Healthcare as an Act of Resistance: Social Work with Undocumented Migrants in Médecins Du Monde

• In Event: Health Social Work with Precarious Groups

Abstract

The aim of this paper is to unravel how social work takes shape, as a human rights profession, in settings of medical humanitarianism with undocumented migrants.

The persisting health inequalities between and within societies put pressure on the highest attainable standard of health as a fundamental human right (Mackenbach et al., 2008). For groups on the margins of society, these disparities are significantly amplified. Undocumented migrants – including those rejected as asylum seekers, overstaying their residence permits or entering a country without documentation – find themselves in an immensely precarious position. Compared to those considered citizens within the borders of the nation-state, they have no or limited claim to the social rights, policies and services through which welfare states aim to guarantee an acceptable standard of living for their productive and legal residents (Könönen, 2018).

In Europe, undocumented migrants should, at minimum, have access to emergency care. However, the policies regulating healthcare for this group differ vastly between member-states (Cuadra, 2012). Despite their legal entitlement to care, the barriers experienced by undocumented migrants to meet this basic human right are manifold and span across the policy arena, the healthcare system and the individual (Hacker et al., 2015). Moreover, increasingly restricting non-citizens’ access to healthcare has become part of wider strategies to dissuade people from irregularly crossing borders (Düvell & Jordan, 2002). In this context, there is growing evidence that undocumented residency contributes to significant health inequalities and injustices (Lafaut, 2023). As a result, medical care for undocumented migrants is largely left in the hands of humanitarian NGOs (Castañeda, 2011).

In light of these crises, Médecins Du Monde – a medical humanitarian NGO – has deliberately expanded its place of practice from distant sites of suffering to include well-resourced welfare states with developed healthcare systems. Within this shift of ‘domestic humanitarianism’, there is an active investment in the non-medical skills and expertise of social workers (Hanrieder & Galesne, 2021). Yet, the profession’s roles and contributions have hitherto not been elucidated in these, nor similar, settings of medical humanitarianism.

In this paper, I therefore present my – currently ongoing but finished by the conference date – qualitative research on social work in Médecins Du Monde in Antwerp, Belgium. More specifically, I shed light on what it means for social work to be a human rights profession with people largely finding themselves outside the purview of the welfare state. Drawing on critical and humanitarian literature, preliminary findings illustrate how social workers in these contexts resist and counteract the situations of ‘bare life’ (Agamben, 1998) and ‘necropolitics’ (Mbembe, 2019) imposed on undocumented migrants in contemporary nation-states. In doing so, I contribute to the scarce research on social work with undocumented migrants and within humanitarian NGOs.

References

Agamben, G. (1998). Homo Sacer: Sovereign Power and Bare Life.
Castañeda, H. (2011). Medical Humanitarianism and Physicians’ Organized Efforts to Provide Aid to Unauthorized Migrants in Germany. Human Organization, 70(1), 1-10. https://doi.org/10.17730/humo.70.1.a16566172p238244
Cuadra, C. B. (2012). Right of access to health care for undocumented migrants in EU: A comparative study of national policies. The European Journal of Public Health, 22(2), 267-271. https://doi.org/10.1093/eurpub/ckr049
Düvell, F., & Jordan, B. (2002). Immigration, asylum and welfare: The European context. Critical Social Policy, 22(3), 498-517. https://doi.org/10.1177/026101830202200307
Hacker, K., Anies, M., Folb, B. L., & Zallman, L. (2015). Barriers to health care for undocumented immigrants: A literature review. Risk Management and Healthcare Policy, 8, 175-183. https://doi.org/10.2147/RMHP.S70173
Hanrieder, T., & Galesne, C. (2021). Domestic humanitarianism: The Mission France of Médecins Sans Frontières and Médecins du Monde. Third World Quarterly, 42(8), 1715-1732. https://doi.org/10.1080/01436597.2021.1916393
Könönen, J. (2018). Differential inclusion of non-citizens in a universalistic welfare state. Citizenship Studies, 22(1), 53-69. https://doi.org/10.1080/13621025.2017.1380602
Lafaut, D. (2023). AUTONOMY WITHOUT BORDERS? UNDERSTANDING THE IMPACT OF UNDOCUMENTED RESIDENCE STATUS ON HEALTHCARE RELATIONSHIPS IN BELGIUM.
Mackenbach, J. P., Roskam, A.-J. R., Schaap, M. M., & Menvielle, G. (2008). Socioeconomic Inequalities in Health in 22 European Countries. N Engl j Med, 14.
Mbembe, A. (2019). Necropolitics.

Author

• Didier Boost, University of Antwerp, Center for Research on Environmental and Social Change