Emergency Care for Women Irregular Migrants Who Arrive in Spain by Small Boat: A Qualitative Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Setting
2.3. Participants
2.4. Data Generation
2.5. Data Analysis
2.6. Ethical Considerations
3. Results
3.1. The Need for Emergency Care Focused on Women Irregular Migrants (WIMs)
3.1.1. WIMs as Objects of Sexual Exploitation
“Upon disembarking, a woman gave us hot chocolate, a sandwich, a shower and dry clothes…after that, they took me to the hospital”.(WIM-5)
“A young WIM wanted to know if she was still a virgin, after they had tried to rape her on the journey”.(KI-5)
“When my brother paid (the trafficking network) they picked me up in a parking lot... when I got in the car I saw two young skinny girls lying in the boot of the car”.(WIM13)
“You arrive feeling tired, sleepy, I couldn’t talk. The sea is terrifying, you are not aware of what is ahead”.(WIM-1)
“They come and rape you for days and when it interests them, they leave you there, bleeding… and you have to carry on with the journey as best as you can”.(WIM-3)
“I wanted to escape and they tied me up to a pole for three days in the sun… they burned chest with boiling water”.(WIM-8)
“A Sub-Saharan woman asked us for a pregnancy test and cried tears of joy upon receiving the negative result. She had been in a car for five days and had been raped by three men”.(KI-9)
“The network decides if they get pregnant and when or if they will have a child. Sometimes they force them to have abortions in advanced pregnancies”.(KI-6)
“They carried out genital mutilation on me when I was 8. When I arrived in Spain they took me to the hospital … Everything was OK”.(WIM-3)
“The trafficking networks use voodoo because Africans have strong beliefs; they tie a rope around their waists and carry a little bag of hair…to protect themselves from ‘juju’”.(KI-5)
“Sometimes I observe fear, and notice WIMs’ submission when they make the journey with a woman who controls the whole group! But we cannot make any mistakes when judging who it is... because she is just another victim of the network herself!”.(KI-3)
“The waves hit the boat and it moved a lot. We were very nervous and some people, (including children) fell in the water and they didn’t know how to swim … Women took the corpses of the children who had drowned, shook them, told them to wake up, cried and shouted …”.(WIM-9)
3.1.2. The Mother-Child Dyad as the Axis in Human Trafficking
“We left the child with the WIM who had brought them, observed how they moved, to whom they got close and whether the WIM consoled them”.(KI-2)
“They asked for my name, nationality, my child’s and my husband’s names … They also asked me about my family several times … They even asked my husband afterwards”.(WIM-11)
“The networks prevent WIMs from feeding their children. They don’t want them to be damaged because they will later be prostituted”(KI-8)
“The woman took the baby, gave it a push and said that is your Mum … and the child said no, mami, no …!”(KI-10)
“My parents want a better life for me. They want me to make the journey to help them … They don’t know how dangerous it is. I don’t want to talk about this!”(WIM-12)
3.2. Developing a Gender Policy for WIMs in Emergency Care
3.2.1. Healthcare in a Police-Controlled Setting: Detecting Weakness
“I wanted to come to Europe for a better life, but they locked us up... we haven’t done anything, why would they do that? We are not criminals”(WIM-6)
