Key note at CESSMIR Conference on Needs and Care Practices for Refugees and Migrants

1. Moving forward:
(re)engaging with migration, mobility and HIV in southern Africa
Jo Vearey, PhD
African Centre for Migration & Society
University of the Witwatersrand
jovearey@gmail.com
@jovearey
19th September 2018
www.mahpsa.org
@mahp_sa

2. Why migration and health?

3. Migration as a determinant of health
a bidirectional relationship
migration  health
migration can determine health
migration  health
health can determine migration

4. A renewed focus on
migration and health
• SDGs: leave no-one behind
• World Health Assembly; WHO; IOM
• Global Compacts
• Universal Healthcare Coverage
• Justice, equity & public health
• Migration-aware and mobility-
competent health responses
Competing agendas
• Politics and power
• Securitisation of migration
• Fear of the other
• Health security

6. Meanings matter
Migrant, migration, movement, mobility
• Internal, cross-border, domestic, international
• Bodies, populations
• Long-term, short-term, circular
• Time, space, transit, journey, trajectory
• For work & study, to seek work, for asylum-seeking
• Documentation, regularity
Language, voice, labelling, definitions, representation
• Vulnerability, stereotypes, deservingness, fear
• Moral panics, crisis,’ trafficking’, smuggling
• Securitisation, health security, borders, boundaries, containment
Global, national, regional, continental, local
• Low-income, high-income, power, geopolitical context, global context, nation state,
sovereignty, policy processes
Health, wellbeing, public health, population health
• Social determinants of health, equity, equality, socio-economic status, gender, age, race,
nationality, epidemiological context, violence -direct and structural
Beyond
binaries

7. The Southern Africa Development Community (SADC)
Diversity
Heterogeneity
(contexts: migration; urbanisation; health systems;
governance; communicable diseases)

8. Migration and health in South(ern) Africa
1. South(ern) Africa is associated with mixed migration flows:
internal > cross-border; livelihood seeking > forced migration; urban refugees; marginalised and hidden
migrant groups; spaces of vulnerability; negative assumptions persist
2. Current public health responses do not engage with,
migration and mobility: implications for communicable disease control (TB and HIV,
malaria); chronic treatment continuity; challenges in accessing the public system for non-nationals;
towards migration aware and mobility competent responses
3. The South(ern) African public health and social welfare
systems are overburdened and struggling: challenges are raised in a
context of high inequality where nationals are also struggling to access their basic rights
4. South Africa is associated with anti-foreigner and
xenophobic attitudes: migration management is associated with increased
securitisation; a lack of regional responses; a restrictive immigration act; limited understanding of
migration dynamics; violence; fear; securitisation of health

9. Migrant friendly v’s migration aware
Migrant friendly
• “Right to health”
• Limited systems response
• Cross-border/non-national
focus: an assumed
homogenous group
• Exceptionalises
• Individual level focus
• Intercultural / cultural
sensitivity
Migration aware
• Migration aware and
mobility competent
• Heterogeneity
• Systems response
• Spatially sensitive
• “Health for all”
• Public health approach
• Regionally-aware

10. Is health being used to support securitization agendas?
NATION STATES
SECURITY AGENDAS
SOVEREIGNTY
BORDER MANAGEMENT
REGULARISATION
COMMUNICABLE DISEASES
PUBLIC HEALTH
HEALTH AND WELLBEING
SECURITISATION OF MIGRATION
HEALTH FOR ALL
LEAVE NO-ONE BEHIND
FREE MOVEMENT
NON-COMMUNICABLE DISEASES
PROTRACTED CRISES

11. “…..the trend to link foreign policy interests to health problems has been criticized
on the grounds that it may result in injecting great power politics and
narrow national security interests into health and humanitarian
matters (Farmer 1999; Mcinnes and Lee 2006), as well as on more theoretical
grounds by the security studies community (Elbe 2005).”
Aldis, 2008
Key concerns:
• Co-opting a health security agenda to support the securitisation of
migration
• Potential for regression of rights for people on the move
• Global / regional / bilateral & multi-level /multi-sectoral / WoG response
needed

12. 1. Accountability & responsibility:
– What’s at stake for who?
– Who is ultimately responsible?
– Non-binding v’s binding agreements; global accountability
– Who has oversight?
– Language and discourses
2. Identify strategic opportunities:
– Do not exceptionalise cross-border movements
– Internal migration as greatest development challenge in SA
– Costing studies: who do we need to convince?
3. Building of alliances:
– Who can – and cannot - do what?
– Who can speak out?
4. Research as action:
– Engaged, slow research, personal relationships
5. Action plans and frameworks

13. @mhadri_
www.mhadri.org

14. Moving forward:
(re)engaging with migration, mobility and HIV in southern Africa
Jo Vearey, PhD
African Centre for Migration & Society
University of the Witwatersrand
jovearey@gmail.com
@jovearey
19th September 2018
www.mahpsa.org
@mahp_sa

15. Advocate for a migration-aware approach.
3.• Migrant friendly approach:
• Individual focus (v’s population focus)
• Facility-level responses (v’s health system
responses)
• Emphasis on language and translation; cultural
competency
• Exceptionalise: focus on non-nationals
• “Right to health” focus
• Migrants perceived as sick, a burden on services, and
in a larger number than they are
• Limited (no) systems response
• Client mobility within the health system is not
addressed
There is a need for “migration aware” responses to HIV
that embed migration as a key social process in
southern Africa.