Rethinking Immunity: An Ethnography of Risk and Migration in Sweden

ABSTRACT

I outline the interplay between biological and socio-cultural dimensions of immunity and risk in the context of migration from Afghanistan to Sweden during the COVID-19 pandemic. Documenting my interlocutors’ responses to everyday situations, I explore the challenges they face in a new society. Their references to immunity reveal ideas about bodily and biological functions, as well as sociocultural aspects of risk and immunity as fluid concepts. Understanding how different groups manage risk, practice care, and perceive immunity requires attention to the circumstances that surround individual and communal experiences of care practices. I reveal their perceptions, hopes, concerns, and strategies for immunization against the real risks they encounter.

KEYWORDS:

• Sweden
• boundary concepts
• COVID-19 pandemic
• immunity
• migration
• risk

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I think one of the reasons why the number of fatal cases in Sweden, although they say it’s high but at the same time it’s not too high, is because their immune system is strong. They’re strong … People in Sweden and the rest of Scandinavia have strong bodies, otherwise the death rate should have been much higher considering that the society in Sweden have been left open. Those who lost their lives were mostly immigrants and old people. It’s all about the immune system.

Aslan made these remarks during a group conversation about experiences of living with the COVID-19 pandemic. It is an August day in 2020, and we are in a garden located in a coastal southern town in Sweden for a daytrip with a group of asylum-seeking families from Afghanistan. The trip is arranged by a non-governmental organization (NGO) which Aslan has been collaborating with on a weekly basis for a few years. Having moved to Sweden from Afghanistan as an asylum seeker, Aslan has been contributing to this organization as a language assistant for the group of adult participants from Afghanistan. Besides providing emotional support, this politically and religiously neutral organization offers newly arrived asylum-seeking families and unaccompanied child migrants an introductory course on Swedish society. By holding lectures, offering workshops, and arranging pedagogical activities, this NGO aims to provide participants with useful insights into the asylum process, and on how relevant institutions operate. Through introducing Swedish legislation, its democratic form of governance, and some socioculturally constructed codes of conduct particular to the country, this introductory course also sets out to explain some of the underlying expectations and demands that should be recognized, discussed, and eventually followed by everyone, including those who receive a permit to reside in Sweden.

I first met Aslan and the rest of the staff as well as the participating families during my ethnographic fieldwork that took place between 2019 and 2021. When I followed the group for a daytrip on that August day in 2020, it was over five months into the pandemic, and the Public Health Authority of Sweden (Folkhälsomyndigheten) had newly released stricter recommendations on how to prevent spreading the virus. The guidelines put a major emphasis on the importance of taking personal responsibility for minimizing its circulation, particularly by keeping a safe physical distance from others. While surveying the participants’ dance of uncertainty when they approach one another and sensing their hesitancy toward hugs or handshakes during that daytrip, I assumed that the group were familiar with the latest COVID-related guidelines.

After arriving in the garden and a brief exploratory walk in the surroundings, the families sit in a circle for afternoon tea. Once the conversation kicks off, it naturally gravitates toward experiences of living with the pandemic. Aslan’s comment on the role of the immune system in surviving the virus is given in response to the participants’ sense of confusion about the mortality rate and why some groups have been hit harder than the others. Aslan’s remarks immediately spark a conversation among the participants. Ali, one of the volunteers who occasionally assists the organization says, “A guy told me, when he was diagnosed with COVID, that he watched a TikTok clip about drinking black tea and how it could cure the disease. So, he drank black tea and recovered.” Sipping hot tea from a paper cup, he continues while laughing: “If it’s true, we must all be immune to the virus because we’ve been drinking black tea since we were kids, it’s mixed with our blood.” Some in the group giggle while others nod with a weak smile.

At first glance, these accounts may seem like a subjective, lay analysis of the biological effects of immune system in response to diseases. Put in the context of migration, they can also be regarded as an example of how the sociocultural notions of immunity and risk are negotiated and contested at the intersection of biology, culture, and society. The COVID-19 pandemic in Sweden, as elsewhere, affected different groups unequally and exacerbated preexisting vulnerabilities among certain groups. From the initial phases in early 2020, alarm bells have rung over the excess morbidity and mortality caused by COVID-19 among those who were categorized as foreign-born¹ and migrant (IOM 2019). After preliminary investigations into the cause(s) of this over mortality, it was argued that structural determinants were the main contributing factors to the situation (Drefahl et al. 2020; Hansson et al. 2021; Ohlin 2020). A question rarely explored, however, was (and remains) how those who are placed in the categories of foreign born and migrant perceived and responded to circumstances caused by the COVID-19 pandemic.

