The recent and ongoing refugee crisis in Europe highlights conflicting attitudes about the rights of migrants and refugees to health care in transition and destination countries. Some European and Scandinavian states, such as Germany and Sweden, have welcomed large numbers of migrants, while others, such as the U.K., have been significantly less open. In part, this is because of reluctance by certain national governments to incur what are seen as the high costs of delivering aid and care (...) to migrants. In response to these assumptions, some theorists have argued that the appropriate way to view the health needs of migrants is not in terms of rights, but in terms of the interests of destination and transition countries—and have argued that providing care to migrants and refugees will generate benefits for their host countries. However, self‐interest alone is less effective at motivating the provision of care for health deprivations that do not pose a threat to third parties, or to migrants and refugees in poor or distant countries. In this paper, I argue that while self‐interest is unlikely in itself to motivate the provision of all necessary health care to all migrants and refugees, and may risk stigmatizing already vulnerable persons, it can provide the foundation upon which such motivations can be built. My goal is therefore to show how and why a more just approach to the provision of health care to migrants can and should be derived from narrower, self‐interested commitments to preserving citizen health. (shrink)

According to the Constitution of the Republic of Poland, every citizen has the right to health care. Unfortunately, some disadvantaged or minority groups have difficulties accessing a general practitioner, psychologist or other specialists in broader medical care. The article reviews scientific research on the issues outlined in the title using the following groups as examples: persons with a substance abuse disorder, the elderly, people with HIV or AIDS, immigrants, refugees and people from the LGBT community. For years, (...) the World Health Organization has stressed that improving the health of members of socially excluded groups can improve the health of the entire population. However, there is still no program in Poland focusing on combating inequalities in the healthcare system. The article presents research results from other countries. Unfortunately, in Poland, there is still a lack of studies on minority groups, their access to the health care system, and the attitudes towards those groups of medical personnel. (shrink)

In the years 1991-2002 I visited the Saharawi refugee camps near the town of Tindouf in south western Algerian desert ten times. The objective of these visits was to provide medical assistance in various areas of health care and organize more effective health care services. Each time I spent 8-12 days in this territory, either alone or as part of a team of medical doctors and nurses. These medical missions, were organized by "Al Awda," an association (...) of solidarity for Saharawi people, located in Catania, Italy. A comprehensive range of services were provided during each of these trips. (shrink)

This paper is an empirical study of what solidarity in a Western European healthcare system means today. Drawing upon empirical research on the 2015 refugee cohort's health needs and their health-seeking behaviour, it unites claims from the literature on solidarity in the fields of migration and healthcare. I argue that the Austrian healthcare system not only is an example of ‘civic solidarity’ in the form of institutionalised obligations to citizens but that it also enacts political forms of solidarity (...) and produces political inclusion for marginalised groups such as refugees. My findings show that being entitled to and accessing services in the healthcare system holds meaning beyond the provision of care: It enables to act autonomously, to build familiar relationships with Austrian institutions, inclusion via the personal electronic health card and to support others in the same solidaristic system. These insights can be used to raise awareness about the inclusional function of healthcare services among practitioners. They also show how solidarity-based healthcare systems can be a motor for shaping positive relationships between immigrants and the host country, and point to additional modes of solidarity in the context of forced migration next to civil society and nonstate support structures. This paper builds upon ethnographic data that were collected between 2018 and 2020 in Vienna, Austria (observational notes before, during and after medical consultations with refugees; interviews with them; interviews with healthcare practitioners and other care providers). (shrink)

As healthcare providers engage in the politics of reforming and humanizing our immigration and asylum “system” it is critical that they are able to refer their patients whose health is directly impacted by our immigration laws and policies to experts who can help them navigate the system and obtain the healthcare they need.

Immigrants lacking health insurance access the health care system through the emergency departments of non-profit hospitals. Because these persons lack health insurance, continued care can pose challenges to those institutions. I analyze the values of our health care institutions, utilizing a Walzerian approach that describes its appropriate sphere of justice. This particular sphere is dominated by a caring response to need. I suggest that the logic of this sphere would be best preserved by (...) providing increased access to health insurance to this population. This access would marry the rights of these members of our community to access care to our responsibility to contribute to financing of the system. I close with some considerations on what it means to be a member of the community. (shrink)

Elderly refugees in Jordanian healthcare settings are a vulnerable group. Most of them come from a collectivist culture where family members are the main source of care. Many elderly refugees can no longer work as they did, and are in need of professional intervention from social workers who will take account of their cultural values and beliefs. This exploratory study seeks to understand the role that religion has in the lives of displaced elderly refugees and the impact of those (...) perspectives on how they make sense of their circumstances. Using a qualitative design the methodology drew upon focus group discussions, semistructured interviews and ethnographic participant observation in the gathering and analysis of data. The study highlights the important role that religious beliefs and values play both in maintaining and enhancing elderly refugee’s sense of community, security and mental well-being, and the fundamental importance of the same in their interactions with professionals. A key finding is that religious sensitivity and awareness are critical to good social work practice with religious elderly refugees from the Arab world. It is also suggested that the findings of this study can be transferred to other populations and age groups. (shrink)

