King's College London, Department of Global Health and Social Medicine, Strand, London, United Kingdom.
King's College London, Faculty of Medicine, Strand, London United Kingdom; London School of Hygiene and Tropical Medicine (LSHTM), Department of Global Health and Development, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom.
Soc Sci Med. 2020 Mar;248:112838. doi: 10.1016/j.socscimed.2020.112838. Epub 2020 Feb 7.
France hosts approximately 368,000 'persons of concern' (e.g. refugees, stateless, people in refugee-like situations, asylum-seekers). Northern France has become a focal area, due to its proximity to the Dover entry-point to the UK and larger numbers of migrants. This study used a structural violence lens to explore the provision of health services to migrants in Calais and La Linière in northern France, to contribute to discourse on the effects of structural violence on non-state service providers and migrants in precarious conditions and inform service provision policies. Our qualitative study design used semi-structured key-informant interviews, conducted in summer 2017 with 20 non-governmental service-providers, 13 who had worked in Calais and 7 in La Linière migrant camp. We analysed interviews thematically, using inductive coding. Themes from analysis were: (i) power dynamics between NGOs and the state; (ii) resource allocation and barriers to accessing services; and (iii) effects of structural violence on social determinants of health. NGO service provision varied due to tense power dynamics between state and NGOs, shifting state requirements, and expanding roles. Interviewees described ongoing uncertainties, and inherent disempowerment associated with humanitarian aid, as negatively affecting migrant health and wellbeing, increasing illness risks, and providing unequal life chances. Structural realities including violence appeared to negatively affect migrant social determinants of health, reducing healthcare access, social inclusion, and sense of empowerment. The role of NGOs in providing migrant health services in northern France was complex and contested. Structural violence negatively affected migrant wellbeing through restricted services, intentional chaos, and related disempowerment. The violence exerted on migrants appeared to diminish their life chances while being an ineffective deterrent, indicating better approaches are needed.
法国约有 368,000 名“关注人士”（例如难民、无国籍人士、处于类似难民状况的人、寻求庇护者）。由于靠近英国多佛尔入境点，以及移民人数较多，法国北部已成为一个焦点地区。本研究使用结构暴力视角，探讨了在法国北部加莱和拉利涅为移民提供医疗服务的情况，以期促进关于结构暴力对非国家服务提供者和处于脆弱境地的移民的影响的讨论，并为服务提供政策提供信息。我们的定性研究设计采用半结构式关键知情人访谈，于 2017 年夏季在法国北部的加莱和拉利涅难民营对 20 名非政府服务提供者进行了访谈，其中 13 人曾在加莱工作，7 人曾在拉利涅难民营工作。我们使用归纳编码对访谈进行了主题分析。分析得出的主题包括：（一）非政府组织与国家之间的权力动态；（二）资源分配和获取服务的障碍；（三）结构暴力对健康社会决定因素的影响。非政府组织的服务提供因国家和非政府组织之间紧张的权力动态、不断变化的国家要求和扩大的角色而有所不同。受访者描述了与人道主义援助相关的持续不确定性和固有的无权状态，这些都对移民的健康和福祉产生负面影响，增加了患病风险，并提供了不平等的生活机会。包括暴力在内的结构性现实似乎对移民的健康社会决定因素产生负面影响，减少了医疗保健的获取、社会包容和赋权感。非政府组织在法国北部为移民提供医疗服务的角色是复杂和有争议的。结构暴力通过限制服务、故意制造混乱和相关的无权状态，对移民的福祉产生负面影响。对移民施加的暴力似乎削弱了他们的生活机会，同时也未能起到有效的威慑作用，这表明需要采取更好的方法。