In this article, I outline the interplay between biological, social, and cultural dimensions of immunity and risk in the context of migration in Sweden. Taking the COVID-19 pandemic as an empirical case, I investigate the sociocultural perceptions of risk and immunity among a group of asylum seekers from Afghanistan. By illustrating their response to everyday situations of a migratory life during the pandemic, I explore the dynamics of resistance and resilience while illuminating some of the challenges they face when navigating everyday life in the new society. As I discuss, although the participants’ references to immunity reveal ideas about bodily and biological functions, they, too, reflect the sociocultural aspects of risk and immunity as fluid concepts. Hence, understanding how different groups manage risk, practice care, and perceive immunity requires close attention to the circumstances that surround individual and communal experiences of care.

Fieldwork

The empirical data informing this article was collected during the ethnographic fieldwork I conducted between 2019 and 2021 in collaboration with a non-governmental organization in a southern town in Sweden. I undertook semi-structured interviews and observations with twelve adult participants – six women and six men in their thirties and forties – with similar duration of stay in Sweden. All the participants were either undergoing an asylum application at the time or had newly received a permit to reside in Sweden. The interviews and observations took place mainly at the locations where the organization held their weekly lectures and activities as well as in the participants’ homes, after receiving their informed consent². Following the outbreak of the COVID-19 pandemic, I became primarily interested in how the participants perceived, assessed, and responded to the concepts of health, unhealth, healing, and risk, particularly in times of crisis while living their migratory life.

The transcriptions and fieldnotes that were taken during and after my observations were anonymized by giving the participants pseudonyms. To gain a better understanding of their perceptions of immunity and experiences of managing what they considered as risk, I charted the collected material based on the participants’ concerns, hopes, dilemmas, and decisions. I analyzed their interpretations of the conditions they have been involved in by examining how they understood and responded to risky situations, how they framed their uncertainties, and in what way they made meaning of their experiences.

Although the focus of this study is, as a consequence of the pandemic, on a small and particular group of people – namely Afghan refugees – the material nevertheless enables me to outline some more general features of risk assessment and immunization landscape in relation to migration. I use the stories presented as an entry-point into discussing how understanding concepts of health and unhealth, risk and resilience, and inclusion and exclusion are bounded to one’s embodied experiences and thus, cannot be framed within “predictive models” (Petryna 2004).

Approaching risk and immunity in the context of migration

In 2015 and 2016, Europe faced one of the most critical effects of human mobility since the Second World War, when over one million people arrived in the continent in search for safety and sanctuary (Migrationsverket 2020; Statistikmyndigheten 2016). This intense human mobility was, and still is, referred to as a “refugee crisis,” mainly due to the unexpectedly rapid influx of people who crossed national borders in search of protection and a better life (Spindler 2015). Dealing with crisis, however, was bilateral. Over 75% of those who survived the tragedies that took place on different migration paths to Europe and arrived there in 2015 had fled ongoing persecutions, violent civil wars, and economic conflicts in Syria, Afghanistan, and Iraq, respectively (IOM 2015; Spindler 2015). The same year, Sweden, as one of the main countries of destination, received slightly fewer than 163,000 individuals who sought asylum upon arrival, the majority of them from the abovementioned countries (Statistikmyndigheten 2016; Statistica 2021). As a country reputed for its generous welfare state and refugee and migration policy within and beyond the European borders (Brochmann 2015), Sweden provided the newcomers with essential aids such as emergency medical and dental care, accommodation, and financial support, to name a few, on their arrival (Ahlén and Palme 2020; Informationsverige 2023). In addition, NGOs, and other nonprofit entities, like the organization where I conducted my fieldwork, provided further emotional and informational support to those in question, including guidelines about how to navigate the Swedish health care system.

In early 2020, COVID-19 swept across the globe in rapid pace. On March 11, 2020, the World Health Organization (WHO) officially characterized the global outbreak of the virus as a pandemic (WHO 2020). Not long after this announcement, Sweden was hit by the first wave of COVID-19 (Folkhälsomyndigheten 2021). Within the first few months of the outbreak and in the midst of the public confusion over the situation, public health reports in Sweden called attention to the noticeable higher morbidity and mortality rate among the groups categorized as foreign-born and migrant (Drefahl et al. 2020; Fallenius 2020; Ohlin 2020). According to the results of a study released in 2020, the migrant population, particularly those who were born in countries within the Middle East and Africa were at higher risk of being admitted to intensive care units and of death (Rostila and Cederström 2021; Rostila et al. 2021).