“There is no intimacy nor time to ask and listen. In five minutes, they aren’t going to tell you anything! It is very difficult to detect human trafficking in these women”(KI-7)
“Doctor asks, police asks…I couldn’t speak, I was tired, water came into small boat … all night”.(WIM-7)
3.2.2. Promoting Screening and Safety Protocols Focused on WIMs
“The journey was terrible, indescribable … I knew that small boat was a matter of life or death. I left everything in the hands of Allah”.(WIM-6)
“In a cell, they don’t speak Arabic, I don’t know if they will return me to Morocco … we are not criminals!”.(WIM-7)
“We need protocols adapted to WIMs and children. Knowing what to do, when and how, it would give us a safety and a higher guarantee of success”.(KI-1)
“If we take one step, the trafficking networks takes three. First the women are alone, then with children, then pregnant”.(KI-3)
“Who protects my baby? Who protects my family? I will say no more!”.(WIM-4)
4. Discussion
5. Limitations
6. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
- De Vito, E.; de Waure, C.; Specchia, M.L.; Ricciardi, W. Public Health Aspects of Migrant Health: A Review of the Evidence on Health Status for Undocumented Migrants in the European Region; WHO Regional Office for Europe: Copenhagen, Denmark, 2015. [Google Scholar]
- Eonomopoulou, A.; Pavli, A.P.; Stasinopoulou, P.; Giannopoulos, L.A.; Tsiodras, S. Migrant screening: Lessons learned from the migrant holding level at the Greek—Turkish borders. J. Infect. Public Health 2016, 10, 177–184. [Google Scholar] [CrossRef]
- Vu, A.; Adam, A.; Wirtz, A.; Pham, K.; Rubenstein, L.; Glass, N.; Beirer, C.; Singh, S. The prevalence of sexual violence among female refugees in complex humanitarian emergencies: A systematic review and meta-analysis. PLoS Curr. 2014, 18, 6. [Google Scholar] [CrossRef]
- Keygnaert, I.; Guieu, A. What the eye does not see: A critical interpretive synthesis of European Union policies addressing sexual violence in vulnerable migrants. Reprod. Health Matters 2015, 23, 45–55. [Google Scholar] [CrossRef]
- Trovato, A.; Reid, A.; Takarinda, K.C.; Montaldo, C.; Decroo, T.; Owiti, P.; Bongiorno, F.; Di Carlo, S. Dangerous crossing: Demographic and clinical features of rescued sea migrants seen in 2014 at an outpatient clinic at Augusta Harbor, Italy. Confl. Health 2016, 10, 14. [Google Scholar] [CrossRef]
- Kassar, H.; Dourgnon, P. The big crossing: Illegal boat migrants in the Mediterranean. Eur. J. Public Health 2014, 24, 11–15. [Google Scholar] [CrossRef]
- Cusumano, E. Emptying the sea with a spoon? Non-governmental providers of migrants search and rescue in the Mediterranean. Mar. Policy 2017, 75, 91–98. [Google Scholar] [CrossRef] [Green Version]
- United Nations High Commissioner for Refugees (UNHCR). Refugees & Migrants Sea Arrivals in Europe. 2016. Available online: https://data2.unhcr.org/ar/documents/download/49921 (accessed on 21 July 2019).
- Campana, P.; Varese, F. Exploitation in human trafficking and smuggling. Eur. J. Crim. Policy Res. 2016, 22, 89–105. [Google Scholar] [CrossRef]
- Save the Children. Multi-Sector Needs Assessment of Migrants and Refugees in Greece. 2015. Available online: https://resourcecentre.savethechildren.net/sites/default/files/documents/greece_assessment_report.pdf (accessed on 21 July 2018).
