Public Health Ethics, Asylum & Protection (unpublished)

Public Health Ethics, Asylum & Protection

Summary Report

28 July 2011- 8 October 2014 Final Version 16.10.2014

Follow-Up of the Research Outlined in the Project Plan

‘Part 1 ‘Acute Humanitarian Need’ from July 2011

By Karin Johansson Blight

RGN, MSc Public Health, PhD Psychiatry

Independent Researcher

Study Summary 28 July 2011- 8 October 2014. By K. Johansson Blight (page: 1-30) 16 October 2014

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The work in this report has been conducted in collaboration with Etikkommissionen i Sverige

(The Ethics Commission Sweden). I would like to dedicate a heartfelt thank you to everyone

who has had an input in and/or commented on the research undertaken in this report since

July 2011, including Etikkommissionen i Sverige and the Human Rights group at Mèdecins

du Monde/Doctors of the World Sweden. With special thanks to Professor Angus Dawson,

Ms Anita D’Orazio, Associate Professor Hans-Peter Søndergaard, Professor Emerita

Elisabeth Hultcrantz, and Dr Göran Bodegård for invaluable expert comments and wisdom.

Thank you also to Mr Ed Paulette and Mr Andrew Blight for volunteer proof-reading of peer-

reviewed articles and chapters.


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CONTENT PAGE

SUMMARY OF RESEARCH 3-4

GENERATED KNOWLEDGE 5-6

IMPLICATIONS AND FURTHER RESEARCH 7-9

REFERENCE LIST 10-15

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APPENDIX 1 Project Plan (Part 1) from 28 July 2011:

THREE WORDS- Acute Humanitarian Need

Research Proposal- Summary (English) 16

APPENDIX 2 Background- From Project Plan (Part 1) 28 July 2011 17-20

APPENDIX 3 Summary of Answers to Research Questions 1-3 21-24

APPENDIX 4 Research Articles and Book Chapters Subject to Peer/

Editorial Review 25

APPENDIX 5 Full List of Published & Unpublished Work since the

Project Plan in July 2011 26-28


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SUMMARY OF RESEARCH

JULY 2011- SEPT 2014

Aim (revised: see Appendix 1 for the original version and Appendix 2 for background):

1) To critically explore the health, social and legal realities of treatment and outcomes for

children and their families in Sweden who have been rejected asylum and protection. In

particular for children who have developed Pervasive Arousal Withdrawal Syndrome1

(PAWS), (other terms used are ‘depressive devitalisation’, ‘apathy’, or ‘dissociative stupor’).

2) To use the information in aim 1) to apply ethical and philosophical reflection to understand

processes of emotional minimisation and dehumanisation. Assumptions the present system

poses risks of a) emotional minimisation, b) processes of dehumanisation which, contribute

to: i) poor public mental health and ii) compromise ethics (e.g. moral disengagement2) and

human rights. Main Research Questions: 1) how can the asylum process/migration

management/ immigration control processes be described and understood using a public

health ethics approach? 2) In what ways can the system be said to contribute to emotional

minimisation and dehumanisation? 3) [Outside of public health ethics] are there

principles/rules that can be applied to enhance understanding and better promote public

health? 4) What are the ‘must haves’ (or ‘pre-requisites’) for a humane process? For

overarching responses to research question 1-3 see Appendix 3 (page 21-24) and for

research question 4, see page 7. Theoretical frameworks draw from public health

(including violence prevention) and public health ethics, bio- and medical ethics, law,

economy and human rights. Qualitative methods and analyses3: the processes have been

studied using qualitative methods. The analysis has been carried out using a variety of

qualitative methods influenced by medicine and the humanities: these draw from discourse-,

case study-, personal narrative-, interpretive- and testimony approaches (Buchanan, 2000,

Denzin, 2001, Denzin and Lincoln, 2003a, Woods, 2013).

1 This is a stress-induced and severely disabling condition involving extensive, or complete, loss of bodily function resulting from exceptional or high levels of cumulative stress (Bodegård, 2005, 2013, Söndergaard et al. 2012). Cumulative stressors that forced migrants may be exposed to include traumatising life events and fear of return due to an arbitrary asylum process (Johansson Blight et al. 2014). Regarding underlying theories of PAWS, this has been succinctly described by Sondergaard et al. 2012 and was included in the presentation Johansson Blight and Søndergaard (2013). Up-dated information about PAWS amongst forced migrants is also available in Swedish in Envall (2013) and Ascher and Hjern (2013) and in English in Bodegård (2013) and Ascher and Hjern (2014). 2 ‘Moral disengagement’ is explored through ‘emotional minimisation’, which refers to actions that diminish victims’ psychological realities of pain and ‘dehumanisation’, which refers to actions that treat victims as less than human (Leidner et al. 2010, Johansson Blight, 2014a). 3 Being qualitative studies, common limitations apply (Denzin and Lincoln, 2003a): for example, in terms of generalizability this is approached as a reflective rather than a statistical matter, and validity and representativeness, for example of rejected asylum seekers’ experiences are limited for example due to that 1) the empirical data draws from secondary sources of data, 2) not all case files contain all documents used in the processing of the case, and 3) law is a context and time bound practice.


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Empirical data I have analysed, snowball sampled, existing case file evidence i.e. asylum

decisions and medical certificates. I have also reviewed medical scientific articles, ethics

references, migration policy reports, legal and human rights frameworks, as well as news

reports. I have aimed for information distribution through a range of publishers and various

fora. Academic outputs cover four process themes: Asylum Assessment; Commissioned

Medical Doctors & Medical Terminology; New Public Management & Economic Reasoning,

and Values & Ideologies. The themes have been summarised from the research presented in

articles, book chapters and reports, which so far includes six research articles and book

chapters subject to (or due) peer/editorial review (for details see Appendix 4):

5 Articles 2 Book Chapters 2 Reports / 1 News article

1 Published after peer-review

(single authored)

1 Published after editorial

review (co-authored)

1 Published report (single

authored)

1 Accepted after peer-review

(single authored)

1 Accepted after editorial

review (single authored)

1 Published report (co-

authored)

2 Under peer-review (one single

authored, one co-authored)

1 Published news article (co-

authored)

1 Manuscript drafted and due

submission (single authored)

Attention has been paid towards the migration authorities’ argument as to why children with

PAWS (and children and adults with other symptoms of severe distress/poor mental health)

should not be granted residency and Sweden’s obligation towards rejected asylum seekers

and vulnerable persons. I have also reflected on common denominators amongst persons

rejected in the documents reviewed (for further information see page 6-7). An extensive

literature review has been undertaken with specific focus on literature in public health ethics,

bioethics (primarily in Sweden), psychiatry and national and international law and Human

Rights Conventions. The literature reviews have mainly focused on published academic work

searched for using Pubmed, Google, Amazon, and at the British Library. Specific attention

has been paid to identifying and discussing empirical data (asylum decisions and medical

certificates) in relation to normative frameworks agreed at national and international level,

specifically in relation to children and adults who have been rejected asylum and protection

and who can be considered vulnerable. In eight of the article, book chapters and reports (in

the table above) case studies of children and adults with PAWS or other symptoms of severe

distress are referred to. Finally, for a full list of documents available, see Appendix 5.