Michael Dummett, philosopher and social critic, is also one of the sharpest and most prominent commentators and campaigners for the fair treatment of immigrants and refugees in Britain and Europe. This book insightfully draws together his thoughts on this major issue for the first time. Exploring the confused and often highly unjust thinking about immigration, Dummett then carefully questions the principles and justifications governing state policies, pointing out that they often conflict with the rights of refugees as laid down by (...) the Geneva Convention. With compelling and often moving examples, On Immigration and Refugees points a new way forward for humane thinking and practice about a problem we cannot afford to ignore. (shrink)

Background: Privacy is one of the key principles in health care and requires understanding of the cultural aspects of patients’ privacy. In Western cultures privacy is focused on the individual, however, in some non-Western cultures, privacy is linked to the collectivism of the community or religion. Objectives: The objective of this study is to describe the factors related to the realisation of privacy of Somali refugees in health care by describing the factors related to the patient, (...) healthcare professional and interpreter. Research design: The data were collected from Somali refugees (N = 29) using a qualitative questionnaire and were analysed by deductive content analysis based on factors related to the patient, healthcare professional and interpreter. Ethical consideration: Ethical approval was obtained from the University of Turku, and research permissions were obtained from all participating institutions. Findings: Factors related to the patient were as follows: privacy was realised when the patient had self-determination; was able to act according to Somali culture; had knowledge and understanding of treatment; and trusted the healthcare professional. Factors related to the healthcare professional were as follows: the healthcare professional was expected to be of the same gender as the patient, act professionally, focus on the health issues, and to have knowledge and understanding of the Somali culture. Factors related to the interpreter were as follows: the presence and Somali background of the interpreter decreased privacy; the interpreter was expected to be of the same gender as the patient; to have competence and to behave professionally. Discussion: Gender congruence, professionalism and caring attitude and common understanding between the Somali patient and Finnish provider increase the privacy of Somali patients. Conclusion: Somali patients’ privacy can be improved by increasing healthcare professionals’ understanding of Somali culture, acknowledging the importance of gender concordance in relation to healthcare professionals and interpreters, and the effect of the presence of the interpreter on patients’ privacy. (shrink)

Michael Dummett, philosopher and social critic, is also one of the sharpest and most prominent commentators and campaigners for the fair treatment of immigrants and refugees in Britain and Europe. This book insightfully draws together his thoughts on this major issue for the first time. Exploring the confused and often highly unjust thinking about immigration, Dummett then carefully questions the principles and justifications governing state policies, pointing out that they often conflict with the rights of refugees as laid down by (...) the Geneva Convention. With compelling and often moving examples, On Immigration and Refugees points a new way forward for humane thinking and practice about a problem we cannot afford to ignore. (shrink)

Medications of choice, necessary supplies, and evidence-based health care now seem like luxuries. The contrast between my experience at a well-funded health unit and the Lev El Lev (“heart to heart”) African Refugee Clinic in Tel Aviv, Israel, is staggering. The complex personal, social, health, psychological, educational, and economic difficulties create a unique ethical environment for the health care provider.

This article comprises a short case exemplifying ethical challenges arising for a participatory researcher working with Afghan women refugees during the Covid-19 pandemic in Germany. The researcher is an Iranian-German woman, qualified as a midwife, undertaking doctoral research on refugees’ access to reproductive health care. Disclosures about some women’s experience of domestic violence are made, which raise ethical issues for the researcher relating to personal-professional boundaries, roles and responsibilities. Two commentaries are given on this case from participatory researchers (...) based in Germany, UK and Austria. Both commentaries highlight the relevance of the ethics of care for participatory research and for this research in particular, which entails very close relationships between the doctoral researcher and the refugee women with whom she is researching. The first commentary analyses the research process in terms of Tronto’s five phases of care, while the second illustrates the importance of caring institutions in supporting researchers working on sensitive topics. (shrink)

Owing to its grappling with a motley of intricate socioeconomic, as well as medico-legal, crises, Haiti has found itself bereft of some of its people, many of whom have had to leave the Caribbean country in search of improved lives elsewhere. Receiving some of the Haitian refugees fleeing abject poverty, unemployment, and other harms and barriers has been the United States, one of Haiti's northern neighbors and a country that has played an outcome-determinative, if not outsized, role in steering the (...) country toward its presently hobbled state. Drawing on the U.S.’s recent treatment of Haitian refugees, this paper argues that U.S. reception of Haitian immigrants rubs salt in the wound of a long history of dehumanizing and oppressive abuses endured by Haitians. Furthermore, and more importantly, this paper posits that U.S. failure to wholly embrace its legal obligation to accept Haitian refugees under international law needs to be understood in the light of the specific horrors inflicted by science, in pre-independence Haiti, on non-consenting, Afro-Haitian experimental subjects. And by extension, such a contextually-nuanced understanding is crucial in shaping the delivery of healthcare services to Haitian refugees fortunate enough to remain in the U.S. —as an awareness and appreciation of the socio-historical context of patients' lived experiences, i.e., their complete social history, can furnish important clues vis-à-vis the presence and etiologies of disease, influence the foci of physical exams, and generally pave the way for the provision of cost-efficient and evidence-based care. (shrink)

