Our health and theirs: Forced migration, othering, and public health

PLOS Medicine, 2020

Migration is a natural state of humankind and has been documented throughout history. Some people may flee violence and persecution, while others simply seek a better life. Although migration is often classified into these two basic categories, the reality is more complex and nuanced: people migrate for a myriad of interconnected cultural, economic, religious, ethnic, and political reasons. Depending upon the epoch, migration has been seen in a positive or a negative light. Currently, the terms migrant and refugee have become politically charged and are widely misused for political and populist purposes. However, no matter how migration is portrayed at a specific point in time, it will inexorably continue. Thus, the need to ensure the protection, health, and welfare of people on the move is imperative and provides the rationale for the accompanying PLOS Medicine Special Issue on Refugee and Migrant Health [1]. This imperative is not only a matter of humanity and equity but is also necessary for the global economy, as migration is inherently linked to economic growth [2]. The governance needed to provide health services to this diverse and widespread group of people-from low-waged migrant workers and undocumented migrants to refugees-is unclear. How can we attain universal health coverage in this complex and uncertain environment? At the 72nd World Health Assembly in May 2019, a global action plan was agreed upon that seeks to establish a "framework of priorities and guiding principles.. .to promote the health of refugees and migrants." The Global Compact on Migration, developed through intergovernmental negotiations and adopted in December 2018, enshrined health as a cross-cutting priority for migration governance. It is, however, unlikely that governments will apply such frameworks, unfortunately. Despite widespread recognition of the numerous migrationrelated health risks, mobile populations are often met with punitive border policies, arbitrary detention, abuse, and extortion and are denied access to healthcare. All too often, government policies prioritize the politics of xenophobia over their responsibilities to act forcefully to counter them. As human beings, migrants are entitled to universal human rights without discrimination, and to the "highest attainable standard of health" according to international law. Migration health remains at the margins of policy prioritization for most governments, and thus universal health coverage remains elusive for the vast majority of migrants and refugees [3]. Seeking to raise awareness of the health inequities and different contexts faced by migrants and forcibly displaced persons, as well as to promote research, service, and policy innovation in this area, this Special Issue is devoted to migrant and refugee health in the broadest sense.

Embodying Borders: A Migrant’s Right to Health, Universal Rights and Local Policies, 2021

I will be focusing on two issues that arise out of my own ethnographic work, in which the contradictions and complexities of the problematic access to the right to health are very evident. These are two tools/approaches to migration management, common across the Global North, that are a source of ill health to forced migrants. First is the ‘humanitarian border’. This refers to the manner in which migration control strategies have engaged with humanitarian activities, and where ‘care’, including health care, functions as a technology of border enforcement and biopolitical power (Walters 2011; Williams 2015). Second is the evermore globally pervasive practice of ‘immigration detention’ (Silverman and Massa 2012; Flynn 2014). Both tools are closely interlinked, and guide policy to ‘care, control and contain’ (cf. Bloch and Schuster 2005 on the British migration regime; Campesi 2018 on the Italian migration regime) the movement of different population groups, and limit to varying degrees people’s freedom of movement. This lack of access or even the violation of their right to health has severe consequences and repercussions on the well-being of migrants, making these issues, despite their statistical ‘smallness’, significant from a moral and political point of view. The aim is not to provide an exhaustive discussion of either, but to provoke further thinking on the impact on people’s health – in other words, on the way they serve, directly or indirectly, to limit or violate forced migrants’ access to their right to health at a particularly vulnerable period during their trajectory.

Antimicrobial Resistance & Infection Control, 2018

The 2015-2017 global migratory crisis saw unprecedented numbers of people on the move and tremendous diversity in terms of age, gender and medical requirements. This article focuses on key emerging public health issues around migrant populations and their interactions with host populations. Basic needs and rights of migrants and refugees are not always respected in regard to article 25 of the Universal Declaration of Human Rights and article 23 of the Refugee Convention. These are populations with varying degrees of vulnerability and needs in terms of protection, security, rights, and access to healthcare. Their health status, initially conditioned by the situation at the point of origin, is often jeopardised by adverse conditions along migratory paths and in intermediate and final destination countries. Due to their condition, forcibly displaced migrants and refugees face a triple burden of non-communicable diseases, infectious diseases, and mental health issues. There are specific challenges regarding chronic infectious and neglected tropical diseases, for which awareness in host countries is imperative. Health risks in terms of susceptibility to, and dissemination of, infectious diseases are not unidirectional. The response, including the humanitarian effort, whose aim is to guarantee access to basic needs (food, water and sanitation, healthcare), is gripped with numerous challenges. Evaluation of current policy shows insufficiency regarding the provision of basic needs to migrant populations, even in the countries that do the most. Governments around the world need to rise to the occasion and adopt policies that guarantee universal health coverage, for migrants and refugees, as well as host populations, in accordance with the UN Sustainable Development Goals. An expert consultation was carried out in the form of a pre-conference workshop during the

Refugees and asylum seekers are defined in many ways but can be considered as those who did not make a voluntary choice to leave their country of origin and cannot return home in safety. Outcome data are limited and mostly focused on perinatal and mental health but do suggest significant levels of unmet need. This scoping review considered 72 studies where refugees and asylum seekers formed part or all of the population studied. Access to appropriate health care across the WHO European Region is very varied and is overwhelmingly shaped by legal frameworks and the regulation of the migration process. The need for improved communication with asylum seekers and coordinated action between agencies within and beyond the medical system is widely noted. Improved data to support intersectoral working to address the health care needs of asylum seekers and refugees are imperative.