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GENERATED KNOWLEDGE

SYSTEM, PROCESS & HEALTH OUTCOMES

System and process

The research in this report focuses on ethical issues in practice, which relates to

and/or impacts on public health, social justice and medicine (Dawson, 2009, 2011).

For many forced migrants in Sweden and elsewhere, the asylum process can be a

process of social exclusion (Grewcock, 2009).

It is theoretically and practically useful to research the asylum system, including its

legal framework, policy and case work to understand how this system works. This can

be done as the asylum system is a social, structural, determinant of health (Kickbusch

and Buse, 2001, Herrman et al. 2010, McDavid Harrison and Dean, 2011).

The asylum process and system, including migration management and immigration

control, can be researched using, public health ethics within bioethics, public health

and social epidemiology frameworks, and by using a wide range of qualitative and

quantitative methods (Denzin, 2001, Denzin and Lincoln, 2003a,b,c, Oakes and

Kaufman, 2006, Dawson, 2009, 2011, Verweij and Dawson, 2009, Marmot, 2013).

As in medicine/public health in general, qualitative and quantitative research methods

can be applied to existing data (asylum decisions, medical certificates, etc.) that is

collected directly by state authorities or through state commissioning to private sector

services. Purpose-made studies (through interviews, observations, surveys, etc.),

including larger studies are possible (such as quantitative health outcome studies), by

using available, existing data, or purpose-made longitudinal or cross-sectional studies.

As this research since July 2011 has shown, health has been politicised in migration

policy and case law in Sweden. Awareness must thus be made about potential

obstacles. This includes for example inconsistencies in frequency reporting and/or

dissonance as to what is agreed in society in general, in the interpretation of health

and mental health in migration policy and by the migration authorities.

What the research reported here has shown is that new or different meanings have

been applied to medical constructs from those agreed in mainstream society. For this

reason I suggest that the health care sector (including public health) should increase

its efforts to abide by bioethics, public health ethics and human rights and apply

person-centred care in dialogue with patients, a non-discriminatory approach and

insist on this primary expertise in relation to migration authorities and society

generally.


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It appears that in the process of assessing asylum and protection a focus is often

placed on the form of evidence and not primarily its content. Quantitative, continuous,

measures are given greater weight than that of narratives of persecution and

humanitarian need, seemingly to facilitate rejections. I suggest that this can pose

specific risks to social justice and equity in health for all. This has a specific impact

on social exclusion: a reductionist interpretation of the process, health and illness,

influences what counts as evidence and devalues narratives, which is at the core of the

asylum process. The data I have reviewed suggests the existence of discrimination in

a way that is contrary to human rights conventions, international law and to medicine

and public health, medical-, bio- and public health ethics. This contributes to the

exclusion of vulnerable persons from protection, many of ethnic minority belonging.

Health outcomes

Since July 2011, scientific (medical) advances, grounded in extensive bioethical

debate, have been made in terms of PAWS. This has helped to denounce politically

driven myths that some children, due to their cultural heritage, would simulate or

malinger severe distress, or be poisoned by their parents, to secure residency

(Kihlbom, 2007). This work has improved Swedish public health through a deeper

understanding of exceptional levels of stress on the health of forced migrant children,

adults and families and the role migration policy and the asylum system as social

determinants has in this (Sondergaard et al. 2012, Bodegård, 2013, Ascher and Hjern,

2014). Prior to this the unequal distribution of health risks to persons seeking or

rejected asylum compared to residents, was not really recognised. Deriving from this

work is also a medical diagnosis4, based on patient narratives, that now is available to

better identify children (and adults) who have symptoms of PAWS, to facilitate

access to competent and appropriate treatment and improve communication (Envall,

2013, Hultcrantz and von Knorring, 2012, Johansson Blight et al. 2014).

Evidence suggests that public health issues such as alleged violence exposure and

violent persecution including undisclosed and disclosed rape, as well as rape as a form

of torture, has been missed in migration authorities’ case law (Butchart et al. 2004,

Karin Johansson Blight, 2014b, 2014e). This demands the health field’s attention.

4 ‘These are the ICD diagnoses F32.3A, a sub-group of the ICD F32.3 that includes ‘Severe psychomotor retardation or a state of stupor of a severe grade’; and Z65.8A, ‘Problems in connection with refugees and those seeking asylum’. The latter is a subgroup of Z65.8W, ‘Other specific problems connected to psychosocial condition’ (Johansson Blight et al. 2014: 309).


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IMPLICATIONS AND FURTHER RESEARCH

PUBLIC HEALTH & PUBLIC HEALTH ETHICS, MEDICINE & BIOETHICS

This study provides evidence that there are vast, what is called inequalities and inequities in

health (Wilson, 2011), in Sweden, which raises concerns about state obligations towards

rejected asylum seekers and vulnerable persons5. This research also suggests that there is a

conflict in values between legitimate interests in harm prevention and in immigration control.

There appears to be a decline in human rights values and disengagement in the asylum

system. The research presented here indicates the presence of nationalistic, institutionalised

prejudice and racism that seems to be encouraged by far right driven ideologies, and which is

likely to impact on matters of cost and, probably, control and the use of technology. This

supports Cohen’s (2006) notion that immigration controls are inherently harmful and unfair.

Pre-requisites for a humane process (response to research question 4): There are limits to

the scope of what can be seen as acceptable national sovereignty (Johri et al. 2012). In

today’s globalised world, nations need to facilitate protection for people in need without

discrimination or selection depending of the receiving Nation State’s perceived needs or

ambitions (economic, cultural, etc.). In order to protect vulnerable people this means that

practice needs to abide by the social contracts agreed through national and international law,

public health, bioethics and human rights. On the basis of the research presented in this

report, I suggest that Sweden should a) review its adherence to principles of ethics (public

health-, medical- and bioethics), human rights and social justice in migration b) review its

work on health inequalities and equities, and on social justice to include forced migrant

populations (including rejected asylum seekers and undocumented migrants), c) review the

granting of protection for political reasons, d) recognise that rape is also a form of torture, e)

consider general grounds for residency for asylum seekers from countries where many

civilians are persecuted, such as Eritrea6, Armenia and Kazakhstan7, and finally, f) recognise

that asylum seekers, refugees, and other forced migrants can also be victims of trafficking8

and rejected vulnerable persons are at a greater risk of becoming victims of trafficking.

