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

Nowhere Home in Oxford

Nowhere Home by Margreth Olin

Nowhere Home by Margreth Olin

Special screening of Margreth Olin’s award-winning documentary: Nowhere Home

When: Tuesday 30th April 2013: 6.15pm introductory talk, 6.30pm screening

Where: The Ultimate Picture Palace, Cowley Road, Oxford

Organised by: Oxford Institute of Social Policy (OISP) in collaboration with the Refugee Studies Centre (RSC) and the Centre on Migration, Policy and Society (COMPAS) at the University of Oxford and the School of Social Policy at the University of Birmingham

Synopsis: Nowhere Home follows the fortunes of a number of young people from Salhus, a Norwegian centre offering temporary residence to unaccompanied asylum-seeking young people as they approach adulthood. While they all hope to remain in Norway, the threat of deportation when they turn 18—and uncertain futures in countries like Afghanistan or Iraq—hangs over them. A visceral and provocative film, Nowhere Home scrutinises what Human Rights Watch has called one of  the ‘major moral dilemmas’ facing Europe today.

Year: 2012 / 90m.

Distributor: Norwegian Film Institute

Watch the trailer online.

Tickets: £8 (£6 concessions). Online booking now open.

Proceeds go to Asylum Welcome (Charity no. 1092265)

Legal status, rights and belonging: International symposia

The analysis of the relationship between legal status, rights and belonging is the central theme of two symposia jointly organised by the School of Social Service Administration at the University of Chicago and the Centre on Migration, Policy and Society (COMPAS), the Refugee Studies Centre (RSC) and the Oxford Institute of Social Policy (OISP) at the University of Oxford.

The symposia are convened by Dr Roberto G. Gonzales  (University of Chicago) and myself .

Main Themes of the International Symposia

The events will be held respectively in Oxford in April 2013 and in Chicago in October 2013 and will address two interrelated aspects of the relationship between legal status, rights and belonging:

The symposium will investigate the interplay between forms and modes of contemporary membership, migration governance (both immigration and emigration), and the politics of belonging. This will be achieved through in-depth examinations of a range of experiences of membership including, but not limited to, those of:  ethnic minorities; citizen children of undocumented migrant parents; former unaccompanied asylum seeking children; people with dual citizenship; ‘failed’ asylum seekers; and stateless people. Participants are invited to discuss issues such as the position of the non-citizen in contemporary immigration and emigration states; the nexus between human mobility, immigration control, and citizenship; the tension in policy and practice between coexisting traditions and regimes of rights; and the intersection of ‘race’ and other social cleavages and legal status. The Oxford symposium is organised by Dr Nando Sigona (Refugee Studies Centre), Vanessa Hughes (COMPAS) & Dr Elaine Chase (Oxford Institute of Social Policy).

  • Illegality, youth and belonging  (Chicago, October 2013)

This second symposium will explore the confusing and contradictory experiences of belonging and illegality that frame the everyday lives of undocumented immigrant youth. Over the last two decades in the United States, non-citizens have experienced a shrinking of rights while immigrant communities have witnessed an intensification of enforcement efforts in neighbourhoods and public spaces. In effect, these trends have sewn fear and anxiety and narrowed the worlds of youth—such that even mundane acts of driving, waiting for the bus, and traffic stops can lead to the loss of a car, prison and deportation. But these young people have also benefited from local and national efforts to widen access—particularly in the realm of education—providing young immigrants important opportunities to establish connections, form relationships, and participate in the day-to-day life of their communities. The experiences of undocumented immigrant youth teach us about the two-sided nature of citizenship—such that persons can be removed from spaces, denied privileges and rights, but can experience belonging too.

Collectively this joint initiative aims to break new ground through analyses that are empirically informed, theoretically engaged and ethnographically rich and drawing on the expertise of scholars from a range of disciplinary backgrounds and state contexts. As immigration has become a topic of great visibility among scholars, policy makers, and the media, this endeavour holds appeal to a range of audiences. Read the Background paper & Call for Papers

Operation Mayapple: Another name & shame campaign from the UK government

A few years ago the Labour government launched a name & shame campaign against employers who employed undocumented migrants and fined them with up to £10,000 for each worker. More recently the coalition government has employed a similar strategy to tackle tax avoidance . Following what must be deemed a successful model, in a similar fashion today the Home Office Border Agency is advertising the results of its latest law & order campaign named Mayapple started in May this year. The campaign is mostly a PR operation that comes after a series of fiascos in migration and border management (some self-inflicted as in the case of the ‘net migration’ policy) that have seriously affected the reputation of the Home Office and its Border Agency.

Video and photo cameras were sent with UKBA officers to film ‘law & order’ operations (maybe inspired by the experience accumulated with the participation to the UK Border Force TV series).

However, this is not a PR operation for the 2000 migrants who having overstayed and/or breached the terms of their visas had to return home.  One third was made of Indian citizens. The rest were mostly from Pakistan, Nigeria, China, Bangladesh and Brazil.

One is left wondering if there is any rationale behind these countries of origin. A devil’s advocate may argue that there is not one rationale but three. To maximise impact and minimise troubles, the ‘illegal migrants’ were carefully cherry picked according to the following criteria: a) no women and no children because human rights activists could make a fuss; b) no citizens of rich and wealthy allies (i.e. US, Canada and Australia) because their embassies could raise a few eyebrows; c) no white people because they don’t fit the stereotype of the ‘illegal’ migrants, and, added benefit, the choice would please a section of the right-wing electoral body.

