Immigrant Health Justice, Biocitizenship, and the Racialized Criminalization of Health Care

Bordered Resistance: Immigrant Health Justice, Biocitizenship, and the Racialized Criminalization of Health Care A Dissertation SUBMITTED TO THE FACULTY OF UNIVERSITY OF MINNESOTA BY Erin Hoekstra IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY Teresa Gowan, Lisa Sun-Hee Park, Co-Advisers June 2019 Copyright Erin Hoekstra, 2019 All Rights Reserved Acknowledgments A community of academics, activists, colleagues, and family and friends have provided the guidance and encouragement that has made this dissertation possible. Words cannot express the depth of my gratitude to my advisors, Teresa Gowan and Lisa Sun- Hee Park, for their generous support and unwavering belief in me as a scholar. From our first coffee at Hard Times when I was a prospective student, Teresa’s excitement about socially important research has been infectious. Her keen ethnographic eye, attention to the craft of writing, and constant encouragement to “be bold, be wrong!” have helped to hone my academic voice and will continue to shape my future research. Lisa’s mentorship has been invaluable – grounding me when I floundered, demystifying academia, and showing me that I do not have to choose between academic pursuits and a commitment to social justice. She has fostered my curiosity and helped me channel anger into critical analysis. My committee members, David Pellow, Cawo Abdi, and Lorena Muñoz, all scholars whom I admire and whose work is inspirational, have provided generous feedback and important perspectives that have guided my work. This dissertation would not have been possible without the institutional and financial support of the Department of Sociology at the University of Minnesota, the Bilinski Foundation, and the Anna Welsch Bright Research Fellowship. Special thanks to David Fitzgerald for giving me an academic home away from home in the borderlands at the Center for Comparative Immigration Studies at the University of California-San Diego. At CCIS, I found an interdisciplinary community of migration scholars whose feedback and varied perspectives have left their mark on this dissertation. i I could not have navigated this long and difficult journey without the support and friendship of so many fellow grad students. I am beyond fortunate that there are too many to name. I want to give a special thanks to the ethnography group and to “DA,” in particular Carolyn Fraker, Tanja Anđić, Madison Van Oort, Yagmur Karakaya, and Anuradha Sajjanhar, whose willingness to listen, give critical feedback, and commiserate on setbacks and celebrate successes together have been invaluable. I am eternally grateful to the members of the EASE group – Emily Springer, Anthony Jimenez, and Sravanthi Kollu – whose solidarity and words of encouragement have sustained me over the past years in ways I cannot even express. Thank you for honoring me with your friendship and inspiring me to be a better scholar and a better person. In academia, as in most occupations, women must often work like they don’t have children. My academic career has benefitted from care work that often remains invisible. This dissertation would have been impossible without the nurturing labor of several women, who have taught me so much about how to be a parent, in particular Janeth, whose strength and commitment as a mother is a quiet defiance in the face of punitive immigration enforcement. The last thing I expected to find in grad school was a partner, much less a partner in life and comrade in struggle as supportive as Raphi Rechitsky. He has believed in me when I did not and continually reminds me that my work matters. Our life together has taken us around the globe and back again, and I can’t wait to see what the next adventures will bring. When I despair that she is inheriting a less just and equitable world, Raisa Hoekstra-Rechitsky’s feisty spirit, defiant joie de vivre, and unbridled ii curiosity are a source of abundant joy and give me hope for our future. I am more than grateful to share life with these two wonderful humans. My deep admiration and gratitude go to the organizations and activists in Arizona providing medical care and humanitarian aid to migrants in the borderlands and beyond, fostering radical hospitality in the face of state repression. Thank you for taking me in, sharing your knowledge and perspectives, and working tirelessly to cultivate mutual aid and community solidarity. I will end in the same way that No More Deaths close their meetings – with an acknowledgment of migrants who have lost their lives crossing the border as well as those currently crossing or struggling to survive under the harsh realities of punitive immigration enforcement. Hasta un mundo libre de la violencia de las fronteras. iii Abstract Bridging