e118 (65.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e154 (52.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003ch3\u003eResults\u003c/h3\u003e\n\u003cp\u003eCountry of origin was documented in 67.4% of adult PSAR and 96.2% of CYPSAR; of these, 90.2% of adults and 96.1% of children were from Afghanistan. Length of time since arrival in UK was documented in less than half of PSAR attending ED (34.8% adults and 47.4% CYP) however, where it was documented, 93.7% of adults and 93.5% of children had arrived in UK within the last 3 months. 2 children were born in the UK, increasing the number of attenders from recently arrived families to 94.2% of children for whom data was available.\u003c/p\u003e\n\u003cp\u003e58.1% of adult PSAR were accompanied by a family member to ED compared to only 15.6% of the comparison adult population. During the study period, COVID-19 pandemic regulations mandated that each CYP should attend with only one additional person. Of those attending with family, this was adhered to in 66.6% of CYPSAR presentations and 87.5% of presentations by the comparison CYP population. For CYPSAR presentations, the accompanying adult was more likely to be the father (25.9% vs 9.6% in the comparison group), whereas the mother attended more frequently in the comparison CYP group (52.9% of presentations in the comparison group vs 10.1% in the CYPSAR group).\u003c/p\u003e\n\u003cp\u003eBoth the adult PSAR and CYPSAR populations were more likely to have multiple ED presentations within the study period (27.6% of adult PSAR and 36.2% of CYPSAR attending ED did so more than once, while 11% and 27% of adult and CYP comparison groups respectively did so). The PSAR groups were less likely to require hospital admission or follow-up than the comparison population (3.9% vs 13.8% in adults; 5.7% vs 10.3% in children). 9.5% of CYPSAR had siblings concurrently presenting to ED; this was not seen in the comparison paediatric population.\u003c/p\u003e\n\u003cp\u003eA documented language barrier was more prevalent in the PSAR population compared to the comparison population (59.2% vs 2.8% in adults; 42.9% vs 3.7% in CYP). Where interpreter use was recorded, this was more likely to be a family member than a certified telephone or face to face interpreter (70.7% of adults where data was available and 53.8% CYP).\u003c/p\u003e\n\u003cp\u003eFor both adult PSAR and CYPSAR groups, a higher percentage (43.5% and 44.8% respectively) presented within working hours than the comparison group (36.7% and 36.8% respectively).\u003c/p\u003e\n\u003cp\u003eED diagnosis is shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eED diagnosis (presented at encounter level)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAdult PSAR\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;260\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCYPSAR\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;455\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAdult non-PSAR\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;109\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCYP non-PSAR\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;135\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAppropriate for ED\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;107\u003c/p\u003e\n\u003cp\u003e41.2% of total presentations\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;124\u003c/p\u003e\n\u003cp\u003e27.3% of total presentations\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;66\u003c/p\u003e\n\u003cp\u003e60.6% of total presentations\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;80\u003c/p\u003e\n\u003cp\u003e59.2% of total presentations\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003en; % of ED-appropriate presentations\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMedical emergency\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e47 (43.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31 (25%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29 (43.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14 (17.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eENT emergency\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (2.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSafeguarding concern\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (2.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAccident/injury\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13 (12.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33 (26.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15 (22.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33 (41.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAsked to attend/re-attend or transfer from another hospital\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (2.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9 (7.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (4.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (2.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRespiratory infection\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6 (5.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44 (35.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (4.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22 (27.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEye problem\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (0.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMusculoskeletal problem\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (2.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (3.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePsychological problem\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (0.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (4.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (2.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePregnancy complication\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19 (17.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eGynaecological problem\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8 (7.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSurgical problem\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (3.