Abstract
Discussions about 'economic migrants' within mainstream media and politics in the UK tend to operate within a morally troubling framing. One dominant view is that a great many asylum seekers are really 'economic migrants' seeking illegitimate access to the UK's economic resources. Those who object to assertions of this kind generally do so by refutation, insisting that asylum seekers are legitimately fleeing persecution and are wronged by the widespread scepticism. In their focus on 'legitimacy', they exclude discussion of those who do migrate partly or wholly to meet their basic material needs. Taken together, these positions marginalise necessitous economic migrants and have serious consequences for health policy, adversely affecting migrants’ access to essential healthcare. In this paper I critically examine this prevailing discourse and urge scholars of health and migration to destabilise it by recognising poverty as a central determinant of both health and migration. I offer arguments for foregrounding necessitous economic migrants in our interventions regarding migration and health, and contend that doing so would make for a more just and ultimately more persuasive way of speaking about necessitous migration as a whole.
Introduction
On the 14th June 2023, the Adriana sank fifty miles off the coast of Pylos in Greece on its way from Libya to Italy. There are believed to have been as many as 750 people on board the fishing trawler, but only 104 survived, and just 82 bodies were recovered. Survivors reported that around a hundred children were locked in the ship's hold when it sank, presumably to keep them sheltered from the midsummer sun and rough waters. Their bodies now lie on the seabed at 15,000 feet, so deep that it would be difficult to recover their remains even if there were the political will to do so.
An investigation carried out by a coalition involving a research group at Goldsmiths, University of London and The Guardian concluded that the Greek coastguard was responsible for the deaths. Having failed to respond to distress calls in a timely manner, the coastguard then made a botched attempt to tow the boat – possibly to move it out of Greek waters and thereby avoid taking responsibility for those on board – which ultimately caused its sinking (Fallon et al., 2023).
A Pakistani police officer named Usman Siddique was among those who survived. In an interview with the Guardian, he described his ordeal: I saw one floating lifejacket. I tried to pull it and saw a dead baby in it. At that moment, I got really scared and started mentally preparing myself that I would be next to die. I thought I would die as the coastguard was looking at us but not rescuing us (Baloch, 2023b). While living in a cramped house with a shared family and having a wife and child, life has been tough. It has been hard to survive. I have seen every other person from Gujrat, my hometown, going to Europe, getting settled and supporting their parents and children to have a better and prosperous life. It pushed me to make this journey. […] I wanted my son to have a good education and support my parents. […] I thought: if I make it to Italy, I can change the living standards of my family (Baloch, 2023b).
There were 350 Pakistanis aboard the Adriana and just 12 survived (Al Jazeera, 2023; ARY News, 2023). These alarming numbers of people desperately trying to leave Pakistan are thought to be due to the economic crisis, which began in 2022 and has led to rising food and fuel prices, shortages of drugs and medical equipment, and falling standards of living (Khabir, 2023).
How should we think and talk about the fact that at least some of those who undertake perilous journeys in order to settle in the UK and other European countries are, like Usman Siddique, best understood as 'economic migrants'? Within mainstream media and politics in the UK these discussions are fraught and tend to operate within a morally troubling framing. One dominant view is that a great many asylum seekers are really 'economic migrants' seeking illegitimate access to the UK's economic resources. Those who object to assertions of this kind generally do so by refutation, retorting that asylum seekers are legitimately fleeing persecution and are wronged by the widespread scepticism (see e.g., Goodfellow, 2023; Islentyeva, 2018). In their focus on 'legitimacy', they exclude discussion of those who do migrate in order to meet their basic material needs.
In this paper I critically examine this discourse, and urge scholars of health and migration to destabilise it, arguing that it is of specific relevance to our work because:
the marginalisation of 'economic migrants' in the UK through this discourse has had serious consequences for health and health policy, limiting undocumented migrants’ access to healthcare in ways that cannot be meaningfully challenged without recognising the legitimacy of necessitous economic migrants; poverty is one of the most important determinants of both health and migration, so the failure of the broader discourse to recognise poverty as a morally (if not legally) legitimate reason for migration constrains any attempt to achieve health or economic justice.