The public and professional responses to these statements have been varied. On the one hand, such discoveries resulted in some groups being wrongly singled out as a risk factor for spreading the virus (Hansson 2022). On the other hand, these reports exposed some potential, preexisting contributing factors to this over-representation, making them a topic of interest anew. Socioeconomic determinants, sociocultural barriers to care, poor health status, and lack of access to COVID-related guidelines during the pandemic were suggested as the prominent explanations behind these perplexing findings (Drefahl et al. 2020; Rostila et al. 2021). Alongside these considerations, official reports confirmed the negative impact of underlying health conditions on the severity of COVID-19 disease (Socialstyrelsen 2021). In parallel, the role of a strong immune system when confronting the pervasive Coronavirus circulated (Swaminathan 2022). As a result, strengthening the body’s immune system attracted attention toward methods of boosting one’s immunity (Humble et al. 2020). Hence, searching and purchasing products that promised to prevent contagion or offered an effective remedy increased (Lundin et al. 2020). The recurring and new care practices, as Aslan described on that August day in 2020, became “all about the immune system” and building immunity against the surrounding risks. In official press releases from the Swedish health authorities, individuals older than 60 and those with underlying medical conditions were considered to be the groups at higher risk of contracting COVID-19 (WHO 2020). In Sweden as elsewhere, being categorized as foreign-born and migrant was added to the list of contributing factors behind an increased risk of being critically infected with COVID-19 and death (Folkhälsomyndigheten 2021). Thus, the importance of having an inherently strong immune system in combating infections became (re)highlighted. A matter that was left unattended to, however, was how those who were placed in the category of foreign-born and by default, at-risk and not immune, were actually facing the risks of a health crisis.

During the pandemic, discussions over poor health among the groups of foreign-born and migrants in Sweden reappeared, calling for attention to address this issue as an individual and communal concern (Elisabeth et al. 2020; Rostila 2021). What was rarely done, however, was an exploration of the coping strategies of the individuals who were placed in those categories, how they assessed the surrounding risks, and how they perceived immunity.

One of the recommendations given to those who undergo a process of resettlement is to create a sense of belonging through joining the new society as an integral entity (Zapata-Barrero and Hellgren 2023). Like immunity and risk, belonging is a fluid concept and thus hard to define, theorize, and make sense of (Antonsich 2010). While in literature belonging has often been mentioned in close relation to the notions of identity, inclusion, and integration, it is argued that a feel-at-home state is shaped at the intersection of personal and social identities (Anthias 2013). In other words, belonging comes through being accepted and included in society. Although being socially engaged is taken as an effort to culturally integrate and immerse oneself in the local society, living with the pandemic shifted the requirements for a so-called successful integration. Before the outbreak in Sweden, staying at home and keeping a distance from society was considered as a risk factor with an adverse impact on the newcomers’ construction of new social identity. During the pandemic, the new features of solidarity, responsible behavior, risk management, and care required maintaining engagement through keeping a distance.

Taking personal responsibility for one’s health and that of the others as a health paradigm in Western societies has resulted in expectations on individuals to prove their care for the community through showing care for their own “self” (Alftberg and Hansson 2012). In the case of the COVID-19 pandemic and boosting one’s immunity, however, such expectations can fall short when concerning social groups that are characterized as vulnerable. In the context of migration, as I will discuss below, the concept of immunity and concerns over strengthening one’s body to face the risks goes beyond preserving the somatic body and becomes a matter of maintaining and immunizing one’s sociocultural body.

Risk and immunity: two boundary concepts

Migration in all its forms is informed by risk and generates uncertainty to different degrees, making risk-taking an inherent element of this process (Beck 1992; Biruk 2021; Caduff 2014; Lupton 2013; Williams and Baláž 2021). In the context of migration, risk becomes a multifaceted concept. Hence, it becomes difficult to not only ontologically define risk, but also human responsibility in identifying, preventing, controlling, and taming risks of a migratory process (Lupton 2013). From this point of view, risk can provide opportunity or cause harm, often leaving it to individuals to assess what risks exist in particular surroundings and which ones are to be taken or avoided (Beck 1992). Understanding different “life-styles, subcultures, social ties and identities” within a new society, thus becomes a skill needed in order to grasp and respond to the risks that one may encounter within that society (Petersen 1996:46).