Poland has faced two waves of migration: the first was of irregular asylum seekers, which led to the humanitarian crisis on the eastern EU–Belarusian border since 2021; the second was of Ukrainians fleeing the Russian invasion. Although there are noticeable differences between these situations, and between the different reactions of the Polish authorities, it is possible to juxtapose them in terms of the right to health. The normative content of refugee and human rights law is the starting point for (...) reconstructing the meaning of the terms ‘refugee’ and ‘right to health’. A refugee is a person who needs international protection because of a well-founded fear of harm, which is not limited to persecution as defined by the Refugee Convention but also includes situations of international and non-international armed conflict. The right to health, which includes, inter alia, entitlements to a ‘system of health protection’ and ‘underlying determinations of health’, is reconstructed on the basis of human rights law and refugee and migration law. There are no legal and moral grounds to grant the right to health differentially to different groups of refugees. Nondiscriminatory health policy requires that refugees have the same access to health care as nationals, although their specific health needs resulting from past experiences and refugee situation require special treatment, that is, an appropriate refugee health policy. The broad understanding of the underlying determinants of health demonstrates the importance of overall migration policy for refugees’ health, which can jeopardise the fragile good of refugee health. (shrink)

The pervasive effects of increasingly restrictive migration policies on the health of immigrant populations in the U.S. have been well-documented, but not so much concerning the unique experiences of Brazilian immigrants, a subgroup of the Latino/a/x population. Considering that, this narrative review article employs a research design that is both conceptual and exploratory—to understand the possible connections and associations between restrictive immigration policies and negative health outcomes among Brazilian immigrants in the U.S. Findings indicate that Brazilian immigrants in (...) the U.S. face an array of health and non-health related challenges, including racism and poor working conditions, with undocumented individuals experiencing worse outcomes. Studies highlight the complex relationship between immigration policies and health and emphasize the detrimental effects of deportation fear, healthcare access obstacles, and mental health repercussions due to hostile immigration policymaking and generalized anti-immigrant sentiment. More research is needed to understand the unique challenges faced by the Brazilian immigrant population concerning several mental and physical health outcomes. (shrink)

The UK’s 2014 Immigration Act aimed to create a ‘Hostile Environment’ for migrants to the UK. One aspect of this was the restriction of access to secondary care for overseas visitors to the UK, although it remains the case that everybody living in the UK has the legal right to access primary care. In this paper, we argue that the effects of this policy extend beyond secondary care, including preventing eligible people from registering with a General Practice, (...) although as an unintended consequence. This problem arises from misinterpretation of policy wording, misleading GP websites and gatekeeping behaviour from front-line staff, even though there are no grounds in the current guidelines or law to support this. Free access to primary healthcare among refugees and asylum seekers living in deprived populations is particularly important in protecting patient health, given the burden of ill-health in this population and the multiple barriers to accessing early intervention they face. The medical profession has a duty to communicate their rights to this patient group—their legal entitlement to access free healthcare, and the vital importance of doing so. (shrink)

Many countries encourage immigration, yet almost without exception they impose medical conditions on the admissibility of prospective immigrants. This paper examines the ethical defensibility of this practice. It argues that the neighbourhood principle, which states that we owe a greater duty to neighbours than to strangers, when properly understood, extends to all human beings, that economic and safety considerations play only a limited role in ethically underwriting an exclusionary policy, and that medical immigration criteria should be harmonized with treatment eligibility (...) criteria for citizens of the relevant countries themselves. (shrink)

The increase in ethnically and linguistically diverse older adults in Canada necessitates attention to their experiences and needs for healthy ageing. Arab immigrant women often report challenges in maintaining health, but little is known about their ageing experiences. This interpretive descriptive study uses a transnational life course framework to understand Arab Muslim immigrant women's experiences of engaging in health‐promoting practices as they age in Canada. Women's stories highlight social dimensions of health such social connectedness, social roles and (...) social support that are constructed and maintained within different migration contexts across the life course. Barriers and facilitators to healthy ageing in this population centred around five themes: (i) the necessity of staying strong, (ii) caring for self while caring for others, (iii) double jeopardy of chronic illnesses and loneliness, (iv) inadequate support within large social networks and (v) navigating access to health‐supporting resources. The findings point to transnational connections and post‐migration social support as major influencers in creating facilitators and barriers to healthy ageing for Arab Muslim immigrant women. (shrink)

