Overseas health and care workers on the coronavirus frontline reacted with fury on Wednesday after Boris Johnson refused to exempt them from the NHS surcharge, insisting that it was “the right way forward”. In interviews with the Guardian, migrant health workers – who face an NHS bill of as much as £2,500 a year for a family of four – spoke out over a relentless working environment, struggles to pay their rent, and a heavy toll on their family life. “We feel insulted,” one said. “We are putting our lives and our family’s lives at risk.” The prime minister resisted pressure from Labour’s Keir Starmer to amend the policy, telling MPs that he “accepts and understands the difficulties faced by our amazing NHS staff” but added: “We must look at the realities … those contributions help us to raise about £900m.” Later the IFS estimated that the contribution from overseas NHS staff amounted to around £90m. The workers who spoke to the Guardian described what they saw as a “struggle” to manage the costs of the surcharge alongside rising visa fees. Some said they were struggling to pay for essentials. One health care assistant, Folasade, 47, originally from Nigeria, said that her work on night shifts in a Midlands hospital was “really hard but I enjoy helping people.” Folasade, who has been in the UK for ten years next month, went on: “I have two children and with the NHS fees and the Home Office visa fees together it’s difficult to find the money. It’s a struggle to pay my rent and I’ve never had a holiday. I pay £500 every month towards my debts for previous fees and next year I have to pay another set. I don’t know yet how I will pay them.” The surcharge has become a heated political issue since the coronavirus crisis began, with politicians and health bodies urging the government to scrap it for migrant care workers after it was paused for a year for doctors, nurses and paramedics. The NHS fee of £400 a year for migrant care workers coming from outside the European Economic Area is paid regardless of use of healthcare services. It is rising in October to £624 a year. On top of these charges, a migrant worker on a ten year pathway to citizenship will pay visa fees every two and a half years to allow them to keep working. These are currently £1033. After three sets of fees, the worker pays for indefinite leave to remain, at the end of ten years for a further £2,389. The costs are far higher than in other European countries. The charity Migrant Voice said that between the NHS surcharge and the visa fees a family of four would pay £50,000 over a decade. One care home manager said she worked over 300 hours a month in a senior role, doing overtime to help pay her bills and childcare for her six year old. Another junior doctor said they had to take out loans to afford the charges, which left them struggling financially. Jeri Lee, a 38-year-old care home manager from Jamaica, said: “There is a lot of diversity in my company, most staff are from the Caribbean, Africa or Europe, only a small number are British. “I’m on a ten year path to UK citizenship, I just paid my third set of fees,” she said. “I was very worried during the Covid peak about becoming ill and not being able to work. My immigration status means I have no access to public funds and wouldn’t have got any benefits if I was sick.” Lee works over 300 hours a month in a senior role, doing overtime to help pay her bills and childcare for her six year old as well as the Home Office fees. “I pay £700 hundred pounds a month in tax and then I have to pay this crazy NHS charge. It’s really taking a toll on me, I work so many hours I don’t get much time with my child,” she said. Junior doctor, Aqsa Ghazanfar, described the expenses she has to pay as insulting. “Frankly I mean myself and lots of my colleagues discussed it and feel insulted,” she said. “We are putting our lives and our family’s lives at risk and none of us have said we are not going to do this job. I am exposing myself to patients who potentially have Covid and bringing it home.” She added: “It is even more insulting [at the moment] - that is the only word I have really. It is appalling that people are still being asked to pay it.” She said that she had to take a loan every time to pay for her family’s visa, as there is “no way that I can pay that much”. Dame Donna Kinnair, chief executive and general secretary of the Royal College of Nursing (RCN), said: “The immigration health surcharge is a grossly unfair financial burden … The government must drop this charge as a matter of urgency.” Migrant Voice director, Nazek Ramadan, said: “An average family of four now has to pay nearly £50,000 over the 10 years from arriving in the UK to getting citizenship. “Ordinary families are being stripped bare. We know parents who are faced with the choice between feeding their children and renewing their visas.” A government spokesperson said: “To bring peace of mind and to recognise the contribution of frontline NHS and other eligible health workers during this pandemic, we announced free and automatic visa extensions for them, including an exemption from the immigration health surcharge.” “NHS Trusts and other employers also offer schemes to support NHS staff in making the payment - in many cases covering the cost of the surcharge themselves. In the longer-term it is right that we ensure a contribution is made to reflect the cost of providing NHS treatment and the surcharge has raised £900m for the NHS.”