The COVID-19 pandemic has shown the multifaceted nature of risk to those who are categorized as foreign-born, migrant, and asylum seeker in a new light. When added to the context of migration, the pandemic has demonstrated how the risk of contagion could be accompanied by the risk of stigmatization, deportation, and exclusion (IOM 2019). During the pandemic, some preexisting and new sociocultural notions of risk and responsibility (re)emerged in different societies, including the multicultural society of Sweden. Through such cultural conceptions, individuals are not only expected to reflect on how to relate to existing and upcoming risks, but also to other members of the societies they inhabit (Washer 2004, 2010). As a key medical paradigm in Western society, all individuals are expected to assess and avoid risks and risky behavior as a way of generating good health (Alftberg and Hansson 2012). From this view, individuals are encouraged to lead a healthy life and be reflexive, “flexible,” and adaptable to the shifting sociocultural ideas of health, illness, and management of the body (Kirschner and Martin 1999; Martin 1994). To succeed, it is advised to follow the guidelines proposed by public health authorities and acknowledge that it is not solely up to the science of medicine to ensure the quality of one’s health.

Generating good health and preserving it through immunizing the body against biological threats is, therefore, viewed as an individual contribution to society, a moral percept that is practiced by responsible citizens (Frykman 1992). In Sweden, this model can be traced back to the 1900s when cultural outlooks on, among other things, nature, the body, and hygiene underwent radical changes. It was through the shift in the perception and practice of self-discipline and orderliness that the preliminary parameters of good citizenship were constructed (Frykman and Löfgren 2019). The biological properties of one’s immune system against infectious agents and the notion of immunity, too, are perceived, made meaning of, and incorporated in one’s life strategies in relation to constructed sociocultural implications of health and unhealth within a society (Martin 1994; Sachs 1996).

However, as the historian of biomedical sciences Löwy (1992) argues, the science of immunology is a “boundary concept” - one that is “loose,” “imprecise,” open to interpretation, and adaptable to the demands of a changing world. Inspired by Löwy’s argument, I argue that in the context of migration, the notions of risk and immunity are also fluid, boundary, and imprecise concepts that are diversely defined and internalized by different groups.

Immunity, on the one hand, refers to the materiality of the body and its innate mechanism against the intruding and infectious agents, the nonself. On the other hand, it raises questions within and beyond biological matters by functioning as a tool in sociocultural transition from insecurity to security, from foreign to familiar, and from becoming to being. From bodily strength in the face of a global pandemic to one’s construction of new social identity through migration, these questions appear in the conjunction between cultural perceptions of body and structural forces that define requirements of a “proper” self and society (Bird and Short 2013:3). Risk, too, is both seen as an objective, unbiased state, and as a status floating between being the state of opportunity and obstacle.

Approaching risk and immunity as boundary concepts, as I argue in the coming sections, reveals how the participants in this study express their perception of risk, self, and inclusion through problematizing their embodied experiences of immunity and membership within different contexts and under diverse circumstances. Thus, considering their (un)immunity or vulnerability in face of a pandemic requires understanding embodied experiences of assessing and responding to the situations that may arise.

The complying bodies

Rahim stood close to the wall behind him, keeping a distance from the rest who also waited for the bus at the pick-up point. It was a warm August day in 2020 and the organization, after months of uncertainty and cancellation, had cautiously arranged an outdoor activity for a group of asylum-seeking families from Afghanistan. The day’s programme was designed in accordance with the latest recommendations introduced by The Public Health Authority of Sweden, with a greater emphasis on keeping a safe physical distance of two meters from one another. Rahim, a man in his late thirties at the time, was one of the participants who showed up for the trip with his son. When we first met at the beginning of my fieldwork in 2019, Rahim shared with me the story of leaving his wife and their young daughter behind to undertake a formidable migratory journey to Europe with their son. After arriving in Sweden in 2016, Rahim applied for asylum with the hope of reuniting with his family once again and starting a new life. For him, however, the waiting process and the fear of rejection was a constant challenge. While waiting for the bus, Rahim told me about his worries for his family’s health, the future, and the potential impact of the pandemic on their asylum process. “My family is healthy, no one is hurt, thank God,” he said with a shallow smile on his face and added, while sighing with despair, “but, being a part of the society seems impossible now.” Having an eye on his son who talked with other children, Rahim continued:

My [Swedish] speaking skills is zero. Among my neighbours, I’m the only foreigner, the rest are from Sweden, the US, the UK. But it was different before, it was good. In the beginning, we used to stop by to say hi, but now we don’t really speak … It used to be good, but it’s different now, they’re different now. They say hi from a far distance, while it’s the same as before in the town, nothing has changed.

