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

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

Globalisation, rights and the non-citizen

The latest issue of Sociology on the sociology of human rights includes a review essay I wrote on ‘Globalisation, rights and the non-citizen’. The essay takes as a starting point three recently published monographs that, through the analysis of three groups of non-citizens – respectively asylum seekers (Lydia Morris), refugee children (Halleli Pinson et al.), and migrant sex workers (Rutvica Andrijasevic) – examine the tension between two coexisting traditions and regimes of rights, those nested in the nation-state and its institutional apparatus and those available to all human beings by virtue of their shared humanity and increasingly institutionalised at international and national levels. You can read the review essay here: http://soc.sagepub.com/content/46/5/982.full.pdf+html

Is the UK government serious about protecting human rights?

by Nando Sigona

For those who have been following the UK government’s relentless undermining of the Human Rights Act (that incorporates the EHRC in the UK legal system) over the last months, its grand commitment to ‘the promotion and protection of human rights’ at the top of the UK’s agenda during its Chairmanship of the Commettee of Ministers of the Council of Europe  (November 2011 – May 2012) will definitively have a bitter sweet taste. It seems hard to reconcile the coexistence of such divergent positions within the same government. It springs to mind the so-called catgate when the Secretary of State for Justice, Kenneth Clark, publicly contested the Home Secretary, Theresa May, for caricaturing yet again the Human Rights Act in her speech at the annual conference of the Conservative Party. As a refresher, in her speech, Theresa May said:

We all know the stories about the Human Rights Act. The violent drug dealer who cannot be sent home because his daughter – for whom he pays no maintenance – lives here. The robber who cannot be removed because he has a girlfriend. The illegal immigrant who cannot be deported because – and I am not making this up – he had pet a cat.

Mr Clark called Theresa May’s claim ‘laughable’ and ‘childlike’, causing havoc among Conservative colleagues and cheers among human rights advocates – incidentally no wonder the Daily Mail took it personally as it they has been running similar stories for years.

The row was solved within a couple of days. Were the ministers’ positions not so irreconcilable at the end of the day? A closer look at Kenneth Clark’s response may provide some clue. He said:

They [the cases Theresa May had referred to in her speech] are British cases and British judges she is complaining about. I cannot believe anybody has ever had deportation refused on the basis of owning a cat.

It seems that Clark’s main complain is for the Home Secretary’s disrespect for the British judicial system rather that for the Human Rights. He is keen to claim the Britishness of these cases that to him (as a Justice Secretary) is an unquestionable guarantee of fairness vis-à-vis what happens abroad instead.

If we take this a step further and return to the UK’s list of priorities for the Chairmanship of the Committee of Ministers of the Council of Europe, the details of the measures for which the UK will seek consensus to implement its main goal to promote and protect human rights give some insights on the matter: first, limit the involvement of the Court to ‘the most important cases’ making it subsidiary ‘where member states fulfil their obligations under the Convention; second, transfer the primary role for the implementation of ECHR to national courts.

It is apparent that we are seeing here a novel permutation of an argument very familiar to Cameron’s government, namely ‘we will get our sovereignty from international/European institutions back ’. But in order to succeed, the Justice Secretary cannot afford a wholesale attack on the European Human Rights Convention, on which the Council of Europe is based. This would certainly antagonises the members of the Council of Europe and reduces sharply the chance of success. The handling of the Dale Farm’s case has already raised some concerns internationally that the government had to patch up. It is therefore legitimate to wonder if Kenneth Clark’s stance in the catgate was merely tactical and ultimately he shares with Theresa May more than the catgate left people believe.