Migration as a social determinant of health for irregular migrants: Israel as case study
Section snippets
Migration: global trends
According to WHO estimates, there are approximately one billion migrants around the world today (2014). According to the United Nations High Commissioner for Refugees (UNHCR), the number of people forcibly displaced by conflict or persecution reached 51.2 million in 2014, the highest recorded level since World War II. In that year, the number of internally displaced persons reached 33.3 million, the highest figure ever recorded (UNHCR, 2013a). Since then, these numbers have only increased as a
Migration to Israel
In present-day Israel, migrant health policymaking follows a guiding logic of ethnonational citizenship. Only two groups – native-born citizens and immigrants who arrive under the country's Law of Return – are considered deserving of access to health care and the social determinants of good health. According to the country's Law of Return, all benefits of citizenship are available to “olim” – Jewish immigrants and other immigrants who may not be Jewish but, as immediate relatives of someone who
Health care services available to irregular migrants in Israel
Currently, health services available to irregular migrants in Israel include basic ambulatory and emergency care. Two clinics in the Tel Aviv area provide these services, primarily through volunteer medical personnel: 1) The “Heart to Heart” Refugee Clinic funded by the Ministry of Health (MOH), and 2) the Open Clinic run by the non-governmental organization Physicians for Human Rights-Israel (PHR-IL). In addition, a mental health clinic for irregular migrants was opened in 2014 by the MOH in
Data collection
Semi-structured, qualitative interviews were conducted with 35 irregular migrants in Israel. Interviews addressed respondents' general state of health and wellbeing; access to and utilization of health care services in their country of origin; access to and utilization of health care services in Israel; expectations of health care services in Israel; current barriers to care-seeking; and strategies for coping with barriers to care. Interviews were conducted in respondents' native languages with
Findings
Overall, study participants identified a high number of barriers to care that fall into two main groups: barriers directly resulting from migration status, and barriers common in low-income and otherwise vulnerable communities but severely exacerbated by irregular migrant status. Migration-related barriers were primarily legal, policy-related, and socio-economic. These include 1) lack of clear or consistent migration legislation, 2) threat of deportation, 3) inability to obtain a work permit,
Discussion
Our findings demonstrate the significance of migration status as a social determinant that greatly affects migrants' health and care-seeking behavior and, moreover, that interacts with other key social determinants with adverse effects. The vast majority of barriers interviewees faced were rooted in their classification as one kind of migrant to Israel (irregular, and hence unwelcome) versus another (a valued immigrant arriving under the country's Law of Return).
Recognizing migration as a social determinant of health: Toward national and global frameworks for action
Irregular migration status in Israel creates “an extra burden of critical consequences” (Quesada et al., 2014: 15) that adds to, and interacts with, health care obstacles that irregular migrants share with other disadvantaged populations. These obstacles, both individually and in combination, greatly affect both migrants' efforts to pursue health care and their overall sense of relative wellbeing. The reality of irregular migration status in the ethnonational Israeli context puts “individuals
Conclusion
A growing body of literature has begun to explore how limited access to the social determinants of good health can negatively affect migrants and migrant communities. Yet few studies have explored how migration itself can function as a social determinant either across the migratory process or, as examined here, by positioning migrants in “ambiguous and often hostile relationships to the state and its institutions” (Castañeda et al., 2015: 378). Not only is the present study distinctive in this
Acknowledgments
The authors acknowledge support from the Research Fund of the Israeli Ministry of Health for translation/interpretation services during data collection.
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