The city of Amsterdam has come up with a new way to help its refugee population

A busker performs by an Amsterdam canal. Image: Getty.

In December 2013 Amsterdam’s city council devised a novel social experiment to deal with its homeless refugees: it put them all in prison.

Okay, this isn’t as bad as it sounds. No one was arrested; everyone was free to leave. The really novel part was what the council did to the refugees inside this repurposed prison: it helped them, offering medical care, food, and legal advice. All this it did with a view to either assisting the refugees to submit successful asylum applications, or to return to their countries of origin.

The undocumented immigrants of Amsterdam are also pretty unusual: they are organised. Known as Wij Zijn Hier (WZH; it translates to “We Are Here”), they worked with the Municipality of Amsterdam and actively campaigned for a longer stay in not-really-prison.

The project only ran for 6 months, the WZH refugees have now left the prison and are living elsewhere. So: did it work?

Some background is in order here. In the Netherlands, undocumented immigrants haven’t been entitled to access social services since 1998; in 2010, the Dutch government ruled that it was actually illegal to provide them with emergency shelter. This fell foul of the European Committee of Social Rights, the international body charged with monitoring human rights compliance, which declared that the ruling flew in the face of the immigrants’ right to “bed, bath and bread”.

This was when the Amsterdam Municipality hit on their social experiment. They converted a former prison into a shelter for all refugees who registered with the Dutch Refugee Council (DRC). For six months undocumented immigrants lived in the Vluchthaven (Refugee Haven), while working on their asylum applications.

There were no specific targets set by either the Amsterdam municipalities or the DRC before moving the refugees into the Vluchthaven. If the project’s only goal had been to encourage the refugees to leave The Netherlands, then it appears to have been a failure: of the 165 refugees housed in Vluchthaven, only three returned to their country of origin and another three are preparing to return. Look at the number of refugees who gained legal residence in that time and the figures improve, but remain fairly damning: just 12 (7 per cent) of the refugees were successfully awarded residency.

Taking into account those refugees who are deceased, have been rehoused or imprisoned, 76 per cent of the refugees are presumably once again living on the streets of Amsterdam. (I say “presumably” as Amsterdam has a limited number of shelters available to undocumented immigrants: although the Dutch are as caring as any other nation it’s highly unlikely they’ve opened their homes to a group of homeless strangers.)

These figures are fairly bleak. But, once we take into account the geographical origin of the refugees, a different story starts to emerge. Some 91 per cent of the refugees housed in Vluchthaven originated from countries where reports from the Dutch government describe human rights issues as “critical”. If return was never really an option the logical way to measure the success of this project is by examining the refugees’ ability to build asylum cases.

Attempting to build a case for asylum while living on the streets sounds like a a particular unpleasant twist in Jarndyce vs Jarndyce – but this is the reality faced by undocumented immigrants in The Netherlands. By providing respite from the endless need to find shelter, the Municipality of Amsterdam made it possible for the refugees to focus on collecting evidence. Out of the 165 immigrants housed in Vluchthaven 45 per cent are engaged with the legal process to gain residence in The Netherlands, while another 12 per cent are currently deadlocked in collecting evidence.

Ali Juma, a WZH co-ordinator and refugee from Burundi, sayss that the end of the Vluchthaven was the end of the group’s ability to effectively gather evidence for their asylum applications. The benefits to having a regular address while attempting to put together a legal case in a foreign country are clear. For the six months that they were housed by Amsterdam Municipality, the refugees of WZH were able to make progress in cases which, since their eviction from Vluchthaven, have ground to a halt.

Negotiations are now underway to continue housing the undocumented asylum seekers of Amsterdam; predictably the entire thing comes down to who will foot the bill. Will the cost of housing WZH be placed entirely on the city of Amsterdam? Or will the Dutch government offer financial assistance?

It’s probably too early to just the success of this scheme: that would require clear, pre-agreed targets, and a timeframe longer than six months. (For various reasons many of the refugees were unable to access the full 6 months worth of legal advice.) But what is clear is that undocumented refugees have a better chance of becoming legal residents of The Netherlands if they aren’t forced to submit asylum applications from the streets.

 
 
 
 

What’s killing northerners?

The Angel of the North. Image: Getty.

There is a stark disparity in wealth and health between people in the north and south of England, commonly referred to as England’s “north-south divide”. The causes of this inequality are complex; it’s influenced by the environment, jobs, migration and lifestyle factors – as well as the long-term political power imbalances, which have concentrated resources and investment in the south, especially in and around London.