5 ‘Vulnerable persons’: includes ‘unaccompanied minors, disabled people, single parents with minor children and ‘persons who have been subjected to torture, rape or other serious forms of psychological, physical or sexual violence’ (Council Directive, 2003: 1). 6 Since May 2013 forced returns to Eritrea from Sweden have been temporarily stopped and in September 2014 the First Secretary of the Eritrean embassy was asked to leave Sweden within 48 hours and is believed to be involved in refugee espionage in Nordic countries (Makar, 2013, TT et al. 2014). 7 Johansson Blight et al. 2012, Mèdecins du Monde Sweden’s Human Rights Group, 2013, 2014. 8 ‘Trafficking’ refers to a relationship that involves forms of power abuse for the purpose of exploitation (see Hathaway, 2005:404). Sweden ratified the Protocol to Prevent, Suppress and Punish Trafficking in Persons especially Women and


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System and process: Describe, explore, analyse, explain and/or evaluate…

… protection for vulnerable migrants. This can be done by focusing on social

protection, transparency, accountability, non-discrimination9 in the migration system

and asylum process including the legal system and case law.

.. the discourse on ‘threats’ in migration policy and in case law. This can be done

using public health ethics and violence prevention frameworks (Martin, 2009).

… immigration control measures such as speedy decisions, detention and deportation,

… the commonly applied cost perspective in migration policy in Sweden and

internationally (Fekete, 2001). Johansson Blight and Johanson (2014) explore

migration management in relation to ‘New Public Management’ (NPM) as this appear

applicable to the system description. NPM in this setting should be further researched.

… how well-founded fear is assessed as well as the use of safe countries (as a

‘nudge’) and its impact on decisions on asylum, protection and health.

… the IT and digitalisation of migration and the use of biometrics.

… and assess the moral value of present migration policy and practice and its

compatibility with existing social contracts in health and public health practice,

bioethics, public health ethics, medical ethics.

… institutional prejudice and racism, and the extent of prejudice and racial bias

directed against individuals or groups in decision making. This needs to be explored

and practice aligned with national and international law.

… adherence to basic principles of bioethics. This includes for example non-

maleficence, which also needs to be ensured amongst migration authorities’

commissioned medical doctors. Guidance and certificates for medical certification in

the asylum process ought to be placed under the health authority rather than other

authorities such as the migration authority, as presently in Sweden.

… the discourse in migration policy and case law that seems to suggest that some

asylum seekers are applying for asylum and protection out of a ‘desire’ to reside in

the country rather than a ‘need’ for protection. This should be further researched.

Work also needs to be done to improve institutions’ trust towards the forced migrants

they are paid to case work.

Children, supplementing the United Nations Convention against Transnational Organizational Crime, 1 July 2004 (UN, 2009) (Available online at: treaties.un.org/ 9 In terms of ethnicity, gender, nationality, and other statues.


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Health outcomes: Describe, explore, analyse, explain and/or evaluate:

… the relationship between traumatising life events, cumulative stressors, serious

distress and fear in rejected asylum seeking populations (by gender, age, and co-

morbidity).

… the relationship between suicide and PAWS.

… migration management, immigration control, the asylum system and process

(including the legal system) and the impact on the health (morbidity, disability,

mortality), humanity and human dignity of forced migrants. Public health and health

professionals ought to critically appraise and systematically research the health impact

of this system and its control mechanism on asylum seeking and other forced migrant

populations for example by applying Human Rights Impact Assessments (Mann et al.

1999, Gruskin et al. 1999, Hunt, 2006, Marmot, 2013, Johansson Blight et al. 2014).

Public health/ medical research (academic/scientific) funding ought to be made

available for this purpose (in Sweden and elsewhere).

… health exposures in migrant populations systematically (this includes pre-, during-,

and post migration experiences of rape and violence, torture and other forms of

human rights abuse) and compare this with how well migration authorities and other

societal actors are meeting rights and expressed and unexpressed health needs. Public

health, health and medical professionals can approach this from a range of public

health ethics perspectives (Dawson and Verweij, 2009, Goldberg, 2009).

… the public health burden of immigration control (specifically amongst persons

rejected asylum and protection and vulnerable groups), using group level health

outcomes including on suicide, PAWS, and cost measures such as DALYS or EQ-5D,

or other evaluation measures (Anand et al. 2006).

… health outcomes in various sub-groups including vulnerable persons (for example

exploring the presence of PAWS amongst unaccompanied minors and/or family

separation and severe distress in the asylum process) and across the migration process

journey (BenEzer, 2006).

… migrant health outcomes ought to be included in the general population health

accounts (including mortality, morbidity, impairment and disability) to enable

monitoring and ensure that migrants are treated with dignity, humanity and respect by

state authorities or commissioned private sector actors.


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Appendix 1 Project Plan (Part 1) 28 July 2011: THREE WORDS- Acute Humanitarian Need

Research Proposal- Summary (English)11

Reference: Johansson Blight, K. (2011). Project Plan Part 1: ‘Three Words- Acute

Humanitarian Need’. Research Proposal. 28 July.

“The present project is set within the fields of public health ethics and migration. There is an

international interest to evolve the knowledge base in particular in relation to forced migration, as

knowledge often becomes fragmented or lost in the process of acceptance or rejection. Research

evidence in transcultural/cultural psychiatry and psychology indicates that health and mental health is

dependent on e.g. cumulative experiences from before migration to after resettlement. The present

system poses particular challenges to forced migrants, in part linked to the administrative

categorisations of status linked to the right to stay. The focus is on public mental health and structural

impacts on this; 1) to improve mental/health for children and adults who are ill, 2) to understand

processes such as how the reception system can allow for a treatment of people (children and adults),

which is very different from how citizens, are treated, despite signs of poor health and expressed

needs of protection. The hypotheses [assumptions]: The present system poses risks of a) emotional

minimisation, b) processes of dehumanisation, which contributes to i) poor public mental health and

ii) compromises ethics (e.g. moral disengagement) and human rights. Overarching aims Project Part

1: 1) To critically explore the health, social and legal reality of treatment and outcomes for children

and their families in Sweden; a) specifically, identify what is needed in practice for residency to be

granted on the basis of ‘acute humanitarian need’ and, b) in particular for children with symptoms /

diagnoses of pervasive refusal syndrome [the revised term used is: Pervasive Arousal Withdrawal

Syndrome, ‘PAWS’, or ‘apathy’]. 2) To use the information in aim 1) to apply ethical and

philosophical reflection to understand processes of emotional minimisation and dehumanisation.

Research questions: How can the migration management processes be described and understood using

a public health ethics approach; a) what are the must haves for a humane reception, b) in what ways

can the system be said to contribute to emotional minimisation and dehumanisation, c) [Outside of

public health ethics] are there principles/rules that can be applied to enhance understanding and better

promote public health? Methods: To explore narrative information gathered over a six months period.

