We need to talk about necessitous economic migrants: Disrupting ‘legitimacy’ in UK migration discourse

The terms asylum seekers and refugees are often used interchangeably in everyday speech. In addition, because the media tend to discuss these two terms in conjunction with economic issues, the public often finds it difficult to distinguish between refugees, asylum seekers, and economic migrants. Nonetheless, these terms have specific meanings that make them distinguishable. Whereas refugees are individuals who have been formally recognized as having fled their country of nationality to escape persecution or conflict, asylum seekers are individuals who are claiming refugee status and waiting for that claim to be evaluated. If a host country's asylum system accepts their claim, then asylum seekers are recognized as formal refugees. Another important distinction is between refugees and economic migrants. Economic migrants are individuals who are seen to have chosen to move to another country in search of a better life, whereas refugees are individuals who are seen as forced to move to another country in order to protect, if not to save, their lives or freedom. Nonetheless, economic migrants may be facing dire circumstances in their country of origin so that, although they cannot be recognized as formal refugees, there are factors pushing them to leave their home country, just as is the case for refugees.

n 26 August 2001 a Norwegian freighter, the MV Tampa, rescued 433 asylum seekers from their vessel the KM Palapa 1 that was in distress in the stretch of ocean between Christmas Island and the coast of Indonesia. At the insistence of the rescued passengers, the captain of the Tampa asked the Australian government for permission to land them on Christmas Island — a request that was refused. There followed a week-long standoff while the world watched the drama unfold. Eventually a settlement was reached under which a third of the passengers were taken to New Zealand and the remainder to the small Pacific island of Nauru, in exchange for an aid package of AUD 20 million from the Australian government. The Tampa saga redefined Australian asylum policy in the eyes of the world and it was watched keenly from Europe where stories about the clandestine entry of asylum seekers had been regularly hitting the headlines for a decade. Throughout the 1990s the countries of the then EU-15 had grappled with the issue of mounting numbers of unsolicited asylum applications, a number that increased from 92,410 in 1982 to a peak of 675,455 a decade later before falling to about 300,000 per annum for the rest of the 1990s. European governments progressively toughened their policies in an atmosphere of popular backlash against asylum seekers that increasingly painted them as illegals and scroungers, or at best as ‘economic migrants’. Those policies took the form of tightening access to individual countries’ borders, toughening refugee determination procedures and providing conditions for asylum seekers that were less and less hospitable. They were aimed at deterrence and they were intended as a clear message to asylum seekers: ‘don’t come here’. Yet there is disagreement about the effectiveness of such policies in the European context. Some have found that asylum seekers interviewed after arrival had only the vaguest notion about their host country’s policy. Some suggest that the fall in applications after 1992 owed much to changing conditions in source countries and relatively little to policies in destination countries. And others point out that trends in applications across the countries of the EU apparently bear little relation to differences in the toughness and the timing of policy changes in the respective EU countries (see Zetter et al., 2003; Theilemann, 2003; Hatton, 2004). In this paper we examine the links between asylum policies and the flow of asylum applications in Australia. While Australia was the focus of attention (and

This paper provides an analysis of the worldwide human smuggling trade and the Protocol Against the Smuggling of Migrants by Land, Air and Sea (the 'Smuggling Protocol'), which supplements the Convention Against Transnational Organized Crime 2000. Since this paper is written from a refugee protection perspective, it therefore examines who refugees are, why they resort to the use of people smugglers, and the dangers they face in doing so. It also considers the subsequent challenge for the international community to safeguard the rights of smuggled refugees and asylum seekers within the broader context of migration management, particularly in regard to the right of non-refoulement and access to protection. Here, two 'challenges' appear to have arisen: firstly the manner by which states differentiate between refugees and asylum seekers and undocumented migrants (or so-called 'economic migrants'), who also resort to, or are exploited by, people smugglers and traffickers; and secondly, the procedures and methods states develop to prevent their asylum systems from being abused for immigration purposes. Accordingly, the Smuggling Protocol is examined to ascertain whether it can and will solve these aforementioned difficultiess, and especially whether it adequately safeguards refugee rights. This paper concludes that whilst the Smuggling Protocol has the potential to do such, its application (and the extent of that application) ultimately depends on the will of the State Parties, and thus could amount to nothing more than a list of 'good intentions'. This paper also examines whether even if the Smuggling Protocol is a positive step in combating the 'crime' of people smuggling, it is nonetheless a 'band aid mechanism' - highlighting the dire need for the international community to re-examine how it can best invest its money, resources, and energy into stopping social inequities and situations of misery and violence, poverty and persecution, which compel people to leave their homelands to begin with. Such a conclusion could be considered presumptuous but, in light of the recent terrorist attacks on the United States, it seems necessary for 'the West' to refocus its energy on how to rid poorer, war torn, alienated, and more desperate regions of the world from such afflictions: afflictions responsible for impelling people to leave their homes creating the demand for people smugglers; afflictions responsible for refugee crises; afflictions responsible for creating terrorist breeding grounds; and afflictions which, in an interconnected world, ultimately impinge on the entire community of nation states.

