The principle of non-discrimination is recognised as vital to the human rights field. In May 2013 the Swedish parliament passed a law that provides undocumented migrants the same limited health care as asylum seekers. In relation, the Swedish Red Cross in a partnership with Malmö University created and distributed a questionnaire amongst Swedish politicians, that in part pertains to this law and also the situation of undocumented migrants’ right to health care.In applying the perspective of non-discrimination, legal challenges to undocumented migrants’ access to health care in Sweden, and the political attitudes surrounding this issue are duly examined. This produces the observation that the non-discrimination principle’s application is of relevant use. In concluding that the legislation examined fails to meet international standards regarding the principle of non-discrimination and the right to health care for undocumented migrants, it provides examples to illustrate that this conclusion is not necessarily representative of the views held by the selected group of politicians included in the twofold questionnaire study.

This study aims to analyze the underlying factors and barriersinfluencing undocumented adults' access to healthcare in Sweden. By focusing on the experiences of five respondents associated with the Swedish Red Cross, the essay seeks to shed light on and enhance the understanding of the limitations faced by undocumented adults, regarding their access to healthcare in Sweden. This study has a qualitative research approach with semi-structured interviews. The studyaddresses three theories for understanding the factors and barriers that affect the access to healthcare by using Goffman (1963) stigma, Young (2011) social justice and Rothstein (2003) trust and social contract theory. The result of the study shows insights information from five respondents of the factors affecting undocumented adults' healthcare access in Sweden. The study ultimately reveals that stigmatization, trust, fear, and social networks are underlying factors that impact the access to healthcare for undocumented adults in Sweden. Additionally,socio-economic barriers are identified as limiting the opportunities for undocumented adults to access healthcare in Sweden. The research highlights that these challenges are not merely individual choices or priorities but rather a result of complex factors and structural impediments. Therefore, addressing the obstacles and underlying factors requires a collective approach to observe and understand the root causes affecting the access to healthcare in Swedenfor undocumented adults.

Bakgrund: Immigranter, flyktingar, asylsökande och papperslösa tillhör samhällets mest sårbara grupper och löper hög risk att utveckla mental ohälsa relaterat till traumatiska upplevelser pre- och postmigrativt. Grupperna är underrepresenterade inom den psykiatriska vården och det råder ett missförhållande mellan behovet av och tillgången till vård för dessa patientgrupper. Syfte: Syftet var att undersöka upplevelsen av den mentala ohälsan och hinder för vård hos immigranter, flyktingar, asylsökande och papperslösa ur ett transkulturellt omvårdnadsperspektiv. Metod: Tio kvalitativa studier och två studier med mixad metod har granskats och analyserats. Leiningers transkulturella omvårdnadsteori har använts för att lyfta resultatet till en högre abstraktionsnivå. Resultat: Tre teman identifierades: Den mentala ohälsan, Hinder för vård och Kulturellt betingade attityder. I resultatet framkom att grupperna lider av mental ohälsa relaterat till erfarenheter genom migrationsprocessen. Bristfällig information, kommunikationssvårigheter och bristande tillit till vårdpersonalen ledde till hinder i vården. Dessutom framkom att stigmatisering, religiösa övertygelser och könsroller påverkade fokusgruppens syn på mental ohälsa. Slutsats: Immigranter, flyktingar, asylsökande och papperslösa är högriskpatienter för mentala ohälsotillstånd men strukturella och personliga faktorer hindrar dem att erhålla vård. Som sjuksköterska är det viktigt att inta en aktiv roll och ha kunskap och förståelse kring dessa människors upplevelser och kulturellt betingade attityder kring mental ohälsa. Klinisk betydelse: Genom att belysa en marginaliserad patientgrupps upplevelser av att leva med mental ohälsa och erhålla vård i en ny kulturell kontext ökar sjuksköterskans medvetenhet om dessa människors situation. Detta kan leda till en bättre vård för dessa patienter. / Background: Immigrants, refugees, asylum