The Intersection Of Migration And Governance Of Public Health: Access To Healthcare For Migrants And Refugees During Crises

Abstract

The paper discusses the role of the public health governance in determining access to healthcare among migrants and refugees in crises with special reference to Balochistan, Pakistan. It is a response to five questions, including how the structure of governance affects the availability, accessibility and continuity of care; how the accessibility of treatment and prevention is mediated by documentation, registration and residency regulations; how migrants and refugees are vulnerable to health compared to the host populations; and how to make health systems more inclusive, accountable, and resilient. The paper use a qualitative research design due to the 21 in-depth interviews carried out based on the purposive sampling in Quetta, Pishin, Killa Saifullah and Loralai. The interpretation of the narratives of the participants was made through the thematic analysis. The results indicate that access is not ensured by the formal health infrastructure. Deliberate exclusion by the administration, discretionary provider gatekeeping, poor accountability and fragmented implementation generate systematic barriers to refugees and migrants particularly at times of crisis. The participants reported documentation issues, referral to an independent clinic, lack of affordability, cause of insufficient treatment, and avoidable worsening of the state of health. This paper postulates that migrant and refugee health is not a governance issue but a humanitarian issue. It endorses that the fair response to crisis needs to be inclusive in registration, non-invasive in service provision, enhanced supervision, and reform of the health system involving the displaced people in the normal and emergency planning of their health systems.