The paper is structured as follows. In the next section, I offer a note on terminology and my positionality as the researcher. The following sections describe the UK border regime and the divisive discourse within which it operates, and the effects of this discourse on undocumented migrants’ access to healthcare. In the last section, I argue that scholars of health and migration should actively challenge this framing because it invisibilises necessitous economic migrants and denies them moral uptake.
Notes on the text
A note on language
A great deal has been written about the language used in public discourse on migration, specifically about the aptness of the term 'migrant' as opposed to the supposedly more humanising terms 'asylum seeker', 'refugee', or 'displaced person'. Several newspapers (including the Guardian, the Washington Post, and Al Jazeera) critically reflected on the use of these words in their reporting of the 2015 'European refugee crisis', in which a million people, mostly those fleeing the Syrian civil war, sought asylum in European countries (Bowden, 2015; Malone, 2015; Marsh, 2015; Taylor, 2015). In these editorials, 'migrant' is deemed to imply a voluntariness that is not true of most of its referents and to downplay the desperation and suffering of those seeking safety. Using the term 'refugee' universally is thought to garner greater compassion and serve as an act of faith in asylum seekers’ testimonies in an otherwise hostile political climate.
I am sympathetic to the need for careful strategy, but linguistically segregating 'good' from 'bad' migrants produces a false and misguided dichotomy. The aim appears to be to separate those who are thought to be honest, needy, involuntary migrants from those who are viewed as deceitful, greedy, and calculating, in order to better protect those in the first category. That is a division this paper seeks to undermine and reject. For that reason, I retain the broadest meaningful term, 'migrant', and suggest we simply add adjectives which describe the primary reason for migration. I will refer to all those whose migration is necessary in order to be able to meet their needs without fear or anxiety as 'necessitous migrants', and those whose migration is necessitated by poverty 'necessitous economic migrants'. In doing so, I borrow from Sarah Song (2018), but she intends for the term to collect together all and only 'forced migrants', which in her sense excludes 'economic migrants', so my use is broader. I could alternatively have used the term 'survival migrant', which was coined for a similar purpose (Betts, 2013), but I want to include and legitimise those whose migration is necessary for the achievement of something more than mere survival.
A note on the author's positionality
In disciplines whose chief methodology is 'argument', which begins from a set of assumptions about what is true and right, announcing one's relationship to the topic at hand can provide important context (Hedgecoe, 2004; Ives and Dunn, 2010). This might make readers more vigilant for signs of bias, which is no bad thing, but it can also help them to understand the stakes for affected people, which is especially important in non-empirical work. Therefore: I am the child of a Kurdish-Iranian father who migrated to the UK in the early 1970s to study and work, rather than out of serious economic need or to escape persecution (but note that Kurds are persecuted in Iran, as well as in Turkey, Iraq, and Syria). I have two relatives who more recently paid to be smuggled to the UK in order to claim asylum. Economic considerations were among the factors that motivated their migration. One was granted refugee status and struggled in the UK for a few years before returning to Iran; the other has been waiting years for their asylum application to be processed. We have countless family friends with broadly similar stories. Many of my relatives in Iran struggle to afford basic necessities, and most of those of working age are trying to leave the country.
This paper, like my other work in this area (Shahvisi, 2018, 2019, 2020, 2021) is motivated by a sense of unease about my own safety, comfort, and prosperity compared to that of my relatives, as well as by a more general philosophical and political commitment to challenging the logic of borders and an opposition to the interconnected harms of racism, colonialism, and capitalism.
Constructing 'legitimate' suffering within the asylum regime
The political construction of 'legitimacy'
In the UK, there is considerable hostility towards all forms of immigration. In a 2023 study, just over half (52%) of respondents thought immigration as a whole should be reduced (Richards et al., 2023). But there are important complexities. A 2014 study found that while 70% of respondents think we should reduce the number of refugees we accept, 70% of the same cohort agreed that 'we should always take in genuine refugees who need a place of safety' (Duffy, 2014, my emphasis).
