Migrant bodies from Pakistan as well as French treatment of migrants argue that the body does not belong to the individual. It has become something that transcends the individual and belongs to wider hierarchies of power and the state. This occurs through anonymisation and medicalisation of migrant bodies as well as the dependency on health as a determinant for migrant futures. These two arguments will demonstrate how migrants have been turned into political tools and sites for the inscription of politics.

 

The ‘state' in the migrant experience is a complicated figure because it encompasses both the state that migrants come from and the state in which they are headed. This leads to a detachment from states and is a prominent factor in migrant separation from belonging to their individual being. This removal of belonging from the individual is what allows the body to become a political tool. A theme of suffering will also undergird this essay. Robbins explains that in reading works of "Biehl, Daniel, and other anthropologists of suffering, we come to realise the shared humanity that links us to others who suffer" (2013, 456). Though Robbins uses this argument of a universalism of suffering to demonstrate a need to transcend the suffering slot into an anthropology of good, I argue that there is still value in investigating themes of suffering. In analysing the suffering of migrants, anthropology can reveal individual suffering so that migrants do not only have to exist as a collective. Anthropology can also start to investigate how migrants become political ‘tools’ of the state with no control over their narratives through the infliction of power. In recognising this reality, it can be revealed why medical anthropology is so important in giving a voice to migrant stories. 

 

Qureshi’s ethnographic work on HIV and labour migration from Pakistan to the Persian Gulf (Countries of the Gulf Cooperation Council or GCC) emphasises medicalisation and anonymisation of migrants. His work uses the biopolitics of health to represent the erasure of individual accounts. ‘Biopolitics’ is a Foucauldian concept regarding “the emergence of health and physical well-being of the population in general as one of the essential objectives of political power… to ensure not only [the population’s] subjection but the constant increase of their utility" (Foucault 2000, 94-96), which links to the transformation of Pakistani migrants into political tools. Migrants leave Pakistan in search of better employment in GCC and send remittances back to their families however, as soon as they arrive, all health and legal protection are stripped. Qureshi discusses how 86% of Pakistani migrants engage in sexual contact with female sex workers, the majority then become infected with HIV. HIV positive migrants are subjected to forcible deportation where “the state loses interest in these failed subjects who are disqualified from generating further foreign exchange" (Qureshi 2013, 218); a form of structural violence. Structural violence includes regimes of medical inspection, nationalist ideologies identifying HIV as a disease of ‘the other’, exposure to exploitation, and potential deportation, all of which “increases their HIV vulnerabilities" (Qureshi 2013, 209). 

 

Migrants become tools of the state in this collectivised and biopolitical process, as they are thrown away (deported) when they are broken (contract HIV). While, the cause of suffering may be the same, the individual experience and interpretation of that experience may be different but is not recognised. It can be argued that structural anonymises and medicalises Pakistani experience by transforming them into a collective biomass, removing the individual. Structural violence demonstrates a level of ‘unworthiness’ of migrants, as they are denied both citizenship and state / health protection in GCC. “Temporary contractual labour” (Qureshi 2013, 209) removes them from citizen belonging in a nationalist drive to keep Pakistani migrants as ‘temporary’ members of their society; anonymised. Further, the lack of protection is emphasised in forced deportation and regimes of medical inspection, highlighting a process of medicalisation of the migrant body. Structural and everyday violence becomes “‘normalised’ and ‘naturalised’ in public consciousness” (Scheper-Hughes cited in Qureshi 2013, 210), establishing a realm of suffering that is out of migrant control. ‘Normalised violence in public consciousness’ draws attention to power of the state in the reduction of migrant agency, it is massively “taken for granted” (Gupta 2012 cited in Qureshi 2013, 210). Decisions made around migrant health can therefore be prominent in achieving ‘biopolitical power’ (Foucault 2000). 

