Exploring Migrant Access to Health: Part 3 – In Conversation: Open University Lecturer Dr Kathryn Medièn talks to Patients Not Passports.

Shortly after the release of our report Migrants’ Access to Healthcare During the Coronavirus Crisis we were delighted to be interviewed by Dr Kathryn Medièn, lecturer in Sociology at the Open University. Dr Medièn has conducted some formidable work on historical struggles for reproductive justice, and the present day effects of immigration controls, policing and health inequalities on migrant and non-white communities in Britain.

Below are some excerpts from the interview, make sure you go to the Open University website to read the full conversation: Patients Not Passports: Challenging border controls in healthcare. We responded jointly as authors of the report, Akram and Aliya from Migrants Organise, Daniel from New Economics Foundation, and James from Medact.

If you missed them then go back and read parts 1 and 2 of our Exploring Migrant Access to Health series:

You recently published a report, can you tell me why you decided to write it and how you went about compiling the data?

Through the migrant groups and healthcare professionals we work with, it had become clear that an enormous problem – the exclusion of migrants from accessing healthcare – was taking place, unidentified, in the middle of the coronavirus pandemic. We had heard of numerous cases, one of which involved a man dying at home of coronavirus without calling a doctor, because he was so fearful of Hostile Environment immigration policies that exist in the NHS. He thought that he or his wife might be deported if they sought treatment. The damage to those we knew, and our concern for the  thousands of other people we didn’t know, all unable to access healthcare, motivated us to record these instances and make them public. We felt it was important to ensure the Government and health authorities had a crystal clear picture of the experiences detailed in our research and the recommendations arising from them, which are also reflected in reports by Doctors of the World and the Lancet. We wanted to be sure they could no longer say they didn’t know.

Throughout the report the connected issues of patient debt and data sharing between NHS Trusts and the Home Office arise as key barriers to healthcare access, both during the current pandemic and more broadly. Can you explain how this system works, and say a little about how the current pandemic is intensifying this barrier?

In our research we found just how corrosive these fears are. We found that the Government’s policy of hostility has been extremely effective with most migrants having received the message that they are not welcome. This has become so embedded in many migrants’ understanding of the NHS that qualifications or exemptions from the policy that are supposed to protect particularly marginalised groups or provide free care for communicable diseases – like coronavirus or HIV – are often not known about and rarely believed to be true. As a result, migrants’ relationship with healthcare workers and basic trust in the system has completely eroded.

It goes without saying that for people at risk of immigration enforcement from the Home Office, having your address passed on is equally if not more dangerous than being unwell. For many people accessing the NHS now means being exposed to increased risk of detention or deportation, or other punitive immigration controls.

Something that struck me when reading the report was the presence of what you describe as a ‘culture of discrimination’ within the health service, which is both exacerbated by and extends beyond the NHS charges. You write about how, in the context of Coronavirus, this weakens trust in the NHS and is incompatible with the delivery of appropriate care. Why is trust such an important issue in this context?

The Hostile Environment legislation, along with other recent Government initiatives such as the anti-terror Prevent laws, should be considered as novel and alarming approaches to creating and implementing policy. Their particular innovation, and therefore their danger, is that they recruit individuals employed by public bodies to work as extensions of the security state. Healthcare workers who chose careers to provide care and support to ill people, are being drawn into acting as border guards – checking a person’s immigration status and even, on occasion, being forced to provide substandard care because of that status. 

This recruitment involves a whole host of training and internal procedures that encourage healthcare workers to no longer see people as only patients. Under the Prevent legislation, healthcare workers are asked to look at relatively normal behaviour amongst Muslims as an indicators of terrorism. Under the Hostile Environment, they are told that individuals with foreign names or those from a BAME background are potentially ineligible for free NHS care, and need to be challenged and checked. This invitation to treat people differently on the basis of race, religion or country of origin gives license for individuals to act with impunity in who they suspect, and from whom they demand proof of entitlement of innocence. In a country with the colonial mentality that Britain has, this opens the door to a worrying and increased trend in racist attitudes now reinforced by the power of the law and disseminated via training and policy.

It becomes clear when reading the report that the lockdown has had untold effects on the lives of migrants and/or BME people in Britain, particularly those who are destitute. You make the case that overcrowded housing, lack of access to the internet and interpreters and the closure of public libraries and community centres are public health issues. Could you talk me through these findings?

We’ve long made the case that austerity in Britain is an inseparable part of the acceleration of anti-migrant policies spearheaded by the Hostile Environment. Much of our work in healthcare, for example, has identified how governments have introduced migrant charging into the NHS in order to lay the groundwork for a broader, as they describe it, ‘culture change’ away from a system of public health provision to one based on the ability to pay, creating much of the infrastructure needed to charge people for treatment. So what we are fighting for is not only migrant justice, but for the very heart of the NHS: our shared values of ensuring that healthcare is there for those who need it.

Go to the Open University website to read the full conversation: Patients Not Passports: Challenging border controls in healthcare.

Read our research: Migrants’ Access to Healthcare During the Coronavirus Crisis