Medical monitoring and follow-up of hunger strikes in a population of undocumented migrants: A case-study in Brussels

Onderzoeksoutput: PhD Thesis

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Brussels is Belgium's most multicultural city and home to the largest group of undocumented migrants. Their number is estimated at about 100.000. Due to the fact that they have no legal residence and thus only a very limited right of access to health care, education, employment or legal protection, they live in very difficult conditions. Desperate and with no prospect of improving their living conditions, some organize and take action do denounce their hardships before the public opinion and the political world. If these actions are not successful, the next step ay imply the occupation of buildings, often giving rise to collective hunger strikes.This is because a loophole in Belgian legislation provides seriously ill people with a temporary residence permit, which can open the door to a work permit and integration in Belgian society. During these hunger strikes a team of volunteer health professionals is called upon, to appropriately monitor the hunger strikes. One of the problem encountered is that the guidelines found in scientific literature only cover the monitoring of hunger strikes by large groups of people, who come from all corners of the world, have no access to health care and live in very challenging conditions.

This doctoral thesis collected information about 18 hunger strikes of undocumented migrants in Brussels from 2008 to 2021, with more than 1600 participants.

In the first part of the thesis, the existing scientific literature on hunger strikesein custodial settings is compared with the experience of health professionals active in the Brussels hunger strikes.

The second part analyses the situation of a group of former hunger strikers, five years after their participation in the hunger strike. By means of a survey, their socio-economic situation is analysed, while a lot of attention is paid to their subjective health status, their health problems and their access to health care. These are mapped and compared, not only with the social determinants of health but also with the current legal status of the former hunger strikers. The ex-hunger strikers, who in the meantime lost their temporary residence permit, are in a worse situation than those who did obtain a residence permit. They were also asked how they had experienced the hunger strike, whether it had brought them any advantages or disadvantages, and whether they thought their participation had been a good decision. It was mainly those who has lost their temporary permit who regretted their participation. They complained that their situation had not improved after five years, and associated a series of their health problems with their participation in the hunger strikes. Other participants were more positive about their participation, citing the collective struggle, the outside help and solidarity, the period in which a regularization of their status was obtained, and access to the labour market as victories.

In a third part of the study, the health professionals involved were asked about their experiences during the monitoring of the hunger strike. In two focus groups, they were able to discuss their concerns with one another. From these discussions we can conclude that proper guidance of care providers is essential to prevent the from developing symptoms of Secundary Traumatic Stress.

This dissertation concludes with recommendations to update and improve the existing manuals for monitoring hunger strikes of undocumented migrants, which date back to 2004. The Royal Decree on Urgent Medical Care of 1996, which describes the medical assistance undocumented migrants can obtain, also needs a review. In general, the fear of undocumented migrants to contact a health professional could be reduced by drawing a clear line between health services and migration services. We also advocate to improve the access to health care for all by promoting the Quintuple Aim concept. We advice that during the training of health professionals enough attention is paid to the prevention of burnout, and that they are better prepared for the complexity of tasks they may face in their future job. Health professions who master the different roles of the CANMeds model will also have the competences in appropriately monitor hunger strikes.
Originele taal-2English
KwalificatieDoctor in Medical Sciences
Toekennende instantie
  • Vrije Universiteit Brussel
  • Vandevoorde, Jan, Promotor
  • Devroey, Dirk, Promotor
  • Depoorter, Anne-Marie, Co-Promotor
  • Louckx, Freddy, Co-Promotor
Datum van toekenning27 feb 2023
Plaats van publicatieBrussels
Gedrukte ISBN's9789461174642
StatusPublished - 2023


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