Life expectancy is also lower in the north, mainly because the region is more deprived. But new analysis of national mortality data highlights a shockingly large mortality gap between young adults, aged 25 to 44, living in the north and south of England. This gap first emerged in the late 1990s, and seems to have been growing ever since.

In 1995, there were 2% more deaths among northerners aged 25 to 34 than southerners (in other words, 2% “excess mortality”). But by 2015, northerners in this age group were 29% more likely to die than their southern counterparts. Likewise, in the 35 to 44 age group, there was 3% difference in mortality between northerners and southerners in 1995. But by 2015, there were 49% more deaths among northerners than southerners in this age group.

Excess mortality in the north compared with south of England by age groups, from 1965 to 2015. Follow the lines to see that people born around 1980 are the ones most affected around 2015.

While mortality increased among northerners aged 25 to 34, and plateaued among 35 to 44-year-olds, southern mortality mainly declined across both age groups. Overall, between 2014 and 2016, northerners aged 25 to 44 were 41% more likely to die than southerners in the same age group. In real terms, this means that between 2014 and 2016, 1,881 more women and 3,530 more men aged between 25 and 44 years died in the north, than in the south.

What’s killing northerners?

To understand what’s driving this mortality gap among young adults, our team of researchers looked at the causes of death from 2014 to 2016, and sorted them into eight groups: accidents, alcohol related, cardiovascular related (heart conditions, diabetes, obesity and so on), suicide, drug related, breast cancer, other cancers and other causes.

Controlling for the age and sex of the population in the north and the south, we found that it was mostly the deaths of northern men contributing to the difference in mortality – and these deaths were caused mainly by cardiovascular conditions, alcohol and drug misuse. Accidents (for men) and cancer (for women) also played important roles.

From 2014 to 2016, northerners were 47% more likely to die for cardiovascular reasons, 109% for alcohol misuse and 60% for drug misuse, across both men and women aged 25 to 44 years old. Although the national rate of death from cardiovascular reasons has dropped since 1981, the longstanding gap between north and south remains.

Death and deprivation

The gap in life expectancy between north and south is usually put down to socioeconomic deprivation. We considered further data for 2016, to find out if this held true for deaths among young people. We found that, while two thirds of the gap were explained by the fact that people lived in deprived areas, the remaining one third could be caused by some unmeasured form of deprivation, or by differences in culture, infrastructure, migration or extreme weather.

Mortality for people aged 25 to 44 years in 2016, at small area geographical level for the whole of England.

Northern men faced a higher risk of dying young than northern women – partly because overall mortality rates are higher for men than for women, pretty much at every age, but also because men tend to be more susceptible to socioeconomic pressures. Although anachronistic, the expectation to have a job and be able to sustain a family weighs more on men. Accidents, alcohol misuse, drug misuse and suicide are all strongly associated with low socioeconomic status.

Suicide risk is twice as high among the most deprived men, compared to the most affluent. Suicide risk has also been associated with unemployment, and substantial increases in suicide have been observed during periods of recession – especially among men. Further evidence tells us that unskilled men between ages 25 and 39 are between ten and 20 times more likely to die from alcohol-related causes, compared to professionals.

Alcohol underpins the steep increase in liver cirrhosis deaths in Britain from the 1990s – which is when the north-south divide in mortality between people aged 25 to 44 also started to emerge. Previous research has shown that men in this age group, who live in the most deprived areas, are five times more likely to die from alcohol-related diseases than those in the most affluent areas. For women in deprived areas, the risk is four times greater.


It’s also widely known that mortality rates for cancer are higher in more deprived areas, and people have worse survival rates in places where smoking and alcohol abuse is more prevalent. Heroin and crack cocaine addiction and deaths from drug overdoses are also strongly associated with deprivation.

The greater number of deaths from accidents in the north should be considered in the context of transport infrastructure investment, which is heavily skewed towards the south – especially London, which enjoys the lowest mortality in the country. What’s more, if reliable and affordable public transport is not available, people will drive more and expose themselves to higher risk of an accident.

Deaths for young adults in the north of England have been increasing compared to those in the south since the late 1990s, creating new health divides between England’s regions. It seems that persistent social, economic and health inequalities are responsible for a growing trend of psychological distress, despair and risk taking among young northerners. Without major changes, the extreme concentration of power, wealth and opportunity in the south will continue to damage people’s health, and worsen the north-south divide.

The Conversation

Evangelos Kontopantelis, Professor in Data Science and Health Services Research, University of Manchester

This article is republished from The Conversation under a Creative Commons license. Read the original article.