The difference made by the word 'genuine' in these surveys is likely to derive from its repetitive, strategic deployment in political discourse. A 2023 critical discourse analysis of political speech found that the term 'genuine' is commonly used by politicians to distinguish between asylum seekers fleeing persecution and those believed to be migrating for economic reasons (Grey, 2023). Members of parliament are often keen to draw a distinction between refugees, whose need they describe as 'genuine' and 'legitimate', and other asylum seekers and undocumented migrants who are instead described as 'bogus' and 'undeserving'. Some recent examples illustrate this tendency. In January 2024, Conservative MP Simon Clarke asserted that: The expectation for a young male who is in essence an economic migrant in all but name seeking a better life in the UK needs to be that he will be detained and removed (HC Deb 16 January, 2024) [W]e need to get the balance right on continuing our generous tradition of allowing safe haven for genuine asylum seekers escaping danger with much more robust action to clamp down on those who have no legitimate claim to be resident in the UK. They are gaming our system, taking advantage of the UK taxpayer's generosity and, worst of all, queue-jumping over the genuine asylum seekers who need help (HC Deb 27 March, 2023). We can have a firm but fair approach to illegal immigration. 'Firm' means stopping people from jumping the queue by crossing the channel. […] 'Fair' means improving support for genuine refugees to help them to build their lives here […] The vast majority of those who arrive are male, and almost exclusively they are over the age of 18. […] Many have paid hundreds of pounds for the journey, and in some cases thousands […] to jump the asylum queue and deny a legitimate asylum seeker a space (HC Deb 20 July, 2021). It's a striking fact that around seven out of ten of those arriving in small boats last year were men under 40, paying people smugglers to queue jump and taking up our capacity to help genuine women and child refugees. This is particularly perverse as those attempting crossings, are not directly fleeing imminent peril as is the intended purpose of our asylum system (Johnson, 2022).
Attitudes towards immigration are strongly influenced by media as well as political discourse. A study of UK-based newspaper coverage of immigration between 2010 and 2012 demonstrated generally negative portrayals of migrants, but more positive portrayals of refugees than of asylum seekers or immigrants more generally (Allen and Blinder, 2013). A recent study of major UK newspapers (The Daily Mail, The Sun and The Guardian) and the transcripts of parliamentary debates also showed that discussions of necessitous economic migrants are often centred on assumptions about duplicity. 'Economic migrants' are portrayed as making bogus claims in order to exploit the UK welfare system, and opponents of this claim tend to merely refute it – objecting that asylum seekers generally do have legitimate grounds for seeking protection – rather than refusing the broader framing. In 2015 alone, the term 'economic migrant' appeared 1507 times in parliamentary debates and newspapers when referring to asylum seekers (Goodfellow, 2023).
1
Liberal and left-wing politicians and commentators do challenge this rhetoric, but in their responses: the distinction between 'economic migrant' and 'asylum seeker' is accepted but it is argued that the people entering the asylum system are 'genuine'; they are not 'economic migrants' and on this basis they should be admitted […] Therefore, though these two different usages are arguably used to advocate for somewhat different asylum laws, they share a similar logic: it is valid to describe some people as 'economic migrants' and to argue or suggest they can be denied entry to Britain while 'genuine asylum seekers' should be allowed into the country (Goodfellow, 2023)
In the UK, public discourse on migration therefore centres on the construction and maintenance of a generally hostile attitude to migration, within which there is a finer distinction made between 'deserving' and 'undeserving' migrants. 2 While this framing has been chiefly nurtured by anti-immigrant actors within politics and (traditional and social) media, it is rooted in a real distinction in international law.
The legal construction of 'legitimacy'
Some refugees are granted protection by invitation, through bespoke resettlement schemes which offer safe routes to the UK, but these are often geographically specific, and apply only to a small number of those in need of protection (Home Office, 2024b; Lenegan, 2024). Most would-be refugees must make their own journeys to the UK and then apply for asylum. In the UK, asylum applications turn on whether or not the applicant meets the legal definition of a refugee, which requires evidence of persecution. According to international law, a refugee is a person who: owing to well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country (United Nations, 1951).
