Skip to main content

Advertisement

Log in

The Letter and Spirit of the Law: Barriers to Healthcare Access for Asylum Seekers in France

  • Published:
Journal of International Migration and Integration Aims and scope Submit manuscript

Abstract

This article focuses on the barriers to healthcare access experienced by asylum seekers in France. Based on data from a qualitative analysis involving 52 semi-structured interviews with asylum seekers, it uses critical race theory (CRT) to understand informal obstacles to healthcare access that are not identifiable in the study of national legislation. Our findings are twofold. First, institutional barriers result from the mismatches between administrative procedures to ensure healthcare access and the real-world concrete difficulties that asylum seekers have to face because of their ethnic and national backgrounds. Second, psychological barriers that hinder refugee from requesting and obtaining proper healthcare (mistrust of public authorities, feeling of discrimination) can be more fully explained by considering the experiences of trauma, insecurity, and marginalization that asylum seekers are forced to endure once they depart from their country of origin. From an academic point of view, this study highlights the importance of including subaltern people in considering the migratory phenomenon, in order to uncover the less visible aspects of discriminatory process. From a political point of view, this study calls for the modification of certain aspects of the asylum procedure which are not suited to the concrete situation of asylum seekers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Notes

  1. Here, we do not refer to consultation with doctors to obtain evidence of their trauma, in order to include this in their application file as refugees. Rather, we are referring to access to healthcare during the waiting period following the filing of the application.

  2. Here we use the term “psychological barriers” because it is a convenient way to describe a mindset or a false belief, preventing someone from doing something that is in his/her power. This does not mean that we reduce the problem of barriers to care to individual attitudes that hold participants individually responsible for their lack of access to healthcare. On the contrary, we will see that these mental barriers are the result of a set of structural constraints that affect the way in which the participants in our study perceive the world, and that their avoidance strategies may even be the result of a logical and coherent reasoning process.

References

  • Bakewell, O. (2010). Some reflections on structure and agency in migration theory. Journal of Ethnic and Migration Studies, 36, 1689–1708

  • Balogun, B., & Joseph-Salisbury, R. (2021). Black/White mixed-race experiences of race and racism in Poland. Ethnic and Racial Studies, 44(2), 234–251.

    Article  Google Scholar 

  • Bell, D. (2004). Silent covenants: Brown v. Board of Education and the unfulfilled hopes for racial reform. Oxford University Press.

  • Bhatia, R. and P. Wallace. 2007. « Experiences of refugees and asylum seekers in general practice: A qualitative study ». BMC Family Practice 8(1):48.

  • Borges, D. (2005). Inchado, Feio, Preguiçoso e inerte: a degeneração do pensamento social brasileiro, 1880-1940. Revista de Ciência Política.

  • Cantekin, D. (2019). Syrian refugees living on the edge: Policy and practice implications for mental health and psychosocial wellbeing. International Migration, 57(2), 200–220.

    Article  Google Scholar 

  • Coutin, S. B. (1998). From refugees to immigrants: The legalization strategies of salvadoran immigrants and activists. International Migration Review, 32(4), 901–925

  • Coutin, S. B. (2000) Legalizing moves: salvadoran immigrants’ struggle for U.S. Residency. Ann Arbor: University of Michigan Press

  • Coutin, S. B., & Chock, P. (1995). Your friend, the illegal: Definition and paradox in newspaper accounts of U.S. Immigration Reform. Identities, 2(1), 123–48

  • Crenshaw, K. (éd.). (1995). Critical race theory: The key writings that formed the movement. New York: New Press

  • Crenshaw, K. W. (2013). The race track: Understanding and challenging structural racism. The New Press.

  • Creswell, J. W. (2013). Qualitative inquiry and research design: Choosing among five approaches (3rd ed.). SAGE Publications.

  • De Genova, N. (2002). Migrant ‘illegality’ and deportability in everyday life. Annual Review of Anthropology, 31, 419–447

  • Delgado, R. (1995). Storytelling for oppositionists and others: A plea for narrative. In Critical Race Theory: The Cutting Edge, edited by R.Delgado, (pp. 60–70). Philadelphia: Temple University Press

  • Delgado, R., & Stefancic, J. (2001). Critical race theory: An introduction. New York University Press.

  • Delgado, R., & Stefancic, J. (2017). Critical race theory: an introduction. Third edition. New York: New York University Press

  • Dhume-Sonzogni, F. (2014). Entre l’école et l’entreprise la discrimination en stage: une sociologie publique de l’ethnicisation des frontières scolaires. Aix-en-Provence: Presses universitaires de Provence : IREMAM.