Since the start of the pandemic, Rahim and his son, like many other people around the world, spent most of their time at home. They were placed in a house in the suburbs, which made it particularly difficult for Rahim to stay motivated and follow his Swedish lessons, something that he knew was the gateway to the new society. He explained:

I do attend my studies, they are distance based now, but I don’t learn anything. When I go there [institute] and meet other people like me, I say some words, they say some in return, and we help each other to learn. You can only learn [the language] when you enter the society.

The situation struck Rahim as perplexing. On the one hand, there was an unfamiliar virus, an invisible threat that put their health at risk. On the other hand, circumstances caused by the pandemic resulted in new, unforeseen challenges that could get in the way of establishing their life in Sweden. The next time I spoke with Rahim over the phone in 2021, I found out that his family had arrived in Sweden, his two children went to school, and his language course offered onsite lectures twice a week. During our conversation, Rahim recalled the early days of living with the pandemic as the single caretaker of their child in his wife’s absence. Desperate to keep their son unharmed, Rahim remembered the early days of the pandemic when he avoided sending him to school, something that was contested by the principal at the school:

They [the school] said I had to send my son to school, and I said, “But it’s Corona, it has no cure, there is not even a vaccine for it yet” and they said, “It doesn’t have an impact on young children” and I said “What are you talking about? Of course it can affect young children too” and they said “Well, yeah, young children can also contract it, but only a mild version of it” and I said “It doesn’t matter, we live alone, God forbid if my son catches the virus and passes it on to me, if something happens to me, who is going to take care of my son?” and they said “In that case it’s the Social services’ responsibility to take care of your son.” They said it so casually, so easily… in the end, I sent my son to school but sometimes I didn’t, and they sent me emails or called me and said, “you must send him.”

Rahim was put in a position to weigh up the risks of sending his son to school during a pandemic against the assumed consequences of resistance, as contracting a deadly virus could threaten both their physical and social bodies. A dilemma that he faced was their unknown immune status and whether there was any chance to reconstruct their bodies’ ability to survive the surrounding hazards. He explained:

When we were still there [before migration], we used to use medicines and it can make the immune system weak, I’m not sure if it’s true of not, I’ve just heard about it … Here, even if they [the people of Sweden] go to the doctor, they are only prescribed to drink water and rest, they don’t use any specific medicines for it. They’re always doing sports, running … even their food, it’s not made with fat or strong spices, it’s natural … [But] the immune system must be built strong from early ages, there is not much to be done in our age … There is hope, of course, but it must start from early ages.

For Rahim and some other participants, this appeared to be a conjunction of facing contradictory demands from the new society and dealing with concerns over their biosocial immunity that was in limbo. Living with the pandemic visualized some unanticipated realities about a system that he and the rest of the participants were expected to make sense of, join, and navigate. At the end, Rahim decided to show his compliance by following regulations that he feared may work against them and sending his son to school, as resistance could result in as much isolation from the society as conforming with the rules.

Like Rahim, Mahshid was another participant who joined the organization’s introductory course with her husband and their young children. Mahshid, a woman in her early thirties, and her family arrived in Sweden separately in 2015 and 2016. Rasool, Mahshid’s husband, applied for asylum on his and their first-born son’s arrival in 2015, and Mahshid and their younger son, who was four years old at the time reached Sweden the year after. When we first met in 2019, Mahshid and their now three children still waited for a decision to be made on their asylum case. After the outbreak of the pandemic and during a video conversation, Mahshid told me about her husband receiving a temporary residence permit, while the rest of the family’s application could be rejected. In that case, they would have to leave Sweden and follow the process from outside the country. A solution, in Mahshid’s view, was to learn the Swedish language fast, enroll in an education, and find a job to prove herself eligible to receive a residence permit. But the pandemic could slow down or stop her plans. Sitting on a bed in a room with blank white walls, Mahshid said:

It was really difficult in the beginning; we all were really scared. I didn’t send the kids to kindergarten; I mean, right after it [pandemic] started … I think I sent the children to school maybe once or twice a week, but the rest of the time I said “No, that’s not gonna happen” … but it was already in the beginning of that year that I thought to myself, “It’s not going to work this way. If the children are going to stay at home and away from school, it will be difficult for me if I fall behind in my studies.”

Like Rahim, Mahshid faced the dilemma of prioritizing one risk over the other. While she was concerned about the threat of contagion in the family, she wondered how the new conditions may prevent her from following her plans and keeping her family on track toward a better future. Realizing the need to adapt to the new way of life during the pandemic, Mahshid was concerned about their unknown immunity status, something that she believed was affected by the surrounding conditions:

Stress is the number one enemy of the immune system … Looking at them [people in Sweden], first they pay a lot of attention to their physical activity, second, they care about their healthy diet, and then they don’t have worrisome thoughts and stress but those like us … They have a strong immune system because they have no stress.