- Granero-Molina, J.; Jiménez-Lasserrotte, M.M.; Fernández-Sola, C.; Hernández-Padilla, J.M.; Sánchez-Hernández, F.; López-Domene, E. Cultural Issues in the provision of emergency care to irregular migrants who arrive in Spain by small boats. J. Transcult. Nurs. 2019, 30, 371–379. [Google Scholar] [CrossRef]
- Dalla, T.; Del Manso, M.; Giambi, C.; Riccardo, F.; Bella, A.; Caporali, M.G.; Dente, M.G.; Declich, D. Italian Survey CARE Working Group. Immunization offer targeting migrants: Policies and practices in Italy. Int. J. Environ. Res. Public Health 2018, 15, 968. [Google Scholar] [CrossRef]
- Pace-Asciak, A.; Mamo, J.; Calleja, N. Tuberculosis among undocumented boat migrants to Malta: Implications for a migrant tuberculosis policy. Int. J. Tuber. Lung Dis. 2013, 17, 1065–1070. [Google Scholar] [CrossRef]
- Rauscher, C.; Salzberger, B. Initial examination and screening of migrants: What makes sense and what is evidence-based? Der Internist 2016, 57, 452–456. [Google Scholar] [CrossRef]
- Kovras, I.; Robins, S. Death as the border: Managing missing migrants and unidentified bodies at the EU’s Mediterranean frontier. Polit. Geogr. 2016, 55, 40–49. [Google Scholar] [CrossRef]
- Brannan, S.; Campbell, R.; Davies, M.; English, V.; Mussell, R.; Sheather, J.C. The Mediterranean refugee crisis: Ethics, international law and migrant health. J. Med. Ethics. 2016, 42, 269–270. [Google Scholar] [CrossRef]
- De Jong, L.; Pavlova, M.; Winters, M.; Rechel, B. A systematic literature review on the use and outcomes of maternal and child healthcare services by undocumented migrants in Europe. Eur. J. Public Health 2017, 27, 990–997. [Google Scholar] [CrossRef]
- Ferrer, L.; Gillardin, F.; Cayuela, A.; Collazos, F.; Casabona, J. Self-reported health status among migrant men and women in Spain pelfi Study. Eur. J. Public Health 2018, 28, 63. [Google Scholar] [CrossRef]
- Lori, J.R.; Boyle, J.S. Forced migration: Health and human rights issues among refugee populations. Nurs. Outloock 2015, 63, 68–76. [Google Scholar] [CrossRef]
- Freedman, J. Sexual and gender-based violence against refugee women: A hidden aspect of the refugee “crisis”. Reprod. Health Matters 2016, 24, 18–26. [Google Scholar] [CrossRef]
- Pottie, K.; Martin, J.P.; Cornish, S.; Biorklund, L.M.; Gayton, I.; Doerner, F.; Schneider, F. Access to healthcare for the most vulnerable migrants: A humanitarian crisis. Confl. Health 2015, 9, 16. [Google Scholar] [CrossRef]
- Hughes, F. Nurses’ role in the health of displaced persons. Int. Nurs. Rev. 2016, 63, 5–6. [Google Scholar] [CrossRef]
- Suphanchaimat, R.; Kantamaturapoj, K.; Putthasri, W.; Prakongsai, P. Challenges in the provision of healthcare services for migrants: A systematic review through providers’ lens. BMC Health Serv. Res. 2015, 15, 390. [Google Scholar] [CrossRef]
- Tsiodras, S. Irregular migrants: A critical care or a public health emergency. Intensive Care Med. 2016, 42, 252–255. [Google Scholar] [CrossRef]
- Van Loenen, T.; van den Muijsenbergh, M.; Hofmeester, M.; Dowrick, C.; van Ginneken, N.; Mechili, E.A.; Angelaki, A.; Lionis, C. Primary care for refugees and newly arrived migrants in Europe: A qualitative study on health needs, barriers and wishes. Eur. J. Public Health 2018, 28, 82–87. [Google Scholar] [CrossRef]
- Zimmerman, C.; Hossain, M.; Watts, C. Human trafficking and health: A conceptual model to inform policy, intervention and research. Soc. Sci. Med. 2011, 73, 327–335. [Google Scholar] [CrossRef]
- Gadamer, H.G. Verdad y Metodo; Sigueme: Salamanca, Spain, 2005. (In Spanish) [Google Scholar]
- Tong, A.; Sainsbury, P.; Craig, J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int. J. Qual. Health Care 2007, 19, 349–357. [Google Scholar] [CrossRef]
- Fleming, V.; Gaidys, U.; Robb, Y. Hermeneutics research in nursing: Developing a Gadamerian-based research method. Nurs. Inq. 2003, 10, 113–120. [Google Scholar] [CrossRef]
- UNICEF. Female Genital Mutilation/Cutting: A Global Concern. Unicef’s Data Work on FGM/C. 2016. Available online: https://www.unicef.org/media/files/FGMC_2016_brochure_final_UNICEF_SPREAD.pdf (accessed on 17 August 2019).
