Reporting Sounds: the lived impact of UK Home Office reporting on the lives of asylum seekers

By Amanda Schmid-Scott.

Forty minutes into the bus journey that takes me from the bustling streets of Bristol’s city centre, through Bishopston and Horfield, and slowly along Gloucester Road, with its vibrant array of independent shops and cafes, we eventually head onto the busy dual carriage way. As we leave the shopfronts and people on foot behind, the bus eventually stops. At the side of the dual carriage way, I disembark and cars rush past at 60 mph. In order to cross to the other side of the road, I am forced to make a run for it when there is a gap in the traffic. I arrive at Patchway police station which, approximately seven miles from central Bristol, is the official immigration reporting centre for the city and the surrounding area. Immigration reporting, often referred to as ‘signing’, is a compulsory requirement for migrants without legal status, including asylum-seekers who are awaiting a decision on their asylum claim. Framed by the Home Office as an administrative procedure, migrants are required to present themselves regularly (usually once a week, or bi-weekly) to one of 13 reporting centres located throughout the UK as a condition of immigration bail.

Today is my first day volunteering with Bristol Signing Support, a group who regularly attends the reporting centre at Patchway to offer practical and emotional support to migrants in what can be a frightening and often isolating experience. This is due to the fact that the Home Office, as well as using reporting appointments as a means of keeping track of the whereabouts of migrants pending legal status, utilise these sites to target potential deportees. This means that each time an individual attends their reporting appointment, they face possible detainment and removal from the UK.

I volunteered with the Bristol Signing Support group for a year from May 2017, and as part of my doctoral research conducted interviews with asylum-seekers subjected to immigration reporting, as well as fellow volunteers and asylum support workers involved in various local community organisations. Over time, I recognised how, alongside the often extreme fear many migrants experience of being detained during their reporting appointments, these sites also impose more surreptitious, mundane forms of harm. Accounts of those subjected to reporting requirements reveals how these often hidden and hard-to-reach reporting sites enforce a continuum of violence, steering migrants towards subjugation, destitution and removal (Schmid-Scott, forthcoming).

Home Office reporting, interactive map (image: Reporting Sounds website)

With funding I obtained during a postdoctoral research fellowship at Newcastle University, I collated a selection of my research interviews to produce Reporting Sounds, an interactive website enabling users to explore the impact of immigration reporting on the lives of asylum-seekers living in the UK. Designed in the form of a map of Bristol, the website combines hand-drawn pen-and-ink illustrations with audio-recorded stories from my field research. These testimonies situate the various harms that are imposed on asylum-seekers in relation to their immigration reporting requirements, invoking the ways in which the impact of reporting affects their everyday lives. These experiences are focused around five individual stories, each indicative of the continuum of violence which constitutes the UK’s asylum process. By centring on their experiences of immigration reporting, these stories connect the administrative systems and sites of UK border control measures with everyday encounters with suffering.

At times, this suffering emerges through more surreptitious and mundane spatiotemporal harms, implicit in the obligation to travel repeatedly to these often remote, difficult-to-access sites, very often for years on end. Mohammed describes requesting to have his reporting schedule reduced – a request that was denied – and how he must pay for the bus to and from his appointments, which is a huge financial burden for those that are already living below the poverty line. Likewise, Hassan recounts not having enough money to pay for the bus fare, and tells the Home Office ‘you can arrest and detain me again’. The inclusion of each individuals’ journey times and travel costs, signalling the proportion of time and money these journeys necessitate, further illuminates the everyday burden regular reporting entails.

Elodie’s story of reporting (image: Reporting Sounds website)

At other times the harms that reporting imposes materialise through the more overt violence of arrest and detainment. Elodie’s experiences of being detained during her reporting appointment, where she suffered a panic attack, point to the danger these sites hold in repeatedly threatening asylum-seekers with potential arrest and detainment. For Mohammed, the fear of being detained affects his sleep prior to signing days; he describes how ‘you never know when you’re coming back’. Samuel also talks of being detained during his reporting appointment within the onsite holding cells and reflects on the shame he felt in being detained ‘as someone who committed a crime’. Bernadette’s account reveals how the threat of being detained is felt beyond the walls of the reporting centre, as she explains: ‘I’m still looking through my window all the time. Between six o’clock and eight o’clock in the morning, that’s what time they normally come.’ As these accounts show, the threat of a possible detainment and subsequent forced removal attempt is intimately felt by individuals, making it an extremely stressful process, and yet one which they must repeatedly engage in, often for years on end.

Samuel’s story of reporting (image: Reporting Sounds website)

Creating an archive

By creating an interactive, auditory web-archive of asylum-seekers’ testimonies, Reporting Sounds sheds light on the relatively unknown border control practice of immigration reporting and provides the opportunity for the public to explore its everyday impact on the lives of asylum-seekers in the UK. As Sara Ahmed’s work has identified, archives are tethered to the question of whose experiences are worth preserving (Ahmed 2006), and through my own attempt at creating an archive of asylum-seekers’ testimonies, this form of data gathering holds space for these otherwise little-known-about and hidden experiences. Using the form of a map to situate their testimonies, and drawing attention to their less-visible sites of impact (that is, the home, the body, the reporting office), imposes a form of ‘counter-mapping’ which, as Craig Dalton and Liz Mason-Deese argue, allows us to challenge and reimagine dominant spatial imaginaries and how certain populations move through these spaces (Dalton and Mason-Deese 2012). While each of these five stories is deeply personal to the individual’s experience of reporting, they are also reflective of the current, contemporary political moment, in which the UK government has placed hostility towards and the removal of asylum seekers at the front and centre of its politics. The last, sixth box is left open for individuals to share their own experiences of reporting.  

In May 2024, I will be hosting an event with Migrants Organise in London, to launch the website and to invite the public to learn more about immigration reporting and the lived experience of asylum. If you would like more information, please get in touch.

Amanda Schmid-Scott is a Lecturer in Criminology at Bristol University. Her research explores the intersections between bureaucracy and violence within border control sites and systems, engaging with feminist theories of violence and resistance to examine how the sites and practices which constitute asylum-seeking are made, negotiated and resisted. She recently completed an ESRC postdoctoral research fellowship at Newcastle University.

Disablement and resistance in the British immigration system

By Rebecca Yeo.

The distinction between deserving and undeserving individuals has always been core to immigration policy in the UK. However, the hostility and restrictions directed at those framed as ‘undeserving’ has steadily increased. The recently introduced Illegal Migration Bill takes these restrictions to a new level to include detaining and preventing new arrivals from even claiming asylum. The need to build effective opposition has never been more urgent. With this goal, it is important to consider the inequities of the current system, possible alternative approaches to resistance and the barriers that must be addressed.

