Médiathèque - Situation des migrants et des minorités dans le contexte des soins : le cas français par le pasteur Anne Miller - Lauprete, aumônier d’hôpital.
Building Bridges across Faith and Culture
This is an introduction to a discussion held on May 19 th 2006 in Lisbon during the 9 th Consultation of the European Network of Health Care Chaplaincy (www.eurochaplains.org ). It is a very brief presentation of minorities and migrants in Europe as seen from a French perspective. After giving a few facts and figures and stating some political issues, I will briefly mention three European institutions which are concerned with the question then I will make a few remarks on the situation in France and will end with questions on healthcare for migrants and minorities.
Otherness: This is the word I have chosen to stimulate discussion and thought.
The idea of otherness obliges us to define our limits, norms and how we conceive tolerance. It raises questions such as what can we accept? How far can we go? What are our experiences with the person who is different? When looking at facts and figures, it is helpful to have these questions in mind. The above poem was written by Sarah Mas Miangu, a migrant woman living in France. I have translated the first few verses into English:
Don’t Take My Blood
Woman in a white uniform! I come from somewhere else. Why do you accuse me ?
What do you want from me; I’m neither mean nor intolerant. It’s otherness.
It’s a border which stands between us, impossible to cross over.
The morning needles give me the shivers,
The coloured tubes on your tray look like soldiers lined up on a battlefield,
The presence of your white uniform in the morning gives me the impression that it’s finished for me.
But I’m a human being in search of an answer. I’m not an object.
No! Don’t touch me and don’t take my blood.
Migration in a nutshell
For some basic facts and figures I have relied upon work done by the Global Commission on International Migration (GCIM) www.gcim.org.
This commission was launched by the United Nations Secretary- General and a number of governments on December 9, 2003 in Geneva. There are 19 Commissioners on the commission. It is independent and was given the mandate to provide the framework for a global response to the question of international migration.
According to work done by this commission, there were nearly 200 million international migrants in 2005 which equals 3% of the world’s population. Almost half the world’s international migrants are women. There were about 56 million migrants in Europe in the year 2000. This is including the European part of the former USSR. It accounts for nearly 8% of Europe’s population.
Why do migrants move?
According to an economist, the initial decision will not be taken if the costs of emigration are not greatly inferior to expected revenues in the country of immigration. (1) The reasons most frequently put forward to explain migration are: wage disparities, unemployment rates, differentials in life expectancy, education gaps and demographic gradients (2). I think need for health care should be added to that list.
During 2003 and 2004 the influx of foreign entrees into several of the OECD (organization for economic cooperation and development) countries was stabile. (3)
According to the Higher Commission of the United Nations for Refugees (Haut Commissariat des Nations Unis pour Réfugiés) the number of asylum seekers has significantly fallen since 2003 and 2004. This makes for a fall of 19% in the European Union. France is not an exception but it is still one of the primary destinations for asylum seekers. (4)
I propose to take a brief glance at political issues behind immigration by looking at the question from four different angles: dynamics involved, selective immigration, illegal immigration and “throw away” immigration.
What are the dynamics involved?
Who benefits from the effects of migration? Economically the answer seems to be complex.
Immigration politics on a European level is having a hard time being unified. Each country has its own policies and laws. Security is an important topic. The politics of handling influx of migrants seems to be converging, namely over the control of European Union borders. In Dublin in 2002 an agreement was made within the European Union concerning asylum seekers. Only the first country visited has the right to give asylum. (5) Habits among migrants are also changing and a new concept is emerging called “repeated migration”. (6) Migrants often aim for a relay country which is usually easier to get into before moving on to a final destination. The recent diversification of European countries receiving migrants has also influenced different dynamics in the influx of migration.
Selective immigration has been practiced throughout history by the USA, Canada, New Zealand and Australia. I believe that some European countries have also recently adopted such a policy. In France the debate was launched in January 2005 by Nicolas Sarkozy who put forward the idea of what he calls “chosen” immigration as opposed to “imposed” immigration. The idea of selective immigration stemmed from an original idea that immigration would be able to replace aging populations. There is sufficient economic analysis on the effects of immigration in general but so far few concerning effects of selective immigration. Economically speaking the impact of selective immigration is uncertain in the long run. Politics based on selective immigration would involve intricate control of people entering countries. As an economist mentions, this could not be done without posing ethical and legal problems. (7)
A recent report was published this year in April by the Senate in France on the subject of illegal immigration. (8) Not only the members of the European Union are having a hard time solving the problem but little is really known concerning the migration phenomenon. Illegal migration can be synonymous to migrant smuggling and human trafficking. In hospitals in France we sometimes meet with sick migrants who are refused entry into the country. Policemen are posted in front of the doors to their hospital rooms ready to escort them back to detention centers at the airport. Up until now they have been able to receive care, but for how long?
