It was early-April 2020 when Elvis, a Filipino undocumented migrant in the UK, died at home with suspected covid. He was so scared of incurring debts he could not repay and of being reported to immigration enforcement that he had not sought any help from the NHS.

The tragedy of Elvis’ death is clear but so too is the enlightened self-interest of providing medical assistance to undocumented migrants. Late detection means the increased potential for infectious covid transmission for us all with deadly consequences.

So what lessons have been learnt about covid related healthcare for undocumented migrants, particularly when vaccines and new treatments are available?

Covid treatment and lifesaving covid vaccines are free in the UK regardless of a person’s immigration status. The Department of Health and Social Care requests NHS trusts ensure “patients that are known to be undergoing testing and treatment for covid only are not subject to Home Office status checks”. NHS England policy is that anyone can register with a GP surgery and so receive vaccination, or go to a vaccine walk-in centre, without any proof of address, immigration status, ID or NHS number.

And yet, vaccine access has come under scrutiny in recent weeks. The Bureau of Investigative Journalism found less than a quarter of GP surgeries (24%) surveyed in cities across England, Scotland and Wales would register someone without proof of address, proof of ID or legal immigration status, despite national NHS Policy. The same investigation revealed walk-in sites sometimes request documents.

Asking for this personal information furthers the suspicion of undocumented migrants, even when it is not NHS policy to share data in these circumstances with the Home Office. Responding to the Bureau’s survey, Dr Habib Naqvi, director of NHS Race and Health Observatory, stated ‘this ad hoc advice is simply not acceptable’.

Trust remains lacking in the government and the vaccination drive. In mid-June, I lined up at a walk-in vaccination clinic in East London for my own first jab. The clinic was open to everyone (including myself, a young British man) and advertised as welcoming undocumented migrants on Refugee Week 2021, promising “no questions asked”.

In front of me was an immigration solicitor saving a space for her client in the queue. I asked why her client felt it necessary to bring a solicitor along and she confirmed he was scared of being identified.

Soon her client joined the queue: He was a man in his 50s, like Elvis. He fitted a demographic of persons at higher risk to the devastating effects of covid. When requested to give his details, he declined but still received the vaccine.

Taking his solicitor along may seem unnecessary but the incident has to be contextualised. Until November 2018, there was a memorandum of understanding between NHS Digital and the Home Office which facilitated patient data sharing for deportation purposes. Although terminated, the memory of this arrangement lingers.

Likewise, there persist circumstances in which the NHS shares data, so raising confusion about how personal information will in fact be used. The NHS must share with the Home Office information about overseas visitors who have an NHS debt of £500 or more which has been unpaid for 2 months. This debt may affect a person’s future immigration application.

Many other forms of hospital and care treatment are chargeable to migrants. An independent review published in late June found Lewisham and Greenwich NHS Trust had charged overseas domestic violence survivors for healthcare services, including for antenatal care, which may have scared people away from receiving treatment.

Despite services for domestic and sexual violence being free, victims of abuses can still face bills of tens of thousands of pounds for other care which are beyond their means to pay back. From an undocumented migrant’s perspective: If I can be tripped up over receiving important (even antenatal) care, why will I not be over covid treatment?

Government statistics point towards a higher covid mortality rate among migrants. Still, to oversimplify the implications of these statistics can lead precipitously to the narrative migrants are to blame for covid.

It has long been a historical trope to see marginalised ethnic groups as unclean and spreading diseases, to talk about people as ‘rats’ and ‘lice’, much as the Nazis claimed Jews spread typhus. Social media bears testimony that undocumented migrants are often blamed for the circulation of covid.

As one post shared 46,000 times on Facebook from last September reads, “there’s no point locking us down when there are 2 million illegals wandering around the UK & our borders are still open”.

The “2 million” statistic is misleading. It is not known how many undocumented migrants live in the UK today but a 2019 report by the Pew Research Centre suggested there were up to 1.2 million undocumented migrants in 2017.

The Home Office is in many ways the author of covid spread among undocumented migrants and similarly asylum seekers.

There have been several outbreaks in government asylum seeker accommodation, which include repurposed former army barracks. These facilities have been criticised as overcrowded and unsanitary. The total number of covid cases at Napier barracks in Kent was at one point equal to more than half of its unlawfully housed resident population.

The Home Office requires landlords to check the immigration status of their tenants and undocumented migrants are not permitted to work. These measures further force undocumented migrants into unsuitable housing as well as illegal and unsafe working conditions, so it is more likely they will be infected with covid.

How can issues around vaccine uptake, covid healthcare and the UK’s hostile environment be solved?

Kawsar Zaman, Founder of Take the Covid-19 Vaccine Campaign, tells me that “without a dedicated public information campaign via a dedicated network of charities, the issue about the required assurances for migrants to be able to take the vaccine without repercussions will persist and ultimately jeopardise the national effort to vaccinate”.

Local community and charitable efforts can go a long away to reassure migrants that vaccine clinics are safe spaces. However, a key player must be the government in distributing vaccines and disseminating public information in a range of languages. The government must ensure vaccine access is for everyone and not just a lottery as to whether there are charitable endeavours in your local area.

For government-led vaccination efforts to achieve further outreach requires building trust. Anna Miller, head of policy and advocacy at Doctors of the World, says: “Charges in all services need to be stopped. Patients don’t distinguish between different NHS services meaning as long as some services charge patients and report them to the Home Office, all NHS services are not trusted”.

When I ask Anna Miller about ensuring the NHS is not overburdened by free healthcare for migrants, she replies: “Delaying access to healthcare services requires more NHS resources in most cases because advanced untreated conditions tend to require more complex and expensive treatment. Ensuring everyone living in the UK has good access to preventative or easy healthcare is the best way to conserve NHS resources”.

A survey by the Joint Council for the Welfare of Immigrants estimates 82% of undocumented migrants entered through legal routes and later fell out of status. If undocumented migrants are not to blame for illegally entering this country with covid then attention must turn to what measures can be taken to prevent covid infections developing once migrants are here.

When the 17th-century writer John Donne penned the famous words “no man is an island” in 1624, he had just suffered an unknown fever spreading through London. Convalescing from his near-death experience, Donne was invigorated to consider his own mortality and the interdependent nature of human existence.

Similarly, in light of the covid pandemic, perhaps a broader reappraisal of the hostile (“compliant” to use present Home Office terminology) environment policy towards undocumented migrants is necessary. Can it ever be worth the human cost and does it just exacerbate the present healthcare crisis?