The disabling impact of immigration controls

In 2012, then-Home Secretary Theresa May stated her aim to create a hostile environment. Subsequent legislation (Immigration Act, 2014; Immigration Act, 2016) was explicitly designed to restrict access to such necessities as housing, financial support and sense of safety. These policies prevent people from meeting their human needs. As one Disabled woman subject to asylum restrictions said to me: ‘If they are torturing someone they can’t expect that person to be okay.’ The Independent Chief Inspector of Borders and Immigration (ICIBI) acknowledges that ‘immigration control measures which deny access to services, can increase vulnerability.’ The result is to disable people with existing impairments, as well as to create new impairments. Immigration policy is actively and deliberately disabling.

Mural created with Disabled people subject to immigration controls, led by artist Andrew Bolton, see disabilitymurals.org.uk (Photograph: Mark Simmons)

Compassion in immigration policy

The hostility of immigration policy has always been combined with expressions of compassion. In her speech to the Conservative Party conference in October 2015, while setting out measures to create a hostile environment, Theresa May also proclaimed: ‘Let Britain stand up for the displaced, the persecuted and the oppressed. For the people who need our help and protection the most.’ Similarly, current Prime Minister Rishi Sunak asserts that he is ‘balancing’ his pledge to ‘stop the boats’ with assertions that ‘the UK remains a safe haven for the most vulnerable.’ Even the UK-Rwanda partnership includes a clause to allow for resettlement of some of ‘the most vulnerable’ refugees from Rwanda to the UK. This may be considered a welcome alternative to hostility. However, as the ICIBI asserts, Home Office efforts to identify ‘vulnerable individuals is a test not just of its competence but also of its capacity for compassion.’ Expressions of compassion towards ‘vulnerable’ individuals are not used to contest, but to reinforce, the legitimacy of hostility towards others.

A social model approach

Insights from the Disabled people’s movement could help focus resistance against the disabling impact of immigration policy. In 1976, the Union of Physically Impaired Against Segregation argued it is ‘society which disables.’ This principle was developed by disabled sociologist Michael Oliver, among others, to replace the individual approach of the charity model with what became known as the social model of disability. This approach calls for collective responsibility to address the disabling impact of inequities faced by people with impairments. A similar approach could focus on resisting the disabling restrictions imposed on people subject to immigration controls. Without negating the emotional and physical pain inherent in many forms of impairment, or in being forced to flee one’s home, effective resistance must challenge the socially constructed, and therefore changeable, injustices. A social model of immigration could bring together the Disabled people’s movement, people subject to immigration controls and allies of both, to build solidarity and collective resistance to the restrictions and inequalities of assumed human value, which underpin current injustices.

The barriers to change

It is meaningless to assert the need for a social model of immigration without acknowledging the barriers. Restricted access to services and support is a central tool of immigration policy. Barriers to change are not, however, exclusively at the level of the state.

Lived experience

Manjeet Kaur paints part of the mural that represents her experience: ‘The wheelchair is chained… I feel restricted by the UK Border Agency, I am not free to do anything.’
(Photograph: Andrew Bolton.)

The social model of disability was developed by Disabled people rather than charitable organisations. However, when people are struggling for immediate survival, there is little capacity to lead resistance. As activist Manjeet Kaur explained to me just months before she died, in the face of immediate struggles as a Disabled asylum seeker, ‘I don’t have the energy… I myself am in a floating boat, I can anytime fall down.’ The capacity for solidarity from the wider Disabled people’s movement is reduced by lack of information and individual struggles in the context of an ever more punitive welfare state. The mantra of the Disabled people’s movement ‘nothing about us, without us’ is as valid as ever, however, the solidarity of allies has never been so important.

Voluntary sector

The asylum voluntary sector may be the obvious source of solidarity. However, rather than seeking advice and collaboration from the Disabled people’s movement, all too often asylum voluntary sector organisations have endorsed Home Office and local authority initiatives towards individuals considered ‘vulnerable’ as if this approach is better than nothing. Of course, some compassion is better than none, but these initiatives adopt a regressive individualistic approach to disability. Like most progressive ideas, the social model of disability and associated concepts have been widely co-opted and distorted to remove demands for systemic change. This risks undermining key struggles of the Disabled people’s movement, including demands for the services and support necessary for independent living as enshrined in the UN Convention on the Rights of Disabled People. A broad-based movement of solidarity is needed to focus on addressing causal injustices.

Public response

Collective resistance is further hampered by lack of public concern. Response to the COVID-19 pandemic exposes how publicly acceptable it is to treat some lives as disposable. The majority of people who have died from COVID are Disabled. Yet public response to this knowledge is not to take collective responsibility to reduce the risk, but instead to remove precautions and leave the responsibility with individuals. The result is to exclude anyone concerned about infection from public space, with at least #Forgotten500k facing the fourth year of lockdown.

Widespread disregard for the value of certain lives may increase the barriers to effective action but if current inequalities are socially constructed the issue is not whether change is possible but how it can be achieved. Systemic change may appear unrealistic, but as author and disability activist Ellen Clifford writes: ‘We have no choice. The stakes have become too high’.

Rebecca Yeo is completing a postdoctoral fellowship at the University of Bristol on refining and promoting a ‘social model of asylum’ as a tool to transform responses to disability and forced migration in the UK. Her work draws on her involvement in the Disabled people’s movement and what she has learned from disabled people seeking asylum.

A recording of Rebecca’s webinar, ‘A social model of asylum: disablement and resistance in the British asylum system,’ is available here. This was part of a webinar series co-hosted by MMB and GRAMNet on ‘The Health of Migrants and the Right to Health.’ A recording of MMB’s emergency discussion on the 2023 Illegal Migration Bill can be watched here.

Previous post by Rebecca Yeo: ‘The power of collaborative art in research for social change,’ 8th March 2022.

Access to healthcare: human right or civil liberty?

By Ella Barclay.

A right to health is enshrined in many international agreements, indicating the perceived importance of wellness and accessible healthcare for the development and flourishing of individuals (UDHR, Art. 25:1; ICESCR, Art. 12.1; CEDAW, 12:1; CRC, Art. 24:1). Despite this, one of the main sites of immigration control targeted within the UK’s ‘hostile environment’ is the NHS, with the healthcare rights of undocumented migrants being largely compromised following the implementation of the 2014 and 2016 Immigration Acts. Such policies constitute an intentional appeal to the public perception of migration as a strain on the UK’s public services. In framing these individuals as ‘criminals’ or ‘deviants’, it is far easier to justify their restriction of rights. However, the nation-state’s freedom to deny access to such rights for undocumented persons leads us to question whether these supposedly universal rights may actually be mere civil liberties.

The National Health Service (Charges to Overseas Visitors) Regulations (2015) introduced NHS charges for all those not ‘ordinarily resident’  within the UK, despite the NHS constitution outlining that access to care should be based on clinical need, not an individual’s ability to pay. To be ‘ordinarily resident’ one must reside within the UK voluntarily, legally and with the intention of remaining for a prolonged period (DHSC, 2022). Healthcare providers establish the charging eligibility of patients through a screening process, involving questions about residency and migrant status. If an individual is found to be eligible for NHS charges, this information will be passed onto that NHS trust’s Overseas Visitor Manager (OVM), who will pursue them for payment. Crucially, the actions of the OVM are dependent on the information gathered by healthcare providers, meaning the administrative burden and moral responsibility effectively fall on clinical staff.

