Background Undocumented migrants experience multiple institutional and legal barriers when trying to access healthcare services. Due to such limitations, healthcare workers often experience ethical dilemmas when caring for undocumented migrants. This article aims to understand how individual healthcare workers who regularly take care of undocumented migrants deal with these dilemmas in practice. So far, the role of healthcare workers in this context has mainly been theorized through the lens of biopolitics, conceiving of healthcare workers as merely obedient instruments of humanitarian government or gatekeeping. Methods Based on semi-structured, in-depth interviews and ethnographic observations with healthcare workers in Belgium, we explore how they ascribe meaning, reflect upon and give shape to care practices in relation to undocumented migrants. We use Foucault’s later work on care of the self to interpret the accounts given by the healthcare workers. Results Healthcare workers in clinical roles exercise a certain degree of freedom in relation to the existing limitations to healthcare access of undocumented migrants. They developed techniques such as purposefully being inattentive to the undocumented status of the migrants. They also try to master their affective responses and transform their bodily attitude towards undocumented patients. They perform practical mental exercises to remind themselves of their role or position in the wider healthcare system and about their commitment to treat all patients equally. These techniques and exercises are inspired by colleagues who function as role models, inspiring them to relate in an ethical way to limitations in healthcare access. The developed care practices sometimes reproduce, sometimes transform the legal and institutional limitations to care for undocumented migrants. Conclusions The findings nuance the biopolitical analysis regarding the role of healthcare workers in healthcare delivery to undocumented migrants that has been dominant so far. Theoretically this article provides a reconceptualization of healthcare ethics as care of the self, an ethical practice that is somewhat independent of the traditional professional ethics. Trial Registration Medical ethics committee UZ Jette, Brussels, Belgium – Registration date: 18/05/2016 – Registration number: B.U.N. 143201628279.

Humanitarian aid projects associated with the emergence of refugee camps within European territories, are generally perceived as apolitical. Scholars however, are increasingly questioning this view, pointing to many, often untold ways, in which humanitarianism interacts with the politics of migration and border enforcement. This article examines the case of a temporary refugee camp set up in Brussels in September 2015. We show how organizational and spatio-temporal particularities, as well as media framing of the humanitarian assistance, led to controversy, civil initiatives, and hyper-politicization, eventually calling the state to take responsibility for the refugees, but simultaneously silenced other explicit political responses.

Purpose Undocumented migrants experience major legal constraints in their health-care access. Little is known on how undocumented migrants cope with these limitations in health-care access as individuals. The purpose of this study is to explore the coping responses of undocumented migrants when they experience limited health-care access in face-to-face encounters with health-care providers. Design/methodology/approach The authors conducted multi-site ethnographic observations and 25 semi-structured in-depth interviews with undocumented migrants in Belgium. They combined the “candidacy model” of health-care access with models from coping literature on racism as a framework. The candidacy model allowed them to understand access to health care as a dynamic and interactive negotiation process between health-care workers and undocumented migrants. Findings Responses to impaired health-care access can be divided into four main strategies: (1) individuals can react with a self-protective response withdrawing from seeking further care; (2) they can get around the obstacle; (3) they can influence the health-care worker involved by deploying discursive or performative skills; or (4) they can seek to confront the source of the obstacle. Research limitations/implications These findings point to the importance of care relations and social networks, as well as discursive and performative skills of undocumented migrants when negotiating barriers in access to health care. Originality/value This study refines the candidacy model by highlighting how individuals respond on a micro-level to shifts towards exclusionary health policies and, by doing so dynamically, change provision of health-care services.

Background So far knowledge about undocumented migrant health status is poor. The objective of this study is to compare patterns in causes of death between undocumented migrants and legal residents, of both migrant and non-migrant origin. Method Using cause-of-death data, we compared undocumented migrants with Belgian residents and documented migrants through logistic regression analyses.. Results This study shows that male undocumented migrants have a significantly higher risk of death from cardiovascular diseases compared to male Belgian residents (OR: 1.37) and documented migrants (OR: 2.17). Male undocumented migrants also have an increased risk of dying from external causes of death compared to documented migrants (OR: 1.93). Furthermore, we found a lower risk of suicidal death in undocumented migrants compared to Belgian residents (OR men: 0.29, OR women: 0.15). Conclusions We found important differences in underlying causes of death between undocumented migrants and residents in Belgium. These findings urge us to claim improved healthcare provision for undocumented migrants in Belgium. Trial registration Medical ethics committee UZ Jette, Brussels, Belgium – Registration date: 18/05/2016 – Registration number: B.U.N. 143201628279.

Although scholars in bioethics usually consider the exclusion of migrants from basic healthcare as unjust, it remains unclear how health professionals should ethically deal with policies restricting access to healthcare for undocumented migrants. Debates on offering less than the most beneficial healthcare have been limited to contributions on ethical bedside rationing. This article draws on semi-structured in-depth interviews that explore health professional’s acceptance, as well as their willingness to resort to the use of deception to secure third-party payer approval for undocumented migrants. The results show that health professionals (1) are sceptical about both the possibility and desirability of verifying whether a patient’s declarations are deceitful in the setting of a consultation, but (2) are reluctant to use deception themselves to circumvent government policies restricting access to healthcare for undocumented migrants. We discuss how this approach of ‘relative impartiality’ threatens professional autonomy and conclude that professional associations should play a much more important role in supporting health professionals in relation to healthcare institutions and governments when their members are confronted with specific rationing practices forcing them to provide suboptimal healthcare.