Why intersectionality

Refugees and migrants across the Greek borders literally and symbolically have occupied the margins of Europe for shorter or longer periods. The first point that makes intersectionality particularly relevant for this analysis relates exactly to this liminal position that the particular groups occupy within the examined context. As Papoutsi and her colleagues (2018) explain, the European ‘hotspot’ policy implemented in countries at the external borders of the Union creates liminal territories adjacent to the borders. There, the European institutions have almost overrun national authorities on the base of a declared - constructed emergency and hence, the situation is described as exceptional. Refugees are in reality illegalized (Sciurba & Furri, 2017) and forced to remain on hold within those exceptional territories until it is decided whether

they will be able to continue their journey or not. Especially after the implementation of the EU-Turkey Agreement in 2016, this waiting time has been dramatically extended, exceeding two years in certain cases (UNHCR, 2018 June 22). While refugees and migrants remain at the borders they are deprived of any claim to belonging and they are excluded not only from the Greek citizenship regime but also from full international protection. Until recently, their health needs were the concern of only the UNHCR and humanitarian actors that were actually invited by the EU to cover the existing services’ gap as surrogate governmental institutions (Kagan, 2012, p. 308-10).

Refugees and migrants who involuntarily have remained within those borderlands, regardless of the fact that they are kept inside Greece, are excluded symbolically but also materially from what Greece as a European state and the European Union itself represent as systems of democracy and human rights (Sciurba & Furri, 2017). At these exclusive and literally isolated positions, they are rendered mutated and invisible, while at the same time their pending status – a situation often described as a limbo (Endicott, 2018) – blurs not only the extent of their entitlement to human rights but also the limits between the institutions responsible and accountable for granting them rights. In this situation, it is almost self-evident that the indefinite entrapment within a space where access to even ‘basic rights’ (Agier, 2011) is not guaranteed poses an immense disadvantage for those groups’ physical and mental well- being. However, what is not equally self-evident is what mechanisms are responsible for the emergence of that disadvantage. At this point, intersectionality as an analytical framework urges us to pay particular attention exactly to what is framed as an exception (i.e. the transformation of the external borders of Europe as humanitarian spaces where exceptional rules apply, Ramsay, 2019) and to those made invisible (Hancock, 2013) and calls for us to orient our inquiries to what has remained un-questioned (Schulz & Mullings, 2006).

As a starting point, intersectionality implies that we should distance ourselves from regarding refugees and migrants through the lens of their mainstream depictions as victimised beings inherently vulnerable to poor health. Instead, we are called to interrogate the hierarchical processes to which refugees are exposed in the specific context of the Greek borderlands and examine the pathways through which they associate with health risk and harm and consequently with the production of health disadvantage. However, the hierarchical processes taking place at the Greek borders are the outcome of the European asylum regime, the management decisions implemented by the Greek state, and the surrogate role of humanitarian actors that operate in tandem shaping the legal and material circumstances of

refugees and migrants. Their imbrication is what shapes the everyday reality for those populations and unavoidably its health impact.

The presence of a series of multiple actors involved in the field and the imbrication between national and European policies, international regulations and everyday management decisions is one of the reasons that other analytical methods are rendered less effective in this case, particularly when it comes to policy analysis. Regardless of the employed model, policy analysis frameworks are concerned with a particular problem, a policy that mandates a distinct course of action among many, and the evaluation of the consequent achieved or non-achieved outcomes (Dunn, 2016). In this particular case study, on the one hand, refugees’ exposure to health risk and harm was not addressed by a particular policy but it was rather seen as a corollary of the border crossing and the asylum procedure. Further, the action taken towards refugees’ health needs involved multiple actors with their own protocols and operational procedures as well as multiple domains and sectors. Moreover, health related actions were cut across by border control and migration control policies. Finally, the evaluation of potential outcomes is actually not feasible given that we lack systematic evidence regarding refugees’ health outcomes before and after the crossing and the first reception procedure.

Further, as McKinnon suggests, “imagining that inequalities are equal as a method for analysing that inequality can only deny what needs to be changed” (McKinnon, 2013, p.1024). Based on this premise, what intersectionality brings to this analysis is the consideration of the fact that the health disadvantage produced against refugees at the Greek borders was not equally distributed among them but rather varied on the base of additional within-group dimensions of difference (Hancock, 2013; Weldon, 2006). Hence, besides addressing the intersecting hierarchical processes, intersectionality urges us to interrogate the multiple within group (i.e. refugees) differences that are relevant to the unequal distribution of the produced health disadvantage in the specific context. In other words, intersectionality sheds light on processes that produce health inequalities between refugees and local populations in Greece and in Europe but also on internal health inequalities within the refugee group.

Being interested in inequalities within a group that is overall severely disadvantaged by the border crossing and asylum policies is a complex task. As empirical evidence (discussed earlier) suggests, the situation that refugees experienced at the Greek borders, deprived of their human rights, represents a case of profound social injustice, which however was assumed to be equally affecting the populations targeted by border crossing and asylum policies setting the rules of the refugee reception process. However, as already stressed, those rules were

differentially enforced through discriminatory practices (e.g. the border closures for certain nationalities), or there were cases where the rules appeared to be the same for everyone but produced unequal outcomes (e.g. refugees were entitled to health care access but women were affected by particular gender-related barriers). In such a context, equality and inequality become elusive (Collins & Bilge, 2016). This represents an additional reason that renders intersectionality as an analytical strategy particularly fitting to the purposes of this study in comparison to traditional thematic analysis. First, due to intersectionality’s emphasis on social justice (Collins & Bilge, 2016) and second, due to its consideration of what remains invisible, unspoken or disregarded (Collins & Bilge, 2016; McKinnon, 2013; Schultz & Mullings, 2006).

Finally, an intersectional analytical framework concerns inequality in the frame of power inequality. From an intersectionality perspective, power is organised across four different domains (i.e. structural, disciplinary, cultural and interpersonal) while none of the domains is rendered more significant or distinct from the others (Collins & Bilge, 2016). Hence, tracing processes that produce health inequalities within refugees and between refugees and local populations in Greece and in Europe requires that we look at power inequalities in interpersonal relationships and encounters (e.g. between family or community members or between refugees and camps’ personnel) (interpersonal domain); at how individuals are affected by the rules that apply to them (disciplinary domain); by the inequalities operating at the way the first reception was designed and implemented (e.g. gender inequalities within camps’ personnel) (structural domain); and also at how they are affected by the ways they are represented in the analysed material. The simultaneous acknowledgement of the four domains of power, renders an intersectionality analysis more fitting to the purposes of the study compared to (critical) discourse analysis which is primarily focused on the way that power operates within discursive structures (Mills, 2001).