The Institute for Global Health and Development
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Item Refugee integration in national health systems of low- and middle-income countries (LMICs): evidence synthesis and future research agenda(Elsevier, 2025-09-12) Olabi, Amina; Palmer, Natasha; Bertone, Maria Paola; Loffreda, Giulia; Bou-Orm, Ibrahim; Sempé, Lucas; Vera Espinoza, Marcia; Dakessian, Arek; Kadetz, Paul; Ager, Alastair; Witter, SophieThis paper reviews evidence on healthcare responses for refugees, documenting the different approaches and their effectiveness and impact in particular in relation to supporting integrating refugees into national health systems. The review adopted a purposeful, iterative approach, utilizing electronic databases, grey literature, and reference lists from relevant studies. A total of 167 studies, primarily from low- and middle-income countries (LMICs), focusing on refugees and forcibly displaced persons with empirical data, were included. The review highlights a substantial literature on refugee health and healthcare access, with well-covered areas including delivery models, access barriers, gaps in coverage, and specific health services such as psychosocial care, non-communicable diseases, mental health, and maternal and child health. However, less attention is given to integration models, health system responses, and their impact on system resilience and social cohesion. Few studies examine the costs, feasibility, or sustainability of integration models, and little research focuses on health system perspectives or comparative analyses. Moreover, the host health system's status, capacity, and needs are often underexplored. Some countries are particularly well-represented in studies, e.g. Turkey, Jordan, Lebanon, Bangladesh, Democratic Republic of Congo (DRC), and Uganda. There is however a paucity of data that would provide the basis for more quantitative or analytical evaluation from a systems perspective. This gap highlights the need for further research on effective integration models, their operational aspects, and their long-term impact on local health systems' resilience and sustainability. To support this research agenda, we propose a conceptual framework to provide analytic guidance for future research on healthcare responses for refugees and health system integration.Item Editorial: Exploring the links between social connections, care and integration(Frontiers Media, 2024-10-08) Vera Espinoza, Marcia; Dakessian, Arek; Boeyink, ClaytonItem Migrants’ entangled socio-political and biological lives during the COVID-19 emergency in Brazil(Taylor and Francis Group, 2024-09-04) Castro, Flávia Rodrigues; Zapata, Gisela P.; Vera Espinoza, Marcia;For migrants in Brazil, the COVID-19 global health crisis meant a considerable worsening of living conditions, with increased basic material needs. The reduction of individuals' existence to the mere search for survival had important repercussions on the activities of Civil Society Organisations (CSOs) in the country, whose work became increasingly focused on the distribution of emergency assistance for these populations. Drawing on 25 interviews with actors from CSOs, this paper unpacks the entanglement between the political and the biological aspects of migrants' lives. It argues that the pandemic brought to the fore the prominence of biological life to the detriment of migrants’ political and social lives in humanitarian responses to the health crisis. In this context, CSOs working with migrant populations in Brazil were pushed to reaffirm this dichotomy, while also contesting and reminding us that the impoverishment of migrants’ political and social lives can endanger the biological life that they meant to prioritise.Item Migration Governance in South America: Change and Continuity in Times of “Crisis”(Springer, 2023-12-28) Vera Espinoza, Marcia; Crawley, Heaven; Teye, Joseph KofiThis chapter provides an overview of recent South America migration governance. Recent migration dynamics in South America have been marked by intra-regional and extra-regional mobility patterns. While such intra-regional movements have had as their destination mainly countries of the Southern Cone—such as Argentina, Chile and Brazil—recent mobility has also changed migration patterns in countries such as Peru, Colombia and Ecuador. In particular, the exodus of more than seven million Venezuelans has led to significant changes in migration flows and policies in the region. This chapter reflects on the changes in migration governance in South America in the last decade, and how it has been framed and justified through the lens of “multiple crises”. The chapter argues that South America has been developing a patchwork approach to migration governance, characterised by fragmented and reactive measures, with practices that evidence both continuity and change. The development of this approach is leading to more control, the criminalisation of migration, increased migrant irregularity and less protection for people on the move.Item The Role of Social Connections, Time and Place in Refugees’ Pathways to Inclusion: Final Report 2020 - 2023(Queen Margaret University, 2023-12) Kerlaff, Leyla; Baillot, Helen; Palombo, Gianluca; Fernandes, Marcus; Vera Espinoza, Marciahis report outlines overall findings from the ABM3 New Scots: A Pathway to Social and Economic Inclusion Project which was funded by the Asylum Migration Integration Fund (AMIF) and delivered in three phases from October 2020 to December 2023. Here we focus on the third and final phase of the research conducted in 2023 while drawing on learning from Phase 1 (see Baillot et al., 2022) and from Phase 2 (Vidal and Palombo, 2022). More in-depth information is also available in our academic publications (see Käkelä et al., 2023; Vera Espinoza et al., 2023) and our interim reports. The three phases of the project and their respective aims are represented in the Timeline at figure 1. The ABM3 New Scots: Pathways to Social and Economic Inclusion Project is a partnership between researchers based at Queen Margaret University’s Institute for Global Health and Development and three third sector organisations who deliver specialist services: Scottish Refugee Council (integration planning), Workers’ Educational Association (English language assessment and learning) and Bridges Programmes (employability support). These practice partners have engaged with the research team to facilitate data collection, interpret findings and share mutual learning. The research component of the ABM3 project has explored the following research questions: 1. What is the role of social connections in refugees’ pathways to social and economic inclusion? 