Does ethnic heterogeneity decrease workers’ effort in the presence of income redistribution? An experimental analysis

By looking at category use within the asylum debate, this paper investigates how participants construct ‘asylum seekers’. Critical discursive psychology is used to study a corpus of public sphere data. Categorization is shown to be a powerful political and rhetorical strategy for participants in the asylum debate as they attempt to impose their own systems of classification onto the debate, and, in doing so, justify the (more or less) harsh treatment of asylum seekers. Three strategies that speakers use to justify the different treatment of asylum seekers are identified: first, speakers distinguish the categories of ‘refugee’ and ‘migrant’; second, the categories of ‘refugees’ and ‘economic migrants’ are conflated; and third, the categories of ‘refugee’ and ‘illegal immigrant’ are simultaneously distinguished and conflated. We conclude by discussing some of the political implications of these analyses – in particular, how category constructions can work to focus attention on asylum seekers' legitimacy, and not on how they can be helped.

This paper examines the healthy immigrant effect in Glasgow, a post-industrial city where the migrant population has more than doubled in the last decade. Using data from a community survey in 15 communities across the city, the paper compares four health outcomes for the following three groups: British-born, social and economic migrants and asylum seekers and refugees. Migrants were found to be healthier than the indigenous population on all four measures, particularly in the case of adult households in both migrant groups and for older asylum seeker and refugee households. Health declines for social and economic migrants with time spent in the UK, but there is no clear pattern for asylum seekers and refugees. Health declined for refugees according to time spent awaiting a decision, whilst their health improved after a leave-to-remain decision. Indigenous and social and economic migrant health declines with time spent living in a deprived area; this was true for three health indicators for the former and two indicators for the latter. Asylum seekers and refugees who had lived in a deprived area for more than a year had slightly better self-rated health and well-being than recent arrivals. The study’s findings highlight the role of destination city and neighbourhood in the health immigrant effect, raise concerns about the restrictions placed upon asylum seekers and the uncertainty afforded to refugees and suggest that spatial concentration may have advantages for asylum seekers and refugees.

The nationalistic and xenophobic movement Operation Dudula has been leading demonstrations throughout South Africa claiming that foreigners are taking South African jobs and that there are ‘no wars in Africa’ to warrant African immigrants’ special treatment. This xenophobic movement blames immigrants (an umbrella term for immigrants, cross-border migrants, economic migrants, asylum seekers and refugees) for societal collapse and challenges the legality of their border crossings. The movement calls the immigrants ‘criminals’ and pressures domestic government officials to deny them the right to work. The conflation of economic migrants with asylum seekers continues in the South African landscape, confusing employers, the general public, and officials at the Department of Home Affairs (DHA). The notion that ‘no foreigner must be employed ahead of a South African’ is at the crux of the debates about immigrants’ right to employment. Yet, there is not a clear demarcation between asylum seekers’ right to work versus the economic migrants’ privilege to work. This confusion of legal categories has led to apples and oranges debates in immigration law domestically and internationally. Through interviews with non-governmental (non-profit) organisations (NGOs/NPOs), employers, industry associations, government officials, and immigration attorneys, and an examination of international and domestic laws and norms, this paper suggests a reframing of how the right to work is analysed and how the employers respond.

Immigration has played a significant role in human history as people move to new places for economic opportunities, religious freedom, and political refuge. However, asylum seekers are often viewed negatively and falsely portrayed in media, leading to fear and distrust among locals. In the current research, participants read a fictitious news article about an asylum seeker's (Syrian, Ukrainian, or Yemeni) motivation for seeking asylum (seeking safety, seeking financial betterment from a position of relative financial hardship, or seeking financial betterment from a position of extreme financial hardship). Participants then reported their willingness to help that asylum seeker, and their prejudice and empathy toward both that asylum seeker and their group as a whole (e.g., Syrian refugees). Results showed that people were more willing to help asylum seekers whose motivation for seeking asylum was grounded in safety concerns rather than moderate financial concerns (studies 1, 2, and 3). Participants also reported more willingness to help the asylum seeker's group as a whole if the individual asylum seeker's motivation was described as seeking safety rather than financial betterment. Further, describing financial concerns as so severe that they endangered survival generated more willingness to help than moderate financial concerns, demonstrating that severe enough financial concerns may be perceived as safety concerns (study 3). We also found that people were more willing to help Ukrainian refugees than Syrian refugees. Altogether, these findings have both theoretical and practical implications.