As the conversation progressed, Mahshid talked about the hardship of the past and her constant battle against discrimination and not having equal rights to education. For her, the pandemic posed a threat to not only her falling behind with her studies and losing the chance of staying in Sweden with her family, but also pulling her back to an unwanted future that was in her horizon before their migratory move:

Our old generations are mostly illiterate, but they [people of Sweden] if they haven’t been fully educated, at least they were educated to some degree because it was obligatory for them, and they all had to educate themselves. So, they have at least some knowledge about their selves either from health perspective, or psychological perspective. A knowledge of the self. At least they know where their kidneys are, they know what happens in their bodies, but which one of our elderly women know what vitamins are good for what organ? Unfortunately, no one knows and all that influences each person’s immune system in different ways.

In the end, Mahshid agreed to send her children to school not only as a sign of her acquiescence to the common rules followed by responsible members of the society, but also as an act of care to protect her family’s future against the risk of uprooting. For Mahshid and the other participants who joined this study, immunity was a case of preservation – securing an anticipated future by strengthening their biosocial bodies.

The integrating cells

Gholam, together with his wife, Ghamar, and their four children, attended the organization’s weekly lectures. The couple were in their mid-thirties at the time and had finally reunited after five years of living apart while Gholam was in search for a better life for their family. He applied for asylum upon his arrival in Sweden in 2014, and after suffering the years of being geographically separated, the family finally reunited in 2019. Shortly after, the COVID-19 pandemic erupted and for many, like them, put the world on hold.

When I met the couple before the pandemic at their home, they talked about the hardship of their pre-migration life, the challenges of learning a new language in Sweden, and the hope of finding a career that would enable them to settle down and build their desired life. They lived in an exclusive, newly built area where only asylum-seeking families from different parts of the world were accommodated. During our next conversation over a year into the pandemic, I got to hear about challenges that the pandemic had posed on them, from further isolation and fear of contagion to the conflicts that they experienced while trying to negotiate the terms of safety in the family. Witnessing his friends’ recovery processes after contracting the virus, Gholam had concluded that it was crucial to lead a healthy way of life as only a healthy body could keep them immune from the prevalent COVID-19 disease. During our conversation, he reflected on how the new lifestyle that he adopted after arriving in Sweden helped him to both deal with the perplexities of an asylum process and build a body that was fit to face the surrounding hazards:

I think it’s about how ready the body is to heal itself, to protect itself which has an influence on each person’s healing process … I think for the body to show how ready it is to deal with diseases goes back to how strong the body is … It was six years ago when I arrived in Sweden … I had a difficult time; I was worried about my family and all that. I got depression, and although I had gone up in weight, my body had become very weak … And it was at that point when I decided nothing was better than health and living healthy … I thought “I can build my body like the Swedes, I can also adapt my body to follow after what they do, why not, I have nothing less than them” … It’s been six years since I moved to Sweden and I’ve only had one mild cold before Corona, other than that, I didn’t get sick because I exercise a lot.

Taking his bodily change as a successful attempt, Gholam considered this as taking a step toward joining the society he wanted to be a part of. For Ghamar, however, changing lifestyle and building the biosocial immunity did not seem equally feasible for everyone:

Yeah, [It takes] hygiene and physical movement, one to two hours of walk[ing], to strengthen the body … [but] people like us who come from Afghanistan or those who have been living a difficult life, it’s about poverty. We have always worked hard, we didn’t have a good diet, our bones are fragile, we didn’t have time to care about our health and now that we’ve been living here … We have a little income from the social services, but we’re still trying to meet the end. There is still no room to focus on our health … If you get a job and are settled, you can work on your lifestyle, otherwise …

This can be an example of how uncertainties about the future can lead to paradoxes in everyday life situations. Ghamar and Gholam both agreed that a change needed to happen for a new beginning. For Gholam, lingering in the pre-migratory habits and failing to comply with the new way of life equaled remaining at the doorstep of the society they were trying to become a part of. For Ghamar, however, change of lifestyle was conditional and not limited to the situations they dealt with in the present, but also the experiences of the past that followed them like a shadow. Ghamar, like the other participants, was concerned about the effect of the pandemic on her family’s health and the potential consequences that it could have on their integration attempt. For her, strengthening their somatic health and securing an anticipated future were two separate yet intertwining life projects that their family had to build from scratch.