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOther\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (1.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (0.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8 (12.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (2.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAppropriate for non-ED setting\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;153\u003c/p\u003e\n\u003cp\u003e58.8% of total presentations\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;331\u003c/p\u003e\n\u003cp\u003e72.7% of total presentations\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;43\u003c/p\u003e\n\u003cp\u003e39.4% of total presentations\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;56\u003c/p\u003e\n\u003cp\u003e41.5% of total presentations\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMinor medical problem\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36 (23.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19 (5.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8 (18.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12 (21.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChronic problem including prescription request\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37 (24.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29 (8.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (2.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7 (12.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSelf-discharged before seeing clinician\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9 (5.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8 (2.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (2.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (3.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo abnormality detected\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10 (6.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36 (10.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (4.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10 (17.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMinor ENT problem\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12 (7.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21 (6.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (9.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (3.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSocial problem \u0026ndash; nil safeguarding\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (0.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMild Respiratory infection\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16 (10.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e141 (42.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11(25.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18 (32.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMinor eye problem\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 (1.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (4.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMinor musculoskeletal problem\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (2.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6 (1.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8 (18.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAnxiety\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (2.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (2.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMinor pregnancy related problem\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (0.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUncomplicated genitourinary problem (including sexually transmitted infections)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9 (5.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (7.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eDental problem\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7 (4.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17 (5.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0 (0.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMinor skin problem\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10 (6.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e47 (14.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (4.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (7.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eFor 58.8% of adult PSAR (vs 39.4% of the comparison adult population) and 72.7% of CYPSAR (vs 41.5% of the comparison paediatric population), presentations were assessed to be more appropriate to be managed in non-ED community settings. The commonest of these \u0026ldquo;inappropriate\u0026rdquo; presentations in both groups of CYP was mild respiratory infection (42.6% in CYPSAR vs 32.0% in comparison group). In adults, the commonest \u0026ldquo;inappropriate\u0026rdquo; presentations in PSAR were chronic problems (including repeat prescription request) at 24.2% (2.3% in the comparison group). Skin presentations were more common in CYPSAR than the comparison group (14.2% vs 7.1%). Of note, there were multiple presentations of common self-limiting conditions such as chicken pox, Hand Foot and Mouth disease and insect bites in the CYPSAR population, which were not seen at all in the comparison group. Dental problems were also commoner in the PSAR and CYPSAR population than comparison populations (4.6% vs 0.0% and 5.1% vs 0.0% respectively). Minor medical problems were commoner in the comparison group (21.4% vs 5.7% in the CYPSAR group) and children were more frequently discharged with \u0026ldquo;no abnormality found\u0026rdquo; in the comparison group (17.9% vs 10.9% in CYPSAR) or seen with chronic problems (12.5% in comparison group vs 8.8% CYPSAR).\u003c/p\u003e\n\u003cp\u003eOf those presentations felt to be appropriately managed in ED, those classified as medical emergencies were most common in both adult PSAR and the comparison adult population (49.3% in both groups). In the paediatric population, respiratory tract infections were the commonest presentation in the CYPSAR population (35.5% in CYPSAR vs 27.5% comparison) as compared to accidents in the comparison paediatric population (41.2% in comparison vs 26.6% in CYPSAR). Only the PSAR adult group presented with pregnancy-related problems including hyperemesis gravidarum, and suspected miscarriage and only the CYPSAR group presented with any pregnancy related problem. In CYP, no CYPSAR presented with mental health problems, whereas this was seen in 2.5% of the comparison population.