Australia has had controversial legislation for mandatory detention of asylum seekers since 1992 and legislation since 2001 allowing indefinite detention of such persons on the mainland, Christmas Island or ‘offshore’ on Manus Island in Papua New Guinea and on the small Pacific island nation of Nauru. Despite frequent protests from lawyers, doctors and humanitarian organisations that such policies infringe human rights and blatantly contravene the 1951 United Nations Refugee Convention, to which Australia is a co-signatory, both major political parties have persisted with these cruel policies. The clear aim is deterrence. Asylum seekers are demonised as potential terrorists or as economic migrants, callously and inaccurately referred to as ‘illegals’, and imprisoned indefinitely with no knowledge of when and where they will be released.1, 2 The reason for such poor morality is political: the issue of asylum seekers who arrive by boat wins and lose elections: votes are more important than morals. In late 2014, a paediatric refugee nurse and I were asked by International Health and Medical Services (IHMS) to spend 5 days on Nauru seeing children in consultation. IHMS are the private health-care providers contracted by the Australian Government to provide health care to asylum seekers in Australia and offshore. Our contract said we would not make any public statement or talk to the media about anything that concerns IHMS or the Department of Immigration and Border Protection. We considered carefully if we should go. In favour was our ability to treat children with acute problems, refer children with mental health problems to a child psychiatrist or psychologist and assess living conditions. The Government has drawn a deliberate veil over its handling of asylum seekers, particularly boat arrivals and the conditions in offshore detention centres. Workers sign strict confidentiality agreements and have been summarily dismissed for social media posts that offend the Government. Journalists have to pay $A8000 for a visa to visit Nauru. When Professor Gillian Triggs, President of the Australian Human Rights Commission (AHRC), was trying to gather information for her inquiry into children in detention,3 she was banned from visiting asylum seekers on Nauru because they were ‘not in Australia’ and therefore not under the jurisdiction of the AHRC. A major reason for us visiting was to see the conditions first-hand. Reasons against going were that this might implicitly condone behaviour we already knew was immoral and the knowledge that we might feel obliged to speak out publicly. We went in December 2014. We did not want to profit from our visit and agreed in advance to donate our earnings to our hospital Refugee Service. We were utterly appalled by the Nauru Processing Centre, a prison camp except in name, which was situated in the centre of the island where it was hottest and most humid (see Fig. 1). Living conditions were Spartan. Asylum seekers lived in lines of adjoining tents without privacy or running water. Many tents had mould on the canvas. Toilet and shower facilities were 30- to 120-m distance. At night, this was a fearsome walk under the eyes of huge, threatening guards. Many children and some women wet the bed rather than brave the walk. Sanitary arrangements for menstruating women were unsatisfactory. Movement was restricted by fences manned by guards. The asylum seekers were starved of information about their fate and all complained of being utterly helpless and powerless. They reported being treated with contempt and tormented by many of the guards. Later, I asked a family who were transferred from Nauru to Villawood Detention Centre in Sydney how the guards in the two places compared. ‘The difference between Villawood and Nauru was like the difference between an angel and a devil’, said the father. Health-care workers were usually more respectful, but a culture of gross injustice is insidious: IHMS staff referred to asylum seekers by their boat arrival numbers rather than by name. The children we saw had a variety of stress-related behaviour problems and somatic complaints. We saw examples of self-harm, the most chilling being a 6-year-old girl with strangulation marks from a fence-tie, whom we referred urgently to the visiting child psychiatrist. In trying to give some measure of hope, we talked of the pending AHRC report on children in detention3 and promised to publicise their plight when we returned to Australia. In this issue, paediatricians who work with asylum seeker and refugee children give their response to the AHRC report.4 Painting of the island of Nauru from Nauru Airport. The Nauru Processing Centre is in the centre of the island (where the phosphate rock is being mined). On our return to Australia, we were nervous about writing a media opinion piece, but our sense of outrage and our promise to the families trumped guilt at breaking our contract and fear of reprisal. A prominent human rights lawyer advised us it was legitimate to break a contract to reveal ‘iniquity’ and what we had witnessed was undoubtedly iniquitous. We decided to provide IHMS with a detailed report of suggested changes but also decided to publish an opinion piece and do subsequent media interviews. We met senior IHMS staff to discuss our report. They expressed disappointment we had gone to the media and felt betrayed. We said we thought IHMS tried hard in the camp and had done excellent work propping up Nauru health care services outside the camp (IHMS asked us to consult on some children at the Republic of Nauru Hospital), but we thought IHMS should protest more about conditions. The IHMS staff said their Government contract forbade them criticising Government policy and they preferred to work for change from within the system. The meeting ended with each of us acknowledging our respect for but disagreement with the others’ position. Doctors can be placed in a moral dilemma by injustice. Psychiatrists in the Soviet Union were strongly criticised for being complicit in State-based use of psychiatric hospitals to suppress political prisoners. Doctors at Abu Ghraib Prison were condemned for condoning torture. The former IHMS chief psychiatrist described the treatment of asylum seekers on Manus Island and Nauru as ‘akin to torture’.5 The Australian Medical Association6 and the Royal Australasian College of Physicians7 have described mandatory detention of children as child abuse. This raises moral questions for doctors working with children in detention, particularly in the most extreme conditions such as on Nauru.7 Although our first duty is to treat a child in extreme need, treating them does not change the underlying problem. Two major charities have different approaches to politics. Red Cross insists on political neutrality and never comments on local socio-political issues in order not to compromise access to people in need. Médecins Sans Frontières provides medical care always with the stated commitment to ‘speak out’ on political and situational problems impairing health. Both charities do wonderful work. As private contractors, IHMS have the potential conflict of money: criticism of the Government could cost them a lucrative contract. IHMS's approach is to provide best possible care while working from within. The alternative of refusing to provide care offshore without the right to speak out would probably see them lose their contract and they argue would disadvantage children. Individual doctors have to decide for themselves.8 Mandatory detention is immoral, but detention on Nauru is an abomination and paediatricians should protest long and loud until it is ended. I thank Alanna Maycock who accompanied me to Nauru, stood up to bullying guards and taught me about courage and recognising and confronting injustice. I thank my son Mark Isaacs for his bravery and for being an inspiration,1 and Philip Britton for helpful discussions.

