This panel explores the connections between migrant legal status and access to healthcare across the globe and highlights how healthcare can function as a technology of migration control and border enforcement. In destination contexts, migrants and refugees often face juridical barriers to accessing care, arising from financing and health systems that are shaped by residency status and/or nationality, while moral ideas of their ‘deservingness’ to care conflate with gender, racial and class-based inequalities. Some prefer to seek treatment upon return to countries of origin, where migrant healthcare needs are indistinguishable from those of non-returnees and diagnoses can neglect migratory determinants of disease. Policies in the domains of biosecurity, migration enforcement, detention, education and housing can marginalize healthcare, while healthcare policies do not always specify their applicability to migrants across legal statuses – a context further complicated by policy incoherence between origin and destination countries. Covid-19 has magnified pre-existing inequalities, as migrant low-wage and healthcare workers particularly grapple with infection risk and disease transmission amid inadequate care, livelihood loss, heightened surveillance, border closures and ineffective governance. This panel thus examines the legal, social, political and economic dynamics that produce patterns of exclusion and inclusion within migrants’ healthcare and also influence the ‘quality’ of available services. It investigates the effects of discursive ideas, systems and practices of care on migrants’ care-seeking strategies and experiences of distress, illness, wellness, resiliency and recovery. In bringing together scholars in the social science with those also working in public health, social psychology and clinical research, the panel is inter-disciplinary in perspective and seeks to connect conversations occurring across epistemologies and methodologies of migration research.
Pre-entry screening for tuberculosis: “it's kind of making mark for like all the Asian”
Dr Jessica L. Potter (North Middlesex University Hospital )
The securitisation of borders against the threat of invading microbes, carried by immigrant bodies, is not a new phenomenon. The recent COVID-19 global pandemic has strengthened the global health security agenda, re-focussing attentions on border control. Tuberculosis (TB) is an infectious disease transmitted through coughing. Countries with a low incidence of TB, including the UK, screen people prior to planned migration from countries with higher burdens of disease. This ethnographic study explored how people migrating to the UK from India experienced pre-entry screening for TB. A focused ethnography of a pre-entry TB screening centre in India was conducted in 2017 over 4 weeks. This included 180 hours of field work, photographs and interviews with clients and staff. Over 1000 individuals were screened for active pulmonary TB as part of their visa application during this period. Additional data from 14 in-depth interviews conducted with migrants diagnosed with TB in the UK and 10 key professionals involved in healthcare delivery and policy-making were included in the final analysis. Foucault’s concept ‘governmentality’ and sociological theories of bordering were used alongside thematic analysis to interpret the data. Individuals revealed previously undocumented harms associated with their experiences of pre-entry screening for TB. My analysis reveals how through the ‘biosecuritisation’ of some, but not all, off-shore bodies; some, but not all, off-shore TB; some, but not all, infectious diseases; pre-entry screening becomes a border force, reinforcing global inequities and racialised hierarchies. In this context, I argue pre-entry screening makes UK citizens live while letting ‘others’ die.
Migrants’ legal status and transnational ‘access’ to healthcare
Dr Sajida Z. Ally (Department of Anthropology, School of Global Studies, University of Sussex)
Ongoing reforms in sponsorship policies, protective legislation and healthcare function as technologies of migrants’ healthcare access in Kuwait, while Sri Lankan state emigration policies have not always prioritized their citizens’ health in the migration process. This paper juxtaposes the discourses surrounding these changes against Sri Lankan migrants’ on-the-ground experiences of using public and private healthcare services across transnational contexts. Drawing on ethnographic research among Sri Lankans in Kuwait’s urban areas, as well as in villages of origin in Sri Lanka, I elaborate migrants’ feelings of satisfaction or dis-incentivization to use services and the meanings that underlie their choices to undergo treatment in particular places. While the everyday politics of accessing care has been radically re-shaped by Covid-19, long-term ethnographic engagement demonstrates migrants’ accumulated experiences of varied opportunities and obstacles to healthcare over time. Rather than to view their self-treatment and visits to private services – due to lack of entitlement or dis-trust of public doctors – as a positioning outside of the state, I suggest that such care-seeking actions are forms of claim-making within the constraints that shape their il/legality. Combined with interviews with doctors and civil society that define analysis of how a continuum of discourses are involved, these findings shed light on the local, state and global structures that exclude, constrain or facilitate access to care. Building on concepts of healthcare ‘access as an interface’ (Levesque et. al. 2013) and health equity as an interrogation of inequitable distributions of power and resources, I argue for the integration of political and juridical context, as well as situated, ethnographic knowledge, into understandings of transmigrants’ healthcare. In doing so, I point towards what an inclusive politics of healthcare might look like in Kuwait.
