Paradoxes of Providing Aid: NGOs, Medicine, and Undocumented Migration in Berlin, Germany

Abstract

This dissertation examines the paradoxes involved in offering medical aid to undocumented migrants in Berlin, Germany. Coinciding with the end of guestworker programs in the 1970s, undocumented migrants have increasingly filled gaps in the German labor market. Political pressures following reunification, along with border militarization in the wake of European Union expansion, have resulted in restrictions on legal entry. However, neoliberal reforms in the labor market and a rapidly aging population have resulted in high demand for undocumented workers in particular sectors of the economy. At the same time, soaring unemployment and nationalist sentiments have made immigration unpopular, with political parties negatively predisposed to assuring the rights of migrant workers. One such right is access to health care services in a nation with a traditionally universal system of coverage. Undocumented migrants are officially denied "medical citizenship" and must rely upon humanitarian aid provided by nongovernmental organizations (NGOs).This study examines the experiences of multiple stakeholders, particularly physicians and NGOs that provide medical aid. It draws upon the anthropology of health policy, a critical approach within medical anthropology. Fieldwork in Berlin during 2004-2006 included participant observation at an outpatient clinic, which yielded case studies of 204 undocumented patients, along with sixty-one interviews. Results indicate that in Germany, certain minimal rights are technically available to migrants; however, they are not assured access to these rights. This underscores the importance of utilizing legal status as a unifying measure of analysis. I argue that the state absolves itself of responsibility by handing off the provision of services to the NGO sector. While laws criminalize the provision of medical aid, they are only selectively enforced, and organizations are recognized for their volunteer work through awards and commendations. These paradoxes allow the state to square the contradiction of condemning yet relying upon undocumented migration. This dissertation presents an ethnographic portrait of the single largest source of medical aid for undocumented migrants in Germany, providing an analysis of patient characteristics and illnesses. Prenatal care highlights the interplay between race, reproduction, and citizenship, and offers a particularly poignant window into the challenges of nation-building in contemporary Germany.