Abstract
Background
This qualitative study explores experiences of living without regular immigration status and implications for health security among irregular migrants in Toronto. Irregular migrants include those who lack secure status in Canada, including visitors who overstay visas; refugee claimants awaiting status determination; and failed claimants remaining in the country without authorization, awaiting deportation or following alternative procedures when judicial appeal is impossible.
Methods
In-depth, semi-structured interviews were conducted with irregular migrants recruited at a downtown community health centre. Interview transcripts were coded and analyzed using grounded theory and qualitative analytical techniques. The theoretical framework employed anthropological metaphors of liminality and examined psychosocial factors associated with stress.
Findings
Experiences of the study sample counter popular assumptions about irregular immigrants. The majority of study participants came to Canada to escape violence as well as lack of economic opportunity in home countries in Latin America, and most have tried to follow correct immigration procedures. Most are parents working in low-paying, exploitative jobs. They have attempted to lead productive and meaningful lives, but lack social support beyond the immediate family. They showed signs of suffering from trauma, depression, chronic stress, family separation and stress-related physical illnesses. Despite expressing self-esteem and using personal coping skills effectively, many reported unmet health needs and described barriers to help-seeking. Beyond the individual, the greatest impact of living without status appeared to be on the family, especially the children.
Conclusions
More comprehensive information about this growing population is needed for health promotion, provision of mental health services and fair policy formulation.
MeSH terms: Immigration, legal status, community health care, mental health
Résumé
Contexte
Cette étude qualitative examine les expériences des personnes vivant à Toronto et n’ayant pas le statut d’immigrant régulier ainsi que les répercussions que cela peut avoir sur leur santé. Les immigrants irréguliers sont ceux qui n’ont pas de statut au Canada. Ils comprennent les visiteurs qui ne repartent pas une fois leur visa de séjour expiré, les demandeurs du statut de réfugié en attente d’une réponse et les demandeurs de statut de réfugié qui n’ont pas été acceptés et qui restent au pays sans autorisation, qui attendent d’être déportés ou qui ont recours à d’autres procédures parce qu’ils ne peuvent pas faire appel de la décision.
Méthodes
Des entrevues approfondies et semi-structurées ont été effectuées auprès d’immigrants irréguliers dans un centre de santé communautaire du centre-ville. Des transcriptions des entrevues ont été codées et analysées à l’aide d’une théorie à base empirique et de techniques analytiques qualitatives. Le cadre théorique reposait sur les métaphores anthropologiques de liminalité et examinait les facteurs psychosociaux associés au stress.
Résultats
Les expériences constatées dans l’échantillonnage de l’étude contredisent les suppositions généralement entretenues sur les immigrants irréguliers. La majorité des participants sont venus au Canada pour fuir la violence et l’incertitude économique de leur pays d’origine d’Amérique latine et la plupart ont essayé de suivre les procédures d’immigration en règle. Ce sont pour la plupart des parents qui sont exploités dans des emplois peu rémunérés. Ils ont tenté de mener une vie productive et constructive, mais ne bénéficient pas d’un soutien social autre que celui de leur famille immédiate. Ils présentent des symptômes de traumatismes, de dépression, de stress chronique, de séparation familiale et de maladies physiques liées au stress. Bien qu’ils affichent une bonne estime de soi et qu’ils aient de bons mécanismes d’adaptation, ils sont nombreux à déclarer avoir des besoins non comblés en matière de santé et faire face à des obstacles au moment de chercher de l’aide. Au-delà des répercussions sur le plan personnel, le fait de vivre sans statut semble surtout avoir des effets négatifs sur la famille, et plus particulièrement sur les enfants.
Conclusions
Il nous faut recueillir davantage d’information sur cette population croissante aux fins de la promotion de la santé, de la prestation de services de santé mentale et de l’élaboration de politiques équitables.
