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Awarded Theses 2018/2019 Nouran El-Hawary Refugee and migrant access to health in transit countries Politics of adaptability, enactment of slow death and inevitability of pain: An ethnography of a poor urban neighbourhood in Rabat (Morocco) ARMA, The Arab Master’s Programme in Democracy and Human Rights NOURAN EL-HAWARY REFUGEE AND MIGRANT ACCESS TO HEALTH IN TRANSIT COUNTRIES POLITICS OF ADAPTABILITY, ENACTMENT OF SLOW DEATH AND INEVITABILITY OF PAIN: AN ETHNOGRAPHY OF A POOR URBAN NEIGHBOURHOOD IN RABAT (MOROCCO) NOURAN EL-HAWARY FOREWORD The Global Campus of Human Rights is a unique network of more than one hundred participating universities around the world, seeking to advance human rights and democracy through regional and global cooperation for education and research. This global network is promoted through seven Regional Programmes which are based in Venice for Europe, in Sarajevo/Bologna for South East Europe, in Yerevan for the Caucasus, in Pretoria for Africa, in Bangkok for Asia- Pacific, in Buenos Aires for Latin America and the Caribbean, and in Beirut for the Arab World. Every year each regional master’s programmes select the best master thesis of the previous academic year that is published online as part of the GC publications. The selected seven GC master theses cover a range of different international human rights topics and challenges. The Global Campus Awarded Theses of the academic year 2018/2019 are: • Begalieva, Nuriza, From Democracy to Autocracy? Growing Threats to Civil Society and Media in Kyrgyzstan, Supervisor: Arusyak Aleksanyan, Yerevan State University. Master’s Programme in Human Rights and Democratisation in the Caucasus (CES), coordinated by Yerevan State University • El-Hawary, Nouran Refugees and Migrant Access to Health in Transit Countries: Politics of Adaptability, Enactment of Slow Death and Inevitability of Pain: an Ethnography of Poor Urban Neighborhood in Rabat (Morocco), Supervisor: Jeremy Gunn, International University of Rabat (UIR). Arab Master’s Programme in Democracy and Human Rights (ARMA), coordinated by Saint Joseph University (Lebanon). II REFUGEE AND MIGRANT ACCESS TO HEALTH IN TRANSIT COUNTRIES • Ferizov Jasenka Prosecution of Crimes of Appropriation of Private Property before the ICTY and the IRMCT, Supervisor: Hans- Joachim Heintze,ić, Ruhr Unversity Bochum. European Regional Master’s Programme in Democracy and Human Rights in South East Europe (ERMA), coordinated by University of Sarajevo and University of Bologna • Frías Sampaio, Emmanuel, Politics of Memory on the Recent Past in Brazil: The Federal Government’s Role in Constructing Collective Memory Between 2003 and 2016, Supervisor. Ana De Maio, University of Buenos Aires. Master’s Programme in Human Rights and Democratisation in Latin American and the Caribbean (LATMA), coordinated by National University of San Martin (Argentina) • Guzmán Torán, Juan José, When the Forest Screams. The Rights of Nature and Indigenous Rights as a Mutually Reinforcing Resistance Platform for the Indigenous Peoples of the Ecuadorian Amazon, Supervisor: Felipe Gómez Isa, University of Deusto Bilbao. European Master’s Programme in Human Rights and Democratisation (EMA), coordinated by Global Campus of Human Rights Headquarters. • Hasanah, Mahesti Between the Domination of Transnational Companies and Its Discourse on Business and Human Rights: Contract Farming and Banana Small Farmers in the Davao Region (The Philippines), Supervisor: Ryan Jeremiah D. Quan, Manila University. Master’s Programme in Human Rights and Democratisation in Asia Pacific (APMA), coordinated by Mahidol University. • Nyemba, Chisomo Right to Data Privacy in the Digital Era: a Critical Assessment of Malawi’s Data Privacy Protection Regime, Supervisor: Akinola E Akintayo, University of Lagos. Master’s Programme in Human Rights and Democratisation in Africa (HRDA), coordinated by Centre for Human Rights, University of Pretoria. III NOURAN EL-HAWARY This publication includes the thesis Refugees and Migrant Access to Health in Transit Countries: Politics of Adaptability, Enactment of Slow Death and Inevitability of Pain: an Ethnography of Poor Urban Neighborhood in Rabat (Morocco) written by Nouran El-Hawary and supervised by Jeremy Gunn, International University of Rabat (UIR). The Institute of Political Science of Saint Joseph University does not intend to give any approval or disapproval to the opinions expressed in this thesis. These opinions belong solely to their author. BIOGRAPHY Nouran has been working as rights and advocacy officer in several international non-governmental organizations, concerning disability rights; health and wellbeing of different vulnerable groups. Being trained in social anthropology from the American University in Cairo,she has