Some bioethicists and political philosophers argue that rich states should restrict the immigration of health workers from poor countries in order to prevent harm to people in these countries. In this essay, I argue that restrictions on the immigration of health workers are unjust, even if this immigration results in bad health outcomes for people in poor countries. I contend that negative duties to refrain from interfering with the occupational liberties of health workers outweighs rich states' (...) positive duties to prevent harm to people in sending countries. Furthermore, I defend this claim against the objection that health workers in poor countries acquire special duties to their compatriots that render them liable to coercive interference. (shrink)

On 27 September 2002, the Bush administration issued final rules allowing states to define a fetus as a child eligible for government‐subsidized health care under the Children's Health Insurance Program. CHIP does not cover any illegal immigrants and only covers legal immigrants who have been in the country for five years. Babies born in the United States, however, are citizens and therefore eligible for assistance. The response from women's groups and pro‐choice advocates was swift and unanimously negative.

With the arrival of another wave of “boat people” to Australian waters in late 2009, issues of human rights of asylum seekers and refugees once again became a major feature of the political landscape. Claims of “queue jumping” were made, particularly by some sections of the media, and they may seem populist, but they are also ironic, given the protracted efforts on the part of the federal government to stymie any orderly appeals process, largely through resort to “privative clauses”. Such (...) clauses demonstrate the many ways in which human rights of those seeking asylum in far-off lands and are potential future immigrants, who often lack much-touted needed papers, yet who are for the most part genuine refugees, are subject to the slings and arrows of political fortune (and misfortune). Approaching the courts if treated unfairly or seeking a further decision as to your fate would seem one of the fundamental premises of human rights. Yet privative clauses—or attempts to ouster the jurisdiction of the courts and to insulate decisions from appeal—have become an increasingly frequent feature of the Australian migration legislation. With a seemingly watertight federal constitutional power set in stone since 1901, to deal with migration and aliens, and without the tempered contemporary update of a federal Bill of Rights, the Australian federal government has been able to narrow the grounds of judicial review in those contexts. We argue that the concerted efforts to deny such fundamental rights of appeal to those most in need of the full armoury of the protection of the law in a modern, affluent democracy, constitutes both a breach of their human rights and a breach of core constitutional principles such as separation of powers. Those principles may not be formally articulated in the text of the Australian Constitution, but in our view they are implicit in the constitutional arrangements, and hence we can conclude with the arguments of former Justice of the High Court of Australia, Michael Kirby, who asked—to whom does sovereignty truly belong? (shrink)

This article discusses cosmopolitanism as the moral foundation for access to health care for migrants. The focus is on countries with sufficiently adequate universal health care for their citizens. The article argues for equal access to this kind of health care for citizens and migrants alike—including migrants at special risk such as asylum seekers or undocumented migrants. Several objections against equal access are raised, such as the cosmopolitan approach being too restrictive or too permissive, (...) or the consequences being undesirable; but the objections are largely refuted. Some special cases in which a restriction of equal access to health care might be justified are described: humanitarian crisis, short term tourism, and the case of a migrant or refugee who will stay only very briefly on a state's territory. (shrink)

The US has built the most extensive immigration detention system globally. Over the last three administrations, several organizations have noted a systemic failure in the provision of health care in detention centers, leading to the torture and death of immigrants. This essay develops the principle of the preferential option for the poor to examine the causes of deficient access to health care and solutions to overcome them. It analyzes the substandard health care in detention (...) centers from the notion of structural violence and systematizes solutions of grassroots immigrant organizations from the idea of solidarity, understood here as a form of friendship with the poor that moves toward relational justice. Its goal is to build bridges between people so that the political will is generated to create policies to improve and enforce health care standards in detention centers and address the unjust foundations of immigration detention. (shrink)

Background: Trust has been identified as a vital value in the nurse–patient relationship. Although increasingly the subject of empirical inquiries, the specific processes used by nurses to foster trust in nurse–patient relationships with older immigrants of non-English speaking backgrounds hospitalised for end-of-life care have not been investigated. Aims: To explore and describe the specific processes that nurses use to foster trust and overcome possible cultural mistrust when caring for older immigrants of non-English speaking backgrounds hospitalised for end-of-life care. (...) Research design: A qualitative descriptive approach was used. Twenty-two registered nurses were recruited from four metropolitan health services in Melbourne, Australia. Ethical considerations: Research approval was granted by the Human Research Ethics Committees of the host institution and four participating health services. Findings: Thematic analysis revealed that fostering trust encompassed the following three commensurate stages: establishing trust, strengthening trust and sustaining trust. Underpinning the successful achievement of these stages was the nurses’ moral commitment (reflected in their intentional, conscious and conscientious approach) to fostering trust as an essential ingredient of quality end-of-life care. Discussion: This study has shown that while professional competencies are important to providing quality end-of-life care to older immigrant patients of non-English speaking backgrounds, it is a nurse’s moral commitment to fostering trust that may ultimately lay the foundations for a trusting quality care relationship to be established and sustained. Conclusion: This study has captured the processes used by nurses to foster trust as an essential element of quality end-of-life care in older immigrants. The characteristics of trust and the different factors influencing its expression in diverse cultural contexts are, however, under-researched. Accordingly, gaps remain in the knowledge and understanding of the specific cultural nuances and manifestations of trust across and within different cultures. This is an area that is germane to further cross-cultural and international collaborative scholarly inquiry and research. (shrink)

