The humanitarian-public healthcare nexus: an analysis of the power relations shaping the implementation of the Law on Urgent Medical Aid in Belgium

This paper concerns the implementation of the Belgian Law on Urgent Medical Aid which regulates healthcare access of undocumented migrants in Belgium. Using ethnographic methods, the complex relationships that emerge during the implementation of the act, between federal and municipal authorities, between civil society organizations and public welfare services, as well as between undocumented migrants and healthcare professionals is analyzed. Firstly, I demonstrate that while there is a functional continuity between civil society organizations and public services in the application procedure, these actors rely on divergent street-level discretionary practices. Secondly, I reveal how interactions and relationships between these different actors are bestowed with power dynamics, in which the control over access to healthcare is continuously renegotiated, contested and instrumentalized. Thirdly, I show how these power struggles result in an increasingly restrictive implementation of the law, and tighter control over undocumented migrants. Drawing on Foucault’s relational approach to power, I analyze how discretionary power circulates through social relationships, how it is transformed across actors in different positions of power, and how, at times, it can also be reversed. As such discretionary power can be productive of resistance, even though the latter determines the shape of the former.