critical health and migration studies, this dissertation examines the health effects of racialized processes of immigrant criminalization, focusing on the organizations that provide medical care in an informal, often underground, health system. Governed by a “biopolitics of disposability” (Giroux 2006), immigrant ineligibility for health care contributes to undocumented migrants’ experience as distinctly vulnerable, exploitable, and ultimately disposable. Whereas health institutions are usually figured as solutions to the violence embodied in unequal health outcomes, this dissertation argues that spaces of health are also perpetrators of structural violence. Clinics operate as de facto border checkpoints, leaving migrant patients susceptible to deportation for accessing emergency medical services. In the face of the violence of the mainstream health system, a network of humanitarian organizations provide health care to uninsured, undocumented migrants, while resisting the collusion between health and immigration enforcement. In contrast to medical humanitarianism’s focus on constructions of migrant “deservingness,” this dissertation argues that the concept of biocitizenship, a medicalized belonging based on common humanity, transcends dichotomies of deserving and undeserving, “good” or “bad” migrants. Biocitizenship also critiques the disentitlement and dehumanization of a biopolitics of disposability. Drawing from twelve months of ethnographic fieldwork with free clinics and humanitarian organizations across Arizona, this dissertation examines immigrant health justice (IHJ) organizations’ use of humanitarianism as both a discursive strategy and a field of action. In the borderlands, IHJ organizations frame their politically-contentious iv work as apolitical medical care and fight for the recognition of the patient status of migrants in need of emergency first aid. In the interior, the IHJ turns its critique toward “health” itself. Employing a rights-based humanitarian discourse, activists castigate the for-profit health system as complicit with immigration enforcement, indicting it for mass structural violence. Centrally, this dissertation argues that these related but distinct discourses across the borderlands and interior amount to an insurgent humanitarianism that exposes the fatal consequences of immigrant criminalization. By claiming various biocitizenships on behalf of their patients, IHJ organizations and activists use medicalized language as the basis of a politics of visibility, highlighting the health needs and fatalities of migrants across the country. v Table of Contents List of Figures vii Preface Into the Field 1 Chapter 1 Introduction: Racialized Criminalization of Immigrants 10 and the Ordinary Crisis of Immigrant Health Chapter 2 The Biopolitics of Disposability: Structural Violence and the 61 Medicalized Devolution of Immigration Enforcement Chapter 3 “Not a Free Version of a Broken System:” Immigrant Health 109 Justice and Substantive Biocitizenship Chapter 4 Insurgent Humanitarianism in the Militarized Borderlands: 172 Border Patrol’s “Moral Alibi” and the Necropolitical Biocitizenship of Migrant-Patients Chapter 5 Conclusion - Politics of Visibility: Counting and Accounting 214 for Migrant Deaths Bibliography 230 vi List of Figures Figure 1: The Barry M. Goldwater Bombing Range 6 Figure 2: Map of the Militarized Borderlands 31 Figure 3: Undocumented Immigrant Population in Arizona (1990-2014) 41 Figure 4: Sheriff Arpaio and MCSO “Illegal Immigration” Hotline Truck 93 Figure 5: Migrant Deaths in the Arizona Borderlands 182 Figure 6: Humane Borders Water Station 187 Figure 7: Border Patrol “Rescue Beacon” 193 Figure 8: No More Deaths Clinic Tent 198 vii Preface Into the Field “Welcome to the United States!” Michael said in Spanish, shining a light into the back of the patient’s throat. With his mouth wide open, Enrique could not respond but looked around with a similar uncertainty I’d seen in the clinic’s newer patients. Nothing about his appearance indicated he had just survived a perilous week-long journey across the border, walking through the remote deserts and mountains of southern Arizona. Somewhere in his late thirties, a little overweight, and wearing a t-shirt and jeans, he more or less fit the description of the clinic’s other patients – he was an uninsured, undocumented Latino immigrant with a relatively-minor health complaint. Because of his lack of insurance and papers and fear of deportation however, he could not access medical care in the mainstream health system. For Enrique, this fear was exacerbated by the fact that his health complaint stemmed from his recent border crossing – a potential case of valley fever. Valley fever is a respiratory infection caused by a fungus that thrives

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