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWe reviewed the UCLH Emergency Department presentations by PSAR in the four-month period (September - December 2021) after the UN withdrawal from Afghanistan. PSAR represented 0.6% of all ED presentations and 6.9% of CYP ED presentations during this period. The majority of PSAR attending during this period were from Afghanistan and had arrived very recently to the UK. This is unsurprising in the context of several recently opened contingency and bridging hotels in the vicinity, in the immediate aftermath of the Afghan evacuation in 2021 (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Patterns of attendance were different in the PSAR group compared to a comparison group, as were the conditions with which they attended, with a notably higher rate of presentations in the PSAR group deemed more appropriate to non-ED settings compared to the non-PSAR group.\u003c/p\u003e\u003cp\u003eAlthough the age and sex distribution were broadly similar across the PSAR and non-PSAR groups, it was more common for the PSAR group to present to ED within working hours, a finding at variance with some other studies (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). This may reflect that this group had very recently arrived and thus were less likely to be employed than the non-PSAR group and so able to attend during the working day. The PSAR group may also have been less aware of alternative \u0026ldquo;in hours\u0026rdquo; options for seeking care, such as primary care (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), dental services, pharmacies, and urgent-care services. This was further supported by the types of presentation identified, with PSAR being more likely to present with dental concerns, for repeat prescriptions, and for minor medical problems.\u003c/p\u003e\u003cp\u003eThe frequency of dental problems seen in PSAR is likely to reflect both high rates of dental problems in this population (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) (likely resulting from poorer dental care in their country of origin) and lack of access to an NHS dentist, because of both known resourcing issues in the UK (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) and likely challenges navigating the NHS system.\u003c/p\u003e\u003cp\u003eThe PSAR group were more likely to be accompanied by a family member than the non-PSAR group and this was more likely in the CYPSAR group to be the father rather than the mother. This may reflect poorer access to education in girls and women in much of Afghanistan (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), increasing the likelihood that those speaking English, and thus attending to interpret and navigate the healthcare system, are male. Although the prevalence of a language barrier in the PSAR population is unsurprising, it is interesting to note the frequency with which a family member was used to translate. This is not in line with best practice, which recommends use of a trained interpreter (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) and may reflect the significant numbers of PSAR seen during this period, resulting in resorting to family members for translation due to constraints on time and resources.\u003c/p\u003e\u003cp\u003ePresentations from the PSAR group were more often deemed suitable for management in non-ED community-based settings compared to the comparison group. Specifically, 41.2% of adult presentations and 27.3% of CYPSAR presentations in the PSAR group were considered appropriate for ED care, compared to 60.6% and 59.2% in the respective comparison groups. This higher rate of presentations more appropriate for other services may reflect a lack of awareness of alternative healthcare options and difficulty in accessing these services.\u003c/p\u003e\u003cp\u003ePSAR populations are known to encounter multiple barriers to appropriate healthcare access. These include language barriers, financial and digital poverty, stigma, and a lack of awareness about entitlement to free NHS care (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). A European systematic review reported increased ED use among migrants (across all backgrounds) compared to native populations. This review also noted a higher frequency of ED visits for low-acuity presentations (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), aligning with our findings that fewer PSAR presentations required admission or ongoing management in a secondary care setting compared to the non-PSAR group.\u003c/p\u003e\u003cp\u003eAnother review of 107 studies (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) revealed more varied patterns: only 18% of studies showed greater healthcare use among migrant populations, with few focusing specifically on PSAR. However, a sub-analysis on ED use found higher rates of ED visits among migrant populations. A 2023 systematic review on ED utilization by migrant and non-migrant populations (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) similarly noted that migrants tend to access the ED for less urgent conditions. However, it found no consensus on whether migrants accessed the ED more frequently overall, and again, only a minority of the included studies specifically examined PSAR.