Do child refugees living in NI need a visa to access urgent care if they have heart problems?

• Paediatric cardiology is an all-island service, with collaboration between different centres. All serious surgery takes place in Dublin.
• All refugees and asylum seekers living in NI require a visa to travel across the border.
• Although target times for getting a visitor visa are around 25 days – so, in theory, this process could take longer – Irish authorities told us sick children would be treated as a priority and, in emergency situations, a “pragmatic approach” would be taken.
• There may also be some knock-on issues, such as parents also requiring a visa to visit their children in hospital.

On 21 September, Member of the Irish Human Rights and Equality Commission Dr Lucy Michael said in a social media post:

“A refugee child in Northern Ireland with a heart condition needs a visa to access urgent care, which can take months to be approved.”

Refugees and asylum seekers living in Northern Ireland are entitled to primary and secondary care, as required.

However, children’s heart services are run on an all-island basis. Significant aspects of urgent care, including all specialist surgery, are provided in Dublin.

Current rules stipulate that refugees or asylum seekers travelling from NI to Ireland will need a visa.

Based on all this, it is reasonable to say that a refugee child in NI who has a heart condition “needs a visa to access urgent care.”

As well as the central claim, Dr Michael also noted that visa waiting times could take months. This is a plausible waiting time for a normal visitor visa – but Irish authorities said cases like this would be prioritised.

According to Ireland’s Department of Foreign Affairs, the current target time for processing a visitor visa is 25 days. This is a target, and it is reasonable to expect this timescale could be higher or lower, depending on many factors.

However, while it is conceivable that approval for a visitor visa might take months, Ireland’s Department of Justice told FactCheckNI that any such visa should take days, rather than weeks – and that “In an emergency situation a pragmatic approach is taken.”

• Paediatric cardiology

Paediatric cardiology is now an all-island service, working within the model of the All-Island Congenital Heart Disease Network.

Key sites in Northern Ireland include the Children’s Heart Centre at the Royal Belfast Hospital for Sick Children (opened in 2019), and the Regional Children’s Cardiac Centre at Craigavon Area Hospital (opened in 2021).

Prior to 2018, children in Northern Ireland who needed heart surgery were required to travel to England. Now, they can access such care on the island of Ireland, with ‘a single paediatric cardiology service across Ireland, delivered through a surgical centre in Dublin, a Children’s Heart Centre in Belfast and supported by enhanced paediatric cardiology services at local hospitals.’

All specialised surgery is performed at the centre in Dublin. This is supported by additional diagnostic services, as well as various pre- and post-operative care, in several local hospitals.

• Healthcare for refugee children in Northern Ireland

Refugees and asylum seekers are entitled to access primary and secondary health services in Northern Ireland.

According to Section 9 of the Provision of Health Services to Persons Not Ordinarily Resident Regulations (Northern Ireland) 2015 there is to be ‘no charge’ for any health services accessed. 

However, when it comes to paediatric cardiology, some services – in particular, surgery – require travel to Dublin. This means crossing the border.

• Visa rules for refugees

Northern Ireland and Ireland are both within the Common Travel Area, within which British and Irish citizens can move freely. Beyond this, the situation is more complex.

Until recently, refugees were not required to hold a visa to travel to Ireland from most European Countries. In July 2022, Ireland temporarily suspended the application of the Council of Europe Agreement on the Abolition of Visas for Refugees for 12 months – reflected in the Immigration Act 2004 (Visas) (Amendment) (No. 2) Order 2022. In July 2023, the suspension was extended for a further 12 months.

Until this suspension ends, any refugee wishing to travel to Ireland from NI requires a visa.

According to Ireland’s Department of Foreign Affairs, the current target processing time for a visitor visa is currently 25 days [correct at the time of writing].

Based on all this, the original claim appears accurate. However, that’s not the end of the story. Governing authorities can build flexibility into rules like this – and, failing that, authorities may also have some discretion about how they enforce their own rules.

• Authorities

FactCheckNI contacted several government departments and other agencies in both Northern Ireland and Ireland about this issue. The key response came from Ireland’s Department of Justice. A spokesperson said:

“Where a person is travelling for an approved medical treatment, they will have their visa applications processed as a priority. In the event that the person requires multiple trips for their medical treatment then a multi-entry visa is available for this purpose.

“Such visas can be processed in an expedited manner (for urgent medical attention this will be days rather than weeks.)

“In an emergency situation a pragmatic approach is taken.”

• Claimant

FactCheckNI got in touch with the claimant, Dr Lucy Michael, to ask her about the original claim.

She pointed us in the direction of two pieces of research that highlighted a potential knock-on issue from the visa requirements: entitlements for families.

In November 2021, the North West Migrants Forum (NWMF) and Committee on the Administration of Justice (CAJ) jointly published a paper, CTA and Freedom of Movement in the Island of Ireland. In March of this year, the Economic and Social Research Institute (ESRI) published Comparing migrant integration in Ireland and Northern Ireland.

Both reports contain a case study (which may or may not refer to the same single case) outlining how this issue may also affect parents and family. The NWMF/CAJ paper states:

““A refugee child born in Belfast with a congenital heart condition requiring urgent treatment. The child was taken to Paediatric Cardiology in Dublin for treatment as part of the all-island congenital heart disease (CHD) Network scheme. Unfortunately, due to her immigration status, the mother was not able to accompany her child for treatment, causing undue stress on the family. A visa was eventually granted after an emergency application. However, the stress and anxiety are ongoing, especially as if they need further treatment, they may find themselves in the same situation again.”