A Visit to Vårdcentralen

In this post, Border Criminologies' Vanessa Barker, Associate Professor (universitetslektor) of Sociology at Stockholm University, reports on her interview with an NGO (thus anonymized here) that provides health care to undocumented migrants in Sweden. This research is part of her broader investigation of how civil society organizations get involved in border protest and how various forms of protest can bring about reform, realize migrants’ rights, or in some cases, inadvertently reproduce or at least facilitate restrictive border control.

Background

The scale and scope of border protest has grown significantly in recent years in direct response to increased and restrictive border controls. As documented on many pages of the Border Criminologies blog, the criminalization of migration has led to new forms of exclusion, inequality, insecurity, and danger. It's important to note that despite these repressive trends, migrants and migrants rights organizations have pushed back and in some cases have reversed or contained restrictive practices or policies. Across Europe, North America, and Australia, thousands (if not millions) of people have poured out onto the streets, rallied at camps, torn down camps, held vigils outside and inside detention centers, gone on hunger strikes, gathered in public squares, provided food, shelter, aid  and information to those in need, and marched on state capitols to protest what they see as unfair, discriminatory, and sometimes violent acts against those who cross borders.

I'm currently investigating how civil society organizations get involved in border protest and how various forms of protest can bring about reform, realize migrants’ rights, or in some cases, inadvertently reproduce or at least facilitate restrictive border control. Some of the organizing themes I explore are: to what extent does border protest pose a specific and serious challenge to state monopolies over population and membership? To what extent does this activity in civil society represent a denationalizing force and what are their effects on or implications for state sovereignty and group membership?

One type of border protest that directly challenges the state’s authority over population is the provision of medical treatment to undocumented migrants in Sweden. Until very recently, all undocumented migrants apart from children of failed asylum seekers were denied access to public health care except for emergency treatment paid for in full, often upfront. Frontline administrators have been prime gatekeepers to healthcare but also proxy border control agents: “I wouldn’t even dare to go near a hospital…the first thing they ask is for your identification number” (quoted in MSF). I'm interested in how public health workers overcome these barriers by claiming the right and ethical obligation to treat those who have been essentially locked out of the state system. Although a health clinic and its provisions of care may not conform to typical or conventional forms of protest such as street demonstrations, I see it as such and much more because these private acts are in fact a public rebuke to the welfare state’s insistence on membership. Public health workers claim the right and obligation to treat anyone, superseding the state’s authority to control, limit, regulate, and name the population. By claiming these bodies, they assert the right of civil society to determine the population. They are part of a social movement demanding and reaffirming the right to health care as human right that must be realized in the domestic or national field. Last week, I met with a representative of one such organization that provides medical treatment to undocumented migrants and advocates for migrants’ rights to health care. My intern who is also a nurse and fluent in Swedish came with me. The meeting was in English. Below are some of my fieldnotes from our conversation.

Field Note

At an undisclosed location, we met JD, a representative of a public health organization that provides treatment and information to undocumented migrants in Sweden and facilitates their access to clinics and care. During off hours of the clinic, we were able to discuss the nature of the work of the organization and its plans for reform. JD explained that when the new health law passed in the summer of 2013, the organization closed the clinic since undocumented migrants were legally entitled to access the health care system. By closing the clinic, JD said they could “force society to take responsibility” and to a certain extent the Parliament “has taken responsibility” by passing the new law. However, the organization soon discovered that many undocumented migrants were denied access to clinics. The day before our arrival, JD explained, the clinic was contacted by a former patient who had been denied access to care: the staff refused to make an appointment with a doctor. The organization quickly called the clinic, explained the patient's rights and insisted they book him an appointment for him. The next day, he was seen by a doctor. This case is not an anomaly; JD explained that in their own survey they found that 25% were denied access to care. The case of Sara, a 20 year old woman and paperless, looked up after the interview, is documented in the survey and illustrates this pattern (translated from Swedish):

“We got different answer when I called the medical center and when I visited it. Over the phone they said that undocumented migrants are only entitled to emergency care. Then I said that we go to the emergency room instead. [When] we went to the health center confusion arose in reception. I do not know if it was a nurse or administrative staff, but they asked if Sara had personal identity, if she applied for asylum, and so on. When we said that Sara is paperless, they said that she was counted as if she was on a visit to Sweden and to care for Sara would cost 1500 SEK.