seekers and undocumented migrants belong to society's most vulnerable groups and are at high risk of developing mental health problems. The groups are underrepresented in psychiatric care and there is a disproportion between the need and the availability of care for these patient groups. Aim: The aim was to examine the experience of mental illness and barriers for access to healthcare of immigrants, refugees, asylum seekers and undocumented migrants from a transcultural nursing perspective. Method: Ten qualitative studies and two mixed-method studies were reviewed and analysed. Leiningers transcultural nursing theory was applied to enable a higher level of abstraction. Results: Three themes were identified: The mental illness, Barriers for care and Culturally influenced attitudes. The result showed that the groups suffered from mental illness related to experiences through the migration process. Inadequate information, communication difficulties and a lack of trust in the medical staff led to obstacles in healthcare. Stigma, religious beliefs and gender roles affected the focus group's view of mental illness. Conclusion: Immigrants, refugees, asylum seekers and undocumented migrants are at high risk for developing mental illness but structural and personal factors preventing them to receive treatment. Nurses should take an active role and gain knowledge about experiences and culturally conditioned attitudes about mental illness among patients. Clinical significance: Highlighting the experience of living with mental illness and obtaining care in a new cultural context, increases the nurses’ knowledge about the marginalized patient group.

Cette thèse porte sur les conditions de passage clandestin des migrants africains à la frontière sud espagnole ainsi que sur leurs logiques d’insertion dans la province andalouse d’Almeria et au-delà, dans l’espace européen. Interrogeant le rapport de force entre migrants et État, cette thèse insiste sur les capacités des migrants à la mobilité et met en lumière l’ambivalence des institutions gouvernementales, en partie liée à la fonction économique des migrants clandestins. Les articulations entre les stratégies des migrants clandestins et les logiques des institutions et des acteurs locaux y sont analysées à partir de la description des interactions, des transactions et des conflits, entre les migrants nouveaux venus, ceux anciennement installés, les ONG, les patrons, les forces de police, etc. L’approche compréhensive de l’expérience des migrants avant et après le passage de la frontière a révélé l’importance des réseaux sociaux dans l’entrée en Europe et dans la recherche d’un logement, d’un emploi et de papiers ; tout en soulignant la fonction du milieu associatif espagnol pour les migrants les plus vulnérables. D’un côté, les institutions gouvernementales oscillent entre contrôle et tolérance ; de l’autre, les migrants évoluent entre contraintes et stratégies, régularités et irrégularités. Leur migration, construite par étape, constitue alors un véritable « jeu de l’oie ». Almeria représente ainsi une étape où chercher des papiers. Cette province spécialisée dans l’agriculture possède une économie souterraine « à découvert » : elle est connue de tous et bénéficie de la complicité des autorités. Almeria centralise ainsi les migrants africains en situation précaire récemment arrivés ou déjà présents en Europe. Cette thèse propose donc de qualifier les mobilités de ces migrants clandestins « d’errance maîtrisée », maîtrise qui se fait essentiellement à travers les relations sociales et la constitution de réseaux sociaux. L’attention portée aux modalités de construction du projet migratoire après le passage de la frontière a également permis de faire émerger la notion d’ « instance zéro ». Il s’agit d’un espace-temps « autre », d’une instance intermédiaire entre le passage de la frontière et l’insertion dans l’espace européen ; un temps plus ou moins long caractérisé par la répétition de situations élémentaires de survie qui autorisent l’exploitation maximale du migrant, lequel cherche alors les moyens d’éviter cette répétition ou d’en sortir. / This PhD thesis deals with the conditions of illegal border crossing of the African migrants in the south of Spain and with their logics of insertion in the Andalusian province of Almeria and beyond, in the European space. By questioning the power struggle between migrants and State, this thesis insists on the migrants’ capacity to move and it highlights the ambivalence of governmental