2. What meaning(s) do refugees ascribe to connections at different stages in their pathways? Building on our learning over the first two phases of the project, and to support our partners to adapt to the needs of their growing and changing client group,1 in the third phase we have focused in on the role of time and place in building social connections towards economic and social inclusion. The research team’s objectives for the project extension period were therefore to: • Explore how time and place impact the social connections that support specific means and markers of integration, including housing and employability; • Analyse the role of place in facilitating social connections between more recently arrived refugee people and more established residents in Scottish Local Authority (LA) areas; and • Discuss the contribution of AMIF partners to participants’ integration journeys. Names used in this report are all pseudonyms, to protect the identity and confidentiality of our participants.Item Actors, Ideas, and International Influence: Understanding Migration Policy Change in South America(SAGE Publications, 2023-05-01) Brumat, Leiza; Vera Espinoza, MarciaThis article analyzes the role of ideas, domestic actors, and international influences in migration policy change (MPCh) in Argentina, Brazil, and Chile. Building on 67 in-depth interviews with key actors in migration governance, public declarations of government representatives, and relevant legislation, we argue that the increased power of “securitist” actors within national bureaucracies shaped MPCh in all three countries. Between 2015 and 2019, these actors promoted a set of programmatic ideas and policy proposals that linked migration to security issues and distinguished between “good” and “bad” immigrants, emulating Global North countries. This set of ideas resulted in policy change at the country level, but at the same time, national-level policy change coexisted with continuity at the regional level. This article contributes to the literature on migration governance, first, by extending the geographical focus of migration policy studies, which frequently focus on party politics, coalitions, and public opinion, beyond the Global North. Second, we further current explanations of MPCh and policy contradictions by differentiating between continuity and change in programmatic ideas, policy proposals, and public philosophies. Third, we advance the regional migration policy literature by distinguishing between different groups of actors within national bureaucracies and enhancing understanding of these actors’ roles at both the national and international levels. Across its sections, this article shows that policy ideas—where and from whom they come—matter. By unpacking the different types of ideas that influence policy shifts and the actors who promote them, we can better understand apparent contradictions in migration policy.Item Reflections on ethics, care and online data collection during the pandemic: Researching the impacts of COVID-19 on migrants in Latin America(Transnational Press London, 2023-03-22) Vera Espinoza, Marcia; de la Reguera, Alethia Fernández; Palla, Irene; Bengochea, JulietaWhile most borders in Latin America were closed during the COVID-19 pandemic, the dynamics of mobility and immobility in the region did not stop. In this extreme context, there was a growing need to understand how the pandemic impacted migrant and refugee populations, as well as the long-lasting effects of measures implemented to mitigate its effects. With many migrants facing exacerbated conditions of vulnerability and with new working modalities affecting all members of society, especially those who were key respondents to protect migrants in the first year of the pandemic, key ethical questions emerged about how, when and where, should research be conducted. This paper reflects on the ethical challenges we faced – such as interviewees' research fatigue, negotiation of access, researcher’s positionality and the strategies to create rapport – and the methodological decisions we made in the context of a regional project (CAMINAR) that conducted online interviews with governmental and non-governmental actors working with migrants between June and August 2020.Item The Role of Social Connections in Refugees’ Pathways to Social and Economic Inclusion: Research Report 2020-2022(Queen Margaret University, 2023) Baillot, Helen; Kerlaff, Leyla; Käkelä, Emmaleena; Vera Espinoza, MarciaItem The role of social connections in refugees’ pathways towards socio-economic integration(University of Oxford, 2023-01) Vera Espinoza, Marcia; Baillot, Helen; Käkelä, Emmaleena; Dakessian, Arek; Kerlaff, LeylaSocial connections are well recognised as contributing to integration. Research undertaken in Scotland offers useful, sometimes counter-intuitive insights into their role over time, plus learnings that could be explored in other contexts.Item From Acts of Care to Practice-Based Resistance: Refugee-Sector Service Provision and Its Impact(s) on Integration(MDPI, 2023-01-11) Käkelä, Emmaleena; Baillot, Helen; Kerlaff, Leyla; Vera Espinoza, MarciaThe UK refugee sector encompasses welfare provision, systems advocacy, capacity development and research. However, to date there has been little attention on refugees’ experiences of the support provided by these services or on the views of the practitioners who deliver them. This paper draws from interviews and workshops with thirty refugee beneficiaries of an integration service in Scotland and twenty practitioners to shed light on how refugees and practitioners perceive and provide meaning to the work of the refugee sector. We identify refugee sector organisations as crucial nodes in refugees’ social networks and explore the multiple roles they play in the integration process. Firstly, we confirm that refugee organisations act as connectors, linking refugees with wider networks of support. Secondly, we demonstrate that the work of the refugee sector involves acts of care that are of intrinsic value to refugees, over and above the achievement of tangible integration outcomes. Finally, we demonstrate that this care also involves acts that seek to overcome and subvert statutory system barriers. We propose to understand these acts as forms of “practice-based resistance” necessitated by a hostile policy environment. The findings expand on understandings of the refugee sector, its role in integration and the multi-faceted nature of integration processes.