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Structural vulnerability: migration and health in social context

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Lauren Carruth, Carlos Martinez, Lahra Smith, Katharine Donato, Carlos Piñones-Rivera, James Quesada

Abstract

Based on the authors’ work in Latin America and Africa, this article describes and applies the concept ‘structural vulnerability’ to the challenges of clinical care and healthcare advocacy for migrants. This concept helps consider how specific social, economic and political hierarchies and policies produce and pattern poor health in two case studies: one at the USA–Mexico border and another in Djibouti. Migrants’ and providers’ various entanglements within inequitable and sometimes violent global migration systems can produce shared structural vulnerabilities that then differentially affect health and other outcomes. In response, we argue providers require specialised training and support; professional associations, healthcare institutions, universities and humanitarian organisations should work to end the criminalisation of medical and humanitarian assistance to migrants; migrants should help lead efforts to reform medical and humanitarian interventions; and alternative care models in Global South to address the structural vulnerabilities inherent to migration and asylum should be supported.

Summary box

  • Global migration can create structural vulnerabilities that affect migrants’ and asylum seekers’ health and the ability of health and service providers to provide them with care.

  • Vulnerabilities caused by the social, political and economic structures inherent to global migration and asylum systems increase the risk of poor health outcomes among migrants, and also place clinicians at risk.

  • Providers require training and support for their care of and advocacy on behalf of different types of migrants.

  • Professional associations, healthcare institutions, universities and humanitarian organisations should work to end the criminalisation of medical and humanitarian assistance to migrants.

  • Given their unique expertise, migrants should help lead efforts to reform medical and humanitarian interventions.

  • Alternative models for addressing the structural vulnerabilities inherent to migration and asylum already exist in the Global South, and should be supported.