Asylum applications have to be made on British soil (Home Office, 2024a), so asylum seekers must enter with legal documentation by airport or ferry port, or else they must cross the border 'illegally'. (These crossings are not illegal if a person applies for asylum on arrival.) A visa is required for entry from every state an asylum seeker is likely to have travelled from, but the UK government advises its departments against granting visas where: the political, economic and security situation in the applicant's country of residence, including whether it is politically unstable, a conflict zone or at risk of becoming one, leads to doubts about their intention to leave the UK at the end of their visit (UK Visas and Immigration, 2023).
For those whose claims do not meet the criteria for refugee status, there are two other categories under which they might be given leave to remain. 'Humanitarian protection' is granted where an applicant would 'face a real risk of suffering serious harm' if returned, where 'serious harm' refers to grave physical injury, e.g.,: execution, the death penalty, torture, or indiscriminate violence (Home Office, 2024a). 'Discretionary leave', which is 'intended to be used sparingly' applies when the previous two categories are not relevant, but where ‘it would, at the time leave is granted, be unjustifiably harsh to expect someone to leave or enforce their removal’ (UK Visas and Immigration, 2024). It is typically invoked where an applicant requires urgent medical care that is not available in their country of origin, or in cases in which the applicant has been, or likely would be, a victim of modern slavery.
Importantly, even those whose asylum claims meet the legal criteria struggle to have them granted. Scepticism pervades the system: empirical studies by human rights organisations have found it skewed towards wrongful refusal (Freedom From Torture, 2019; Shaw and Kaye, 2013; Shaw and Witkin, 2004), and whistle-blowers have revealed that caseworkers are incentivised in their workload models to refuse applications (see e.g., Hill, 2019). Despite this, two thirds of initial decisions are positive, and more than half of appeals are successful, indicating an alarming initial error rate (Home Office, 2023). These numbers suggest that most applicants do have non-economic grounds for being granted leave to remain. 3
I offer the above details for two reasons. First, to emphasise that poverty is not legally recognised as grounds for settlement in the UK. A person like Usman Siddique cannot seek asylum based on economic hardship, no matter how desperate their circumstances. This exclusion is particularly relevant to scholars of health and wellbeing because poverty directly undermines health through restricted access to healthcare, nutrition, sanitation, housing, and education (Abdalla et al., 2022), but also because the economic system that produces so much poverty globally is antithetical to good health for all (Flynn, 2021). Second, to draw attention to the fact that necessitous economic migrants who are excluded from legal pathways and are unwilling to return to the poverty they left often become 'undocumented' in the UK, which has serious consequences for their access to health.
The health consequences of the 'legitimacy' discourse
There are estimated to be between 800,000 and 1.2 million undocumented people in the UK (Pew Research Center, 2019) and over a quarter are children (Jolly et al., 2020). Some enter the UK as visa-holders but lose their immigration status through leaving a relationship or job to which that status is tied. Others enter without documentation and either have not yet made an asylum application or have had their application rejected. Some do not intend to apply for asylum because they cannot make a case within the narrow parameters just described.
The Immigration Acts of 2014 and 2016 specifically sought to, the words of then-Home Secretary Theresa May, 'create, here in Britain, a really hostile environment for illegal immigrants' (Kirkup, 2012). Among other prohibitions introduced by these Acts, undocumented migrants are not permitted to work, claim welfare, or rent accommodation. Many work illegally for less than the minimum wage, live in substandard illegal rentals, are destitute and have low food security (Hay, 2023; Jolly and Thompson, 2023). Further, undocumented migrants cannot use the National Health Service (NHS) without charge. Access is contingent on 'ordinary residence' status, defined as documented proof of five years’ residence in the UK. Individuals without this status must pay for most NHS care. The scale of these costs is substantial: pregnancy care amounts to £7000 (Shahvisi and Finnerty, 2019), and leukaemia care £33,000 (Campbell, 2019).
