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

TEDxEastEnd 2012

TEDxEastEnd 2012 is an opportunity to explore the realities and ideas around our increasingly interconnected world – how we can take advantage of the benefits this produces and tackle the simultaneous challenges it presents.  The line-up of the forthcoming event on Sat 13th October is impressive and I gladly accepted the invitation to join the list of speakers. My talk is scheduled at the end of the second segment (around 5pm). Tickets for TEDxEastEnd are sold out but the event will be broadcasted in live streaming from 2-7pm.

The story of Jo waiting for a future

From ‘Positive Contributions: Being a Refugee in Britain’ by Nando Sigona and Andreea R. Torre

In the mid-2000s, I carried out a piece of research for the Refugee Housing Association on the everyday lives of refugees and asylum seekers in Britain. At the time, the ‘bogus asylum seeker’ was in the news on a daily basis; moral panic on asylum was widespread and the Labour Party was struggling to come to term with a politically poisonous issue.

I set to investigate the positive contribution that refugees bring to Britain. The main aim was to offer an alternative image to counter hegemonic negative views, but I also wanted to avoid reproducing simplistic representations of refugees either as (voiceless) victims or unattainable political heroes. The kind of positive contribution I was looking for was very much mundane, ordinary and understated. The main aim of this report was to show, through their voices (drawings and photos), that refugees and asylum seekers contribute positively to British society, not just in economic terms but also, and above all, socially and culturally.

The report ‘Positive contributions: Being a refugee in Britain’ develops the idea of positive contribution in three main directions:

  • refugees enrich British society through their presence by multiplying points of view and creating an attitude that is conducive to questioning assumed truths and credos
  • their knowledge, skills and resources enhance society as a whole when they become part of our common shared values and culture
  • forced migration is a result of highly interrelated social and economic processes occurring at global level. As individuals living in ‘our midst’ refugees, asylum seekers and forced migrants bring direct and actual experience of these processes to society

One of the twenty refugees I interviewed was Jo, a Catholic, Georgian, Kurdish and former Soviet citizen. In his previous life, he was a journalist, a human rights activist, an interpreter and, years ago, a soldier in the Soviet army. In 2001 he went to a party in Tiblisi. There were many important people there. Someone took a photo of him speaking with a Vatican envoy. The authorities didn’t like it and he was arrested and tortured for two weeks. His organisation was banned. When he came out of prison he was told to leave the country. He applied for asylum in Britain in 2002. His case was rejected by the Home Office. He appealed but for the next three years didn’t hear back. When I met him he put on the table a large folder with papers, photos, newspaper cuts.

What have I been waiting for? Can you explain it to me, please?

He said and showed me a letter he had just received from the Asylum and Immigration Tribunal saying that, because the notes taken at his first interview at the Home Office were illegible, his appeal had been frozen for the past three years. This is one story like many one can hear from people who have been through the asylum system, of a life left in standby, of legal limbo and precariousness. But there is also something else, a question I asked myself at the time and that didn’t find an answer yet:

How could the Home Office refuse his application for asylum in the first instance if the notes taken at the interview were unreadable?

L’Union européenne et les Roms : pauvreté, haine anti-Tziganes et gouvernance de la mobilité

Lors d’une récente communication au Parlement et au Conseil européen, la Commission européenne (2011) est revenue sur la question des Roms, suite aux événements relatifs aux expulsions de Roms roumains par la France l’été dernier. Cette intervention était très attendue car la Commission avait jusque là évité de prendre position sur ce sujet, laissant l’initiative aux États membres. Cette réticence était d’autant plus marquée lorsque les Roms résidaient dans les États membres les plus riches. […]

Extract from: Sigona, N. (2011) “L’Union européenne et les Roms : pauvreté, haine anti-Tziganes et gouvernance de la mobilité”, Cultures & Conflits, 1/2011 (n° 81-82), p. 213-222. URL: www.cairn.info/revue-cultures-et-conflits-2011-1-page-213.htm.