"Not a free version of a broken system:" Medical humanitarianism and immigrant health justice in the United States. (September 2021)

• Record Type: Journal Article
• Authors: Hoekstra, Erin
• Is Part Of: Social science & medicine. Volume 285(2021)
• Publication Date: 2021-09
• Subjects: Medical humanitarianism -- Immigration -- Health care -- Immigrant health justice -- Political advocacy -- Arizona -- Ethnography; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2021.114287
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: Medical humanitarian organizations are increasingly the primary healthcare providers for unauthorized migrants in high-income countries. Existing studies of medical humanitarianism in the Global North reveal tensions between principles of traditionally apolitical humanitarianism and human rights. In practice, these tensions translate into organizational debates about prioritizing direct service provision to meet immediate needs or advocacy to effect long-term systemic change. Informed by these debates, this paper asserts the importance of immigration and health policy contexts as central to shaping the relationship between healthcare provision and political advocacy within medical humanitarian NGOs. Drawing from twelve months of fieldwork with medical humanitarian NGOs in Arizona, I analyze data from ethnographic participant observation and interviews with volunteer healthcare providers at a medical humanitarian organization I call Community Clinic of Phoenix (CCP), a free clinic for uninsured, undocumented immigrants. I find that, in the context of Arizona's anti-immigrant rhetoric and policies, CCP employs medical humanitarianism as both a discourse and a model of care to challenge immigrants' exclusion from health coverage and criminalization through immigration enforcement. The clinic's emphasis on immigrant health justice shapes their critiques of the structural failures of U.S. immigration and health systems, their approach to providing equitable access to quality healthcare for uninsured immigrants, and their work to create broad social change for immigrant rights and health justice. Driven by their mission of "not replicating a free version of a broken system, " the clinic's healthcare provision amid a climate inhospitable to immigrants demonstrates the importance of both conceptualizing and practicing medical humanitarianism as healthcare advocacy. Highlights: Some medical humanitarian NGOs view healthcare provision as distinct from advocacy. Immigration and health policy contexts shape NGOs' healthcare provision and advocacy. Medical humanitarianism in the U.S. addresses migrant exclusion and criminalization. Medical provision amid climate of migrant criminalization is healthcare advocacy. Immigrant health justice frames advocacy as intrinsic to medical humanitarianism.