The information will be presented as cases and analysed through focus group interviews with experts

in the field. The narrative information will be collected through a voluntary organisation working with

human rights and health in relation to forced migration. The information will be supplemented by

legal and expert statements as well as information produced by the Swedish Migration Board.” (2)

Larger revisions made to the original study plan above12: Overarching project aims: Whilst the study has critically explored the health, social and legal reality of treatment and

outcomes primarily for children who have developed PAWS and their families in Sweden,

the aim to “a) identify what is needed in practice for residency to be granted on the basis of

‘acute humanitarian need’” has not specifically been approached in the way it was put in the

original project plan. Methods: Narrative information has been gathered on an on-going basis

throughout these years (since July 2011). Cases has been selected in dialogue with human

rights advocates and medical experts in the field using snowball sampling as well as an action

research approach (Greenwood and Levin, 2003). The information has been presented

through case summaries, case studies and group level frequencies.

11 Some minor proof-reading changes have been made to this text. 12 This study, since July 2011, has not included a retrospective follow-up of children with PAWS. Moreover, whilst I have reflected on the construct of dehumanisation and the process of such, I have not explored the construct of ‘humanity’. This study has not used focus groups as originally outlined, instead to enhance quality, expert opinions have been sought in relation to all articles/chapters prior to submission for peer or editorial review.


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Appendix 2 Background- From Project Plan (Part 1) 28 July 2011

Appendix 2 contains some up-dates/revisions from the original in July 2011.

Introduction

Part 1 of the proposed research aims to contribute with understandings that can be used to

prevent suffering and strengthen public mental health in the population of forced migrants in

Sweden. It is a collaborative project between legal advice and health care service for rejected

asylum seekers and other migrants. The pilot project specifically concern children who are

categorised as having Pervasive Arousal Withdrawal Syndrome (PAWS) (Bodegård, 2013) or

symptoms and/or signs thereof. It is important to acknowledge that the situation for children

within the Swedish asylum seeking and refugee reception system is highly political. In the

Swedish debate forced migrant children have, arguably, been used in political discourse, and

in action to promote more restrictive and controlled migration. The reality is that children

who are clearly displaying symptoms of severe distress are being deported or are under

consideration for deportation back to places the children themselves or their families have

alleged to have been forced to leave. It is clear that there are children and families in the

Swedish system of migration management who are suffering hugely. There are children

living with symptoms of poor mental/health, which if encountered in the general population

would likely be treated as alarming, needing medical attention and care.

With this socio-political reality in mind, scientific medical research provides a forum

for critical scrutiny and reflection to prevent illness and promote mental/health. To explore

this, relevant research questions include for example: what is the reasoning behind decisions

to reject permission to stay? How can this reasoning be understood; are there trends around

decisions that can be noted? There should be a possibility to grant permission to stay on the

basis of ‘acute humanitarian need’; what are the arguments for this not applying to children

with pervasive refusal syndrome or symptoms of pervasive refusal syndrome? What is seen

as relevant to the safeguarding of children’s mental/health? Moreover, in line with the aim in

the proposed main study, which is to apply ethical and philosophical reflection to understand

processes of emotional minimisation and dehumanisation, a) how can the migration

management processes be described and understood using a public health ethics approach; b)

are these processes abiding by specific ethical principles /rules? C) [Outside of public health

ethics] are there principles/rules that can be applied to enhance understanding and better

promote public health?

The project is carried out step-wise, and whilst resting on a predominantly qualitative

paradigm there is an awareness that quantitative approaches that abide to principles of public

health ethics and bioethics, would also be scientifically possible: a mixed methods approach

would be good. Nevertheless, a scientific requirement linked to qualitative methods is that

pre-notions need to be made explicit. One important pre-notion in this study is that no child

deserves the suffering many forced migrant children in Sweden are presently enduring.


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Migration: Forced Migration

There are different types of migration. Internal migration commonly refers to migration

within a country’s border and concerns for example the urbanisation of the world’s

population. International migration on the other hand refers to migration across international

borders, and this is what the present project plan concerns. An international migrant has been

defined by the United Nations (UN) Recommendations on Statistics of International

Migration as ‘… any person who changes his or her country of usual residence’ (UN,

2009:1).

International migration can be either voluntary or forced. Whilst acknowledging overlaps,

voluntary migration can be said to refer to labour market migration and family reunion.

Forced migrants, who the present project plan concern, have commonly been affected by,

what Forced Migration Online (FMO) describes as armed conflict including civil war,

generalized violence, or persecution on the grounds of nationality, race, religion, political

opinion or social group and have for these reasons been forced to leave their homes. In

addition to this, state authorities are unwilling or unable to protect them and thus, asylum and

protection are sought in other countries. According to the United Nations High Commissioner

for Refugees (UNHCR), refugee status is a common form of protection in for example

Germany and France, and in these countries subsidiary protection status is a complement to

refugee status. However, the opposite applies for example in Sweden (UNHCR, 2007); where

humanitarian reasons are more common than (non-Quota refugee) protection status

(European Council on Refugees and Exiles, 2004). This means that a first time asylum

applicant would potentially be granted refugee status in one EU country but not another,

purely on the basis that the level of acceptance rates in relation to different categories

available for forced migrants differ between countries. Moreover, a large proportion of

people who have migrated due to conflicts, violence and/or persecution, will include asylum

seekers under international law. People who are displaced from their country of living due to

conflicts, violence and/or persecution may however also become anonymous migrants for

fear of being rejected asylum and protection, and of return (FMO, 2011). In some cases,

people in this situation may also for this or other reasons, including other involuntary reasons

turn to smuggling and trafficking operations to be able to avoid immigration controls (ibid.).

The current state of managed migration: context description

This section intends to briefly describe the context forced migrants within the EU and on

entrance to EU face. The Swedish reception system is part of the overall European Strategy to

manage migration, an organised effort which has grown in force since the 1990s. The

emphasis is on border control and security, and presently there is substantial amount of

money and efforts put into managing migration, primarily at the borders. The gradual

increase in border control and security in migration management has in part been motivated

by economic arguments such as: ‘[c]loser cooperation and integrated policies can help

countries to protect their borders without obstructing the economic development and

international trade that can enable the effective management of international migration’

(Martin and Widgren, 2002: 36). A driving organisation for migration management within the

EU is the intelligence-driven, autonomous, agency called ‘Frontex’.


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That is, the European Agency for the Management of Operational Cooperation at the External

Borders of the Member States of the European Union (European Commission, 2004).