Health Policy, 2019

Infectious Disease Clinics of North America, 2011

In a world where profound inequalities exist, migration continues to be a fact of life. While migration enhances the diversity of nations, it also brings about a number of challenges, in particular when addressing health and social welfare. Countries are faced with the challenge of not only understanding and acknowledging the specific needs of migrant populations, but most importantly of finding the best way to meet those needs in the context of social, economic, and political pressures.

BMC public health, 2015

Asylum seekers, refugees and persons without legal status have been reported to experience a range of difficulties when accessing public services and supports in the UK. While research has identified health care barriers to equitable access such as language difficulties, it has not considered the broader social contexts of marginalization experienced through the dynamics of 'othering'. The current study explores health and health care experiences of Somali and Iraqi asylum seekers, refugees and persons without legal status, highlighting 'minoritization' processes and the 'pathologization' of difference as analytical lenses to understand the multiple layers of oppression that contribute to health inequities. For the study, qualitative methods were used to document the lived experiences of asylum seekers, refugees and persons without legal status. Thirty-five in-depth interviews and five focus groups were used to explore personal accounts, reveal shared underst...

NNRF, 2020

The human right to the highest possible standard of mental and physical health applies to everyone, regardless of immigration status. This right imposes obligations on states to provide access to good quality healthcare, as well as other areas that affect health, including good housing. Refugees and asylum seekers are considered to be members of a population who are particularly vulnerable and in need of special protection. However, many of those who live in the UK, often find it difficult to exercise their right (EHRC, 2018a; EHRC, 2018b; EHRC, 2018c). This report explores the health experiences of refugees and asylum seekers in the Greater Nottingham area, whilst aiming to identify examples of best practice and areas for improvement.

Journal of Immigrant and Minority Health, 2018

The world is currently witnessing the greatest refugee crisis of all times. 1 According to the United Nations Refugee Agency, the current number of forcibly displaced people is 65.6 million worldwide, including refugees, asylum seekers, internally displaced people and stateless persons [1]. These people live in a political limbo with very limited access to resources to meet their basic needs such as housing, healthcare, sanitation, education, and employment. Among all these problems, however, health has a special status. Literature shows that refugees have a higher rate of mortality and morbidity compared to the host community in country of asylum. They are faced with a greater risk of psychological problems, and communicable and chronic diseases. Many studies show that refugees have a higher rate of morbidity and mortality because of the situation in their country of origin and also conditions in their country of asylum, such as overcrowded refugee camps, poor sanitation and under-nourishment. In addition, they encounter barriers to access to healthcare services in host countries [2]. These barriers include language and cultural differences, discrimination from the public and from some health professionals, mistrust and financial constraints [3]. Recently the attention of the international community on refugees has increased significantly due to tragic instances such as the heartbreaking picture of a young boy drowned at the shores of the Aegean Sea or the devastating photos of women, children and elderly in inhumane conditions. However, this attention was not sufficient to solve the basic problems such as the limitations of international law to define the legal status of refugees. The governments of host countries continue not to include refugees in their national policies due to the fact that they do not reside in their country and consider them as temporary guests. The lack of formal citizenship and national bonds, still constitute the leading factors that limit the responsiveness of the national governments and international community to the Correspondence to: A. M. Ozgumus; P. E. Ekmekci. Author Contributions The article basically depends on a literature. The literature review was done by the first author, Ms. Ozgumus, with the guidance of Dr. Ekmekci. Data and statistics which may be referred are gathered by Ms. Ozgumus and Dr. Ekmekci. Then, the first version was drafted by Ms. Ozgumus and reviewed by Dr. Ekmekci, so that the ideas in the article was developed further. After that the article was reviewed and finalized by both authors. Conflict of interest We hereby indicate that there is no conflict of interest. Ethical Approval All authors have reviewed and approved the manuscript and agree with its submission to the Journal of Immigrant and Minority Health. The study does not involve any human subject. Therefore, no institutional review board approval is needed. 1 We use the term "refugee" for all people who run away from their home countries due to political unrest, war, infringement of human rights, regardless of their legal status, such as refugee, asylum seeker, stateless or person under temporary protection.

Social Science & Medicine - Mental Health, 2022

This article contributes new insights into how refugees, asylum seekers and undocumented migrants experience access to healthcare in the UK from both the perspective of caseworker volunteers and the assessment of policy regulations that influence such experiences. Drawing on material taken from qualitative interviews conducted with Doctors of the World caseworkers and Freedom of Information documents from NHS trusts, we reveal the various complexities faced by refugees, asylum seekers and undocumented migrants when trying to access vital health care. These issues include, charging regulations, the refusal to register patients at GP practices without proof of ID, language barriers and complications navigating the healthcare system. We found that such deterrents lead to risky help and health seeking, lack of or inadequate healthcare, and worse health outcomes among these populations. DOTW caseworkers perceived policies such as charging regulations, to be unjust as they plunge patients into significant debt, which is reported to the Home Office and can lead to the detainment or deportation of patients and their families. Study participants called on the UK government to recognise health as a fundamental human right, to develop inclusive social policy and to create an empathetic health system that allows refugees, asylum seekers and undocumented migrants equitable access to health and social services. To achieve health for all, they argued the need for clearer guidelines regarding access to healthcare and charging regulations, with some suggesting the importance of revising current Department of Health and Social Care policies and Home Office measures. Our article concludes that there is a need to tackle the underlying causes of ill health, including discriminatory policies, racism, and exclusion; addressing the social and economic determinants of health; and providing meaningful and culturally sensitive healthcare and social support.