Immigration medicine and the work carried out by Panel Physicians within the Canadian immigration system give rise to ethically troublesome practices and consequences. In this analysis in three parts, we explore the context of the immigration medical examination, characterize the observed and potential burdens and harms for immigrant and refugee applicants with HIV, and critically assess the possibilities for transforming immigration medical practices and policy to reduce inequities. We use the Code of Ethics of the Canadian Medical Association and the (...) Medical Ethics Manual of the World Medical Association to analyse six practices that fail to meet ethical expectations. This analysis opens up new lines of inquiry into the medico-administrative practices regulating immigration to Canada. It also extends knowledge about the functioning of immigration medical policy and the collection and uses of HIV-related health information. We argue that to reduce burdens and harms to prospective immigrants and refugees to Canada with HIV, changes must occur in how Citizenship and Immigration Canada asks Panel Physicians to work with these applicants. This argument is empirically informed by institutional ethnographic research results of the Canadian immigration system and its treatment of applicants with HIV. (shrink)

Based on ethnographic research within refugee-serving institutions in Philadelphia, Pennsylvania, this paper examines the relationship between physicians and the knowledge they produce and consume about caring for refugees from around the world. I explore the “seething presence” of race in refugee medicine, a domain of medical practice whose entanglement with racial ideology and practice has been underexamined. I consider how knowledge about refugees from different groups—whether racially laden designations like “Asian” or “African” or national markers like Congolese or Burmese—circulates in (...) clinical spaces as health-care teams diagnose and treat refugees using standards of “evidence-based” medicine. Assessing the primary literatures that refugee health-care providers use to justify varying care plans, I argue that race, while often unmentioned, structures the practice of refugee medicine. Additionally, the implicit use of race as an analytic, not racism or economic injustice, often disguises the impact of structural racism and inequality in refugee health disparities. I end with some reflections on how we might conduct a more just practice of refugee health care—and by extension, health care more generally—by shifting our gaze from the particularities of seemingly obvious cultural difference to social structure. (shrink)

Colombia has received the largest influx of Venezuelan refugees and migrants. Since 2015, more than 3 million Venezuelan migrants have entered the country. Those arriving in Cúcuta have several options for entering Colombian territory. One of the main routes involves a difficult and dangerous journey of nearly 200 km to the Metropolitan Area of Bucaramanga, which serves as a key territory for accessing various destinations. Because of its geographical location, this area serves as an important transit city, facilitating travel to (...) other major cities in Colombia, such as Bogotá, Medellín, and Cali; it is also a residence destination for Venezuelan migrants. Among the specific reasons why immigrants choose Bucaramanga over other cities are factors like climate, the existence of various cooperation organizations that provide assistance, and the considerable number of migrant individuals previously settled in this area; thus, many new migrants have family or friendship connections there. Furthermore, for many, it is the safest option or the only place they can go to when the weather turns cold. In this study, we analyze the institutional response and identify barriers that limit the protection of Venezuelan migrants’ right to access to healthcare in this location where Venezuelan citizens have faced economic, legal, bureaucratic, and social barriers. This has profound consequences for migrants’ health and poses a risk to their lives. The article is primarily based on interviews and fieldwork conducted with migrant populations between 2022 and 2023 to identify the barriers and supporting elements they experienced in terms of health care services. Likewise, this study makes a significant contribution by directly examining the experiences of Venezuelan migrants in relation to the right to health in this area. This provides a useful understanding of the social phenomenon at both the academic and institutional levels. (shrink)

ArgumentTwo medical delegations, one from Palestine and one from the United States, were sent to detainment camps in Cyprus in the summer of 1947. The British Mandatory government had set up these camps in the summer of 1946 to stem the flow of Jewish immigrants into Palestine after World War II. The purpose of the medical delegations was to screen the camps' inhabitants and to propose a mental-health program for their life in Palestine. We examine the activities of these (...) two delegations within the context of their scientific interest in the psycho-pathology of displaced persons after World War II and as part of a broader project of mental hygiene. According to the delegations, the detainees would be a potential source of strength for building a new society if they adapted to life in Palestine. However, they would become a burden if they failed to be absorbed. At the same time, the medical delegations also saw the detainee camps as a potential “living laboratory” for scientific exploration. The case of the two medical delegations in Cyprus is also a story about constructing and transgressing medical borders. Apart from the obvious fact that this case study deals with movement of people, refugees as well as health-care workers, it is also about the transmission of knowledge and professions across the ocean. (shrink)