institutions, partly linked with the economical function of undocumented migrants. The analysis of connections between the strategies of undocumented migrants and the logics of institutions and local actors are based on the description of the interactions, transactions and existing conflicts between the migrants recently arrived, those who are already installed, the NGOs, the managers, the police forces, etc. The ethnographic study of the migrants’ experience before and after crossing the border reveals the importance of social networks to reach Europe and to look for housing, employment and papers. At the same time, it points out the function of Spanish associations for the most vulnerable migrants. On one hand, the governmental institutions fluctuate between control and tolerance; one the other hand, the migrants glide between constraints and strategies, regularity and irregularity. Their migration, built on several stages, constitutes then a real “snakes and ladders”. Almeria represents a stage where it is possible to look for papers. This province, specialized in agriculture, has an informal “uncovered” economy: everybody knows it including the authorities. Almeria centralizes the African migrants who are in a precarious situation, whatever the time of their arrival in Europe. This thesis proposes to qualify the mobility of those undocumented migrants as “a mastered roving”, mastering that is essentially done through social relations and the constitution of social networks. The attention turned to the construction’s terms of the migratory project after the border crossing also allows generating the notion of “zero square”. This means a special space-time, intermediate between the border crossing and the insertion in the European space; a time more or less lengthy, characterized by the repetition of basic survival situations that authorize the maximal exploitation of the migrant, who, therefore is looking for the means to avoid this repetition or to get out of it.

The aim of the study is to examine and analyze social workers’ perceptions of law practice of supportive regulations for abused, undocumented women who are in need of protection, in order to problematize the connection between norm and practice in social service case management. In a qualitative approach, the study is conducted through eight interviews, based on two vignettes, with representatives from the public sector in Gothenburg. The vignettes were based on two fictive narratives that both include women who are victims of abuse, but have different ethnicity and legal status. By using vignettes it was anticipated to find whether there are different perceptions among the social workers in terms of considering the residents’ ethnicity and legal status in relation to the possibilities of receiving support. According to Swedish law the social services have responsibility to assist all residents within the country. Since the undocumented migrants have difficulties claiming their rights in the public sector, many stay in destructive relationships. The focal point of this study is the uncertainties and inconsistencies among social service staff regarding offering support to these women, especially after acute situations. The UN’s Declaration of Human Rights expresses that all humans are equal, regardless of ethnicity, gender, etc. (see declaration). Thus, rejecting a woman her right to claim social service contradicts these regulations. The results of the study relates to T.H Marshall´s, Lister´s and Fernández´s discussion about citizenship, de los Reyes theory about postcolonialism, Mattson´s intersectionality, Hasenfeld´s Human Service Organizations, Libsky´s Street-level Bureaucrat and Johansson’s Freedom of Action. Further, different concepts on new institutional theory from Johansson and Svensson, Johnsson and Laanemets, are used to analyze our data. Our selected theories, concepts and reasoning can be used to understand our empirical data in different levels in society.   The study shows that the juridical fate of undocumented women who have been subject to violence is not only determined by laws and regulations, but also on individual attitudes of social workers as well as cultural interests within an organization. These results indicate that the widely accepted notion of Sweden being an equal society, does not comply with practice. In conclusion, this study shows that social workers have an important role in the development of a women-friendly, gender inclusive theory and praxis of citizenship.