(Image: Hush Naidoo Jade Photography on Unsplash)

While primary care, including emergency services, GP registration and vaccinations, is always free of charge and cannot be denied to any individual, all other care is chargeable at a rate of 150%, which must be paid before treatment can be provided. Maternity care constitutes an exception to this policy, defined as ‘immediately necessary’, meaning individuals are not required to pay prior to receiving care but are instead billed after the fact. If an individual is unable to pay for their care after receiving it, their residency status will be shared with the Home Office, thereby alerting immigration officers to the potentially undocumented status of the patient.

Many scholars have argued that this practice of data-sharing conflicts with the NHS’s Caldicott Principles, which emphasise confidentiality and privacy in the interests of both the individual and the institution (Papageorgiou et al., 2020; Reynolds and Mitchell, 2019; Robinson et al., 2018). However, where undocumented migrants in the UK are presented as criminals and their mere existence presented as a threat to state security, this violation of an inherent NHS value is seemingly justified. More specifically, the principles of the Data Protection Act (2018) can be revoked where withholding data is seen to place public interests at risk. Withholding data is therefore seen to hinder effective immigration control: in other words, these individuals are considered not to have a right to privacy (Crépeau and Hastie, 2015; Kulakiewicz et al., 2022; Van Durme, 2017). Once the Home Office has been notified that an individual is residing without the correct authorisation, not only can they choose to deport the individual, they can also keep such ‘deviance’ on record, which will be taken into consideration if the undocumented individual were ever to apply for a visa. This forces undocumented individuals into a ‘rights trap’; they must either incriminate themselves to receive the safe care they are owed under international legislation or go without healthcare they may dearly need (Gentleman, 2018; Hermansson et al., 2020).

Although the impact of such policies on the wellbeing of migrants is well-documented (DOTW, 2017; Hamada et al., 2021; Pellegrino et al., 2021; Westwood et al., 2016), restricting the accessibility of healthcare for a substantial portion of our population has further-reaching consequences. Even where primary services may be free of charge, threats of data-sharing prevent undocumented individuals from exercising their rights to such care, which undermines public health and herd immunity (BMA, 2021; Bulman, 2020; Weller and Aldridge, 2019). Similarly, the deterrent effect of charging policies costs the NHS more than the initial price of providing treatment to all. De Jong et al. (2017), Jones et al. (2019) and WHO (2018) report that undocumented persons are often hospitalised for longer after pregnancy and for otherwise treatable illnesses as a result of their decisions not to seek care due to fears of detection. Preventative care is not only more effective but also more cost-efficient than remedial care, indicating that current policies are not only discriminatory and detrimental to individual and public wellbeing, but also counterproductive for the NHS and the economy (McHale and Speakman, 2020; Norris, 2022).

Charging those not ‘ordinarily resident’ for healthcare also has a serious impact on the NHS. The British Medical Association (2019) reports that a large proportion of healthcare staff find their workload to have increased significantly following the implementation of charging policies. Similarly, NHS staff are working outside of their billed hours to provide informal help to undocumented migrants, as they are not able to support them fully within appointments. This support ranges from signposting and advocacy to financial support and even forging documents (Feldman et al., 2019).

Documenting the far-reaching impacts of this hostile environment policy exposes the irrationality of charging practices, and denying this human right in the name of securitisation sets a dangerous precedent for nation-states’ treatment of vulnerable persons. The UK cannot be said to be upholding their pledges to international legislation when individuals residing within its borders are unable to access basic healthcare. Where international policies can be manipulated and shaped to fit a nation-state’s own agenda we must question who can hold these states accountable, and who will protect the rights of our undocumented populations.

Ella Barclay is a first-year PhD student in Sociology at the University of the West of England. Her research takes an ethnographic approach to understand the experiences of pregnancy, labour and early motherhood for undocumented migrant women within the UK’s hostile environment. Ella completed the MSc in Migration and Mobility Studies at the University of Bristol in 2020 and is an MMB Alumni Ambassador.

Looking back to ‘The Postcolonial Age of Migration’: a post-pandemic view

New writing on migration and mobilities – an MMB special series

By Ranabir Samaddar.

My book The Postcolonial Age of Migration was published in 2020 when the COVID-19 pandemic raged in India and elsewhere. Global mobility had screeched to a halt, as had mobility within India. Locked down in my house when I received a copy, I was driven to reflecting on what I had written: did I do justice to our age in describing it as the postcolonial age of migration?

While writing the book I was aware of the importance of historical sensitivity in making sense of our postcolonial age. Time and again the book goes back to colonial histories of war, plunder, changes in land use, peasant dispossession, ecological marginality, primitive accumulation and the continuities of all these themes in our time. With this backdrop the book discussed colonial practices of violence and border-making exercises and how they were being reproduced today on a global scale. It argued that wars, famines and ecological changes accounted in a big way for today’s migrations and forced migration flows and influenced patterns of labour mobility. This was also the context of the emergence of modern humanitarianism with its specific doctrine of protection. In brief, the book analysed the imprints of the colonial roots of modern humanitarianism and protection.

Yet, as I reflected on the book in the midst of the pandemic, it dawned on me that it was silent on one of the most important realities of our time. The overwhelming presence of COVID-19 made me realise that it did not take into account epidemiological disasters as integral to the colonial history of migration and the postcolonial age of migration. The absence of any concern for migrant workers and refugees in the structure of global public health concerns should have been noted. The book discusses camps and speaks of health concerns of the refugees in camps, but the larger perspective of public health was absent.

India’s history of epidemics offers insights into the country’s poor public health infrastructure. The history of the 1897 outbreak of bubonic plague in colonial Bombay is well known and the present situation of COVID-19 has evoked comparisons. Thousands fled the city in the closing years of the 19th century, spreading the disease in the process. Public health infrastructure was zero. Residents locked themselves up in their houses in fear of plague-control officers who could pick anyone up, quarantine them, and separate children from their families.

A refugee Hindu family during the 1897 bubonic plague, Bombay (Image: Wellcome Images)

In the following 20 years about 10 million people died of the disease across India. Plague was accompanied by other infectious diseases such as cholera, smallpox, malaria, tuberculosis and influenza. Malaria killed millions through the years, and an estimated five per cent of the country’s population perished in the influenza epidemic of 1918-19. As one commentator put it, of all these diseases, it was only the bubonic plague that was declared as crisis. ‘Then, as now, only one out of a handful of deadly afflictions, the one that most directly threatened commerce, trade, and the accumulation of capital—was identified as a crisis.’ The plague became the Bombay government’s priority for the next two decades. As capital and labour began fleeing the city in the wake of the disease, the government implemented massive efforts to bring them back in. We are probably witnessing today something similar to what happened in the past.

