‘Unkind Cuts’: Health Policy and Practice versus the Health and Emotional Well-Being of Asylum-Seekers and Refugees in Ireland

Abstract

Healthcare is the keystone of a number of complex progressive social justice issues that evoke complex emotions. As the demography of Ireland rapidly changes, the practices and expectations of some asylum-seekers and others seeking refugee status present new opportunities and challenges for health-service providers. This paper looks at some of the emotions evoked in healthcare issues. It draws on observations and interviews from empirical fieldwork carried out for the Health Research Board. The research was conducted both in the Adelaide and Meath Hospital, incorporating the National Children's Hospital, Tallaght and in a number of refugee reception centres in Ireland. At one level, honouring faith choices within a healthcare setting is a societal acknowledgement—often made to people at their most vulnerable—that the potent and cathartic transformative rituals they value are significant in mediating and managing their emotions. This paper argues that, at another level, it is a practical and symbolic communication of a statutory commitment to interculturalism and community cohesion.

Keywords:

• Healthcare
• Emotional Needs
• Migrants
• Circumcision
• Republic of Ireland

Acknowledgements

The author wishes to acknowledge the significant and particularly generous encouragement, advice and expertise received from Maruška Svašek in the development of this paper. She would also like to pay respect to the men and women who, contrary to their wishes, were unable to find a home in Ireland, and whose fears, aspirations and dreams contributed to the content of this article.

Notes

1. In the field of education studies, Louis Raths (1947) has argued that children's emotional needs strongly influence their ability to learn. He identified eight important, interrelated needs, including the need ‘to belong, to achieve, to have a feeling of economic security, to be free from fear, to love and to be loved, to be free from intense feeling of guilt, to share in decision making, and to understand the world’ (Raths 1947: 14). Only if these needs were met, he argued, would a child achieve its full learning potential. On wider debates about cultural vs biological aspects of emotions, see Leavitt (1996); Milton and Svašek (2005).

2. Tensions surrounding these ‘problem’ areas manifested themselves throughout the system in practical terms through the scheduling of appointments, hospital diet plans, catering, compliance with medical regimes, communication between individuals that crossed cultural and gendered norms, and with the material culture associated with the Catholic Church which remains a strong influence on state services.

3. Conversely, the Mosney Centre is a conversion of an old Butlin's Holiday Camp and the material culture of that camp still exists, so that those awaiting court decisions about their immigration status eat their food in the Kosy Korner Kafe with a large, smiling clown in wood relief looking down over the entrance.

4. See also Alexandra Hall's paper in this Special Issue.

5. Filtered through the lens of an undetermined status, all seems subject to reinterpretation and distortion. Gone are the social expectations and ritualised behaviour that regulate ‘normal’ interaction. Instead new intercultural norms are developed with rules of reciprocity and emotional engagement tentatively negotiated and formulated within the confines of the temporary status. Writing about the experiences of asylum-seekers and undocumented migrants in the British detention system, Athwal and Bourne (2007: 106) suggest that the high levels of sudden death of so many ‘is an unrecognised endictment of our society’.

6. As both a cultural construct and the site of competing medical knowledge and hypothesis, the body has long been the subject of anthropological investigations (Littlewood 1997; Lock 1993; Turner 1984).