Syftet med denna studie var att undersöka kunskap och uppfattningar om papperslösas tillgång och rätt till vård hos personal inom öppen hälso- och sjukvård i Landstinget i Uppsala län. Ett ytterligare syfte var att undersöka om information kring handhavandet av papperslösa finns på arbetsplatserna, vad personal i så fall anser om detta, samt vad de önskar för information.   Studien är av en deskriptiv design med kvantitativ ansats. 86 anställda vid vårdcentraler i Uppsala län besvarade enkäter med frågor angående kunskap och uppfattningar om lagstiftning samt tillgång till och önskan om information gällande papperslösa. Insamlad data har sammanställts i Microsoft Excel och presenterats i tabeller och diagram.   Resultatet av studien tyder på att det finns en kunskapsbrist bland personal inom öppen hälso- och sjukvård angående lagstiftningen om papperslösas tillgång till sjukvård. Enligt de medverkandes vetskap finns ingen information tillgänglig på arbetsplatsen gällande papperslösa, och så gott som alla önskar information av något slag. Majoriteten av de tillfrågade anser att papperslösa ska ha samma rätt till vård som svenska medborgare.   Slutsatsen av denna studie är att det finns ett behov av information och riktlinjer gällande handläggning av papperslösa i Landstinget i Uppsala län. / The aim of this study was to investigate knowledge and opinions concerning undocumented migrants’ access and right to health care among employees within the primary health care sector in the county council of Uppsala. An additional aim was to investigate whether there is information available about management of undocumented migrants at the workplaces, and if so what the employees think about it and what kind of information they wish to receive.   The study is quantitative with a descriptive design. 86 employees at primary health care centres within the county of Uppsala answered questionnaires concerning knowledge and opinions about legislation as well as access to and demand for information concerning undocumented migrants. Collected data was compiled using Microsoft Excel and was then presented in tables and diagrams.   The result of the study indicates that there is a lack of knowledge among employees within the primary health care sector concerning legislation on undocumented migrants’ access to health care. According to the employees’ knowledge there is no information available at the workplace concerning undocumented migrants, and nearly everyone requested information of some kind. The majority of the employees are of the opinion that undocumented migrants should have the same right to health care as Swedish citizens.   The conclusion of this study is that there is a need for information and guidelines concerning management of undocumented migrants in the county council of Uppsala.

Syftet med denna studie är att öka kunskapen om diakoners arbete med papperslösa. I Sverige finns det 10 000-tals papperslösa som befinner sig här efter att undanhållit sig utvisningsbeslut, smugglats in som traffickingoffer eller strävar efter att arbeta ihop inkomster att skicka till hemlandet. Med en kvalitativ ansats har jag intervjuat sex stycken diakoner som arbetar i Svenska kyrkan i Stockholm, och som alla möter och erbjuder socialt stöd till papperslösa. Resultatet har jag analyserat utifrån teori om ekologiskt perspektiv på socialt arbete med flyktingar och migranter, samt teorier om värdegrunder i socialt arbete. Resultatet visar att diakonerna fokuserar på det sociala arbetet på mikronivå, men att viss samverkan på mesonivå förekommer. Dock förekommer inte särskilt mycket samverkan med andra diakoner som möter papperslösa. De diakoner som samverkar minst uttrycker en ensamhet rörande sitt arbete. Diakonerna ställs inför etiska överväganden rörande resursfördelning och då prioriteras papperslösa overstayers framför de som befinner sig i Sverige för att arbeta. Resultatet visar även att diakonerna upplever en maktlöshet rörande sitt arbete och gör etiska överväganden huruvida det är värt att bistå människor som lever papperslösa, trots att det i vissa fall verkar bättre att återvända. Denna maktlöshet kan kopplas till de juridiska kunskaper diakonerna besitter eller saknar, då den diakon som har störst juridisk kunskap även är den som uttrycker mest hopp. Med ökad samverkan mellan diakoner som arbetar med gruppen, och med ökande juridiska kunskaper gällande lagstiftningen verkar både känslan av ensamhet och maktlöshet att minska.   Nyckelord: Papperslösa, diakon, Svenska kyrkan, trosbaserat socialt arbete, flyktingar, migration   Keywords: Undocumented Migrants, Irregular Migrants, Deacon, Church of Sweden, Faith-based Social Work, Refugees, Migration

This study is aimed to increase the knowledge about the Swedish immigration authorities’ assessment of the asylum applications based on particularly distressing circumstances, submitted by disabled undocumented migrants. Making an attempt to explain the reasons of asylum-seekers’ health deterioration during the asylum process, this study determines the factors in migration authorities proceedings affecting such deterioration. Documents in five personal files concerning six disabled asylum-seekers, whose applications were declined, were studied by applying two observational methods: content analysis of the documents in the personal files and non-participant observations made during receptions of undocumented migrants at the Swedish Asylum Committee. The results of the study have shown that migration authorities' way of applying the principle of child’s best interests have a declarative character, while the disability perspective is completely ignored. The migrations authorities make free interpretations of the information on the countries of asylum-seekers' origin, while adaptation to Swedish conditions does not work at all as cause for residence permit. Advocates, who neglect their prior duties, have also a negative influence on the asylum process. Analyzed from the perspective of appropriate sociological concepts, the results of this study have shown that the above mentioned observations cause disabled undocumented migrants health deterioration.