- Kandala, N.B.; Shell-Duncan, B. Trends in female genital mutilation/cutting in Senegal: What can we learn from successive household surveys in sub-Saharan African countries? Int. J. Equity Health 2019, 18, 25. [Google Scholar] [CrossRef]
- Martinez, O.; Wu, E.; Sandfort, T.; Dodge, B.; Carballo-Dieguez, A.; Pinto, R.; Rhodes, S.D.; Moya, E.; Chavez-Baray, S. Evaluating the impact of immigration policies on health status among undocumented immigrants: A systematic review. J. Inmigr. Minor. Health 2015, 17, 947–970. [Google Scholar] [CrossRef]
- Angulo-Pasel, C. The categorized and invisible: The effects of the ‘border’ on women migrant transit flows in Mexico. Soc. Sci. 2019, 8, 144. [Google Scholar] [CrossRef]
- Save the Children. Protecting Children on the Move. Monitoring, Evaluation, Accountability and Learning in Protection Programming with Children on the Move. 2018. Available online: https://resourcecentre.savethechildren.net/node/13638/pdf/children_on_the_move_programme_guide.pdf (accessed on 17 August 2019).
- Gieles, N.C.; Tankink, J.B.; van Midde, M.; Düker, J.; van der Lan, P.; Wessels, C.M.; Bloemenkamp, K.W.M.; Bonsel, G.; van den Akker, T.; Goosen, S.; et al. Maternal and perinatal outcomes of asylum seekers and undocumented migrants in Europe: A systematic review. Eur. J. Public Health 2019, 29, 714–723. [Google Scholar] [CrossRef]
- Ortensi, L.E.; Menonna, A. Migrating with Special Needs? Projections of flows of migrant women with female genital mutilation/cutting toward Europe 2016-2030. Eur. J. Popul. 2017, 33, 559–583. [Google Scholar] [CrossRef]
- Grotti, V.; Malakasis, C.; Quagliariello, C.; Sahraoui, N. Shifting vulnerabilities: Gender and reproductive care on the migrant trail to Europe. Comp. Migr. Stud. 2018, 6, 23. [Google Scholar] [CrossRef]
- Office of the United Nations High Commissioner for Human Rights (OHCHR). Principles and Guidelines, Supported by Practical Guidance, on the Human Rights Protection of Migrants in Vulnerable Situations. 2018. Available online: https://www.ohchr.org/Documents/Issues/Migration/PrinciplesAndGuidelines.pdf (accessed on 29 August 2019).
- Women’s Link Worldwide (WLW). La Trata de Mujeres y Niñas Nigerianas: Esclavitud Entre Fronterasy Prejuicios. 2014. Available online: http://www.lrmcidii.org/wp-content/uploads/2014/04/Women_s_Link_Trata_de_mujeres_y_ni_as_africanas.pdf (accessed on 28 June 2019).
