Navigating Emergency Care After Injury: A Qualitative Study of Asylum Seekers and Refugees in England and Wales Using the Candidacy Framework (BE SURE Study)

BACKGROUND: Asylum seekers and refugees (ASRs) face significant challenges when accessing emergency and pre-hospital care following injury. Language barriers, unfamiliarity with service pathways and limited trust in authorities hinder access to emergency services. We report results of focus groups with asylum seekers and refugees who have accessed emergency services to understand their use of services and care received. METHOD: We recruited participants through community organisations and support networks which advocate and support asylum seekers and refugees across four areas in England and Wales. We gained informed consent to record and transcribe all focus groups. We applied framework analysis to map emergent qualitative themes onto the seven domains of the Candidacy Framework, in order to examine how access to services was recognised, navigated, and negotiated. RESULTS: We report findings from 35 participants, who demonstrated the ability to recognise situations when emergency care was required, yet their ability to seek help was shaped by uncertainty, fear, and experiences of exclusion. Cultural norms, immigration status, and systemic barriers including complex service pathways and financial constraints affected perceptions of eligibility and influenced help-seeking after injury. Communication difficulties were the most persistent challenge, cutting across all candidacy domains and compounding existing vulnerabilities. CONCLUSION: This study highlights persistent inequities in access to emergency care for asylum seekers and refugees following injury in England and Wales. Using the Candidacy Framework, it demonstrates how language barriers, uncertainty about entitlements, and structural constraints shape how individuals recognise need, navigate services, and experience emergency care. Addressing these challenges requires embedding equity within emergency care systems through improved communication, navigation support, and sensitivity to the lived realities of asylum seekers and refugees.