Frontext was established on 26 October 2004, has its own financial regulation and works

closely with the International Organisation for Migration (IOM), the UNHCR and the

International Centre for Migration Policy Development (ICMPD), Europol, Interpol and

United Nations Office on Drugs and Crime (UNODC) (European Commission, 2006,

Frontex, 2010, Frontex 2014a). Frontex’s management board consists of representatives of

the heads of the EU member states’ border agencies that are signatories to the Schengen

agreement as well as Iceland, Norway and Switzerland (Frontex, 2010). Frontex promotes,

coordinates and develops European border management to enhance external border security

and to coordinate operational cooperation (Frontex, 2010, 2014b). The core activity is

operational to “…reinforce and streamline cooperation between Europe’s border-control

players”, promoting a “pan-European model of Integrated Border Management” (Frontex,

2014c). A main task is to assist in the co-ordination of return flights in cases of forced return,

and to coordinate operational cooperation between Member States at the EU external land,

sea and air level (Frontex, 2010). Frontex staff are employed on temporary contracts as

“Temporary and Contract Agents”, and “Seconded National Experts” the latter refers to

‘national or international civil servants or persons employed in the private sector…’ (Frontex,

2014d: 1). Frontex also manage a pooled resource consisting of between 600 officers ‘Rapid

Border Intervention Teams’ (‘RABIT’) from various member states, undertaking, for

example, surveillance and interviewing undocumented persons. The officers are

technologically equipped, and have access to aircrafts, boats, heartbeat detectors, and dogs

(Jones, 2014). RABIT team members are also entitled to carry weapons and ammunition,

across borders, that are permitted for use in self-defence or to defend another person

(European Commission, 2007).

Further developments within the managed migration framework, now include deportation of

unaccompanied minors to government funded ‘reception houses’ in countries at war (Ecpat,

2010, Hammarberg, 2010). On the 22 April 2010 a position paper was published by the

Defence for Children-ECPAT the Netherlands and UNICEF-the Netherlands. The documents

refer to the fact that since 2005 the Dutch government finances reception houses, also often

named ‘orphanages’, in Angola and Congo for the return of separated children to their

country of origin.

Another reception house was started in Sierra Leone in 2009, and as further stated in the

report; Norway, Denmark, the UK and Sweden fund houses in countries of origin or are

planning to. As highlighted in the position paper requests for asylum are being refused

(Ecpat, 2010), on the grounds that there is a safe and adequate place for return in their

countries of origin. Nevertheless, this is not without problems and questions interpretations of

safety and protection, as pointed out in the report:

‘[t]here are certainly cases where it would be best for the child to go back to the home

environment, especially if there exists a caring family context. However, we should be aware

that minors who have migrated in many cases have done this with the support of their

families, who wanted them to escape from hardship and severe risks’ (Hammarberg, 2010:1).


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Migration management and mental health

If interested in the health of vulnerable people and populations, the processes of migration

management raise several concerns. For example, it seems that there has been a gradual

introduction of mechanisms that make claiming asylum difficult and puts migrants,

particularly those judged to be ‘… undeserving of the protection and welfare provision of EU

states’ (Watters, 2007: 397) at high risk of social exclusion and many of the deterrence

policies pose a risk to mental health (Silove et al. 2000, Kinzie, 2006, Johansson Blight

2009). It is arguably the case that much of the migration management system has been

designed to keep unwanted migrants out of western countries, and what this contribute to

(and constitute) are conditions that, as they would in general populations, pose threats to

mental health (social determinants such as discrimination and racism, housing problems,

unemployment, and limited health care access) (Johansson Blight, 2009).

As highlighted in Johansson Blight (2009) a particular concern is the practice of ‘speedily

denying refugee status’, which within the EU has been argued to be the rule rather than the

exception (Oakley, 2007). The concerns are that this practice compromise fairness in the

asylum procedure due to difficulties in assembling supporting documentations to asylum

applications, and this may have particularly negative effects on vulnerable people including

torture victims and persons with mental disorder (ibid.), other persons with mental health

problems, and children. Moreover, as has been shown in reviewed health research, there are

additional mental health threats relating to detention, temporary visa protection, and also long

asylum periods, etc. (see for example Johansson Blight, 2009, Dudley et al. 2012).

It is important to acknowledge that it is under these restricted conditions that people have to

cope and live, with the concurrent effects of war experiences, forced migration, a life in

uncertainty, family separation, concern for the family in the home country, fear of

deportation, etc. Mental disorder development in forced migrant populations can be explained

as relating to a) individual factors (such as age at the time of stress exposure) as well as b) the

type of event (for example a particularly strong association has been found between torture

and post-traumatic stress, and high levels of pre-migration trauma have been found to

increase the risk of long-term chronic psychiatric disability) and c) the social environment-

i.e. the exposure to stressors in the pre-migration-, migration- and, importantly, also the post-

migration environment (the country in which the person settles) (Johansson Blight, 2009,

Harvey, 1996). Theoretically the development of poor mental health can be derived by

cumulating stress exposures across the migration phases (i.e. pre-, during, and post-

migration). In other words, the post-migration environment can pose threats to mental health,

and can also add to previous traumatic experience. The social conditions are hence important

to mental/health for all people residing within the nation borders. However, while it is not

possible to change the past, what can be done is to understand how the social environment

can minimise risks of increased stress on already pressured individuals and instead provide

opportunities for improving public mental health and prevent disorder development. To do

so, stressful socio-environmental exposures firstly need to be known and to some extent

understood, and the relationship and impact on mental health outcomes need to be

acknowledged.


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Appendix 3 Summary of Answers to Research Questions 1-3

1) How can the asylum process, migration management and immigration control be

described and understood using a public health ethics approach? Some suggestions:

Justice, health and human rights (in Johansson Blight, 2014a)

I have used a framework that allows for a flexible account of justice (Wilson, 2009).

Including Mann’s (1997) paradigm, which proposes that the practice of medicine and

public health, bioethics and human rights ought to work together for health.

Law, bioethics and public health ethics (in Johansson Blight, 2014a, 2014b, 2014d)

Bioethics is of upmost importance in the asylum process (Söndergaard, 2005,

Bodegård, 2013, see also Ashcroft, 2005). How institutions are supported and work is

important to public health (Peter, 2004, Wilson 2009). I have focused on structural

determinants (legal and policy factors) (McDavid Harrison and Dean, 2011).

Violence exposure and cumulative stress (in Johansson Blight, 2014a, 2014b, 2014e)

Disadvantages (and advantages) in health and determinants, accumulate over the life

course; exposures to potentially traumatising life events and high levels of stress, over

time, can develop into severe poor mental health distress/reactions (Söndergaard et al.

2012, Marmot et al. 2012, Dudley et al. 2012, Bodgeård, 2013, Ascher and Hjern,

2014). I have referred to Petrini and Gainotti’s (2008) ‘personalistic’ approach that

focuses on the being and dignity of forced migrants in the migration system and

Butchart et al (2004) in relation to violence exposure in asylum narratives.