Introduction: Vulnerable European Union citizens (vulnerable EU citizens) are those who come to Sweden from EU member states. In Sweden the term “vulnerable EU citizens” is associated with the word “beggars”, which in turn is associated with Roma people. By November 2015 the number of vulnerable EU citizens in Sweden was estimated to be 4 700. The majority of these were from Romania. Roma as citizens of an EU member state have the right to reside in EU countries in accordance with the EU’s freedom of movement rights concept for up to but no longer than three months. However, to obtain the right for residence after three months, proof of financial resources and health insurance are required. Lacking these resources, vulnerable EU citizens have subsequently lost their right for residence and therefore became undocumented. They often find themselves in the same situation as undocumented migrants from outside the EU, having poor health outcomes and limited access to health care. In my study I aim to explore access to health care for vulnerable EU citizens in Umeå, a city in eastern Sweden. Methods: A qualitative design methodology has been applied in this thesis. Those contacted for this study were; Doctors of the World, Health on Equal Terms, Staff for planning and control Västerbotten Region, University Hospital of Umeå and representatives of vulnerable EU citizens’ community from Romania in Umeå. Seven in-depth interviews were collected with professionals and volunteers from these organisation/institutions and members of vulnerable EU citizens’ community. Questions were asked about their experience and knowledge regarding access to health care for vulnerable EU citizens. Data was analyzed using qualitative content analysis. Results: Three main categories and one final theme were developed during data analysis. The first category “Difficult to access health care for vulnerable EU citizens in Sweden without European Health Insurance” elaborates the dependence of vulnerable EU citizens’ access to health care on having health insurance, specifically European Health Insurance and National Health Insurance. It also describes what kind of access to health care vulnerable EU citizens have in Sweden. The second category “Decision about how much access to health care provide for vulnerable EU citizens lies on medical personnel” discusses the situation of health care personnel when they treat vulnerable EU citizens in hospitals. The third category “Organisations, Doctors of the World and Health on Equal Terms, mediate connection between vulnerable EU citizens and hospitals, so they can have their right to health fulfilled” elaborates about the role the organisation plays when vulnerable EU citizens are in need of health care. After grouping categories and looking at the data from more interpretive, abstracted higher level, the final theme was created “Lack of attention from the national and international levels to the situation of vulnerable EU citizens’ access to health care”. Conclusion: This study highlights the difficulty for vulnerable EU citizens to access health care in Umeå if they do not have European Health Insurance. Being treated as undocumented migrants is the only way they have access to emergency services. Health care personnel feel insecure when treating vulnerable EU citizens, because there are no clear guidelines when vulnerable EU citizens can be treated as undocumented migrants as well as what is included in the clause “the care that cannot wait”. Because of this situation, vulnerable EU citizens sometimes are not able to receive the medical help they need. Organisations, Doctors of the World and Health on Equal Terms, help to mediate the connection between vulnerable EU citizens and hospitals which helps them to access the health care and fulfille their right to health. Lack of attention from the national as well as international governments to this situation is found to be important factor influencing vulneralbe EU citizens’ access to health care