For Mahshid, who also experienced the pain of being separated from her family, facing the demand to change direction and comply with the rules of a new health landscape seemed imperative. It was during the early phases of the pandemic when Rasool, Mahshid’s husband, was diagnosed with diabetes. Besides concerns over management of the disease, they were uncertain about how to avoid further complications that could be caused by new contagions. In the end, Mahshid and her husband contracted COVID-19 in spring 2021. After making a recovery, she tried to find new ways of keeping her family unharmed in the future:

Because of Rasool’s diabetes, we completely changed our diet … All in all, life in general has a new order now… I mean, now we understand why Swedish people, from young to old, go for a run and care about their diet. We must do the same … There is a difference between our immunities, 100 percent. The smallest thing is about their diet. If you look at their food, it’s simply cooked with water … Also, if you ever visit a doctor here, they don’t give you medicines easily. But there [before migration], we thought “No, if we visit a doctor, we should at least receive three injections and antibiotics and this and that,” and eating medicines from early ages leaves its impact on the body … That’s why their immune system is higher in comparison with ours.

Making sense of immunity and risk while lingering in between two worlds of pre- and post-migration is a multifaceted process, open to (re)interpretation by those involved and the surrounding world. Dealing with the pandemic as an added feature has, in turn, exacerbated the situation by putting those who are already categorized as vulnerable and at-risk in a double-vulnerable state. The remarks above show attempts of complying with the rules that are perceived and practiced differently depending on the time and space. In the post-migration phase, caring for one’s self and facing the surrounding risks could mean, at times, putting immediate health concerns aside and focusing on surviving the hurdles of poverty and other societal hazards simply to make ends met. During the ongoing migratory phase in the new society, however, the notion of survival and immunization of the self against risks has taken new shape, while holding on to the hope of a better future remains central.

Discussion: rethinking immunity and risk as boundary concepts

The narratives presented above provide a glimpse into how vulnerable people experience a vulnerable time. They reveal some of the hopes and dilemmas that the individuals who seek asylum may experience during a resettlement process. The experiences of those who joined this study provide, firstly, contextualized information to better understand some of the challenges they face during a pandemic. Their stories also reveal a fraction of their biosocial and biocultural perception of immunity and risk and how their “immunitary” stories are shaped around the hope of transitioning from being temporary residents to permanent, immune, and rightful citizens (Brown 2019). Narrating their experiences of dealing with immunization against risks, the individuals who contributed to this study take a metaphorical approach to immune system, discussing it not as a biological mechanism but as an expression to reveal their cultural notions of immunity and risk in relation to their lived experiences.

Utterances as such can be an example into how a health-related crisis, such as the COVID-19 pandemic can highlight the interaction between body and society while challenging the cultural notions of risk, responsibility, immunity, and membership (Brown et al. 2020; Washer 2004). For one thing, those who are placed in the categories of foreign-born and migrant not only should internalize and adopt the shifting care practices, but also add new sociocultural guidelines into their coping-strategy toolbox. At the same time, they are required to (re)interpret some of the recommendations that may appear to be in contradiction with the principles of a so-called successful integration. This can be indicative of what Martin (1994) calls the demand for becoming a “flexible” self (Martin 1994). When it comes to the participants in this study, a time of crisis resulted in (not) knowing if their bodies were fit and flexible enough to meet the requirements of achieving real citizenship while wondering what could be considered as active participation or passive negligence. In other words, it is about the risk of uncertainty about their immunity against the unknown.

While immunity refers to the materiality of the body and its innate mechanism against intruding and infectious agents, it also points to matters beyond biological properties. The notion of immunity in the context of migration can also function as a framework for transitioning between different stages of a migratory process. By discussing the participants’ embodied experiences of living a migratory life during the pandemic, I show the interplay between biological and cultural dimensions of immunity and risk. I illustrate in what way the individuals who joined this study face the demand to (re)define these notions through interpreting, internalizing, and practicing them in their daily life. However, the fluidity of immunity and risk can provide those categorized as vulnerable with both opportunity and obstacles as the notion of immunity in the context of migration can function as a framework for transitioning between different stages of a migratory process.

Inspired by what Löwy (1992) calls the impreciseness of a boundary concept, I argue that understanding how these notions are perceived and practiced by different groups can illuminate dismissed details behind health-related questions. The confusion they may cause can partly arise from facing a demand for identifying, legitimizing, and managing risk and immunity perceptions where the care for one’s self is seen as not only an individual and social responsibility, but also as a cultural attribute (Alftberg and Hansson 2012).