There is also a further aspect to consider. As shown in an excellent piece published in the Brixton Blog, the Operation Mayapple doesn’t affect only the ‘illegal migrants’ who are eventually removed or the approval rating of  Damian Green, local residents in areas that have been targeted by UKBA’s raids feel criminalised and angered by UKBA’s heavy-handiness during the arrests. After last year’s riots, the Home Office should be wary of exacerbating community relations to achieve short term political gains.

120000 migrant children fall through the net: new report

An estimated 120,000 children living in the UK without legal immigration status are at risk of destitution, exploitation and social exclusion because of contradictory and frequently changing rules and regulations which jeopardise their access to healthcare, education, protection by the police and other public services, a new report published today by the University of Oxford shows.

The report No Way Out, No Way In: Irregular migrant children and families in the UK is published by the ESRC Centre on Migration, Policy and Society (COMPAS) at the University of Oxford. It shows that irregular migrant children – more than half of whom were born in the UK and have lived here their entire lives – are being trapped between laws protecting children and the enforcement of migration control.

Dr Nando Sigona, the report’s main author, said: “Current immigration policy seems to override the concern for children’s rights. Nobody, not the public, nor the children or their families, benefits from this”.

Both international and British laws guarantee children access to education and healthcare, irrespective of their immigration status, and oblige public authorities to work in the children’s best interests. But increased demands on public authorities by the UK Border Agency – such as asking social services to report suspected irregular migrants – are pushing families and children away from essential services, leaving them more vulnerable and isolated. This can also mean that children and their families who are victims of serious crime may be afraid to report it to police because of their fears about their immigration status.

Frontline professionals like GPs and teachers are increasingly being asked to check the legal status of children in their care. Not having legal status can mean the children either don’t go to school or can’t participate fully. It also means they may not be able to register with a GP or that pregnant mothers who lack legal status may avoid antenatal and postnatal care for fear of being reported to UKBA.

Dr Paramjit Gill of The Royal College of General Practitioners stated: “Having a large group of young people without access to healthcare has significant public health implications such as missing out on routine immunisation and screening programmes”.

Dr Sigona said: “The point of the report is to identify the situation that these children are in, and the difficulties that this places on the public service providers with whom they come into contact. Teachers, GPs and social workers should be allowed to do their jobs without having to act as de facto immigration control officers”.

Through a vivid portrait of children’s everyday lives, the report shows the profound extent to which the immigration system can affect the health and educational achievements of irregular migrant children from an early age, and seeks to contribute to the policy debate on how to reconcile the protection of children’s rights and migration control for the benefit of both the children and British society more broadly.

Ilona Pinter, Policy Advisor on Young Refugees and Migrants, The Children’s Society said: “This research shows the harsh reality facing tens of thousands of undocumented migrant children across the UK. Denying families access to support and vital services is leaving children hungry, homeless and destitute. Regardless of their immigration status, the government has a responsibility to protect all children in the UK”.

Finally, considering that children who were born or spent most of their childhood in the UK are unlikely to be deported, and the potential negative impacts on British society of a long term excluded population, the report recommends policy makers to provide effective pathways for irregular migrant children to regularise their legal status.

About the report

The study was carried out by a research team at the ESRC Centre on Migration, Policy and Society (COMPAS). It was funded by the Barrow Cadbury Trust and was part of a comparative research project in collaboration with the Institute for the Study of International Migration (ISIM) at Georgetown University (USA). The research team conducted their qualitative study over two years, interviewing 49 irregular migrant families from Jamaica, Afghanistan, China, Brazil, Nigeria and ethnic Kurds reaching in total over one hundred minors, and carrying out 30 interviews with public service providers (teachers and GPs), local authorities, policy makers and support organisations.

About the authors of the report

Dr Nando Sigona, the main author of the study, is Research Associate at the ESRC Centre on Migration, Policy and Society (COMPAS) and Senior Research Officer at the Refugee Studies Centre,both at the University of Oxford. His main research interests include: irregular and child migration, asylum in the EU, Roma politics and anti-Gypsyism in Europe, and the relationship between migration, citizenship and belonging.

Vanessa Hughes is Research Assistant at the ESRC Centre on Migration, Policy and Society where she contributes on a number of research activities and projects on irregular and child migration, migrant integration in the EU, citizenship, and urban change.

Asylum, development aid and conditionality

In recent communications on asylum and migration, the EU Commission has fully embraced the idea that ‘migration management’ and EU development policy should go hand in hand. Leaving aside the validity of the wide-spread assumption that successful development policies lead to less migration (see Hein de Haas’ post for an insightful discussion of this point), the recent documents consolidate the shift towards establishing a direct nexus between development aid and immigration policing, with the EC seems endorsing unproblematicly the contested and contestable idea that development aid should be made conditional to would-be beneficiaries’ assistance in return and repatriation of ‘unwanted’ immigrants. This approach was a topic of lively confrontation in Tony Blair’s Cabinet in the 2000s. I’ve recently interviewed a former Labour MP and Cabinet Minister who recalls that ‘there was a big row in the government about using development money to force governments to take back asylum seekers. […] Blair was determined to make aid conditional and was arguing that ‘the whole international system needs updating’. This became an issue for discussion at some EU summits and Sweden fought very hard against it’. Nowadays conditionality seems fairly established in EU circles. Blair is no longer the PM, but also Sweden is no longer the same.