While primary care and a few other basic services remain free for all patients, undocumented migrants are often deterred by concerns about surveillance by immigration authorities. This reluctance frequently results in delayed healthcare seeking, leading to worse health outcomes. Secondary care referrals (excluding acute emergencies) incur charges, with unpaid medical debts triggering information-sharing with the Home Office after a two-month grace period. Many undocumented patients accordingly refuse referrals for essential care (Jayanetti, 2023). This puts healthcare providers in the morally fraught position of weighing clinical necessity against patients’ financial and legal vulnerabilities.
The manufacturing of concern about 'health tourism' by politicians and mainstream media was a key driver in the establishment of the new charging regime (Shahvisi, 2019). It is a special case of the broader anxiety about migrants entering the UK in order to 'illegitimately' extract economic resources. The perception of the NHS as a cornerstone of British national identity and its widespread public support make it a key instrument for this kind of political manipulation. Immigration (rather than inadequate public funding) is presented as the primary threat to the institution's sustainability, allowing politicians to position themselves as defenders of a beloved national institution while advancing an anti-immigration agenda. Yet health tourism constitutes just 0.3% of the NHS's annual expenditure, approximately 300 million pounds (Milne, 2016), and the UK exports more health tourists than it receives (Hanefeld et al., 2013). Further, empirical evidence indicates that the implementation of healthcare charges for migrants has not generated fiscal benefits for the NHS (Morris and Nanda, 2021) and the administrative costs exceed any revenue generated, suggesting that these policies are motivated by ideology rather than economics (Shahvisi, 2019).
Importantly, in the UK asylum seekers and refugees have the same complete access to NHS services as those who are 'ordinarily resident', while undocumented migrants are charged for their care. 4 The charging regime is designed to exclude, punish, and deter those deemed to be 'economic migrants,' in line with, and precisely because of, the discourse that is the target of this paper. In this way, the distinction between 'good' and 'bad' migrants is enshrined within health policy in the UK. Challenging this unjust regime requires robust engagement with the harmful framing that created it.
Refusing the terms of the debate
Given the degree of distrust and refusal within the UK asylum regime and the fact that economic need is not legally recognised, there is good strategic sense in the general insistence that asylum seekers are not 'economic migrants' but are instead 'legitimate' in their need. Yet this tactic implies that necessitous economic migrants either do not exist or, if they do, have no legitimate claim to protection. Further, there is danger in becoming so habituated to a strategy as to forget the wrongfulness of the framing that demands it and in doing so find that we have no place from which to challenge the injustices it produces. In this final section, I contend that wherever possible, we should actively challenge the broader terms of the discussion, rather than reactively strategising within them. In what follows, I offer a set of brief considerations to this effect.
Resisting invisibilisation
There are obvious difficulties with gathering accurate data on necessitous economic migrants: it would be problematic to ask asylum seekers or undocumented people to disclose any economic motivations given their legal vulnerabilities and they would likely be reluctant to do so, as any such data would be vulnerable to co-optation by those determined to portray all asylum seekers as 'economic migrants'. Government figures on asylum refusals in the UK tell us very little, since there are many reasons why asylum applications are unsuccessful, including the determined hostility of the system towards all migrants.
As well as the anecdotal cases known to those of us with friends and family who have sought refuge from poverty, various journalists’ investigations of would-be, thwarted, or returned asylum seekers, like those after the sinking of the Adriana, make clear that poverty is a major driver of necessitous migration. For example, investigations by the BBC and Al Jazeera reveal that poverty, unemployment, corruption, and cronyism are the leading factors driving large numbers of young Kurds away from the Kurdistan Region of Iraq (BBC News, 2021; Ibrahim, 2021).
Strategically excluding economic migration from discussions of necessitous migration is therefore dishonest, and dishonesty is not a prudent long-term strategy. Anti-immigration actors have access to similar information to the rest of us: they too know that there are necessitous economic migrants (even if they would not use that term), and they are willing to talk about them. If we are not honest about necessitous economic migration, we effectively cede the discursive space to those who are committed to their continued exclusion.