The countrywide lockdown of 2020 reminded us of these earlier eras as the country witnessed masses of migrants returning home on foot, a growing hunger crisis, stockyards and storages overflowing with millions of tons of surplus food, and arbitrary powers being exercised across the nation. This was a call back to the Epidemic Diseases Act of 1897. In the outbreak of the plague the city of Mumbai (then Bombay) came to a halt. Thousands of workers (according to some estimates 300,000) left the city. This only sharpened the crisis further. The Bombay Improvement Trust was formed to restore the city’s ‘reputation’ of cleanliness. Yet in those efforts, the policy focus was on making the city ‘clean’ rather than setting up and improving public health infrastructure. Cleaning the city was a ‘public’ purpose; ensuring health of the people was less of a priority. We still do not know, as we did not know in 1896-98, if draconian measures such as the sudden and total lockdown can stop or control contagion. So far, we have waited and tolerated a ‘minimum number of deaths’ (including collateral deaths such as of migrants on the roads or rail tracks) to allow the pandemic to pass away. Social Darwinism matched perfectly the economic policies that were to follow the pandemic.

Disease does not act alone. It acts in unison with a policy of eroding public health infrastructure. Pushing refugees and migrant workers to the fence and robbing them of access to the public distribution of food, public health provisions and employment in public works became wittingly or unwittingly a part of disease control measure. In many ways independent India followed the colonial approach.  

In this context the migrant is seen, like the virus, to spread disease. The migrant’s body is considered suspect. Like the virus, in country after country, the migrant has been symbolised as the enemy from outside. We are now accustomed to the idea that our civilisation is at war with a new kind of external enemy. Like a parasite it breeds in the most vulnerable areas of human life, waiting for the moment to release a pathological violence upon its otherwise oblivious prey. The colony also represented this threat to the metropolitan world. Colonies brought ‘tropical diseases’ and were the source of mysterious illnesses and dangers. 

Political society has long held the belief that viruses and migrant workers both belong to the outside. The outbreak of the epidemic and the sudden emergence of thousands upon thousands of migrant workers on the roads in India trying to escape the trap of lockdown signalled the end of the mythical safety of a society of settled population groups and of the state that guards this insularity. The range of policy problems and debacles in coping with the pandemic arose from the ignorance of the phenomenon of mobility – of both pathogens and workers. There is no doubt that any account of postcolonial imprints on the current age of migration will be incomplete without an examination of the interrelated notions of public health and refugee and migration flows.

Ranabir Samaddar is the Distinguished Chair in Migration and Forced Migration Studies, Calcutta Research Group. His research focuses on migration and refugee studies, the theory and practices of dialogue, nationalism and post-colonial statehood in South Asia, and new regimes of technological restructuring and labour control. His book The Postcolonial Age of Migration was published in 2020 by Routledge and you can watch an interview with him about the book on the MMB Insights and Sounds 2022 series.

Organising against fear: migrant nannies and domestic workers during COVID

New writing on migration and mobilities – an MMB special series

By Maud Perrier

Migrant nannies and domestic workers were largely absent from mainstream feminist commentary during the COVID-19 pandemic as well as from public discussion of childcare. In the UK broadsheets, most of the media coverage of the childcare crisis during this time was dominated by stories of working mothers’ struggles to manage caring for children and working from home. The unequal division of labour between men and women, and fears about women’s stalled careers and promotion gaps in the near future, were the main sources of middle-class feminist anxiety. As Veronica Deutsch argues the middle-classes expertise as orators of their own suffering along with pandemic-induced nationalism combined to position migrant nannies as out of reach from public sympathy.

(Image: Félix Prado on Unsplash)

The depiction of the pandemic as representing the ‘death of the working mother’ reproduced a white liberal feminist analysis that simultaneously privileged individual professional success and invisibilised these women’s reliance on paid childcare. At the same time the demand for live-in nannies as a safe option increased substantially and there was mounting evidence globally that domestic workers faced heightened restrictions on their movements and ability to see their families, and that many faced unemployment, homelessness and death after catching the virus at work. Two years on from the start of COVID, how can we centre the experiences of migrant and racialised minority nannies’ who organised during the pandemic to shift how we think about solidarity and care between women across ‘race’ and migration status?

Between October 2020 and February 2021, I carried out interviews with nanny organisers through two worker-led grass-roots organisations – one with migrant nannies in the UK and the other with nannies and domestic workers in the US – to learn how their organising changed during the pandemic. The Boston-based organisers belong to the Matahari Women Workers’ Centre, a medium-sized long-established organisation, but the London Nanny Solidarity Network was only established during COVID. The Nanny Solidarity Network was set up to respond to the destitution that migrant nannies in West London faced during the pandemic and within a few weeks was delivering English-language training, mutual aid, welfare support and immigration/employment legal advice to more than 100 members.

Across both sites, my interviewees reported that for many nannies in their organisations their relationships with parent-employers significantly worsened during the pandemic and were characterised by increased fear and vulnerability. Nannies recounted stories of employers breaking lockdown rules and not following social-distancing regulations. One interviewee was asked to come into work after her employer’s family returned from a trip abroad without following quarantine rules. Another was asked to look after a friend’s child without considering the heightened risk of transmission for the nanny. Anastancia Cuna, a well-known domestic worker organiser, aptly describes these situations as employers capitalising on the economic conditions of the pandemic.

To fight this climate of fear, the Domestic Employers Network successfully developed resources to empower workers to navigate this increased vulnerability – for example, COVID contracts and guidance about safe working, which workers could use to hold their employers to account. The conversation guide includes the discussion of procedures adopted to reduce exposure when someone tests positive, as well as transport and entering work routines. It also includes a section recommending that employers commit to higher rates of pay during the pandemic and agree to give nannies paid time off for sickness or for relatives’ sickness. These documents form an important part of the organisation’s praxis empowering workers to refuse to give in to fear. The resources suggest quite a different story about how to negotiate deepening divisions during the pandemic, which highlights the importance of formal legal frameworks in building solidarity. At a time when few governments offered any formal protection for these workers, a last resort was to appeal to employers’ consciences about their legal responsibilities.

The pandemic put on hold the well-documented organising that is historically carried out by nannies in public parks across the globe, as well as their shame demonstrations outside employers’ homes. But organisations like the Nanny Solidarity Network and Matahari Women Workers’ Center developed methods to continue building worker power virtually through online assemblies. They also managed the distribution of state aid in the US via the National Domestic Workers Alliance and in the UK through mutual aid. But interviewees emphasised that temporarily becoming a cash assistance organisation proved challenging at times as it contradicted their aim of building worker power. Online spaces of sociality were also vital sources of community survival for unemployed workers throughout and beyond the pandemic in both countries.

Pre pandemic, discussions of teachers’ and childcare workers’ strikes assumed that solidarity between parents and teachers and between lecturers and students would act as a strategic wedge in labour relations, which neoliberal senior managers underestimated at their peril. Jane McAveley describes these ties as the ‘ace up the sleeve’ of care workers who can mobilise their ties to the community to their advantage in such disputes. My research showed that while nannies in the UK and the US may not be able to count on such direct community solidarity, they have developed alternative techniques of building allyship and community within a hostile environment.