Footnotes
Acknowledgements: We are grateful for the help of Access Alliance Multicultural Community Health Centre, and for the financial support of the Dean’s Fund, Faculty of Medicine, University of Toronto. We thank Mary Roufail and Julie Mooney for valuable research assistance. We also thank the women and men who came forward to share their personal migration and health experiences.
References
- 1.McKee M, Janson S. Forced migration: The need for a public health response. Eur J Public Health. 2001;11:361. doi: 10.1093/eurpub/11.4.361. [DOI] [PubMed] [Google Scholar]
- 2.Torres AM, Sanz B. Health care provision for illegal immigrants: Should public health be concerned? J Epidemiol Community Health. 2000;54:478–79. doi: 10.1136/jech.54.6.478. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Ku L, Matani S. Left out: Immigrants’ access to health care and insurance. Health Affairs. 2001;20:247–56. doi: 10.1377/hlthaff.20.1.247. [DOI] [PubMed] [Google Scholar]
- 4.Roer-Strier D, Olshatin-Mann O. To see and not be seen: Latin American illegal foreign workers in Jerusalem. Int Migration. 1999;37(2):414–36. doi: 10.1111/1468-2435.00078. [DOI] [PubMed] [Google Scholar]
- 5.Goldman DP, Smith JP, Sood N. Legal status and health insurance among immigrants. Health Affairs. 2005;24:1640–53. doi: 10.1377/hlthaff.24.6.1640. [DOI] [PubMed] [Google Scholar]
- 6.Goldman D, Smith J, Sood N. Immigrants and the cost of medical care. Health Affairs. 2006;25:1700–11. doi: 10.1377/hlthaff.25.6.1700. [DOI] [PubMed] [Google Scholar]
- 7.Wayland S. Unsettled: Legal and Policy Barriers for Newcomers to Canada, A joint initiative of Community Foundations of Canada and the Law Commission of Canada. 2006. [Google Scholar]
- 8.Gagnon A. Responsiveness of the Canadian health care system towards newcomers. Discussion paper no. 40, Commission on the Future of Health Care in Canada. 2002. [Google Scholar]
- 9.Sales R. The deserving and the undeserving? Refugees, asylum seekers and welfare in Britain. Critical Soc Pol. 2002;22(3):456–78. doi: 10.1177/026101830202200305. [DOI] [Google Scholar]
- 10.Steel Z, Frommer N, Silove D. Part I-The mental health impacts of migration: The law and its effects. Failing to understand: Refugee determination and the traumatized applicant. Int J Law Psychiatry. 2004;27:511–28. doi: 10.1016/j.ijlp.2004.08.006. [DOI] [PubMed] [Google Scholar]
- 11.Papademetriou D. Migration Information Source. Washington, DC: Migration Policy Institute; 2005. The global struggle with illegal migration: No end in sight. [Google Scholar]
- 12.Oxman-Martinez J, Hanley J, Lach L, Khanlou N, Weerasinghe S, Agnew V. Intersection of Canadian policy parameters affecting women with precarious immigration status: A baseline for understanding barriers to health. J Immigrant Health. 2005;7(4):247–58. doi: 10.1007/s10903-005-5122-2. [DOI] [PubMed] [Google Scholar]
- 13.Caulford P, Vali Y. Providing health care to medically uninsured immigrants and refugees. CMAJ. 2006;174:1253–54. doi: 10.1503/cmaj.051206. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Gushulak B, Macpherson D. Health issues associated with the smuggling and trafficking of migrants. J Immigrant Health. 2000;2:67–78. doi: 10.1023/A:1009581817682. [DOI] [PubMed] [Google Scholar]
- 15.Kirby M. Final Report: Out of the Shadows at Last: Transforming Mental Health, Mental Illness and Addiction Services in Canada. Canada: Standing Senate Committee on Social Affairs, Science and Technology; 2006. [Google Scholar]