always accompanied her practice in realm of social development. She is interested in investigating the trickle down of health public policies on vulnerable groups accessibility, by leveraging their own experiences with system(s) and actual voices. ABSTRACT This thesis project builds on three months of ethnographic and interview research undertaken between February-May 2019 to explore refugee and migrant access to health in one of Rabat’s poor neighbourhoods, Youssoufia, which has a high concentration of sub-Saharan African migrants. Morocco’s new National Immigration and Asylum Strategy (2014) officially grants them the right to access primary health care (PHC) on an equal basis with Moroccans. This strategy goes hand-in-hand with the Moroccan government’s national attempt to extend universal health coverage (UHC) for the poor and less-advantaged classes in order to achieve social equality and health equity through the proliferation of PHC facilities. Focusing on Youssoufia, the field findings suggest that despite the government’s numerous reforms, proper implementation of the strategy was hindered by the poor governance and accountability of the health sector, on one hand, and inadequate multi- stakeholders migration management on the other hand. All that combined with poor social determinants of health among refugees and migrants made them depend on medical alternatives presented in self-medication and popular healing practices. This research challenges the predominant proposition assuming migrants and refugees burden national health resources. Rather, it highlights the fact that promoting refugee and migrant access to PHC has been negatively impacted by the dysfunctional national health systems of transit countries in North Africa that have been subject to a massive disadvantage behind the neo-liberal policies imposed by the Structural Adjustments Programmes (SAPs) of the World Bank that have market-based approaches to health care and the social determinants of health. IV REFUGEE AND MIGRANT ACCESS TO HEALTH IN TRANSIT COUNTRIES ‘nhna yanmutu bilbihar aw intu titdau biblad al-nas …’ 1 (we die in the sea and you (state leaders) get medicated abroad) 2 1 The previous quote wittily projects the contemporary cynical situation of health in several Arab countries that is marked by the avoidance of states leaders and sometimes high officials from using national medical services and going abroad to Europe and the US for any treatment. It reflects a huge distrust in the system as well as inadequacy. It also communicates the reasons why migration to Europe is motivated. The availability of quality basic social services, like health, promise a minimum of decent living conditions that are disregarded in home countries. ‘Liberer L’Algérie’ YouTube video, 5:08, from a video clip posted by a group of artists to protest against the 5th mandate of the Algerian president Boutafliqa in February 2019, posted by Oussama Zaine (1 March 2019) <www.youtube.com/watch?v=blYMUHRtZ9Y&t=203s> accessed 18 April 2020. V NOURAN EL-HAWARY ACKWNOWLEDGEMENTS The writing and the completion of this thesis would not be possible without the help and support of a number of people. First of all, I am deeply indebted to my supervisor, Professor Jeremy Gunn, for his unwavering support and guidance. Professor Gunn provided crucial direction during the early stages and continued to offer generous support and insightful attentive feedback throughout several drafts. I could not have wished for a better supervisor, and I consider myself very fortunate for having the opportunity to work with him. I am immensely grateful to Professor Mehdi Alouia who has helped me in deciding my fieldwork site and scope in Morocco. His constant encouragement as well as frequent, thorough comments and perspectives have been crucial to the initiation of fieldwork and the writing process of this thesis. I also want to express my sincere gratitude to Jihad Nammour – the Academic Coordinator of ArMA programme – Dr Boudouin Dupert, Dr Stephane Lagout and Dr George Ulric for their support and insightful suggestions when this project was in its primitive inception phase. On a personal note, I owe a great deal to my family and numerous friends who have offered support and encouragement during this intense time, away from my beloved home, Egypt. I would like to thank my family; I am especially indebted to my father, Anwar El-Hawary for believing in me even if I have nothing that is outstanding, for teaching me the true value of life against the societal constructs of how life should be; my mother Asmaa El-Hussieny who opened my eyes to the wonders of Africa; and my brother Basem El-Hawary for listening to me and being a great source of support. A very special thank goes to my husband,
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