Over the past century and a half, an international system to assist refugees has evolved, which gives priority to health. This thesis looks at the processes by which policies for the health of refugees have been formulated and implemented in three historical periods. It begins with the Red Cross movement of the late 1800s when medical care was first organised for those wounded in war. Provision of basic medical care for entire populations affected by the World Wars is then reviewed, highlighting the creation of organizations by governments collectively for relief and aid. The bulk of the analysis, however, focuses on the past forty years when western charities and inter-governmental organizations increasingly made medical and public health interventions available for refugee relief in poorer countries. Organizational policies, mandates and structures of the specialised agencies of the United Nations and the charitable agencies based in Europe and North America are examined. This places existing policies for the health of refugees within the context of the cultural and political environment in which they originate. It also identifies more general patterns in institutional responses, allowing their roles in particular relief operations to be anticipated. Health policies for the Afghan refugees in Pakistan during the 1980s are then analyzed. Not only does this analysis validate earlier conclusions about international policies for refugee health, it reveals unbalanced relationships of power between internationally- and nationally-based organizations. In so doing, cultural dimensions of the policy process and the complexity of vested interests within national societies arc found lo have been neglected. Although recommendations can be made, the policy process indicates that they are unlikely to be put into practice. Consequently, more general conclusions about the policy process, key policy issues and characteristics of existing policies for the health of refugees bring the analysis to a close. In particular, this research indicates that there is a coherent system through which health relief is provided. Health relief is not, however, promoted as a human right; instead it is provided as a humanitarian activity by powerful groups within national societies and globally. Sadly, many of the activities carried out under the aegis of relief appear to be symbolic since they do not alter existing balances of power. The intention of these policies to promote the health of refugees is, therefore, subject to debate.

Trans people are increasingly visible in society, yet remain highly vulnerable to ignorance and discrimination. This can be particularly damaging in the context of healthcare, where trans people often find it difficult to access both general and specialist services. However, trans people are not powerless; they frequently exercise agency in navigating and addressing challenges in healthcare settings. This thesis provides an ethnographic account of how discourses of trans health are negotiated in the UK within and between trans community spaces, activist groups and the professional sphere of medical practice. A descriptive and interrogative account of healthcare services and health literatures is provided; this is interwoven with an analysis of emotional and temporal narratives of patient experience, as constructed collectively on the Internet. Drawing upon conversations, articles and documents produced and/or published online, the thesis explores how competing and intersecting understandings shape not only the material conditions of healthcare, but also the means by which trans identities and experiences are defined and made possible. Trans possibility is conceptualised in terms of two overarching discursive repertoires: ‘trans as condition’ and ‘trans as movement’. The former emerges largely from medical accounts, and broadly positions ‘trans’ as clearly definable and delineated. The latter emerges largely from the ideas of the emergent trans social movement and broadly positions ‘trans’ as queer, fluid and flexible. Health professionals, trans patients and activists draw differently upon discourses of condition and/or movement within a range of contexts in order to justify, reify, survive or question modes of healthcare provision and understandings of trans possibility. This thesis concludes that interactions between trans patients and the practices of specialist ‘gender identity’ services play a particularly key role in mediating discourses of trans health. Through understanding this process, we might better understand and address the wider challenges that trans people face.