\u003c/p\u003e\u003cp\u003eIt was notable that the rate of re-presentation to ED was almost double in the PSAR group compared to the general ED population (27.6% of adult PSAR and 36.2% of CYPSAR vs 11% and 27% of adult and CYP comparison groups respectively). Whilst it is beyond the scope of this article to look for causality, plausible explanations may include barriers to access to care (such as language, digital poverty, lack of knowledge of rights of access to care) resulting in challenges to assessment and therefore reducing diagnostic accuracy, limitations of understanding in the PSAR population regarding discharge/pharmacy instructions and challenges with navigating the healthcare system. Poor and crowded living conditions may contribute to increased rates of infection and re-infection between family members and other hotel residents with pathogens such as chickenpox, scabies, and impetigo, consistent with previously published data (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDisruptions to healthcare and trauma experienced in the country of origin, on the journey to UK, in addition to cultural differences in the approach to healthcare may contribute to health anxiety and increased health seeking behaviour. This hypothesis is further supported by the finding that relatively few PSAR required admission or ongoing management in a secondary care setting, indicating that their presenting condition may have been better managed by alternative services.\u003c/p\u003e\u003cp\u003eIt should however be highlighted that within the paediatric population, certain categories of presentations\u0026mdash;such as \u0026ldquo;minor medical problems\u0026rdquo;, \u0026ldquo;seeking a prescription\u0026rdquo;, or being discharged with \"no abnormality detected\"\u0026mdash;were more common in the non-PSAR group. This pattern of use of ED for children and young people (CYP) is supported the literature (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) and may be due to the perceived urgency of minor medical issues and a reluctance to wait for community-based appointments. These factors may be more pronounced in the non-PSAR group, who may feel more empowered to seek medical attention and exhibit the \"worried well\" effect (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAlthough numbers were small, there appears to be a lower frequency of mental health related presentations in the PSAR group; this may perhaps result from cultural beliefs or perceived stigma around recognition of mental health pathology.\u003c/p\u003e\u003cp\u003ePregnancy issues were relatively common in the PSAR group (17.8% of appropriate presentations); this may relate to a significant majority of Afghan families arriving in the evacuation being of childbearing age, and with multiple successive pregnancies being more common in Afghanistan than in the UK (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), meaning a higher likelihood that a woman is pregnant at any given time. A small number of CYPSAR presented with pregnancy related concerns: this was not seen in the comparison group. This may reflect cultural differences in age at marriage, however, it could be due to the political instability and inequalities faced by this population, leading to pregnancy at an early age for multiple reasons. (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eUCLH hosts a service for PSAR, providing proactive health assessment, care planning and signposting. Due to complexities in commissioning arrangements, PSAR arriving via the ARAP scheme were not eligible for this service during the period for which data was collected. It is notable that no PSAR who \u003cem\u003ehad\u003c/em\u003e received proactive health assessments presented to UCLH ED during the period of this review. Although it is not possible to infer that this was causatively related to the health assessment they had received, the authors postulate that proactive health holistic assessments and early identification of medical, psychological, and social concerns may contribute to a reduction in unscheduled emergency presentations in this vulnerable group.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eWe were not able to perform statistical analysis on our data, due to small numbers, and lack of formal age-matching of our comparison group. We only examined a snapshot of time, which may not reflect longer term trends. It is possible that our coded \u0026lsquo;PSAR population\u0026rsquo; inadvertently omitted some PSAR from the analysis, if they were not resident in the known accommodation addresses, unknowingly introducing a possible selection bias. Assessment of appropriateness of presentation were, by necessity, subjective. As this is an evaluation of a service in one NHS trust at one timepoint, it is not possible to generalise our findings to other populations or settings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis review highlights important patterns in Emergency Department use among PSAR following the 2021 Afghan evacuation. While PSAR constituted a small proportion of overall ED attendances, their presentations were more often for non-urgent issues better suited to primary or community care settings. This, alongside higher re-presentation rates and a reliance on family members for interpretation, underscores the impact of structural barriers, including language, digital exclusion, and lack of familiarity with the UK healthcare system. Cultural beliefs and disrupted prior healthcare access may also influence presentation patterns, including under-representation of mental health concerns and higher rates of pregnancy-related visits. Although causality cannot be inferred from our data, the absence of ED presentations from PSAR who had received proactive health assessments suggests that early, coordinated, and accessible care pathways may help reduce inappropriate ED use. Targeted interventions, such as improved access to interpreters, enhanced signposting to primary care, and culturally sensitive community engagement, are essential to support the health needs of this vulnerable and growing population.