Photo: BRICKS • Afghani Immigrants Handmade Bricks • Qom • IRAN-13 from flicker photo stream

At a research meeting last week, a general practitioner who offers health checks to young, unaccompanied refugees, described his work. He had interviewed 44 young men from Afghanistan who all, report themselves to be in good health, with no special needs. But when prompted, it seems that not one of them sleeps well. One says he sees the people who drowned during his crossing from Libya to Greece when he closes his eyes. Another reports that thoughts of his family wake him in the night – he hasn’t heard anything for months. The GP emphasizes that there are as many reasons for leaving Afghanistan as there are refugees – each young man reports a different motivation: death, threats, poverty, fear, oppression, combined with a strong hope for something better elsewhere.

The GP reports his shock at the young men’s bodies. Not only are they highly muscular – a result of forced agricultural labour in Iran prior to entering Europe – but they are scarred.  For the young men themselves, their scars are hardly worth mentioning – an ordinary side-effect of routine beatings.  The young men have been beaten in school in Afghanistan during the Taliban era; when labouring in the fields in Iran; and on their journey to Europe.

These young asylum seekers’ healthcare needs are not obvious and do not fit into standard models of General Practice. The health status and healthcare needs of asylum seekers in Europe are under-researched with a scant evidence base. Accounts of young refugees’ own priorities with regard to their health and healthcare are rare in the published literature. Health professionals describe enormous unmet need, particularly among young people, engendered by mass movement into austerity-struck Greece. The young people (mostly boys) making the journey to Europe from Iran, Iraq, Syria and Afghanistan start out in good health. The journey can be arduous and once they arrive in Europe, their long-term access to healthcare services depends on their refugee status. The prospects of the unprecedentedly large number of applications for asylum being granted leave to remain in Europe are uncertain.  Even the European countries most open to refugees are hesitating in the face of the number of arrivals and the rise of xenophobic national politics.

On the train, returning home from the meeting, I sit next to a young woman who tells me she is returning from routine post-transplant heart biopsy. She bears scars both from the transplant and the biopsy.  She says she’s exhausted and worries about sleeping through her station.

The Bagdad Teaching Hospital does not perform heart transplants but does have expertise in advanced cardiac care, for the time being.  Falling oil prices have justified the introduction of charges for individual services in Iraqi hospitals. The ongoing violence against Isis necessitates medics forming alliances with specific militia for protection. The militia get preferential treatment, but there is no protection from the lack of medical supplies (such as stents) and absence of skilled professionals, as emigration offers an escape from violence, threats, and under-funding.

A universal health service for which residents share both responsibility and access offering collective support in times of trouble has been a powerful symbol for nation-building in Europe and beyond.  The preferential treatment that militia receive in the Bagdad Teaching Hospital in the name of a war against Isis is a troubling disruption of collective healthcare.

Young refugees arriving in Europe do not, for the most part, need immediate access to health services. Those who get residency do not judge access to health services as their top priority. Establishing an independent life and security in terms of housing, relationships, finance, and education are more important. And above all, developing a way to belong.  As I’ve written in this blog before, hope is a key quality offered by a socialised health service. A lack of hope is what makes austerity measures so damaging, not just now, but for future generations. The closing of Europe’s borders to refugees from the Syrian conflict is another denial of hope, for which the Turkish president berates Europe.

The young Afghani refugees and the train passenger with a new heart show us what bodies can bear, providing they have hope. In the absence of hope all they have are scars.