Scholars and activists have long been calling for more intimate organising in feminised sectors whereby the relational ties between caregivers and care-receivers are leveraged to secure gains from employers and governments. What these nannies’ voices suggest is that the question of intimacy with whom needs to be much more at the centre of this discussion post pandemic. This requires careful consideration if more worker-led migrant organisations are to join coalitions with low-income parents and low-paid childcare workers – such as the Care that Works coalition – which are powerful enough to hold states to account for their disappearing act.

Maud Perrier is a Senior Lecturer in the School of Sociology, Politics and International Studies at the University of Bristol. Her research focuses on care workers’ organising, social reproduction theory, motherhood and maternal workers, socialist feminist movements in UK, North America and Australia. Her most recent book is Childcare Struggles, Maternal Workers and Social Reproduction (Bristol University Press, 2022). A recording of the book launch with MMB Director Bridget Anderson is available here.

The cure or the cause? The impact of medical tourism on global health inequality

By Ella Barclay.

Migration motivated by the improvement of one’s health is not a new phenomenon. Nineteenth-century doctors around the world prescribed visits to foreign spas to improve wellbeing and London’s Harley Street was one of many internationally renowned centres for medical care. Despite this, there has been a recent boom in such movement, with individuals increasingly opting to access care beyond their state borders (Morgan, 2010). This phenomenon, termed ‘medical tourism’, has developed into a globalised industry, with states now viewing healthcare as a commercialised product. Various destinations have chosen to profit from this trend, even marketing themselves as ‘international healthcare capitals’ (Hanefeld et al., 2014). However, concerns have been raised regarding the actual value of this phenomenon, with many questioning whether this growing market is helping or hindering global equality.

Medical tourism as the cure

Contrary to the assumption that the healthcare industry thrives in economically developed countries, the rise of medical tourism has been described as a case of ‘reverse globalisation’ (Connell, 2013), shifting power and wealth back into less economically developed states (LEDCs). These destinations have embraced the commercialisation of international medical care, offering up affordable treatment to citizens of, typically, more economically developed states who wish to travel abroad for their procedures and simultaneously experience the tourist aspects of these ‘exotic’ destinations (Johnson et al., 2010). Funnelling large sums of their state budget into this sector, LEDCs have profited greatly from this phenomenon, with medical migrants contributing significantly to the medical and tourist sectors.

(Image: Annie Spratt on Unsplash)

The growth of this industry within LEDCs also counters the effects of ‘brain drain’, by creating jobs within the healthcare sector (Oberman, 2013). Where the mass migration of medically trained individuals to Western states was previously the norm, leading to labour shortages within native states, the rise of medical tourism in LEDCs has created many new healthcare centres, offering highly paid jobs to citizens (Cohen, 2011). This again boosts the state’s economy by allowing for a ‘return investment’ in their residents; the individuals who are trained within (and, therefore, funded by) the state remain within that territory to ‘give back’ to the economy. Here, one could argue that Western states will suffer from labour shortages as we heavily rely on this migrant workforce. However, as people increasingly seek treatment abroad, the strain on state resources will be simultaneously alleviated. Subsequently, the wait time for elective treatments within national systems will be reduced, thereby benefiting medical tourists and residents alike.

Lastly, with the growth of the global market for any commercialised good comes competition and innovation (Lee et al., 2011). Each state wants to offer the newest and best treatment to its high-paying customers, thereby continually funding medical research, technology development and infrastructure, to ensure they are the go-to medical tourist destination. This ongoing competitiveness has hastened medical advancements over the past two decades and greatly improved the quality of healthcare available globally.

Medical tourism as the cause

The novelty of this phenomenon means the medical tourism market is not well regulated. Although the quality of care provided by verified clinics is improving, there are no regulations in place to prevent unqualified and illegitimate clinics from targeting foreign patients. Defined by critics as ‘rogue medical tourism’ (Hunter and Oultram, 2010), individuals offer impossibly cheap treatments, exploiting the naivety and frugality of medical migrants by allowing non-medical staff to carry out procedures in unsanitary and inadequate surroundings. This aspect of medical tourism not only causes harm to the individual but also re-asserts the strain on their home healthcare system, as they will inevitably want to address any ‘botched’ treatments within their own country.

International clinics may also offer treatments that are illegal in other states, such as euthanasia or stem-cell research (Higginbotham, 2011). The availability of these treatments could be seen to enhance autonomy, however, there remains a question of where the line can be drawn concerning treatment that is seen as unethical in one state yet permitted and even promoted in another. Evidently, claims of ‘enhanced quality of healthcare globally’ by proponents of medical tourism are debatable.

Similarly, there is a question of whether this supposedly high-quality healthcare benefits all persons, or simply the elite few who can enjoy the luxury of medical tourism. Having recognised the potential economic value of this industry, state funding currently prioritises healthcare efforts that serve foreign, wealthy patients, as these yield a profit. More money is put into the development of the luxury provision of healthcare, than into the necessary provision of healthcare to impoverished persons; in an effort to harness the full potential of medical tourism, states are neglecting the wellbeing of their own citizens (Bookman and Bookman, 2007). Not only are these individuals denied access to this high-quality care due to their inability to pay, but they also lack basic health rights, such as access to sanitation and clean water, highlighting the need to invest in this lower sector of care provision, not de-fund it. This constitutes a ‘dual medical system’, in which the standard of care available is dependent on one’s socioeconomic status, thereby increasing healthcare inequalities within the state (Manna et al., 2020). Although medical tourism may reverse the effects of globalisation by placing wealth back in the hands of LEDCs, on a national scale the growth of this industry makes the disadvantaged worse off. Claims that this phenomenon is benefiting LEDCs when inequality within these states only grows are misinformed.

Conclusion

Medical tourism may have the potential to benefit global health inequality, but the current over-investment into this sector is exacerbating the already compromised health of those worst-off, creating a dichotomy within the provision of healthcare. To view health as a commercialised product rather than a human right is to ignore the importance of access to healthcare for basic wellbeing and growth. Until this inequality is addressed, and a basic level of care is provided to all within and across states, it is both misguided and unethical to invest in a global industry that favours luxury over human rights.

Ella Barclay is a PhD student in Sociology at the University of the West of England. Her research focuses on the sexual and reproductive rights of undocumented migrants within the UK’s hostile environment and involves ethnographic research with migrant mothers in Bristol. Ella completed the MSc in Migration and Mobility Studies at the University of Bristol in 2020 and is an MMB Alumni Ambassador.

‘Six new home carers near you!’ How digital platforms shape domestic services

By Jing Hiah.

Finding cleaning and child rearing services is easier than ever in many parts of the world. Install an app on your phone and start browsing through hundreds of (female) workers. If you decide not to directly hire their services – perhaps you feel too embarrassed (can’t we take care of ourselves?!) – you’ll be sent reminders by email: ‘Six new home carers near you. Contact them now!’