This chapter analyses a large-scale hunger strike act, performed by 300 migrants, staged in a makeshift ‘camp’ in the Law School building in Athens in January 2011. It began when the 300 men — all asylum seekers and economic migrants — embarked on a hunger strike in order to pressurize the Greek government into paying attention to their demands for legal status. I examine this event as a means of practising resistance and as a spectacle that draws attention to migrants’ disappearing bodies in order to create a political space for recognition. The construction of the hunger strike was dramaturgically compelling: the staging and scene can be analysed in relation to their positions on the threshold between public and private. In this chapter, however, I shift the focus from defining the hunger strike as ‘performance’, which is briefly summarized here, and turn towards considering this performance within the context of crisis and austerity in Greece as a situation of extremity, multiplied by migrants’ precarious legal status. Thus, rather than rely on the mapping of performance and hunger strike, my argument seeks to position the social conditions of the crisis contemporary to the hunger strike as a performance that distinctly stages a politics of dispossession. Hunger as a conscious, unravelling performance of resistance displays wider socio-political dispossession.

In Malaysia, refugees remain mostly invisible and face various challenges in terms of protection, healthcare and education. They are often preserved as ‘illegal immigrants’, therefore always at risk of arrest, detention, punishment and deportation. The worse sufferers of these are the children and youth, who are also considered to be illegitimate and deprived of rights including the right to education. This is a case study of a young Rohingya refugee man whose dedication and struggles, despite his problematic identity imposed by various authorities, continue to find a way out and serve fellow refugees through a community organization. However, the dream to have an education and flourish as a full-fledged human being remains a far cry for those marginalized, underprivileged Rohingya refugees and their children. Their experience in Malaysia is far from exceptional, of the sufferings that refugees are forced to bear in many countries in South and Southeast Asia. Nonetheless, this case aims to facilitate the basic understanding of displacement, the refugee situation, international law and particularly refugee children’s rights to education. It provides a deeper understanding of the root causes of Rohingya’s current ‘stateless’ situation in Malaysia, identifies the challenges faced by a refugee community organization, refugee children’s struggles and rights to education. It initiates thoughts to examine the government policies and look for alternative strategies that may benefit the refugee children as well as the national development in the long run. Dilemma: Are Rohingya in Malaysia ‘refugees’ or ‘economic migrants’? Should the children of Rohingya be given access to education? Should Malaysia sign the 1951 Refugee Convention? Theory: Statelessness theory Type of the Case: Experience-based applied single case study Protagonist: Present Options Malaysia can take the stand that being nonsignatory to the 1951 Refugee Convention and its 1967 protocol, it is not bound to come up with policies for refugees. By providing ‘temporary’ shelter to a significant number of refugees and asylum-seekers, Malaysia has done enough for the refugees. At the international level, Malaysia is considered to be sympathetic towards refugees. Refugee and asylum seekers’ presence has been exerting pressure on Malaysian culture and society. In contrast, refugee and migration issues are receiving attention from the government and civil society in Malaysia. Former government has tried to adopt some policies like providing short-term work permit for a small number of registered Rohingya refugees in certain plantations and manufacturing sectors on an experimental basis to avoid social and economic risks posed by unemployed refugees. Malaysia should sign the 1951 Refugee Convention and its 1967 protocol because it is a member of the United Nations (UN) and party to many other major international human rights documents such as Convention against Torture and Other Cruel Inhuman or Degrading Treatment or Punishment (CAT) and Convention on the Rights of the Child (CRC) to name a few. Discussions and Case Questions What are the root causes of Rohingyas’ current statelessness situation and how should the Malaysian government tackle the issue? What are the challenges faced by Rohingya community organizations in integrating with the society? Should Malaysia look at improving the Rohingya children’s access to education or the community should take on the responsibility?