 

This suffering becomes a suffering of the collective, not of the individual, which Becker’s work can also help to highlight. Becker’s cross-comparative work on body standards in Fiji and America discusses how the body is a cultural symbol of society. Becker’s work consequentially raises the fundamental question: to who does the body actually belong? "The impact of culturally specific notions of personhood on the experience of embodiment… core cultural values are encoded… aesthetic or moral ideals of body shape” (Becker 1994, 100), linking to how migrant bodies that transcend the individual and belong to power become anonymous collectives. The body is a reflection of values and societal intricacies, not an individual but a symbol or tool of wider society and culture. Becker’s argument emphasises that "a key strategy in representing the self lies in a manipulation of cultural symbols" (Goffman cited in Becker 1994, 101), showing how people are composed of the standards of their society and stigmatised if different to reflect the degree of adoption of values and norms. The Pakistani migrant body fits Becker’s argument as these bodies are symbols and tools of transnational suffering and a migration movement more than they are of individuals. It allows them to become political tools and sites of political inscription, as they become subjects of the state with a removed sense of belonging and biographical reality. Foucault’s biopolitics argues how health exists as a biopolitical objective and a point of power, which is evident in the political subjectification of migrants by the state.

 

This argument similarly plays out in the ethnographic work of Fassin and d’Halluin on French immigration policies and the medical certificates of asylum seekers. French immigration will highlight, just as Pakistani migrants have, how suffering becomes a collective experience, anonymising and medicalising migrant realities. Fassin and d’Halluin describe how the eligibility of migrants to certain social rights is based on the physical body. "Whether through traditional law or modern torture, the body has always been a privileged site on which to demonstrate the evidence of power” (Fassin and d’Halluin 2005, 597), which in this ethnography, regards a process of proving ‘deservingness’ into France. Aslylum seekers’ must prove their physical torture and mental traumas to allow access into France, which objectifies migrant bodies and experiences.

 

Foucault explains how Government – referring not to the political state, but to forms of governance and governing abilities – is able to offer solutions to problems, but "it also structures specific forms of intervention. For a political rationality is not pure, neutral knowledge which simply re-present's the governing reality; instead it itself constituted the intellectual processing of the reality" (Lemke 2001, 191). Power determines the process of ‘reality’, furthering how an individual reality will never come to the forefront. This especially regards how in France, “medical authority progressively substitutes itself for the asylum seekers' word. In this process of objectification, it is the experience of the victims as political subjects that is progressively erased” (Fassin and d’Halluin 2005, 597). The ‘erasing’ of experience coupled with a removal of mental health concerns is what anonymises these people and makes them a collective of suffering. Obeyesekere discusses how mental illness does not have the same ‘obvious’ factor as physical illness, and is much more culturally conceptualised, “accompanied and superlaid by social-psychological conditions that are products of human experience in different sociocultural settings" (1985, 136). This makes it easier for ethical concerns to be hidden in processes of proving mental trauma and also makes it more difficult to ‘prove’ these traumas in the fist place. Stories of the mind are massively disregarded and creates a separation between mind and body, which can then correspond with the Cartesian mind / body dualism. While many anthropologists have rejected Descartes’ dualism, naming it as “one of the fundamental mistakes of the Western scientific tradition” (2009, 153), Ecks notes that this dualism still plays out today, hence his title, ‘Welcome Home, Descartes!’. Dualism is evident in the collectivised experience of migrants, as the body becomes separate from the political, lived experience and reduced to mere biological existence, "the body is nothing but a machine that can be dissected and its parts sold off to the highest bidder” (Descartes cited in Ecks 2009). In proving trauma to attain medical certification and right to refugee status, narratives and political journeys are forgotten and the body becomes an objecr, a machine, a tool that is used in a process of determining deservingness. 

 

In both cases Pakistani and French migrants, are subjected to a removal of biographical reality and their minds and stories rendered separate from the subjectivity of their bodies. Migrant bodies become the collective that is layered with anonymous and medicalised replacements of power hierarchies and the state. 