Public collective hunger strikes take place in complex social and political contexts, require medical attention and present ethical challenges to physicians. Empirical research, the ethical debate to date and existing guidelines by the World Medical Association focus almost exclusively on hunger strikes in detention. However, the public space differs substantially with regard to the conditions for the provision of health care and the diverse groups of healthcare providers or stakeholders involved. By reviewing empirical research on the experience of (...) health professionals with public collective hunger strikes, we identified the following ethical challenges: (1) establishment of a trustful physician–striker relationship, (2) balancing of medico‐ethical principles in medical decision‐making, (3) handling of loyalty conflicts and (4) preservation of professional independence and the risk of political instrumentalization. Some of these challenges have already been described and discussed, yet not contextualized for public collective strikes, while others are novel. The presence of voluntary physicians may offer opportunities for a trustful relationship and, hence, for ethical treatment decisions. According to our findings, it requires more attention to how to realise autonomous medical decisions in the complex context of a dynamic, often unstructured and politically charged setting, which ethical norms should shape the professional role of voluntary physicians, and what is the influence of the hunger strikers' collective on individual healthcare decisions. Our article can serve as a starting point for further ethical discussion. It can also provide the basis for the development of potential guidelines to support health professionals involved in public collective hunger strikes. (shrink)

BackgroundIn many Western countries like Germany, the social integration of children with an immigrant background has become an urgent social tasks. The probability of them living in high-risk environments and being disadvantaged regarding health and education-related variables is still relatively higher. Yet, promoting language acquisition is not the only relevant factor for their social integration, but also the support of earlier developmental processes associated with adequate early parenting in their first months of life. The Emotional Availability Scales measure the (...) quality of caregiver-child-interactions as an indicator of the quality of their relationship and thus of such early parenting, focusing on mutual and emotional aspects of their interaction.MethodThis pilot study examined in a randomized controlled trial the effects of the prevention project First Steps regarding the hypothesis that the Emotional Availability improved to a greater extent in “difficult-to-reach” immigrant mother-child dyads in a psychoanalytically oriented early intervention compared to a usual care intervention offered by paraprofessionals with an immigrant background. A sample of N = 118 immigrant women in Germany from 37 different countries and their children was compared with regard to the parental EA-dimensions sensitivity, structuring, non-intrusiveness and non-hostility and the child dimensions responsiveness to and involvement of the caregiver in the pre-post RCT design.Results and ConclusionDifferent from what was expected, repeated ANOVAs revealed no significant pre-post group differences for the parental dimensions. For the child dimensions the effect of time of measurement was highly significant, which can be interpreted as mostly natural developmental effects. Still, on the level of simple main effects for each intervention, only in the FIRST STEPS groups child responsiveness significantly improved. When controlled for confounding variables, a significant interaction effect for maternal sensitivity in favor of the FIRST STEPS intervention was found. The systematic group differences indicate that the more extensive and professional intervention, focusing on the individual needs of the participants, is more suitable to support the quality of the mother-child-relationship amongst immigrant mother-child dyads than usual care. The results are discussed taking into account the context of the maternal migration process and potential maternal traumatization.Clinical Trial Registration[https://clinicaltrials.gov], identifier [DRKS00004632]. (shrink)

Oral healthcare is attracting much attention after decades of neglect from policymakers. Recent studies have shown a strong association between oral and overall health, which can lead to serious health problems. Availability of oral healthcare services is an essential part of ensuring universal healthcare coverage. More importantly, current gaps in its accessibility by minority or marginalized population groups are crucial public health as well as ethical concerns. One notable effort to address this issue comes from Non-Governmental Organizations (...) (NGOs), which offer oral healthcare services for non-insured refugees. However, the challenge remains that these care services are not comprehensive, which has implications for the refugees’ oral and general health. In this article, we discuss this complex issue in the German healthcare context by including ethical reflections. Therefore, the purpose of this article is to discuss the ethical challenges related to oral healthcare services provided by NGOs for refugees in Germany. First, we will introduce the general oral healthcare context worldwide and in Germany. Second, we will provide a general description of the oral healthcare services provided by NGOs for refugees in Germany, as well as an overview of existing gaps. This will provide us with the context for our third and most important task—discussing the ethical implications of the gaps. In doing so, and since the ethical implications can be several, we demarcate the scope of our analysis by focusing on the specific ethical issues of justice, harm, and autonomy. Finally, we offer some recommendations for how to move forward. (shrink)

