Our health and theirs: Forced migration, othering, and public health
Introduction
Understanding the stories and experiences underpinning forced migration is crucial in responding to the health needs of refugees, asylum seekers and irregular migrants. In this paper we explore how the relatively few forced migrants who resettle in developed countries are received. Following a brief discussion which sets the context for population movements, we consider how forced migrants are constructed as the ‘other’. We examine the role of public discourse and of political, legal and media responses in creating and reinforcing the position of forced migrants as different, as not belonging. The effects of this process and the marginalisation that results are discussed in relation to the health of migrants and that of host populations. We conclude by suggesting some of the ways in which public health may reframe thinking about forced migrants and respond to this othering at health service delivery and policy level.
Forced population movements “have extraordinarily diverse historical and political causes and involve people who, while all displaced, find themselves in qualitatively different situations and predicaments” (Malkki, 1995). What forced migrants have in common is the limited choice available to them and the pressured decisions they are compelled to make as they leave their homes in an effort to ensure their own, and their family's, survival.
Conditions of conflict, political unrest and economic difficulties are likely to occur simultaneously and interact to contribute to the difficult decision to flee (Castles & Loughna, 2003). It should be noted that the vast majority of involuntary migration involves the displacement of people within, rather than across, borders—UNHCR recorded 7.6 million ‘persons of concern’, internally displaced (IDPs) and stateless persons, at the end of 2004, but recognised this as likely to significantly underestimate the problem (UNHCR, 2005a). Furthermore, of those that do manage to flee their country, around 90% will remain within the same region and it is a very small minority who eventually settle in developed countries. How this small minority of forced migrants are received in rich, western nations is the focus of this paper.
Section snippets
Refugees and asylum seekers
The journeys of refugees from home to final destination may include multiple border crossings, arduous land journeys, and protracted stays in formal or informal camps. They are typically marked by ongoing fear of violence and persecution: from militants, from authorities in the host country, from those who control the camps and from other refugees. Those charged with protecting such refugees may abuse their role: United Nations peacekeepers, NGO workers, and local camp staff may exploit
Othering
We adopt a framework of ‘othering’ to explore how refugees as a group are ‘constructed’ in their place of destination; and how they are set apart from mainstream communities. ‘Othering’ is a process that “serves to mark and name those thought to be different from oneself” (Weis, 1995). ‘Othering’ defines and secures one's own identity by distancing and stigmatising an(other). Its purpose is to reinforce notions of our own ‘normality’, and to set up the difference of others as a point of
The language of threat
The adoption of metaphors of threat, of natural disaster, of invasion, of war, and of contagion, have helped construct people on the move in an impersonal, destructive and destabilising light.
Turton (2003) draws attention to the use of metaphors of water (drip, stream and flood) in describing flows of forced migrants. Indeed metaphors of natural disaster are commonly employed in reporting refugee movements. Populations pour across borders, their condition and number often described with
Queue jumping and the uninvited guest
One of the most powerful ways in which asylum seekers and forced migrants are portrayed is as ‘uninvited’, imposing and making demands on ‘us’. Typically, the focus is on ostensible deception, trickery and fraud that may be required to enter or remain in a country without a valid visa. The responsibility of the state to uphold moral principles, and fulfil a range of legal duties and obligations under international law, is rarely acknowledged or explicitly stated.
Notions of the ‘uninvited guest’
Charity and choice
Refugees and asylum seekers are rarely portrayed as individuals with agency, skill or resilience, with capacity to contribute and be an asset to their new communities. Rather, as the language of ‘burden-sharing’ suggests, they are perceived as needy, helpless and a drain on resources. This representation starts with the reporting of humanitarian crises and is reinforced upon arrival. Dauvergne (2003) reflects that refugees and illegal migrants occupy a place in the collective imagination as
Overload
One of the difficulties facing refugees is a public perception in developed countries of ‘overload’ in relation to immigration numbers in general and refugees in particular (Tazreiter, 2003). Policy decisions to tie offshore and onshore refugee programs together create a fictional threshold, implying that a country is at its absolute limit in terms of absorbing refugees. The reality is that demand for refugee status is often overstated and the circumstances and motivations of refugees
Maintaining the other
Maintaining the ‘otherness’ of refugees and asylum seekers, requires that they and their stories remain distant and strange, that we rarely hear from them or come to know them. So even though we may feel for the ‘victim’, we know and learn little of their personal circumstances, the emergencies that precipitated their flight, or their complex causes. Ignatieff (1998, p. 295) describes this as ‘empathy without understanding’: a condition that enables us to remain unconnected, makes it easy for
Public health and othering
…the social construction of boundaries of ‘self’ and ‘other’ and their relationship to boundaries of ‘safety’ and ‘danger’ are particularly relevant to understanding notions of health and disease (Flowers, 2001, p. 51).
Many forced migrants have fled poor, developing countries, where access to health care was limited, and services disrupted by conflict (Zwi, Fustukian, & Sethi, 2002). Exposure to disease and ill-health will have been substantial. The journeys of smuggled and trafficked persons
Responding to othering—towards an inclusive public health
Public health seeks to address health needs through the organised efforts of society. Most recently Beaglehole, Bonita, Horton, Adams, and McKee (2004) have defined it as “collective action for sustained population-wide health improvement”. This recognises the importance of developing population-wide interventions and addressing structural impediments to promoting health gain. Good public health engages with these issues, with other sectors, and with the political process, to promote better
Conclusion
This paper has highlighted the ways in which forced migrants are ‘othered’, excluded and marginalised, and has raised concerns regarding the knock-on effects for the health of these migrants and the general public. It has argued the potentially negative effects of othering, and highlighted how this process not infrequently draws upon the legitimacy of public health and its metaphors to exclude those already seriously marginalised. Much work remains to be done in this area. Empirical research is
Acknowledgements
A number of colleagues provided valuable comments on the paper in its penultimate stages—for comments from Eileen Pittaway, Derrick Silove, Paul Kelly, Rosemary Aldrich, Niamh Stephenson, Daniel Tarantola and Pascale Allotey, we are most grateful. The authors wish to acknowledge valuable feedback and suggestions provided by the anonymous reviewers: these helped strengthen the paper and further clarified our thinking on this issue.
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