Domestic service is reportedly the fastest growing sector in the platform or ‘gig’ economy – that is, economic activity facilitated by digital platforms that mediate supply and demand, creating digital marketplaces. Rising demand for home-based care and domestic workers and health professionals (and even virtual nannies during the COVID-19 lockdown) has been prompted by factors including women’s entrance into the paid labour market, longer lifespans and the retrenchment of the welfare state. Platform companies like Care.com, Helpling and Handy have designed digitised infrastructures that connect domestic workers to those wanting their services. This is the focus of my project ‘New mobilities or persistent inequalities’, which I will be researching during my 20-month stay at the University of Bristol.

(Image: Magnet.me on Unsplash)

New mobilities or persistent inequalities?

Paid domestic work can be broadly understood as all tasks conducted in the private household including cleaning, child rearing and care of the elderly. While inequalities and difference in paid domestic work are hotly debated, it has been cited as a quintessential example of ‘invisible work’ due to its poor labour conditions combined with legal disenfranchisement, which make the sector vulnerable to exploitation. Furthermore, the demand for domestic workers is highly gendered, as it is associated with women’s ‘natural’ qualities. Racialisation also plays a part, with some minority groups considered to be better fitted to perform domestic work, and this has intersected with female migration in different parts of the world. Immigration regulations further control the rights and mobilities of domestic workers, whether they have entered on domestic worker, family reunion or other visas, or overstayed.

Anonymised example of an app for finding domestic workers (created by the author)

My project will explore how vulnerabilities and inequalities in domestic work are shaped by digital platforms. The literature so far suggests that these platforms offer some groups of marginalised workers, such as migrants, racialised minorities and workers with familial obligations (often women), new and flexible opportunities to access work. However, there is also growing evidence that platforms contribute to a degradation of employment relations. They do not guarantee minimum wages or income security and they challenge worker organisation. Furthermore, work on surveillance capitalism and visibility regimes has found the digital infrastructures of platforms and the associated online visibilities of workers to cause further inequality in the domestic employment relationship.

So, what about the ‘six new home carers near you’? It’s important to remember that the carers have no idea who ‘you’ are and neither do they know anything about your household. You do all the picking and choosing. This picking and choosing, research shows, is not only based on the profiles of the individuals on the app: employers also often check the broader social media presence of workers, for example on Facebook and Instagram. For some workers it has become a full-time (unpaid) job to perform gender and ethnicity through their platform profiles. Meanwhile, they have no idea about the appearance, relationships or even gender, race, occupation or name of potential employers. Workers therefore often have to give up their privacy, manage their various connected social media profiles and invest in social media skills, which they may be unfamiliar with and certainly don’t get paid for.

Possibilities for ‘good’ platformed domestic work jobs

So today I was trying to get the attention of [the kid the nanny is taking care of] and he was glued to his Switch. I gave him ample warning that we were about to change to a different task and he has 5 minutes left before we move on. He told me no, that he wants to keep [playing] and that he’ll just ask his mom for more time. Imagine my surprise when [their] mom storms out of the room, takes the Switch, and firmly says ‘I never want to hear that again. Nanny is always right and don’t you forget it.’ And just walks away….

This family is definitely my unicorn family, and it was just solidified today that I never want to leave them! I felt so freaking empowered!

(Post on an online nanny support group.)

Inequalities related to paid domestic work have been recognised to be pretty persistent and these inequalities may have become even more serious when mediated by the digital infrastructures of platforms. Yet does that make a job in paid domestic work by definition a ‘bad’ job? The post of the (self-identified) nanny above on an online nanny support group gives us some insight into various aspects of what, according to sociologists of work, makes a job a ‘good’ job – namely a sense of autonomy, control over work activities and social contact (other aspects include income, health and control over work hours).

So, while the employment relationship between paid domestic workers and their employers may be characterized by inequalities, what also matters is the manner in which employers and workers approach these inequalities in their everyday relationships. The various discussions in the online nanny support group show that it is not only important to workers to be treated fairly, but that many employers also do their best to secure fair and good relationships. Since there has been less work done on the perspectives of employers, the aim of my project is to also include their perspectives in my analysis of platformed domestic work. I am looking forward to hearing from employers and workers how they secure fair relationships in platformed domestic labour relations.

Jing Hiah is an Assistant Professor in Criminology at the Erasmus University Rotterdam and a Dutch Research Council (NWO) Rubicon Postdoctoral Fellow. She is visiting the University of Bristol from December 2021 until July 2023 as a guest of MMB and SPAIS. During this time she will be carrying out her study on domestic labour platforms funded by the Dutch Research Council, the Erasmus Trustfonds and an innovation grant of the Erasmus School of Law.

The power of collaborative art in research for social change

By Rebecca Yeo.

On Human Rights Day, 10th December 2021, a mural on the wall of Easton Community Centre was officially opened. It brings together and promotes messages from Deaf, Disabled and asylum-seeking people living in the Bristol area. The collaborative process of creating the mural is the latest in a series of projects facilitated by artist Andrew Bolton and myself, including work in Bolivia and in the UK. In this most recent project in Easton we specifically sought to bring together the Disabled people’s movement and people with experience of the UK immigration system, as well as to develop creative means of engagement during the pandemic.

‘Disability and migration: a mural for social change’, Easton Community Centre, Bristol, 2021 (image: Mark Simmons)

My research focuses on responses to disability and forced migration in the UK (Yeo, 2015, 2017, 2019, 2021). Within this, I investigate and seek to reduce the barriers separating the asylum sector and the Disabled people’s movement – there is considerable overlap in the experiences of people in both. Many asylum seekers, for example, experience severe mental distress or have other impairments. However, with this mural we were not only working with asylum seekers who identify as Disabled but with a wider section of both groups to build an understanding of the similarities and differences in their experiences.  

The mural conveys key messages of the hopes and struggles faced by asylum seekers and Disabled citizens. Some people contributed images and others used words to explain what they wanted the world to understand. Andy, the mural artist, worked with each person to include elements of their ideas or images in the overall design. Some people helped to paint the mural background directly onto the wall. Others painted their contributions onto wooden boards, which were then varnished and fixed to the wall. Alongside the painting, each person was invited to contribute to a short film, explaining their messages in their own words.

This collaborative and creative research approach brought together people whose voices are rarely heard in the mainstream media. The images highlight that the asylum system itself is actively and deliberately disabling, but the mural also makes clear that these injustices are not inevitable. The top of the mural is divided into three rainbows: on the left, a colourful rainbow represents visions for how things could be; in the middle, the rainbow has more muted colours, representing things changing for better, or worse; and on the far right, a grey rainbow represents the worst injustices. 

At the start of the first rainbow, a chain of interconnected people provide help and solidarity to each other (left). However, the University of Bristol’s Student Disability and Accessibility Network explained how this chain of support has been made increasingly fragile through underfunding, and how responses to COVID have been pulling it apart.

