Sanctuary, health and social cohesion: evaluation of local authority City of Sanctuary strategies.

Background: 1. Immigration increase. Net immigration in UK and England began increasing from 1996.1 The Covid-19 pandemic was associated with initial reductions in immigration followed by an unprecedented steep increase. Most immigrants voluntarily relocate – typically for family reasons, work or study. However, some are compelled to move. Some are classed as asylum seekers or refugees, though the charity City of Sanctuary UK (see below) often uses the terms ‘People Seeking Sanctuary’ and ‘Sanctuary Seekers.’ In 2023, 1.2 million people immigrated into the UK (net immigration 685,000), of which asylum seekers, refugees and Ukrainian schemes applicants formed 11% of new arrivals (approx. 141,000 individuals).1 Some immigration routes haves been termed irregular or illegal by the government. In the year ending June 2024, 38,784 irregular arrivals were detected and an unknown number are undetected.2 Most of those detected are adult males and around a fifth are children.2 2. Health inequality. Forcibly displaced people often experience trauma and loss in the countries they flee and the journeys that follow before, during and following their migration journey: loss of loved ones, community, social status, and possessions.3 Risks of death, injury and incarceration can be high. Arrival in England often involves exposure to material, social and psycho-social determinants of ill health: poverty, homelessness, isolation, prejudice, little or no access to services, and lengthy, stressful contact with the immigration system and overstretched public service providers, who are sometimes viewed with suspicion.3-7 Lacking adequate support or opportunity, many are particularly vulnerable to mental and physical illness, exploitation and crime. Global systematic reviews find much worse health, especially mental health outcomes, for forcibly displaced people compared to non-migrants.8-11 English and UK data fit these findings, for example suggesting more than double the suicide rate for asylum seekers versus non-migrants before Covid prior to the Covid pandemic, along with increases in suicide and other mental illness indicators for forcibly displaced people more recently.12 Men and children are particularly at risk of poor mental health.12-14 3. Politics of immigration. The problematisation of immigration has long been a major policy driver. Brexit, the Home Office’s Hostile Environment Policy, the ‘small boats’ policy, and the latest general election campaigns all illustrate how the perceived need to deter and reduce immigration is mainstreamed in English politics.16-17 While deterrent policies often claim a focus on ‘illegal immigration,’ they are criticised for their wider impacts, encouraging racism and xenophobia, dividing communities, yet still failing in their stated aim of reducing immigration.17-19 Anti-immigration and anti-Muslim rhetoric, spread on social media and bolstered by official government policy, have been cited as driving forces behind recent riots across England and Northern Ireland (July and August 2024).18 4. City of Sanctuary. With relatively little resource, divided public opinion, and national policies that restrict and disrupt public health and welfare provision for forcibly displaced people, some English local authorities have nonetheless declared themselves ‘City of Sanctuary’ authorities.20-24 The charity ‘City of Sanctuary’ (CoS) UK started in Sheffield in 2005 to encourage coordinated action to help people seeking sanctuary. Sixteen local authorities developed and implemented CoS strategies. More plan to follow but these innovative local actors have little evidence to guide them, making the task of specifying what should go into a strategy difficult – something that stakeholders involved have told us directly. In this Expression of Interest, we state that a rapid an evaluation of local authority City of Sanctuary strategies will generate urgently needed evidence, at a time when national civil unrest and a change in government provide both acute need and opportunity for new approaches. We make the case that these strategies offer important learning to inform action on less divisive, more feasible, public health oriented local policies for people seeking sanctuary – with potential benefits for safety, wellbeing and cohesion of wider communities in this time of crisis. See Appendix for more details on CoS as requested by SPHR. Also note that although CoS UK uses the term ‘City of Sanctuary’, local authorities that apply do not necessarily have to be cities – they might also include other geographies e.g. towns, villages.