- Theofanidis, D.; Fountouki, A. Refugees and migrants in Greece: An ethnographic reflective case study. J. Transcult. Nurs. 2018, 30, 26–31. [Google Scholar] [CrossRef]
- Hendow, M. Tunisian migrant journeys: Human rights concerns for tunisians arriving by sea. Laws 2013, 2, 187–209. [Google Scholar] [CrossRef]
- Lundin, C.; Hadziabdic, E.; Hjelm, K. Language interpretation conditions and boundaries in multilingual and multicultural emergency healthcare. BMC Int. Health Hum. Rights 2018, 18, 23. [Google Scholar] [CrossRef]
- Esposito, F.; Quinto, C.R.; De Masi, F.; Gargano, O.; Costa, P.A. Voices of Nigerian women survivors of trafficking held in Italian centres for identification and expulsion. Int. Migr. 2016, 54, 133–419. [Google Scholar] [CrossRef]
- Pallister-Wilkins, P. The humanitarian politics of european border policing: Frontex and border police in Evros. Int. Polit. Sociol. 2015, 9, 53–69. [Google Scholar] [CrossRef]
- Chiarenza, A.; Dauvrin, M.; Chiesa, V.; Baatout, S.; Verrept, H. Supporting access to healthcare for refugees and migrants in European countries under particular migratory pressure. BMC Health Serv. Res. 2019, 19, 513. [Google Scholar] [CrossRef]
- Hacker, K.; Anies, M.; Folb, B.L.; Zallman, L. Barriers to health care for undocumented immigrants: A literature review. Risks Manag. Health Policy 2015, 30, 175–183. [Google Scholar] [CrossRef]
- Gea-Sánchez, M.; Alconada-Romero, A.; Briones-Vozmediano, E.; Pastells, R.; Gastaldo, D.; Molina, F. Undocumented immigrant women in Spain: A scoping review on access to and utilization of health and social services. J. Immigr. Minor. Health 2017, 19, 194–204. [Google Scholar] [CrossRef]
- Keygnaert, I.; Dialmy, A.; ManÇo, A.; Keygnaert, J.; Vettemburg, N.; Roeklens, K.; Temmerman, N. Sexual violence and sub-Saharan migrants in Morocco: A community-based participatory assessment using respondent driven sampling. Global Health 2014, 10, 32. [Google Scholar] [CrossRef]
- Vogel, L. Medicine at sea: The front line of the migrant crisis. CMAJ. 2016, 188, E6. [Google Scholar] [CrossRef]
- Doffer, C.; Vakilzadeh, A.; Happie, C.; Kleinert, E.; Muller, F.; Ernst, D.; Schmidt, E.E.; Behrens, G.; Merkesdal, S.; Wetzke, M.; et al. Pregnancy related health care needs in refugees—A current three center experience in Europe. Int. J. Environ. Res. Public Health 2018, 15, 1934. [Google Scholar] [CrossRef]
- Robjant, K.; Roberts, J.; Katona, C. Treating posttraumatic stress disorder in female victims of trafficking using narrative exposure therapy: A retrospective audit. Front. Psychiatry 2017, 8, 63. [Google Scholar]
- Ministerio de Trabajo, Migraciones y Seguridad Social (Gobierno de España). Ayuda de Emergencia FAMI. Available online: http://extranjeros.mitramiss.gob.es/es/Fondos_comunitarios/fami/emergencia/index.html (accessed on 29 August 2019).
Participant | Sex | Age | Profession | Travel Status/Agency | Days (in Spain) | Country |
---|---|---|---|---|---|---|
WIM-1 | Female | 29 | Immigrant | Pregnant | 39 | Nigeria |
WIM-2 | Female | 34 | Immigrant | Pregnant | 32 | Algeria |
WIM-3 | Female | 19 | Immigrant | Alone | 42 | Gambia |
WIM-4 | Female | 18 | Immigrant | Brother | 56 | Guinea Conakry |
WIM-5 | Female | 33 | Immigrant | Pregnant | 45 | Ivory Coast |
WIM-6 | Female | 34 | Immigrant | Alone | 28 | Nigeria |
WIM-7 | Female | 30 | Immigrant | Son, Pregnant | 36 | Morocco |
WIM-8 | Female | 29 | Immigrant | Alone | 41 | Senegal |
WIM-9 | Female | 23 | Immigrant | Alone | 18 | Gambia |
WIM-10 | Female | 35 | Immigrant | Daughter | 16 | Ivory Coast |
WIM-11 | Female | 21 | Immigrant | Husband and Son | 19 | Cameroon |
WIM-12 | Female | 39 | Immigrant | Pregnant | 25 | Nigeria |
WIM-13 | Female | 28 | Immigrant | Alone | 31 | Nigeria |
KI-1 | Female | 50 | Cultural mediator | Andalusian Government | - | Spain |
KI-2 | Male | 49 | Captain | Maritime Rescue | - | Spain |