I protested and told me that we had met [the organization] who told us that there is a new law allowing undocumented right to care. Then they wondered at the health center why not [the organization] offered us care in this case. I did not know what to say but said they told us that the health center will offer Sara care. In the end, Sara got a reserved number, and then got to see a doctor who spoke her language. It cost 50 SEK. Now they have taken samples and we're going back to check. If we were not aware of the new law, or if Sara went to the health center itself, I do not think she had received care without paying a lot of money.”

JD said they think that many administrators just don’t know the law and that many undocumented migrants were still afraid to seek care for security reasons. Many live in hiding, JD said, and have been reluctant to seek medical treatment for fear of border control, deportation, and other security concerns.

Despite the new law, the organization soon discovered that EU migrants who have papers or valid permits to be in Sweden but who lack health care insurance in their home country are also denied access to the Swedish system. Sweden expects payment from the home country’s health insurance plan. In response to the continued need for medical treatment, the organization decided to reopen the clinic this past January. It has also expanded its role as an information provider to migrants, patients, and now to public health care providers, explaining patients’ rights to health care. The organization is also expanding its advocacy role, preparing to enter the public debate in a much more visible way.

But part of the difficulty in advocating for those locked out of the system, JD explained, was providing the detail of those who live mostly in the shadows or underground who are fearful to provide too much background or identifying information. They know or hear of others who have been deported. During the REVA campaign (i.e., the highly controversial joint police and border control operation to checks ID on public transport and issue deportation orders) last spring, one of the clinic’s own volunteers ceased coming to work for fear of being stopped by border control. When trying to advocate or simply raise awareness about the difficult situation and hard life conditions many of their patients must contend with, JD explained, “it is hard to give a face” to a journalist, for example, who was keen to report the story but refused to go forward without a photo and name.

As a field researcher, I was also keen to document the environment but was aware that the clinic’s address was secret and the nature of work sensitive so I refrained from noting the location, address, names, or taking visual evidence. In this case, I made the choice for ethical reasons to protect the organization and its clients but I'm not sure if I also reinforced the hidden nature of paperless lives in Sweden (for more on ethics and difficulties with visual methods concerning Border Criminologies, see two related posts by Luigi Gariglio and Mary Bosworth).

As we continued the interview, I asked JD about some of the politics of their work and what JD thought might be possible in the future. JD listed several and formidable barriers—a political context where no one is “going to win an election on undocumented migrants,” opposition from the far-right party which counter-poses worthy Swedish pensioners against unworthy “illegal” migrants, and somewhat entrenched resistance on the part of one of the largest and powerful political parties in Sweden, the Social Democrats—but despite these obstacles, JD was still optimistic that migrants’ rights to public health care are attainable. JD noted that much has changed in the discourse and public debate. For example, eighteen years ago, when the organization first began, it was largely considered “provocative” and “immoral” to provide public health care to undocumented migrants in Sweden but now the Swedish Parliament has passed a new law providing access to (a minimum level) public health care to all undocumented migrants.

The remaining debate centers on the fees, subsidies, and the implementation and expansion of care rather than the provision of care itself. JD sees this has a significant step, a “move in the border [...] of what is acceptable.” Moreover, the organization does not act alone. As JD explained, it is part of a broad and deep network of “60-70 organizations,” including some of the largest and most powerful NGOs in Sweden and some of most well-known international NGOs. The network also includes nurses, doctors, and some of the most important labor unions in Sweden—a key component to reform. JD sees the upcoming national election as a critical opportunity to raise the organizations’ activist role, to use the information and data from the clinic to inform the public debate, to provide a “platform” for those who cannot speak due to security concerns. They will continue to push their demands for migrants’ rights to health care as a human right that is nondiscriminatory and the same for everyone. When asked if this was possible in the future, JD sounded hopeful and pointed that momentum was already going in this direction with children and pregnant women at the forefront of these efforts to open access.

The interview was too short of course, and I was left with more questions than answers about the possibilities of reform. I'm eager to continue the research.

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How to cite this blog post (Harvard style): Barker V (2014) A Visit to Vårdcentralen. Available at: http://bordercriminologies.law.ox.ac.uk/a-visit-to-vardcentralen (accessed [date]).