Throw away immigration
This is the recent motto for associations fighting against selective immigration in France. They say that developed countries want only the advantages of migration and will throw away migrants once they have finished using them.
Institutions in Europe dealing with the migrant question
Churches’ Commission for Migrants in Europe
Founded in 1964, the CCME is an organization of churches and ecumenical councils. By raising issues of racism and xenophobia within the churches and in society, it develops awareness on the subject. Studies are also conducted on the situation of migrants, refugees and minority ethnic people at local, national and international levels.
Migrant Friendly Hospitals
Migrant friendly hospitals are a European initiative to promote health and literacy for migrants and ethnic minorities.
There are at least 12 pilot hospitals. Theses hospitals can be found in the following countries: Austria, Germany, Greece, Denmark, Spain, Finland, France, Ireland, Italy, Netherlands, Sweden, and the United Kingdom.
The Amsterdam declaration is a document resulting from work done when representatives of each migrant friendly hospital met in 2004. This document provides guidelines for hospitals that provide health care for migrants.
“The increasing diversity of patient populations poses new challenges to hospitals. Hospitals are frequently the first point of access for migrants and ethnic minorities as they offer a low threshold service, particularly in emergency situations. With growing importance of migration and the increasing multicultural composition of populations, the role of hospitals in the provision of health care for migrants and ethnic minorities will become increasingly prominent in the future. The European initiative “The migrant-friendly hospital” invites pilot hospitals who are willing to participate in a project that offers international expertise and resources to implement model interventions enabling them to respond effectively to these newly arising needs regarding structures, processes and outcomes of their services.” (9)
France: a country of contradictions
May 2006: A law restricting immigrants’ rights
This month, a law on selective immigration was reviewed by the National Assembly and was passed on May 17 th. In France, this law is considered to be the most restrictive one on immigration since World War II.
This same month President Jacques Chirac proclaimed May 10 th as an official day of commemoration of the abolition of slavery. Official texts and poems were addressed to schools and hospitals for lecture.
February 2006: A circular from the Ministry of the Interior giving police extensive rights to arrest foreigners without official status or who are trying to renew their status
In February hospitals in France received a decree from the Ministry of the Interior stating the right for policemen to check identity and arrest foreigners in public institutions. Doctors and hospital staff are alarmed by this official text which came into force in February 2006 and was to be applied immediately. It allows controls to be exercised within the hospitals and even in operating rooms!
January 2000: Universal Medical Coverage for everyone residing in France
July 1998: A law fighting against social exclusion at all levels and for all people
Earlier laws are still effective. These laws are based upon humanitarian values and promote rights for all individuals. These rights include accessibility to healthcare and give social workers the possibility to hospitalize people and get them medication even if they do not have official papers or permits for staying in France.
February 2005: A circular from the Ministry of Health restating the obligation for
Hospitals to respect religious beliefs and convictions of patients and to provide them with the possibility to practice their faith while hospitalized
This legal obligation dates back to 1905 in France.
This concept, according to the French philosopher Pierre-André Taguieff (10), is used when talking about social and political projects of a group or a community that undermine values promoted by the French Republic and its constitution, namely secularity(“Laïcité”). By subjugating members of the group or the community to norms established by the group, the group controls opinions and the behavior of their members. The word tribalism might be an approximate equivalent. Communautarism is opposite in meaning to such words as individualism or universalism. Nationalism and communautarism are conflictual concepts. The phenomenon is ideological and directly contests the internal construction of a nation.
Communautarism occupies the public arena often in false protest against racism. Communautarism does not distinguish cultural difference from law, rules or ethical standards. It demands subservience to an authority in the name of culture or tradition. It could be called politics dressed in a cultural costume.
Multi culturalism is thought of as being an Anglo- Saxon concept. According to some French intellectuals, this concept is not in keeping with a secular position which advocates neutrality and assimilation.
In France the issue of the Islamic veil coined the question of communautarism and on March 15, 2004 a new law was passed prohibiting ostentatious religious clothing or jewelry to be worn in public schools.
How do we deal with otherness? How do we respect the other person’s identity? What are the limits? Is it possible to draw clear borders between cultural traditions and ethical behavior, common law or rules and regulations? How do our answers to these questions affect care and attention we give to people hospitalized or working in hospitals?