- 16.Mehta C, Nik T, Mora I, Wade J. Chicago’s Undocumented Immigrants: An Analysis of Wages, Working Conditions, and Economic Contributions. 2002. [Google Scholar]
- 17.Berk M, Schur C. The effect of fear on access to care among undocumented Latino immigrants. J Immigrant Health. 2001;3:151–56. doi: 10.1023/A:1011389105821. [DOI] [PubMed] [Google Scholar]
- 18.Reijneveld S, Verheij R, van Herten L, de Bakker D. Contacts of general practitioners with illegal immigrants. Scand J Public Health. 2001;29:308–13. doi: 10.1177/14034948010290040301. [DOI] [PubMed] [Google Scholar]
- 19.Law S, Hutton M, Chan D. Clinical, social and service use characteristics of Fuzhounese undocumented immigrant patients. Psychiatric Services. 2003;54(7):1034–37. doi: 10.1176/appi.ps.54.7.1034. [DOI] [PubMed] [Google Scholar]
- 20.Aroian K. Health risks and problems encountered by illegal immigrants. Issues in Mental Health Nursing. 1993;14:379–97. doi: 10.3109/01612849309006901. [DOI] [PubMed] [Google Scholar]
- 21.Koser K. Asylum policies, trafficking and vulnerability. Int Migration. 2000;38(3):91–111. doi: 10.1111/1468-2435.00116. [DOI] [Google Scholar]
- 22.Chaivin P. Out-of-status person’s access to health care: A cross-sectional survey in 19 cities of 7 European countries; 2006. [Google Scholar]
- 23.Friere M. Issues of Access to Services for Undocumented Individuals and their Children, Testimony of M. Friere, Chief Psychiatrist, Toronto Board of Education; 1999. [Google Scholar]
- 24.Nyers P. Access not fear: Non-status immigrants and city services: A preliminary report. 2006. [Google Scholar]
- 25.Khanlou N, Mill C. Precarious immigration status: Exploring impacts on health; 2005. [Google Scholar]
- 26.Chavez L. Shadowed Lives: Undocumented Immigrants in American Society. Fort Worth, TX: Holt, Rinehart and Winston; 1992. [Google Scholar]
- 27.Nijhawan M. Deportability, medicine, and the law. Anthropology & Med. 2005;12(13):271–85. doi: 10.1080/13648470500291436. [DOI] [PubMed] [Google Scholar]
- 28.Denzin N, Lincoln Y. Handbook of Qualitative Research. Thousand Oaks, CA: Sage Publications; 1994. Introduction: Entering the field of qualitative research; p. 3. [Google Scholar]
- 29.Silove D, Coello M, Tang K, Aroche J, Soares M, Lingam R, et al. Towards a researcher-advocacy model for asylum seekers: A pilot study amongst East Timorese living in Australia. Transcultural Psychiatry. 2002;39(4):452–68. doi: 10.1177/136346150203900404. [DOI] [Google Scholar]
- 30.Patton MQ. Qualitative Evaluation and Research Methods. 2nd ed. Newbury Park, CA: Sage Publications; 1990. [Google Scholar]
- 31.Can J Public Health. 2005.
- 32.Grove N, Zwi A. Our health and theirs: Forced migration, othering and public health. Soc Sci Med. 2006;62:1931–42. doi: 10.1016/j.socscimed.2005.08.061. [DOI] [PubMed] [Google Scholar]
- 33.Watters C, Ingleby D. Locations of care: Meeting the mental health and social care needs of refugees in Europe. Int J Law Psychiatry. 2004;27:549–70. doi: 10.1016/j.ijlp.2004.08.004. [DOI] [PubMed] [Google Scholar]
- 34.Fassin D. Social illegitimacy as a foundation of health inequality: How the political treatment of immigrants illuminates a French paradox. In: Castro A, Singer M, editors. Unhealthy Health Policy: A Critical Anthropological Examination. Walnut Creek, CA: Altimira Press; 2004. [Google Scholar]