Liver disease refers to a wide spectrum of both acute conditions caused by various injurious agents, such as viruses, toxins, alcohol and pharmacological agents, as well as chronic liver diseases, which may over time lead to cirrhosis. Cirrhosis, from whatever cause, predisposes to hepatocellular carcinoma, a primary liver cancer, particularly if the cirrhosis is caused by hepatitis B or C infection. Most acute liver diseases can be managed conservatively or by withdrawing the hepatotoxic agent responsible. Severe acute liver damage may result in liver failure, or be so overwhelming as to induce irreversible liver damage (fulminant liver failure), which is associated with significant mortality rates. A proportion of acute infections and diseases may cause ongoing liver injury, resulting in chronic liver disease and cirrhosis. Like acute liver damage, chronic disease often goes undiagnosed during the early stages of the condition. Many cases only present to practitioners when substantial permanent damage has already occurred, at which time signs of liver failure and or cirrhosis are apparent. A minority of cases are detected at an earlier stage, either as a result of screening of families for inherited liver disease or as a result of abnormal liver function being found on blood tests performed during a routine medical examination. The liver is the major organ involved in a number of key metabolic processes. Damaged or reduced functional capacity can result in jaundice, hypoglycaemia, prolonged blood clotting, protein malnutrition, increased risk of infection, confusion, impaired lung and kidney function, fluid retention and fatigue. In addition, severe liver disease is often linked to vague symptoms such as malaise and fatigue, all of which results in significant morbidity, greatly impairing an individual's quality of life. Liver failure of any degree, once present, is associated with a significantly increased risk of premature death. The major liver diseases from a public health perspective are hepatitis C and B infection, alcoholic liver disease, primary liver cancer and haemochromatosis. The substantial public health impact of chronic liver disease can be gauged from the reported death rate per 100 000 population, although the figures may not be truly representative as mortality figures are underestimated in some countries. Data are available for the current EU states (Table 1). The differences observed between countries mainly reflect regional variations in the incidence of hepatitis B and hepatitis C infection (1, 2). Unfortunately, comparative figures for countries on the eastern and southern borders of the European Union are not available. However, World Health Organization data on the incidence of viral hepatitis per 100 000 population clearly shows the very great burden of hepatitis, even with the likelihood of under-reporting. The incidence of hepatitis C is reported as: Czechoslovakia 3.11, Estonia 26.65, Latvia 12.52, Russia 22.12, Ukraine 9.46, Croatia 3.38, Macedonia 1.28, Albania 4.37; and of hepatitis B: Romania 12.01, Russia 44.18, Ukraine 18.85, Belarus 9.34, Georgia 10.22, Moldavia 17.58, Yugoslavia 3.68. These data are relevant as several of these states are joining the European Union in the near future, and in addition many economic migrants and asylum seekers who journey to the European Union originate from this part of the world. It would therefore appear that both hepatitis B- and C-induced liver damage are conditions that will account for significantly more morbidity and mortality in the European Union in the future. Incidence of hepatitis B infection per 100 000 people in Europe. Prevalence of hepatitis C as a percentage of the total population of a region. There are an estimated 5 million carriers of hepatitis C in western Europe, with a higher but not well-documented carriage rate in eastern Europe. In western Europe, hepatitis C accounts for 70% of all cases of chronic hepatitis, 40% of cases of cirrhosis, and 60% of cases of hepatocellular carcinoma. End-stage liver disease resulting from infection now represents the major indication for liver transplant surgery in western Europe. The major route of infection is through blood and blood products. New infections are asymptomatic in 80% of cases. While blood-bank screening is reducing the incidence in western Europe, and universal precautions are also helping, this is not the case in eastern Europe. Occupational and perinatal exposure remain important routes of infection. A large percentage of new cases in western Europe are related to intravenous drug abuse and to the increased prevalence of hepatitis C infection in economic migrants and asylum seekers from eastern Europe and the ex-Soviet republics (Table 2). Unfortunately, 40% of those with an acute infection face life-long chronic infection. Approximately 20% of these develop cirrhosis. Indeed, of the causes of death in those who develop chronic hepatitis, 80% are due to cirrhosis or its complications. Co-infection with hepatitis B is an added risk factor, with chronic hepatitis B being more common in eastern Europe and southern Balkan countries. Once cirrhosis develops, 1–4% of patients per year develop hepatocellular carcinoma. Hepatitis B infection and chronic hepatitis C are both premalignant diseases. Vaccination has been proven to reduce infection rates and the incidence of hepatocellular carcinoma as a result of hepatitis B, following