Together with many other Disabled people, students expressed their relief when, during lockdown, university lectures along with many public events became accessible from home. They hoped that lockdown might increase empathy and commitment to long-term provision for people who need remote access. However, Lizzy Horn, a woman who has been largely housebound for the last 13 years described her frustration when, after the first lockdown, the need for remote access was again sidelined. She contributed this Haiku:

Gaze from my window,
The world moves on once again,
I am left behind.

Meanwhile, people seeking asylum described the disabling effects of government policy. Under the colourful rainbow, a group of people chat happily. But in the centre, under the fading rainbow, one man stands with his backpack after leaving a house (below). On the right, the same man is homeless, crouching in a bush. Without food, shelter or hope for the future, he explained that asylum policy had caused him to ‘lose [his] mind’. A uniformed officer and a suited man stand together ignoring the homeless man. These figures represent immigration officers and politicians as well as those in academia, local government and beyond who collude with the police and government policy rather than risk speaking out against injustice.

Three stages of homelessness

Above this, a series of cages hang from the sky bring together experiences of asylum seekers and Disabled citizens. People from both groups talked about feeling trapped and being unable to move on in their lives. In the first cage (right), under the muted rainbow, a wheelchair user is surrounded by confusing information from social and mainstream media. The socially constructed nature of the cage is highlighted by having a second image of the same wheelchair user under the brightly coloured rainbow, but this time sitting in a comfortable pagoda, able to engage with and contribute to the world (see cage image above).

The middle cage (below) contains a Deaf person with their arms out signing ‘Where?’ In front of the cage there is a hand with the words, ‘Where is the interpreter?’ This image from Lynn Stewart Taylor is the symbol for the campaign that she established in response to government failure to provide British Sign Language interpreters for public health announcements about COVID. As with many images in this mural, the image is also very relevant to a wider population: government announcements about the pandemic have routinely been provided only for English language speakers. The final cage holds a dead canary, evoking the historical practice of taking canaries into mines to warn of gas leaks. This mural warns that urgent action is needed to save lives. 

Next to the final cage there is a drawing of Kamil Ahmad, a Disabled asylum seeker who was murdered in Bristol in 2016. The image is repeated from his contribution to a mural in 2012 – it depicts him holding his head in despair at the injustices caused by the Home Office. The mural is dedicated to him, in a quest to build solidarity and prevent further injustices. 

The mural enabled participants to claim a space in a public setting and raise awareness of their experiences of marginalisation. The images and messages will also be submitted to the United Nations as part of this year’s shadow report from Deaf and Disabled people. The UN uses this report, alongside an official government submission, to assess how the UK is meeting its obligations under the UN Convention on the Rights of Disabled People. This is the first time that the experiences of asylum seekers have been included in the shadow report.

In these ways, this mural is intended not just to convey people’s experiences but also to contribute to change. The key message is that if we work together it is possible to build a better world and extend the colourful rainbow to include everyone. It calls for solidarity between the asylum sector, the Disabled people’s movement and allies – as one contributor put it, ‘togetherness is strength’.

Rebecca Yeo is an ESRC Postdoctoral Research Fellow in the School for Sociology, Politics and International Studies, University of Bristol. Her research focuses on refining and promoting a social model of asylum as a means to transform responses to disability and forced migration in the UK.

All images by Rebecca Yeo and Andrew Bolton except where indicated.

Collateral damage: the implications of border restrictions on practitioners working with refugee populations

By Vicky Canning.

The acknowledgement that asylum systems across Europe are ‘hostile environments’ for migrant groups has increased in academic and practitioner consciousness, particularly in the aftermath of the 2015 refugee reception crisis. However, although the impacts of socio-political hostilities on migrants are well documented, little has been written about the implications of border restrictions on practitioners working with refugee populations. In recent years I have led a research project that expands the focus of hostilities to consider the variable impacts of intensified bordering practices on this group.

Based on qualitative research across Britain, Denmark, and Sweden (2016–2018), the project highlights that increasingly restrictive or punitive approaches to immigration have had multiple negative effects on practitioners in this sector. This has potential for longer term negative impacts on the practitioners themselves, but also – importantly – on refugee populations who require various forms of legal aid, or social and psychological support. The working conditions of practitioners is often reflected in the standard of care that they are able to offer. Vicarious trauma and compassion fatigue are two of the most commonly cited problems. Importantly, and as this blog addresses, this research indicates that practitioners are facing new and serious problems working in this area, many of which are direct outcomes of the intensification of Northern European border regimes. 

(Image: Jannik Kiel on Unspalsh)

Emotional and workplace impacts on practitioners

Interviews with practitioners indicate that increasingly restrictive or punitive approaches to immigration have had multiple effects on those working in this sector. One stark issue highlighted by lawyers, psychologists, detention custody officers and support workers is that they felt their ability to effectively perform their own role well has been compromised. Some indicated increasing levels of stress and, in Sweden in particular (a strong state centric welfare model), a decreased faith in state and state decisions. Terms such as ‘powerless’ and ‘stress’ were included in practitioners’ responses to questions about the impacts of escalated harms in asylum – in particular, when they felt they could support people seeking asylum while being held in an indefinite state of uncertainty or crisis.

Keeping up to date with the workings of the asylum process is increasingly difficult at a time when laws and policies are changing regularly, thus affecting the rights or welfare entitlements that people seeking asylum can access. This is particularly difficult for practitioners who are working with refugee groups to provide humanitarian assistance, as they find themselves in positions where they are implementing laws they cannot agree with. Those working with survivors of trauma or sexual violence raised concerns about their client’s inability to focus on therapy or integration programmes due to risk of dispersal or other illnesses getting worse. People seeking asylum can be more concerned with pressing issues arising in the immediate future, such as the threat of homelessness, fear of detention or deportation, or concern for family and friends still residing in areas of conflict or migrating across borders.

The trend towards disempowerment

Practitioners also highlighted feelings and experiences ranging from sadness or upset to disempowerment and hopelessness. People working in a deportation centre in Denmark felt dismay at the lack of clarity regarding the expectations of their role and that their participation did not always have a positive impact:

‘I had days when I went home thinking that today I was definitely a part of the problem, not the solution, today my presence here was a band aid at best but the patient’s haemorrhaging and I’m not actually doing what I’m supposed to be doing.’

In some places, the limits to the support that practitioners are able to provide are not only affected by economic resources but also managerial and policy decisions on what is or is not allowed. As one nurse in an immigration detention centre reflected, ‘You want to do more than you are allowed; you are not allowed to.

The emotional effects of seeing people living in avoidable and degrading circumstances are also clear. Many felt that cuts to staffing or services reduced their ability to offer adequate support, as one women’s support worker in Scotland indicated, ‘It really is crippling ‘cause we can’t meet the needs. Literally turning people away every day who are in crisis, so that is awful.’ Shortly after this interview, in 2016, the interviewee contacted me to say their role had been removed. To date, it has not been replaced.