While tactical compromises are often required, tactics which injure one marginalised group in order to help another are only defensible when they are temporary, brief, and quickly compensated for. But this moral compromise is decades old with no apparent exit strategy, making it look less like an expedient gambit and more like routine exclusion. The strategy in this case is invisibilising and divisive, erasing and vilifying one marginalised group in pursuit of political gains for another. These gains are minor, given the general hostility toward asylum seekers, and the strategy offers no answers to urgent questions about how, where, and when the needs of necessitous economic migrants will be discussed.
Raia Apostolova refers to 'categorical fetishism' to describe the way in which our fixation on producing firm categories of migrants to serve short-term political objectives 'blinds us to the temporal dimension of our discursive strategies' (2015). In other words, a set of classifications that serves a particular purpose in a particular moment can cause grave and enduring harm if it constructs a value-laden set of categories that are widely used beyond the original context and taken up by those who do not share the original political goals. Making distinctions between migrant groups is often important in practical terms (e.g., it allows us to establish and meet more fine-grained needs), but in the present political context, such distinctions are vulnerable to misuse.
When people are portrayed as 'illegal' and their suffering as 'illegitimate', they are effectively excluded from the 'moral community' – the set of persons presented by governments and mass media as worthy of protection and concern. Rejecting these categories does not on its own reverse this dehumanisation, but challenging the terminology can raise different questions. Referring to 'necessitous economic migrants' demands answers: why must some people leave their home states to protect their health and wellbeing? What happens when we ignore their needs and refuse them entry? What structural solutions exist for this structural problem? The failure to engage seriously with these questions represents another form of invisibilisation. It scuppers our ability to see clearly how much of the poverty that drives migration stems from Global North actions, including historic colonialism, contemporary economic policies, and military interventions (Shahvisi 2020).
One specific upshot of all of the above is that if we strategically ignore necessitous economic migrants it becomes more or less impossible to raise specific, practical concerns about the way they are treated. Of particular relevance here is the marginalisation of undocumented migrants and their exclusion from a range of essential services, including NHS healthcare.
A failure of 'moral uptake'
The concept of 'uptake' originates in J.L. Austin's speech act theory, which posits that for certain communicative acts to succeed, the audience must recognize the speaker's intended illocutionary force – that is, what the speaker is doing with their words (such as promising, warning, or demanding), rather than merely what they are saying. This recognition of the illocutionary act, of what the speaker is doing with their words, is often guided by linguistic and social conventions (Austin, 1975: 116–7). 'Uptake' occurs when this recognition succeeds and is met with an appropriate response. Philosophers of gender and race have discussed the failures of uptake that take place where a particular form of harm, usually the result of oppression, is articulated in some form but is not (adequately) recognised, leading to an additional communicative injustice with both ethical and epistemic dimensions (see e.g., Fricker 2007; Kukla 2014; Langton 1993).
Here I am interested in the more general kind of uptake we typically give one another when we recognise that a person has been wronged or is otherwise suffering in some way. We may offer sympathy or empathy, but we also typically offer some form of moral recognition. Austin's concept of uptake can be extended to encompass 'moral uptake' – the recognition and response we seek and offer when a situation belongs to the realm of moral concern. For instance, when someone tells us they have been discriminated against, exploited, or betrayed, moral uptake involves recognising that experience as one of injustice, rather than just unpleasantness or inconvenience. Moral uptake is not only a requirement for justice but also serves as an important expression of solidarity and humanity. As Nancy Potter writes: By giving uptake, I say: you can count on me to take you seriously according to your idea of seriousness and not mine alone; you can expect me to treat your picture of the world, or your claims against me, or your cries of pain and anger, with respect […] And by taking the voices, needs, concerns, and emotions of another seriously, we indicate to that person that we recognize her full humanity (2000: 490).
