Global Health, Global Security

Article by Lorenzo Rinelli

“There is a strong association between population movements and the spread of disease” (World Health Organization, Sixty-first World Healthy Assembly, A61/12, 7 April 2008)

Think then how global health is intrinsically linked to the health of migrants. Think then how migrants’ health should be among everyone’s primary concerns. Instead, the health of the host nations is the primary paradigm through which the concept of global health is understood, as the nation state is generally conceived as a sealed unit which needs to be secured within a globalized world. There is a link between imagining disease and imagining foreignness, a semantic continuum of threats, ranging from disease to terrorism, linked to undocumented migration.

A Global Network of Detention Centers
National governments have set up a network of detention centers around the world to capture, contain and quarantine migrants and asylum seekers depriving them of the most elementary health rights, both preventive and curative, which instead are basic entitlements of the host population.

In Europe, detention centers for migrants, asylum seekers and nomads are today an architectural feature of most cities. They have reinvented urban spaces and often re-translated a building’s original purpose. They are former railroad depots, old grain stores, and recycled factories. Some are new; others are in adjuncts of old prisons.Rome is home to the largest center in Italy which, ironically, is located in a former police academy.

Since 1995, when the Schengen agreement came into force, detention camps for foreigners have mushroomed across the European Union. There are now 224 detention camps scattered across the European Union;  according to globaldetentionproject.org all together they can house more than 30,000 people – asylum-seekers and undocumented immigrants awaiting deportation – who are often held in administrative detention for as long as 18 months, as permitted by a new law. Often times this period is even longer.

Incredibly enough, most detention centres are being run quietly across Europe and beyond, with little political supervision. Together, these camps function like a macabre web which captures migrating bodies, filtering through those who are permitted to cross borders (see Migreurop’s website for a detailed map).

Conditions of the detention facilities
Governments are reluctant to admit to their existence, let alone permit entry to the centers; with little external observation, hygienic conditions often fall far below international health norms. Reading through a New York Times article there is a sense of what a detention center looks like in Europe:

“Refugee lawyers who have visited it say a camp in Venna, in an abandoned railroad depot 35 minutes outside the northern Greek city of Komotini, is plagued with vermin.” They are living here with rats,” said Evgenia Papanastasiou, a lawyer in the nearby Greek city of Kavala. “The railway depot is five kilometers from the village and when the UNHCR came in the authorities cleaned up the place and burned the mattresses,” she said. Ten days later it was full again.”(“Obscurity and Confinement for Migrants in Europe” The New York Times)

Even the best centers resemble prisons with cameras and coils of barbed wire; the most horrible are infested with different types of vermin and rats. There is a chronic lack of medical care, riots, arson; suicides are common occurrences (see: Caroline Brothers, The New York Times Media Group, “Refugees Detained in the Shadows In Europe and Beyond, Makeshift Measures Become Permanent”). Detainees are sometimes overwhelmed with the disgusting odor of vomit, urine and sweat; sewage leaks into the dormitories and people sleep in rows on the floors of overcrowded rooms. Officials may be using the dreadful conditions in the camps and lengthy detention periods as a deterrent. In fact, according to a familiar conceptualization of migration, if conditions in detention centers are too high, it is understood that it might be an encouraging factor for more people to come.

For the immigrant who lacks proper legal status, the body more than anything else is a way of being present in the world. Therefore, if the body remains the only way to express oneself then it is common to see it being used as a tool of manipulation and destruction, even by acts of self-mutilation. “I’ve seen people breaking their hands or feet or eating batteries and razor blades just to go to the hospital. The other day a Romanian guy drank a bottle of detergent, just to get out” (Global Post).

The photo below won the second place of the prestigious World Press Photo in 2004. It symbolizes the lengths detainees are willing to go to while in detention centers in order to show their despair. This particular photo protests the new, restrictive, Dutch asylum law passed in 2004.