Expanding the guidelines for the care of forced migrants
Suzana Duarte Santos Mallard (Institute of Psychosociology and Community Ecology (EICOS), Universidade Federal do Rio de Janeiro )
Therapeutic clinics for migrants can be considered as a point of tension and site of possibility for the psychological trauma and care of forced migrants. They represent points of convergence for narratives of individual experience and provide insight into broader ethical, social, and political issues. Encounters in these clinics affect refugees, therapists, and the wider community. These encounters produce knowledge and prompt reflection in the field of psychology and define the possibilities and outcomes of those involved. A close examination of these dynamics can provide insight into how clinicians can expand guidelines for the care of forced migrants. Drawing on extensive interviews with therapists in Brazil and the United States, this paper proposes a series of steps for expanding and enhancing psychological care for forced migrants. These steps could enable therapists to identify the specific vulnerabilities of their patients to more quickly and effectively address their needs. They entail: 1) making it a priority to let the migrants find their own voice, and being willing to reflect and question one’s own assumptions; 2) engaged listening, which has the potential to remove migrants from the silence that their condition imposes; and 3) forging a bond that can help restore a sense of agency and trust. Previous studies of forced migrants have suggested that this population is objectified and thereby excluded from exercising their will. The above steps seek to restore migrants’ subjecthood within the therapeutic context. Thus, every professional working with this population should be committed to providing these forms of engaged and self-reflexive care when interacting with migrants.
Healthcare access among migrant children and their families in the UK: Reconsidering law, ethics and society
Dr Catarina Alves Soares (Barts Healthcare NHS Trust)
Dr Sunanda Bhatia (Imperial College Healthcare NHS Trust)
Dr Bryony Hopkinshaw (Medact Migrant Solidarity Group)
Dr Jonathan Broad (Medact Migrant Solidarity Group)
Dr. Sarah Boutros (Medact Migrant Solidarity Group)
In the increasingly hostile policy environment and discourse around migration, children and families face barriers to access the national health service (NHS) healthcare. In this paper, we discuss the healthcare context, and the implications of ethics and law on the quality of care provided to migrant children and their families. We ground the paper around adapted clinical case scenarios of children whose healthcare is impacted by their legal migration status, particularly undocumented children who lack legal documentation, and unaccompanied asylum-seeking children. This paper discusses whether current ethical, legal and professional frameworks advocate or hinder access to healthcare and influences on the quality of care. There are detrimental and discriminatory effects of policies within healthcare and society including border enforcement. For instance, the NHS has seen recent expansions of charging children for healthcare and charging for reproductive health including pregnancy and delivery in migrant families. Not only are such policies unfavourable in safeguarding this vulnerable group, but they also lead to moral conflict among stakeholders such as healthcare staff. Having witnessed extenuating circumstances makes children who are unaccompanied and seeking asylum extremely vulnerable; but it also builds their resilience and independence. Therefore, it is imperative to enable their voices to be heard as well as to advocate for a higher level of wellbeing.
Access to healthcare, insurance provision and health status of Sri Lankan migrant domestic workers
Dr Hiranthi Jayaweera, Research Affiliate (former Senior Researcher), Centre on Migration, Policy and Society (COMPAS), School of Anthropology, University of Oxford
Poor health affects Sri Lankan women who migrate overseas for domestic work before they migrate, while they are abroad, and on return to Sri Lanka. Provisions to ensure equitable access to healthcare are failing them, both in their own country and abroad. Compared to documentation of the violations of human rights of Sri Lankan overseas domestic workers particularly in Gulf Co-operation Council (GCC) countries, relatively little attention has been paid so far to their health and barriers in access to healthcare. Based on primary qualitative research conducted in 2014-15 with 60 pre-departure and returned domestic workers and 20 stakeholders representing state, civil society and international organisations, this paper explores the impact of the Sri Lankan labour migration governance framework relevant to health, as well as the impact of GCC receiving country policies and employer practices, on migrants’ access to healthcare and health status throughout the entire migration process. The research findings point to gaps and anomalies in the governance framework around health that have a negative impact on the women’s health and health rights across the migration process, including during recruitment, training, and medical testing; in the employment contract, insurance, Sri Lankan embassy involvement in receiving countries; and in the provision of health support on return. The domestic workers’ working conditions and lack of health support in destination countries lead to significant deterioration of the health of most. It is clear that the women knowingly sacrifice their health in continuing the cycle of migration. Recommendations for policy and practice reform are based on viewing migrant health holistically, connecting the entire migration journey, and family health as well as the individual migrant’s health.
Marcia Vera Espinoza
Queen Mary University of London
Aristotle University of Thessaloniki
Jessica L. Potter
North Middlesex University Hospital
Suzana Duarte Santos Mallard
UFRJ - EICOS
Catarina Alves Soares
Barts Health NHS Trust, London, United Kingdom
Imperial NHS Healthcare Trusts
Medact Migrant Solidarity Group
Medact Migrant Solidarity Group
Medact Migrant Solidarity Group