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

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

King Nigel’s Speech: recasting ‘us’ and ‘them’

[Article published in OpenDemocracy, 13 May 2013)

In the UK political debate, boundaries are being blurred between the two hot topics on the political agenda: migration and the EU. This should be a wake-up call for the 2.7 million European immigrants living and working in the UK, says Nando Sigona.

Nigel Farage, UKIP leader

Written by the government and delivered by the reigning monarch, the Queen’s speech sets out the legislative agenda for the year ahead. As expected, David Cameron, the UK Conservative Prime Minister and his coalition government have used this year’s Queen’s speech to offer a quick if rather panicked response to the recent electoral success of the UK Independence Party (UKIP) which gained 139 council seats in the 2013 local elections.

The speech places immigration firmly at the centre of the political agenda, as if the crisis of the banking system and a poorly performing economy didn’t exist or could be attributed through some rather obscure association to the presence of non-British residents. As Alex Andreou has explained in a comment in the New Statesman, Nigel Farage, leader of UKIP, ‘has merely acted as the catalyst, by stepping into an emotional vacuum left by mainstream parties’, providing a comforting but ultimately useless solution to the current crisis at a time when mainstream parties are all perceived as distant, elitist and impermeable to what is happening outside Westminster. What the Queen’s speech did is to legitimate the anti-immigration and anti-EU rhetoric of UKIP as a solution to the crisis, something that the Conservative Party right-wing had failed to achieve until now.

Besides the headline-grabbing statements against illegal migrants, speeding deportation for foreign-born criminals and fighting alleged abuses of the welfare system, the Queen’s speech is underpinned by a wider vision which at the core criminalises migrants and migration to an extent we hadn’t previously observed in recent mainstream British politics. This criminalisation also extends to EU citizens, until recently kept relatively protected from anti-immigration campaigners and politicians. This is with the noticeable exception of Romanians and Bulgarians, whose possible arrival following the lifting of the existing restrictions on access to the job market and welfare system in early 2014 is generating waves of moral panic.

By associating intra-EU mobility more closely to immigration, the Queen’s speech blurs the boundaries between the two hot topics on the political agenda: migration and the EU, and turns the moral panic generated by the arrival and settlement of Romanians and Bulgarians, the ‘new’ Europeans to paraphraseformer US Defense Secretary Donald Rumsfeld, into yet another argument in support of Eurosceptic politics.

As a researcher working on migration, asylum and minority rights for over a decade, I am familiar with the rising criminalisation of asylum seekers in the UK: the use of enforced destitution, dispersal and detention to deter new arrivals and force those no longer entitled to stay to leave the country. Furthermore, I have documented the plight of undocumented children and young people kept in legal limbo, non-deportable and yet excluded from formal citizenship.

As a foreigner myself, an EU citizen who has lived in the UK for the last 12 years, I feel increasingly uncomfortable with the tone and contents of the debate on immigration. I feel more and more part of the population I study, experiencing personally some of the feelings and anxieties that I am used to hearing from the individuals I interview.

Of course, this is not to say that as an Italian I go through the same ordeal as, for example, that of someone seeking asylum in the UK. But I can certainly say that over the last year or so I have felt increasingly more like an immigrant to whom the right to reside in the UK is granted from above (and can be withdrawn if needs be for electoral considerations) than an EU citizen, that is, part of a pan-European political community founded on the principles of freedom of movement and equality among its citizens.

With this realisation came a renewed sense of empathy for those non-EU migrants who on a daily basis have to negotiate or subject key decisions in their personal life to a faceless bureaucrat somewhere in Croydon (i.e. the UK Border Agency’s HQ) who can decide if a marriage is legitimate, if one can go to a funeral back home, or if a non-British father can be with his British partner at the birth of their child in London. For Romanian and Bulgarian migrants the boundary between being an immigrant and an EU citizen has already been blurred for a while, long before the so-called ‘old’ Europeans.

According to the Oxford-based Migration Observatory, data from the 2011 Census suggest that 2.7 million residents of England and Wales were born in other EU countries. About 1.1 million of those (41%) were born in countries which joined the EU in 2004 (Cyprus, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Malta, Poland, Slovakia, and Slovenia) or afterwards (Bulgaria and Romania). The majority of the EU citizens are therefore people like me (and it feels awkward to talk of myself in terms of my nationality): Italians, Germans, Spaniards, French, Greeks etc.

Until recently, one wouldn’t have heard politicians talk about ‘us’ in the same breath with the ‘other’ foreigners, but the economic crisis and a government in search of scapegoats are changing the terms of the debate. This is a wake-up call for many who felt that the tough talk on immigration was never about them, that somehow they were bullet-proofed from attacks by right-wingers and alike. In other words this is a wake-up call for a largely politically invisible population, with no right to vote at general elections, no spokespersons or campaign organisations, but also with rather powerful states behind them and relatively good social positions in British society.

We may realise soon that all mainstream political parties, faced with the challenge of UKIP, may be prepared to sacrifice us for the sake of electoral victory. For if the Queen’s speech marks a further shift towards the right of the political spectrum of the political debate on immigration, the Labour opposition demonstrates once again little will to fight the battle for immigrants and immigrants’ rights, as well as for the EU and EU citizens. The shadow minister Yvette Cooper more often than not attacks the government for not being able to control immigration and borders, as confirmed recently in a major speech at the Institute for Public Policy Research (IPPR). It’s hard to see how these tactical responses may lead to a different strategy and new ways of thinking on migration.

The Queen’s speech has thus contributed to redrawing the boundaries between ‘us’ and ‘them’, and for some of us this came as a realisation that the position we thought to occupy in British society as fellow EU citizens is gradually being eroded by a dangerous combination of anti-foreigner and anti-EU sentiments. This is happening without much opposition. Times of crisis also bring new opportunities. New spaces for political mobilisation may yet open up and lead to the emergence of new political subjects in British politics: ‘old’ and ‘new’ Europeans fighting back.

 

Nowhere Home in Oxford

Nowhere Home by Margreth Olin

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

When: Tuesday 30^th 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)

Cui prodest? On the Home Office proposal to toughen visa requirements for Brazilians

Theresa May (official picture), Home Office

Current disagreement within the Cabinet on the Home Office proposal to toughen visa requirements for Brazilian migrants and visitors highlights a deeper tension around the government’s strategy on immigration – the ruthless pursuit  of the ‘net migration’ target by the Home Office while recently successful in its own terms, produces short term gains that are hardly shared with other government departments. Diplomatic (Foreign Office) and economic (Treasury) considerations would suggest a different and less insular approach to migration that shows a better appreciation of the interconnectedness of migration to other national interests and agendas. The proposed measure would do little to reduce the population of Brazilian undocumented migrants currently in the country, but much to damage the relationship with a strategic partner of the UK.