seminal studies in Taiwan. Unfortunately, optimal vaccination schedules have not been achieved in eastern Europe, mainly due to economic restrictions. In the case of hepatitis C, vaccination is not a possibility, and a reliable vaccine is not on the horizon. Treatment for chronic hepatitis C is not yet as effective as could be wished. In all, only 40% of those with genotype 1, prevalent in most countries, respond to combination therapy. Treatment is expensive (several thousand Euro per patient) and lengthy (minimum 6 months). Consequently, prevention is the key to reducing the burden of disease caused by hepatitis C. Even allowing for a slowly falling prevalence of hepatitis C infection in western Europe, there remains a large cohort of currently infected individuals progressing to cirrhosis and primary liver cell cancer, who represent an enormous future health and financial burden to Europe, considering the costs of anti-viral therapy, monitoring tests and treatment of the complications of chronic liver disease. The situation in eastern Europe is worse. Education, public health measures and identification of individuals at pre-cirrhotic stages represent means to diminish overall costs while increasing the benefits of treatment. Hepatocellular carcinoma is a type of primary liver cell cancer whose major risk factors are hepatitis B infection, and cirrhosis due to any cause. Thus, the incidence of hepatocellular carcinoma is linked both to the prevalence of chronic viral hepatitis and to other major additional causes of cirrhosis such as excessive alcohol consumption. Calculations based on reasonable estimates indicate that the current age-adjusted incidence figures will sharply increase during the next few decades. Cancer registry data document annual rates in males in the Mediterranean regions of 10 cases per 100 000, with an estimated incidence in northern Europe of half this figure. Consequently, the number of new cases in Europe as a whole is at least 25 000 per year. Only 50% survive for 1 year if untreated. Smaller diameter tumours and single tumours have improved survival after therapy. However, detection of early tumours suitable for resection and alternative treatments requires surveillance programmes of groups most at risk; hepatitis B-infected individuals and those with cirrhosis, particularly due to hepatitis C and alcohol. Surveillance currently relies on ultrasound techniques in combination with serological markers of hepatocellular carcinoma development. Even though relatively inexpensive, there are no structured, nationally based, surveillance programmes for individuals most at risk and even then the cost–benefit analysis has to be clearly demonstrated. Diseases attributable directly or indirectly to excessive alcohol intake are placing a great burden on healthcare systems. German and UK studies have shown that in 25–40% of all acute medical admissions, alcohol plays a contributory role. A report from the Royal College of Physicians in the UK has estimated that up to 12% of all hospital costs are related to harmful alcohol consumption. Precise figures in Europe are not available but Eurostat does publish death rates per 100 000 related to alcohol abuse, the majority attributable to alcoholic liver disease. In the European Union states these are (in males): Austria 6.3, Belgium 3.6, Denmark 8.5, Finland 7.7, France 6.9, Germany 10.8, Greece 0.9, Ireland 3.2, Italy 0.6, Luxembourg 8.7, Netherlands 1.7, Portugal 1.4, Spain 1.3, Sweden 5, UK 1.1. In addition, in northern Italy, the Dionysos Study reported that 4% of the population had alcoholic liver disease of varying severity. After hepatitis C infection, alcoholic liver disease is currently the second most common indication for liver transplantation throughout European member states. There is concern that alcohol consumption is increasing in adolescents and young adults in many countries, whilst overall per capita consumption is increasing in eastern Europe (Figure 3). Percentage of 15-year-olds consuming alcohol at least once a week by country. Increasing consumption is likely to result in larger numbers of people suffering from associated liver disease in the future. There is an urgent need to identify risk factors, other than total consumption, for the development of significant alcoholic liver disease, cirrhosis and subsequent hepatocellular carcinoma, to allow for the development of targeted healthcare. However, as with hepatitis C infection, public-health promotion and increasing public awareness of the serious complications of excessive alcohol consumption are likely to be key factors in the future reduction of the rates of alcohol-related liver disease. Haemochromatosis is an inherited condition common in northern European countries. The cardinal feature of the disease is iron overload, characterized by deposition of excessive iron in tissues and organs throughout the body, resulting in damage and organ failure over time. The spectrum of conditions associated with iron overload includes liver disease, diabetes, impotence, abnormal skin pigmentation, joint damage and heart disease, including heart failure. Excessive iron overload is associated with a documented increased risk of premature death, with cirrhosis, liver failure, liver cancer and diabetes contributing most to this risk. Many patients with haemochromatosis remain undiagnosed as gradual iron overload occurs for years before patients