Catholic health care has long been a key place where the Church embodies its social doctrine. However, the moral methodology that shapes Catholic bioethics relies on an act-based approach to decision making, which is rooted in the pre–Vatican II manualist tradition, focusing primarily on clinical issues related to the beginning and end of life. This essay argues that given the doctrinal status of Catholic social thought, Catholic bioethics must revisit its scope and methodology. It proceeds in three steps: (...) a meta-analysis of traditional Catholic bioethics, validating the claim made above; an overview of the limited literature published since 1980 engaging Catholic bioethics and CST; and a map of a Catholic bioethics informed by CST generated from a dual starting point. The essay concludes by focusing on both the places where marginalized persons encounter Catholic health care and the ethical issues presented, including race, health care disparities, immigration status, and gender inequality, as well as the interrelated perspective of the common good, expanding the array of issues to include environmental degradation, unions, health care financing, and more. (shrink)

The fourth-century B.C. was a period during which a large number of Greek cities were affected by civil wars, military conquests, and destruction, with the displacement of large numbers of men, women and children as a result. This has implications for the modern debate on Athenian attitudes to immigration, which normally focuses on just two groups of free non-citizens: adult, able-bodied men who moved to Athens voluntarily to take advantage of the city’s economic opportunities and on the free non-citizen population (...) who had come to Athens as slaves and who stayed on after their manumission. This article argues that refugees were likely to have constituted a considerable component of the migration to Athens during certain troubled periods in the course of the fourth century. This means that the size of Athens’s immigrant population was likely to have fluctuated considerably, that many of the refugees would have been destitute, that women and children may have made up an even greater proportion of the non-citizen population than normally assumed, and, thus, that a considerable number of these immigrants would not have been able to contribute substantially to Athens’s grain trade or military. The implications of this for our assessment of the Athenian motives for admitting groups of refugees are discussed, and it is argued that the requirement that all male and all unaccompanied female immigrants had to find an Athenian sponsor and pay a special metic tax may have constituted a certain level of control over immigrant numbers. (shrink)

In recent years, politically active Latinx and Asian American Pacific Islander youth have addressed anti-Black racism within their own immigrant and refugee communities, engaged in protests against police violence, and expressed support for #SAYHERNAME. Reflecting the broader patterns of a new political generation and of progressive social movement leadership, women and nonbinary youth have disproportionately committed to inclusive fights for racial justice. In this essay, through two biographical examples, we highlight the role of grassroots youth organizing groups in training their (...) diverse young members to become effective allies, introducing them to intersectional frameworks that motivate solidarity across racial and ethnic boundaries. (shrink)

Illustrating the tensions and possibilities that the notion of the ethic of care as a democratic and citizenship issue may have in discourses of citizenship education in western states is the focus of this article. I first consider some theoretical debates on the definition of an ethic of care, especially in relation to issues of justice and (im)partiality. Then, I discuss the reconceptualization of care on the basis of two related but distinct themes: the reconciliation of justice (...) and care, and the rethinking of citizenship. Following this, I lay out some implications for citizenship education and answer the question of what learning and teaching for/about a reconceptualized ethic of care can contribute to changing current perceptions of and actions towards immigrants, refugees and asylum seekers. (shrink)

Scholars increasingly point toward schools as meaningful contexts in which to provide psychosocial care for refugee children. Collaborative mental health care in school forms a particular practice of school-based mental health care provision. Developed in Canada and inspired by systemic intervention approaches, collaborative mental health care in schools involves the formation of an interdisciplinary care network, in which mental health care providers and school partners collaborate with each other and the (...) refugee family in a joint assessment of child development and mental health, as well as joint intervention planning and provision. It aims to move away from an individual perspective on refugee children’s development, toward an engagement with refugee families’ perspectives on their migration histories, cultural background and social condition in shaping assessment and intervention, as such fostering refugee empowerment, equality, and participation in the host society. Relating to the first stage of van Yperen’s four-stage model for establishing evidence-based youth care, this article aims to engage in an initial exploration of the effectiveness of a developing school-based collaborative mental health care practice in Leuven, Belgium. First, we propose a detailed description, co-developed through reflection on case documents, written process reflections, intervision, an initial identification of intervention themes, and articulating interconnections with scholarly literature on transcultural and systemic refugee trauma care. Second, we engage in an in-depth exploration of processes and working mechanisms, obtained through co-constructed clinical case analysis of case work collected through our practice in schools in Leuven, Belgium. Our descriptive analysis indicates the role of central processes that may operate as working mechanisms in school-based collaborative mental health care and points to how collaborative mental health care may mobilize the school and the family-school interaction as a vehicle of restoring safety and stability in the aftermath of cumulative traumatization. Our analysis furthermore forms an important starting point for reflections on future research opportunities, and central clinical dynamics touching upon power disparities and low-threshold access to mental health care for refugee families. (shrink)

