Healthcare of undocumented migrant children

[Article published in the Runnymede  Bulletin Spring 2013]

 Nando Sigona analyses the predicament of undocumented migrants and the way the uncertainty and stress of the family struggle, as well as restricted access to healthcare services, impact the mental and physical well-being of the children.

Cover, Runnymede Bulletin, Spring 2013

Cover, Runnymede Bulletin, Spring 2013

Meeting the health needs of a growing and super-diverse, foreign-born population in the UK is a challenge for health services. However, these needs are currently only partially acknowledged and addressed.

Government policy has focused largely on addressing ethnic inequality in health, leaving aside other factors that may have an impact on migrants’ health needs and experiences of the healthcare system, such as country of birth, language, length of residence in the UK and immigration status. The Confidential Enquiry into Maternal and Child Health is a case in point. While it showed that about 20 per cent of deaths directly or indirectly related to pregnancy occur in women with poor or no antenatal care, it failed to consider that one of the main deterrents to access maternity care may be the policy of charging “non-ordinarily resident” patients that was introduced in 2004. Significantly, the Department of Health did not carry out a health impact assessment of the new rules.

According to Maternity Action, “charging women for maternity care has the effect of deterring women from accessing care, irrespective of formal rules requiring care to be provided even if the woman cannot pay in advance”. Many women are not prepared to take on a debt which they are unable to pay and consequently limit accessing services until delivery.

This is further exacerbated by current initiatives aimed at directly linking debt incurred with the NHS to entitlement to gain legal access to the UK. Similarly, research has focused on the health needs and outcomes of specific categories of migrants, such as refugees, asylum seekers, unaccompanied minors, and thus paying significantly less attention to other categories, such as undocumented migrants, including children.

Drawing on research that my colleagues and I carried out at the University of Oxford (2010–2012) and which was funded by the Barrow Cadbury Trust, I will try to highlight, through the testimonies of undocumented parents, some of the impacts of that the lack of legal immigration status has on children’s health status and access to healthcare.

The combination of precarious immigration status, restricted access to healthcare, and financial hardship often has serious effects on migrants’ physical and mental health and can result in chronic conditions such as asthma, migraines and depression. Michelle, a Jamaican mother, explained how her immigration status affected her:

Mentally, it’s really bad. We’re just sitting here, staring, wondering where the next meal is going to come from, when the next bill is going to be paid.

The precarious situation that many undocumented parents experience often means that any change in their situation or negative experience can easily lead to a downward spiral. Talking about her father’s funeral in Jamaica, Jackie, a mother of three, said:

Everyone was like going over, I couldn’t go… my sisters, brothers, they all went over. I was the only child that wasn’t there. I couldn’t eat, couldn’t do nothing.

Seventeen out of 53 interviewees in the Oxford study, both parents and independent migrant children, reported mental health issues that were associated with stress linked to their immigration status. However, signs of stress, exhaustion, anxiety and other impacts on health due to financial and immigration status insecurities were noticeable in most interviews. The majority of the interviewees who explicitly talked about their mental health problems were parents. A number of them reported that they were treated with anti-depressants and/or counselling during pregnancy.

Reasons given for feeling depressed or “low” included fear of being deported or detained, not knowing what will happen in both the near and the distant future, not being able to talk about their problems, losing support networks, or not having any support in the first instance and thus feeling isolated, and being in inadequate accommodation arrangements. Princess, a Jamaican mother of two, explained the uncertainty that she experienced on a daily basis:

At the end of the day, you don’t know. It’s like in your heart you’re wondering ‘is someone going to knock at your door? Is someone going to knock at your door?

Parents’ mental health status has repercussions on children. In the study, we observed that this effect often became circular, in that the parent then again worried about their children being affected by their situation. A young mother explained:

When I’m crying she always catches me, even when I don’t want her to see me. ‘Mum, what’s wrong? Why are you crying? Don’t worry, don’t worry. It will get better, I’m gonna pray. Don’t worry.’ You know, when an eight-year-old says that to you ‘it will get better’ it breaks your heart more, it breaks your heart more.

A Kurdish mother spoke out her concern for the wellbeing of her children who had already experienced detention and deportation and had to witness how she was sat down on the floor and handcuffed by the police:

The children were looking into my eyes, they were distraught. I mean the things we went through in the five years, when we came and when we went.

Read the full report: No way out, no way in: Irregular migrant children and families in the UK

UK immigration policy: we need to talk about citizens (and citizenship)

[Article published in OpenDemocracy 50:50 on 4 February 2013]

The family rules introduced by the UK government as part of its crusade to curb net migration are surreptitiously redefining the meaning of citizenship and the boundaries between the state and its subjects, says Nando Sigona.

There is nothing new about seeing immigration and immigrants used as scapegoats for popular anxiety or as a diversion from the economic crisis (see the significant following of Golden Dawn in Greece). It is even less surprising to see politicians mobilize electoral support around the moral panic surrounding new immigrant arrivals (see lately the terms and tone of the debate on potential new arrivals from Romania and Bulgaria). Still, the new immigration family rulesintroduced last summer shed light on a less visible side of immigration policy and practice: the permeability and historically contingent nature of the boundaries between citizenship and non-citizenship and the concrete ways immigration rules produce and shape not only the position, entitlements and experiences of non-citizens in society, but also the very meaning of what citizenship is and of what being a citizen entails.

