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.

The UK–Philippine trade in nurses: is it ever ethical?

By Megan Anjeri Buxton.

Funding for home-grown nurses has been steadily declining in the UK since the 1980s. The last nail in the coffin came in 2016 when the bursary for nursing students was entirely scrapped. As a result, we have a graduation rate of 27 nurses per 100,000 people. Hardly enough to meet the demands of a generally unhealthy and ageing population – and that’s before the pandemic hit. Practicing nurses are also rightfully fed up with poor employment conditions and low pay and they are leaving in droves. The NHS needs 50,000 more nurses and is looking towards the Philippines to fill a lot of this gap.   

Currently, there are 40,000 Filipino nurses working in the UK, a staggering number that results from an arrangement made between the UK and Philippine governments. Established in 2003, this bilateral agreement provides the UK with Filipino nurses, and the Philippines with compensatory funds from the UK as well as remittances from their overseas workforce. Despite this agreement being purportedly a ‘win-win’, the increasing ‘industrial-complex’ that has come to characterise the trade in nurses is sucking the Philippines dry.  

A nurse in full PPE during the COVID-19 pandemic (image: Ömer Yıldız on Unsplash)

Context  

For the UK, relying on overseas healthcare personnel is hardly new. Since the NHS came into being in 1948 it has been staffed by workers from the Commonwealth who nursed a nation recovering from war back into health. The UK has a habit of poaching nurses from nations who are most in need. In the past both Ghana and South Africa have condemned the part the UK played in their severe nurse shortages. Similarly, in 2014 the most targeted countries for recruitment to the UK were Spain, Portugal and Italy, each of which were suffering from devastating economic crises.  

Looking abroad for nurses is not surprising for a nation that is founded on the extraction of resources from elsewhere for its own convenience. The financial costs of recruiting an overseas nurse are only ten per cent of what it would cost the UK to train its own. Overseas nurses are also ‘ready-made’, with seven years of training replaced by only the few weeks it takes to recruit one. The externalisation of costs is a sign of the commodification of nurses who are viewed not as humans providing essential healthcare but as goods to be bought and sold.   

The ethics of recruitment  

Although managed by the Philippines Overseas Employment Agency (POEA), the export-led model in the nursing field in the Philippines has led to increasing private-sector involvement. Many nursing schools, or ‘migrant institutions’, train nurses specifically to go overseas. Because they are profit driven many schools have enrolled students far beyond capacity, jeopardising the quality of training. Schools often have business deals with licensure exam review centres. There have been instances where schools have bribed officials from the Professional Regulation Commission of Nursing to leak exam questions. Such corruption has resulted in a system of nurse training that follows industry models. Profit seeking has compromised the quality of care and nurses themselves have been transformed into a mass-produced commodity.   

Within the sector more and more schools have been established that cater only for the export market. This means that the syllabus does not match the needs of healthcare in the Philippines, and that skills become specialised towards western diseases and illnesses. In fact, some recruitment companies that operate internationally have amalgamated with nursing schools, streamlining the export process. As a result, not only is the Philippines losing nurses, but doctors are re-training as nurses and also leaving the country. The Philippines has half the amount of nurses and ten times fewer doctors per capita than does the UK. Over the past decade hundreds of hospitals have closed and the mortality rate has increased to the level it was 30 years ago. For Jaime Galvez-Tan, previously the Executive Director of the National Institutes of Health in the Philippines, this phenomenon is less an example of ‘brain-drain’ than of ‘brain-haemorrhage’.  

In the UK certain measures have been put in place to ensure that recruitment practices remain ethical. The 1999 Department of Health guidelines state that compliance with its code of practice ‘minimises harm to the health and care systems of countries of origin’. The industry in nurse recruitment that has resulted from the bilateral arrangement between the UK and the Philippines appears to fall far short of these guidelines. The ethics of the recruitment agencies – who also follow a profit-based business model – are not dependable when the sector is not regulated by a government body.

Having a code of practice suggests that the UK government should monitor agency recruitment carefully. But a study of NHS Trusts found that few had any information on recruitment activity and most had none at all. A long chain of outsourcing and sub-contracting – from companies involved in initial training to ones that market emigration opportunities, to those that guide nurses through the visa application process, to companies that arrange travel and English Language Tests – makes it difficult to keep track of the specific activities involved in recruitment. The monitoring process for the code of practice is not sufficient to deal with these complexities. It simply ‘encourages’ health and social care organisations to respond to surveys capturing international recruitment activity and to share information on any known breaches of the code of practice. The agencies themselves are only sent an email every two years asking them to ‘confirm their compliance with the principles of the code of practice’ and to supply two referees to confirm that they use the agency and that it complies with the code of practice.

The pandemic has further highlighted the questionable ethics of Filipino nurse employment in the UK. Nurses come to the UK on a Tier-2 visa, which makes their ability to legally reside in the UK dependent on them being in employment. Without a job, their legal residence is withdrawn. As a result, many Filipino nurses have felt under pressure by management to work extra shifts and work in COVID wards as they feel they ‘owe’ the hospital for allowing them to enter and reside in the UK. This has likely contributed to the disproportionately high number of Filipino NHS nurses who have died from COVID. A letter to parliament from the Filipino UK Nurses Association points out that of the 50 Filipino nurses who died last year almost 40 were in a high-risk category and should have been allowed home to shield. 

Overall, then, a picture is painted of a trade agreement that is creating a fatal imbalance in the distribution of nurses between the UK and Philippines. It has led to a training industry that values profit over education, a recruitment industry that is left largely unmonitored and a work environment in the UK that puts Filipino nurses at risk. From origin to destination each leg in this chain is unethical.

Megan Anjeri Buxton is a student on the MSc Migration and Mobility Studies at the University of Bristol.

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.