KI-3 | Male | 22 | Team Leader | Psychologist | Spain | |
KI-4 | Male | 53 | Captain | Maritime Rescue | - | Spain |
KI-5 | Male | 47 | Cultural mediator | Spanish Red Cross | - | Senegal |
KI-6 | Female | 35 | Cultural mediator | Spanish Red Cross | - | Morocco |
KI-7 | Female | 29 | Nurse | Andalusian Health Service | - | Spain |
KI-8 | Female | 27 | Nurse | Andalusian Health Service | - | Spain |
KI-9 | Female | 25 | Nurse | Andalusian Health Service | - | Spain |
KI-10 | Female | 30 | Nurse | Spanish Red Cross | - | Spain |
Stage | Subject | Content/Example Questions |
---|---|---|
Introduction | Motives, reasons | Learn about the experiences and healthcare needs of WIMs during the migratory journey |
Objective | Improving first emergency care protocols for WIMs | |
Beginning | General introductory question | Can you tell us about your own particular experience, reasons for coming, and what you went through during the migratory journey? |
Development | Conversation guide | Tell me about any problems that you faced from the time you left your country to when you arrived on the coast of Spain. Tell me about the rescue experience. What was your relationship with volunteers, nurses and police during maritime rescue and emergency care? |
Closing | Final question | Do you have anything else you would like to share about your experiences during the migratory journey and emergency care? |
Appreciation | Thanking participants for their time and reminding them that their testimony will be very helpful. |
Theme | Subtheme | Units of Meaning |
---|---|---|
The need for emergency care focused on WIMs. | WIMs as objects of sexual exploitation. | Specific needs, physical assessment, violence, marks and scars, sexual abuse, gynaecological assessment, abortion medication, genital mutilation, pregnancy test, signs of trafficking, psychosocial support. |
The mother–child dyad as the axis in human trafficking. | Awareness, active observation, identifying babies, collaboration amongst women, older children, network tools, young people. | |
Developing a gender policy for WIMs in emergency care. | Healthcare in a police-controlled setting: detecting weaknesses. | Lack of space, time and personnel, safety versus healthcare, fear and distrust, intimacy, communication, police custody, cultural mediator. |
Promoting screening and safety protocols focused on WIMs. | Gynaecological assessment, identifying sexually transmitted diseases, female genital mutilation, emotional instability, mental health, risk report, joint protocols, trafficking of women, identifying voodoo, cultural aspects, specific training. |
© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
López-Domene, E.; Granero-Molina, J.; Fernández-Sola, C.; Hernández-Padilla, J.M.; López-Rodríguez, M.d.M.; Fernández-Medina, I.M.; Guerra-Martín, M.D.; Jiménez-Lasserrrotte, M.d.M. Emergency Care for Women Irregular Migrants Who Arrive in Spain by Small Boat: A Qualitative Study. Int. J. Environ. Res. Public Health 2019, 16, 3287. https://doi.org/10.3390/ijerph16183287
López-Domene E, Granero-Molina J, Fernández-Sola C, Hernández-Padilla JM, López-Rodríguez MdM, Fernández-Medina IM, Guerra-Martín MD, Jiménez-Lasserrrotte MdM. Emergency Care for Women Irregular Migrants Who Arrive in Spain by Small Boat: A Qualitative Study. International Journal of Environmental Research and Public Health. 2019; 16(18):3287. https://doi.org/10.3390/ijerph16183287
Chicago/Turabian StyleLópez-Domene, Esperanza, José Granero-Molina, Cayetano Fernández-Sola, José Manuel Hernández-Padilla, María del Mar López-Rodríguez, Isabel María Fernández-Medina, Maria Dolores Guerra-Martín, and María del Mar Jiménez-Lasserrrotte. 2019. "Emergency Care for Women Irregular Migrants Who Arrive in Spain by Small Boat: A Qualitative Study" International Journal of Environmental Research and Public Health 16, no. 18: 3287. https://doi.org/10.3390/ijerph16183287