present with end-organ damage and related symptoms. Increased awareness of the disease has led to an increased incidence, primarily as a result of improved diagnosis and recognition. Early diagnosis is vital as a simple, cost-effective treatment, venesection, is available for patients. Regular removal of units of blood prevents iron deposition and is associated with long-term improved patient survival. Unfortunately, neither diabetes nor cirrhosis, once present, responds to this treatment. Nevertheless, recognition of iron overload in those patients is of vital importance to additional family members who can be screened for the condition by means of a simple blood test, hopefully prior to significant tissue damage occurring. Hereditary haemochromatosis has been estimated to affect between 1 : 1000 and 1 : 3000 people in northern Europe (Figure 4).1–9 The condition becomes less frequent in eastern or southern countries. In 1996, the genetic abnormality responsible for 80–100% of cases was discovered. Identification of the gene has enabled estimation of the gene frequency and therefore those at risk of the condition to be calculated (Table 3).10–19 The genetic data suggests that hereditary haemochromatosis is among one of the most common inherited conditions worldwide, and has led to suggestions that population-based screening would be cost-effective. However, there is some discrepancy between the numbers who carry the genetic risk for the disease and those with actual abnormalities in iron load, consistent with the condition. It is possible that additional unknown genetic factors as well as environmental factors account for this disparity. Until such time as we have a better mean of identifying those who will develop the disease, arguments against the introduction of screening will persist. Prevalence of haemachromatosis in Europe: % population. Acute liver failure, fortunately relatively uncommon, is associated with high mortality rates, despite often multidisciplinary management in an intensive-care setting. Recent data from both Europe and the USA have confirmed that paracetamol overdose remains the most common cause of acute liver failure despite restrictions on its use and the addition of clear warnings on packaging, accounting for almost 40% of cases.20, 21 Additional frequent causes include drug reactions and viral hepatitis. Spontaneous survival rates for acute liver failure vary according to aetiology from between 60 and 70% for paracetamol overdose to as low as 18% for patients with viral hepatitis. Many patients require extreme measures to improve survival; in all 30–40% require emergency liver transplantation. Overall mortality rates for those unable to undergo urgent transplantation have been reported to be as high as 35–57%.21, 22 Similarly, chronic liver diseases, in particular cirrhosis, has a poor prognosis, Recent evidence suggests that cirrhosis reduces the estimated life expectancy by 37 years and by 20 years among 30 and 50-year-olds, respectively.23 In addition, the incidence of hepato-cellular carcinoma in European patients with cirrhosis has been reported to be in the order of 5–6% per annum.24 As well as high mortality rates, chronic liver disease typically results in a significant reduction in the quality of life of the patient. One recent study revealed that patients with moderate to severe liver disease reported similar reductions in all aspects of quality of life to patients recovering from a stroke.25 Such data confirm the significant social impact of liver disease on patients and their families. The financial burden of direct costs alone for liver disease is considerable and set to increase. It has been documented that just over 2% of all hospital discharges in America in 1998 cited a hepatitis C-related diagnosis.26 The estimated direct medical costs for hepatitis C alone during that year was US$1 billion. Medical treatment employing combination interferon-alpha therapy costs €4000−5000 per quality-adjusted year of life gained, and is effective in only about 40% of cases.27 Over one-third of all liver transplants are currently performed for hepatitis C-related conditions, which represents a five-fold increase on figures from 1990. The estimated cost per liver transplant reported in the literature varies from an average of €33 000 to €94 000.28, 29 Another regularly used benchmark of cost, length of hospital stay, is also prolonged for individuals with chronic liver disease, with a reported average of 10.2 days, although specialist gastroenterology consultation can reduce this.30 With future epidemiological projections predicting a four-fold increase in the number of people at risk of chronic liver disease over the next 10–15 years, the enormous financial implications for health services throughout Europe are only too apparent, if significant steps are not taken in attempt to reduce transmission of infective hepatitis and the regular abuse of alcohol among European populations. The costs of treating end-stage liver disease and hepatocellular carcinoma superimposed on cirrhosis are high. Prevention of cirrhosis and thus hepatocellular carcinoma is the key to reducing health care costs and overall disease burden. Prevention of hepatitis B and C infection by vaccination and universal precautions, as well as identification and treatment of chronic hepatitis C patients and reduction of alcohol consumption would all contribute to this objective.