Breaking trust

Finally, this research found that impacts on practitioners are exacerbated by increasing mistrust between people seeking asylum and governmental and non-governmental organisations, particularly in the UK and Sweden. For others, the emotional impacts of witnessing the degradation of people seeking asylum were palpable, as a social worker in the North West of England suggests:

‘Sometimes we need to separate our feelings away from the client, but for the first time since I have worked in this field I felt as if I was about to cry when I went to the hospital because I’ve never seen somebody who has been neglected by the system like this woman I came across, because you don’t treat people like this, this is unacceptable in 21st century Britain’.

Practitioners often alluded to a loss of faith in humanitarianism in their respective states. One torture rehabilitation director remarked that, ‘they’re testing this unfortunately, a social experiment, how far they can get with their whip’, while a barrister in London questioned the rationale of governmental agendas, asking ‘Even if you accept the premise that migration is a problem and needs to be reduced, why don’t you wait to see what the last set of bad laws did before you bring in the next of the bad laws?

In Sweden, a typically state centric nation, the impacts of this increasing mistrust were strengthened with the introduction of the REVA Project – a collaboration between Swedish Police, the Migration Agency and prison service that targets people suspected of living illegally in Sweden in order to speed up detection and deportation – which has received subsequent criticism for racism (see Barker 2017).

Migrant groups and practitioners are therefore left in precarious positions: anyone without documentation or who is awaiting the outcome of an asylum claim may be subject to arrest and possible detention or deportation, while some practitioners simultaneously lose faith in governmental agendas and face reduced capacity to undertake their role due to external pressures.

In the UK, the Nationality and Borders Bill, now in the House of Lords for readings after being debated for only nine minutes in the House of Commons, will inevitably continue this trend, creating an ever more hostile environment towards migrants and in which practitioners working with refugee populations have to operate, a trend I have previously critiqued as degradation by design.

Vicky Canning is a Senior Lecturer in the School for Policy Studies (SPS), University of Bristol. Her research focuses on the rights of women seeking asylum and support for survivors of sexual violence and torture across NGOs and migrant rights organisations, and on mitigating border harms. A longer version of this blogpost was published by SPS on 17th December 2021.

Sweden faces COVID-19 with a neoliberal elderly care system and a racialised labour market

Letter from Afar – the blog series about life and research in the time of COVID-19.

By Anders Neergaard.

Dear friends,

Reading newspapers every day and strolling around the streets and parks of Malmö (Sweden) I watch people trying to live with the pandemic. It’s scary as a human being but interesting as a sociologist. It raises so many questions that need further research. Being who I am, I often study a phenomenon or practice in terms of how class, gender and racialisation affect people. Thus, this blog post is about how inequalities intersect with the pandemic health strategies of elderly care, mobility and migration.

In newspapers around the world (such as The Guardian, El País and Página 12) Sweden is making headlines as one of few countries that have not implemented legislated lockdowns of society, instead trying instructions and recommendations for physical distancing (please do not call it social distancing, as we are trying to maintain social closeness in times of physical distance). Is this Swedish approach an experiment, and if so, what will be the consequences compared to other strategies? While these are important questions, we need more time and better material to be able to answer such questions.

Instead, I want to focus on two particular, and partially connected, aspects of what seems to be an Achilles heel in limiting the consequences of the pandemic. One concerns the neo-liberalised care of the elderly in Sweden, and the other the racialised (often of migrants) class structure.

Two elderly people in wheelchairs sit at a table waiting to be served
Elderly residents of a care home in Sweden. Image: Elitsha

One of the few things we know about COVID-19 is that it aggressively targets the elderly. Thus, the organisation of elderly care is at the core of understanding who dies and why in the pandemic. Most people would argue that care of the elderly is a central aspect of humane societies (despite the fact raised by many economists that their direct contribution to the economy often stops with retirement). Thus, we have some forms of organised elderly care, but it is rarely an area of priority in politics. The elderly care system was far from being good during the heydays of the social democratic welfare state, but the neoliberal re-regulation (using privatisation) (Peck 2004), New Public Management and shrinking municipal taxation (in Sweden the municipalities are formally responsible for care of the elderly) has created a system based on scarcity, just-in-time services and profits (Szebehely 2017). Consequently, elderly care is characterised by employees who have to care for numerous elderly people, elderly people receiving care who have to meet many employees and an austere elderly care infrastructure (Behtoui et al. 2016). In times of the COVID-19 pandemic, this mean that elderly care is a hotbed for the spread of the virus.

Another way of showing the vulnerability of elderly care services is by looking at its care workers (I focus on paid care work, but we shouldn’t forget that a substantial part is carried out by daughters or other female relatives as unpaid work). Within this group, assistant nurses (by far the most prevalent job in elderly care in Sweden) are disproportionately represented by women and racialised workers, both women and men (often migrants) whose role intersects with poor working conditions, low wages and discrimination (Behtoui et al. 2020).

This reflects the gendered and racialised Swedish class structure, meaning that women in general and racialised men and women (many migrants or children to migrants) in particular are overrepresented within the working class, and are overrepresented in working class jobs that have lower wages and poorer working conditions (Neergaard 2018).

What does this have to do with elderly care and the COVID-19 pandemic? In answering, I would like to highlight two key points. In this pandemic two particular categories of jobs with low wages and poor working conditions are important in making the society function but are also highly exposed to COVID-19 and thus to spreading it. The first, mentioned above, are assistant nurses directly involved in caring for the elderly and in containing the virus. The second is the more general category of service workers, especially bus and taxi drivers and ticket inspectors of public transport, but also workers in retail and restaurants. Both these groups work in economically underfunded services, are highly exposed to COVID-19 in their daily work and have been neglected when it comes to protective equipment and instructions for avoiding contagion.

Furthermore, if one of these workers is infected with the virus, then the chance of continued infections is substantial due to their housing situation. In a recent analysis of Statistics Sweden, it was shown that almost one in three immigrants from countries outside Europe, who have been in Sweden for less than ten years, lives in a home with more than two people per bedroom. The corresponding figure for persons born in Sweden, with at least one domestic-born parent, is 2 per cent. Many of these immigrant households are three-generation families that include elderly grandparents due to the difficulties of finding adequate housing among the lower and racially discriminated sections of the working class (SCB 2019).

We don’t yet know when robust statistics will be produced that show Sweden’s excess mortality in the era of COVID-19, although preliminary statistics show a strong overrepresentation of elderly within care, as well as migrant and racialised workers and their parents. However, we shouldn’t focus only on the government’s interventions to contain the pandemic. What I have argued in this short text is that the combination of a neoliberal elderly care regime with a racialised (and gendered) working class structure seems also to be a central factor in explaining why the elderly in care, and the elderly within racialised families, have been more exposed to COVID-19 in Sweden.

Anders Neergaard is Professor in the Department of Culture and Society and Director of the Institute for Research on Migration, Ethnicity and Society (REMESO) at Linköping University, Sweden. His research focuses on inequality, power and resistance, especially related to discrimination, migration, racialisation and racism.