As reflexive selves (Giddens 1991), those who are in the process of learning about the socioculturally constructed norms and values of Swedish society are expected to respond to the COVID-19 pandemic as “private alternative experts” by assessing and addressing the risks the correct way (Beck 1992:61). At the same time, they need to know the unknown, yet-to-discover boundaries between personal choice and public obligation, in order to gain full membership of the new society. This is different from a normative view on belonging and a desire to become like them. The participants in this study narrated their struggles in understanding their new situations and finding a way to build fit bodies with the hope of not remaining still or being pushed back when they have sacrificed everything to go forward in life. Thus, at the intersection between risk and reward, the participants in this study examine the ways of inclusion through prioritizing the risks they face based on the circumstances they are involved in. This can lead to the challenge of reviewing, modifying, and renewing their coping strategies in accordance with the new “immunitary logics,” sometimes without fully understanding how to implement them in their new daily lives (Brown 2019:2).

Although being socially engaged is taken as an effort to culturally integrate into a local society, living with the pandemic has shifted the requirements for a so-called successful integration. Following COVID-related recommendations can mean intentionally separating from the society that the participants in this study are trying to become a part of. Joining the society, building a sense of belonging, and integration as migratory goals should be approached cautiously as it can risk viewing the migrant populations’ responses from a normative perspective. My ambition in this article is to reveal how the participants’ re-interpretation and reference to immunity and risk reveals their attempt to familiarize themselves with the demands of the new society. Not knowing if their bodies are sufficiently immune to meet the requirements of membership in the new society, they try to follow in the footsteps of those who belong to minimize the risk of both contagion and exclusion.

The narratives of those who joined this study can show a segment of exercising “a regulated autonomy” for the good of the collective (Petersen 1996:48), and adopting new ways of self-care for entering the community (Mason 2012). Through this process, the boundary concepts of risk and immunity are interpreted differently depending on time, space, and surrounding conditions. Thus, before addressing health vulnerabilities as a result of (un)immunity and poor risk assessment, it is necessary to understand how concepts of health, unhealth, and preservation of health are perceived, experienced, and responded to by different groups (Kenen 1996). For the group of asylum seekers who participated in this research, demands of the new risk landscape and immunization of the self against the threats of the unknown appear to be contradictory depending on the challenges that they deal with in their everyday life. Thus, the meaning of immunity is fluid and open to interpretation while building immunity against threats, sometimes, can require prioritization of one risk over others. Focusing on the body and health before, during, and after a pandemic can be seen as an individual act of self-care while it can also be perceived as a condition for fulfilling the requirements of a successful integration. Oscillating between experiences of the past and present and hopes of the future, the individuals who narrated their experiences showed their concerns over interpretation and incorporation of the fluid notions of health and immunity in their lives as an act of compliance to the rules of the new society. This situation can cause confusion for those who are put in the in-between position of citizens-in-the-making, with the consequence of remaining at the doorstep of the society they want to join (Malkki 1992). By not being able to get a grip of navigating the changing rules of care and citizenship, they may also risk dwelling between being the at-risk and vulnerable groups with the potential of becoming risky (Mason 2012). Remaining in this becoming status and hovering in the in-betweenness is the bigger risk to avoid (Thomassen 2012).

Acknowledgments

I am indebted to the families who generously allowed me into their lives, as well as the leaders of the organization who kindly welcomed me into their team and agreed to collaborate with me. I would also like to express my sincere appreciation to the editors and the three anonymous reviewers of the Journal of Medical Anthropology for their insightful comments and valuable remarks. Last but not least, I would like to express my gratitude to Susanne Lundin, Kristofer Hansson, and Margareta Troein for their generous support throughout my research and the writing process.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was funded by theJoint Faculties of Humanities and Theology at Lund University

Notes on contributors

Talieh Mirsalehi

Talieh Mirsalehi is a PhD candidate in ethnology at the Department of Arts and Cultural Sciences at Lund University, Lund, Sweden. In her doctoral research, she focuses on the relation between migration, health perceptions, and care practices with particular emphasis on individuals who undergo the asylum process in Sweden.

Notes

1. Foreign-born is a term refers to the population who either were born in another country other than Sweden, or one or both of their parents were born in another country. For more information, please check: https://www.regeringen.se/contentassets/8592e456f2184550b83c4aa215e3ebba/begreppet-invandrare—anvandningen-i-myndigheters-verksamhet.

2. The current study is approved by the Swedish Regional Ethical Review Board (2019–03501). The Ethics Review Authority (Etikprövningsmyndigheten) is a state authority under the Ministry of Education in Sweden. Starting its operations on January 1^st, 2019, this state authority examines applications for ethics review of research involving humans and human biological material.