System actors’ relationship (in Johansson Blight, 2014a, 2014b, 2014c, 2014d)

Research theory and methods to do with public health ethics, mental health and social

exclusion have highlighted a need to focus on relationships (Bhui, 2002, Pogge, 2004,

Dawson, 2009, 2010, 2011, Herlihy and Turner 2009, Bhugra et al. 2010). In this

research, the focus is on relationships between different groups, categorisations and

group divisions (Bhugra and Bhui, 2002, Dawson, 2009).

Social determinants and exclusion (in Johansson Blight, 2014b, Johansson Blight et

al. 2014). I have used intersectional analysis that includes ethnicity, race and gender.

In line with social epidemiology, I have approached the asylum process as a process

of exclusion, and the legal system as a social determinant of health that matters to

social justice (Shaw et al, 1999, Krieger, 2000, Oakes and Kaufman, 2006, Kamali,

2009, Grewcock, 2009, Bhui, 2009, Venkatapuram and Marmot, 2009).


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Economic reasoning (in Johansson Blight and Johanson, 2014)

Economic reasoning in migration policy and case law has been explored to better

understand the mechanisms behind how persons may be excluded throughout the

process, to inform the assessment of justice in the asylum process and in its

institutions (Sen, 2004, Peter, 2004, Marmot et al. 2012). For this purpose we referred

to Fuchs (1998) who argues that economic analysis can provide some information

about the consequences of distributions but cannot on its own determine how basic

values are formed or inform choices for people.

System and process values (in Johansson Blight, 2014a, 2014b, 2014c, 2014d)

In terms of understanding system and process values I have for example referred to

Buchanan (2000). I have also used value theory (Schroeder, 2012) to explore ‘subject

matters in migration policy and case law. Further, to gain an insight into systematic

discriminatory action and abuse (Krieger, 2000, Kamali, 2001), institutional prejudice

and racism are considered ideological problems (Bhui, 2002, McKenzie, 2002).

Rather than a dichotomous positioning of ‘social conditions that cause disease and

targeted interventions’ (Goldberg 2009:76) to improve public health, the research

undertaken here has been conducted with a notion that the values driving systems and

processes will impact on what is considered a ‘threat’ to public health and decisions

on who, how and why individuals and/or groups are targeted.

2) In what ways can the system [asylum process/migration management/immigration

control] be said to contribute to emotional minimisation and dehumanisation? Some

findings:

The research findings also indicate that there is a conflict in values between migration

authorities practice and health care outside this system. Where, migrants are treated in

a way that in the general population would be considered risky or harmful to health.

I have found indications of serious flaws in the assessments of asylum and protection

that conflicts with principles agreed through international law, human rights

conventions, justice and social justice (Johansson Blight, 2014b, 2014e). Findings

suggest that in the assessment of asylum applications, political persecution, rape as

torture, well-founded fear and severe and cumulative stress have been left largely

unexplored. This seems to have contributed to rejections of protection.


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I have found that interpretations of health in migration policy, the expectations of

Commissioned Medical Doctors, and the focus on “objective” measures that are not

always readily applicable to the illness state, and where requests are made for

quantitative evidence (weights, dates, etc.), as this is viewed as enhancing credibility,

seem to contribute to discrimination, disengagement and dehumanisation (Johansson

Blight, 2014a, 2014d). However, in the legal process it is the content of information

that should have priority, and not the form (Johansson Blight, 2014b).

Further, if such vital information is missed in the application of case law this may be

described as epistemic kinds of injustices (Carel and Györffy, 2014). Two forms of

which are testimonial injustice that is, when ‘prejudice causes a hearer to unfairly

assign a lower level of credibility to a speaker’s testimony or report. This can be done

by doubting, ignoring, or failing to take someone’s testimony seriously until it is

corroborated by another’ (Carel and Györffy 2014: 1256). Or hermeneutical injustice,

‘which occurs when a gap in collective interpretative resources puts a speaker at a

disadvantage. This injustice occurs when society as a whole lacks an interpretative

framework to understand particular experiences’ (ibid.). This can also contribute to

secondary traumatisation, create an unjust process, and introduce wider social

injustice (Johansson Blight, 2014b, 2014d).

What counts as credible evidence of health and persecution in the process is likely to

influence budgeting through the decision makers’ decisions. Caution needs to be

applied to the potential presence of institutionalised perceptions of economic reasons.

Further, a substantial proportion of the aid budget is spent on the administration of

migration management within Sweden (Johansson Blight and Johanson, 2014); part of

which seems to be to budget for technology for immigration control, speedy decisions

and deportations. However, to cost deportations through the aid budget is a paradox as

the latter is there to improve the conditions for poor people.

The findings in this research (Johansson Blight, 2014a, 2014d, Johansson Blight and

Johanson, 2014) raise the concern that the original harm prevention perspective

becomes secondary to the control of immigration. The present research also finds

supports to Cohen’s (2006) notion of the existence of a racism of controls. A key

concern is whether immigration control per se is inherently harmful and/or

intrinsically unfair, thus discrediting the very idea of immigration control as a

legitimate state interest. These concerns need further research and discussion.


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3) [Outside of public health ethics] are there principles/rules that can be applied to

enhance understanding and better promote public health? Some suggestions:

Law and ‘soft law’: The main legal references I have used in this research since July

2011 are: i) Foley, C. (2003) ‘Combating Torture. A Manual for Judges and

Prosecutors’. Human Rights Centre, University of Essex, Foreign and Commonwealth

Office, Great Britain; ii) Hathaway, J. (2005); iii) United Nation Treaty Collection, at:

treaties.un.org/; iv) United Nation District General Reports, and v) European

Commission’s Council Directives on asylum reception, anti-trafficking measures, and

vulnerable groups. These legal frameworks can be used in combination with a public

health framework that is interlinked with social justice and care for vulnerable groups.

Human Rights Conventions: United Nation conventions that I have referred to, or

that are applicable to, this research includes for example (for signatures and

ratifications see United Nations (UN) Treaty Collection, available at:

https://treaties.un.org): UN Convention against Torture and Other Cruel, Inhuman or

Degrading Treatment or Punishment (1984). This Convention is useful to refer to

when exploring aspects of rape and in families who have sought asylum and

protection and who have children with symptoms of PAWS. This includes Article 1

and 14 (the right to rehabilitation as part of redress) (Sveaass, 2013); UN Convention

relating to the Status of Refugees (1951) and related protocols and conventions

concerning Refugees and Stateless Persons (UN, 2006); UN Convention on the Rights

of the Child (1989); UN Convention on the Rights of Persons with Disabilities

(2006); UN Universal Declaration of Human Rights (1948); UN International

Covenant on Civil and Political Rights (1966); UN International Convention on the

Elimination of All Forms of Racial Discrimination (1966), and Human Security such

as the UN Convention against Transnational Organized Crime (2000) (UN, 2006).