 

My second argument regards the dependency of migrants on their health, as it acts as a determinant for the future. Health becomes a form of identity and a dictator in the course of migrants lives, constructing them to become sites for the inscription of politics. For Pakistani migrants, health acts as a determinant for the future because of the regimes of medical examinations that determine eligibility to work in GCC. Medical examinations are crucial for the destiny of migrants because a positive HIV status results in deportation. “A large number of HIV positive Pakistani migrant workers in the GCC countries have been deported without their HIV status being explained to them or any discussion of their condition" (Qureshi 2013, 209-210), and being deported in many cases without any knowledge of health status, reflects a mass removal of control in their decisions. Qureshi explains how when migrants test HIV positive the expulsion from GCC is immediate, being removed to detention centers with no time to pack their bags, say goodbye or arrange any unfinished business such as collect wages before they are sent away. Upon arrival in Pakistan, migrants must confirm Pakistani nationality at the Federal Investigation Agency (FIA). As HIV positive subjects back in Pakistan, “the initial shock and denial is usually followed by social ostracisation. Due to the stigma, the HIV testing of spouses and other family members - 'unsuspecting wives' in the policy parlance - takes even longer" (Qureshi 2013, 216). Health impacts both the physical destiny of migrants in removing them from GCC as well as the social destiny of stigma they are forced to face back in Pakistan when they also become aware of their HIV status. As a result of stigma, “the onus is on migrants themselves to prove their citizenship to Pakistan” (Quereshi 2013, 218), whilst also influencing health testing of migrant families, impacting these futures too.

 

‘Biological Citizenship’, by Petryna provides an interesting angle to look at the dependency of health on the future. Petryna’s work on biological citizenship post-Chernobyl nuclear disaster demonstrates how "the injured biology of a population has become the basis for social membership and for staking claims to citizenship" (2004, 261). Chernobyl ‘suffers’ (legal classification for those affected by the disaster) use their health to claim compensation for their experience. Citizens depend on achieving ‘suffering’ status to obtain social welfare and biological citizenship, securing economic and social entitlement. A clinical administrator describes this phenomenon by saying, "illnesses had become a form of currency… the diagnosis we write is money" (Petryna 2004, 263). Ill health status is the currency to which Chernobyl victims claim rights. Ironically in Pakistan, ill health status provides a form of ‘negative’ currency instead. This negative currency I am referring to is a currency that is not worth anything, as illness for migrants in Pakistan removes them from biological citizenship rather than grants it. Though the reality of a biological citizenship is different, both cases emphasis how health status can determine future realities. The concept of biological citizenship is also crucial because it highlights the power of health in dictating reality. Dependency on health consequentially makes migrants sites for the inscription of politics, because they become forced to rely on it. Politics becomes entitled to inscribe migrant reality for them. 

 

Dependency on health in determining future destinies is also seen in French immigration. Migrants become expected to prove trauma and provide physical evidence to support their deservingness for refugee status. Fassin and d’Halluin note a paradox in this process of proof, explaining how in the increasing expectation of physical evidence, comes the decreasing belief in the victim’s demonstration of that evidence (2005, 598). French society creates an aura of suspicion around asylum seekers trying to prove their worth. Though, however difficult, migrant futures depend on their ability to prove the deservingness of their health story. If seekers want to apply for refugee status, they need a medical certificate to prove their case’s validity, which is achieved through proving physical tortures and mental traumas. 

 

Comede, the Center for Rights and Ethics in Health (Centre droit et éthique de la santé) is an organisation that helps asylum seekers create these medical certificates. One of the Comede coordinators pointed out that "the government agents and magistrates attach greater importance to the physical effects of torture, when in fact it is part of a program designed to destructure and depersonalise the individual" (Fasson and d’Halluin 2005, 602), referring to the medicalised reality of these certificates. The individual is ‘de-structured’, removed from the agency of decision-making. The body therefore “marks the prints of power… [and] ’the scars down on the body’ are ‘written words of primitive law’” (Clastres 1974, 159 cited in Fassin and d’Halluin 2005, 597), which also links to Becker’s idea of cultural symbols and the body not belonging to the individual. This symbolic collective of suffering subjects that migrants have become, makes them political tools in the sense that ‘evidence of power’ and biopolitical objectives are able to govern narratives and decide futures. Ticktin asks, “what does it mean to allow sick and sexually violated bodies to cross borders while impoverished ones cannot" (2011, 3) describing how “the suffering body must be recognised as morally legitimate" (2011, 4). ‘Morally legitimate’ refers to how migrant health stories becomes a point of entrance and conditions of suffering become desirable, as they are key for migrant entrance. These ‘regimes of care’ in the form of humanitarian enterprises such as Comede exemplifies, “the ‘new humanity’, worthy of rescue… their bodies are what they use to barter for papers [but also] maintains a racialised postcolonial nation-state, rendering immigrants visible in French society primarily in the form of gendered and racialised victims - they can never be equal" (Ticktin 2011, 24). Ticktin’s argument brings light to how ‘regimes of care’ determine migrant futures in declaring through the physical body who is worthy and who is not. Migrant futures however, even if deemed ‘worthy’ in attaining refugee status ‘will never be equal’, demonstrating how health dictates migrant future also in terms of the lived social reality existing as a victim. Humanitarian organisations try to address the ethics of such medical certificates and recognise the pain in having to prove trauma, but only show how fundamentally subjected ‘victims’ are to the value of their health story. 

