Patients Not Passports

Updated: Apr 9

11 million ‘illegal’ people experience prejudicial attitudes and live under discriminatory policies, lacking access to critical health resources (Castañeda et al, 2015). In the UK, heightened immigration enforcement in recent years has led to increased deportations which have in turn decreased the health and wellbeing of many migrants; demonstrating how immigration policy can become synonymous with public health (Zaklaki, 2019). Likewise, in the US this policy in healthcare was found to exacerbate migrant vulnerability, where many doctors are compromising medical ethics by not providing care to patients in dire need (Jimenez AM, 2021).

A lot of these regressive immigration policies increase stress and obstruct access to healthcare. It is important to consider policies that shape the broader health landscapes in which immigrants live and to strive for more deeper understanding of a policy’s impact. This helps us avoid making broad generalisations of all immigrant populations (Castañeda et al, 2015). Internationally, policy making on migration has generally been conducted as separate to the health sector as they often have incompatible goals. Migrant health policy-making tends to focus on human rights and the associated service challenges.

‘Illegal’ (irregular/undocumented) migrants are individuals who enter a country without the required documents/permits, or those who overstay the authorised length of stay in a country

(Zimmerman et al, 2011)

However, poor policy conditions and contradictory policy goals, such as prioritisation of increased foreign labour whilst maintaining restrictive rights for migrants can exacerbate risk conditions related to migration health and pose extra challenges. In the past 50 years, on top of having the most limited access to healthcare, the number of undocumented migrants encountering health risks has also been on the rise (more so than other migrant groups). Migration health insurance schemes are encumbered by restrictive immigration legislation or exclude ‘illegal’ migrants and their families from coverage. Even where multilateral agreements exist, their implementation isn’t universal. (Zimmerman et al. 2011).

The 61st World Health Assembly (WHO 2008), called upon member states to

“promote equitable access to health promotion and care for migrants, to promote bilateral and multilateral cooperation on migrants’ health among countries involved in the whole migration process.”

Furthermore, in 2010 the WHO came up with key elements for it’s migrant health policy and legal framework. The three pillars to this were disease control elements; migration management/control and norms, which looked at wider human rights and international law perspectives (WHO 2010). At an international level, the document didn’t speak about legal/political issues at all. It had a very Eurocentric focus, completely neglecting the wider structural effects of migration policy makes people so vulnerable. It’s also interesting how on their website, WHO denounces any systematic association between migrants and imported communicable diseases (WHO 2018), yet has a whole section on infectious disease control from migrants in the paper.

Disease control is being used an as excuse to control migration and as a scape goat for tighter immigration restrictions. Jelinek et al (2002), found how Europeans travelling back from Malaria-endemic areas in Africa, import just as much malaria as African immigrants yet get none of the backlash. Other criticisms of these global policy processes in migrants’ health rights include that it ignores migrants' political, legal, labour, civil and sociocultural rights; that there’s a need for policy coherency across sectors and that migration policies often fail to achieve their objectives/have hidden or contradictory objectives (Castle 2004). Rogaly (2008), added that all these international processes are fundamentally in neoliberal interests which severely impacts the livelihoods of the world’s poor.

“Depending on the regional impact of immigrants and the amount of travel in the local population, data from national sources in Europe can be heavily skewed toward one or another group”

(Jelinek et al, 2002)

Nationally, the Immigration Act of 2014 changed the definition of a ‘deserving’ citizen in access to the National Health Services (NHS) in the UK. NHS providers can only legally provide healthcare to ‘legal’ migrants who deserve it. Deservingness of immigrant populations has been a relatively neglected area in academia; in fact, there has been a lack of discussion on the role of discrimination (racism/anti-immigrant prejudices) and the importance of understanding migrants' ‘deservingness’ of healthcare (Castañeda et al, 2015; Willen 2012). Migrants in the UK now have to pay surcharges for health care access and are forced into poorer living conditions which can trigger latent tuberculosis. While, undocumented migrants are now denied care. On the other hand, Spain has one of the most liberal immigration policies in the EU. After realising the economic value of migrants, Spain started to recruit legal workers from Sub Saharan African countries. At the same time, it attempted to forge agreements with various African countries for increased repatriation in exchange for greater economic and financial support. In terms of illegality, Spain has a strict expulsion policy with no legalisation for undocumented immigrants possible, many of them are kept within detention centres at the Ceuta and Melilla borders for years. (Choe, 2007; Andersson, 2014).

More needs to be done to support migrant’s health rather than increasing their morbidity. Increased outreach and community mobilisation programmes as well as health promotion addressing fear of diagnosis and the success of treatment are key to increasing HIV testing among migrants. Additional to this, is the prioritisation of the health access rights of ‘illegal’ migrants once diagnosed or who are at risk of infection. Also, more investment is needed to expand the presence of HIV testing facilities beyond just sexual health clinics, but to all health clinics to decrease testing deterrence (Fakoya et al, 2008). The European Academic Science Advisory Council (EASAC, 2007), highlighted the importance of global coordination; member states should not only work on assisting healthcare finances for migrants but should also prioritise tackling infectious diseases in the first place, to reduce the global burden of disease and risk of transmission into the country.

In light of recent events, many "illegal" migrants have died from COVID-19 due to delayed health-seeking behaviours. These delays occurring as a result from fears of deportation. The UK government is now making an open call for undocumented migrants to register with local GPs to get the COVID vaccination (BBC, 2021) which is important in efforts to end this pandemic. However, I hope this is a lesson that immigrant health is public health rather than a reason to push more aggressive conditions towards undocumented migrants.

The undocumented migrants' health is absent in global debates- where they aren’t recognised in most European health systems and where they aren’t seen as ‘deserving’ of healthcare when they are recognised. Furthermore, personifying infectious diseases to geographical locations and its people has deeply problematised health care access for the people who need it the most. Those involved in clandestine migration need to be heard and accepted; not criminalised and these issues have not even begun to be mentioned in global health debates.

Contact the author: @ludic.n

Disclaimer: the views, thoughts, and opinions expressed in the text belong solely to the author and do not necessarily reflect the official policy or position of Identity International.

Andersson, R., 2014. Illegality, Inc.: Clandestine Migration and the Business of Bordering Europe 1st ed., Oakland: University of California Press.

BBC., 2020. 'Covid: 'No deportation risk' for illegal migrants getting the vaccination.' 8th February 2021. Available at:

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Willen, S.S., 2012. How is health-related “ deservingness” reckoned? Perspectives from unauthorized im/migrants in Tel Aviv. Social Science and Medicine, 74(6), pp.812–821.

Zaklaki RD. Access to health care for illegal migrants: ethical implications of a new health policy in the UK. Br J Gen Pract. 2019 Feb;69(679):56-57. doi: 10.3399/bjgp19X700841. PMID: 30704992; PMCID: PMC6355273.

Zimmerman, C., Kiss, L. & Hossain, M., 2011. Migration and Health: A Framework for 21st Century Policy-Making. PLoS Medicine, 8(5).

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