Bioethics: There are many bioethical principles that are useful when researching the

health and public health implications of the asylum system and process. These include

the Hippocratic Oath (Miles, 2004). As well as, for example, WMA International

Code of Medical Ethics, WMA Declaration of Lisbon on the Rights of the Patient and

the WMA Declaration of Geneva Right of everyone to the enjoyment of the highest

attainable standard of physical and mental health (Right to Health) (available at:

http://www.wma.net/). As well as guidance promoted at national level (for Sweden

see for example Engström, 2010).

http://www.wma.net/


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Appendix 4 Research Articles and Book Chapters Subject to Peer/Editorial Review

Author/s Title Methods/Empirical Info.

Content Publication info.

1. Johansson Blight, K.

‘Can Asylum Seeking Be ‘Managed’ Ethically?’ Book chapter

Literature review News report Case description of a deportation of a child with Pervasive Arousal Withdrawal Syndrome (PAWS).

The chapter raises questions aimed at public health ethics, asylum and protection. It outlines, in brief, migration management in Sweden and health assessments.

In: Barrett, D., Bolan, G., Dawson, A., Ortmann, L., Reis, A., Saenz, C. (Eds.). Global Perspectives on Public Health Ethics: A Casebook. Springer Publisher. Accepted; forthcoming 2015.

2. Johansson Blight, K., D’Orazio, A., Hultcrantz, E., Søndergaard, H.P.

‘The Role of the Health Care Services in the Asylum Process’ Book chapter

Literature review Case file evidence 24 families’ decisions (30 children with PAWS) Clinical experiences

The chapter prompts reflection on matters to do with health care services’ role in relation to the asylum process. It describes in brief, PAWS, discusses treatment, and suggests that the legal system in the asylum process is a social determinant of health.

In: Overland, G., Guribye E., Lie, B. (Eds). Traumatised Refugees in the Nordic Countries' Cambridge Scholars Publishing. ISBN (13): 978-1-4438-6136-6. Published.


‘Questioning Fairness in Swedish Asylum Decisions’ Article

Literature review Case file evidence 58 case file decisions (for 24 families with 30 children with PAWS) 3 in-depth case studies.

The article focuses on the way the asylum process is administered through case law and in relation to migration policy. It includes an outline of the impact of asylum assessments on mental health and social exclusion.

State Crime, Pluto journals. Accepted for publication 25 February 2014. Anticipated publication spring 2015, and online in 2014.


‘Medical Doctors Commissioned by Institutions that Regulate and Control Migration in Sweden: Implications for Public Health Ethics, Policy and Practice’ Article

Literature review News reports Case file evidence 1 decision and two medical certificates. A precedence court decision concerning 1 person’s decision.

Questions raised in the article concern how the Commissioned Medical Officers’ decision making is undertaken and the effect on public health in terms of professional tensions, politicisation of medical constructs and moral disengagement.

Public Health Ethics. Advance Access published 08082014, doi:10.1093/phe/phu020 Oxford Journals. Published.

5. Johansson Blight, K., Johanson, U.

‘The Use of Economic Arguments in the Asylum Process’ Article

Literature review Case file evidence 3 families’ decisions.

This article gives some insight into how economy may influence decision making with regards to asylum and protection for vulnerable persons. As well as the amalgamation of Swedish foreign aid with Swedish domestic expenditure relating to the asylum process and migration management.

Public Health Ethics Submitted 13/07/2014. Under review.


‘Prevalent values and ideologies in contemporary Swedish migration policy- the impact on and recognition of vulnerable groups’ Article

Literature review Asylum interview document for 1 person. A precedence court decision concerning 1 person’s decision. A European Court of Human Rights deliberation concerning 1 person.

This article discusses values and ideologies in migration by exploring and discussing the implementation of the system and process and its legitimacy. Value theory is used to analyse subject matter used in migration policy and case law, which appears to polarise.

Public Health Ethics Submitted 26/09/2014. Under review.


‘Rejected Asylum Seeker But in Need of Protection’ Article

Literature review Case file evidence 1 person’s asylum interview and decisions.

In this article rape as torture and well-founded fear is specifically discussed. The legal documents refer to a woman from Eritrea. Reference is made to a violence prevention perspective.

Due submission for peer-review.


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Appendix 5 List of Published & Unpublished Work since the Project Plan in July 2011

Peer reviewed articles Published

1. Johansson Blight, K. ‘Medical Doctors Commissioned by Institutions that Regulate and Control

Migration in Sweden: Implications for Public Health Ethics, Policy and Practice’ (part of Special

Issue Guest Editor: Laura Bisaillon, PhD, on “Health Providers Working for the State: Investigations

into the Politics of Practice and the Contradictions for People, Policy and Providing Care”).

Public Health Ethics. Publisher: Oxford Journals. Advance Access published 08082014,

doi:10.1093/phe/phu020. Available at: http://phe.oxfordjournals.org/content/early/recent

2. Johansson Blight, K. (2014) ‘Questioning fairness in Swedish asylum decisions’. State Crime

Journal. Publisher: Pluto journals. Early version online via the State Crime Initiative’s

(http://statecrime.org/) website, at: http://statecrime.org/journal_article/karin_johansson_blight/

Under Review/Due submission

3. Johansson Blight, K., Johanson, U. ‘The Use of Economic Arguments in the Asylum Process’.

Public Health Ethics. Under review.

4. Johansson Blight, K. ‘Prevalent values and ideologies in contemporary Swedish migration policy-

the impact on and recognition of vulnerable groups’. Public Health Ethics. Submitted.

5. Johansson Blight, K. ‘Rejected Asylum Seeker in Need of Protection’. International Journal of

Refugee Law. Due submission.

Book Chapters Published

6. Johansson Blight, K., D’Orazio, A., Hultcrantz, E., Søndergaard, H-P. (2014). ‘The role of the

health care services in the asylum process’. In ‘Traumatised Refugees in the Nordic Countries' eds. G.

Overland, E. Guribye and B. Lie. Publisher: Cambridge Scholars Publishing. ISBN (13): 978-1-4438-

6136-6. Available at: http://www.cambridgescholars.com/nordic-work-with-traumatised-refugees

Accepted

7. Johansson Blight, K. ‘Can Asylum Seeking Be ‘Managed’ Ethically?’, Case Topic–Public Health,

Migration Management and Forced Migration, Protection of Vulnerable and Marginalized Groups.

Accepted for publication in: Global Perspectives on Public Health Ethics: A Casebook. Editors:

Barrett, D., Bolan, G., Dawson, A., Ortmann, L., Reis, A., Saenz, C. Publisher: Springer Publisher.