Responses to COVID-19 have been characterized by rapid border closures that have transformed the pandemic from a crisis of health to a crisis of mobility. While Canada was quick to implement border restrictions for non-citizens like refugees and asylum seekers, exemptions were made for some migrant groups like temporary workers. The pandemic marked a departure from who is considered worthy of admission to Canada. In fact, the border through restricted and securitized measures has filtered desirable versus non-desirable migrants, creating (...) a hierarchy among migrants within Canada’s immigration system by categorizing groups into those deserving versus non-deserving of admission. Deeply embedded societal discrimination and structural inequalities means that COVID-19 has exacerbated the vulnerabilities of migrant groups more than others. COVID-19 has placed an uneven burden on refugees who face increased border restrictions, significant health and safety risks, and limitations in accessing human rights. This paper documents the challenges, social and economic impacts, and exacerbated vulnerabilities border closures have imposed on refugees, asylum seekers and temporary migrants. We assess the many challenges that COVID-19 has created at the intersection of border studies, security resilience and human rights. We employ the conceptual frame of security resilience to critically analyse the dynamics of how and why border strategies have restricted migrant groups in times of crisis and amounted to an unjustified weakening of refugee rights. Finally, we argue that social resilience, which is rooted in rights-based strategies, not only ensures that societies are prepared to meet external shocks and disruptions, but that policy responses mitigate societal discrimination and inequalities. We highlight these strategies as effective mechanisms for reconciling both public health concerns and the rights of migrants to create more cohesive societies in times of crisis. (shrink)

The recent war in Europe, the Ukraine–Russia war, has had a huge impact in the lives of millions of people in the European continent—in the lives of both those who have fled the conflict and of those who have welcomed them with open arms. In this paper, we conduct a philosophical investigation into the issue of hospitality to others, to strangers, to foreigners trying to understand this phenomenon taking place in Europe, and elsewhere. First, we investigate the Jewish Mitzvah of (...) Hospitality by referring to two passages in the Torah that exemplify hospitality and one that instantiates its opposite, hostility to the other, to strangers and foreigners. Following from this, we provide a discussion on Jewish ethics and its deontological and virtue ethics connections. In the last section, we engage with a discussion connecting the field of education and the matter of hospitality. (shrink)

There are now over 1.1 million people overseen by Immigration and Customs Enforcement (ICE), with about 33,000 detained in jails and federal detention centers around the country at any particular time. The average detention time is two months, but some are detained for much longer periods. Since its inception, one hundred and twenty one deaths and countless cases of medical neglect have occurred. Given its secrecy, and lack of accountability and oversight, it is not clear how many of these deaths (...) are the result of grossly inadequate medical care. ICE is a branch of a government agency in a democratic country, thus the citizens on whose behalf it allegedly operates have an obligation to ensure that it operates in conformity with the fundamental principles of justice on which this nation was founded. ICE is a young and rapidly growing bureaucracy with little oversight. It operates using a mix of federal, state, local and private centers, many of which are penal institutions. It has a history of serious abuse, and even when it operates in conformity with its penal standards, it inflicts additional harm onto vulnerable people, especially asylum seekers and parents of minor children. It thus requires our constant vigilance and concern. Our immigration policies and detention practices are deeply troubling, but until we elect to reform them, we have a special obligation to the vulnerable populations that we house in ICE detention. (shrink)

Immigrant and refugee presence in western nation-states challenges symbolic national boundaries and is perceived as a threat to the dominant majorities. In this context, hate speech is reinforced in the form not only of violent racist acts (hard hate speech) but mostly of mitigated rejection and covert discriminatory practices (soft hate speech). In both cases, hate speech draws on and simultaneously entrenches national discourse aiming to represent the nation as a linguaculturally homogeneous entity. Studies concentrating on hate speech usually investigate (...) public discourse produced by adults. The present study explores the reproduction of (soft) hate speech among immigrant students within the Greek educational context. Adopting a critical discourse-analytic perspective, we employ analytical tools from the Discourse-Historical Approach allowing us to trace how specific discursive strategies contribute to the reproduction of soft hate speech, which seems to draw on national discourse in the form of either racist discourse or humanitarian discourse. (shrink)

Belgium, and Europe in general, has seen a strong increase in the number of refugees arriving over the past three years. At the same time we also note an increasing polarization of Belgian public opinion on this subject. Among the main actors to shape this public opinion are news media, as they contribute to or combat stereotyping of (sub)groups in the population. The purpose of the current study is to analyze to which extent media consumption and trust have an impact (...) on public opinion on two minority groups – immigrants and refugees – in a representative sample of the Belgian adult population (n = 1500). We gathered data on Belgian news media consumption and trust, and attitudes on immigrants and refugees through an online questionnaire. The results indicate that Belgian adults hold more positive attitudes on immigrants than on refugees. The reading of quality online newspapers as well as high levels of trust in television and radio are correlated with a positive attitude towards both groups, whereas the consumption of commercial television and popular newspapers go along with a negative attitude. Fear of terrorism (negative relation) and a negative evaluation of media coverage of refugees (positive relation) also have a sizeable influence. In terms of regional differences within Belgium, we find that citizens in the Brussels Capital Region hold more positive attitudes towards both groups than those in Flanders and Wallonia. (shrink)