This presentation was given so that the following questions could be discussed within our group on Friday morning, May 19 2006.
1. Does your country have a long or a short history of immigration? What are the main nationalities representing immigration today in your country? Which minority groups pose the most difficulties and why?
2. What kind of legal difficulties does a foreigner face when he wants to live and/or work in your country? Have there been any recent changes in these laws?
3. How are the terms integration and cultural assimilation understood in your country?
4. Would you describe the presence of foreign communities your country in terms of communautarism or multiculturalism?
5. What are the most strongly voiced protests coming from immigrant and minority communities in your country?
6. How would you describe the attitude of nationals towards the question of immigration and minority groups in your country?
7. What administrative drawbacks do qualified immigrants run up against when looking for employment? Are their diplomas recognized?
8. What are immigrants rights regarding health care? Is there discrimination towards specific ethnic groups?
9. Are there organisations, associations or institutions which are involved in helping immigrants and ethnic minorities receive health care? Do you have any contact with a Migrant Friendly Hospital in your country?
10. What are some of the major obstacles for hospitals in your country when caring for immigrants? What ethical questions arise when caring for sick immigrants or ethnically different groups? What are some of the important anthropological difficulties which occur when caring for immigrants and minorities (different approaches to pain, different symbolic meanings of blood etc.)?
11. How do we as chaplains relate to these different questions in our practice? How do we provide appropriate support for people we meet from minority groups and also for hospital staff responsible for caring for these people?
Anne Miller-Lauprete, delegate representing La Commission de l’Aumônerie des Etablissements Sanitaires et Médico -Sociaux de la Fédération Protestante de France
Note 1 : El Mouhoub Mouhoud – « Les migrations internationales : une composante de la mondialisation » in Les Nouvelles Migrations, Un enjeu Nord-Sud de la mondialisation, dirigé par El Mouhoub Mouhoud, France, Collection : Le tour du sujet, Universalis, 2005, p. 38
Note 2: Migration at a Glance in: Press Kit, www.gcim.org
Note 3: Garson (Jean-Pierre) – « Un panorama des migrations dans les pays de l’OCDE » in Les Nouvelles Migrations, Un enjeu Nord-Sud de la mondialisation, dirigé par El Mouhoub Mouhoud, France, Collection : Le tour du sujet, Universalis, 2005, p. 47
Note 4: Garson (Jean-Pierre) – « Un panorama des migrations dans les pays de l’OCDE » in Les Nouvelles Migrations, Un enjeu Nord-Sud de la mondialisation, dirigé par El Mouhoub Mouhoud, France, Collection : Le tour du sujet, Universalis, 2005, p. 50
Note 5 : Wihtol de Wenden (Catherine) – « Vers des politiques d’immigration sélectives » in Les Nouvelles Migrations, Un enjeu Nord-Sud de la mondialisation, dirigé par El Mouhoub Mouhoud, France, Collection : Le tour du sujet, Universalis, 2005, p. 113
Note 6 : El Mouhoub Mouhoud – « Les nouvelles migrations en Europe » in Les Nouvelles Migrations, Un enjeu Nord-Sud de la mondialisation, dirigé par El Mouhoub Mouhoud, France, Collection : Le tour du sujet, Universalis, 2005, p. 141
Note 7 : Ragot (Lionel) – « Les perspectives économiques d’une immigration « choisie » en France » in Les Nouvelles Migrations, Un enjeu Nord-Sud de la mondialisation, dirigé par El Mouhoub Mouhoud, France, Collection : Le tour du sujet, Universalis, 2005, p. 138
Note 8: Rapport de la commission d’enquête sur l’immigration clandestine, créée en vertu d’une résolution adoptée par le Sénat le 27 octobre 2005, remis à Monsieur le président du Sénat le 6 avril 2006, Dépôt publié au Journal Officiel du 7 avril 2006, Annexe au procès verbal de la séance du 11 avril 2006
Note 9: “Information for Interested Hospitals” in Migrant-Friendly-Hospitals, a European Initiative to Promote Health and health Literacy for Migrants and Ethnic Minorities, Ludwig-Boltzman-Insitute for the Sociology of Health and Medicine, Vienna, Austria, p. 2
Note 10: Taguieff (Pierrre-André) – « Multiculturalisme et communautarisme devant les principes républicains » in La République enlisée. Pluralisme, communautarisme et citoyenneté, Paris, Éditions des Syrtes, janvier 2005