Forthcoming 2015.

http://phe.oxfordjournals.org/content/early/recent

http://www.cambridgescholars.com/nordic-work-with-traumatised-refugees


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Newspaper articles Published

8. Spira, H., Dorazio, A., Johansson Blight, K., Hultcrantz, E. Nylund, B., Rosendahl, K.

(2012). ‘Asylpolitik som skadar tilliten’ (Asylum politics that harms trust). Upsala Nya

Tidning. 27 December. Debate article in Swedish published in the Swedish morning newspaper,

Uppsala Nya Tidning. The article concerns Sweden's suggestion on visa restrictions for the

Balkan region and highlights the dissonance in today's asylum politics. Available at:

http://www.unt.se/debatt/asylpolitik-som-skadar-tilliten-2027091.aspx

Reports Published

9. Johansson Blight, K., Dorazio, A., Wilks, E. Hultcrantz E (2012). ‘Children without a voice. Report

on children with symptoms of severe depressive devitalisation who have been refused asylum and

protection in Sweden’. January 2012. Etikkommissionen i Sverige. The report was presented to the

Swedish Government in a Government committee hearing 1 December 2011 and submitted for

example as evidence to Tribunal 12, 12 May 2012 (http://tribunal12.org/).

10. Johansson Blight, K. (2012). ‘Comments to the Swedish Migration Board report on their survey of

children with depressive devitalisation from March 2011’. (Kommentarer till Migrationsverkets

rapport ‘Kartläggning av barn med uppgivenhetssymtom’ från mars 2011). Etikkommissionen i

Sverige.

Unpublished13

11. Johansson Blight, K. et al. (2013). Angående Migrationsverkets “Utlåtande från läkare vid

prövning av hälsotillstånd i ärenden om uppehållstillstånd eller verkställighetshinder” (About the

Swedish Migration Board’s ‘Statement from medical doctors’ assessment of health status in decisions

on residence permit or impediments to enforcements”). Submitted to the National Board of Health and

Welfare, Dnr 3851/2013.

12. Johansson Blight, K. (2013). Barnen utan röst. Etiska reflektioner och ställningstaganden gällande

datainsamling till sammanställningen om barn med uppgivenhetssymtom genom utdrag ur domar,

beslut och intyg samt enkäten ‘Enkät rörande apatiska/ devataliserade barnfamiljer med

avvisningsbeslut (A-enkäten) (Ethical reflections and decisions relating to the data collection of

empirical data compiled in the report ‘Children without a voice’), 20 September. In Swedish.

13 Unpublished documents are available on: http://independent.academia.edu/KarinJohanssonBlight or by contacting me directly via email: [email protected].

http://tribunal12.org/

http://independent.academia.edu/KarinJohanssonBlight


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13. Johansson Blight, K. (2013). ‘Discourse analysis of the newspaper interview with Migration

Minister Tobias Billström’ in Orrenius, N. De flesta bor inte hos de som är blonda och blåögda,

Jakten på papperslösa, Dagens Nyheter 17 March 2013. Brief analysis. In English.

14. Johansson Blight, K. (2013) ‘Discourse analysis, 2 December 2013 of Ekeroth, K. (2013) Till

Borzoo Tavakoli från Kent Ekeroth’. Brief analysis. In Swedish.

15. Johansson Blight, K. (2013). ‘Synnerligen Ömmande Omständigheter och Självmordsbenägenhet’

(Exceptionally Distressing Circumstances and Assessment of Suicide Risk). Literature Review and

Opinion on the Feasibility of the Migration Court of Appeal Deliberation MIG 2007:35’s Reasoning

on Suicide Risk. Compiled in response to a request made by a member of the public. 26 February.

16. Johansson Blight, K. (2013). ‘Frågor och svar om barnen i Barnen utan röst och asylprocessen’.

(Questions and answers about the children in Children without a voice and the asylum process).

Unpublished data. Submitted after request to a human rights advocate to be used in preparation to a

radio debate with Swedish migration authorities. 6 March. In Swedish.

17. Johansson Blight, K. (2014). ‘Om aktuellt avslagsbeslut, skrivet av Karin Johansson Blight

14juli2014’ (About the present rejection decision, written by Karin Johansson Blight 14 July 2014).

Comments and questions regarding a rejection decision submitted to lawyer.

Presentations14

18. Johansson Blight, K. presented for Johansson Blight, K. and Søndergaard, HP. (2013). ‘Impaired

function, ethics and social justice: steroid patterns amongst ‘apathetic’ refugee children in Sweden’.

Under theme: Health of Sans Papiers, refugees and asylum seekers: towards a bioethics working

agenda. 27 June 2013. Conference on ‘Migration and Bioethics: The case of undocumented

migrants, refugees and asylum seekers’. 25-28 June 2013. In Brocher Centre, Geneva, Switzerland

19. Johansson Blight, K. et al. (2012). The role of the health care services in the asylum process

[Hälso- och sjukvårdens roll i asylprocessen] at the 18th Nordic Conference for care providers who

work with traumatised refugees, organised by RVTS, Norway.

20. Johansson Blight, K. (2011) presented in a joint presentation ‘Findings from the situational report

‘Children without a voice’ (Barnen utan röst)’ to the Swedish Government. 29 Nov, 2011, A

Government committee hearing about children with depressive devitalisation, Thursday 1 December

2011, at 13.00-16.00, Gamla riksdagshuset Riksgatan 2, (2:a Kammarsalen), Stockholm, Sweden.

14 In addition to this, I have also been part contributing, with expert advice towards University students’ essays: 1 BSc in Social work and 1 MA in law as well as to lawyers and journalists.


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The title of this report: The title is ‘Public Health Ethics, Asylum and Protection’ and the report is a study

summary of the Project Plan ‘Part 1 ‘Acute Humanitarian Need’.

Report author: This report is written by Dr Karin Johansson Blight. Dr Johansson Blight is a Registered General

Nurse (RGN) in Sweden and the United Kingdom (UK). She has a BSc in Nursing (from the Red Cross University

College, Sweden, 1997), an MSc Public Health (from London School of Hygiene and Tropical Medicine, UK,

1999), and a PhD in Psychiatry (from Karolinska Institutet, Sweden, 2009).

Researcher: The report author, Karin Johansson Blight, PhD, has also carried out the research in this report. Dr

Johansson Blight is an Independent Researcher who lives in the United Kingdom. The research undertaken by Dr

Johansson Blight has been undertaken in collaboration with Etikkommissionen i Sverige (the Ethics Commission

Sweden) and other experts in this field. Funding and finance of this research: The research in this report has

been undertaken unfunded. This means that the report author (and researcher) has worked in an unpaid,

voluntary, uncompensated, capacity when conducting this research.

Public Health Ethics, Asylum & Protection (unpublished)

Documents

Transcript of Public Health Ethics, Asylum & Protection (unpublished)