2.

Undocumented migrants,
healthcare and health
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In this chapter, I shall provide some contextual information

about undocumented migrants in Europe. I discuss concepts of
‘undocumentedness’, and various estimates of the number of
undocumented people, as well as outlining healthcare policies and
practices across a number of European countries, with a particular
focus on Switzerland. I will also address the question of undocumented
migrants’ health issues.

Estimates of the uncountable

and concepts of the unnamed
Lacking the legal entitlement to stay in a country, undocumented
migrants have been described as ‘formally excluded, but physically
present within the state’s territory’ (Karlsen 2016:136). The category
generally includes those who have overstayed their visas, people who
crossed the border without legal entitlement to do so, and failed asylum
seekers (Kotsioni 2016).
Undocumented migrants’ names therefore do not appear in official
state registers, as their movements across countries are rarely tracked by
the authorities and no census reaches them. Furthermore, and as we will
see in greater detail below, the multiple and ever-changing categories
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describing a person’s legal status make it difficult to produce accurate

data (see Jandl 2004 for further details). Because of these difficulties,

© 2018 Marianne Jossen, CC BY 4.0 https://doi.org/10.11647/OBP.0139.02

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 8 Undocumented Migrants and Healthcare

research can produce only rough estimates about the number of

undocumented migrants. The International Organization for Migration
(IOM) estimates that in 2010, worldwide, about 10–15% of the estimated
214 million international migrants went undocumented (IOM 2010). The
Clandestino Project estimated that in 2008, between 1.9 and 3.8 million
undocumented migrants lived in the European Union (at that time
comprising twenty-seven countries). This equates to approximately
0.39–0.77% of the total population and 7–13% of the foreign population
(Clandestino Project 2009; Vogel et al. 2011). The Clandestino Project
provides the highest and lowest estimates for a number of countries, as
Figure 1 shows.

Fig. 1 Estimates of undocumented migrants in 2008. Graphic by Marcel Waldvogel based

on data from the Clandestino Project (2009) and on a map by Wikimedia-Commons-User
Alexrk2, https://commons.wikimedia.org/wiki/File:Europe_blank_laea_location_map.svg

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 2. Undocumented migrants, healthcare and health  9

Some updated numbers have become available in the interim

(Clandestino Project 2017), pointing to a rise in numbers, as the table
below shows.

Country Estimates in 2008 Updated estimates (year of update)

Germany 178,000–400,000 180,000–520,000 (2015)
Greece 172,000–209,000 390,000 (2011)
Spain 280,000–354,000 300,000–390,000 (2009)

Fig. 2 Latest updates concerning the number of undocumented migrants with

comparison to estimates of 2008, according to the Clandestino Project (2017).

Accordingly, the Frontex Annual Risk Analyses show increases in

most of the indicators of irregular migration flows in the EU from both
2013‒2014 and 2014‒2015 (Frontex 2015; 2016). The table below shows
examples of two of these indicators: refusal of entry to the EU and
detected illegal border crossings.

Indicator 2014 2015

Refusal of entry to the EU 144,887 188,495
Detected illegal border crossings 282,962 1,822,337

Fig. 3 Indicators for irregular migration in 2014 and 2015, according to Frontex (2016).

However, the category of illegal border crossings includes not only those
who go undocumented, but everyone who asks for asylum. Moreover
there were more people who crossed the border and subsequently
asked for asylum in 2015 than in the year before. It is therefore difficult
to determine the exact increase in undocumented migrants.
The most recent estimates for Switzerland can be found in a state-
commissioned study by Morlok et al. (2015). While an earlier study,
also commissioned by the government, estimated a population of 90,000
undocumented migrants in 2005 (Longchamp 2005), Morlok et al. (2015)
give a lower estimate of 76,000 undocumented migrants for 2015, a figure
based on various sources of information. As Figure 4 shows, the estimate
is extrapolated from expert interviews. The experts estimated the number
of undocumented migrants to range between 58,000 and 105,000. The
number is further contextualised using analyses of the number of known
fatalities and births of persons without residency in Switzerland.

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 10 Undocumented Migrants and Healthcare

Fig. 4 Estimates of undocumented migrants in Switzerland in 2014.

Graphic reproduced with permission from Morlok et al. (2015).

Morlok et al. (2015) further estimated that two thirds (63%) of the
undocumented migrants entered the country without permission to
do so, or overstayed their tourist visa. The final third is made up of
individuals who lost their legal right to stay after longer periods of
time, for example after a divorce (18%), as well as failed asylum seekers
(19%). It is further estimated that about 43% of undocumented migrants
in Switzerland were born in South America, while 24% originated in
Europe, with a further 19% coming from Africa and 11% from Asia.
The majority are between eighteen and forty years old. About 41% have
received only a basic education, between six and nine years of primary
school. The remaining 59% have received secondary education‒a three
to four-year apprenticeship‒or higher education such as a university
degree.
This said, it is important to keep in mind that being undocumented
is not a personal characteristic but a social construct. In the words of
Bloch et al. undocumented migration results from

the interplay between restructured labour markets and increasingly

complex migration controls and categories [that] created the interstices
within which undocumented migrants found space. (2014:17)

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