 

After demonstrating the ways in which migrant bodies become political tools and a site for the inscription of politics, a word must be said about the resulting importance of medical anthropology. Scheper-Hughes demonstrates how medical anthropologists can give a “voice to the submerged, fragmented and largely muted subcultures of the sick" (1990, 190) arguing for a critically applied as opposed to a clinically applied approach to medical anthropology. In this questioning, the local voice is able to come through and be heard amongst the noise of biopolitical forces. Biomedicine and biopolitics can create subjectivity in health and "the health of people everywhere is inextricably entangled with global politics, social issues and economics" (Lock and Nguyen 2010, 4). This recognition offers the potential to hear and change the narratives of migranta. There is still however a long way to go for medical anthropology, but it can offer a beacon of hope for the future. 

 

This essay has examined through GCC and French treatment of migration, how the body has become a political tool and a site for the inscription of politics. This was emphasised by arguing that migrant bodies become collectivised through an anonymisation and medicalisation of suffering. A loss of the individual allows power hierarchies to reduce migrants to a collective symbol of suffering that makes them tools of the state. The second argument discussed the dependency on health in dictating migrant futures and how politics can be consequentially inscribed into migrant realities. A final word was said on the importance of medical anthropology as a result, to give voices to those who have been unable to share their health story. 

 

 

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Works Cited 

 

Becker, Anne. 1994. Nurturing and negligence: Working on others’ bodies in Fiji in T. J. Csordas (ed.) Embodiment and experience: the existential ground of culture and self. Pp 100-115. Cambridge University Press

 

Ecks, Stefan. 2008. "Welcome Home, Descartes! Rethinking the Anthropology of the Body". Perspectives in Biology and Medicine 52 (1): 153-158. Project Muse. doi:10.1353/pbm.0.0075.

 

Fassin, D., & E. d'Halluin (2005). The Truth from the Body: Medical Certificates as Ultimate Evidence for Asylum Seekers. American Anthropologist. 107(4). pp. 597-608.

 

Foucault, M. 2000. “Politics of health in the 18th century.” In Foucault, Michel. Power. Essential Works of Foucault, Volume 3. New York: The New Press: 90-105.

 

Lock, M. and Nguyen, V-K. ‘Introduction’ in An Anthropology of Biomedicine. Chichester: Wiley Blackwell. 2010. 

 

Obeyesekere, Gananath. 1985. “Depression, Buddhism, and the work of culture in Sri Lanka.” In A. M. Kleinman & B. Good (Eds.), Culture and Depression, (pp. 134- 152). Berkeley: University of California Press.

 

Petryna, Adriana. 2004. “Biological citizenship: The Science and Politics of Chernobyl-Exposed Populations” Osiris, Vol. 19, pp. 250-26.

 

Qureshi, A. (2013). Structural violence and the state: HIV and labour migration from Pakistan to the Persian Gulf. Anthropology & medicine, 20(3), 209-220.

 

Robbins, J. Beyond the Suffering Subject: Toward an Anthropology of the Good. Journal of the Royal Anthropological Institute 19(3) 

 

Scheper-Hughes, Nancy. 1990. Three Propositions for a Critically Applied Medical Anthropology. Social Science and Medicine 30(2): 189-197.

 

Thomas Lemke (2001) 'The birth of bio-politics': Michel Foucault's lecture at the Collège de France on neo-liberal governmentality, Economy and Society, 30:2, 190-207

 

Ticktin, Miriam I. 2011. Casualties of Care : Immigration and the Politics of Humanitarianism in France. 1st arg. University of C