We should not forget that the great majority of those detained are escaping harsh realities of war, famine, and various traumas. They are the first who need protection because they are the most vulnerable to health risks. The destruction of their habitat often means the disruption of their health system especially for women and children. Instead, once captured they are treated as a virus to be quarantined and eliminated. In almost every case, the study made by MSF (Doctors without Borders) in 2010 in Italy shows that detention has a distinctively negative effect upon the individual person and only in very few cases do detainees describe their personal situation as having improved after detention.

The prison-like environments existing in many detention centers, the isolation from the rest of society, the unreliable and always changing flow of information and the disruption of a life plan, all have an impact on mental and physical health and can lead to depression, lack of appetite, insomnia, and in the most extreme case — suicide. In Denmark from 2001 to 2006, the rate of suicide attempts among inmates was six times that of the Danish population, according to the Danish Asylum Seekers Advice Bureau.

The manner in which detainees see themselves, their self-esteem, is significantly impacted by detention and will therefore impact the way they relate to the society once they are eventually freed. According to the WHO “there is also evidence that hypertension, cardiovascular diseases, diabetes and cancer are an increasing burden on migrant populations and impose considerable demands on health systems of destination countries” (Health of migrants. Report by the Secretariat. EB122/11.Report by the “Obscurity and Confinement for Migrants in Europe – The New York Times.”).

As a result, there is double dimension of health stemming from migration: on one hand, migrants do carry with them health risks linked to their countries of origin and transit. On the other hand, they tend to develop new health risks linked to their detention and vulnerability to the harsh living conditions in their host countries. This double effect increases due to a lack of prevention and treatment measures to detect and heal medical conditions, before, during, and after migration.

For a more proper health
Therefore, it is time to conceive a more comprehensive approach to global health and migration that would benefit both host and migrant populations. Negating this approach increases the health risks of the host population and the already traumatic reality of the migrant especially for children and women.

Cultural, religious and linguistic factors must be taken into consideration when deciding how to deal with the health of immigrant populations. As Abdelmalek Sayad (The Suffering of the Immigrant (Polity, 2004) clearly explained, the immigrant-patient is sucked into a dialogue with doctors which is often characterized by mutual confusion and a deep mistrust. The distrustful relationship exists not only because the interests of the parties involved do not coincide, but because of a different conception of the body and mind. In the same report MSF declared that:

“In fact, the asylum applicants have usually suffered traumas and are diffident, emotionally unstable, culturally and linguistically isolated, and unable to explain their needs and problems clearly to the centre staff and the authorities, thereby jeopardising their chances of benefiting from the services and, above all, their access to forms of protection provided for by the regulations.”

A new approach would entail a deep sensibility towards different understandings of human body and mind that goes beyond a mere cultural thoughtfulness towards a different approach to medicine. This would create  more helpful and accessible health service for migrants. Greater access to health services for migrants will necessarily decrease a risk of epidemics in both countries of origin and destination.

Needless to say, the entire design of detention centers must be revised if not completely dismantled. If detention centers will continue to function as gateways into host countries they must provide better health services, better living conditions, and rehabilitation for post-trauma. This approach includes disaggregating health information by gender, age, origin, culture, plan, etc. which in turn will enhance cultural and gender sensitivity among health service providers. Instead of creating a network of prisons to quarantine and annihilate human beings, it is important to create a network of collaborating centers for enhancing the capacity for medical cooperation at a global level.

To improve the health of migrants’ means to improve the health of the world population, and this goes beyond a security focused approach to migration control which only superficially aims at solving health issues.To privilege a discourse of risk and securitization will only increase the gap between developed and developing world, between those who can afford to prevent diseases and those who carry diseases within them. In other words, what has to change is the very essence of the relationship between health and security, where the latter is understood within the former for a more proper idea of health.

European Alternatives, together with Migreurop, is leading the Open Access Nowcampaign, calling for the free access of civil society and journalists to detention centres in Europe.

To find out more, go to the campaign’s website.