The place oof health and the micro-prowers of health professionals in rtenetion centers for unauthorised migrants multi-situated ethnographic research (France-Spain).

This research aimed to identify the place of health in Immigrants Retention Centres (IRC) and analyse the role of the health professionals regarding border control and immigration policies. The current structures to confine unauthorised migrants seem to address a two-fold issue: the repressive approach to controlling immigration and the increasing set-up of facilities participating in a mode of government centred on national security concern.
Method. Ethnographical study was conducted in the Medical Units of a French (capacity: 35 pers.) and a Spanish (150 pers.) ICR for respectively, 9-months with a regularity of 30 half-days of presence every fortnight and 21 continuous days over a 3-weeks period. Qualitative data from observational notes and conversional interviews were triangulated and analysed under the Critical Categorical Content Discourse method, with Atlas.ti support. Findings. Illnesses that could halt deportation were infectious diseases involving treatment requiring a specialized infrastructure (tuberculosis); in France, those whose representation is bound to feelings of fear and disgust (mange) and mental illness that poses a threat to the individual and other persons; in Spain, pregnancy is a reason to allow a release from IRC. Squats are raid when expulsion quotas need to be filled; it accounted for the increased number of substance dependent persons in ICR at that time. Health professionals in IRC confront moral dilemmas. In France, they have a recognised micro-power able to overturn a deportation order: the medical certificate. Discussion. In ensuring healthcare access, they are drawn into the vigilance and control logics of the IRC security regime, despite themselves. Standardization of the medical practices is their main fall back and provides for risks management, which relies on the architecture and the neatness of the space, individual strategies of exception and social relationship that are shaped by a moral economy. The retreat into medical grounds allows keeping things “professional”and helps balance the tension resulting from providing medical care in a space that automatically appears to translate any act into one carried out in compliance with the repressive policy against undesired migration.
Institutionalisation of European IRC medical units network is recommended to confront inequalities in care (access and quality).