The conversation on migration seems to be mainly focused on the consequences of human mobility, polarised between those campaigning for migration and migrants’ rights on the one hand, and those concerned with the impact of migration on public services, social cohesion and security on the other.  Less attention is afforded to the impact of immigration governance on migrants and even less on citizens. There are some noticeable exceptions, as demonstrated by recent work carried out at the University of Oxford. Researchon undocumented migrant children in the UK shows how, despite both international and British laws which guarantee children access to education and healthcare irrespective of their immigration status, increased demands on public authorities by the UK Border Agency (UKBA) are pushing children and families away from essential services, leaving them more vulnerable and isolated. Similarly, Bridget Anderson’s latest book examines how the ‘dangerous politics of immigration control’ shapes the relationship between Good CitizensFailed Citizens and Non-Citizens.

UK citizens are becoming used to the gradual and pervasive penetration of UKBA into their hospitals, GP practices, universities, colleges and schools; the turning of public services into outposts of immigration enforcement. They are becoming used to being asked to present a valid visa or passport when applying for a job, or to sign a register used to assess whether they are a ‘bogus’ or genuine student when attending a lecture. These practices have become the norm for all, immigrants and citizens alike, and up to now they have faced relatively little opposition.

Initiatives such as the National Allegations Database, which encourages the public to act as UKBA informers through spying on their neighbours, or on anyone who they think, for whatever reason, might be residing illegally in the UK, have moved the bar even further, subcontracting an important task of immigration control to law-abiding citizens. Information collected via the database is to be processed by new privatized immigration officers working for Capita plc.

While this attempt to stretch immigration control well beyond the control of external borders into public services seems to be the dominant trend, there are also signs that this approach may turn out to be both politically and administratively unmanageable. The frequent scandals that have seen the UKBA and its sister agency UK Border Force accused repeatedly of poor efficacy and transparency, despite management reshuffles and various rounds of restructuring, highlight the limits of a bureaucratic apparatus that is overgrown through successive layers of legislation. These constant reforms have left behind a complex machinery, full of incongruences that make it not only extremely difficult to manage but also vulnerable to legal challenges from multiple sides.

There is nevertheless an element of novelty to the way the new family rules, almost as a side effect, intervene and interfere in one of the most intimate and private spheres of a citizen’s life. This raises important questions concerning what exactly it is that the government assesses when evaluating the impact of immigration policy, and how it defines (rather narrowly) the ‘main affected groups’ in a way that consciously leaves aside an analysis of the unequal impacts of its measures on citizens and citizenship.

The introduction of the new family policy has made family reunion for citizens and migrants with non-EU partners more difficult, and subject to a complex and time-consuming procedure which can take months to complete. This has obvious consequences for relationships, and particularly for children. The rules set a new minimum income threshold of £18,600 for bringing to the UK a spouse or partner, fiancé(e) or proposed civil partner of non-EU nationality, with an even higher threshold depending on the number of dependent children. These measures are part of the UK government’s grand plan to curb net migration to ‘the tens of thousands rather than the hundreds of thousands’, in the words of British Prime Minister David Cameron. The use of net migration, that is the difference between in-migration and out-migration, as a compass of immigration policy is highly questionable and has been criticised on a number of grounds, not least because it relies on the level of emigration, an independent variable that is not directly or significantly affected by immigration policy.

There is also a further aspect to consider. As Agnes Woolley has explained, the immigration rules do not impact all citizens in the same way. The analysisof the University of Oxford’s Migration Observatory clearly shows that some groups of citizens are affected significantly more than others, including the more than 40% of British people in employment who do not qualify due to their low income. Those who will not qualify are mainly women, young people in their twenties, or residents of Wales, Merseyside, North West England, and Yorkshire and Humberside. A look at the recently released Census dataconfirms that there are a very large number of UK citizens from a variety of social backgrounds who increasingly live in mixed status families who could be impacted by the new family rules. If we turn numbers into words, we could say that the government’s goal to control immigration and immigrants has become a vehicle for class politics, or, perhaps more crudely, that the citizenship rights of many Britons are being threatened by a policy designed to serve the interests and visions of a London-centric, ageing, male-dominated elite.

Families directly affected by the new rules are starting to speak out in an effort to create public interest and support. Stories are beginning to surface of families torn apart by the new rules, of young couples no longer able to live together, of children separated by one of their parents, of elderly family members left behind in order to comply with the new rules. Many of these stories are being collated in a new blog entitled BritCits, the name of which is in itself revealing, suggesting as it does an analysis of the devastating impact of these new immigration policy from the perspective not of would-be entrants, but of British citizens. The inefficiency of the system is also back under public scrutiny following the recent revelation of yet another backlog; victims here include wealthy British citizens kept away for months from their American wives because applications are sitting in boxes unopened. These stories challenge unspoken assumptions regarding who it is that is the target of immigration policy, and also who should feel the urge to oppose them. This realisation may ultimately succeed in creating a larger social movement against effects and side effects of current immigration policy which, in contrast to an immigration discourse that polarises immigrants and citizens, unites them in a common cause.

Education, migration and mobility: conference

In what ways does the condition of undocumentedness impact on migrant children’s access to, and experiences of education? How do teachers engage with these children? To what extent, if any, current immigration enforcement practice penetrate school premises? Vanessa Hughes and I gave a paper at the British Association for International and Comparative Education (BAICE) conference in Cambridge (Churchill College, 8-10 September) around these questions based on the material we collected during our research on irregular migrant children and families in the UK. We also took the opportunity to distribute a few hard copies of the report and executive summary. An article addressing the same questions is in preparation.