Immigration and Housing Policy

This study explores the rhetoric, discourse, visual representation, and news narratives regarding asylum seekers (AS) in the European Union in Israeli media. Integrating cultural representation theory and foreign news proximity-distance approaches, this research focuses on differences in media coverage of AS in the EU between mainstream, community, and social media, and then suggests a model and theoretical implications. The sample included 340 Hebrew language news items from television, print and online newspapers, radio broadcasts, and social media posts from 2011 to 2019. A thematic analysis was conducted. Based on theory of representation, this study found that AS are presented as Others in two different ways based on media type. Community and social media seek to productively compare the Other (AS) to Israelis to encourage concern over Israeli identity and values. In contrast, mainstream media promote narratives that do not invite comparisons—either tacit or explicit—to Israel. Based on proximity-distance approaches, we found that mainstream media content is appropriated by social and community media for different rhetorical ends using a scale of proximity ranging from hostile to hospitable. Community and social media used mainly domestication rhetoric in contrast to mainstream media, which distance the issue, covering it as newsworthy.

For over twenty years, Italy has faced the phenomenon of so-called “forced” international migrations. By virtue of its geographic position in the Mediterranean, this country constitutes, in many cases, the first landing and the transit country for asylum seekers in their flight from wars, political crises, environmental catastrophes and depletion of resources. This also implied a growing number of “rejections” that is, asylum seekers to whom no form of protection was grantedand are unlikely to return to their country of origin. A segment of them represents an intense geographic mobility or, better to say, multiple mobilities that intersect and fuel each other.Scholars have mostly explored the trajectories of mobility of the native people or so-called “economic migrants”. Much more rarely, refugees and asylum seekers have been perceived and framed as mobile subjects, protagonists of multiple and plural geographic, social, and migration movements.Therefore, this editorial and the whole Special Issue focus on the social changes that are reshaping migration scenarios, with particular attention paid to the paths of international and national mobility of refugees and asylum seekers outside the reception system, as well as their geographical, social and migration trajectories.Specifically, after introducing the topic, this paper, on the one hand, reconstructs the framework of Italian asylum policies, progressively more restrictive and discriminatory and destined to become a model for the entire European Union, analyzing the impact of the legal system and migration policies on the construction of the material and labor vulnerability of migrants and their exploitation within the national labor market. On the other hand, it deepens and reconstructs the theoretical perspectives on the phenomenon of mobility, the intersection between spatial dimension and temporal dimensions. Particular attention is paid to the pandemic and to the sociological interpretations of this phenomenon, the “mirror function” that it performs within society and the global migration scenario, the instrumental uses that have been made of this crisis in the political, economic, legal and social fields and the impact it has had on the common ethnographic and research practices shared by the papers that make up the Special Issue. Finally, the Editorial present the structure of the Special Issue and the contents of the articles, organized according to coherent theoretical and empirical path, aimed at illuminating all the facets of the “prism of new mobility”.