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eARAP\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Afghan Relocation and Assistance Programme\u003c/p\u003e\n\u003cp\u003eCYP\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;children and young people\u003c/p\u003e\n\u003cp\u003eCYPSAR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;children and young people seeking asylum and refugees\u003c/p\u003e\n\u003cp\u003eED\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;emergency department\u003c/p\u003e\n\u003cp\u003eEHRS\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;electronic healthcare record system\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGP\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;general practitioner\u003c/p\u003e\n\u003cp\u003ePSAR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;people seeking asylum and refugees\u003c/p\u003e\n\u003cp\u003eUCLH\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;University College London Hospital\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;UIN \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;unique identifier number\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate: Ethics approval was not required as determined by the Children and Young People’s Governance Review Panel, UCLH. The project was registered as a service evaluation in accordance with local processes. All work adhered to the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent for publication: this was deemed not to be required by the Governance review panel above.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests: The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding: none.\u003c/p\u003e\n\u003cp\u003eAuthors' contributions: SD, S Eckersley, NL and S Eisen conceived the manuscript. S Eckersley, SD, MD and BJ collected data. S Eckersley and SD analysed the data. S Eisen and NL reviewed and edited the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAcknowledgements: we would like to acknowledge the support of the UCLH Data team in extracting data from EHRS.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eThe UN, Refugee Agency UK. Asylum in the UK [Internet]. 2024 [cited 2024 Sep 21]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.unhcr.org/uk/asylum-uk\u003c/span\u003e\u003cspan address=\"https://www.unhcr.org/uk/asylum-uk\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGov.UK. Afghan relocations and assistance: further information on eligibility criteria, offer details and how to apply [Internet]. London: UK Government; 2024 [cited 2024 Sep 21]. 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Available from: [\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.healthwatch.co.uk/news/2024-07-08/our-position-nhs-dentistry]\u003c/span\u003e\u003cspan address=\"https://www.healthwatch.co.uk/news/2024-07-08/our-position-nhs-dentistry]\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"People seeking asylum, emergency care, attendance patterns, inclusion health, health inequality","lastPublishedDoi":"10.21203/rs.3.rs-6879195/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6879195/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePeople seeking asylum and refugees (PSAR) are known to be at risk of multiple and complex health needs and frequently face barriers in accessing appropriate healthcare. Numbers of PSAR arriving in the UK and living in temporary accommodation have increased significantly in recent years due to a combination of factors, including the Afghan Relocation and Assistance Programme (ARAP) established in 2021. This study explores and characterises attendance of people seeking asylum and refugees to the Emergency Department of a central London hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA retrospective review was undertaken of attendances to our Emergency Department (ED) by PSAR between September-December 2021. PSAR were identified by postcode of known Home Office temporary accommodation. A cohort of 100 adults and 100 children/young people (CYP) who were not PSAR were randomly selected within the same time period for comparison.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e715 PSAR presentations were included (260 adult, 455 CYP) by 474 individuals (181 adults, 293 CYP). 90.2% of adults and 96.1% of children were from Afghanistan and, where documented, 93.7% of adults and 93.5% of children had arrived in the UK within the past 3 months. 58.8% of adult PSAR and 72.7% of children and young people seeking asylum (CYPSAR) were deemed to have presentations more appropriate for other settings compared to 39.4% and 41.5% of the comparison group respectively. PSAR were more likely to have multiple presentations (27.6% of adults and 36.2% of CYP; 11% and 27% in comparison group respectively) and were less likely to require hospital admission or follow-up than the comparison group (3.9% of adults and 5.7% of CYP; 13.8% and 10.3% in the comparison group respectively).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePSAR attending our ED during the study period were predominantly recently arrived from Afghanistan. PSAR were more likely to have a presentation deemed more suitable for other settings, less likely to be admitted, and more likely to have multiple attendances than a non-PSAR comparison group. Further work to understand the reasons underlying these findings is important, to support improved provision of appropriate healthcare services which may contribute to reductions in unscheduled emergency presentations in this vulnerable group.\u003c/p\u003e","manuscriptTitle":"Use of the Emergency Department by People Seeking Asylum and Refugees in living in Temporary Accommodation: A Critical Evaluation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-15 13:57:37","doi":"10.21203/rs.3.rs-6879195/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-29T02:15:14+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-25T13:35:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-24T17:27:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"90424359107029678188733364069712020420","date":"2025-07-18T10:30:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"181955637143025062059637519945910510124","date":"2025-07-14T11:45:32+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-11T07:41:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-07T14:48:27+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-18T13:03:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-17T07:50:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-06-17T07:47:29+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"216cee0b-cc68-41ce-8efe-828662442c3a","owner":[],"postedDate":"July 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-17T03:23:08+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-15 13:57:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6879195","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6879195","identity":"rs-6879195","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}