Accessing and analysing the documents

The material analysed includes publicly available on-line documents produced by the most prominent NGOs involved in the health sector of refugees’ first reception. As explained earlier, my interest in documents produced by the humanitarian actors responsible for providing health related services at the Greek borders stemmed from the fact that those actors were systematically present in the field during the whole examined period, at the intermediate

level between refugees and state and European institutions, they advocated for refugees' and migrants' health rights, and they consistently reported on their activity. In order to identify and retrieve the relevant documents, I started my research from the UNHCR’s operational portal (https://data2.unhcr.org). Through the search engine available at the portal, I downloaded all types of documents (i.e. Highlights, Needs Assessment, News, and Documents) that referred to the situation in Greece, particularly the Health sector, between 2015 and 2018, in English and in Greek language. The research and the collection of the documents took place during June 2018. Besides documents that were produced by UNHCR bodies, the results also generated joint documents and reports by prominent international organizations (e.g. OXFAM).

Next, through the ‘Who’s Doing What Where’ search engine at the same portal, I identified seven UNHCR partnering organisations with a prominent role in providing health related services at the borders: ARSIS-Association for the Social Support of Youth; High Relief Commission (HRC); International Federation of Red Cross and Red Crescent Societies (IFRC); The Israel Forum for International Humanitarian Aid-IsraAID; Doctors of the World (DOW); Doctors without Borders (DWB); and PRAKSIS. Then, I visited each partnering organisation’s website, where available, and I manually searched and downloaded documents referring to the situation at the Greek borders. Using the snowball technique, I also identified and retrieved documents produced by the Women and Health Alliance International (WAHA); an additional crucial actor in providing health related services in the islands. Documents produced by WAHA were retrieved in January 2019.

In total, 417 documents were retrieved from the UNHCR and the eight identified humanitarian organisations, including reports, press releases, news pieces, advocacy pieces, and meeting minutes. The next step was to read the retrieved documents in order to confirm the relevance of their content and their selection. In this process, I excluded from the analysis documents that exclusively concerned refugee facilities in the mainland; or included overlapping information (e.g. with versions available in Greek and English); general European reports without particular references to Greece; periodically produced documents (e.g. arrivals' reports) containing the same type of information with changes only in numbers (i.e. the most recent versions of the documents were selected only for analysis). This selection process resulted in 372 documents that were then integrated in the analysis. The list of the analysed documents can be found in Appendix A.

The selected material included information regarding the activity of each organization at the borders and also in reception facilities at the mainland as well as opinion and advocacy texts highlighting emerging problems, unmet needs, and human rights violations affecting refugees’ health and overall well-being. Those documents have been integrated in the present analysis for the following reasons. First, because in order to get a better understanding of any specific text, one needs to approach it within its context of thought and action (Prior, 2003). Documents that strictly refer to health are embedded within a broader body of texts shaping the narrative of humanitarian organizations regarding the developments at the borders and the moments of organizational failure. Second, because across the present thesis, health is understood as a social and political notion shaped by multiple structural factors and social determinants (Link & Phelan, 1995). An intersectional analysis that is considered with the different power domains and aims to reveal how health inequalities emerge in the specific context cannot disregard the multitude of forces that simultaneously affect the everyday conditions that refugees and migrants find themselves in while navigating the asylum process. Hence, information regarding human rights violations, gaps and failures in camp management, inconsistencies, and differences between camps or geographical regions is seen as crucial for the understanding of particular risks and omissions that existed in the specific context and differentially affected individuals and group. Moreover, they are indicative of the power negotiations at play within relationships between the involved actors including refugees and the local community. Last but not least, the organizations that were officially involved in the health sector, according to UNHCR’s classification, offered a great variety of services beyond medical care. This is consistent with the understanding of health as a holistic notion of well- being with social and political implications and further justifies the integration in the analysis of documents that do not refer to health from a strictly medical viewpoint.

Analysis.

As already stressed, the current analysis is interested in revealing the significant intersecting hierarchical categories in the context of migration camps across the Greek borders that were constructed by institutional and discursive arrangements and affected refugees' and migrants' experience and health. In this process, the examined documents are approached as having a dual function, namely as factual sources and as structuring the meaning of the facts and the subjects involved (Prior, 2003). This dual role of documents follows from and is consistent with the social constructionism epistemological approach adopted in the thesis as

well as with intersectionality. Intersectionality does not consider power domains (i.e. interpersonal, disciplinary, structural, and discursive) as distinct (Collins & Bilge, 2016). Hence, together with the fact that the documents include factual information regarding the material consequences of the hierarchical categories operating in the specific context, the function of documents as discursive materials inscribed in the cultural domain and producing particular worldviews (Flick, 2018; Prior, 2003) is also acknowledged.

The analysis involved uploading the documents into nVivo and coding the emerging themes. Given that I aimed to reveal elusive inequality producing processes, I was equally concerned with what the data say as well as with what they don’t say regarding the empirical realities of health harming processes at the Greek borders. Moreover, instead of being exclusively focused on emerging patterns, I also interrogated what is hinted, implied or mentioned as isolated incidents within the documents, in order to grasp subtle processes through which health inequality emerged. This allowed me to trace cases where particular groups of refugees were hurt by discriminatory practices as well as others where groups of refugees were differentially affected by equally applied regulations (Collins & Bilge, 2016).

For the coding and identification of themes, I used the following guidelines. First of all, in line with a situated approach suggesting the need to explore the particular categories that emerge as located in the operations of power in a specific context, before focusing on their intersections (Anthias, 2013), I examined which hierarchical categories emerged as salient in the specific context. As explained in the previous section, although I was conscious of the significance of the categories of the refugee, gender and race, I adopted an explorative approach to allow what was particular to the context to emerge as well. Second, in order to explore the material consequences and exclusions produced by the hierarchical processes and their intersections operating in the Greek borderlands, Ι organised my analysis across specific topics/questions. I selected my topics guided by the core components of intersectionality as an analytical framework as summarised by Collins and Bilge (2016) (i.e. intersecting categories, power as operating across multiple levels, interconnected inequality producing processes, situated analysis, complexity, and emphasis on social justice and equity), and building on previous work on intersectionality based analysis (Hankivsky et al., 2012; Lombardo & Verloo, 2009). The selected topics/questions aimed to reveal pathways for exposure to health risk or limited/interrupted access to health promoting resources and care in order to uncover inequalities as they emerged at the Greek borderlands and across the interpersonal, disciplinary, structural and cultural domain (Collins & Bilge, 2016). The selected topics/questions were:

1. Unmet health needs, health risks as well as references to diseases and epidemiological data.

2. Social determinants of health in living conditions (e.g. accommodation, hygiene facilities).

3. Health related services and target groups. Those services included health care, preventive interventions as well as services aiming to improve living conditions (social determinants of health).

4. Health inequalities observed at the borders.

5. Did the offered health related services maintained or buffered addressed inequalities and in what ways (re)produced others?

6. Did the first reception and the offered health related services stigmatized certain subgroups or individuals?

7. Exposure to discrimination (interpersonal and structural).

8. Exposure to violence (who was involved as perpetrator and victim).

9. Dimensions of difference among refugees (e.g. gender, age) and in what ways associated with differential exposure to health risk or access to health promoting resources.

10. Intersectionality.

11. Power hierarchies and domain (e.g. racism, gender inequality).

Following these guidelines, I consider that my analysis is consistent with my epistemological stance, with intersectionality as analytical framework as well as with the examined context and hence, effective in allowing neglected or subtle health inequality producing processes to emerge.