School of International Service, American University, Washington, District of Columbia, USA
Department of Anthropology, History, and Social Medicine, University of California Berkeley, Berkeley, California, USA.
BMJ Glob Health. 2021 Apr;6(Suppl 1). doi: 10.1136/bmjgh-2021-005109.
Based on the authors' work in Latin America and Africa, this article describes and applies the concept 'structural vulnerability' to the challenges of clinical care and healthcare advocacy for migrants. This concept helps consider how specific social, economic and political hierarchies and policies produce and pattern poor health in two case studies: one at the USA-Mexico border and another in Djibouti. Migrants' and providers' various entanglements within inequitable and sometimes violent global migration systems can produce shared structural vulnerabilities that then differentially affect health and other outcomes. In response, we argue providers require specialised training and support; professional associations, healthcare institutions, universities and humanitarian organisations should work to end the criminalisation of medical and humanitarian assistance to migrants; migrants should help lead efforts to reform medical and humanitarian interventions; and alternative care models in Global South to address the structural vulnerabilities inherent to migration and asylum should be supported.
基于作者在拉丁美洲和非洲的工作，本文将“结构性脆弱”这一概念应用于移民的临床护理和医疗保健倡导所面临的挑战中。这一概念有助于考虑特定的社会、经济和政治等级制度和政策是如何在两个案例研究中导致和塑造移民的不良健康状况的：一个案例发生在美墨边境，另一个案例发生在吉布提。移民和提供者在不平等且有时是暴力的全球移民系统中的各种纠葛，可能会产生共同的结构性脆弱性，从而对健康和其他结果产生不同的影响。有鉴于此，我们认为提供者需要接受专门的培训和支持；专业协会、医疗机构、大学和人道主义组织应努力结束对向移民提供医疗和人道主义援助的定罪；移民应帮助领导努力改革医疗和人道主义干预措施；支持在全球南方建立替代护理模式，以解决移民和庇护所固有的结构性脆弱性。