Another barrier to giving appropriate moral uptake relates to the fact that migrants of colour from Global South countries are often conceived of in Western discourses as either 'victims' or 'threats'. Consider Haw's study of the representations of asylum seekers in Australian news discourse as 'threats or troublemakers' or else 'hapless victims' (Haw, 2023); Innes’ analysis of the construction of asylum seekers as 'threats' in UK mass media and political discourses (Innes, 2010); and Chouliaraki and Zaborowski's analysis of the way the 'victimhood/threat' representation is mobilised in news coverage across eight European countries, including the UK (Chouliaraki and Zaborowski, 2017). When people migrate because of poverty, they act on their own agency, making rational decisions, which is to say, decisions that others would also make in the same position. It is difficult to parse this realisation of agency within a politically charged context in which asylum seekers are understood as victim or threats, and Western states are understood as saviours (Sirriyeh, 2018). There is a well-established practice of presenting 'genuine' refugees as victims who are grateful, passive, and non-agentic (Grey, 2023). This attitude is typified by then-Home Secretary Jack Straw's comment, in 1999, that 'I do not believe that the genuine asylum seeker who is fleeing persecution will mind where in the country he is properly accommodated for the period while his claim is processed' (HC Deb 9 November, 1999). Necessitous economic migrants tend to be viewed, in contrast, as threats, not only because they seek access to economic resources that are deemed to be scarce, but also precisely because, in their decision to attempt to rescue themselves from poverty, they disrupt a broader conceptualisation of the West as the arbiter of who deserves help, and migrants as the pliant recipients (Sirriyeh, 2018).
States fail necessitous economic migrants by refusing them access to resources needed to meet their basic needs. Giving moral uptake requires us to publicly acknowledge that poverty, as a powerful determinant of health and wellbeing, is a rational and understandable reason for migration. It means discussing these issues in moral rather than purely legal terms and recognizing that necessitous economic migrants do no wrong in attempting to meet their needs. Rather, it is Global North states and their legal frameworks that wrong these migrants by thwarting them.
Conclusion
Recent figures show that 712 million people – nearly one tenth of the global population – live in 'extreme poverty', subsisting on less than $2.15 per day (World Bank, 2024). 5 Importantly, global inequality is not improving, and remains close to its levels under Western imperialism in the early twentieth century (Chancel et al., 2022). Closing the borders of wealthy countries to those migrating away from poverty only exacerbates these disparities and failing to discuss necessitous economic migration further stabilises a deeply dysfunctional global economic system.
Broadening our conception of legitimate migration has wider significance. Since 2008, 376 million people have been displaced by climate disasters (Internal Displacement Monitoring Centre, 2021). Projections suggest that more than a billion people could be displaced by 2050 due to climate crisis or its effects (Institute for Economics and Peace, 2020). As with necessitous economic migration, the 1951 Refugee Convention does not recognise 'climate refugees'. Poverty, climate crisis and health are intimately connected, not least because climate crisis impoverishes people by destroying their health, homes, and livelihoods, and those most acutely affected by climate crisis are already the world's poorest.
In this paper, I have reviewed the current state of play for necessitous economic migrants to Global North states like the UK and the implications this has for undocumented migrants’ access to healthcare. I have made the modest suggestion that scholars of health and migration challenge how we talk about necessitous migration as an act of resistance to a global migration and economic regime that deliberately refuses to take poverty and its consequences seriously. I have not argued here for a change in the law, because that is beyond my expertise, but this text should be seen as an accompaniment to the work of those legal scholars exploring the possibility of interpreting 'persecution' broadly, to include the economic marginalisation of particular groups (e.g., Foster, 2007; Storey, 2014).
Talking more openly about necessitous economic migration means talking more openly about global economic injustice, which plays a key role in the other major determinants of migration: conflict, persecution, and climate crisis. When public and legal discourses construct necessitous economic migrants as illegitimate, we should say what we see: an unjust global system protecting its concentrated wealth from those it has systematically impoverished. It is our job as scholars of health and migration to reject the terms of those discourses and make space for alternative ways of recognising and responding to suffering.
Footnotes
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
