Refugees and migrant access to health in transit countries: politics of adaptability, enactment of slow death and inevitability of pain: an ethnography of poor urban neighborhood in Rabat (Morocco)

Abstract

This thesis project builds on three months of ethnographic and interview research undertaken between February-May 2019 to explore refugee and migrant access to health in one of Rabat’s poor neighbourhoods, Youssoufia, which has a high concentration of sub-Saharan African migrants. Morocco’s new National Immigration and Asylum Strategy (2014) officially grants them the right to access primary health care (PHC) on an equal basis with Moroccans. This strategy goes hand-in-hand with the Moroccan government’s national attempt to extend universal health coverage (UHC) for the poor and less-advantaged classes in order to achieve social equality and health equity through the proliferation of PHC facilities. Focusing on Youssoufia, the field findings suggest that despite the government’s numerous reforms, proper implementation of the strategy was hindered by the poor governance and accountability of the health sector, on one hand, and inadequate multistakeholders migration management on the other hand. All that combined with poor social determinants of health among refugees and migrants made them depend on medical alternatives presented in self-medication and popular healing practices. This research challenges the predominant proposition assuming migrants and refugees burden national health resources. Rather, it highlights the fact that promoting refugee and migrant access to PHC has been negatively impacted by the dysfunctional national health systems of transit countries in North Africa that have been subject to a massive disadvantage behind the neo-liberal policies imposed by the Structural Adjustments Programmes (SAPs) of the World Bank that have market-based approaches to health care and the social determinants of health.