NaDiRa short study: Refugees in the health system

The interplay of subjective effects of racism and institutional racism in access to welfare state services

National Monitoring of Discrimination and Racism (NaDiRa)

Project team:

• Andrea Rumpel
• Rebekka Schalley
• Till Behnke

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Project description:

The research project focuses on the question of what effects racism has on the health and health care of refugees. For this purpose, the interplay of (1) subjective experiences as well as (2) entanglements of institutional and structural racism in access to welfare state health care services is examined using the example of substance-using refugees. In doing so, the project explores the questions: How is racism experienced and does it play a role as a pathogenic factor? Is institutional racism subjectively significant and what are the different experiences?  

Results:

Living conditions lead to different exclusions through residence status. On the institutional level, this is visible through the marking of a distinction or observation of difference between refugees and non-refugees, which is based on the attribution of cultural differences as well as victimisation.
Residence status denies or restricts access to health care. It thus impedes and prevents access to health care and can also act as a disease-causing factor.
Language functions as an access entitlement or condition to health care. It both limits and prevents access to adequate health care and carries a strong dependency relationship with others.

Surprising insights:

The results show exclusion by inclusion: The refugees with whom the interviews took place managed to come to Germany, apply for asylum and get accommodation. This can be seen as inclusion. In part, this inclusion is also increased by a residence permit (as opposed to a toleration). Subsequently, however, this leads not only to further inclusions, but also to exclusions: This can be clearly seen in health care, from which the interlocutors* feel excluded due to living conditions, residence status and language.

Short studies in preparation of the racism monitor:

In order to prepare a comprehensive racism monitor, DeZIM called on scholars* from the DeZIM research community in 2020 to develop innovative study ideas. These should extend existing research projects, pursue new and innovative approaches or build an infrastructure to research racism. By 2021, more than 120 researchers at the six locations of the DeZIM research community had conducted a total of 34 short studies. These are divided into six thematic priorities:

• Health system
• Education system and labour market
• Institutional racism
• Dealing with experiences of racism
• Participation and the media
• Racist ideologies and attitudes

Funding: Federal Ministry for Education, Family Affairs, Senior Citizens, Women and Youth (Third-party funding)