  • Eklöf, N., Abdulkarim, H., Hupli, M., & Leino-Kilpi, H. (2016). Somali asylum seekers’ perceptions of privacy in healthcare. Nursing Ethics, 23(5), 535–546.

    Article  Google Scholar 

  • Fassin, D. (2004). Social illegitimacy as a foundation of health inequality: How the political treatment of immigrants illuminates a French paradox. In A. Castro & M. Singer (Eds.), Unhealthy health policy: A critical medical examination. Altamira Press.

  • Fassin, D., Eric Fassin, 2006. De la question sociale à la question raciale? représenter la société française. Découverte.

  • Feldmann, C. T., Bensing, J. M., De Ruijter, A., & Boeije, H. R. (2007). Afghan refugees and their general practitioners in the Netherlands: To trust or not to trust?: Afghan refugees and their general practitioners in the Netherlands. Sociology of Health & Illness, 29(4), 515–535.

    Article  Google Scholar 

  • Freeman, G. (2004). Immigrant incorporation in western democracies. The International Migration Review, 38(3), 945–969.

    Article  Google Scholar 

  • Gibson, R., & Kitto, S. C. (2014). A comparison of health access between permanent residents, undocumented immigrants and refugee claimants in Toronto, Canada. Journal of Immigrant and Minority Health., 16(1), 165–176.

    Article  Google Scholar 

  • Glaser, B. G., & Strauss, A. L. (1968). The discovery of grounded theory: Strategies for qualitative research. Weidenfeld and Nicolson.

  • Grit, K., Den Otter, J. J., & Spreij, A. (2012). Access to health care for undocumented migrants: A comparative policy analysis of England and the Netherlands. Journal of Health Politics, Policy and Law, 37(1), 37–67.

    Article  Google Scholar 

  • Gunst, M., Jarman, K., Yarwood, V., Rokadiya, S., Capsaskis, L., Orcutt, M., & Abbara, A. (2019). Healthcare access for refugees in Greece: Challenges and opportunities. Health Policy, 123(9), 818–824.

    Article  Google Scholar 

  • Hoyez, A.-C. (2015). Trajectoires de santé et trajectoires migratoires chez les migrants sud-asiatiques en France: La santé à l’épreuve de la précarité et du sentiment d’isolement. Migrations Société, N° 161(5), 157.

    Article  Google Scholar 

  • Humphris, R., & Bradby, H. (2017). Health status of refugees and asylum seekers in Europe. In Oxford research encyclopedia of global public health. Oxford University Press.

  • Kullgren, J. T. (2003). Restrictions on undocumented immigrants’ access to health services: The public health implications of welfare reform. American Journal of Public Health, 93(10), 1630–1633.

    Article  Google Scholar 

  • Larchanché, S. (2012). Intangible obstacles: Health implications of stigmatization, structural violence, and fear among undocumented immigrants in France. Social Science & Medicine, 74(6), 858–863.

    Article  Google Scholar 

  • MacFarlane, A., Dzebisova, Z., Karapish, D., Kovacevic, B., Ogbebor, F., & Okonkwo, E. (2009). Arranging and negotiating the use of informal interpreters in general practice consultations: Experiences of refugees and asylum seekers in the west of Ireland. Social Science & Medicine, 69(2), 210–214.

    Article  Google Scholar 

  • Maier, T., Schmidt, M., & Mueller, J. (2010). Mental health and healthcare utilization in adult asylum seekers. Swiss Medical Weekly., 140.

  • Mangrio, E., & Forss, K. S. (2017). Refugees’ experiences of healthcare in the host country: A scoping review. BMC Health Services Research, 17(1), 814–830.

    Article  Google Scholar 

  • Morris, M. D., Popper, S. T., Rodwell, T. C., Brodine, S. K., & Brouwer, K. C. (2009). Healthcare barriers of refugees post-resettlement. Journal of Community Health, 34(6), 529–538.

    Article  Google Scholar 

  • Noël, O. (2014). Groupe de travail ‘faire société commune dans une société diverse:’ fabriquer autrement les politiques publiques. Migrations Société., 155(5), 101–114.

    Article  Google Scholar 

  • Norredam, M., Mygind, A., & Krasnik, A. (2006). Ethnic disparities in health. Access to health care for asylum seekers in the European Union—A comparative study of country policies. European Journal of Public Health, 16(3), 285–289.

