Solidaristic inclusion through healthcare

In 2015, the number of asylum applications in Austria was 88,098, making it one of the countries that hosted the most refugees per capita within the EU. For two years, from 2018 to 2020, I repeatedly met four Syrian women and three men from Somalia, Afghanistan and Benin at their private homes and asylum accommodations in Vienna, interviewed them at several points in time and accompanied them to their medical appointments. As many other Syrians, the women were quickly recognized as refugees according to the Geneva Convention in contrast, the men were waiting for court decisions to be recognized as asylum seekers at the time. The stories and experiences of refugees showed that interactions in the Austrian solidarity-based public health system not only met their medical needs, but also produced political inclusion: Those concerned confidently foregrounded their ability to manage healthcare autonomously, experienced independence through familiarity with healthcare providers and institutions, and had a sense of belonging to the healthcare system‘s solidaristic community through receiving their personal electronic health card. Moreover, the refugees themselves promoted the institutionalized civic solidarity of the public health system, with regular tuberculosis screening and blood donations.

What also mattered to refugees were the healthcare institutions‘ rooms and corridors, the routes to get to and away from them, and the procedures that take place in them and technologies that belong to them. Knowing these features helped these individuals regain control in a context that is often characterized by dependency and uncertainty. For example, Maria displayed a personal history that showcased familiarity with her general practitioner‘s treatment room while we were waiting for the doctor, pulling out the scale hidden beneath the examination table and helping herself to colourful sweets from a large jar. Others expressed the importance of having a sense of familiarity with healthcare institutions through explaining and showing to me how everything functioned within these institutions. The individual respondents commented on the waiting time when entering the waiting room, informed me about the usual waiting time to expect, eagerly explained to me where to find the restroom and commented that the empty waiting room during the Christmas holidays was normally full of people.

A couple of days after being admitted to asylum procedures, refugees in Austria receive their “e-Card”, an electronic health card with a personal insurance number. The e-Card is scanned in a card reader at every visit to the doctor, this lets health workers know whether there is a valid insurance cover. I characterize receiving the e-card as the first administrative step for newly arrived refugees that is neither connected to the determination of their legal status, nor to other asylum matters. Obtaining an e-card means becoming a member of the civic solidarity community of the healthcare system. Research participants perceived this as a straightforward process “without problems” (Maria). In each of the participants narratives, the e-card seemed to be an entry ticket to the regular healthcare system in which they were treated like everyone else. For example, one respondent, Paulin states: “If I am sick, I have an e-card. I will go to the doctor with my e-card.” Being asked about her experiences in the healthcare system, Sabah, another respondent, directly mentioned the e-card as door opener:

Looking at how the Austrian healthcare system enacts political inclusion for refugees, opens up what solidarity has the potential to mean in healthcare systems today. It shows how certain practices within the institutionalized support structures in the healthcare system – typically understood as civic solidarity by Sally Scholz (2008) and outside the political agenda for inclusion in migration scholarship (Agustín & Jørgensen, 2019) – should also be understood as political solidarity. These insights hold important real-world implications. Refugees medical practitioners are often not aware of how their services provide political inclusion for refugees. There is an additional value of solidarity-based healthcare systems to providing care for all beneficiaries. These serices can also shape positive relationships between refugees and the host country and act as an effective way of fostering a sense of belonging.