    Article  Google Scholar 

  • Office français de protection des réfugiés et apatrides. (2018) Available at: https://www.ofpra.gouv.fr/fr/l-ofpra/actualites/les-donnees-de-l-asile-2017-a-l. Accessed 29 Sept 2020.

  • Pace, M., Al-Obaydi, S., Nourian, M. N., & Kamimura, A. (2015). Health services for refugees in the United States: Policies and recommendations. Public Policy and Administration Research, 5(8), 63–69.

    Google Scholar 

  • Pulitano, E. (2013). In Liberty’s Shadow: The discourse of refugees and asylum seekers in critical race theory and immigration Law/Politics. Identities, 20(2), 172–189

  • Romero, M. (2008) Crossing the immigration and race border: A critical race theory approach to immigration studies. Contemporary Justice Review, 11(1), 23–37

  • Rutter, J., & Latorre, M. (2009). Social housing allocation and immigrant communities. Manchester: Equality and Human Rights Commission

  • Schepers, W., G. Juchtmans, and Nicaise I. (2017). “Reaching out to hard-to-survey groups among the poor”. Survey protocols, statistical issues and research design. (Milestone 20.5). InGRID, Leuven.

  • Scott, P. (2014). Black African asylum seekers’ experiences of healthcare access in an eastern German state. International Journal of Migration, Health and Social Care, 10(3), 134–147.

    Article  Google Scholar 

  • Slingenberg, L. (2016). The reception of asylum seekers under international law: Between sovereignty and equality. Hart Publishing.

  • Small, N., & Gott, M. (2012). The contemporary relevance of Glaser and Strauss. Mortality, 17(4), 355–377.

    Article  Google Scholar 

  • Stovall, D. (2005). A challenge to traditional theory: CRT, African-American community organizers, and education. Discourse: Studies in the Cultural Politics of Education, 26(1), 95–108.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Paul May.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix

Appendix

Ethics

We ensured that all participants gave formal informed consent, using an information sheet (in English and French) that explained the purpose of our research, and how the data would be used. When the person did not speak either language, we asked the translator to explain the contents of these documents. Participants agreed to give their age and the name of their disease, when they were sick. We do not disclose the family names of the participants, however, a few participants wanted to remain anonymous, so we gave them fictitious names (* in Table 1).

Table 1 List of interviews

Contact with interviewees

We used a “snowball sampling” technique to compose the sample, since this method is particularly recommended for investigating hard-to-reach populations (Schepers et al., 2017). The methodology for collection and analysis was inspired by Glaser and Strauss (Glaser & Strauss, 1968; Small & Gott, 2012). Contact with refused asylum seekers was established through the NGOs and unions.

However, snowball sampling is not considered to be representative of a larger population. Consequently, in order to limit potential biases, we used two tools: linear snowball sampling (subjects give several contact references, but only one new subject is recruited from among them) and the use of key informants (experts who know the target population and provide access to a diverse sample in terms of gender, national origin, and age) (Salganik, 2006). Starting from there, we followed a two-step procedure.

In the first step, we identified organizations that could provide initial access to people who fit the characteristics of the study: people who had applied for political asylum in the Paris region and who were still waiting for an answer at the time of the interview. We contacted NGOs that focus on the protection of asylum seekers and refugees (Center Primo Levi, France Terre d’Asile). Two employees of these associations gave us access to the field and the respondents. Information was provided about the project to potential respondents and interviews were set up with volunteers. Through our contact with the associations, we put together a diverse group of participants in terms of national origin, age, and gender.

In the second step, the interviewees were invited to circulate the information to other people they know and for whom this project could be relevant. Here we used linear sampling: each individual participant recommended exactly one other participant. The reason is that people tend to designate people they know, friends, close acquaintances, and people of similar national descent. We wanted to increase the diversity of respondents’ origins in terms of gender and national origin. We did not want a given nationality to be overrepresented. After expanding the sampling to other rejected refugee groups, the data became richer and the differences between respondents’ origin became more varied.

Interviews were divided into two parts. The first part gave participants an opportunity to freely explain their migration journey, without interruption and without constraint. The goal was to be immersed in the context in which they live and to identify the general structural constraints they had to face. The second part of the interview consisted of more targeted questions about their access to healthcare institutions and the strategies they use to overcome obstacles to care.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

May, P. The Letter and Spirit of the Law: Barriers to Healthcare Access for Asylum Seekers in France. Int. Migration & Integration 22, 1383–1401 (2021). https://doi.org/10.1007/s12134-021-00821-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12134-021-00821-5

Keywords

Navigation